Jacob Z. Hess, Ph.D., Co-Founder AllofLife.org

[Note: Since posting these questions years ago, there are many improvements that have been made to the mental health website, including some that touch on these issues below. Not all these concerns remain current, while some still do].

Like most families, ours has faced the exhausting and exasperating burden of mental illness. And like most Mormons, I’m grateful for the growing efforts in the Church (punctuated by Elder Holland’s seminal talk in 2013) to support an increasingly sensitive and thoughtful conversation about mental/emotional challenges in our faith community. From recognizing the brutal legitimacy of these struggles, to offering wise counsel for loved ones and hopeful encouragement for those struggling, to the impassioned witness of Jesus’ ability to heal – there is so much to love about this new Church effort to raise awareness around mental health.

Soon after Elder Holland’s talk was given, though, I noticed some concerning ways his message was being interpreted – including perspectives that felt quite at odds with the spirit of his remarks. For instance, I personally heard accounts of individuals with personal concerns about anti-depressant treatment being pressured to drop their silly questions, along the lines of, “SEE…God expects you to use everything He has provided – including Prozac. That’s what Elder Holland said[1]!”

Far less attention was given to the other verb Elder Holland used in the same paragraph– namely, to “prayerfully and responsibly consider” counsel and solutions recommended – not to mention the broad, multi-faceted picture of healing portrayed in his talk.

After 15 years of studying contrasting interpretations of questions like these, I’m fascinated by the diverging ways that human beings narrate suffering and grief in various forms (with depression the focus of my dissertation research). Out of this narrative interviewing research, I’ve been especially struck by the practical, real-life consequences of various narratives we adopt for choices made (or not made) and paths taken (or not taken).[2]

Because the particular mental health narrative adopted by people clearly matters in all sorts of practical ways, I can’t help but raise three specific questions about the LDS Church’s new mental health page. Although relevant to anyone facing mental/emotional challenges, these questions are addressed specifically to the creators of this new mental health campaign.

I raise these questions sincerely, hoping simply to add my voice to the ongoing conversation.[3].

1. Are you aware how acutely the professional, medical and research communities are divided over the nature of mental health problems – and what to do about them? It’s common to hear some mental health organizations proclaiming the “truth” about mental illness – as if researchers had uncovered clear realities that are now generally accepted consensuses. For those closest to the research, however, such a declaration is baffling, given how quickly and dramatically the scientific landscape has changed in the last 15-20 years. This includes paradigm-breaking discoveries of brain changeability (neuroplasticity) and the advent of mindfulness-based treatment approaches.

Taking in a full view of this research literature, it would be more accurate to say (a) we are in the middle of a dramatic period of expansion in mental health understanding (“further light and knowledge” in Mormon lingo) and (b) thoughtful, smart researchers and professionals (and patients) currently hold remarkably different views of the nature of mental illness, and what to do about it. All this, one could argue, is expected – and even inevitable – in a period of such rapidly shifting paradigms within mental health and medical science.

Rather than declaring one perspective as indisputable truth, some colleagues and I have experimented in recent years with a different approach – publishing careful explorations of key mental health questions in peer-reviewed journals[4] and then creating materials that help promote thoughtful public conversation around the same issues.[5]

What we’ve found is that people are often relieved to have the space to explore for themselves different perspectives and options in response to the serious problem of mental/emotional illness. Rather than being pressed in one direction or another, individuals and families who have a chance to explore their sense of what is best often find not only a pathway of healing more authentically chosen – but also one that is literally more effective for them. No matter their choice, our goal as mental health collaborators has been providing support for people’s exploration and deliberation of different options.

2. Can you help me understand why you’ve chosen to advocate one particular (disability) perspective on recovery, without acknowledging other viable approaches? One of the key questions that continues to be explored in the larger mental health discourse centers on the nature, meaning and possibility of recovery. On one hand are those arguing that mental illness is most accurately described as primarily reflecting an enduring deficiency in the body that may persist over one’s life, but can be managed or controlled through medical means. Daniel Fisher, former member of the White House Commission on Mental Health, calls this a “rehabilitation” or “disability” approach to mental illness. While recognizing that some people may find deeper and longer-term levels of healing, this approach de-emphasizes that possibility as any sort of general aspiration and instead encourages people to accept the general reality of mental illness as what will likely be an enduring part of their life – or even part of who they are.

Another perspective speaks of lasting, sustainable recovery as a possibility worth holding out for those facing mental/emotional struggles, however serious. Without raising naïve hopes for quick healing (and while recognizing that some may live with struggles for a longer than expected period of time), this approach emphasizes lasting healing as a legitimate possibility to aspire towards, even in the most despairing of cases. As one woman previously diagnosed with schizophrenia (and now living independently) told me in an interview, “never predict the recovery of another individual.” In particular, this approach resists labeling mental health conditions either as life those struggling must simply accept for good or who these people are (“my son is ADHD…my husband is bipolar”).

Depending on the distinct interpretation of recovery adopted, it seems clear that practical, measurable consequences for prognosis and long-term healing can ensue (see our in-depth review paper of some of these potential consequences).

So much of the larger message and spirit of the Church’s mental health website centers on hope in the form of ultimate healing through Christ. This is a message welcome to anyone who claims to believe in the Deliverer himself. At the same time, much of the website’s descriptive language about the lived reality of mental health conditions underscores and recapitulates a disability narrative of recovery with striking fidelity. From “living with mental illness” headlining the site, to phrases like “learning to cope with a mental illness,” the nature of mental illness is portrayed as a chronic disability that is best managed and controlled in the practical day-to-day reality. Christ’s help is thus framed as hugely and supremely valuable, albeit without altering the fundamentally chronic nature of the conditions – e.g., “He can help you feel peace and find meaning in life despite your mental illness.” Lest the enduring temporal nature of mental illness was not completely clear, even the e-mail inviting questions is pointedly labeled, “disability@ldschurch.org.” [update: this is no longer the listed email on the site].

Without denying that some can and do find these conditions coming up over a life-time (for many different reasons), can you see how this kind of language may set up others to assume this will be the case for them too?[6] This can lead to what we’ve called learned hopelessness – a state of mind that can arguably multiply and compound the despair those facing mental/emotional challenges already feel.

3. Given the scientific picture of long-term outcomes for those on psychiatric medications, are there risks to framing medical treatment as an essential, indispensable part of recovery – or even an expectation from God?  Currently, the website offers fairly explicit encouragement regarding medical aspects of healing (understood by most readers as psychiatric treatment). More than simply raising medical treatment as one option to consider, the website raises this possibility as an indispensable and key part of recovery – e.g., “spiritual healing and medical healing work together to form the key to lasting happiness.” [note: this has been removed from the website]. 

At best, the current medical literature paints a very complex picture about psychiatric treatment. In my dissertation research on depression, I was struck, among other things, at how widely different the experiences of people on anti-depressants were – ranging from those who saw the treatment as literally ‘redemptive’ to others who saw it as responsible for deterioration.

The FDA has approved these anti-depressants, of course, because of research documenting a particular group of people benefiting over placebo when taking an anti-depressant over a certain amount of time (typically 3-6 weeks).  The existing research base, then, supports a sensible use approach where someone uses an anti-depressant for a short-period of time, and then eventually tapers off with a doctor’s support.

That is not however, how these medications are being used in many (most) cases. It has become common practice to prescribe and use anti-depressants for many years – even decades.[7]

If not for the findings of controlled trials exploring long-term outcomes of people on anti-depressants, there may be little reason for concern. But the consistent results of these long-term studies (summarized here, by a Boston journalist Bob Whitaker) raise questions worthy of at least our serious consideration. I have interviewed Bob twice – and found him a humble and honest journalist. He began looking into the long-term evidence after a friend took his life by suicide.

What he found, contrary to his initial hunches, was an empirical picture suggesting that long-term use of psychiatric medications (in contrast to sensible, short-term usage) is partially contributing to the increasing rates of chronic mental disability in our country (see again the 22 research studies and articles annotated here).

**Note to medical doctors:  Don’t stop reading! Harvard and other medical schools across the country have invited Bob Whitaker’s data-driven presentations because his summaries of the evidence are impeccable and fair. His is not an anti-medication message – and he regularly insists there is an important place for psychiatrists in this picture. He’s simply calling for a bigger conversation – including about the appropriate place of these meds in a larger picture of sustainable recovery.   

At a minimum, these long-term findings might give us pause when it comes to sending any absolute or prescriptive message about treatment in our educational efforts.

I mentioned earlier some of the ways people have interpreted Elder Holland’s original talk – especially three lines right in the middle.[8] Rather than providing some context and nuance around that part of his talk, the new campaign underscores and highlights those three lines at the mid-point of the new video. Rather than encouraging people to prayerfully consider professional recommendations (sorting through what feels right or not), the website takes up a language of compliance – recommending that people “make every effort to comply with your bishop, doctor, and counselor’s recommendations.”

Compliance = obedience. And the Latter-day Saints will obey, if that’s what is asked of them. For instance, I’ve watched LDS parents acquiesce to a doctor’s recommendations for their child to be on psychiatric medication, even though they felt uncomfortable with it.

I respect that many believe this kind of decision is a good model to follow – with the best chance of allaying mental health problems and suicide.

I raise these questions above hoping at least to raise another perspective on how and why other people (who care equally about supporting those facing serious mental/emotional challenges) may be concerned with some aspects of this newly-minted mental health website. And to be very clear, as cited above, there is reason to believe that some elements of your current message may inadvertently and indirectly (and over the long-term) contribute to increasing the chronic burden of mental distress in our community over time.

To conclude, I can’t resist three simple recommendations for the creators of the website that would go a long way towards resolving some of the issues outlined above:

1. Understand and acknowledge at some point in the educational effort that profoundly different perspectives exist in the medical and research (and patient) communities – and that this is okay. The attitude of  ‘there is a lot more to learn’ openness was an element of the MormonsandGays.org website that many people appreciated. A little more of that in this website’s messaging would give leaders and members space to explore different perspectives together.

In the absence of that, you will be read as endorsing one particular perspective. Rather than promoting thoughtful dialogue, the practical result will be insinuating the yielding to one particular course of treatment as reflecting the fulfillment of God’s expectations. Is that really what you want?

If so, bishops, mission presidents and relief society presidents will surely faithfully represent this same message to distressed members – “God expects you to embrace all these gifts…I understand you have concerns, but it’s important to be compliant, etc.”

There are SO many different things that can help someone facing mental/emotional challenges. Why not paint this full-spectrum picture for people, rather than dictating what precisely should happen in response? [9] In this way, you would be encouraging members to explore what felt right among the various options, thus making space for a vibrant conversation among people about how best to respond.

2. Leave open the possibility of lasting, sustainable healing. In apparent contrast to the larger doctrinal foundation of hope in Christ and some lovely interview excerpts, the current descriptive language on the website clearly and consistently insinuates a lived experience of chronic disability for those facing mental/emotional challenges.

Consider at least introduces the possibility of deep and sustainable healing as an aspiration to move towards in this life. More than a wild hope, this possibility is wholly consistent with the optimistic findings of current brain science, epigenetics and the long-term recovery literature across mental health conditions.

3. Respect people’s intuition and space to make treatment decisions that feel right for them. This may include embracing anti-depressants or resisting them as a part of their healing journey. Either way, it seems wise for institutions that hold such power and trust to stay far away from insinuating that obedience to a particular treatment regimen is God’s will.

Within that space, people can then craft a wellness plan that is right for them, incorporating all the elements that they and their loved ones (in consultation with trusted professionals) decide is best.

And that’s it!  Three questions about the new mental health campaign.

Thank you for considering my thoughts.

Notes: 

[1] These three lines, in particular, have been leveraged to add pressure:  “If you had appendicitis, God would expect you to seek a priesthood blessing and get the best medical care available. So too with emotional disorders. Our Father in Heaven expects us to use all of the marvelous gifts He has provided in this glorious dispensation.”

[2] This is especially apparent over the long-term, with sustainable recovery and long-term outcomes becoming a central focus of my research in recent years (see  Hess & Lacasse, 2011)

[3] I’ve been telling people for years that asking sincere questions is not a sign of lacking faith – and, indeed, welcome in the Church. A belief in the power of open, respectful questioning motivates my involvement in directing Village Square Salt Lake City as well.

[4] Three examples:  “Narrating the Brain: Investigating Contrasting Portrayals of the Embodiment of Mental Disorder” (Hess, Gantt & Lacasse, 2015); “Is There a Getting Better From This, or Not?” Examining the Meaning and Possibility of Recovery from Mental Disorder (Hess, Lacasse, Harmon, Williams and Vierling-Claassen, 2014) “What Does It Mean for an Intervention to ‘Work’? Making Sense of Conflicting Treatment Outcomes for Youth Facing Emotional Problems” (Hess & Lacasse, 2011)

[5] Over the last couple of years, a small team of volunteers at our mental health non-profit interviewed experts and patients around the country – creating a 15 lesson class freely available to the public (see Mindweather 101:  Working Creatively with Intense Emotion.

[6] If it was in the nature of mental health problems to endure over time in this way – if that was their natural course – it would seem wise to do just that. If the outcome literature or the brain science confirmed an enduring, chronic experience of serious mental health problems, then conveying this message is what people should do. But that’s simply not what the brain science or clinical outcomes suggests.

[7] Life-long treatment is a logical implication of a life-long prognosis, as discussed earlier.

[8] These three lines, in particular, have been leveraged to add pressure:  “If you had appendicitis, God would expect you to seek a priesthood blessing and get the best medical care available. So too with emotional disorders. Our Father in Heaven expects us to use all of the marvelous gifts He has provided in this glorious dispensation.”

[9] As it stands, your message about the nature of mental illness and its appropriate response hews tightly to the messaging of the National Alliance on Mental Illness (which you reference on your website). While NAMI has done commendable work to provide support and community for those facing mental illness, several years ago they were forced to disclose that they receive the bulk of their funding from a wide array of pharmaceutical companies. Consequently, many concerns have been raised in research and professional communities at the selective interpretation of the research present in NAMI materials and classes –reflecting content that virtually always centers on pharmaceutical products while typically minimizing brain changeability and the potential of lasting healing.