In recent years, Mormonism has been doing much better when talking about depression and mental health struggles, helping destigmatize them and encouraging its members to seek assistance. Elder Jeffrey R. Holland’s October 2013 General Conference address, “Like a Broken Vessel” spoke candidly about these topics, and the church’s mental health section at LDS.org/mentalhealth is likewise open-hearted about depression and mental health illnesses, and also teaches us about ways we can compassionately interact with those in our families, wards, and circle of contacts who grapple with them.
In non-official LDS circles, the LoveLoud Festival (now a month away from its second event) has raised awareness about the suicide crisis among Utah teens and young adults, especially those who identify as LGBT+. LoveLoud’s founder, LDS rock star Dan Reynolds of the band Imagine Dragons, has just this past week been featured in a full-length documentary, Believer (began airing June 25th on HBO) about his coming to awareness about the struggles of LGBT Mormons, and his energetic work in conceiving and organizing the first festival. We are grateful for both of these great developments.
Just as with every medical issue, though, it’s important to explore as fully as we can the literature and scientific research surrounding it. And in the case of depression and suicide, as well as several other mental health issues, the findings don’t present as clean a picture as most of us have understood about the efficacy and advisability of even short-time use of anti-depressants, especially among teens and young adults, as well as about long-term benefits for most everyone. The first line treatment program for clinical depression today is drug therapy (and recent church-initiated mental health education affirming this approach), but increasingly, many researchers are asking if that should be the case.
This episode features two important voices who are asking questions like this: Robert Whitaker, a celebrated journalist and author who focuses on science and medicine, and Jacob Hess, Ph.D., a mental health researcher and advocate for better discussions about important questions such as “How can people find more sustainable healing from depression?” Neither Bob nor Jacob are anti- anti-depressants so much as pro- “informed consent.” In this discussion, they overview much of the literature about long-term anti-depressant outcomes and offer background into the paradigm shift that took place some thirty years ago when anti-depressant use began to soar, and they compare it with actual findings about both short- and long-term outcomes. They also share information about many factors that contribute to depression, anxiety, and several other mental health challenges and what research is showing about effective therapies that help with those either in combination with medication or without it.
The story they tell is fascinating, as well as difficult to hear but also hopeful. We hope you will pay close attention to this episode and share it with those you know who could benefit from hearing a wider view on today’s understanding of the causes of many mental health struggles and prevailing treatment approaches.
Depression Risk Factor Inventory
Based on the medical literature showing anything contributing to depression, this inventory can help someone identify areas of depression vulnerability (or strength), in turn providing data to create a comprehensive plan of possible adjustments that could support more sustainable healing.
Mindweather 101 Class
Nearly seven hours of free online education from researchers and mindfulness teachers on the potential of a more gentle approach to pursuing sustainable healing from serious mental/emotional distress–co-created by Jacob Hess & Thomas McConkie.
Robert Whitaker’s comprehensive summaries of the scientific evidence documenting long-term outcome of psychotropic meds: Anatomy of an Epidemic (here are specific summaries of the historical & empirical evidence specific to antidepressants).
Robert Whitaker’s mental health site (started after his first book Mad in America), now one of the more popular mental health reform websites: Mad in America
16 video excerpts from a Jacob Hess interview with Robert Whitaker
List of additional recovery resources to support those seeking more sustainable healing from depression, anxiety, and ADHD –- as well as wise support for safe tapering.
Website of Jacob Hess’s non-profit “All of Life.” Here’s a summary of current projects, including its suicide risk factor project and best practice reviews.
Foundation for Excellence in Mental Health Care – the leading national foundation gathering resources for more innovative research and development of recovery-oriented supports.
Jacob Hess’s 2018 summaries of these mental health questions and possibilities – the first, a general summary & the second a summary specific to the Latter-day Saint community:
(1) A Plea for a More Honest + Less Despairing American Mental Health Conversation (video)
(2) Why I Believe My Faith’s Embrace of the NAMI Approach Is Ultimately Hurting People Facing Depression (Despite Earnest Intentions Otherwise);
Jacob Hess’s two recent pieces on suicide:
(1) Ten Simple Things We Can Do Immediately to Reduce Suicide: A Zero-Cost Public Mental Health Proposal
(2) Another Hypothesized Contributor to Youth Suicide That We’re (Mostly) Not Talking About. Can We Start Now?
While I really appreciated Jacob’s view that depression must be addressed as something with multiple causes, and thus must be treated holistically, the focus in the first half of this podcast inherently reduced medical interventions to a conspiracy by the pharmaceutical companies payment to the APA and the profession of medicine. I can honestly say that Robert’s claims of conspiracy instilled in me a degree of contempt towards this episode.
I have lived through depression, and been a caretaker of someone with Major Depression Disorder and Generalized Anxiety Disorder for the better part of forty years. No psychiatrist among the literally dozens I have worked with over this period reduces their treatment to pharmaceutical treatment alone: every one of them seeks to ensure that the patient accompanies any pharmaceutical treatment with therapy and other means in order to treat the causes of depression. Robert’s characterization of the psychiatric profession was patently false and misleading, and to the extent that Jacob said that he agreed with Robert tended to reduce the effectiveness of the very appropriate message Jacob was trying to convey: that pharmaceuticals, if used at all, should be part of a comprehensive approach toward depression.
Both Robert and Jacob reduced the medical perspective of depression as being a deficiency of neurotransmitters, which is to dramatically oversimplify the science here. Depression is a complex neurotransmitter disease of the brain — yes, it is a disease — not necessarily caused by a lack of seratonin, but rather, an systemic imbalance and inability for the synapses to properly use and reuse neurotransmitters. While SSRIs and other psychoactive drugs can increase the overall levels of neurotransmitter chemicals, they do not, by themselves, do much to solve the system problems involved in neurotransmission.
At this point, we have decades to go before we have a remotely effective understanding of the brain. The profession of psychiatry is perhaps still in the era of using leaches to solve problems — there is no definitive diagnosis to determine what problem is causing depression, nor is there a definitive formula for remediating the symptoms. The scientific method is our best approach toward getting to an answer. And whether we like it or not, whether Robert thinks it is conspiratorial or not, the medical profession attempts to use the best methods of science to get to answers and cures for suffering.
Pharma is an easy target to hate, but it also employs science to get to appropriate solutions to medical problems. And yes, because the FDA requires extensive testing and proof of the science to the extent possible, pharma benefits by having a huge barrier to entry for competition. Pharma invests a lot of money to get to a medicine that has been tested and proven to help. And because of the FDA barriers, Pharma companies make huge profits once they have something that has been proven to work in some way without significant adverse effects. Are there cases of fraud and abuse? Absolutely. Do Pharma companies make exorbitant profits? Unquestionably. But are Pharma companies in a conspiracy with doctors and the American Psychiatric Association to push drugs without science or medical best practices? Absolutely not.
I have seen the dramatic effects of psychiatry properly done. I have also seen the dramatically bad results of psychiatry done wrong. I have also seen people die because they don’t get available treatment and rely upon unscientific alternative medicine or don’t avail themselves of medical professionals’ advice. In my opinion, this podcast — at least in the first half of it — did significant harm to the community by promoting the rejection of medical science based upon Robert’s conspiracy theory.
The balanced approach, proposed by Elder Jeffrey R Holland, is to avail oneself by ALL the best practices, both spiritual as well as medical. This podcast condemned Elder Holland’s very sound advice to seek the best practices — truth — from wherever it may come. I sensed that Jacob agrees with this premise, yet he agreed with Robert in condemning Holland’s address.
So if we condemn the balanced approach recommended by Elder Holland, then what? If we condemn and stigmatize using medical treatment of depression, then what is the alternative? Shall we go back to the bishop because the depressed feels inherently unworthy and then subject ourselves to church disciple for being depressed? Shall we pursue homeopathic “medicines”, the dilution of which ensures that not a single molecule of the “medicine” actually is used in the cure? Shall we pursue essential oils or other treatments that have never proven to be helpful as well? Thank goodness this podcast didn’t recommend such alternative “medicine” as the alternative for scientifically-based medicine. But this podcast clearly condemned the medical profession for being in conspiracy with pharma.
Just to be clear, I am no fan of either big Pharma, nor do I like the idea of chronic dependency upon psychoactive medications. I do think the mind does much better when we have a comprehensive, holistic view of mental, spiritual, emotional, and physical health, Depression is indeed a medical condition, but the causes are often very complex and require care and attention. Medications are a valid tool in treatment of depression, but they are not the only tool, and must be used with care and balance. At the end of the Podcast, Jacob confirmed this to be the case, but I’m afraid that the gross disservice to the medical profession was already done earlier in the podcast.
I know it’s hard for people to think that academic psychiatry in the United States has told a fraudulent story to the American public for 35 years, but unfortunately it’s easy to document. The pharmaceutical companies helped fund that story and participated in presenting dishonest science to the public, but in a very real sense, it’s academic psychiatry that betrayed the people. Their profession was the one that had the duty to be a faithful reporter of science, their research and so forth.
For instance, for the longest time, the American Psychiatric Association told the public that depression was caused by low serotonin, and that antidepressants helped fix that chemical imbalance. Yet, if you follow the science, you find that low-serotonin hypothesis never panned out, and that the APA, in its own 1999 textbook, acknowledged that was so. The textbook proclaimed the hypothesis dead. So there you have people being falsely told that they had a known brain disorder, when the science had not found that to be so.
Here is another example of such betrayal. In the TADS study of adolescent depression, the researchers reported–in the abstract and in their conclusion– that there was no excess suicide risk in those treated with placebo versus those treated with an antidepressant. A chart showed a fairly equal number of suicide attempts in both the placebo and CBT groups, compares to those in the medicated group. But in fact, all but one of the suicide attempts in the patients randomized to placebo and CBT occurred after they were then switched to the antidepressant. All told, 17 of 18 suicide attempts were in youths on drugs. You can read more about this deception here: https://www.madinamerica.com/2012/02/the-real-suicide-data-from-the-tads-study-comes-to-light/
There are so many examples of this type, where data was spun or hidden in published reports. You often have to dig into the published studies to ferret out the real results.
As I think I said on the podcast, it’s not a matter of whether people should take the drugs. It’s a matter of informed consent. That’s the ethical principle that I was trying to set forth.
I think depression is an extremely important topic for LDS, and I would hope discussion of depression might continue on MormonMatters.
Seems to me that we LDS offer a “Plan of Happiness”, with all the trappings of a happy life, provided we worthily obey.
But what if we aren’t happy?
The typical response was that if we are depressed, there must be something amiss in our lives: we are not worthily obeying. This, in and of itself is depressing.
So the medical answer promises relief to the sufferer by removing the depression-enhancing guilt and shame associated with “unworthiness”.
So far, so good. But the medical answer only treats part of the problem. Psychiatry recognizes this, thus encourages patients toward therapy to address the non-medical causes of depression.
But here is the deal: depression is not just unhappiness, but rather a systemic deficiency in neural-synaptic activity. Unhappiness, trauma, illness, any number of problems may have caused the synaptic deficiency, but the deficiency is quite meeically real.
Compare the mind to a network of computers connected together. If the network switches are not working properly, losing packets or just being really slow, the ability of all the computers in the network to do their work is seriously impaired.
The mind is a compkex neural network of processing nodes. When that network is “depressed”, the mind does not fear nctiin properly. It’s not just emotionally sad, it’s in a state of “athymia”, lacking in the ability to emote. As well, even the mind’s ability to think clearly is impaired.
As the conscious mind noticed this lack of energy (athymia), it compounds the depression by needling frustrated with one’s own ability to feel better. This crrates a downward spiral.
The right neurotransmitter stimulus may help kick-start the brain into processing better, addressing the athymia by stimulating the activity of the neural network. If it works. Then the brain itself may accelerate recovery to the point that the brain can fix the underlying causes. This is where short term use of SSRIs or other neurotransmitter agonists (dugs) might help.
But to go back to the computer network metaphor, flooding the brain with a given neurotransmitter is kind of like increasing carrying capacity of the network wiring: it might help a little/-maybe even a lot in the short term, provide that is what the problem was, but it never can get to the actual cause, unless the actual cause was the capacity of the network wiring.
So, yeah. There is no free lunch here—there are no quick answers.
This podcast is an ideal place to discuss the nature of depression from a spiritusl perspective. If the primary and most enduring aspect of depression is athymia—the depression of emotional energy, then the answer may be found in thymos: spiritual energy. And “Thymos” was/is what Plato defined as the spiritual dimension of the tripartite soul.
I have seen this process close-up and personally. Thymotic drive is the personal passion with which we thrive: it’s the sense of personal identity and self respect that drives us to action, either in passion as positive energy or in anger/wrath as negative energy. A depressed person really cannot do either, but as one recovers—often vía medications as temporary fixes to the imbalance, the patient is able to emote—often in very negative ways at first.
For example, SSRIs can give a depressed teenager the strength necessary to commit suicide in self loathing/anger. This is a very thymotic act: wrathful toward self.
This isn’t to say that the SSRI caused the suicide, but it certainly enabled it—and there is a big difference. This increase in thymotic energy is essential, but must be carefully managed.
But how? And that is the discussion missing here, or at least begs a follow-on.
I (mostly) enjoyed this podcast. I feel like it gives hope, that depression won’t last forever. However, I feel like it sets up a paradigm to shame people who may not be able to make changes in their lives. I wish there was a way to combine this approach with destigmatization.
There definitely is, Rukie! Ours is not a “pro-stigmatizing” approach – and the idea that many life changes can make an indirect, and gradual influence on depression vulnerability can be approached in a very gentle and mindful way. That, at least, is what I always teach. We explore adjustments as we are ready – not in a frenzy of “I need to change everything” or “I’m awful because I can’t change this”…but as we’re ready, as we’re able.
For many people I’ve taught, they’ve hardly heard from anyone that they CAN make changes that will reduce their vulnerability over time. So that possibility alone becomes very relieving.
Clearly, we’ve touched a nerve here, Mark – which is understandable, given the deeply personal matter this is. In the strong emotion behind your response, I do think you’re skewing what we’re saying somewhat.
For instance, neither of us are “condemning” Elder Holland’s address or approach, as much as pointing out how three sentences have been interpreted as some kind of divine mandate for medical management as a ubiquitous, even “expected” part of recovery. Especially in light of the evidence for long-term outcomes, this concern seems not only reasonable, but quite consistent with how that one part of his remarks have been taken.
If by “conspiracy,” you mean someone twirling their mustache and plotting how to make more people sick “in league with the doctors,” then of course we’re not talking about a conspiracy. However, if by that same word you mean research details that the general public has not been privy to (nor doctors) and a medical practice that’s been heavily influenced by industry, then there’s clearly a lot to talk about….so why not allow and encourage that conversation?
Five different counties in Utah are currently suing Opioid manufacturers for inflating the positive benefits, and covering up the full extent of adverse effects. We’re essentially proposing that we consider this same possibility for antidepressants.
Rather than hurting people, our strong feeling is that the lack of this conversation is what’s potentially harmful – and that, in fact, exploring these possibilities can lead to common sense adjustments to protocol that can save lives (as you hint about in the final parts of your second message).
Our shared sense is we’ll be much better off bringing all our passions and concerns together in a conversation that includes these disagreements. Though it might unsettle folks (like yourself) who are convinced of the narrative of psychiatry’s great forward progress, that surely would be worth it if our concerns are as empirically justified as we believe them to be. One doctor threw Bob’s book (Anatomy of an Epidemic) across the room after reading it – feeling a similar frustration – but then had to admit that the long-term evidence couldn’t be denied. If you’re willing, pick up a copy of that book to see your feelings after hearing his whole review. Many thousands have written Bob claiming the book was life-changing in a very positive way.
Thank you Jacob, for your reply.
You said, “ if by that same word you mean research details that the general public has not been privy to (nor doctors) and a medical practice that’s been heavily influenced by industry, then there’s clearly a lot to talk about….so why not allow and encourage that conversation?
Sure, let’s have THAT conversation. But that wasn’t the conversation Bob was proposing. Instead, he was condemning the APA and psychiatrists as being complicit in the Pharma industry’s conspiracy. And the truth is far more complicated than that.
Take for example, Bob and your condemnation of what Elder Holland said. You implied that by him saying that members should avail themselves of professional options, that this green-lights a purely pharma solution of taking a pill to get better. Such reductionist rhetoric skews what Elder Holland was recommending, as well as being profoundly hypocritical on Bob’s part: by categorically rejecting solutions including pharmaceuticals for chronic depression, he’s doing exactly what he’s accusing Elder Holland of doing.
No, I haven’t read his book, and given his bombastic presentation and accusations I have exactly zero inclination to do so.
I did not, by the way, imply that psychiatry had made great forward progress, nor am I a fan of pharmaceutical solutions. In fact, I suggested that psychiatry is barely at the “leeches” stage of medicine in understanding the complexities of the mind and brain. My issues is how you and particularly Bob point out Pharma’s pursuit of profit as a categorical disqualifier for any validity of a pharmaceutical solution. And yes, Bob painted this in dramatic conspiratorial terms. Just because someone makes a profit or pays for promotion it does not mean they are guilty of subterfuge.
Did Pharma skew results? Are they corrupt? Again, I acknowledged that they have done so and are often corrupt, but certainly not always.
Consider the fact that at the time SSRIs emerged on the market, there was, and remains, a significant resistance in the marketplace and culture that a drug to fix an emotional problem sounds an awful lot like something akin to alcoholism and drug abuse. Prior to SSRIs, treatment of mental disorders, and particularly anxiety, was often via valium and other highly addictive and mind/mood altering substances. SSRIs do not work in this same fashion, but rather, attempt to enable the natural seratonin within one’s brain to be used more efficiently by not being re-uptaken back into the neurons. A person on an SSRI does not get “high”, but in fact it takes weeks before any effects are felt. But to a culture, SSRIs were “drugs for the mind” — and there was a stigma against the drug.
In response, the pharma companies sought to destigmatize SSRIs. Bob mentioned this specifically in this podcast, but failed to note WHY the pharmas were doing so, and what was meant by the stigma. Bob oversimplified pharma’s decision making process, and flat out used this as an example of conspiracy. This is bad science, and bad journalism. It sensationalizes the issues, and paints pharmaceutical solutions in the worst possible light. If you both think that Holland erred in recommending science, then shame on you both for condemning pharma and with it, the scientific, double-blind processes that can save lives.
Jacob, this isn’t about a nerve being touched. It’s about irresponsible journalism and condemnation of valid therapeutic tools.
As I noted in my second post, above, I’d love to have the conversation about how we can treat depression, and certainly that should include the limitations and potential distortions of pharma. But to do so, let’s drop the conspiracy theory and focus on the facts in evidence.
If it’s a “focus on facts” and “evidence” you want, Mark – then you’ll stay open to evidence that might conflict with your own convictions (even if you take issue with how it’s presented). It was the (consistent) evidence in the long-term medical studies that led Bob to the conclusions he reached. It’s why he’s done grand rounds at Yale and all across the nation – and remains in conversation with hundreds of psychiatrists about ways to adjust protocol to maximize safety.
In my view, the real danger comes not from considering more of the evidence, but rather, to write off voices like Bob and mine who are inviting consideration of other perspectives in this conversation…pretending that all the good science lines up with the predominant narrative of healing.
To be clear (and perhaps, to address your greatest concern), if someone has found benefit in medical treatment, great! Bob and I would both welcome that. What we’re critiquing is not this – but a larger story that leads people to believe (a) the nature of their brain requires long-term treatment and (b) this may be essential, and even required for individual well-being. Neither of those positions lines up with the scientific evidence as we understand it. And yes, if we have a disagreement there, let’s agree to explore that without painting either side as the Evil Empire (or the Evil Rebels). On that, we are in agreement.
Where we can improve how we present this – and ensure that people don’t hear us suggesting Darth Vader overseeing all, I want to improve! (And admittedly, the degree to which people are conscious of some of these problems in the system is a point about which Bob and I have some disagreement as well).
So thank you for your candor to share. The more passionate disagreement we can air out in this broader conversation (and yes, in a more productive way), the better shot we have at reaching treatment protocols that minimize harm – and maximize benefit. Neither of us believe we are there…so let’s GET THERE, darn it! (:
Thank you for having the courage to have this conversation. I have spent the past 5 years of my life speaking out on behalf of those who have been injured by psychiatric medications. The stigma for those who not only have sought treatment, but then have found it to be detrimental is ten fold. We are told remain silent, thay we are adding to the mental health stigma, that our message is detrimental to those who need these drugs, or that our adverse reactions are merely a symptom of an underlying pathology (which Robert Whitaker so expertly pointed out is non existent). The pharmaceutical funded narrative is often used to drown out the lived experience of millions of people like myself who have found that the drugs we believed to be life saving, turned into life altering, disabling nightmares. Like Jacob , I have no desire to remove the pharmaceutical option from the table. What I was is informed consent, recognition and support for those for whom these treatments do not work and help for those who have been injured by these drugs.
I really appreciated this episode. Thank you for your efforts. I like Mark also noticed myself cringing a bit at the negativity toward Pharma but in the end felt like you both did a good job in providing balance. I have not personally suffered from severe depression but my wife has. She listened to the podcast today and related very closely to what was said. I have sat in many of her Dr. appointments and have experienced this lack of informed consent and watched the negative affects on her as she used the medications. She has since been able to replace the medications with many of the things you spoke of and is doing much better. This is obviously over simplified as it is her story to tell not mine but nevertheless we have been through a lot together.
This all being said, I appreciate Marks passion that comes from his own personal experiences. Between the episode itself and the previous comments I feel more informed and compassionate than I ever was before and that is all I can hope for.
Thank you again