Scars

I’ve spent a lot of time in trees.

When I grew up, there was no such thing as video games. In those days, we were lucky to have a colour TV and four channels, but watching it was a privilege. Instead, I would usually be outside, bare foot and naive, exploring the creek behind my house and the thin ribbon of bushland that guarded it, or climbing the tree in my backyard, or picking up sticks from the ground and using them as weapons so I could fight off pretend villains like the superheroes I aspired to.

Eventually I discovered cricket and learnt to ride my bike, which changed my outdoor pass times. If I wasn’t practising my cricket skills, I would ride for hours on the footpaths and bikeways that criss-crossed my neighbourhood. There were no bike helmets in those days, and still no shoes. It was an innocent time.

My adventurous spirit and lack of protective equipment invariably resulted in injuries. Once when playing with a stick in the front yard, I somehow managed to dig the sharp end into my right leg, gouging a chunk out of my lower thigh. A few years later when riding my bike, the handlebars of my BMX came loose and trapped my legs so I was unable to peddle. It also stopped me from using the footbrake and steering properly, and there was nowhere else for me to go except into a pole next to a low concrete bridge over the creek, and then over the handlebars and onto a causeway which was covered in large rocks and debris. Amongst the injuries sustained was a large graze to my elbow, which my teenage sister helped tend and dress for me. Unfortunately no one had taught her that the dressing needed to go cotton side up, not onto the wound. A few days later, the scab had to be torn off to remove the dressing.

Several decades later, I would also find myself being thrown off a bike, but this time after a man driving a 4-Wheel Drive didn’t notice that I was riding on the footpath and kept coming out of the driveway he was in. Thankfully this time I was wearing shoes and a helmet, though it still didn’t help much when face smacked into the bitumen after bouncing of his windscreen and sprawling five metres through the air. I wasn’t that beautiful to start with, so my bitumen face didn’t matter too much and the scars eventually healed. But three weeks later when I couldn’t move my arm properly, I suspected that there was something wrong and the MRI showed a fracture of the head of my left radius (bone near my elbow).

The common link in each of my war stories was the eventual outcome – scars. I’ve now got a collection of scars ranging from small to obvious, internal and external. Scars are an interesting though rarely considered part of our normal function. Our body faces assault in various forms all the time. Usually we’re able to stop infections before they take hold. Sometimes, an infection or injury will still get the better of us, but our body will be able to heal our tissues completely, fully restoring our function and appearance as if nothing ever happened. Sometimes, there’s just too much damage, and our body has to do the best it can. It has to fill in the gap left by the irreparable tissue to maximise the structure and function of that tissue. To do that, it uses a scar.

Microscopically, scar tissue is made up of collagen, a dense fibrous tissue that’s also found in tendons. When a breach in the tissue occurs, there are three distinct phases that are followed to create a scar: the inflammatory phase, the fibroplastic phase, and the remodelling phase. The boring, intricate scientific details don’t matter for this essay, but essentially the phases are needed for cleaning up the debris, laying the scaffolding, and reinforcing the scar.

What’s more interesting are some other characteristics of scars that we don’t often appreciate. Firstly, scars hurt. Ok, so that sounds obvious … it always hurts when the injury first happens. The inflammatory phase is the time that a wound hurts the most, but in physiological terms, this phase only lasts about 48 hours. As time goes on, the scar hurts less and less, and in most scars, the pain eventually goes away completely. However, there are a few scars that are still sensitive when touched, sometimes for years.

Some people have a tendency to form bigger scars than others. This is called keloid scarring, and is a process of excessive inflammation of the forming scar tissue which causes too much collagen to be laid down. Keloid scars can be large, itchy and painful. Keloid scarring is thought to have a genetic component to it.

Even if you’re lucky to avoid keloid scarring, scars are usually considered ugly and unwanted. Maybe it’s because they’re associated with pain, or they ruin our otherwise perfect skin. Either way, many people don’t like their scars.

Scars are also weaker than normal tissue, though not by much. By the time a wound has completely healed, the scar strength is about 98% of that of the normal tissue.

Sometimes we’re afraid of getting scars, probably for the same reasons I’ve described. Doing things that are risky might lead to getting hurt, and those scars are a permanent reminder of how we not only failed but also how we hurt ourselves in the process.

Although, I think we have the wrong ideas about scarring. Sure, sometimes scars can be ugly, or painful, or weak. But scars can also tell us a lot about ourselves if we’re willing to look past the superficial and see what they really represent.

Scars can show our bravery to others, remind us of our courage, help us learn from our mistakes, and remember our successes. They can enable empathy, and remind us of our vulnerability and our humanity. They prove that we’ve overcome adversity. Altogether, they tell us our history.

When I see my scars, I remember how I should be careful with sharp objects, or to dress wounds carefully, or to watch out for 4-Wheel Drives. The caesarean scar on my wife’s abdomen reminds me of the mix of fear and joy at the birth of my two children. My scars help me to remember what others are going through in their journey. They remind me that I’m not invincible. When I ask my patients about their scars, they often tell me of how they overcame desperate illness and survived.

At Easter time, we often focus on the power of the resurrection, and so we should. Through the resurrection, we have the opportunity to embrace eternal life with a loving God, who sacrificed his own son to give us that chance.

But one thing that always intrigued me about the Easter story was that after Jesus was resurrected, in his glorious new body, he still bore the scars of the crucifixion. John gives a clear account in the gospel of John 20:24-27, “Now Thomas (also known as Didymus), one of the Twelve, was not with the disciples when Jesus came. So the other disciples told him, ‘We have seen the Lord!’ But he said to them, ‘Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.’ A week later his disciples were in the house again, and Thomas was with them. Though the doors were locked, Jesus came and stood among them and said, ‘Peace be with you!’ Then he said to Thomas, ‘Put your finger here; see my hands. Reach out your hand and put it into my side. Stop doubting and believe.’”

Before I fully understood the significance of this verse, I had assumed that Jesus’s resurrected body was supernaturally perfect. He had just experienced the power of the resurrection after all. It sort of threw me when I realised that Jesus’s supernatural body was still scarred. And if scars are considered ugly, painful and weak, then it doesn’t seem to make sense.

I’ve come to realise that God knew exactly what he was doing. Those scars on Jesus’s hands, feet and side demonstrate that he gave up his deity to embrace humanity. They show his amazing sacrifice by taking our place on the cross. They prove that that he overcame the power of sin and death. They will remind us of his amazing love for us for the rest of eternity.

Yes, our scars seem ugly, painful and weak on the outside, but they are signs of our struggles, our strength, our victories – things that we have learnt from, and things that we can be proud of.

Scars aren’t a sign of weakness, but of our humanity. Scars are evidence that we’ve overcome adversity, that we are strong. Scars are a permanent reminder of the gift of God to man. Scars are nothing to be ashamed of.

Don’t look at your scars as a sign of weakness and shame, but instead, see your strengths through the story of your scars.

Bibliography

Gauglitz, G. G., Korting, H. C., Pavicic, T., Ruzicka, T., & Jeschke, M. G. (2011). Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med, 17(1-2), 113-125. doi: 10.2119/molmed.2009.00153

Hardy, M. A. (1989). The biology of scar formation. Phys Ther, 69(12), 1014-1024.

Dr Caroline Leaf – Exacerbating the Stigma of Mental Illness

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It was late in the afternoon, you know, that time when the caffeine level has hit critical and the only way you can concentrate on the rest of the day is the promise you’ll be going home soon.

The person sitting in front of me was a new patient, a professional young woman in her late 20’s, of Pakistani descent. She wasn’t keen to discuss her problems, but she didn’t know what else to do. After talking to her for a few minutes, it was fairly obvious that she was suffering from Generalised Anxiety Disorder, and I literally mean suffering. She was always fearful but without any reason to be so. She couldn’t eat, she couldn’t sleep, her heart raced all the time.

I was actually really worried for her. She let me do some basic tests to rule out any physical cause that was contributing to her symptoms, but that was as far as she let me help her. Despite talking at length about her diagnosis, she could not accept the fact that she had a psychiatric condition, and did not accept any treatment for it. She chose not to follow up with me either. I only saw her twice.

Perhaps it was fear for her job, social isolation, or a cultural factor. Perhaps it was the anxiety itself. Whatever the reason, despite having severe ongoing symptoms, she could not accept that she was mentally ill. She was a victim twice over, suffering from both mental illness, and its stigma.

Unfortunately, this young lady is not an isolated case. Stigma follows mental illness like a shadow, an extra layer of unnecessary suffering, delaying proper diagnosis and treatment of diseases that respond best to early intervention.

What contributes to the stigma of mental illness? Fundamentally, the stigma of mental illness is based on ignorance. Ignorance breeds stereotypes, stereotypes give rise to prejudice, and prejudice results in discrimination. This ignorance usually takes three main forms; people with mental illness are homicidal maniacs who need to be feared; they have childlike perceptions of the world that should be marveled; or they are responsible for their illness because they have weak character [1].

Poor information from people who claim to be experts doesn’t help either. For example, on her social media feed today, Dr Caroline Leaf said, “Psychiatric labels lock people into mental ill-health; recognizing the mind can lead us into trouble and that our mind is powerful enough to lead us out frees us! 2 Timothy1:7 Teaching on mental health @TrinaEJenkins 1st Baptist Glenardin.”

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. It’s disturbing enough that Dr Leaf, who did not train in cognitive neuroscience, medicine or psychology, can stand up in front of people and lecture as an “expert” in mental health. It’s even more disturbing when her views on mental health are antiquated and inane.

Today’s post, for example. Suggesting that psychiatric labels lock people in to mental ill-health is like saying that a medical diagnosis locks them into physical ill-health. It’s a nonsense. Does diagnosing someone with cancer lock them into cancer? It’s the opposite, isn’t it? Once the correct diagnosis is made, a person with cancer can receive the correct treatment. Failing to label the symptoms correctly simply allows the disease to continue unabated.

Mental illness is no different. A correct label opens the door to the correct treatment. Avoiding a label only results in an untreated illness, and more unnecessary suffering.

Dr Leaf’s suggestion that psychiatric labels lock people in to their illness is born out of a misguided belief about the power of words over our thoughts and our health in general, an echo of the pseudo-science of neuro-linguistic programming.

The second part of her post, that “recognizing the mind can lead us into trouble and that our mind is powerful enough to lead us out frees us” is also baseless. Her assumptions, that thought is the main driving force that controls our lives, and that fixing our thought patterns fixes our physical and psychological health, are fundamental to all of her teaching. I won’t go into it again here, but further information on how Dr Leaf’s theory of toxic thinking contradicts basic neuroscience can be found in a number of my blogs, and in the second half of my book [2].

I’ve also written on 2 Timothy 1:7 before, another of Dr Leaf’s favourite scriptures, a verse whose meaning has nothing to do with mental health, but seized upon by Dr Leaf because one English translation of the original Greek uses the words “a sound mind”.

So Dr Leaf believes that labelling someone as having a mental illness will lock them into that illness, an outdated, unscientific and purely illogical notion that is only going to increase the stigma of mental illness. If I were @TrinaEJenkins and the good parishioners of 1st Baptist Glenardin, I would be asking for my money back.

With due respect, and in all seriousness, the stigma of mental illness is already disproportionate. Mental illness can cause insurmountable suffering, and sometimes death, to those who are afflicted by it. The Christian church does not need misinformation compounding the suffering for those affected by poor mental health. Dr Leaf should not be lecturing anyone on mental health until she has been properly credentialed.

References

  1. Corrigan, P.W. and Watson, A.C., Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002. 1(1): 16-20 http://www.ncbi.nlm.nih.gov/pubmed/16946807
  2. Pitt, C.E., Hold That Thought: Reappraising the work of Dr Caroline Leaf, 2014 Pitt Medical Trust, Brisbane, Australia, URL http://www.smashwords.com/books/view/466848