Elder Holland on Depression

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Elder Jeffrey R. Holland gave a talk at the Saturday afternoon session of the October 2013 General Conference that resonated with many struggling with psychiatric and psychological disorders. He specifically addressed Major Depressive Disorder but his words are broadly applicable. As someone with a PhD in clinical psychology, I appreciated his message of hope and love to those who struggle. While my interests and specialties are in understanding and helping those with neurological disorders, I have experience and training in helping people who struggle with depression, anxiety, ADHD, addictions, and other emotional and mental disorders. Thus I can say as a professional that Elder Holland nailed the issue of mental and emotional disorders right on the head.

In the past, many church leaders and members had unflattering views of psychological and psychiatric treatment; frankly, much of it was deserved. Diagnosis and treatment of psychiatric disorders in the past was mediocre to harmful in the past. We have come a long way. Most of this improvement in the fields of psychiatry and psychology has come in the past 30 years, with broader improvements in public understanding over the past 15-20 years.

At any given time in the U.S., 5-15% (varies by state) of adults meet criteria for clinical depression with an overall prevalence around 6.5% (Sources: http://www.cdc.gov/features/dsdepression/http://www.nimh.nih.gov/statistics/1mdd_adult.shtml). The 6.5% rate is from 2008 and rates have increased since then. 2% of the U.S. adult population suffer from severe depression (actual rate is slightly higher due to under-reporting and under-treatment).

The good news is that psychological and psychiatric treatment for depression and anxiety is highly effective (in general, effectiveness for individuals will vary). Around 70% of individuals will respond well to a combination of medication and “talk therapy”. That is not comforting for those who do not respond but there is always room for hope. You can find out more about depression and validated treatment by reading this information from the National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/depression/index.shtml

If you missed Elder Holland’s talk, you can watch it below. If you didn’t miss it, it is well worth your time to watch it again. I’ll write more on this topic soon. If you have any questions about psychological, psychiatric, or neurological disorders, I’ll be happy to try to answer your questions. If you are struggling with depression or anxiety or some other similar (or more severe) challenge, seek help from a competent professional in conjunction with seeking help from the Lord.

On Suicide

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I just found out that one of my friends from high school days killed himself. I’ll call him Jacob (not his real name). What started out as a beautiful day quickly turned around. I knew that Jacob had been struggling with some issues (that’s an understatement) but the news came as a shock. While we were not close friends, we kept in touch through Facebook. Now he’s gone. And you know what? It’s not fair. Suicide is terrible, it is tragic. It does terrible things to those left behind. I can imagine the hurt and pain and despair that leads someone to do it but that doesn’t make it right. In some ways suicide is the ultimate form of free will; it is literally taking your life into your own hands and saying, “Thus far and no more.” However, while it is exercising free will, it does so in tragic circumstances. Jacob has gone to the other side. I don’t know what lies in store for him there. That’s between God and Jacob.

I’ve written a lot about death on this site. Some of the deaths I’ve written about have been tragic, others not at all. Jacob is now the third friend of mine who has taken his life. All of those deaths were completely unnecessary. Death comes to all but we need not and should not hasten it along.

While my primary interests are with the brain and with neuroimaging, I also do clinical work, including therapy. I’ve talked with people who have made attempts at taking their own lives. I have an acquaintance who has struggled for years with thoughts of taking his life. He’s told me that while he never made any attempts, there were days and weeks and months and years where he thought about it over and over. Why did he never take his life? He said that he was able to grab onto the bright days and persevere. He knew it was wrong and that it would hurt a lot of people so he did not do it. Plus, he had faith in God that things would get better in the future. Thankfully they have for him.

So what do we know about suicide from prophets? There are two really good articles that address the topic. One was given by Pres. Ezra Taft Benson, the other by Elder M. Russell Ballard, both in the 1980s. Pres. Benson said, “As the showdown between good and evil approaches with its accompanying trials and tribulations, Satan is increasingly striving to overcome the Saints with despair, discouragement, despondency, and depression” (Source). Pres. Benson then goes on and provides 12 things we can do to lift our spirits when we feel down even despondent. His suggestions are: repentance, prayer, service, work, health (focus on increasing physical health), reading (scriptures), blessing (priesthood), friends (family), music, endurance, and goals. While his suggestions are wonderful, they should not replace management by a competent mental health professional should that be necessary. However, by themselves, Pres. Benson’s suggestions would do a lot for depression. Many of them are not very different than what I tell my depressed clients but again, psychological and psychiatric care is vital in many cases. I also should add that not all depression is caused by sin but sin can cause depression, which is why repentance may be necessary in some cases. However, there is great power in the Atonement of Jesus Christ, power enough to overcome the deepest, darkest depression.

Elder Ballard’s article, Suicide: Some Things We Know, and Some We Do Not, is particularly powerful.

He states, “The act of taking one’s life is truly a tragedy because this single act leaves so many victims: first the one who dies, then the dozens of others—family and friends—who are left behind, some to face years of deep pain and confusion. The living victims struggle, often desperately, with difficult emotions. In addition to the feelings of grief, anger, guilt, and rejection which the victims of such a family feel, Latter-day Saints carry an additional burden. The purpose of our mortal lives, we know, is to prove ourselves, to eventually return to live in the celestial kingdom. One who commits suicide closes the door on all that, some have thought, consigning himself to the telestial kingdom.

Or does he? What is the truth regarding suicide?”

After noting that suicide is wrong, Elder Ballard provides this quote by Elder McConkie,

“The late Elder Bruce R. McConkie, formerly of the Quorum of the Twelve, expressed what many Church leaders have taught: ‘Suicide consists in the voluntary and intentional taking of one’s own life, particularly where the person involved is accountable and has a sound mind. … Persons subject to great stresses may lose control of themselves and become mentally clouded to the point that they are no longer accountable for their acts. Such are not to be condemned for taking their own lives. It should also be remembered that judgment is the Lord’s; he knows the thoughts, intents, and abilities of men; and he in his infinite wisdom will make all things right in due course.’ (Mormon Doctrine, Salt Lake City: Bookcraft, 1966, p. 771; some italics added.)”

Clearly, there are many things that need to be taken into account regarding the circumstances surrounding a suicide. My friend Jacob was passing through some severe trials – many severe trials. I cannot even fathom going through all he was going through. Elder Ballard talks about this as well:

“I feel that the Lord also recognizes differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance that led to despair and a loss of self-control?

Obviously, we do not know the full circumstances surrounding every suicide. Only the Lord knows all the details, and he it is who will judge our actions here on earth….

Suicide is a sin—a very grievous one, yet the Lord will not judge the person who commits that sin strictly by the act itself. The Lord will look at that person’s circumstances and the degree of his accountability at the time of the act. Of course, this gives us no reason to excuse ourselves in committing sins, nor will the Lord excuse us, if I understand correctly. We must constantly strive to do our best in emulating the Savior in every aspect of our lives. At the same time, however, let us remember that spiritual growth comes ‘line upon line,’ that the key—in the spirit world as well as in mortality—is to keep progressing along the right path.”

In short, we do not know all of people’s circumstances. Yes, many of us were hurt by Jacob’s actions; yes, what he did was wrong but we cannot pass final judgment on him, only God can do that. All that is left for us to do is mourn with those who mourn and provide what comfort we can. We can learn from this experience and try to help others who are struggling.

For those of you who might be struggling with your own despairing thoughts, I say to you, “Hold on!” The darkness is real, the despair is deep and painful, but there is reason to hope. “Hang on, hang on, when all is shattered, when all your hope is gone. Who knows how long? There is a twilight, a nighttime, and a dawn. We break, we bend. With hand in hand when hope is gone just hang on, hang on.” (Guster). After the darkness of night there will be day. If you are struggling with thoughts of ending your own life, please reach out to others.

Also, watch the following two videos to see what prophets have said about hope. Again, competent mental health providers can be extremely beneficial but true and lasting happiness is not found apart from Christ and His Atonement. We can find great hope in Christ. It might not be easy but hope can spring up even during the darkest night.

Two Brothers – A Mormon Messages Video for Youth

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As someone who is training as a clinical psychologist (although I plan on an academic and research career), the following video resonated with me. The gospel of Jesus Christ has great power; that power comes from Christ – from His Priesthood and His Atonement. This video gives a perfect example of how through faith, repentance, and much prayer our weaknesses can become strengths. I am not saying that mental health issues should be tackled only by faith and prayer. Competent mental health professionals can provide necessary treatment for problems. Just as we should rely on the best medical care we can acquire – in addition to relying on faith in Christ – when we have physical illness, so should we seek out professional help when necessary for mental health issues. However, many mental health issues can be solved by faith in Christ and by His Atonement through repentance.

Faith, Psychology, and Therapy

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While I spend most of my time doing research (both testing participants and dealing with the MRIs of their brains), I also spend time conducting therapy with clients. The more I learn about common mental health issues such as depression or anxiety, the more convinced I am of the benefits the gospel of Jesus Christ can have for mental illness. I find that at least some of the time in every session I find myself thinking, “The gospel sure could help with this problem.” I am not implying that the gospel is a panacea for issues such as depression but it can benefit a person tremendously.

I am going to focus on a narrow range of psychological disorders in this post. As psychologists we are most concerned about people with depression who state that they feel hopeless. It is usually a precursor to suicidal thoughts and intent, at least in the United States of America (depression manifests differently in different cultures). That is why when someone states or acknowledges that they feel hopeless, we become quite concerned. There might still be other things that are keeping people from killing themselves but hope is one of the most important keys. Those who are without hope despair (see Moroni 10:22) and have a tendency to act in desperation. However, there is a cure for this despair.

The gospel of Jesus Christ and faith in Christ provides one thing that makes mental illness – be it depression or anxiety or even something more severe – bearable. The gospel and faith provide hope. Hope is not always happiness but it can exist even if happiness is gone; hope can exist even when the inner calm is gone. For someone who is suffering from a mental illness, I believe that illness can become more bearable when faith in Christ leads to hope – hope for a better and brighter day and hope for a life when there will no longer be sadness and sorrow, at least not quite like we experience here in mortality.

It would be inaccurate to state that much sorrow and even depression was not caused by sin and other wickedness; after all, Moroni wrote, “Despair cometh because of iniquity” (Moroni 10:22). Also, “Wickedness never was happiness.” (Alma 41:10). People will not always find happiness in sin (see Mormon 2:13), whether in this life or the next, they will sorrow. Sometimes sorrow is good – it can help spur people to repentance (see 2 Cor. 7:10) – sometimes people become so ingrained in wicked habits that their sorrow is not unto repentance (see Mormon 2:13).

If you do a scripture search for the word sorrow you find many instances of the word; in most of the cases sorrow is juxtaposed with sin – the people’s own or some one else’s (see Mormon 5:9,11; 2 Nephi 1:17; Alma 31:2). The righteous can be sad and feel down because of the wickedness of those around them and those they love. The cure, at least in the scriptures, for most sorrow is repentance.

I want to repeat that in no way do I think all depression is caused by wickedness but I also not deny that wickedness can play a large role in the sorrow and depression people feel. It is not possible to live a wicked lifestyle and remain happy over time; we all have a divine spark within us that is offended by wickedness. As that flame burns dim, it affects how we feel. I have to add that any member of The Church of Jesus Christ of Latter-day Saints who is depressed should receive treatment from a competent mental health provider (and preferably one who respects one’s religious beliefs). Sometimes a bishop can be involved if the person feels that he or she has unresolved issues but the gospel is not a panacea for depression. As Elder Wilford Andersen stated at the April 2010 General Conference: “I do not wish to minimize the reality of clinical depression. For some, solutions to depression and anxieties will be found through consultation with competent professionals. But for most of us, sadness and fear begin to melt away and are replaced by happiness and peace when we put our trust in the Author of the plan of happiness and when we develop faith in the Prince of Peace.” (Andersen, Apr. 2010 Conference).

Now I want to shift gears for the rest of this post. Within the organization of The Church of Jesus Christ of Latter-day Saints are built many tools that while not explicitly established as treatment for mental health issues, can be beneficial for a range of psychological problems. One frequent contributing factor in depression are feelings of loneliness. All LDS Church members should be assigned home teachers (two men or a combination of a man and a young man 14-18 years old) who are supposed to visit monthly. All members of the Relief Society (women 18 and over) are also assigned visiting teachers (two women who are part of the Relief Society as well). In theory no one in a ward or branch (and thus the whole church) should feel completely isolated because they should be visited regularly by fellow church members. This program is not perfect but there are many people who fulfill their responsibilities every month. Related to this, all church members are also either a part of a Primary class (for the children), a Priesthood quorum (young men and men), a young woman’s class, or the Relief Society. Thus, ideally there should be a number of people who are involved and interested in each church member (in addition to the Bishop or Branch President). People are not perfect so this organization does not always work as it could but the organization is sound, even if the people are not always sound.

In addition, all church members are ideally assigned a responsibility – from librarian to Elder’s quorum president to Primary teacher to Bishop to General Authority to ward usher. All should have some level of responsibility and should (I’m dwelling in an ideal world for this post) feel needed. Some callings are busier than others – most bishops spend at least 20 hours per week fulfilling their responsibilities whereas a ward greeter might only spend a few minutes each week with his or her calling. Regardless of the level of responsibility, if a person has the right attitude he or she will feel needed. Even something as simple as that can alleviate symptoms of depression.

One thing that we often teach people who are depressed is that they should do something active every day, even if it is only for a few minutes. The Church provides numerous opportunities for people to be active and involved with other people. The Church provides a social situation where friends can be made. These social interactions are also key in helping people feel less depressed. That gets back to feelings of isolation or aloneness that so many people who are depressed feel.

Now what about other mental illnesses? I want to focus briefly on social phobia (performance anxiety or anything else related). The best and most lasting treatments for phobias are behavior treatments and in particular, exposure therapy. Exposure does not work for everyone but it is generally very effective. If someone has performance anxiety (specifically about public speaking) there are opportunities to overcome that anxiety. A person might be called as a teacher in church and have to teach every week. A person also might be asked to give a talk in Sacrament Meeting or bear his testimony or say a public prayer. Doing any of these these can serve as an informal exposure therapy. In addition, many young men and women in the Church serve full-time missions where they spend 18 to 24 months interacting with complete strangers. If you want a good situation to get over any social phobia one might have – that is a great time to overcome a phobia. With repeated exposure things become normalized and easier to do. This does not mean all anxiety will go away but it can be alleviated by The Church of Jesus Christ of Latter-day Saints.

Fear comes not of faith – faith replaces fear. Fear is at the root of a lot of anxiety disorders and faith can help someone overcome that fear. Again, I do not want to downplay the role that competent professionals can play but I think there are a lot of blessings that come through believing and living the gospel of Jesus Christ. Certainly we will not be free from sorrow or psychological or medical or neurological problems but through faith we can find meaning in such adversity and have hope to overcome.