Helping Depressed Mormon Clients:

1. Helping Depressed Mormon Clients: Looking for Aid in Mormon Doctrine and Theology Matthew R. Draper, PhD; Brett Breton, PhD, Julie Ogilvie, Natalie Haight, Kiley King

2. Dispelling the Myths • Mormonism does not cause depression • In a meta-analysis: • 4% of studies find a negative relationship between Mormonism and mental health measures • 24% find no relationship • 71% find a positive relationship • This compared to an overall 51% positive relationship between non-Mormon religiosity and mental health • (Judd, 2006; 2012) • The negative results relative to Mormonism entailed issues with anxiety, authoritarianism, and ethnocentrism/prejudice (Bergin, et. al, 1994)

3. But Antidepressants? • Utah is #1 in antidepressant medications • Ergo, Mormonism causes depression • Logical fallacy of correlation/causation • Active LDS are in the minority, even in Utah County (Knowlton, 2012) • Utah is also #1 in antibiotics, analgesics, and anti-inflammatory medications (Judd, 2006) • Mormons are much less likely to “self medicate” with alcohol or other drugs • In addition, when education is controlled for, the relationship between anti-depressant use and Mormonism vanishes (Heaton, Bahr, & Jacobsen, 2004)

4. Antidepressants? Continued • The suicide rate among active LDS are dramatically lower than inactive or non-Mormon (Hilton, Fellingham, & Lyon, 2002) • Divorce rates amongst active LDS who are “sealed” in their temples are half to one-fifth the national average (Lobdell, 2000). • So, if Mormonism causes depression, then we should see much higher suicide and divorce numbers

5. Desirability • Some argue that the numbers for Mormons are due to cultural pressure to mask misery and to fake happiness • This is called a “Desirability effect” • It is controlled for in many studies • In fact, the deeper you dig, the better it seems that LDS folks are doing • Physical health, mental health, low delinquency among children, low rates of addiction to illicit substances, etc. • Anecdote about Mennonites and depression

6. Rates of Issues by Religion

7. Reactionary Mormonism • The columns represent a combination of mental-health issues measured in a meta-analysis (Judd, 2006) • Combining mental health diagnoses, addiction, and suicide • “Active” is defined as believing in the faith + attending • “Inactive” is defined as not believing in the faith + not attending • “Non-LDS” is self-explanatory

8. Reactionary, Continued • From this meta we can see that less-active LDS have greater difficulties • The chicken/egg conundrum is unclear • We coined the phrase “Reactionary Mormonism” to describe anecdotal observations reflected in empirical research • Mormons: No wine at all with dinner (anathema to think otherwise) • Non-Mormons: A glass of wine with dinner • Inactive LDS: A bottle of wine with dinner

9. However! • We seek to help with two issues: • Even active LDS clients suffer • And often their faith informs the manifestation of their suffering • Less-active LDS clients suffer • And their former faith often informs the manifestation of their suffering • What follows are clinical observations followed by conversation with LDS theologians about these clinical cases that greatly helped resolve some of the client’s core issues

10. A Note of Caution • Careful when you read research • Most researchers lump all “Mormons” together into one group • From active and devout to actively atheistic • When you parse those groups out, however, many of the outcomes across levels of devotion are fascinatingly different • For example: numbers are better for active LDS, EXCEPT actives have higher pornography and masturbation rates, and less-actives have a better sex life and lower rates of masturbation and pornography use

11. Four Common Issues • This list is neither comprehensive nor exhaustive, but common in our experience when working with people from an LDS background: • Suffering • Perfectionism • Anger • Sexuality

12. Suffering? • A common belief from LDS culture is that “righteousness” (in terms of strict obedience to a long list of commandments) is a down-payment or monthly subscription to happiness and freedom from suffering

13. Jill’s Suffering • Story of “Jill” • After desperate attempts to find the sin to explain her suffering could not find one • Common misinterpretation of Alma 41: 10 “Behold, wickedness never was happiness” • Misinterpreted as “if I’m unhappy, I must be wicked” • Well-meaning LDS leader confirmed her belief • After much soul-searching together they realized that Jill’s suffering must be due to a lack of faith, and with sufficient faith her depression would remit • After months of trying to increase her faith, her depression did not remit • Ashamed, she quit attending her beloved congregation

14. How to Help Jill? • Helping her understand: • Living one’s religion (as an LDS) does not, and should not guarantee a life without problems • “A life without opposition, sometimes bitter and often hard to bear, would be contrary to the plan of salvation by ancient and latter-day prophets” (Judd, 2006) • How many devout men and women in scripture died content, of old age, surrounded by loved ones? • Were they wicked, or lacking in faith? • Adding guilt and shame to suffering only makes the suffering unnecessarily worse.

15. Opposition • “Opposition in all things” (2 Nephi, 2:11) • Later in that same verse: “Wherefore, all things must needs be a compound in one” • Life and death, happiness and misery • Suffering and Joy co-constitute one another • Hence, do not feel guilty about your suffering for it always already exists in relation to joy, and makes joy possible • Refer to scripture about the importance and nature of suffering: D&C 109: 76 – reaping joy after suffering; D&C 122:7 – all misery is made good • The importance of suffering and the role of savior/comforter 1 Cor. 9:27; 11:30–33; 2 Cor. 4:16–17; 12:7

16. Jill? • Indeed, the purpose of suffering is to give the sufferer a reason to pray, and to teach compassion (Robinson, 1992; Draper, 2002) • Jill suffered because of her suffering (shame compounded her depression) • As she came to realize that she was not sinful because of her depression, she ceased feeling ashamed of it • Because of her suffering, she could compassionately relate to others • Because of her suffering she could pray to her God for support with a clear conscience • No, her depression didn’t magically vanish, but she went back to living her life again

17. Damnation? • Salvation can come through damnation 1 Cor, Chapter 5 • For “Erika”: “How can your damnation lead to salvation?” • For her it did not, but as she worked on it, she found that her suffering gave her compassion and perspective to help others • Her suffering did not “save” her, but it continually allowed her to help many • And she derived great meaning from compassionately caring for others • At that point, she had no desire to lose her suffering

18. Perfectionism • Perfectionism causes more problems than it solves, relative to mental health • LDS Theologians have been aware of this for some time and have commented on it repeatedly, for example:

19. Perfectionism, Cont. • “Those suffering from perfectionism tend to be wonderful, contributing, and effective people, and yet may feel that no matter what they do, it is never enough. These good people suffer from exaggerating their minor mistakes, weaknesses, or shortcomings to the point that they may become dysfunctional” (Samuelson, 2006).

20. The Case of Mary • Mary presented with chronic GAD and panic without agoraphobia • The content of her anxiety centered around having to obey “every commandment” • She became so crippled trying to obey every “commandment” that she could no longer work or go to school • I had her count all of the commandments she tried to obey every day, and the list was staggering • When gently confronted about this, she replied “in our church we are commanded to be perfect, and to be perfect you have to obey all of the commandments”

21. Misunderstanding Perfect • Some fundamentally misunderstand Matthew 5:48 “be ye therefore perfect” • As far as we can tell, the word closest to what Christ actually said was “telios”(Luow & Nida, 1988) • Telios means “mature” and “whole” and “finished“ • The listeners at the time would have been reminded of the “Shema”(Deut. 6: 4-5) • Telios = perfect = “God is one Lord” (Danker, 2000). • People can love God and trust him because he is whole, complete, and mature (Draper, 2013).

22. Perfect = Safely Loveable • “Be ye therefore perfect” means be whole, complete, and mature so other people can trust you and love you without risk • Note it has nothing at all to do with obeying every supposed commandment • Careful not to throw the commandments out, if we break certain commandments it would be hard to trust/love us • Mary very defensive about the commandments and terrified that my position meant licentiousness

23. Mary Becoming Telios • Mary and I developed a plan for her to practice being loveable and trustable • She began to re-connect with others slowly, eventually got a part-time job and eventually got back into school • Interestingly, she found that her previous understanding of “perfect” interfered with her Telios • If someone was tattooed or smelled if cigarette smoke she could not be around them, terrified that their imperfection would rub off on her • When she focused on becoming Telios, however, she found compassion

24. Anger? • Case of Rachel • Mother of two, working almost full-time going to school full-time • All childcare and home duties were her responsibility • Husband did not help • Incestuous pressure from adoptive brothers • Perfectionistic, critical mother • Presents with suicidal depression • Which terrified her • Didn’t tell anyone

25. Rachel, Cont. • Klein, an expert in suicide and depression once told me that “Depression is anger that cannot be let out or expressed” • Rachel clearly had things she could feel angry about, and most people would • When I shared this with her, she stated “but in our church we are told we can never be angry” • Read with her John 2: 13 – 15 • You destroyed my testimony! She yelled.

26. Misunderstanding Anger • “To be angry is to yield to the influence of Satan” (Monson, 2009) • In addition: “We have all felt anger” in the same talk, which could imply that we have all yielded to the influence of Satan • Well, of course, but look at what he means • Monson means abuse and being governed by our anger rather than vice-versa • Basically, the sin of wrath • The feeling of anger is not a problem

27. Examples of Anger • Eph 4: 26 - 27 “Be ye angry, and sin not: let not the sun go down upon your wrath. Neither give place to the devil” • Be angry! (Paul validates the feelings of the saints in Ephesus) • BUT! He counsels that even though we are angry to resolve the source of our contention and not let it fester

28. Purpose of Anger • And anger is the emotion that motivates us to resolve problems in some cases • “Any emotion serves a function. Although most people think of anger as destructive, it can have positive effects. A quick, mild ‘constructive’ display of anger on your part tells your friend or romantic partner ‘hey, that hurt! Don’t do it again!’” (Kalat & Shiota, 2007)

29. The Purpose of Anger, Cont. • “Reproving betimes with sharpness” and later “showing forth afterwards an increase of love” • We would not reprove sharply if we did not feel anger • That’s different from abusive wrath • Captain Moroni: “I am in my anger” • Jesus Christ and the money changers • Heavenly Father (23 references to God’s wrath in the D&C alone and no references to God loving His children in that book)

30. Anger is Not Sinful • But what we do about it, can be • However, never allowing ourselves to feel anger or to allow it to motivate us to change our world or our relationships stagnates and poisons us

31. Purpose of Anger • “Anger can obstruct, erode, or even demolish relational intimacy . . . When it is engaged in, at least to some degree, in the context of spiritual practice. As much as anger’s fire can injuriously burn, it can also illuminate . It all depends on what kind of relationship with anger we cultivate” (Masters, 1998 p. 1)

32. Rachel, and Loving Anger • Rachel came back • Worked through with her the above ideas • Started to confront the lack of help from husband • Started to confront incestuous pressure from brothers • Started to confront her critical mother • LOTS of anxiety about doing so at first • Gradually, however, her relationships changed for the better • And her depression remitted

33. Misunderstandings about Sex • Common, an American problem, not a Mormon problem • But Mormons put their own twist on this issue

34. The Case of “Ken” and “Barbie” • She’s a surfer girl from Cali • How she met her future husband • Conversion • Whirlwind romance • Temple marriage • Complete lack of sexual intimacy in the marriage • Pornography found • “Barbie” didn’t have a problem with pornography per se, but did have a problem that it interfered greatly with her marriage

35. Ken’s Misunderstanding • Ken raised in a home where the subject of sex was relegated to shame-based silence • Ken loved Barbie and did not want to shame her • But the girls on the internet he did not love, therefore had no problem engaging in “shameful” behaviors with them • To Ken, sex = inherently bad, the body = inherently filthy/corrupt • The fetishization of pixels, the pornographication of marriage

36. Not a Happy Ending • Ken could not (or would not) comprehend a sex-affirming doctrine • “That’s NOT Mormonism. I’m a returned missionary, you’re wrong” he said • In our third session he turned to Barbie and said “You can never be for me what the girls on the internet are” • Meaning, she could never arouse him • That was his last session • But not all endings are sad

37. Mormons and Sex • Fear Regarding Discussion of Sex • If you talk about it, fornication! • Absence of Healthy Discussion • Confusion • i.e. “petting/necking” • Story of wet dream / masturbation mix-up • Consequences of not having healthy discussions: • Children turn to other sources for information: Other children The Internet Pornography

38. Elder Hugh B. Brown has noted: • “Many marriages have been wrecked on the dangerous rocks of ignorant and debased sex behavior, both before and after marriage. Gross ignorance on the part of newlyweds on the subject of the proper place and functioning of sex results in much unhappiness and many broken homes. • “Thousands of young people come to the marriage altar almost illiterate insofar as this basic and fundamental function is concerned. … • “If they who contemplate this most glorifying and intimate of all human relationships [marriage] would seek to qualify for its responsibilities. … if they would frankly discuss the delicate and sanctifying aspects of harmonious sex life which are involved in marriage, … much sorrow, heartbreak, and tragedy could be avoided.” (You and Your Marriage, Salt Lake City: Bookcraft, 1960, pp. 22–23, 73.)

39. Misinterpretation of Doctrines: • Alma 39: 3 -5 • Greatest sin second to murder is “not tending to the ministry” and “boasting”, not the sexual indiscretion • Adam and Eve • Born naked signifying there is nothing wrong about the human body in God’s eyes • Genesis 2: 18 • Help meet is two words….where helpmeet basically means slave, help meet means the companionship of Eve was necessary to Adam’s salvation • We should be responsible for ourselves…. • i.e. story bishop enforcing “panty hose rule”

40. How can sex and sexuality help depression within the doctrines of the LDS church? • Moses 3:24 • “Therefore shall a man leave his father and his mother, and shall cleave unto his wife; and they shall be one flesh.” Spouse can be a great support and help to those struggling with depression Physical intimacy also releases serotonin “Intimate relations were designed by the Lord as a sacred opportunity to renew marriage covenants, provide therapy, and keep you two in love. It is essential in a stressful world that the two of you enjoy your physical and emotional relationship.” (Douglas Brinley, Jan. 2012) “Several years ago when I was a young missionary and had just received a new companion, we met a Protestant minister who invited us in out of the cold. After exchanging points of view on various topics, he asked us, “And what is the Mormon attitude towards sexuality?” I choked on my cup of hot chocolate, but my new companion seemed unmoved. “Well,” said the minister after a moment of silence, “could you please tell me the Mormon philosophy toward sexuality?” I was tongue-tied and believed my new companion knew next to nothing on the matter. However, when my companion realized that I didn’t have an answer, he finally said, “Sir, we believe in it.” It has been more than twenty years since that time, and I have been asked the same question by numerous students, friends, professional people, and LDS members and nonmembers alike. And still, I haven’t yet been able to come up with a better answer than the one given by my supposedly naive companion: “We believe in it.” But we also believe in the good that can be derived from the appropriate use of intimacy in marriage. We are well aware of the joy and unity that can come to a married couple when this particular dimension of the marital relationship is nurtured.” (Brent A. Barlow, Sept. 1986).

41. Questions? Ideas?

42. Readings/References • Barlow, B.A., (1986, September) They Shall Be One: Thoughts on Intimacy in Marriage. Ensign. • Bergin, E. Payne, I., Jenkins, P., and Cornwall, M. “Religion andMental Health: Mormons and Other Groups,” In M. Cornwall, Tim E. Heaton, andLawrence A. Young (eds.), Contemporary Mormonism: Social Science Perspectives,Urbana and Chicago: University of Illinois Press, 1994, p.139. • Colvin, G. Mormons and their ‘Sex Talk’. Retrieved January 25, 2013, from <http://www.patheos.com/blogs/kiwimormon/2012/01/mormons-and-their-sex-talk/> • Danker, F. W. (2000). A Greek-English Lexicon of the New Testament and Other Christian Literature, 3rd ed. Chicago: University of Chicago Press. • Draper, R. (2002). A Fulness of Joy. Covenant Communications, American Fork, UT. • Draper, R. (2012). Teliosand the Purpose of Perfection. Personal communication with an LDS theologian. • Heaton, T., Bahr, S., and Jacobson, C. A Statistical Profile of Mormons: Health, Wealth, and Social Life, Lewiston (New York): Edwin Mellen Press,2004, pp. 146 (drug use), 30-31 (education), and 157-158 (physical health). • Hilton, S., Fellingham G., and Lyon, J. (2002). “Suicide Rates and Religious Commitment in Young Adult Males in Utah,” American Journal of Epidemiology, 155:415

43. Readings, Cont. • Judd, D. “Religiosity, Mental Health, and the Latter-day Saints: A PreliminaryReview of the Literature (1923-95),” in J. T. Duke (editor), Latter-day Saint Social Life:Social Research on the LDS Church and its Members, Provo (Utah): Religious StudiesCenter, 1998, p. 473. • Judd, D. (2006). Religion Mental Health, and Latter Day Saints. Presentation given at the Weekly Forum Address of Brigham Young University. Provo, UT. • Kalat, J. W. & Shiota, M. N. (2007).  Emotion.  Belmont CA : Thomson Wadsworth. • Knowlton, D. (2012). Religions participation rates in Utah. Active Mormons are the minority. Personal communication with an expert on Mormon culture and an anthropologist of Mormonism. • Lewis, C.S. (1960). Mere Christianity. The Macmilan Company: New York. • Lobdell, W. (2000). “Holy Matrimony: In Era of Divorce, Mormon Temple WeddingsAre Built to Last,” Los Angeles Times, Saturday, April 8, p. 6. • Louw, J., and Nida, E. (1988). Greek-English Lexicon of the New Testament Based on Semantic Domains. New York, ABS. • Masters, R. A. (1998, Fall).  Fire is Also Light.  ReVision, 21, 42-50. • Maxwell, N. A. (1996). If thou endure it well. Bookcraft: Salt Lake City. • Robinson, S. E. (2008). Believing Christ. Deseret Book Publishing: Salt Lake City. • Robinson, S. E. (1995). Following Christ. Deseret Book Publishing, Salt Lake City. • Samuelson, C.O., (2007, October) I Will Not Leave You Comfortless. Ensign. • Samuelson, C.O., (2006, January) What Does it Mean to Be Perfect? Ensign.