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Here is the uncomfortable fact: most Americans now get their news from social and video platforms. More than TV. More than news sites and apps. Our public square has been quietly subcontracted to feeds tuned for time‑on‑platform, not truth‑seeking or neighborliness. We feel the cost in our bones—sharper extremism, thinner civility, cultural tribes that shout past each other, rumors that outrun corrections, and a steady undertow of loneliness. Especially for the young, the scroll isn’t just a pastime; it’s the water they swim in.

And the research is stubborn. When people use less social media, they hurt less. In randomized trials, trimming use to about thirty minutes a day lowers loneliness and depression; a one‑week break nudges anxiety down and well‑being up. The gains are modest, yes—but they’re real. Which means the real question isn’t whether less is better. It’s how to make “less” the easy choice for millions of people at once.

If the system is shaping us, then we have to reshape the incentives, its defaults, its hours, its business model. What follows are a few practical legal and social ideas that may help address the raft of negative consequences of social media. 

Refit Section 230: A safe harbor you keep only if you sail safely

Section 230 of the federal Communications Decency Act was built to keep platforms from being sued as the publisher for what users post, and to let the platforms moderate in good faith. Over time the shield has stretched to cover not just hosting speech, but how platforms distribute and rank it. That wasn’t carved into the Constitution; Congress wrote 230, and much of the expansion has come at the hands of well-meaning court rulings. But those court interpretations don’t have the broader picture that a legislature can. Congress can and should update Section 230.

The fix isn’t necessarily to blow up 230. That could invite chaos. But we could make the Section 230 shield conditional on predictable, speech-neutral design choices:

• No immunity for paid placement. Ads and paid “boosts” should live under ordinary tort and consumer protection law, not inside 230’s blanket.
• Narrow protection for risky amplification. When a recommender system actively pushes content, immunity shouldn’t apply. That’s an editorial decision, regardless of whether it is made by an algorithm or not. 
• Reasonable design and transparency to keep the shield. Think chronological feeds and overnight quiet hours for minors by default, documented age assurance, and researcher access to basic risk metrics.

Why this matters: today’s largest platforms depend on two things—paid targeting and opaque, engagement‑maximizing ranking. If paid boosts lose 230’s protection, and if default friction becomes the price of immunity, the business math changes. Lawsuits won’t swallow the internet; the First Amendment still limits claims. But the near‑automatic shield over product design would no longer be unconditional.

Section 230 was created specifically to give internet platforms legal protections that don’t apply to other publishers. And without those additional protections, the social media regime that exists today could not survive, all without implicating the First Amendment even a little bit. 

Starve the Surveillance Ad Engine

Engagement‑hungry design exists because surveillance targeting is so profitable. If we limit the precision and persistence of tracking, then time on social media becomes less lucrative, and the perverse incentives drop. 

Europe is already proving the point: the Digital Services Act bans targeted ads to minors and profiling‑based ads that use sensitive data. Enforcement has forced real product changes (LinkedIn has already disabled a targeting tool in Europe). A U.S. version can go further while staying speech‑neutral.

A clean U.S. starting point is already on the books in California. The 2023 Delete Act (SB 362) requires the state to launch a single portal—DROP—by Jan. 1, 2026. Beginning Aug. 1, 2026, data brokers must check the portal at least every 45 days and purge the personal data of anyone who files a deletion request. If we were to adopt that same one-click ease to delete data across US states, we could start to see a big change.

Pairing data deletion with federal bans on both targeted ads to minors and the use of sensitive data for ad targeting, you drain much of the oxygen from engagement‑hungry feeds without restricting anyone’s speech.

When the ROI on hyper‑personalized ads falls, investors and product teams shift: calmer, subscription‑leaning models look better; contextual ads regain ground; feeds lose pressure to maximize time‑on‑platform at all hours. 

It’s not the advertising that is causing social media’s problems; it is the advertising that provides the funding that incentivizes social media platforms to cause problems and drag their consumers back over and over again, profiting off our worst instincts. 

Make Healthy Design the Default

Certain default settings make it extraordinarily easy to draw people back in. And without limiting individuals’ ability to use those settings if they prefer, we can pass simple laws requiring that interface defaults be high friction. For example: 

• Forwarding limits. WhatsApp’s cap on forwarding already‑viral messages to a single chat produced a 70% drop in “highly forwarded” messages. 
• Autoplay off. A randomized study of Netflix users found that disabling autoplay reduced session length and total watching. Autoplay is a sticky design pattern; switching it off by default trims use without banning anything.
• Default chronological feeds and overnight quiet hours for minors. New York’s SAFE for Kids Act now bars algorithmic feeds for minors unless parents opt in, and blocks notifications between midnight and 6 a.m. The proposed rules detail how to verify age and consent. 

States could experiment with these rules, or Congress could nationalize these defaults by giving the FTC clear authority—building on its consumer protection powers—to set baseline attention‑safety standards for large platforms, especially for minors. This is still a far cry from having a large Surgeon General’s Warning each time you log into Instagram that says, “Social Media has been shown to lead to anxiety, depression, and loneliness.” But if we can’t make smaller changes to reverse this trend, that might be precisely what is needed.

These small design decisions bend millions of daily personal choices, without taking the choices away from the consumers. 

Make “Offline” the Default

There’s a fourth way to curb our dependence on social media that doesn’t require a single new statute: change what our institutions expect of us. When schools, workplaces, congregations, and community spaces set better defaults, people spend less time in the feed—because the offline choice becomes the easy choice. It’s culture. And culture often moves faster than law.

Schools can reclaim the school day with phone‑free policies—pouches or lockers, with clear exceptions for emergencies. Pair that with analog alternatives (board‑game tables, open gyms, music rooms, maker spaces) so lunch provides the engagement without the screen time.

What is more durable than individual resolve is rituals. Congregations and faith groups can play a key role in helping de-escalate. For example, in 2018, President Russell M. Nelson invited Latter‑day Saint youth to a seven‑day social‑media fast, and later invited women to try ten days—framing abstention as a joyful reset of attention and purpose. Any congregation, club, or neighborhood can copy the pattern: announce a time‑bound fast, fill the gap with service and fellowship. These groups can also fill in the desire for connection that so often feeds the most unhealthy social media habits. 

“Third places”—places where you are allowed to exist without paying money—have seen a precipitous drop off. Often the easiest and most comfortable of these places are online. Not only can more congregational connection help this, other groups such as libraries and parks can find ways to engage, especially young people. And might I suggest the ancient and still relevant practice of breaking bread with one another face-to-face.

Less social media won’t come from one heroic law. It will come from a hundred ordinary decisions—repeated until they feel like the way things have always been. That’s culture, and ultimately it is what will help us turn around. 

Hard questions, honest answers

Skeptics will argue that these proposals flirt with censorship, invite doomed lawsuits, or amount to cosmetic fixes. It’s true that free speech doctrine sharply limits what states can do, and that even without Section 230, many claims will still fail on First Amendment or causation grounds. It’s also true that warning labels and nudges alone rarely change behavior. Those cautions matter.

But the core of my suggestions are different. It doesn’t tell platforms what they must carry or suppress. It focuses on distribution mechanics, ads, data, and design—areas where Congress clearly has authority to condition immunity or regulate trade practices in content‑neutral ways. And the record shows that friction rules do more than signal: forwarding caps have slashed virality, autoplay‑off trims viewing time, and randomized trials confirm that short breaks improve well‑being. These changes may not solve everything, but they move the needle in measurable, constitutional ways.

If we want less misinformation, fewer extremism incentives, better privacy, and less loneliness, we should stop pretending a perfectly disciplined thumb is the answer. Make healthier design the default. Our social media death spiral was created by our culture. And if we want to address it, we need to find a way to change that culture. Perhaps that will happen through laws to change the incentives. Perhaps it will take going after the culture itself. Now is not the time to wait for perfect answers. It’s time to start trying things. 

The post Less Feed, More Life appeared first on Public Square Magazine.

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Faith is hard. One of my favorite writers is Flannery O’Connor, an American Southern Gothic novelist and short story writer. O’Connor was a devout Catholic, and her published prayer journals and letters give us a glimpse into her life of faith. In a letter to a lifelong friend and pen pal, Louise Abbot, O’Connor responds to what must have been Abbot describing a trial of faith, saying: 

I think there is no suffering greater than what is caused by the doubts of those who want to believe. I know what torment this is, but I can only see it, in myself anyway, as the process by which faith is deepened. A faith that just accepts is a child’s faith and all right for children, but eventually you have to grow religiously, as [in] every other way, though some never do.

What people don’t realize is how much religion costs. They think faith is a big electric blanket, when of course it is the cross. It is much harder to believe than not to believe. If you feel you can’t believe, you must at least do this: keep an open mind. Keep it open toward faith, keep wanting it, keep asking for it, and leave the rest to God.

It is interesting that she both acknowledges that for some, faith can be excruciating—the cross itself—but also the way by which faith is deepened. In other words, this is how it is supposed to work.

Many I know who have struggled with faith are unsure how to initiate these kinds of conversations with friends or seek out literature that will help them find the truth. Perhaps they have reached out to loved ones about their doubts, and have received dismissive or surface-level answers like “just read your scriptures more” or “It sounds like you’ve been reading anti-material.” Often they have been convinced by nonbelievers or former believers that any faith-positive source is biased or deceptive, or that once the “shelf is broken,” there is no going back. 

Too often, we treat church meetings as the place where every spiritual concern must be resolved. But not every question belongs in the chapel pew. Some conversations about faith are sacred—and require a different setting, a different pace, and a different kind of attention.

Faith is hard, and we should normalize the challenges, and ebbs and flows, and questions that come along with a life of devotion. No believer goes through mortality without crying out to God in agony of a great loss, or feeling silence from the heavens, or seeking out greater meaning or understanding of God’s plan. After all, this is part of the process. 

But how we go about normalizing these struggles matters.  In our efforts to normalize any challenge, we risk romanticizing it—or worse, reinforcing it. Nowhere is this more apparent than in the movement to normalize mental health challenges. 

Mental health has become the lens through which we view nearly everything. Diagnoses appear in social media bios. Therapyspeak—words like “toxic,” “trauma,” and “boundaries”—has seeped into casual conversation, often stripped of clinical meaning. Employers hand out mental health toolkits, colleges offer petting zoos during finals, and celebrities tout the virtues of therapy for every relationship hurdle.

But things aren’t getting better. Symptoms of anxiety and depression continue to rise, especially among adolescent girls. Even emotionally stable teens now pathologize normal ups and downs, often self-diagnosing via TikTok. Gallup reports that Americans’ self-assessed mental health is the worst it’s been in over two decades. Suicide rates have increased by 30% in the last 20 years. Parents are more fearful than ever—reluctant to let their children roam the neighborhood, convinced that every stranger at Target might be a kidnapper.

We are more anxious, more fragile, and more volatile. This culture of constant rumination and performative validation is not serving us well. Bringing in “faith crisis” to every church meeting risks creating the same culture of unhealthy navel-gazing in our spiritual lives.

First, the right setting: In The Church of Jesus Christ of Latter-day Saints, we are often taught that the most important part of church attendance is taking the sacrament and renewing our baptismal covenants. President Dallin H. Oaks has taught that we attend church to serve (not to be served) and teaching manuals such as Preach My Gospel for missionaries and Teaching, No Greater Call for general membership emphasize that our primary purpose should be to invite others to come unto Christ. I would humbly suggest that the right setting for a deep dive into questions and doubts is probably not in our regular Sunday meetings. 

This is somewhat tricky. Avoiding hard questions might leave struggling members isolated—or lead them to those who’ve left the covenant path and want others to follow.

On the other hand, among the members and visitors at church each week are likely widows, those who are caring for elderly parents, have sick or disabled children, have lost jobs, have mental health issues, and myriad other challenges. These people come to church for the balm of Gilead that is the Gospel of Jesus Christ. Our niche Joseph Smith historical questions, while they may feel immediate and pressing to us, can detract from that important purpose.

Flannery O’Connor chose faith, even when it didn’t feel effortless. During her graduate school years, she attended Mass daily. She journaled about the tension between her desire for God and her sense of distance from Him. “My thoughts are all elsewhere,” she confessed. But she showed up anyway. She didn’t wait for certainty before practicing devotion. When prayer felt elusive, she turned to writing, pouring out her longings, her doubts, and her imperfect love into beautifully wrought prayers. She didn’t pretend to be more faithful than she was—she simply brought her full self to God and asked for help.

We can do the same. In times of spiritual struggle, our offering may be small—a prayer uttered in hope rather than confidence, a Sunday School comment made despite nagging doubt, a verse of scripture read with an open, aching heart. But small offerings matter. They are expressions of our desire to stay in a relationship with God. And that desire, acted on, can become the seed of faith.

The right people and the right sources also matter. When we’re struggling with mental health, we’re careful—ideally—not to rely on unqualified influencers or unreliable forums for advice. The same care should apply when we’re facing serious gospel questions. Not every voice online—or even in our social circles—is equipped to help. President Russell M. Nelson has warned us against “increasing (our) doubts by rehearsing them with other doubters.”

For some, the right person might be a trusted family member, a close friend, a ministering sister or brother—someone who can listen without panic and respond without platitudes. For others, it might be a mentor, a bishop, or someone with experience navigating similar questions. But we also have to prepare to be that kind of person for others—to receive their questions with love and patience rather than fear or defensiveness.

The Church provides a helpful resource called Helping Others with Questions in the Gospel Topics Library, which outlines practical ways to support loved ones in faith crises. Outside of official church resources, organizations like Mormonr or FAIR Latter-day Saints offer thoughtful, research-based responses to common questions and criticisms. These sources won’t perfectly answer every question—but they are striving to be both spiritually grounded and intellectually responsible.

It’s not wrong to hear out questions or criticisms. But we shouldn’t let them monopolize the conversation in our hearts and minds. Doubt may be a part of our path—but we get to choose who we walk with, and who we let guide us, and how much space we want to give to those doubts.

Flannery O’Connor was not only a gospel seeker, but also a guide. Her own wrestling made her a compassionate companion to others in their searching. She never claimed to have perfect faith—only a determined one. Her writing continues to offer a kind of spiritual hospitality to those who want to believe but aren’t sure how.

In that way, O’Connor mirrors the very work of the gospel: inviting the wounded, the weary, and the wondering to come unto Christ, even when we ourselves are prone to wander. If we can become the kind of believers who sit with others in that space—without panic, without platitudes, but with patience and love—then our faith, however imperfect, becomes not only our anchor but someone else’s lifeline.

Faith is hard. But as with most hard things, it is transformative, refining us in the very hardest of times to become who only God can see in us. That is the work of a disciple—not to have all the answers, but to keep walking with God, and help others do the same.

The post The Hidden Cost of Normalizing Doubt appeared first on Public Square Magazine.

And the angel said unto me: Behold the Lamb of God, yea, even the Son of the Eternal Father! Knowest thou the meaning of the tree which thy father saw?

And I answered him, saying: Yea, it is the love of God, which sheddeth itself abroad in the hearts of the children of men; wherefore, it is the most desirable above all things.

And he spake unto me, saying: Yea, and the most joyous to the soul.

And after he had said these words, he said unto me: Look! And I looked, and I beheld the Son of God going forth among the children of men . . .

. . . And I beheld multitudes of people who were sick, and who were afflicted with all manner of diseases, and with devils and unclean spirits . . . And they were healed by the power of the Lamb of God [emphasis added].

There is much I do not understand about the love of God and Jesus Christ, but I gained a testimony as a young man that it is real. Motivated by this testimony, I sought during my career as a psychologist to gain greater insight into how their love can help people heal from mental illness. My testimony of their love has also helped me endure difficult questions, much uncertainty, and many other challenges to my faith during my life.

The Crucible of Mental Illness

I was ten years old when I found out my dad was mentally ill. To the best of my recollection, it was a snowy, freezing winter night in our small prairie town of High River, Alberta. Mom was sitting on the edge of my bed, looking concerned. I had pulled the quilt on my bed to my chin, trying to keep warm. I don’t remember all of the details, but I still vividly remember my fear and grief.

“Why doesn’t Dad ever come to my hockey games, Mom?” I asked, looking at her, trying to hold back tears.

“The doctors say your dad’s had a nervous breakdown,” Mom said.

“What’s that?” I asked. 

 “Your dad feels sad most of the time,” Mom explained. “He’s tired and has trouble thinking. He doesn’t feel good enough to go to work, church, or even to your hockey games. It’s a mental illness, not a physical sickness.”  

“Can’t the doctors help him?” 

“They’re trying,” Mom said. “They gave him some medicine, but it hasn’t helped much. Next week, your dad’s going to the hospital, and the doctors will try electroshock therapy.” My eyes widened in alarm.

Mom patted my hand, trying to reassure me. “I know it sounds scary, but it’s not as bad as it sounds. They’re going to put your dad to sleep and hook electrodes to his head. They’ll deliver an electric current to his brain while he’s asleep. He won’t feel or remember it.” 

“What if it doesn’t help?”

“I don’t know, Scott.”

“He’s got to get better,” I whispered, fighting off the panic. 

But Dad didn’t get better. After he returned from the hospital, our family settled into a painful routine defined by Dad’s emotional absence. Almost every day, when I arrived home from school, I found him in his recliner chair in the living room reading the scriptures or asleep. If he wasn’t in the recliner chair, he was upstairs in his bedroom, sleeping. Dad rarely went to work or church. He never again went fishing with me. He never again came to watch my hockey or baseball games. 

As a young boy and later during my teenage years, I felt frustration, anger, and grief that nobody was able to help my dad. Religious explanations and solutions to Dad’s depression were insufficient, although friendships with members of our small Latter-day Saint branch in High River were a source of comfort and happiness to our family. The assistance Dad and Mom sought from psychiatric and psychological professionals also failed to cure him. Dad’s depression undermined my sense of worth and goodness and raised many difficult questions for me about religion and psychology. During my adolescent and high school years, I struggled academically, emotionally, and spiritually. I survived Dad’s absence by playing ice hockey and baseball and socializing with my friends, most of whom were not church members. 

I graduated from high school when I was 16, and later that fall, enrolled in biology, chemistry, and evolutionary theory classes at the University of Calgary. Atheistic assumptions pervaded the content of these classes. As the semester progressed, my doubts about God’s existence increased. My attendance at church and religious involvement declined. My interest in learning also declined, and class attendance became increasingly infrequent. Not surprisingly, my grades suffered (0.50 GPA).

After this disastrous semester, my older sister, Vicki, convinced me to transfer to Ricks College in Rexburg, Idaho. Leaving the country and starting over with a fresh start seemed like the best solution for my academic problems. Ricks College was a positive change for me in many ways. There wasn’t much to do in Rexburg besides attending classes and church, so my grades improved. I also made some Latter-day Saint friends; however, I continued to struggle with loneliness, low self-esteem, depression, and religious doubts. Dad was still struggling with severe depression, and I continued to feel his absence in my life.

Experiencing Divine Love

One cold February evening during my third semester at Ricks College, I left my apartment and walked to the east side of Rexburg to a snow-covered field where I could be alone to think and pray. I knew that I needed help if I was going to overcome my depression and feel better about myself. After I had prayed for about an hour and was about to give up, I was blessed with a beautiful, healing experience. I felt encircled by light, love, and comfort. Peace and joy flooded over me. It was powerful and unlike anything I’d ever experienced. I basked in the healing warmth of the light and love for about an hour, even though it was a cold winter night. I received a powerful assurance that God loved me, believed in my goodness, and that changing my life and doing His will more fully would bring me happiness and joy.

After this, I walked through the snowy streets of Rexburg back to my apartment. As I stepped through the door and closed it behind me, my returned missionary roommate, Fred, who was sitting on the couch in our small living room, glanced up at me. He looked surprised and said, “Scott, you had a special experience tonight, didn’t you?”

It was my turn to be surprised, and I said, “Yes, I did, Fred. How did you know?”

“I can see it in your countenance,” he said. “You’re radiating light and love. I can see it and feel it.”

My life changed after this experience. It didn’t happen overnight, but my depression gradually lifted, and I gained greater self-worth and faith in my own goodness and potential. My sense of life purpose and direction grew as the months passed. Turning to God and Christ and feeling their divine love, rather than abandoning my hope in their existence, strengthened me emotionally and spiritually and helped set me on a healthier path.

I like how Truman Madsen described the healing power of God’s love. It resonates with my experience on that cold winter night in Rexburg. 

Love is Fire. That is the great secret. It is Fire with a large F. It is Divine Fire. When it is in you it lights you, all of you. And transforms. No self-induced flicker can compare with it. . . [God’s] flame burns and encircles, reaching the self at its core, its spiritual center, and then moving outward to physical fingers and toes.

My Dad’s Survival and Eventual Recovery

After completing two years of college, I interrupted my studies to serve a mission for the Church in British Columbia, Canada. During my mission, I learned that Dad was beginning to recover from his depression. While I was still serving, he sent me a letter, told me about his progress, and shared his testimony of the Savior. 

It thrills me that after 2000 years, His birth is remembered and the story retold by so many people in so many different countries. I think that in itself is a testimony of His Divinity. No other life has had that impact upon the world. Aside from His greatest work as the Redeemer, He has also literally changed the secular history of the world. In closing, I would like to assure you that you do serve the Savior of the world. I received that testimony by the spirit many years ago and many different times. It was so strong that it stayed with me through all the bad years and helped to sustain me.

After I returned from my mission, Dad told me that his testimony kept him from committing suicide during the many years of his depression. He said, “I promised Heavenly Father and the Savior that I wouldn’t do it.” His testimony that God and Christ loved him kept him alive and made his eventual recovery possible. The medications and psychological counseling he experienced also helped Dad to some degree. He said the counseling helped him see that his perfectionistic thinking and unrealistically high expectations contributed to his feelings of inadequacy, discouragement, and depression. Dad said the counseling also helped him learn to be kinder and gentler to himself and to be more careful about his thinking patterns and self-talk.

Spiritual Experiences During My Mission

During my mission, I was blessed with additional experiences with God and Christ’s love. One of these experiences, which profoundly influenced my future career, occurred on an afternoon in late 1976. My companion and I were in our missionary apartment in North Vancouver and found ourselves with time between appointments to read. I noticed the Ensign magazine had published a talk Elder Neal A. Maxwell had given at BYU titled, Some Thoughts on the Gospel and the Behavioral Sciences. In the talk, Elder Maxwell encouraged Latter-day Saint behavioral scientists to “become more of a link and bridge between revealed truth and the world of scholarship.” As I read and reflected on Elder Maxwell’s words, I felt warmth and love flood over me. I received a strong impression and witness that I should go into psychology for my profession and seek to build bridges between the gospel and the behavioral sciences. This surprised me because, at the time, I had not been seeking guidance about my future career plans. However, the impression was strong and clarified counsel I had received in my patriarchal blessing at the age of 14 that I should “work in scientific fields” and do research work “for the good of the people.” 

Conflicts Between My Faith and Psychology

After completing my mission, I returned to Ricks College for one semester, married, and worked for a year to save money to continue my education. In September 1979, I started classes at Brigham Young University, majoring in psychology. I naively assumed that most faculty and students at BYU would share my interests in integrating gospel perspectives and values with psychology, but I was wrong. I quickly realized that many professors and students were reluctant to discuss the possible interface between psychology and religion. One professor and several students gave me hostile stares and silent treatment one day when I commented during class that deterministic views of behaviorism seemed to conflict with gospel teachings about moral agency. Another well-meaning professor encouraged me to drop my interest in integrating religion and psychology, saying, “There’s no future in it.” 

My first bishop at BYU, Jonathan M. Chamberlain, was a psychologist. One day, while talking with me and my friend, who was also majoring in psychology, Jonathan said, “Ours is a dangerous profession.” He then shared his views about the spiritual and moral challenges he anticipated we would face during our careers. I didn’t feel alarmed by his warning, not realizing how powerful the challenges would be during the next several decades.

Because of my dad’s mental illness and the things he shared with me about the mental health professionals who treated him, I already knew there was an anti-religious bias in mainstream psychology. Sigmund Freud, the father of modern-day psychiatry and clinical psychology, believed that Western civilization would be better off if it gave up its neurotic need for religious “illusions” and replaced them with “the rational operation of the intellect.” Other early psychology leaders, such as John B. Watson, B.F. Skinner, Albert Bandura, and Carl Rogers either ignored or portrayed religious beliefs and behaviors in pejorative ways. They, like Freud, placed their faith in atheistic naturalism, which assumes that the universe can be explained without any appeal to God or intelligent design. Atheistic naturalism also embraces other assumptions about reality that dramatically conflict with the theistic worldview and Latter-day Saint doctrine.

Not all prominent behavioral scientists had negative views of religion, of course. Some, such as William James, Carl Jung, Gordon Allport, and Victor Frankl, wrote openly and positively about religion. However, their writings did not significantly alter the anti-religious climate in mainstream psychology, which was still pervasive when I began my education at BYU. In 1979, in an interview published in the APA Monitor, Robert Hogan, a professor at Johns Hopkins University, vividly and accurately portrayed the zeitgeist of mainstream psychology at that time when he said: “Religion is the most important social force in the history of man. . . . But in psychology, anyone who gets involved in or tries to talk in an analytic, careful way about religion is immediately branded a meathead; a mystic; an intuitive, touchy-feely sort of moron.” 

But change was in the air. In early 1980, one of the world’s most prestigious psychology journals published an article titled Psychotherapy and Religious Values. The author, Allen E. Bergin, a professor at BYU and internationally renowned psychotherapy researcher, confronted mainstream psychologists’ anti-religious biases and asserted that theistic perspectives are needed in mainstream psychology. Allen’s article shocked many psychologists—inspired many others—and catalyzed an international movement to integrate spiritual perspectives into psychology and psychotherapy. As a student at BYU at the time, I found myself on the front lines of this movement. 

Building Bridges Between Religion and Psychology

Several months before the publication of his landmark article, Allen was a guest speaker in one of my classes and presented about it. I was thrilled that a professor of Allen’s stature had written such a courageous article. Shortly thereafter, I volunteered to work on his research team and assist with a meta-analysis literature review on religion and mental health. I also helped Allen with a data-based study about religion and mental health in several samples of BYU students. 

While a Ph.D. student at the University of Minnesota, I stayed in contact with Allen, who provided encouragement and support. When I encountered career-threatening religious bias from a professor in my doctoral program, Allen’s support was crucial. Although the biases were usually not overt, they were real, powerful, and at times threatening, especially for graduate students and early-career psychologists. On one occasion, Allen told me we needed to “establish a beachhead” so that future mental health professionals wouldn’t have to fight the same battles. And at times, it felt like we were fighting a war—a war over ideologies and power.

Challenging the assumptions and biases of atheistic naturalism, of course, did not involve a war with guns and bombs, but those fighting to create safety and intellectual space for theistic perspectives in mainstream psychology risked their degrees, jobs, grants, reputations, and careers. As a doctoral student, and after my graduation, I experienced prejudice and discrimination many times both because of my interest in integrating psychology and religion and because I was a Latter-day Saint. 

During my Ph.D. program, I also experienced a tragedy when my beloved mother was killed in a car accident. My grief about Mom’s death, combined with the anxiety and stress I was experiencing in my professional training, motivated me to seek psychotherapy to cope with my pain. Although I told my psychotherapist during the first session that I thought two or three months of therapy would be sufficient to solve my problems, I stayed in treatment for 18 months. During that time, I worked through my grief about Mom’s death, explored the pain I still felt over Dad’s absence during my adolescence, and found more profound healing in my relationship with him. I also talked about some of my religious doubts and unhealthy, perfectionistic ways of understanding and living my religion. My therapy experience strengthened my confidence that both psychology and religion have much to offer those who are struggling with emotional and spiritual difficulties. 

Despite the professional and personal challenges I experienced during my Ph.D. program, I graduated with my Ph.D. in 1988 and was offered a faculty position at Central Washington University. Two years later, I accepted a position at BYU. During the 1990s, Allen and I wrote and edited some articles and books about spirituality, mental health, and psychotherapy. Our research, and the research of many colleagues worldwide during the past few decades, has provided overwhelming support for the mental health benefits of religious commitment and spiritual practices. Devoutly religious people of virtually all faith traditions tend to enjoy better psychological well-being and life satisfaction. In addition, during stressful times, people who engage in religious coping (e.g., praying, meditating, reading scriptures) tend to adjust better to crises and problems. People who turn to God for help in coping with stress also have lower levels of anxiety and depression.

The Healing Power of Divine Love

After Allen’s retirement, I collaborated more with two of my private practitioner colleagues, Michael Berrett and Randy Hardman. We specialized in treating women who were struggling with eating disorders, and we conducted research studies in our effort to understand better how faith and spirituality could help in treatment and recovery. Our research and clinical work revealed that most of our patients lost their sense of spiritual connection with God during the development of their eating disorder illness, even when that relationship had once been meaningful.

We found that during treatment, as patients re-established connections with God, they regained a positive spiritual identity, seeing themselves as creations of God with divine worth. They began to see God as loving and forgiving and rediscovered how to trust and interpret their spiritual intuitions and impressions. They also learned to give and receive love and experienced renewed purpose and meaning. They transitioned from external, materialistic measures of self-esteem (e.g., thinness) to valuing and living by internal spiritual principles (e.g., honesty, courage). Many sought and regained social support within their religious community after they completed inpatient treatment. 

In one of our qualitative research studies, our patients told us how important their relationship with God was in their treatment and recovery and offered insights into how God’s love and the love of others helped them. Below are a few of their comments:

Having a relationship with God has changed my outlook on life. God wants me to be happy. I know that He loves me unconditionally. I have found out who I am and that I am of great worth.

There’s no way I would be where I am today without help from God. I honestly was so sick and confused and lost, and there’s just no way I could’ve picked myself up. I believe spirituality has given me added strength and insight I otherwise would not have had. It has also helped me to be more aware of the needs of others. Serving others has really furthered my recovery.

God has helped me directly by introducing very special people into my life when I needed them. These people helped me with their love, support, friendships, and examples. It was divinely orchestrated. He has introduced thoughts and ideas to me, letting me know He is there and cares.

God has always been there for me—I just shut and locked the door during my eating disorder. As I started treatment, when I still wouldn’t let Him in, God sent other people to help me heal. He provided me with my family and the staff at the treatment center. As I started to let them in—their love and support—I could see glimpses of God’s love for me. When I was ready and let Him in, He welcomed me. He pulled me from my own hell. I have no doubt now that He is very personally aware of and active in my life.

Divine Love as My Lodestar

In addition to the experiences I shared earlier, I have been blessed with many more experiences when I have felt God and Christ’s love for me. Some of my experiences with their love occurred when I was in church, some when I was in the temple, some when I was kneeling in prayer, some when I was serving others, and some when I was out in nature. Often, I was praying and pondering when I felt their love. I also felt their love through other people’s caring expressions and actions. I have also felt God and Christ’s providential care, protection, and inspiration—additional manifestations of their love. If we desire it and seek to live close to them, I believe we can feel God and Christ’s love often—and most importantly—during our times of greatest difficulty and need.

Steve Young recently shared many important insights about love in his books, “The Law of Love” and “The Law of Love in Action.” Like Steve, I have found that love—God and Christ’s love and the love of those seeking to emulate Jesus Christ’s love—has been the foundation of my faith and helped me endure and grow from the challenges in my spiritual journey. Steve wrote:

With the law of love as my guiding light, my steely foundation of faith, I can stare into the enormity of human foibles. From polygamy, racism, difficult issues in Church history, sexism, queerphobia, to anything else that can destabilize my relationship to the institutional Church, I can stare at it, chew on it, and own it. I can find the grace to manage through it without flinching. It can be devastatingly heavy and painful, but I can go back to the fundamental message of the Restoration, which is this: every single person on earth has a divine heritage from loving Heavenly Parents who knew us before. They have a plan for our growth on this earth; and Christ came to heal us and save us. 

Divine love—the love of God and Jesus and the Christlike love of others—has been my lodestar and helped sustain my faith during painful and difficult life experiences. When I experienced severe illnesses and untimely deaths of family and friends, divine love comforted me in my grief and brought me hope for eventual healing and joyful reunions. When I encountered conflicts between my personal beliefs and church doctrines, policies, and history, divine love motivated me to seek understanding by searching the scriptures, the writings of modern prophets, and other faith-promoting writings, including those by scholars and researchers. When I experienced misuse of religious authority by clergy and professional jealousy, dishonesty, and backstabbing by Latter-day Saint colleagues, divine love motivated me to leave judgment to God and to forgive those who offended me. When I experienced the pain of family members and friends no longer fitting into the Latter-day Saint “ideal” (e.g., choosing divorce, choosing a different lifestyle, revoking church membership), divine love motivated me to continue loving them without reservation or judgment, and helped my love for them grow even stronger. When I recognized my pride, weaknesses, and sin, divine love motivated me to humble myself, repent, and express gratitude for the miracle of forgiveness made possible by the incomprehensible atonement of Jesus Christ. 

After over four decades of research about religion and mental health and my lived experiences with religion in all of its complexity and contradictions, I believe that God and Christ’s love are beautiful, amazing realities. Turning to God and Christ with hope and faith can comfort, strengthen, and heal us emotionally and spiritually. Although I don’t “know the meaning of all things” and still have many unanswered questions, I have a testimony “that [God] loveth his children.” I have experienced that love and agree with Nephi and the angel that it is “the most desirable above all things” and “the most joyous to the soul.”

The post From Darkness to Light: The Healing Power of Divine Love appeared first on Public Square Magazine.

What can we learn from people who find sustainable healing from depression?  This has been a question burning under my fingernails ever since learning about a remarkable researcher named Kelly Turner.  

Dr. Kelly Turner noticed something usual in her early studies at the University of California at Berkeley. Across the 1,000+ known cases of “spontaneous” or “radical” remission from cancer (where someone finds lasting healing after being told by their doctor that they were going to die), very few questions were typically asked of the survivors themselves. So, she set about doing just that—conducting interviews with initially just 20 people and ultimately gathering many hundreds of stories all around the world.   

Her findings are summarized in the bestseller, Radical Remission: Surviving Cancer Against All Odds, now translated into 22 languages—along with Radical Hope: 10 Key Healing Factors from Exceptional Survivors of Cancer & Other Diseases. Dr. Turner’s work has been an inspiration to many families facing cancer—and a reminder to the rest of us not to overlook important things that can be learned from especially encouraging cases.  

Fixated on the hardest realities. If you’ve ever studied the history of psychology, you can appreciate how much the entire mental health field could benefit from this kind of reminder. Even those who love psychology know it’s had a fixation on lurid and worst-case scenarios for a long time. That’s precisely why positive psychology (ala Martin Seligman, Barbara Fredrickson, Ed Diener, and many others) has also been so refreshing. 

Even so, this focus on the negative has been so captivating for so long that it’s common to find mental health professionals who are convinced that no healing from depression (or other mental health conditions) is even possible. “People don’t get better from this,” one doctor told me once. So convinced are some about the impossibility of healing that when they hear a story of someone claiming to have experienced healing, their first inclination is to doubt that they ever experienced (real) depression in the first place.  

This is partly what has motivated me to take a similar approach as Dr. Turner, but applied to the surprising numbers of depression healing stories out there. For many years now, I’ve been gathering accounts of deep or lasting healing from depression, anxiety, and other mental health conditions. Some are people I’ve interviewed; others are individuals who have published memoirs, blog accounts, or videos on Youtube. So many of these stories are profoundly inspiring. I used to collect basketball and baseball cards—now I collect stories of profound and beautiful healing. 

So, what can be learned by looking across these many personal stories of deeper emotional healing? In what follows, I will act as a “tour guide” as we walk through some of the most interesting patterns arising in an analysis of nearly 80 stories of people sharing about their own experience finding deep and lasting healing from serious cases of depression. This research was funded and made possible by Impact Suite and Malouf—which developed the Lift app for depression and anxiety.  I presented a small summary of these findings in a 2022 Liahona article entitled “New Hope for Deeper Healing from Depression and Anxiety.” 

The extent of deep and profound pain. Fair warning: some of these stories may be surprising to hear and, in some cases, challenging to ideas held by many (including the belief that true depression is inherently chronic). For that reason, I begin this introduction by giving you a glimpse of what people say about their own initial experience of profound pain, followed by a glimpse of the eventual happiness they speak of finding. The reality of the agony faced by narrators of the stories included in this analysis was real (and don’t forget, these are the same people who eventually found deeper, more sustainable emotional healing):  

• “I had been fighting with severe clinical depression; it robbed me of my life, of enjoying my husband and children.” (2)
• “For ten months, I was assailed by out-of-control anxiety attacks which alternated with dark, suicidal depressions. Each day felt like an eternity as I struggled to stay alive in the face of overwhelming feelings of hopelessness and despair. … Having run out of options, I felt as if I were trapped in a dark tunnel in which both ends were sealed off, and a sign on the door read, ‘No Exit.’” (4)  
• “The sky turned threatening. Bleak, dark, so dark. Empty. No motivation. Wanting badly to surrender, retreat—from life, from people, from work, from responsibility. I never imagined that there could be emotional and psychological pain so overwhelming it made me desperate for relief. I could and do understand how many people turn to various kinds of escape … Some days, I was gasping for breath and hoping not to drown.” (6)
• “I can hardly eat, sleep, or think straight. The only thing I can do is cry unending tears.” After the birth of her first child, her husband discovered her in the backyard, “clawing the earth furiously with my bare hands, intent on digging a grave so that I could bury myself alive.” (40) 
• “Grief and sadness clung to me like it was part of my own flesh.” (42)
• “I was in hell.”  During 26 months of hospitalization, this woman was, for a considerable part of this time, “one of the most disturbed patients in the hospital.” (43)
• “Days passed with me in bed, overwhelmed by a sensation of falling, spiraling, and spinning into a pitch-black tunnel day after bleak day. … It felt as though every nerve in my body was popping. Imagine large strong hands slowly applying pressure while breaking a family-size package of uncooked, dry spaghetti. I was the spaghetti.” (47)
• One woman’s depression felt so severe that she felt it might “vaporize her into millions of tiny molecules.” (66) 
• “I was struggling with grief and bereavement when my husband unexpectedly ended our thirteen-year relationship. I was devastated, suicidal, and felt completely alone. I had severe anxiety, waking up every morning with horrible dreams and panic attacks. I was also constantly crying, unfocused, and had no appetite.” (77)
• “I just want the pain to stop … Let’s just say if a car were coming towards me, I wouldn’t scream, I wouldn’t cry, I wouldn’t run, I would just stand there.” (94)
• “When I got depressed or anxious, I used to feel like a dark curtain was being drawn over my brain. It seemed almost physical.” This man remembers praying, “God, please help me make my mind stop torturing me,” and how a new day felt, “The alarm goes off, or you are probably awake before it even rings. A new day, and it is nanoseconds before you feel that dread in your stomach, that fear of what the day will bring. I’ve had these mornings in abundance.  I know that feeling like I know that water gets wet.” (96) 
• One man’s wife recounted in an interview with the couple, “Something was different. I saw him on the floor, and I knew it was depression.” She went on to describe “5 years of really, really dark depression,”—recollecting that during these years, “he suffered greatly, and had multiple symptoms of depression, including daily suicidal thoughts. He was in a deep darkness.” (108)
• “The sky turned threatening. It was bleak, dark, so dark. Empty. I had no motivation.”

In addition to the sheer intensity of their prior experience with depression, many of these people suffered for many years, even “decades of unrelenting depression.” The instigators and contributors to this agony are widely varied, with people speaking about a wide variety of circumstances—from brutal and intense trauma (trafficked at 7 years old) to current circumstances influencing their emotional burden (painful health challenges, etc.). There is so much more to the painful backdrops that couldn’t be included, but one woman’s story illustrates the complexity well: 

“I was an empty shell … thirty years old and ready to die. I didn’t know who I was. I had been drinking since I was thirteen and drugging since I was sixteen. I had my first death wish at age twelve and tried to kill myself, but I was too scared to jump off the pier. I sat on that pier half the night, crying and praying for an end to my miserable life. I tried again when I was fifteen. That time I took seventeen downers, wrote half a dozen good-bye notes and was astonished to wake up the next day and find that it hadn’t worked. I was supposed to be dead! … The hopelessness of that moment still tugs at my heart. … My third and most serious suicide attempt was at age twenty-four. My drug-addicted husband had beaten me for the hundredth time—punching me and kicking me until I was half-senseless. My two babies were sleeping peacefully in their cribs. I went into my bedroom and swallowed the remainder of my new tranquilizer prescription—about twenty-four pills. I woke up in the intensive care unit three days later. … I withdrew into myself even more than before. … Only with daily use of marijuana and beer could I function at all.”

“I went in and out of depression for the next six years and the thought of suicide never left me. I hated myself so much. Eventually, I just hung on for my babies who were getting bigger every year. I felt that I would live until they could fend for themselves, and then I would kill myself and get it over with once and for all. I was so sick and out of touch that I thought my children would be able to handle losing their mother to suicide when they reached ages six and seven. … I spent some of the time on the bathroom floor, begging God to help me, asking why God wouldn’t help me. But most of the time I was in bed with the pillows and the covers over my head alternately sleeping and crying. I had reached that awful impasse of being too afraid to live and too afraid to die. Having tried everything to help myself, and having failed, I had reached the bottom. I was thirty years old, and I had wasted my life.” (12)

This same woman later spoke of how well she was, including how she had “recently graduated from the State University with honors,” and that she was “currently in graduate school,” with a “goal is to be a therapist.” (12) It’s this contrast between before and after which is so striking—and which makes these narratives so exciting to study. 

The possibility of deepening healing. Every story included in this analysis was selected based on two fundamental criteria: (1) as evident above, clear indicators of real and serious depression (not just a few bad days), and (2) equally clear indicators of having experienced some degree of deep and lasting healing [numbers in parenthesis correspond to the participant # in the study]. See for yourself the kind of peace and healing people in this review found:  

• “It was as if a heavy curtain was drawn back from the window of my soul, and I could see my true self in the light for the very first time. For the first time in my life, I felt settled, calm, and peaceful.” (46) 
• “Today is my birthday, and it’s the first birthday in a long time that I truly felt like celebrating. I now have a life that I love, and wake up grateful for it every day. … Today, my life is amazing. It’s not just an improvement over my old life but rather a completely new universe. I don’t really know how to explain it; I never knew that life could be like this! Life is easy and enjoyable; it’s not a daily struggle to convince myself to get out of bed and get myself motivated to do simple tasks. I will catch myself smiling or singing for no reason. I’ve laughed and danced more in the last month than I have in the last 10 years combined. I am so excited to be alive. I didn’t even know that it was possible to feel this much joy and contentment. What’s wild is that I know my body is still healing, so things are just going to get better!” (51)
• “It’s hard to put into words what coming out of depression feels like. All I know is that I feel right now in a way that I thought I’d never be able to again.” (65) 
• “I am totally healed from depression. I have never struggled with depression for over two decades now. I’ve gone through some hard times since then, some really difficult times. I’ve felt sadness and anger at times. Those are temporary emotions, so [they are] very different from soul-killing depression. I have learned how to be healed from depression. When the blackness of depression creeps anywhere close to me, I now know how to fight it and win … really win … not just push it down, put on a happy face and act like everything is okay.  I’ve learned how to actually be profoundly happy, content, and at peace deep in my soul. Yes, it is really true. I’m not faking it.  I am healed.  I believe that everyone is capable of being healed from depression as well.” (69)
• “I have no depression in my life whatsoever — literally none. I have sadness, and joy, and elation, and satisfaction, and gratitude beyond belief. But all of it is weather, and it just spins around the planet. It doesn’t sit on me long enough to kill me. It’s just ideas.” (73)
• “Now, thankfully, I don’t get depressed.” (78) 
• “I was completely healed—totally free of all those things.” (101)
• “Life has never been this good before—I enjoy my life and feel peace.” (102)  
• “My life is now full of purpose, I appreciate things more, and I am much happier than I ever was. I’m in a good place right now.”

To be clear, these are not intended as pre-post outcome measures since they are not presented here as before-after glimpses from the same stories. Rather, I’m referencing here especially notable examples from different stories to paint a picture of how vivid the shift has been in these people’s lives—which is a characteristic of all of these stories. This is especially evident in the contrast within individual stories, for instance: 

• One man described his life as starting with a “seemingly endless sea of pain, fear, rage, guilt, grief, and loneliness.” => But he eventually describes coming to “live a life of deep peace and boundless joy.” (44)
• Another individual said, “I was so depressed that I could hardly motivate myself to do anything” [telling loved ones] how horrible I felt and how hopeless everything seemed,” adding that “they were so afraid that I may try and hurt myself.” => “About four months ago, I remember telling friends that I felt ‘normal.’ Not manically happy or incredibly depressed, but content. I told them that I don’t think I had ever felt that way before. The feeling hasn’t left. I have now been off of all my psychiatric medications for two months. My job is going great, and I feel blessed.” (71)
• A third said, “Suicide was never an option for me, but I thought about it and fought against those thoughts for years. In the meantime, I had my good days along with the not-so-good ones. The last 5 years got worse and worse. I finally gave in to the fact that I would end up feeling tethered to a life I hated every day of. … I may never like life again, and this must be what enduring to the end means. I never thought I would like life or enjoy any of it again. I never thought the words I love life would ever come out of my mouth from an automatic thought” => “I can’t sit back and hold this in any longer. People need to know! Depression and anxiety do not need to be a lifelong sentence of misery! Healing—it is possible! I am living proof!!” (109)

A healing work in progress. To be clear, while some of these people talk about their healing as completed and finished, others speak of a degree of substantial healing they are still seeking: 

• “I pray for healing. Mine has reached a point that, at one time, I would not have thought possible, considering where my long journey started.” (36)
• “I do struggle from time to time … and have learned to be patient. I do believe I will be completely healed from ALL mental health issues.” (102)  

Among those still seeking deeper healing, however, they still speak of the state they are in as new and different:

• “As I changed my life in this way, my depression and anxiety have massively reduced. It isn’t a straight line. I still have bad days—because of personal challenges and because I still live in a culture where all the forces we’ve been talking about are running rampant. But I no longer feel pain leaking out of my brain uncontrollably. That’s gone.” (21)
• “Life has not become less demanding, but it cannot harm me as much anymore—and this makes all the difference.” (46)
• Describing his difficult moments, one man insists that this is “not an experience of depression. I had that for years, but now, when the rain comes, it rains, but it doesn’t stay. It doesn’t stay long enough to immerse me and drown me anymore.” (73)  
• “I’m a very happy person now. … I still have ups and downs, of course, but I think no more than anyone else.” (43)

For a condition where relapse is common, the people I studied often point out they are not relapsing anymore. Yet as you can see, this state of deeper healing should not be idealized or overstated either. Every one of these people acknowledges some hard moments and times. But consistently across participants, these times are also qualitatively different than where they were before. 

As you can see, not everyone who speaks about deeper healing talks the same. Some describe depression as something in the past, while others still refer to it as a condition they are “living well” with in their life. As one man said, “Depression doesn’t define me; it isn’t my identity; it just describes my personal odyssey. … We live with depression as a temporary mortal companion, with healing underway already in mortality.” (6) 

Even if complete healing remains a journey, every one of the people reviewed here described having found deeper and more sustainable healing. And there was a sense of confidence, hope and joy in pursuing even more. “I’ve always been fascinated by the few souls I’ve met through my life who seemed to be truly happy,” wrote one person. This person continued:

Even when their life was in a shamble, their smile was genuine, and light beamed from within them. Have you ever met people like that? If you have, you’ll never forget them. Even if you forget their name, their face will always linger in your mind when you think of what happiness is. (26)

After recounting his journey of recovery, another person said, “I had no idea I could ever be that happy.” (25)

In summary, participants needed to show some clear evidence of having suffered from real depression and found some degree of real and lasting healing. Any sign of chronic, enduring disorder was the main exclusion criteria; if that was spotted, they were not included in the review.  

The variety of stories gathered. All this is important foreground to the project being reported here—a project that will be ongoing as I collect more narratives of healing from depression and anxiety. (Although anxiety often figures prominently alongside and interwoven in many depression narratives, stories that center explicitly or exclusively around anxiety will be reported separately in a future analysis. Although most experiences here reflected unipolar depression, there were a few cases of bipolar depression in this review as well).

Naturally, the stories gathered vary a great deal. Some of these accounts are more plainly autobiographical and largely centered on sharing raw experiences, while others are interwoven with life lessons and advice to other sufferers. Sometimes they are shorter, and sometimes longer—with a whole library of beautiful memoirs that I’ve been able to gather and review.  

This points to one of the central limitations of the project. Ideally, each and every person could have been interviewed personally, so they would all field the same questions. I did these kinds of interviews with approximately 20 people—but the rest of the stories were gathered through a variety of other means. Practically speaking, that means I can only know what I can know from what they opt to publish—with areas that remain out of reach. That makes any kind of more standardized, statistical assessment at this point impossible.  

This sampling approach also disallows other questions that could clear up the relative influence of certain factors in someone’s recovery. As it stands, I was often left to evaluate independently whether something that took place in their story of recovery pertained to that healing—or was a fruit and manifestation of that healing.  

All this is to say, none of what I share will be convincing empirically to those wholly doubtful of the possibility of deeper kinds of emotional healing from even serious depression. Yet my central goal is not to persuade people through data like a conventional study. Rather, my aim is to illustrate what the pathway of deeper, more lasting, and sustainable healing actually looks like in real color and detail, based on the experiences of those who have actually found it.  

To those still doubtful, I would add that virtually every one of the individual themes described below has been confirmed in plenty of other empirical research (see my own reviews here and here).

On a personal level, reading the stories of these people has been thrilling and exhilarating—touching beyond belief at times. Special thanks to Christian Lippert and Debbie Lathrop for assisting in the review of these memoirs. And I’d also like to express appreciation to the many people who agreed to interviews and who continue to share their stories with me as part of this project.  

What I am sharing in what follows is approximately 120 pages of analysis based on lessons and insights from across 77 stories. What you will be hearing in these reports is my best attempt to paint a picture—a word mural of sorts—of the major patterns I’m seeing in these stories so far, including

1. Retaining Hope in the Possibility of Deeper Healing. Consistently across stories, you witness a central role for some kind of hope that anything can be fundamentally different—with recurring evidence at how that influences the progress people make emotionally. This raises important questions about the increasingly common professional judgments about depression as an intrinsically chronic disability.
2. Learning and Changing as a Catalyst for Emotional Healing. Learning and growing in different ways also appears to make a significant difference in deeper emotional healing. That includes changing inside and in the details of our external life habits. Here, we explore what participants say about the “Big Three” of nutrition, exercise, and sleep—as well as the basic elements of schedule and financial order.
3. The Many Varieties of Internal Work as a Catalyst for Emotional Healing. Of equal importance to the many kinds of external lifestyle adjustments is the wide scope of internal shifts that take place for people who find deeper healing. These include the less noticeable “Big Three” of mental diet, mental activity, and mental rest, along with that surprisingly challenging ability to be present in different life situations, including the painful ones. Learning to work with thoughts and emotions differently also appears to make a substantial difference for healing.
4. Relationships That Heal & Healing Relationships. If not already a well-established classic observation, it’s become almost cliché to acknowledge the centrality of relationships in human health, both physically and emotionally. That’s clear in this analysis as well.  By “relationships,” of course, we’re referring to the healthy and nurturing kind. Traumatizing and abusive relationships can set anyone back emotionally, and navigating away from toxic connections and through the residue of past trauma was clearly demonstrated again to be crucial for deeper healing from depression.
5. Higher Connection and Deeper Healing. Since most of these other patterns identified here are commonly discussed by mental health professionals, the salience of spirituality in people’s healing stories has been the stand-out surprise of the study so far. Although I’m a person of faith myself, I’m not accustomed to seeing priority attention to God within modern mental health discussions. But over and over, people who had found deeper and more lasting healing describe profoundly transcendent experiences that shifted how they related to God and life as a whole—moments they repeatedly described as consequential to their healing journey. Among other things, these people described no longer feeling alone—and, indeed, feeling precious, loved, and guided in a life they newly experienced as profoundly meaningful and purposive.
6. Increasing Emotional Freedom, Reducing Long-term Dependence. We all know illegal drugs and alcohol can have a devastating impact on people’s emotional health, especially when long-term dependence arises. That’s not controversial in the least. But we have been encouraged to see a reliance on legally prescribed psycho-active medications differently, and for good reason. Many of these prescriptions have proven helpful to people in coping and managing in the short term. What’s clear in many other long-term accounts, however, is that a path of cautious and gentle tapering off antidepressants can be a helpful catalyst to deeper emotional healing. That’s something I’ve observed in interviews for many years, and it came up again clearly and consistently in this review of accounts. Although this topic has received growing attention among researchers, it has received far less attention among the general public.

I finish this exploration of themes with some concluding thoughts about broader patterns and takeaways, however preliminary. By definition, my attempt will be incomplete since each of these people has a profoundly rich experience that even a biography-sized volume wouldn’t quite tap. And once again, I’m necessarily only drawing on the portion of their experiences that I was able to see. In some cases, direct quotes have been edited for readability (in other cases, italics are added to part of a text for emphasis).   

That’s partly why I’m presenting this as a snapshot of what I’ve been able to review and learn so far, rather than something final and definitive. My goal is to continue gathering more stories. Of this writing, I have a number of additional stories to add to this growing analysis, which I hope to update over time. Please send more stories my way—or any feedback or interest in collaboration as well (jzhess@gmail.com). 

I especially hope what follows will be encouraging to anyone currently grappling with the heavy weight of depression—and to those who love them. You deserve more hope and happiness than you have likely found to this point. I believe that with all my heart. And I’m convinced that God wants to lead those earnestly seeking to follow His ways to deeper healing much faster than you know.  I hope some of what I share here will persuade you of the same and that you will begin to find healing miracles in the new year ahead.   

The post Patterns in Stories of Lasting Healing from Depression  appeared first on Public Square Magazine.

This is the second essay in a new series exploring important questions raised by the worsening mental health crisis in America—with a focus on different ways to creatively support those seeking to move towards deeper emotional healing. (For part one, see “Hope Sometimes Hurts. Hopelessness Hurts More.”)

Several years ago, I taught a Mindfulness-based Stress Reduction class to teenagers whom we had randomly assigned to take the class or be on a waitlist for later.  Following the 8-week mindfulness course, teens consistently showed measurable decreases in both depression and anxiety symptoms compared to those in the control group.  

Except for one girl—who had been diligent in doing all the mindfulness practices, but without any apparent relief to her depressive symptoms. In a follow-up interview, the only differentiating factor I could find was that she was on year two of an antidepressant. 

One year later, in collaboration with exercise trainer, Jake Asay, we conducted another experiment—this time trying to replicate an international 10-week group exercise program that had been shown to be impactful for people grappling with depression in England (so much so that overseas physicians would often “prescribe” the exercise program to their patients with mild to moderate depression). Once again, we found participants generally experiencing measurable improvements emotionally—including reductions in depression symptoms. 

Except for one older woman—who had worked hard to be consistent on all the exercises. Yet despite her diligence, she reported little to no improvement in her depression symptoms. 

Why? Once more, the most prominent factor differentiating her from the rest of the group was that she had been on antidepressants for a number of years.   

These are, of course, only anecdotes—with more definitive answers dependent on more rigorous research studies, which is precisely the purpose of this essay.  I begin here to illustrate why this specific question has been of such interest to me:  Are there times when antidepressant treatment that continues for years can get in the way of other opportunities to stimulate deeper emotional healing? 

This would be a good place to remind readers that none of what follows constitutes individual medical advice. I write here as a researcher and mental health educator seeking to raise some additional information to inform our larger public discussion about these painful emotional struggles that overwhelm so many wonderful people. And what is right for your own healing is best discerned in consultation with those you trust the most, including family members and good professionals—ultimately following your own deepest intuition and spiritual guidance.

These are deeply sensitive questions that have profound implications for so many lives. I write with great respect and love for the many individuals and families who have spent years, even decades, navigating complicated emotional health questions.

It’s also worth remembering that a wide range of factors can become barriers to emotional healing—including chronic stress, certain physical health conditions, and past trauma. In our mental health conversations, possible inadvertent, iatrogenic effects coming from trusted treatment options are rarely something you hear considered directly and openly. 

In the spirit of leaving “no stone unturned” in our widening mental health epidemic, I’m encouraging here some greater attention to this possibility—with all the appropriate sensitivity and care for ways in which antidepressants have been helpful and continue to be helpful to many.  

Appreciating short-term benefits without forgetting the longer-term picture. Like you, I have known and spoken with many who have found antidepressants beneficial at different times of their life. For someone grappling with the aching, agonizing emotional burden of depression, any kind of relief can be huge.

That’s why the language in my recent mental health article for the Church of Jesus Christ’s Liahona magazine has been updated to more explicitly mention “qualified medical professionals offering medication” in a list of “additional help from a variety of outside supports” that people may turn to as needed—and why I further acknowledged that “when used appropriately, outside resources can support us as we seek deeper healing.”

It’s true that this kind of shorter-term support can be a help to many as they seek deeper healing. But will these medical interventions lead them to deeper, more sustainable healing?  

That’s a very different question—and one I’ve focused much of my career trying to explore.  Based on everything I’ve seen and learned, I’m admittedly concerned that we’ve been so focused on the initial relief these therapeutic tools can provide that we’ve paid much less attention to what happens next—after the potent effects of those initial weeks and months shift into something else.

Most of the broader research literature focuses on these same initial effects and shorter-term outcomes (ranging from several weeks to a few months at most). It’s that research that the FDA and other regulatory bodies have leaned upon to reach their conclusions and approve antidepressants and other psychiatric medications.

Although the average length of these controlled studies is about 2 months, clearly patients are taking antidepressants at much longer durations. In a 2018 analysis of federal data conducted by the New York Times, they found:

• Nearly 25 million adults had been on antidepressants for at least two years, a 60 percent increase since 2010.
• Another 15.5 million Americans had been taking antidepressants for at least five years, which had doubled since 2010, and more than tripled since 2000.

In the report, Dr. Mark Olfson, a professor of psychiatry at Columbia University, said “What you see is the number of long-term users just piling up year after year.”

Given the steep increases in depression and anxiety during the pandemic, there has been a corresponding global spike in usage of antidepressants and other psychiatric medications—no doubt, increasing these long-term trends further. While this may be understandable as an attempt to cope and manage through difficult situations, what do these larger trends mean for people’s emotional healing over time?

In the months ahead, I’ll be releasing a lot more data from my narrative-based sustainable healing research project. But it’s these other larger scale statistical studies that we should pay attention to first. So, what do these more rigorous long-term studies say—especially those examining the outcomes with people on (and off) antidepressant treatment across years?

The available evidence base on that question has received remarkably little attention. Not by doctors. Not by families. And not by patients. 

I believe that’s a significant problem. Remarkably enough, this longer-term evidence is not formally taken into account in either our U.S. drug approval process or “best practice” guides created to guide medical practice. Despite previous proposals to make such studies mandatory, no current FDA stipulations require long-term evaluations for any ongoing regularly approval process of psychiatric treatments.

That’s what has motivated my interest in reviewing the available studies looking at “downstream” results—and doing more to bring them to public attention, so that both distressed individuals and the family and professionals supporting them could benefit from what they suggest. It can be discouraging to continue to feel worse, even when you are working hard to be compliant in treatment. These insight below have often been encouraging for people to learn about as they consider next steps in their own journey to deeper emotional healing.   

Scientific evidence regarding long-term trajectories of treatment. The list below comprises all the long-term studies of antidepressant outcomes of which I’m aware— specifically, those with rigorous measures of well-being years into antidepressant treatment (I welcome anyone else bringing additional studies to light). 

I give credit to award-winning journalist Robert Whitaker for introducing me and so many others to this long-term literature. I have interviewed Bob twice and found him to be a man of great integrity and unusual humility—which is why I believe so many scholars and medical doctors, including at institutions like Harvard and Yale, have welcomed him for academic presentations and grand rounds visits with medical staff.

The remainder of this paper aims to translate this long-term literature for a broader audience. In doing so, many of Whitaker’s own analyses are provided verbatim, with adjustments for brevity—along with summaries of his graphics and statistics. The relevant studies are clustered into two groups: (I) examinations of the long-term trajectory of those staying on antidepressants and (II) investigations more directly comparing those on (and off) antidepressants over the same time span. The studies are listed chronologically in each section, with hyperlinks provided to the original studies so you can read more if you’d like.   

I. Long-term trajectory of those staying on antidepressants.

1. 1973 — a 4-6 year follow-up of 94 depressed patients. Van Scheyen, J. (1973). Recurrent vital depression. Psychiatry, Neurologia, Neurochirugia, 76, 93-112.

J.D. Van Scheyen, a Dutch psychiatrist, reviewed follow-up data for nearly 100 patients and concluded based on that and his review of the existing literature that “it was evident, particularly in the female patients, that more systematic long-term antidepressant medication, with or without ECT [electroconvulsive therapy], exerts a paradoxical effect on the recurrent nature of the vital depression. In other words, this therapeutic approach was associated with an increase in recurrent rate and a decrease in cycle duration.”

The researcher also summarized, “more systematic treatment with antidepressants was associated in a relatively large number of patients with an increase rather than a decrease in the rate of recurrence.” While the antidepressants participants took in this study were tricyclic antidepressants (Tryptizol, Tofranil, Noveril)—well-known now to have more side effects, they are still used today, not infrequently.  

As Dr. Scheyen notes in the paper, other psychiatrists had observed that antidepressants were causing a “chronification” of the disease. He went on to acknowledge other researchers’ concerns that “continued antidepressant medication” can lead to an increase in emotional volatility and potentially, therefore, cause “a pharmacogenically determined change to a more chronic course.” Dr. Scheyen then asked, “Should [this increase] be regarded as an untoward long-term side effect of treatment with tricyclic antidepressants?”

2. 1992 — an 18-month follow-up comparison of depression symptoms.  Shea, M. et al. (1992) Course of depressive symptoms over follow up. Findings from the National Institute of Mental Health Treatment of Depression Research Program. Archives of General Psychiatry, 49, 782-787.

In this NIMH study which compared four types of treatment (two forms of psychotherapy, an antidepressant, and placebo), the group that was initially treated with the antidepressant had the lowest stay-well rate by the end of the study (19%)—and the highest relapse rate (50%). If study dropouts were included in the analysis, then the results for the antidepressant patients “look even worse … patients receiving the antidepressant were most likely to seek treatment following termination, produced the highest probability of relapse, and exhibited the fewest weeks of reduced or minimal symptoms during the follow-up period.”

3. 1998 — a one-year follow-up of 98 people. Rost, K., Zhang, M., Fortney, J., et al. (1998). Persistent poor outcomes of undetected major depression in primary care: implications for intervention. General Hospital Psychiatry, 20, 12-20.

This study used statewide telephone screening to identify and follow 98 adults with current major depression who made one or more visits to a primary care physician during the previous 6 months.  Patients in general practice receiving standard antidepressant treatment (in accordance with practice guidelines for maintenance over time) had higher rates of relapse than those receiving no medical intervention.  

4. 1986 — a two-year follow-up of depressed patients. Blackburn, I. M., Eunson, K., & St Bishop, S. (1986). A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy, and a combination of both. Journal of Affective Disorders, 10, 67-75.

This research team likewise found that significantly more patients in the group given anti-depressants alone relapsed at both 6-month and 2-year time points when compared to psychotherapy. As they summarize, “There were significantly more relapses at 6 months in the pharmacotherapy group compared to the combined treatment group and the 2 cognitive therapy groups together. The number of individuals who relapsed at some point over the 2 years was significantly higher in the pharmacotherapy group than in either of the cognitive therapy groups.”

5. 2000 – 96 patients followed up to 12 years.  Judd, L.  (2000). Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? American Journal of Psychiatry 1501-4. Two-thirds of all unipolar depressed patients either do not respond to initial treatment with an antidepressant or only partially respond, and these patients fared poorly over the long-term. NIMH-funded investigators reported in this study that “[medical] resolution of major depressive episode with residual subthreshold depressive symptoms, even the first lifetime episode, appears to be the first step of a more severe, relapsing, and chronic future course.”

6. 2004 — a one-year NIMH follow-up of 118 people. Rush, J., (2004). One-year clinical outcomes of depressed public sector outpatients. Biological Psychiatry 56: 46-53.

126 patients originally treated with antidepressants were given emotional and clinical support “specifically designed to maximize clinical outcomes.” 26% responded to antidepressants (defined as a 50% reduction in symptoms), with half of those who responded (13%) staying better for a significant period of time. At the one-year mark, however, only 5-6% of treated patients remained in remission and doing well, which is a much lower remission rate than is typically found in studies of unmedicated depressed patients. 

Psychiatrists at Texas Southwestern Medical Center in Dallas who authored the study noted that most clinical studies “cherry-pick” patients most likely to respond well to an antidepressant. In this long-term study of “real-world” patients, the lower percentage of 13% of patients who stayed better for any length of time may be more realistic. These “findings reveal remarkably low response and remission rates,” the lead author John Rush acknowledged.

7. 2010 – a one year NIMH follow-up of 4041 people. Pigott, H. 79 (2010) Efficacy and Effectiveness of Antidepressants. Psychotherapy and Psychosomatics 267-279. In a large NIMH trial of 4,041 “real-world” outpatients, known as the STAR*D study, only 108 patients remitted and stayed well and in the trial during the one-year follow up. This is a stay-well rate of 3%.

8. 2010 — follow-up of multiple years for over 260,000 patients facing depression. MN Community Measures, 2010 Health Care Quality Report.

This study analyzed all patients in Minnesota treated for depression over time—documenting that over the course of several years, well over 80% of patients remained depressed while being administered long-term medical treatment. Whitaker points out in his talk that this is the opposite of outcome numbers in previous eras, where large majorities of people seeking depression support were finding longer-term healing.

9. 2017 — comparative analysis of outcomes 9 years out. Vittengl, J. R. (2017). Poorer long-term outcomes among persons with major depressive disorder treated with medication. Psychotherapy and Psychosomatics, 86, 302-304.

Jeffrey Vittengl at Truman University conducted a study finding that taking antidepressant medications resulted in more severe depression symptoms after nine years. As Peter Simons summarizes, “Even after controlling for depression severity, participants who took medication had significantly more severe symptoms at the nine-year follow-up than participants who did not. In fact, even people who received no treatment at all did better than those who received medication.”

In addition to collecting information on depression, generalized anxiety disorder, and panic disorder, the researchers gathered data on other medical conditions, family history of mental health conditions, childhood trauma, personality factors, social support, daily functioning, and alcohol use. While these factors did impact depressive symptoms, Vittengl found they did so equally between the groups. As Simons notes, “That is, initial depression severity does predict lack of improvement—but it does so whether the person is taking medication or not. Therefore, it does not explain how outcomes could be worse with medication.”

10. 2018 — 30-year follow-up of 591 adults in a community sample. Hengartner, M. P., Angst, J., & Rössler, W. (2018). Antidepressant use prospectively relates to a poorer long-term outcome of depression: Results from a prospective community cohort study over 30 years. Psychotherapy and Psychosomatics, 87,181–183.

In this prospective study, researchers from Zurich University of Applied Sciences and the University of Zurich followed 591 Swiss adults from the age of 20-21 until they were 49-50 years old, finding that those who took antidepressants at some point in the study were more likely to have worse depression symptoms after 30 years—even when controlling for initial symptoms and other factors. This finding was independent of illness severity as well as a large number of other potential confounding factors.

As Peter Simons summarizes, “Assessments began in 1979 (baseline assessment) when participants were all 20-21 years old, and assessments were conducted again in 1981, 1986, 1988, 1993, 1999, and finally in 2008 (when they were 49-50 years old). At each assessment, the primary outcome was the severity of depressive symptoms within the previous year. Also, at each assessment, participants reported whether they had been prescribed antidepressants within the previous year. In order to create their predictive model, the authors tested whether being prescribed antidepressants at one assessment (e.g. 1988) increased the likelihood of more severe depressive symptoms at the next time point (e.g. 1993).”

The authors controlled for numerous factors—including gender, education level, marital status, any affective disorder at baseline, suicidality at baseline, family history of depression, subjective distress, childhood adversity, and low parental income. Although each of these factors could be a third variable explaining the results, the researchers found that even taking them into account, antidepressant use was still associated with an 81% increased likelihood of depression severity increase.

The authors (which include Jules Angst, a world leader in mood disorders) write, “These findings are in line with a growing body of evidence from several naturalistic observational studies suggesting that (long-term) antidepressant use may produce a poor long-term outcome in people with depression.”

II. Long-term trajectory of those facing depression who are never treated with antidepressants (compared with those who stay on). 

11. 1995 — a six-year NIMH follow-up on 547 people diagnosed with depression. Coryell, W. (1995). Characteristics and significance of untreated major depressive disorder.American Journal of Psychiatry,152, 1124-9.

NIMH-funded investigators led by University of Iowa psychiatrist William Coryell tracked the outcomes of medicated and unmedicated depressed people over a period of six years; those who were “treated” for the illness were three times more likely than the untreated group to suffer a “cessation” of their “principal social role” and nearly seven times more likely to become “incapacitated.” While many of the treated patients saw their economic status markedly decline during the six years, only 17 percent of the unmedicated group saw their incomes drop, and 59 percent saw their incomes rise.  The NIMH researchers noted that overall: “The untreated individuals described here had milder and shorter-lived illness [than those who were treated], and, despite the absence of treatment, did not show significant changes in socioeconomic status in the long term.”

12. 1997 — a six-month follow-up of 148 depressed patients. Ronalds, C. Outcome of anxiety and depressive disorders in primary care.British Journal of Psychiatry, 171(1997): 427-33.

In a 1997 study of the outcomes of 148 depressed patients at a large inner-city facility, British scientists reported that ninety-five never-medicated patients saw their symptoms decrease by 62 percent in six months, whereas the fifty-three drug-treated patients experienced only a 33 percent reduction in symptoms.  The medicated patients, they noted, most often “continued to have depressive symptoms throughout the six months.”

13. 1998 — a twelve-month World Health Organization follow-up on 740 people screened for depression in 15 cities around the world. Goldberg, D., et al. (1998). The effects of detection and treatment of major depression in primary care: A naturalistic study in 15 cities. British Journal of General Practice, 48, 1840-44.

A World Health Organization (WHO) study of depressed patients in 15 cities around the world was designed to assess the merits of screening for the disorder. The study hypothesized that those treated with antidepressants would have the best long-term outcomes, and those whose depression was not detected (and thus didn’t receive treatment) would fare the worst. 

Yet the results were the opposite of expected. At the end of one year, the subset of 484 people who didn’t receive psychotropic medications enjoyed much better “general health” and had depressive symptoms that were “much milder.” The non-medicated group was also less likely to still be “mentally ill.” By comparison, the group that suffered most from “continued depression” were the patients receiving ongoing antidepressant treatment.

As the lead WHO researcher summarized: “Patients not given drugs had milder illnesses but did significantly better than those receiving drugs, both in terms of symptoms lost and their diagnostic status.” This was so “even after adjustment for initial scores on each instrument.” The researchers concluded that the “study does not support the view that failure to recognize depression [and get people into treatment] has serious adverse consequences.”

14. 2000 — a ten-year follow-up of 222 people who had suffered a first episode of depression. Weel-Baumgarten, E. (2000). Treatment of depression related to recurrence. Journal of Clinical Psychiatry & Therapeutics, 25, 61-66.

In a retrospective study tracking 10-year case history outcomes, Dutch investigators found that 76% of those not treated with an antidepressant recovered and never relapsed, compared to 50% of those prescribed an antidepressant. The lead researcher wrote, “Even when a diagnosis of Major Depressive Disorder has been made, spontaneous recovery should be considered for a number of cases in general practice, and watchful waiting could prove worthwhile.”

15. 2003 — 1281 people were assessed for anti-depressants and rates of disability. Dewa, C. (2003). Pattern of antidepressant use and duration of depression-related absence from work. British Journal of Psychiatry, 183,507-13.

In Canada, Carolyn Dewa and her colleagues at the Center for Addiction and Mental Health in Ontario set out to explore the relationship between antidepressants and disability rates using administrative data from three major Canadian financial and insurance sector companies. They first identified 1,281 people who went on short-term disability between 1996 and 1998 because they missed ten consecutive workdays due to depression. 

Among this group, by examining prescription drug claims, this group learned that the 564 people who opted not to go on antidepressants returned to work, on average, in 77 days—while the medicated group took 105 days to get back on the job, on average.  More importantly, those who took an antidepressant were more than twice as likely to transition to long-term disability, with 9 percent of the unmedicated group submitting a request for long-term disability compared with 19 percent of those who took an antidepressant. 

In short, “those who did not use antidepressants returned to work sooner than those who did.”  Among the possible explanations, the researchers asked, “Does the lack of antidepressant use reflect a resistance to adopting a sick role and consequently a more rapid return to work?”  Of course, alternative explanations are also possible—including that more severe cases are more likely to stay on medication longer.  Neither hypothesis can be dismissed from the current evidence—with both deserving consideration.

16. 2004 – 5-year study of 9500+ people. Patten, S. (2004). The impact of antidepressant treatment on population health. Population Health Metrics, 9-16. In a five-year study of 9,508 depressed patients in Canada, medicated patients were depressed on average 19 weeks a year, versus 11 weeks for those not taking the drugs. The Canadian investigators concluded that their finds were consistent with Giovanni Fava’s hypothesis that “antidepressant treatment may lead to a deterioration in the long-term course of mood disorders.”

17. 2006 — up to 15-year NIMH follow-up of 84 unmedicated people facing depression. Posternak, M. et al., (2006). The naturalistic course of major depression in the absence of somatic therapy. Journal of Nervous and Mental Disease, 194, 324-349.

Noting that much of the existing knowledge for poor long-term outcomes in textbooks told the story of medicated depression, Dr. Michael Posternak, a psychiatrist at Brown University, wrote that “unfortunately, we have little direct knowledge regarding the untreated course of major depression.” In an NIMH study of “untreated depression,” Posternak and his team subsequently identified a subset of 84 people in a larger NIMH study who had relapsed back into depression but had chosen not to go back on antidepressants.

How did these 84 people fare over the years they were tracked?  Twenty-three percent of the non-medicated patients recovered in one month—and another subset of patients recovered within three months. That number rose to 67% in six months; and 85% within a year. Given these numbers, Posternak and colleagues pointed out that German psychiatrist Emil Kraepelin had observed that untreated depressive episodes usually cleared up within six to eight months—adding that their own results provided “perhaps the most methodologically rigorous confirmation of this estimate.” 

In sum: most people in this study struck by a bout of major depression naturally recovered. As the study authors concluded, “These results suggest that there is a high rate of recovery in individuals not receiving somatic [medical] treatment of their depressive illness, particularly in the first 3 months of an episode.” In particular, for all 84 subjects who went unmedicated, the “median time to recovery was 13 weeks.”

The research team went on to acknowledge that “treatment-seeking behavior is known to be associated with a worse prognosis” before concluding: “If as many as 85% of depressed individuals who go without somatic [medical] treatments spontaneously recover within one year, it would be extremely difficult for any intervention to demonstrate a superior result to this.”

18. 2008 — a two-year follow-up of 172 patients facing depression. Bockting, C. (2008). Continuation and maintenance use of antidepressants in recurrent depression. Psychotherapy and Psychosomatics, 77,17-26.

Dutch researchers examined how consistently antidepressants were used in the 2 years prior to a recurrence of depression in a group of 172 individuals. “Despite continuous use” of antidepressants, the group most committed to ongoing treatment relapsed 60.4%. By comparison, those who stopped taking antidepressants after they got feeling better—and who also pursued other preventive interventions—had an 8% relapse rate (the relapse rate was closer to 46% for those who stopped the antidepressant without any distinctively preventive support).  That meant a 26% average relapse rate across those stopping antidepressants —which was substantially lower than those who stayed on the medication.   

Given the positive short-term effect that many have reported on starting an antidepressant, lead researcher Claudi Bockting wrote, “Continued antidepressant treatment may oppose the initial acute effects of [the] antidepressant.” 

19.  2011 — a1-year analysis of 35000 patients. Verdoux, H. (2011). Impact of duration of antidepressant treatment on the risk of a new sequence of antidepressant treatment, Pharmopsychiatry 44, 96-101. French researchers, in a study of 35,000 first-episode patients, found that the longer patients were treated with an antidepressant before withdrawing it, the higher the rate of relapse. Those who were exposed to an antidepressant for longer than six months had more than twice the risk of relapse than those exposed for less than one month.

20. 2017 — 9-year following of nearly 3300 people. Vittengl, J. (2017). Poorer long-term outcomes among persons with major depressive disorder treated with medication, Psychotherapy and Psychosomatics 86, 302-304. An analysis of the outcomes of 3,294 people who were diagnosed with depression and followed for nine years revealed that those who took antidepressants during that period had more severe symptoms at the end of nine years than those who didn’t take such medication. The difference in outcomes could not be explained by any difference in initial severity of depression.

21. 2019 — 90 patients followed over one year.  Hengartner M. (2019). Antidepressant Use During Acute Inpatient Care Is Associated With an Increased Risk of Psychiatric Rehospitalisation Over a 12-Month Follow-Up After Discharge. Frontiers in Psychiatry 10, 79. Swiss investigators, in a study of 90 psychiatric patients discharged from two psychiatric hospitals, found that those treated with an antidepressant while in the hospital were more than three times as likely to be rehospitalized in the following 12 months than those who were not treated with an antidepressant. At the study outset, the antidepressant-user and non-user groups were “matched into pairs” on a variety of clinical outcomes including illness severity, functional deficit, and psychosocial impairment, a design intended to isolate the effects of the antidepressant use.

22. 2019 — 1 year follow-up of 148 people. Amsterdam, J. (2019). Prior antidepressant treatment trials may predict a greater risk of depressive relapse during antidepressant maintenance therapy. Journal of Clinical Psychopharmacology 39, 344-350. A study of 148 people with a bipolar II diagnosis who had recovered from a depressive episode found that the “largest predictor of relapse” over the next 50 weeks was whether they had taken an antidepressant before enrolling in the study. Those who had taken an antidepressant were nearly three times more likely to relapse.

This is the available long-term literature I’m aware of specific to antidepressants—with one exception.  

The wisdom of gradual tapering. There is another clustering of long-term literature examining the trajectory of those who try to step away from antidepressants after having been on them for a certain length of time—sometimes comparing those people with others who stay on the medications. I’ve chosen to review this literature separately in a future paper, because of the extra confounding variable of withdrawal effects which makes these studies especially complicated to evaluate.  

(Due to higher rates of relapse among those who taper, this literature has sometimes been used as justification for encouraging long-term usage generally. However without adequately accounting for withdrawal effects and the general difficulty of tapering—along with the fact that relapse shows up more frequently in those who take antidepressants for longer periods of time—that broad-brushstroke conclusion is almost certainly overstated and misleading).

As many people know from their experience, the choice to taper off antidepressants can be fraught—especially if people take that step quickly, and without adequate preparation or support. Yet I’ve also interviewed a number of people who taper off antidepressants gradually and safely and find themselves “feeling more like myself” afterwards (an interesting parallel to the initial benefit they felt from the medications). 

Whatever other lessons may be taken from this discontinuation research, the most widely-agreed upon takeaway is the indispensable wisdom of careful, gradual, and cautious tapering protocols. Too often, patients are encouraged to titrate off medication quickly—as rapidly as 50% reductions. 

This is simply too fast. The three best reviews of the available research on antidepressant discontinuation make this crystal clear.  See, for instance:

• Maund, E., et al. (2019). Managing antidepressant discontinuation: A systematic review, The Annals of Family Medicine 17 (1), 52-60.
• Davies, J & Read, J. (2019). A systematic review into the incidence, severity, and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97:111-121.
• Horowitz, M.A. & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms The Lancet, 6(6), 538-546. 

For those who feel tapering is the right next step in their healing, it is ideal to have professional support in the process. This clearly won’t be the right choice for everyone. For some people, staying in treatment on a long-term basis may be the best option. The important issue is that people have a choice.

For those interested in more education about best practices in the tapering process, check out the Withdrawal Project—a comprehensive online resource created by my colleague and friend Laura Delano (whose own story of long-term healing I wrote about here).   

Biological explanations for what’s going on.  There are several prevailing biological theories as to why long-term usage of an antidepressant might, in some cases and for some people, trigger a worsening and more chronic course of emotional illness. The most common explanations include the following: 

a. Ongoing compensatory changes in the brain. Stephen Hyman, former director of the NIMH, first raised an explanation in 1996, suggesting that the ongoing administration of psychiatric medication prompts a series of compensatory adaptations in the brain in order to maintain “equilibrium in the face of alterations in the environment or changes in the internal milieu.” For instance, ongoing antidepressant treatment has been shown to prompt down-regulation of the synaptic function of forebrain 5-HT2 receptors. (Essentially, in response to extra serotonin being flooded into the brain, it begins to limit its own natural production to avoid excess serotonin levels so that homeostasis and balance can be maintained).  

Whatever initial adjustment to brain chemicals may have taken place, remember, the focus here is on the longer-term picture. And just like other things we’re familiar with in the physical world, one sensible step can often trigger other rippling effects we don’t always anticipate. (Think about how widespread use of antibiotics has prompted new adjustments based on unanticipated longer-term effects). For instance, a team led by Dr. El-Mallakh at the University of Louisville found in 2011 that treatment with an SSRI antidepressant leads to a reduced density of receptors for serotonin in the brain. In experiments with animals, such reductions in serotonergic functions were “associated with increased depressive and anxious behaviors.” 

Dr. El-Mallakh went on to suggest that over time, antidepressants “may induce processes that are the opposite of what the medication originally produced,” noting that “rather than raise serotonin levels, the drugs over the long-term impaired serotonergic pathways in the brain.” This may “cause a worsening of the illness [and may] continue for a period of time after discontinuation of the medication.” 

b. Inducing a more unresponsive biological state.  In 2003, Giovanni Fava wrote about these same “compensatory adaptations” and suggested that “a chronic and treatment-resistant depressive state is proposed to occur in individuals exposed to [SSRI antidepressants] for prolonged periods.” He called this condition “tardive dysphoria…due to the delay in the onset of this chronic depressive state,” explaining: “Tardive dysphoria manifests as a chronic dysphoric state that is initially transiently relieved by—but ultimately becomes unresponsive to—antidepressant medication. Serotonergic antidepressants may be of particular importance in the development of tardive dysphoria.” 

Giovanni Fava elaborated further in 2011, “When we prolong treatment over 6-9 months, we may recruit processes that oppose the initial acute effects of antidepressant drugs. … We may also propel the illness to a malignant and treatment-unresponsive course that may take the form of resistance or episode acceleration. When drug treatment ends, these processes may be unopposed and yield withdrawal symptoms and increased vulnerability to relapse.”

c. The presence of heightened biological sensitivity. Similar to painkillers leading to a hypersensitivity to pain over the long-term, some have speculated that a comparable hyper-reactivity could be developing with antidepressants as well. As Peter Simons summarizes, “The prevailing theory on why antidepressants might make depression worse is receptor sensitization—the idea that long-term use modifies the ways that neuroreceptors work, causing the medication to become ineffective, and potentially making people vulnerable to worsening depression.”

Larger take-aways. What are we to make of all the foregoing? I conclude with a few final suggestions.  

1. Take this possibility seriously. Among this available long-term antidepressant research, this pattern of long-term worsening shows up consistently enough that it’s worth taking seriously. Whatever advantages have been established for short-term antidepressant treatment, statistically speaking, there are some clear risks in my judgment for people taking them long-term.   

What kinds of adjustments would this suggest for thoughtful and sensitive usage of antidepressants? These questions certainly deserve more attention and discussion—especially given the fact that our mainstream mental health system relies on these therapeutic tools on an increasingly long-term basis. 

2. Multiple interpretations are possible. Of course, some have pointed out that more severe depression may necessitate a longer-term course of treatment by definition—raising this as another explanation for some of these correlations above. That explanation should be considered as well, alongside the distinct possibility that chronic treatment has worsened the long-term course of the illness.  This was formally proposed by psychiatrist Giovanni Fava in 1994, when he suggested that the time had come to consider the possibility that “psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat.” After a decade of more research, he reiterated this by highlighting that a “statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse.”

To those skeptical of these conclusions, be aware that this pattern of increasing chronicity associated with long-term treatment is not exclusive to antidepressants. Other classes of psychiatric medications show the same patterns. Antianxiety drugs have comparable long-term outcomes.  And so do antipsychotics (see this full-text review or this summary of the 25 studies involved).

3. Differentiating short and long-term usage. Broadly speaking, we continue to pay very little attention to the difference between short-term and long-term usage of antidepressants, and that really needs to change.

Based on the available short-term research, it’s understandable why people might be encouraged to consider antidepressants as a part of their initial response to depression. But this is not what people are being told. On numerous occasions, I’ve heard of young and old people being told, “you need to be on this antidepressant for the rest of your life.”

If that’s the kind of advice we are giving, we ought to at least pay attention to what the longer-term research has to say about it. And if we encourage long-term use—insisting this is something they must be on indefinitely (or pretending that it’s not a big deal to stay on for years), we are not only misrepresenting the empirical reality. We are also likely setting people up to be in a difficult emotional spot later. This was evident in the aforementioned New York Times analysis entitled, “Many People Taking Antidepressants Discover They Cannot Quit.” 

While there is more to be said about potential side effects in the short term, it’s true that antidepressants can be a short-term relief that can help some as they seek deeper healing.  But let’s not mistake them as the source of deeper and more lasting healing—expecting them to deliver more than they’ve been designed to provide. 

Check this message against your own experience as well: If you are taking antidepressants or other psychiatric medications long-term, do you feel emotionally well?  Do you regularly feel peace and joy in your life? If your loved one is taking them, do you see them experiencing deepening emotional well-being?

Let’s at least allow ourselves to ask these questions and take this conversation seriously. And while we’re doing it, let’s stop pressuring people—especially young people—to go on antidepressants and stay on them forever.

4. Providing support to those ready to taper. Let’s also work to ensure that people feel supported if they feel tapering would be a good option for them. Currently, “there is a wide on-ramp, but it’s often difficult to find the off-ramp,” said Gina Nikkel, former director of the Foundation for Excellence in Mental Health Care. That’s something we can change.   

Although it can take time and significant work to taper in a healthy and safe way, and while it’s true can be risks to navigate (which is why this may not be the right choice for everyone), it’s also important to stop seeing the decision to taper off medication as inherently problematic and unwise. As you can see in the evidence above, for some people their long-term emotional well-being may benefit from such a choice.   

For further reading: 

For those who want to go deeper on this long-term evidence, I recommend:

• Robert Whitaker’s own review of this same material in this chapter of his book and other helpful presentations are available online (see, for instance, this excerpt). 
• Dr. Giovanni Fava (2003). Can long-term treatment with antidepressant drugs worsen the clinical course of depression? Journal of Clinical Psychiatry, 64, 123-133.
• This earlier 2011 review article I did with Florida State professor Jeffrey Lacasse: What Does It Mean for an Intervention to ‘Work’? Making Sense of Conflicting Treatment Outcomes for Youth Facing Emotional Problems. Families in Society: The Journal of Contemporary Social Services, 92(3), 301-308.
• And other public writing about depression I’ve published in recent years: Towards a Less Depressing Story about Depression; If More Treatment Is the Answer, Why Haven’t the Numbers Gone Down?; Is It Time for a Paradigm Shift in Mental Health?; Is There No Balm in Gilead?: For Faithful Saints Struggling with Depression; Letter to a Desperately Depressed Human Being; To Depressed, Anxious Saints Everywhere

The post Does Your Depression Keep Getting Worse? This Might Be Why appeared first on Public Square Magazine.

Core truths are unchanging—but the most effective language inspiring transformation changes with circumstance and most pressing needs. We live in a world—and in a church—that is beyond any dispute, wounded and afflicted to an unprecedented degree. Depression is stratospheric. Anxiety disorders are magnitudes beyond past numbers. More than 25% of American adults will be suffering from a mental disorder this year—the most common being anxiety disorder. And only one in three of that latter group receive professional help. Increasingly, the syndrome afflicts teens and children (8% according to the above study). Several studies indicate one in three women will experience sexual violence in their life (see, for instance, this regional study consistent with larger studies). Twenty-five percent will experience domestic abuse. In the last two years, 25% of young girls contemplated suicide. 44% of teens in America feel persistent “hopelessness”—an all-time high. Tragically, some varieties of mental illness are aggravated by misapprehension or misapplication of religious truth: the obsessive-compulsive disorder called scrupulosity is defined as a sense of shame or guilt that becomes pathological. In sum, “Almost every measure of mental health is getting worse, for every teenage demographic, and it’s happening all across the country.” These numbers are almost incomprehensible, and I can’t read them without tremendous sadness.

I do not claim, and the scriptures do not claim, that sin is not a feature of the contemporary world or individual conduct. I do believe, and scripture suggests, that in our modern era something else has been introduced into the human predicament in addition to or alongside sin. That “something else” (woundedness in all its varieties) has its own etiologies, manifestations, and needed remedies. At times, both ancient and modern scripture treat sin as itself one variety of woundedness. In Luke 7, Christ forgives the woman who “sinned much” and then told her: “hē pistis sou sesōken se.” This identical phrase appears verbatim in Mark 5:34; Mark 10:52; Matthew 9:22; and Luke 17:19. It is translated every time as “thy faith hath made thee whole.” Clearly, these four employments of the term sesōken tell us that Christ’s healing encompasses the plague, blindness, hemorrhaging, and paralysis. And here in Luke 7, we learn with the troubled woman, Christ heals our sins as well. In 3 Nephi 9:13, the point is made explicitly by Jesus Himself. “Repent of your sins,” He pleads, “that I may heal you.”  Christ portrays Himself as a healer of sin as well as of every other kind of affliction. 

Church leadership has responded to the particular conditions of our modern moment with an enormously increased attention to the varieties of woundedness about us. A simple General Conference word search, for instance, reveals that the word “heal” is occurring with almost 500% greater frequency than in any previous decade in the nineteenth or twentieth century. “Wounded” has also been occurring with greater frequency since 2010 than at any previous period in history. After this past April conference, that statistic will need to be revised upward even more dramatically, because the conference witnessed an unprecedented, explicit recognition of the extent of human woundedness and the scope of Christ’s healing concerns. 

• Sister Reyna Aburto referenced Christ’s capacity to “make us whole” from “emotional strife,” invoking “the healing power of the savior.” 
• Elder Patrick Kearon’s talk, “He is risen with healing in his wings,” referenced Christ’s capacity to remedy “abuse, violence or oppression” and heal those who feel “beyond repair,” to “heal the unhealable.” 
• Elder Jeffrey Holland addressed suicide, “depression, despair” and “self-harm” as afflictions Christ can heal. 
• Elder Dale Renlund (who in April 2017 gave a landmark address likening us all to Christ’s “diseased sheep progress[ing] toward healing”), spoke of those who have been “marginalized, oppressed or subjugated.” 
• Sister Amy Wright offered her testimony that “Christ Heals that which is Broken.” 
• Elder Ulisses Soares said, “Christ’s atoning sacrifice can heal our emotional and spiritual wounds.” 
• Elder Gerrit Gong said in his talk “Christ heals the broken-hearted.” 
• Pres. Russel Nelson also testified of Christ’s “healing … power.”

It is impossible to miss these sweeping currents that recognize a new landscape needing new emphases alongside the old ones. I do not read this as a new doctrine dismissing the reality of sin, or claims that we have no need for repentance. I see it as a new emphasis for a new series of challenges unique to this era. 

I have reflected on the spectacle of the campus preacher in the many years since, and found in it a powerful reminder to ask, how do we witness most effectively? What is the end we seek, and how do differing stewardships configure the kind of witnessing and ministering we are called to do?

Some forms of woundedness need therapy and perhaps medication. Most of us are not therapists or physicians. Some types need repentance and forgiveness. Most of us do not have keys to exhort. Some kinds of woundedness—the kind that scripture associates with the loss of plain and precious truths—might be addressed by a more vibrant encounter with the healing truths of the restoration. Presumably, this is a ministry in which all can and should participate who have themselves experienced and come to appreciate the unique strengths and virtues of Restoration principles, and Christ’s healing power—of which I can bear personal witness.

Our American culture also suffers under a number of ideological afflictions. Rampant, atomistic individualism—which distorts the principle of agency and communal responsibility into an ethic of self-expression and “authenticity.” The prosperity gospel—which makes gospel living just a more enlightened form of self-interest and acquisitiveness. And moral therapeutic deism—which alarms some members concerned about too much emphasis on healing and sin as woundedness. In that morally lax school, you are perfect as you are. God loves you (just not enough to want you to improve). Guilt is in this view inherently destructive, because you only need to be true to yourself, and not to any outside Person or ideal. And offenses you commit against a moral order are never your fault because genes or environment or emotional damage is always the culprit. 

Emphasis on any principle—torn from context, intent, and audience—can lead to danger. In the seventeenth century, an emphasis on election as a theological principle, trust in Christ as personal savior and one’s assured salvation through faith, led to an extreme orientation called “antinomianism.” In this school of thought, one was no longer responsible to human interpretations of law, because God’s promises exempted one from social or legal accountability. In this case, reasonable doctrines led to outrageous interpretations. Much earlier, Paul, in his epistle to the Romans, realized that the gift of Atonement itself could be taken to shocking extremes. If I am saved by grace, and grace is a response to sin, then should I not “sin the more, that grace may abound?”  “God forbid,” he replied. It is hard to imagine any true teaching that cannot be perversely interpreted by taking it to extremes. 

God’s love is never absolution for our own accountability. Our agency may never be whole and unimpeded (by genes, training, environment), but neither is it ever completely extinct. That God loves us in our sin and weakness does not mean He does not want to lead us out and upward. I hope that those who deplore the tendencies in our contemporary moment to rationalize rather than eliminate human evil in all its forms will continue to explicate those moments of subterfuge and self-deception that are their legitimate concerns.

We are all at different places in the covenant path. Some members need to up their game. Some need to be more gentle with themselves. I am happy I don’t have to discern which is which and that the Spirit can minister to each as needed. Meanwhile, I believe we cannot go wrong in seeking everywhere and always “to comfort those who stand in need of comfort.”

The post The Urgent Need to Console the Wounded appeared first on Public Square Magazine.

Well, it did happen to me. That big Goliath attacked me 7 short years later. 

Battling waxing and waning major depressive disorder (MDD) for several long years and spending days institutionalized in a psychiatric ward in 2019, I know something of the formidable fight to live when you wish you could die, something of lying for days in bed because there is nothing in you that can arouse your facilities to participate in any part of living, something of feeling that God is distant and inaccessible, and something of losing the worst of things: hope. In the darkness of those days and in the dreadful agony of those nights, healing was such a foreign word, totally inconceivable and unthinkable. Oh, I yearned for it, but the idea of being whole, of living without debilitating depression was too far away, too unreachable, too difficult to make the journey towards it. Making it irrefutably worse was the professional who told me I would just have to manage this for the duration of my life! Talk about adding gas to an already burning inferno! 

For many harrowing months, the words and grace of my sweet Jesus kept me alive. Especially when I could not get close enough to touch Him as it were, I could sense His yearning to help me, His desire to save me from myself. I had a harder time finding and connecting with God the Father, but I settled on the idea that if I could feel Jesus, God the Father probably wasn’t too far away, and so I decided I could rest in the assurance that They both wanted to help me. One day at a time, we chose life. These few words by Elder J. Holland that I committed to memory and that the Spirit brought to my mind many times saved me from going through with a pre-planned suicide attempt: “… do not vote against the preciousness of life by ending it!” My life was precious even—especially when—I couldn’t feel or see that.

It has been a long and difficult battle to find, accept, and settle into the concept of long-term healing, of wholeness, of functionality—to believe such realities can really happen for me. There have been so many low valleys where I crawled in metaphorical mire up to my neck, but recently I have been walking instead of crawling, and I seem to be avoiding the mudholes much better these days. I still have a long way to go, but I’m starting to see and even feel this righteously coveted long-term healing. Most days I am in a better place than I was in 2019. Some days, I topple backward at surprisingly rapid speeds, and the spiral is fast and furious and overwhelmingly depressing.  But the more recent pattern has been a few good days (even in a row!) intermixed with some depressing ones. It’s progression, and it’s glorious!

Here are seven realizations that have become personal habits (in which I daily participate) that are helping me along the path to greater long-term healing and hope. 

The Laws of God. When I was admitted to the psychiatric ward in 2019, it appeared that the overwhelming majority of those admitted on the unit during the time I was there were admitted for (a) primary condition(s) such as bipolar or schizophrenia, etc., but most also had accompanying substance abuse issues, other comorbidities caused by addiction. Never in my life have I been thankful for the Word of Wisdom like I was thankful for it during my time of admission. I saw that the gospel didn’t prevent my MDD, but living the tenets of just one law, the Word of Wisdom, did prevent me from dealing with other debilitating co-morbidities that would in fact complicate the severity of the primary condition(s). This was a groundbreaking discovery for me! I realized that even if MDD made my life feel out of control and at times totally hopeless and pointless, I could still choose to honor the Word of Wisdom and not turn very bad into way worse. So, my first realization towards healing: live the laws of God, especially the Word of Wisdom and the Law of Chastity. Those laws are a protection against worse.

Grace and Gratitude Journal. In the thick of MDD darkness, a friend felt impressed to give me a little homemade notebook. She gave no instructions for its use, but the Holy Ghost invited me to make it a Grace and Gratitude journal. With great difficulty, I began. It was miserable. Most evenings prior to retiring to bed, I could not think of a way I had seen the grace of Jesus in my life, and recounting ten things for which I was grateful was mission impossible. I kept at it, and over time, it became so much easier, and by day’s end, I already knew several incidences where the grace of my dear Jesus was manifest and only ten things for which to be thankful? Now, I can whip out ten things in less than a minute. This practice has truly helped elevate me to a better mental sphere. So, my second realization towards healing: don’t underestimate the power and strength of gratitude in the process of healing. Actually, I don’t think it’s possible to heal without it. 

Meet me Outside. The Spirit told me a few months ago that I needed to be outside more, that I would find and feel God closer outside, that I could, in a way, meet Him outside. There in the early mornings undisturbed by the stressors of the day, we could work out some problems and talk things over and consider solutions—in the mountains, on walking trails, at parks, around town. Anywhere outside! I am an early riser, but now I am an early riser and walker/jogger 6 days/week. Along with daily delving in the scriptures, this walking/jogging time is my time with God in His beautiful nature, and it’s rejuvenating. I enjoyed hiking before, but now I LOVE it. On top of a mountain, I look down and “in awesome wonder, consider …” So, my third realization towards healing: get outside and move! I now consider this as important to my hope, health, and healing as good nutrition and adequate sleep. 

Babies and Sunrises. The greatest sorrow of my life has been my childless state. Not having any children of my own has contributed to my MDD. Though at times painful to see others—in Sheri Dew’s words—“bear” and “bear with” their children, I have also found an unrivaled feeling of hope and peace holding the babies of other kind parents who let me do so. One of my favorite quotes in all the world is this one by Elder B. Packer: “Every time a child is born, the world is renewed in innocence.” Well, for me it’s not just THE world. It’s MY world that gets renewed. I get renewed. There is a sense of freshness, holiness, yes, innocence that spreads outward from a holy baby so recently come from God. Equal in glory is one of God’s sunrises. Watching it blossom into existence signals that light is coming, hope for another day is dawning. There have been holy moments—with a baby in my arms or gazing at a promising sunrise—when my depression has been replaced with a divine joy. So, my fourth realization towards healing: hold a baby and watch a sunrise. There are no words adequate for either of those miracles. 

Push the Animals Back. In Relief Society a couple of weeks ago, a sister shared this quote by CS Lewis: “All your wishes and hopes (and we could substitute mental health challenges and troubles) for the day rush at you like wild animals. And the first job each morning consists simply in shoving them all back; in listening to that other voice, taking that other point of view, letting that other larger, stronger, quieter life come flowing in. And so on, all day.” This idea bolted through me like lightning! Our first daily job is to shove back the animals and allow for the quieter life to take front and center stage. For me, this includes prayer, scripture pondering and studying, daily meditation, and moments of mindfulness that center me for the day’s challenges. Whatever animals stare me in the face when I wake up, I have started pushing them back and giving myself space and grace for the “quieter life.” So, my fifth realization towards healing: shove the animals back and allow the “stronger, quieter life (to) come flowing in” with each new day. 

Connection. I started to really notice about a year ago that we humans are made to connect. We need daily connecting. We need the synergy, energy, and life-giving benefits of connection. Without it, it’s common to tank emotionally and mentally. I began to see a pattern in my own life; I would nosedive hard and fast when I couldn’t connect or when I blundered attempts at connectivity. Since major depression often gives way to isolation and can seriously injure, destroy, and ruin relationships, those who thus suffer must work extra hard at connecting. I am most indebted to those kind souls who have pardoned my stupidity and inability to adequately subdue the monster that is MDD and have understandingly and patiently stood by on the sidelines waiting and praying for me—with love and forgiveness in their hearts. For them, I stand in awe of this gift they give me over and over and over. So, my 6th realization towards healing: work at getting and staying connected. There is sustaining and healing power—that is not available in any other form—in human connectivity. We are built and programmed for it. We must connect to thrive.

Power. Peace. Hope. A few months ago, the Spirit told me that I needed to be in and around a temple more. Having gone regularly for years, I was surprised by this admonition. Being that a temple was just built and dedicated where I live, this was very doable. I have increased my efforts to worship therein. One recent early morning as I walked outside near the temple, I felt—in a way I’ve never felt before—pure power emanating from  that holy place. I have felt the power and peace of the holy temple many times inside its walls, but never have I felt such a sense of power radiating from the outside towards me. It was enveloping, redeeming, healing, gushing like water—like in Ezekiel’s vision. The promise, though given through Joseph Smith to early Saints in Kirtland, is from God to every temple worthy and temple going Saint of the latter days: we can be endowed with His power! It’s real. Power. Peace. Hope. I have found all three of those things in and near His holy houses. What MDD takes away, God restores. So, my 7th realization towards healing: go where there is power. Go where there is peace. Go where there is hope. Go to the temple.

The image of that sorrowing soldier, devoid of hope, strapped to that green military cot in the windswept Middle East still haunts me today. I wonder if he chose life or succumbed to death. If I could find him again, I would tell him that the same nasty Goliath came for me, too, and that it’s been the fight of my life. But then I would tell him for the first time in what seems like a hundred years, I have this authentic and freeing hope, born of Jesus, His words, and those who minister for Him, that is encouraging me to believe in long-term healing. If then he was to notice and inquire, “And what are these?” I would answer, “God be thanked, happy tears spilling down my cheeks—finally, oh finally.”

The post How I’m Finding Deeper Healing from Depression appeared first on Public Square Magazine.

I sit with several of my Public Square friends to discuss their recent articles discussing accuracies, and inaccuracies, of common assumptions about Utah.

The post Scary Stories About Utah appeared first on Public Square Magazine.

Other articles in the series include: Are Utahns Uniquely Drawn to Pornography?, Do Utahns Struggle With Body Image More Than Others?, Are Religious LGBT Youth in Utah More (or Less) Prone to Suicidality?

One final favorite Scary Story people love telling about Utah centers around just how depressed people are in the state! Much of this was initially generated by an oft cited Deseret News story from 2007, referring to Utah as the most depressed state in the country.  A year earlier, the Deseret News reported that a pharmacy benefits company released a study claiming that Utahns took more anti-depressants in 2000 than any other state.  (2019 statistics reported that Utah ranked 16th in antidepressant use). 

Since then, many nod knowingly when this tale of rampant depression in Utah is invoked. Some go on to sermonize about perfectionism and guilt among the state’s dominant religious community as presumably one of the factors fueling heightened depression. That, of course, fits nicely with those who see religion generally (and the Church of Jesus Christ of Latter-day Saints specifically) as somehow exacerbating many of the various emotional and behavioral struggles increasingly epidemic in modern society. 

There will always be a handful of studies or “scholarly analyses” that can be used to claim scientific backing for one’s own world view. It becomes problematic, however, when a broader picture of research goes directly counter to deeply held views and assumptions.  Just as we have witnessed in this series with popular narratives of addiction, plastic surgery, and youth suicide being challenged, you might be surprised how much the prevailing scary story of depression in Utah is contradicted by available evidence. 

When it comes to mental health, the evidence is similarly compelling in confirming a generally positive association with faith and religious adherence. For instance: 

 A 2012 large scale review of religious and spiritual factors influencing depression concluded “Of the 178 most methodologically rigorous studies, 119 (67%) find inverse relationships between religiosity and depression, while in contrast, only 6% report greater depression. Religious beliefs and practices may help people to cope better with stressful life circumstances, give meaning and hope, and surround depressed persons with a supportive community.”

• A 2014 study in the Journal of Religion and Health “of nearly 2,500 young women finds that across all participants, more frequent religious attendance and a strong prayer life were significant predictors of lower rates of depression.”
• In a 2016 study of religion and depression in adolescence, the researchers concluded “Using a nationally representative sample of adolescents in the US, we find robust effects of religiosity on depression that are particularly strong for the most depressed. These effects are not a result of social context. Instead, we find that religiosity buffers against stressors, possibly through improved social and psychological resources.”
• In a 2021 study just released regarding community connectedness during the COVID-19 pandemic, study co-author Dan Cox referred to Latter-day Saints in relating that, “In terms of their social connectedness, they’re doing way better than than your average American. This has a whole host of benefits. We know that loneliness is incredibly damaging to your emotional health, to physical health, so being rooted in these communities, having people they can rely on to weather something like a pandemic, which for many folks was socially isolating, is just an incredibly good position to be in.”

This same positive religion-mental health pattern also shows up in specific studies aimed at members of the Church of Jesus Christ of Latter-day Saints also. For instance: 

• One earlier analysis of 1990’s data showed that the suicide rate among active Latter-day Saint youth was lower than it was for peers from 1991-1995.
• Another study using 1996 data showed that active Latter-day Saints had the best health status compared with other populations, and consequently, the lowest levels of mental illness.
• A Gallup “Well Being Survey” conducted in 2012 documented that in the United States at the time, “Jews and [Latter-day Saints] have the highest well-being of any of the faith groups examined in this analysis.”
• A 2016 study with a survey size of 1.3 million people showed that members of the Church in the United States report a high number of positive emotional experiences and relatively high life satisfaction. 

None of this is to suggest that people of faith, and more specifically members of the predominant religion in Utah, don’t also struggle (even mightily) with depression and anxiety—as also shows up clearly in other studies. For instance more recently in 2019, the Center for Disease Control reported that Utah had the 6th-highest suicide rate.  

But as a whole, this broader scope of evidence counters much of the popular perception that somehow faith and religious observance are core causes of depression, and act as negative risk factors for mental health. Based on the preponderance of available evidence, that’s simply not an honest scientific story.  

Different mental health outcomes according to how faith is practiced. So why do some people insist that their experience with faith was so emotionally unsettling and burdensome? A fair question to explore is how certain kinds of personal approaches to faith relate to healthy or unhealthy emotional outcomes.  

Many years ago, Albert Ellis famously claimed at the American Psychological Association convention that religious commitment led people towards worse mental health when compared with the general population. At the time, he was debated by Latter-day Saint psychologist Allen Bergin—who began conducting research over the next decade that would eventually force Ellis to back off his blanket generalization.    

It was actually more complicated than either man acknowledged. Rather than religiosity helping or hurting mental health in a simplistic, blanket sense, deeper analysis showed that mental health outcomes depended on how, why, and to what extent people participated in their faith. For people “intrinsically committed” (finding living their faith as personally rewarding), the research was clear:  that faith commitment was most often beneficial to mental health overall. 

For purposes here, instead of focusing alone on whether someone is spiritual or religious, it may be more relevant to ask someone more personally: how am I spiritual or religious? Why am I practicing my faith the way I do? Does how I adhere to my faith influence how I feel? Am I being religious for external reasons—or to keep up a certain appearance?  Or are there deeper reasons for my religious practices?  

This distinction shows up in other research too.  For instance, a study of older residents of Cache County in the late 1990s suggested higher depression rates among Latter-day Saints compared with non-Latter-day Saints, but found church attendance was correlated with lower depression. And in the analysis of 1996 Utah data referenced above, active Latter-day Saints were measurably healthier than non-Latter-day Saints and less active Latter-day Saints. 

It’s not hard to imagine how inner turmoil, which often manifests itself as emotional struggle, could arise for someone who has, at one stage, exhibited strong commitments practicing core teachings of a faith. When these practices are later ignored, or a person moves toward a more “extrinsic” way of practicing faith in their life, it would make sense this might create a dissonance that is not without precedent, and is described throughout scripture. For example, King Benjamin raises concern with those who “cometh out in open rebellion against God”—noting that “if that man repenteth not … the demands of divine justice do awaken his immortal soul to a lively sense of his own guilt, which doth cause him to shrink from the presence of the Lord, and doth fill his breast with guilt, and pain, and anguish, which is like an unquenchable fire.” The results of open rebellion, as opposed to a lessening of commitment to one’s faith, may be open to debate here—but it should surprise no one to see challenging emotions arise in both cases.  

Faith interacts with other strong variables in influencing mental health. According to the broader picture of evidence then, a foundation of faith is generally protective against mental health problems, particularly when practiced actively and lived intrinsically.    

Clearly, there are many more, wide-ranging influences on emotional health—including some that may uniquely operate in and out of Utah (and explain some of the state-level differences).  

One of the most commonly cited factors, for instance, is Utah’s high elevation (third highest average elevation in the US at ~6,100 feet above sea level)—with studies often connecting depression and suicide rates with elevation, and similar correlations showing up in other high-altitude states. As just one example, a 2011 study shows a positive association between altitude and suicide rates (a helpful discussion as to possible reasons why is found here). 

There is another factor at play here—far less commonly cited—but which there is good reason to believe may be playing a unique role in Utah’s mental health trends. As stated above, Utah is currently ranked 16th in the nation for antidepressant use per capita (with studies a decade earlier placing the state as first in antidepressant usage per capita).  

If it’s true that Utah has a relatively high antidepressant usage rate, it raises some important questions, with the first of them being why? 

Whereas most people leverage this data as easy evidence that Utahns are just more depressed (widely seen as a proxy judgment on Latter-day Saint teaching), that once again, simply does not account for all this other data above. Even more specific statistics by locality unsettles that story even more. For instance, geographic studies indicate that many areas in Utah with significant Latter-day Saint populations are less likely to use antidepressants. For example, Utah County has one of the highest Latter-day Saint populations in the state, but the Utah Department of Health reports that Provo—the largest city in Utah County—has the lowest antidepressant usage in Utah. Idaho also has a large per capita Latter-day Saint population, but it is below average for antidepressant usage.

Rather than making blanket inferences concerning religiosity and depression in connection with antidepressant use, could the higher use of antidepressants be considered a potential variable in increased rates of depression and suicide? There is some surprisingly robust data suggesting the answer is yes—especially these three findings: 

1. A growing and sizable amount of research confirms unique levels of risk in young, developing, teenage brains when they are prescribed antidepressants—with a roughly doubling of suicidality showing up across many controlled trials (summary review here).  
2. There are also seven different lines of evidence that confirm a linkage between antidepressant use and uncharacteristic suicidality generally
3. Finally, twenty-two long-term studies document a trend of worsening depression over time for those taking antidepressants 5, 10, and 15 years in a row—when compared with those who never take them (complicated by the fact that these medications can be difficult to taper off, as the New York Times investigated in 2018).  

A logical conclusion to this information may be that whatever short-term benefit one may continue receiving from an antidepressant initially, it’s hard to deny a more complicated picture  emerges over time. Unfortunately, it seems increasingly clear from population level data that the more a population embraces these treatments as the primary response to depression—the more their burden of suicidality and chronic depression will grow.  

All of this raises some challenging questions about the overall approach we continue to take in responding to mental health challenges. It was respected scholars Allan Horowitz and Jerome Wakefield who raised concern in their 2012 book Loss of Sadness with “medicating normal sadness” for the way it often “treats as pathological what is actually an inherent and valuable part of the human condition.” As they summarized:

For thousands of years, people have used religion, spirituality, and philosophy to understand how their unhappiness is tied into larger questions about life. Such questioning allows people to comprehend how their emotions are related to basic aspects of human existence and to gain a deeper appreciation of their feelings ….Quite aside from philosophical issues, there may be psychological benefits of normal sadness that treatment would nullify. We do not as yet fully understand why we are biologically designed to experience sadness in response to loss, and, until we do, it is possible that there are benefits of withdrawing into a sad state after a major loss that are not immediately apparent but that are nonetheless real and important to long-term psychological functioning.

Having said all this, let’s be clear that antidepressants have helped millions of people, and untold numbers of people in Utah. I am certainly not advocating that those taking antidepressants immediately stop taking the medication. (When that is the right step, it needs to happen very, very gradually—and ideally with lots of support and some medical supervision). So, this is not an anti-medication message—it’s about being thoughtful in our use of medication and cautioning against over-relying on this as our long-term solution, including for youth. What research is showing is that they may not necessarily be the best first choice, and that there are other options which can and should be explored for those suffering from depression.

1. Believing there was hope in the possibility of deeper healing                            
2. Making small and large life adjustments in their lifestyles
3. Prioritizing the big three—nutrition, physical activity, and sleep
4. Not neglecting the ‘other big three’—mental diet, mental activity, and mental rest
5. Working through issues of trauma, healing and forgiveness                            
6. Learning to work with thoughts and emotions in a new way
7. Nourishing community & emotional support
8. Seeing your own self and life as having true worth, meaning, and purpose 
9. Deepening or realigning your spiritual connection 
10. Growing freedom through less emotional dependence on substances or behaviors. 

It’s worth pointing out that all ten of these shifts are well-represented in the teachings of every major faith—including the Church of Jesus Christ of Latter-day Saints. Rather than targeting faith as somehow detrimental to emotional health overall, then, maybe it’s time to recognize the profound salutary and preventive effect faith can and does play for so many—in and out of Utah.  

So, is Utah more depressed than other places? You’d have to try really hard to make that case based on the available scientific data. Let’s stop pretending that Scary Story is somehow research-based and backed by good evidence. 

It’s not. The story that is backed by the broader picture of evidence is much more encouraging about Utah and the strong influence of faith than many have been led to believe.

The post Are Utahns More Depressed Than Everyone Else? appeared first on Public Square Magazine.

Other articles in the series include: Are Utahns Uniquely Drawn to Pornography?, Do Utahns Struggle With Body Image More Than Others?, Are Utahns More Depressed than Everyone Else?

Are LGBT Latter-day Saint youth in Utah at a higher risk of suicidal thoughts, plans, and attempts than their non-Latter-day Saint peers? According to two recent studies making use of a large, representative dataset, the answer is no. In fact, researchers find that LGBT youth in Utah who are not Latter-day Saints show almost twice the incidence of suicidal thoughts and behaviors than those who are Latter-day Saints. These effects are significant, persist after controlling for demographic variables, and appear to be partly mediated through lower levels of family conflict, depression, and substance abuse among Latter-day Saints. 

Before digging into these findings, it’s worth taking a step back to place them in context. In December 2014, a national media outlet printed an off-the-cuff remark from an LGBT advocate, who claimed that “Mormons have the highest rate of gay suicide in the country,” along with several other statistical claims about LGBT youth suicide in the Church. This interview understandably sparked alarm and gave additional shape to an existing narrative about gay youth suicide in Utah that dated at least to 2012, following a nationally publicized suicide in Utah. The idea that there was an “epidemic,” as some put it, of gay youth in Utah committing suicide because of the Church’s conservative beliefs became widely accepted.

It’s hard to overstate just how entrenched this narrative became online during the 2010s. Conversations among Church members and critics online that touched on sexuality or same-sex marriage would inevitably arrive at the topic of youth suicide. Church members who attempted to engage on these questions, however meekly, were accused of raising suicide rates simply by believing in and affirming Church teachings.

The Church of Jesus Christ of Latter-day Saints itself felt compelled to take these claims of epidemic suicide seriously, responding both through numerous private meetings with advocates and through public gestures, such as donating to an LGBT support group for suicide prevention training.

Michael Staley, who works at the Utah Office of the Medical Examiner and is himself gay, and not a member of the Church, has repeatedly thrown cold water on key claims of the narrative:

Despite a general perception that many of Utah’s youth suicides arise from intolerance toward LGBT people promulgated (though not necessarily intentionally) by teachings of The Church of Jesus Christ of Latter-day Saints, the state’s suicide prevention research coordinator says that may not be the case.

“There’s no data to show that, period,” says Michael Staley, who works in the Utah Office of the Medical Examiner and is the first person who would know, since he leads an effort to collect, compile and analyze suicide information from around the state. …

While the Centers for Disease Control and Prevention reported in 2016 that LGBT youth die by suicide at double the rate of their non-LGBT peers, Staley says data specific to Utah so far doesn’t validate the sexuality-religion narrative. “The people who are driving that narrative are going to be disappointed,” Staley says, while at the same time recognizing that “theoretically, it makes sense.”

Proponents of the narrative point to a 2009 study finding that LGBT youth from “highly rejecting” families are more likely to have attempted suicide. No doubt this is true. But the study, conducted on a small convenience sample from California, makes no attempt to study the effect of religion or the Church of Jesus Christ specifically, never mentioning religion at all. Others have offered circumstantial evidence, pointing out, for example, that the suicide rate among youth in Utah rose steeply beginning in 2013. This is true, but these data cover all youth, and it is unknown whether the increase was driven by LGBT youth, straight youth, or both. Nor do Church teachings seem a likely explanation for the sudden rise: the Church’s purportedly suicide-causing teachings long predate 2013, while California Proposition 8 (2008) and the November 2015 handbook policy, both purported to be triggers, were either too early or too late. 

While the key claims of the Latter-day Saint LGBT suicide narrative are unsupported and in some cases, as new research suggests, roughly the opposite of the truth, there has been at least one salutary effect of such sustained attention to the problem: Utah is becoming a leader in data collection on youth suicide.

“We’re building the most comprehensive database of information about suicide decedents around. That’s huge,” Staley says in an interview with QSaltLake Magazine. In fact, it’s the first undertaking of its kind in the country and, because of the organization of the state’s medical examiner’s office, it’s possible in Utah and only a handful of other states. Staley calls the effort “progressive” and “pioneering.”

The new research I referred to at the beginning of this article makes use of excellent survey data collected by Utah state agencies: the large and representative 2019 SHARP dataset covering youth in middle school and high school.

The first paper, by James McGraw, Meagan Docherty, Jay Chinn, and Annette Mahoney, published in Psychology of Sexual Orientation and Gender Diversity, investigates the extent to which LGBT and Latter-day Saint identity predict suicidal thoughts and behaviors (STB) among young people in Utah. STB is an aggregate measure, summing up indicators for the presence of suicidal thoughts, plans, and attempts in the previous 12 months (the maximum value of STB is thus 3).

The relevant figures from the paper are surprisingly stark. Latter-day Saint LGBT youth had an average STB value of 0.57, while non-Latter-day Saint LGBT youth had an average of 1.09—nearly twice as high. The difference between these two means was highly statistically significant. For reference, non-Latter-day Saint heterosexual youth had an average STB value of 0.42, while Latter-day Saint heterosexual youth had an average of 0.23.

The paper also found statistically significant differences between Latter-day Saint LGBT youth and their non-Latter-day Saint peers on several other markers: the Latter-day Saint youth were less likely to be experiencing familial conflict, depression, substance abuse, or self-harm, and reported being closer to their parents, on average. All these differences, thanks to the large sample, were statistically significant. These findings are descriptive, however, and are not controlling for other variables such as race or sex.

Perhaps most striking, though not emphasized by the researchers, are findings on depression revealed by an interaction effects model. Interaction effects can reveal how the size and direction of the effect of one variable on the outcome varies with another variable. The effect of LGBT identity on depression, controlling for demographics, family connections, substance abuse, and community connections, was estimated to be positive for all religious groups, but this effect was significantly smaller among Latter-day Saint youth compared to youth who indicated their religion as “none.” To put it another way, when it came to depression, LGBT youth benefited more from being Latter-day Saints, relative to having no religion, than straight youth did. In fact, straight Latter-day Saint youth had higher estimated rates of depression than Catholics and Protestants, once controls were included—the same was not true of gay Latter-day Saints.

One possible explanation of these findings is that the LGBT youth most likely to be harmed by Church teachings are also those most likely to have already left the Church, thus pushing rates of suicidal thoughts and behaviors lower in the Latter-day Saint group and higher in the non-Latter-day Saint groups (in other words, introducing what is called “survivorship bias”). The authors of the BYU study investigate this possibility using a second survey dataset that includes information about suicidality among LGBT youth who have disaffiliated from the Church. They conclude that their main findings hold even after adjusting for this information.

There remain limitations and potential sources of statistical bias in these papers, as is always the case with observational, cross-sectional studies. Inferring causation in the social sciences can only be done cautiously and provisionally. It should also be kept in mind that suicidal thoughts, plans, and attempts, the subjects of these studies, are distinct from completed suicides.

A final caution is that population measures cannot tell individual stories. For illustration, consider vaccines that are, on the population level, very safe. The overall safety of a vaccine doesn’t mean no one has ever been harmed by it. Similarly, even if it turns out participation in the Church has a protective effect against suicide for gay youth overall, there would still be some youth for whom this is not the case, or for whom the effect is opposite, for a variety of reasons specific to family, ward, and individual circumstances. On the other hand, individual stories, while valid, cannot tell us about rates of suicidal behavior across different religious groups, just as an individual’s adverse reaction to a vaccine does not prove that vaccines are unsafe. Statistics and individual stories are both valid and should be seen for what they are. Both rules and exceptions exist.  

Despite these caveats and cautions, the findings of these two studies tell us something important about the experiences of LGBT youth in Utah. They refute claims that higher rates of suicidal thoughts and behaviors among LGBT youth in Utah are uniquely or disproportionately Latter-day Saint phenomena. And the negative statistical relationship observed between Latter-day Saint identity and suicidality among LGBT youth, even after accounting for demographic variables, makes the narrative of Church-caused youth suicide much less plausible than before.

Other, more plausible, conjectures could be made. Perhaps rapid secularization has contributed to rising suicide rates among American youth, including LGBT youth. Perhaps the rise in youth suicides in Utah over the last decade is partially explained by a rapid cultural shift, within the Church (as with society as a whole), toward prescribing antidepressants to minors (black box warnings on antidepressants prescribed in the US warn of increased risk of suicidal thoughts and behaviors in young people relative to placebo). Maybe progressive secular ideology, which has been growing in popularity, is harmful to young people, causing depression and suicidality. These conjectures are, I would argue, worth investigating, but they remain conjectures. They shouldn’t be asserted without caveats, let alone repeated without verification by national media outlets—there has been enough of that.

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As with so many children of abuse, she struggled to understand a world where she was hurt by the people who were supposed to love her the most. 

In her journey, she discovered The Church of Jesus Christ of Latter-day Saints. She was baptized and found growing peace through the gospel. Yet she felt she still needed additional help to heal the PTSD and anxiety her abusive childhood left her with. So, she sought out mental health professionals within the structure and boundaries of this new faith that had become so meaningful to her.

When she brought up her anxiety, the Latter-day Saint therapist working with Alison asked how she felt while reading her scriptures, and Alison confessed that she sometimes felt pressure to improve. So the therapist recommended she stop reading her scriptures for a week.

Alison felt surprised.  

Soon after Alison’s marriage, intimacy became a major stumbling block as it is for many who experience sexual abuse. Sexuality is a particularly complicated subject, and Alison felt as though much of the world would look down on the chastity standards she had adopted as part of her new faith. In order to feel confident in the counsel the therapist would provide for her, she once again sought out a Latter-day Saint therapist.

Early on, after Alison was asked about her views on sexuality, the therapist suggested she had misunderstood Church teachings as overly prudish. Alison trusted her therapist and expected that because of their shared faith tradition, she could feel safe with these suggestions. But in short order, the therapist assigned Alison graphic prurient readings and videos that Alison described as “pornographic.” It was only after Alison noted a steep decline in her spirituality that she stepped away from her therapy altogether.

But according to a recent letter signed by more than two hundred Latter-day Saint therapists, it should not surprise us that many do not. They wrote “It is not within the scope of our professional ethics to decide what qualifies as ‘guidance consistent with doctrine.’” But rather to merely, “support client self-determination.”

If professionals like these won’t help clients ensure that therapy remains within the bounds of Church teachings, why do they believe clients specifically seek them out? The letter suggests “mental health clients often wish to see a therapist who shares their cultural experiences … a Mormon therapist builds trust based on the quality of our cultural competency.”

That desire for a safe therapeutic space among Latter-day Saint clients is real.  In an informal survey in preparation for this article, I gathered data from 117 individuals who sought out and received counseling from Latter-day Saint therapists. When asked why they chose to see a Latter-day Saint therapist: 

• 15% of clients indicated, “You could save time not having to explain Latter-day Saint culture and terminology.”
• 25% of clients suggested, “They could provide advice based on an understanding of cultural issues unique to Latter-day Saints.”
• 53% replied, “You would feel safe from being looked down on for your unique beliefs and culture.”
• 62% “They would not provide advice or treatment that violated gospel principles.”

While the survey was informal, the results make clear that a significant number of those who seek out Latter-day Saint therapists do so for more than merely cultural reasons. In fact, they not only think those therapists who advertise their shared faith will be able to provide advice within the guidelines of the gospel, but they expect them to.

Yet those who signed the letter suggest that their role is to “put the client’s agency and self-determination at the center” instead.  Presumably, this suggests they believe their therapy can potentially help those who wish to stay within the boundaries of the gospel, but that it’s not their role to protect those boundaries.

Jeff Bennion, a licensed marriage and family therapist, tells me, “I see all the time therapists who lead their clients outside the boundaries of the gospel while believing they are merely helping with self-determination. In many cases, it seems these therapists don’t even realize they’re doing that.”

Seeking Spiritual Safety in Therapy

Hyrum had grown up as a Latter-day Saint but always had more energy than usual and didn’t always feel like he fit in at church. Yet ultimately he described feeling the love of God at church and identifying himself as a Latter-day Saint. 

As a teenager, he began to experience depression. And so his parents sought out a Latter-day Saint therapist who could help him. Hyrum says “my parents just wanted the therapist to convince me to be more righteous so that I would be happier.”

In the first session, however, the therapist told Hyrum that the sessions were his and that they didn’t need to do what his parents wanted. Within a few sessions, Hyrum began to open up, and the therapist asked him how he felt about Church rules. He admittedly sometimes wished he could break the Church’s guidelines, but he didn’t want to feel that way and assumed that by telling his therapist, he could help him work through those conflicted feelings. But something else happened entirely. When Hyrum admitted his feelings, the therapist asked him more questions about them and used language that made him feel as though his feelings were not only natural but right. And eventually, he started to ask Hyrum if he felt he’d be “more in alignment with his feelings” if he acted on them.

Within only a few months he was role-playing with his therapist how to inform his parents that he did not want to follow the guidelines of the Church regarding chastity and the word of wisdom. 

For the next twelve years, Hyrum says he described himself as an atheist-agnostic until eventually recognizing a spiritual hole inside. He eventually returned to the Church of Jesus of Christ and feels more at peace today than ever before. 

Hyrum tells me he wishes he could go back to that crucial moment in the therapist’s office and stop his younger self from admitting his darker feelings. “It’s tricky,” he tells me, “I needed someone to help with my depression. But I thought I could trust my therapist to keep me spiritually safe … I still sometimes wonder if it’s my fault for telling him.”

Hyrum is far from alone. 

My informal survey asked respondents if their therapists ever made suggestions that they felt were outside the boundaries of the Church’s teachings. Of the 72 respondents who said that they chose a Latter-day Saint therapist specifically so they would not provide advice or treatment outside the boundaries of the gospel, over half of them (51%) said their therapist made recommendations they believed to be outside of gospel boundaries. 

These same people elaborated on how they responded when their therapist first made the suggestion. Their responses illuminate the real vulnerability that exists among clients seeking support from a Latter-day Saint therapist:

• “My first instinct was to wonder … whether I misunderstood the gospel standards.”
• “I felt confused, but I assumed they knew what they were doing.”
• “Hesitancy at first, but [name redacted] helped me realize the Church was more open-minded than I thought.”
• “I didn’t say anything. And I never went back.”
• “My first thought was, ‘I didn’t realize this was okay.’”

Strikingly, none of these people reported pushing back or clarifying their boundaries. And many admitted they had left the session believing that the therapist’s recommendation somehow implied Church approval.

Perhaps the most natural solution to some of these challenges, as many have pointed out, is to ask therapists to provide more transparent “informed consent” in terms of acknowledging their own values relevant to a client’s specific concerns. In the case of a Latter-day Saint therapist who has significant critiques of core doctrines taught by the Church of Jesus Christ, this would mean being upfront and candid about that with potential Latter-day Saint clients. In other cases this could mean disclosing more clearly the role a therapist sees themselves playing—for instance, potentially explaining to clients that they don’t see themselves responsible for maintaining boundaries of Church teachings.

But in my informal survey, only three respondents (of 117) selected yes to the question, “Did your therapist disclose that it was not their responsibility to maintain boundaries of Church teachings?”

But even when therapists believe they have made their role clear, the disclosure does not always have the effect therapists may hope. 

Wielding Spiritual Power

Ethan was nine when he first saw pornography. Like so many he was curious. But by the time he was a teenager, it had become obsessive. The habit affected his schoolwork to such a degree that he lost his place on his school’s wrestling team, and he felt he could not relate to girls of his same age. He also felt tremendous religious guilt. 

Ethan worked with his bishop to begin to quit the habit. Slowly, but surely he had reduced his usage to only a few times a day. He had gotten his academic eligibility back and was excited to try out for the team again the next year. At that point, his bishop recommended he see a therapist. At first, Ethan wasn’t able to get an appointment with a Latter-day Saint therapist, so he went to a practitioner from a different faith tradition. But Ethan tells me that with his habit no longer out of control, the therapist wasn’t sure what he wanted help with. So he went on a waiting list to see a Latter-day Saint mental health professional.

He remembered the excitement he felt when he finally got his appointment for his first session. It felt like a weight on his shoulders was about to be removed. 

During the first session, Ethan tells me his therapist informed him that she would not tell him what he should or shouldn’t do and that it was his job to tell her what his values were.

During only the second session, however, Ethan’s therapist asked him why he wanted to stop viewing pornography altogether. He admitted to her it was no longer affecting his school or relationships, but that he felt guilty about it. So, she told him, “You don’t have a pornography problem, you have a guilt problem.”

Ethan tells me that it never occurred to him until that moment that you could be a faithful Latter-day Saint and watch pornography every day. 

I pressed Evan, “But she had just told you she wouldn’t decide what is right and wrong.”

“Sure, but that had been a few weeks before. I knew she wouldn’t tell me what to do, but it never occurred to me that she would tell me to do something wrong.”

Since there had been a recent General Conference address on shame culture, Ethan told me that he assumed that the Church had been changing its position on pornography. “Why else would she have told me that?”

Ethan went on to tell me that the conversation did help him feel considerably less guilt and more freedom. He went home and dove right back into his habit. Ethan remembers his mother confronting him about it a few weeks or months later, and him retorting, “my therapist says it’s okay.”

Within a few months, his habit had reverted to the point it was once again affecting his daily life. “But,” he tells me, his therapist “never brought up quitting [in therapy]. It was all about how to deal with the guilt.”

To recap:  Ethan went into therapy wanting to quit pornography entirely. His therapist disclosed that it was his responsibility to maintain his boundaries. And yet within two sessions, he had adopted an entirely new path based on a suggestion he did not generate and that he had never before considered. 

This brings to mind Brigham Young University professor Brent Slife’s important and timely argument that therapists often act even unwittingly as “crypto-missionaries.” Therapists may aspire to provide their clients with “self-determination,” but as the stories of Alison, Hyrum, Ethan, and many others suggest, this frequently does not occur for clients who hope to maintain religious boundaries. 

The therapists who signed this public letter, however, seem to suggest that even if clients expect them to maintain the guidelines of the Church, this would be impossible since these guidelines are not always perfectly clear. They wrote, “Our clients are frequently confused” about “what qualifies as ‘guidance consistent with doctrine.’”

From my interviews, however, it appears that many clients recognize this and hope that their therapists will in fact help them see Church doctrine from different points of view, but importantly still within the broadly accepted guidelines of the Church. 

My informal survey asked respondents to identify which if any of the following were “Church guidelines.”

• Love one another
• Forgive others
• Be honest with others
• Regularly pray and read scriptures
• Attend sacrament meeting and the temple regularly
• Believe in God, Jesus Christ, Joseph Smith, and the modern-day prophet.
• Do not have sex outside of marriage
• Do not view pornography
• Do not engage in emotional, physical, or sexual abuse
• Do not partake of tobacco, alcohol, or illegal drugs

More than 90% of respondents selected each of those options, except attend sacrament and the temple regularly (perhaps because of current COVID restrictions). Yes, there remain some questions about Church guidelines, but there appears to be a robust agreement around general Church guidelines and values that clients seeking out Latter-day Saint therapists expect them to share and encourage in sessions. Thus, advertising that you are a “Latter-day Saint” therapist does not appear to be a nebulous category that merely communicates cultural familiarity, but rather communicates to many clients a robust shared value system that they expect to be able to rely on.

Nothing suggests these therapists intend to mislead their clients. Those who signed the letter wrote, “It would be highly unethical and ineffective to ‘trick’ our clients into ‘trusting us’ with a goal of influencing them in regards to their relationship with the Church or to promote values that go against (or go in favor of) Church teachings.” But the differences in expectations amplified through the power differences between a therapist and client frequently seem to create a situation where clients are being legitimately misled. 

Dr. Cedar Barstow, an educator and psychotherapist, explains that there is an inherent power difference between therapists and their clients. She writes, “The power difference between therapist and person in therapy, or other similar pairs, is the dynamic that creates down-power vulnerability. Down-power vulnerability, based in a role, is what creates the need for ethical guidelines to protect people from harm.”

When therapists advertise themselves as Latter-day Saints, it is clear that they create an expectation among a significant portion of clients that they will provide therapy within the broadly agreed-upon boundaries of the Church. These clients trust their therapists to help them improve their mental health while keeping them spiritually safe. Gratefully, once again, many Latter-day Saint therapists do exactly this and provide support within these expected boundaries.  

Yet in all too many cases, Latter-day Saint therapists seem to be significantly violating that trust. 

And those therapists who signed the letter cavalierly suggesting that maintaining spiritual boundaries is not their job, now arguably have a huge gulf of trust to overcome with their clients who reasonably expected otherwise.

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