“Does God Want Me to Get on Prozac?”

The buzz around Elder Jeffrey Holland’s recent talk started almost immediately:  “it’s the first time someone has addressed mental illness in general conference.” Although serious mental and emotional challenges have been discussed regularly ( e.g., by Elder Richard Scott) and more specific recommendations made in writing by other general authorities (e.g. by Elder Alexander Morrison), this was the first time an apostle had made such explicit statements in General Conference about depression itself.

Perhaps the best thing about Elder Holland’s talk was the gentle, but direct encouragement towards other members to understand that serious mental and emotional problems are legitimate, debilitating conditions – with clinical depression described as “an affliction so severe that it significantly restricts a person’s ability to function fully, a crater in the mind so deep that no one can responsibly suggest it would surely go away if those victims would just square their shoulders and think more positively – though I am a vigorous advocate of square shoulders and positive thinking!” Elder Holland goes on, “No, this dark night of the mind and spirit is more than mere discouragement” – relating his own encounter with some of these intense feelings as well.

For anyone facing depression who has ever heard from a family member, “come on – just look at the sunshine outside.  It’s a beautiful day.  Just think on the bright side!” – these words must have been deeply relieving.  And for the family members trying and desperately wanting to be helpful, Elder Holland’s words offer some exquisite guidance on a more gentle and compassionate and patient and hopeful response.

Indeed, there is so much abundant hope and good counsel in his talk (including about preventing illness wherever possible by monitoring our stress levels better), that it has intrigued me how much attention one part of his talk, in particular, has received. After encouraging members facing debilitating depression to “seek the advice of reputable people with certified training, professional skills and good values,” Elder Holland directs people to “prayerfully and responsibly consider the counsel they give and the solutions they prescribe.”

Fair enough! When offered counsel from a therapist or a medical professional, that’s what anyone should do, right?  Think carefully and prayerfully about what to do in their own situation. But Elder Holland didn’t stop there: “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.”

“Wow, did you hear what Elder Holland just said?!!”  The flood-gates opened….one LDS woman who had not felt right about starting an anti-depressant (but who had faced substantial pressure from her family in that regard), received a text message from a family member moments afterwards, stating simply: “SEE?!!”  For a topic as nuanced and charged as the appropriate role of anti-depressants in sustainable healing, many were lightning quick to interpret his words as a full resolution – even a carte blanche endorsement of anti-depressants as something that perhaps even God was commanding us to use-when-prescribed?

For those who feel it’s the right thing personally to take an anti-depressant, such words may offer a helpful confirmation.  But what about those who feel some level of personal resistance to anti-depressants – who just don’t feel right about it?  Should they be pressured to acquiesce on the basis of Elder Holland’s statement?  Should anti-depressants be incontrovertibly accepted by the faithful as one of the “marvelous gifts God has provided” for us in our day?  And more to the point, should dissenting from a doctor’s opinion be considered demonstrating recklessness or less faith?

These are tough questions – and surely deserving of more open, thoughtful, mindful conversation among us (the very kind of gentle consideration Elder Holland demonstrated himself).  After writing 600 pages about anti-depressants in my dissertation research, I’m well aware of a nuanced and ongoing professional and research debate regarding the appropriate role of anti-depressants in healing from depression.  Researchers and professionals definitely do not agree on the answers – and there is a need for a great deal more evidence gathered on the subject.

There is also a wide personal diversity in experiences. While on one hand, many have experienced some relief and support from anti-depressants, there are many others who feel nothing or worse in taking them and growing concern with the outcomes of long-term use (which appears to make people more depressed after many years of taking them – when compared with those who never tried them).

Given the diversity of both professional and personal opinion, there is a crucial need for more space and openness to discuss these questions.  Once again, it seems clear that Elder Holland’s talk was intended to enrich our Church conversation about mental health and grow more compassion and gentleness among us – more mindful attention and mindful listening.

One thing is clear:  To use Elder Holland’s words as some kind of weapon to pressure someone into any course of action regarding medication is hypothetical to the apostle’s core message – and indeed, to the larger health of the Kingdom.  In my previous post, I have also suggested that a pattern of unquestioning obedience to medical authority may actually underlie our surprisingly high levels of anti-depressants and other prescription drugs in Utah.

Bottom line:  Let’s dialogue.  And how about supporting each other in what feels right in each of our unique circumstances?  As Joseph Smith himself underscored, pressure, control or compulsion “in any degree” is always unrighteous – EVEN when we’re convinced we know what someone else really needs.

Lots of Prozac and Mental Illness in Utah: What Gives?

Last week a new national study reported that Utah, of all places, is home to the highest rate of mental illness in the nation – with nearly 22.4 percent of the state’s adult population purportedly experiencing some kind of mental disorder in the last year (5.14 percent severely). Twelve years ago, a study by a pharmacy company indicated that Utahans had ordered more Prozac than any other state per capita. In both cases, many have been happy (and quick) to proclaim these findings as definitive evidence of the “harmful mental health effects” of Mormonism.

Unfortunately, these same critics have disregarded other various studies showing active Mormons less depressed and less suicidal than the average population – and even living 5-10 years longer than most Americans. Even so, it’s still worth wondering why Utah would show itself anywhere near the top of any of these negative lists:  So what’s going on?

After finishing my own study on depression and anti-depressants several years ago, I was asked during my dissertation defense, “why is there such a high rate of Prozac in Utah?” After pointing out the studies confirming mental health benefits for active Mormons, I suggested that the answer may be more complex than it initially seems.  For instance, since Mormons don’t turn to alcohol and illegal drugs like most Americans do to “self-medicate,” there may be more of a natural impetus towards legal avenues.

Another contributor that doesn’t often get acknowledged is that Utahans are very conservative, by and large:  We trust authority.  When my liberal friends hear from their doctor they have a certain diagnosis and need to take this or that, they’re likely to respond, “Whatever…I’ll go get a second opinion from my naturopath.”

But that’s not what we say in Utah.  We listen.  And more than likely, we obey.  (Several people I interviewed told me how they went along with their doctor’s suggestions, even though they felt uncomfortable with them because…after all, “he’s the doctor”). While there are obviously many exceptions, I would argue that conservatives as a whole are more likely to accept a doctor’s prescribed counsel and more likely to become medical consumers as a result (Brent Sharman, a local psychologist, has argued for the same possibility).  This would explain why Utah also ranks seventh in overall prescription totals – including higher than normal rankings in use of penicillin, insulin, thyroid hormones, antirheumatics, and anticonvulsants.

So what’s responsible for high prescription rates?  Mormon culture?  Or doctor-following culture?

Perhaps a little of both.  Most important questions have a complexity that is unacknowledged.  And yet it’s clear in this case, that most of the inquiry on this particular issue focuses on the “easy target” – Mormon culture.  Mindfulness is about acknowledging and opening to anything arising – and not selectively focusing on our preferred answers (whether for or against the Church). If we balanced out the discussion more, perhaps we would notice how readily Utahans are also turning to national advocacy groups for information about mental health – groups with strong ties to the Pharmaceutical Industry.  Perhaps we could notice how different the messages of these groups are, when compared with the science itself.  And maybe we would notice what an impact some of these messages may be having on actual individuals and families.  For instance, once you come to accept the notion of a permanent chemical deficiency in the brain, you are clearly more likely to pursue certain treatments (and less likely to try others) (for an academic examination of this connection, see my in-press article here with colleagues at Florida State, Brown University and BYU).

So what’s the answer?  How about a more balanced, open dialogue – for starters? The problem isn’t trusting doctors – who can be a crucial support to our health.  The problem is when the terms of the health discussion are being set by large companies, rather than by individual patients and their doctors.  As my colleague Jeff Lacasse and I recently argued, “If the general public is to make treatment decisions that are fully informed of the entire scope of costs and benefits, they deserve a picture independent of those standing to profit from those treatments” (Hess & Lacasse, 2011).  In collaboration with a number of colleagues, we also just released our own online mental health curricula – without any ties to industry and with LOTS of ties to the actual scientific research:  Mindweather 101. Check it out!  And I’d love to hear your own thoughts on how to get a bigger dialogue going about mental health…and yes, that means bigger than glibly blaming it on “Mormon culture.”