By Sean E. Brotherson
I was recently asked by a kind bishop to attend a ward council meeting and provide some specific training on a specific topic. The subject? Depression.
What I had planned as a fifteen-minute overview of the topic became a caring and concerned hour-long discussion of depression as a challenging life issue between the bishop, the members of the ward council, and myself. I found myself only needing to answer some questions and offer clarifications, as ward leaders in attendance volunteered much insight based on personal experience with depression or supporting others who had experienced depression. In my discussion with the bishop, he frankly suggested that depression was perhaps the most common and persistently challenging issue that he encountered in his visits with ward members. Often his interviews with members were not to discuss specific moral concerns or to extend callings, but to simply offer hope and encouragement and support to members struggling with the burden of emotional anxiety or lasting depression.
I can relate to this bishop. I personally have struggled with depression. I have talked with and supported family members, friends, and church members who have been plagued by recurrent experiences with depression. It is a challenging and sometimes overwhelming experience. And yet, I have learned and believe that for those who struggle at times with feelings of despair or darkness, there can also be light. Light in the darkness.
Welcome to Chapter 1 in a 3-Part Series
The subject of depression, while increasingly understood and written about, is not always an easy subject to explore and make sense of, especially for those who have not experienced depression themselves. I have struggled with how to approach this topic. I hope my solutions will provide some help and insight to some who look for understanding.
This week will offer the first in a 3-part series on understanding and dealing with depression as Latter-day Saints. This first article is a general overview. The next two articles will be personal interviews with Latter-day Saints who have themselves lived with depression and also done much to support others who have experienced depression. They are normal, faithful, loving Latter-day Saints-who have known depression. They are caring spouses and good parents-who have been affected by depression. They are outstanding church leaders and community citizens-who have dealt with depression. I hope that their willingness to discuss this issue from a personal perspective will allow you to see that depression is not something that is uncommon or abnormal or sinful. It is a relatively common life challenge that can affect members of the church at all ages and all stages of life.
Where is Happiness?
The Prophet Joseph Smith is recorded to have said, as included in Scriptural Teachings of the Prophet Joseph Smith, the following:
“Happiness is the object and design of our existence; and will be the end thereof, if we pursue the path that leads to it; and this path is virtue, uprightness, faithfulness, holiness, and keeping all the commandments of God.” (Scriptural Teachings of the Prophet Joseph Smith, arranged by Joseph Fielding Smith and edited by Richard C. Galbraith, 1993, p. 287. Salt Lake City, UT: Deseret Book Company)
As “the object and design of our existence,” we hope to experience happiness in life and the relationships that we treasure. Yet for many individuals who are troubled by doubt or despair, happiness is too often an illusion or only an occasional fleeting moment. It seems to be a promise that was made to the world but for some reason is not available to them personally. This may feel true especially for those who have followed the teachings and practices of the gospel of Christ. They have kept the commandments but where is the peace that they long to feel? Where is the joy? Where is the fulfillment?
The specter of depression challenges many families. President Ezra Taft Benson taught, “We live, in an age when, as the Lord foretold, men’s hearts are failing them, not only physically but in spirit . . . [and] Satan is increasingly striving to overcome the Saints with despair, discouragement, despondency, and depression” (“Do Not Despair,” Ensign, October 1986, p. 2). Despair. Discouragement. Despondency. Depression. These may be familiar words to you or to someone that you know and love.
To me, it is helpful to begin understanding depression with a simple metaphor. It’s like wearing concrete shoes.
When depression is experienced, it often feels that you wake up in the morning and begin by putting on a big pair of concrete shoes. One of them says “Discouragement” on it and the other says “Depression.” After putting them on, it is hard even to get up and walk out of the door. And even when you are able to walk down the street, it often feels as if each step is a hard, laborious effort rather than a simple, easy step. The concrete shoes of depression make it harder to run and play ball at the park with your children, because you just don’t feel like trying too hard when the shoes weigh you down so much. And you have to worry about any situation that you might get in because the shoes are a problem. If you try swimming while the concrete shoes of depression are being worn, they turn a normal situation into what feels like a life-threatening struggle, because with the weight of the concrete shoes you are just making the effort to keep your head above water. It can make a normally desirable activity like playing ball in the park simply unappealing. And worse, it can make a normal activity with some challenges like swimming become a frustrating, exhausting struggle.
When a person feels this way on a regular basis, then it becomes challenging to feel and experience the happiness that the Lord intended for us to experience.
What Is Depression?
So far, I have been talking in a general way about a specific condition. You may wonder if it applies to you.
It is important to distinguish between the common experience of feeling sad or getting discouraged occasionally and the much more serious problem of pervasive anxiety, sadness or pessimism that often characterizes chronic depression. Life itself is marked by challenging experiences and bouts of failure and success. President Boyd K. Packer has commented on this reality and stated:
“It was meant to be that life would be a challenge. To suffer some anxiety, some depression, some disappointment, even some failure is normal . . . There is great purpose in our struggle in life.
” (“Solving Emotional Problems in the Lord’s Own Way,” Ensign, May 1978)
It is not unusual, therefore, to have experiences in life that disappoint us, sadden us, or challenge us emotionally. A single disappointment or a solitary tearful episode does not qualify as depression and should not be confused as such. However, this is somewhat different than the deadening, lasting sense of burden and discouragement that accompanies chronic depression.
Chronic depression must be understood for what it is. It is, specifically, a common illness that is marked by a persistent cluster of related symptoms that usually occur over an extended period of time. This amount of time is typically for two weeks or longer and includes a series of related symptoms. Depression is an illness that affects a person in multiple aspects of life, including a person’s body, emotions, mind and spirit. Symptoms are commonly seen in at least four areas: a person’s thinking (cognitive or mental area), a person’s mood (emotional area), a person’s behavior (social area), and a person’s physical well-being (physical area).
- A person’s thinking when chronically depressed tends to include persistent thoughts of inadequacy or self-worth, a pessimism about events and the future in general, a sense of failure, or difficulties with memory or concentration.
- A person’s mood when chronically depressed tends to include consistent sadness or despair, feelings of anxiety or irritability, tearfulness or crying, or excessive feelings of personal guilt or that life is simply overwhelming.
- A person’s behavior when chronically depressed may include passivity or difficulty in getting involved and completing tasks, social withdrawal from friends or activities, general loss of interest or pleasure in activities, indecisiveness, decreased school or work performance, or recurrent thoughts about suicide.
- A person’s physical well-being when chronically depressed may include significant changes in appetite or weight (loss of weight or weight gain), sleep disturbance (insomnia or excessive sleep), excessive fatigue or low energy, or exaggerated physical ailments (headaches, stomach pains, illness, etc.)
I would like to emphasize three points about chronic depression: (1) It is a condition that occurs on a continuum of experience; (2) It is a specific illness that can be diagnosed and treated by a practicing and competent professional; and (3) It is something that is highly treatable and responds well to intervention in most cases.
First, no individual should read what is written above and immediately decide, “Hey, I’m depressed!” But they should not dismiss it either. Chronic depression is a condition that can occur in a mild way for a brief period or at a moderate level or in a very severe way for a long period of time. It varies by individual and by circumstances. However, the earlier it is noticed and addressed the less likely it is to be repeated or to descend from a mild condition into a very severe and lasting condition. So, it is helpful to be aware of the symptoms and to be sensitive to whether you or those you care about may be experiencing them. Dr. Russell Crane, a practicing therapist and professor of marriage and family therapy at Brigham Young University, has written: “Depression is best thought of as a continuum-with normal sadness on one end and extreme feelings of depression on the other. Most of us experience normal fluctuations in mood. But the intensity and duration of the negative mood in a depressed person is excessive” (“I Have a Question,” Ensign, April 1984, p. 21).
Second, while the experience of chronic depression may vary, it is important to remember that it is a specific illness that responds to treatment. It may for some persons be like the common cold. Occasionally they notice a few symptoms and it occurs mildly for a time and responds to simple bed rest and other measures. For others, it is more like diabetes, which does not “go away” but can be largely managed with awareness, care, and good medical treatment that continues over time. Rather than trying to look at the symptoms described and do a self-diagnosis, it is inexpensive and easy to meet with a competent professional and take a brief diagnostic exam for depression. It can be important to access professional assistance from a medical doctor or mental health practitioner (such as a psychologist, therapist or counselor). This is because such individuals have the background and training to assist with assessment, diagnosis, and treatment of depression, which may include counseling and medication in some circumstances. Although it is common for Latter-day Saints to value “positive thinking,” many individuals who are dealing with depression cannot simply “get better” by thinking positively. Struggling to do so without assistance can often lead to further frustration and more severe challenges.
Third, chronic depression is a condition that in most circumstances responds well to treatment suggestions that are encouraged and provided by competent professionals. Individuals struggling with depression will benefit from such strategies as caring and support from family members and friends, learning to think reflectively and consciously about their lives, medication that can adjust chemical levels in the brain and elevate mood, counseling about ways to cope with life challenges, and other methods of treatment. The point is that help is available and it is often helpful. It should not be avoided.
Who Experiences Depression?
The feelings and challenges associated with depression may seem difficult to understand for some who have not directly experienced it. We have questions. Why does depression occur? Does it happen because of sin? Bad choices? The weather?
Think about your own knowledge of depression. Do you know someone personally who has struggled in a significant way with depression?
You might be surprised to learn that research studies suggest nearly 20 percent of the adult population, or 1 out of 5 persons, has experienced chronic depression at some point during their adult lives. If you also include bouts of depression that lasted for a shorter period or related to specific circumstances, such as loss of a job, then that number increases dramatically. What does that mean? It means basically that you or someone you know has experienced, is experiencing, or will likely experience depression in a significant way at some point.
Experiencing depression is in no way incompatible with personal achievement, meaningful family life, or positive church service. I know of numerous individuals who have dealt with depression through counseling or medication and also been successful in their careers; served in church callings such as Relief Society president or stake president; written books and spoken to large audiences; raised happy and loving children; etc.
My parents first worried about me as a kid when in my early school years the teachers got concerned because my hair was falling out. What was going on? I was just a high-anxiety kid. My level of anxiety was high and I internalized it and out came the hair. Pretty weird. But we dealt with it and somehow it didn’t stop me from learning to read and brushing my teeth and graduating and getting married and so on.
There are some rather prominent examples from figures in the scriptures that use language that suggests despair, discouragement and even depression. We do not know for certain that they experienced chronic depression as defined in this article, nor is that truly important. We do know that the feelings and challenges associated with depression are common in mortality and understood by the Lord, who loves us and can sustain us in such challenges.
Read these statements from the following figures:
Nephi – “O then, if I have seen so great things, if the Lord in his condescension unto the children of men hath visited men in so much mercy, why should my heart weep and my soul linger in the valley of sorrow, and my flesh waste away, and my strength slacken, because of mine afflictions?” (2 Nephi 4:26)
The Prophet Joseph Smith – “O God, where art thou? And where is the pavilion that covereth thy hiding place?” (Doctrine and Covenants 121:1)
Isaiah on the Savior, Jesus Christ – “He is despised and rejected of men; a man of sorrows, and acquainted with grief: and we hid as it were our faces from him; he was despised, and we esteemed him not.” (Isaiah 53:3)
These few statements from the prophets give insight into the feelings that are common for those who experience depression in a significant way. If you were to ask them to verbalize what it is they feel and why it is so difficult, they would say such things:
- My heart weeps.
- My soul lingers in sorrow.
- My strength slackens.
- Where is the Lord? Where does he hide?
- I feel despised and rejected.
The scriptures speak always to the realities of our lives even when they do not speak with the precision of a medical diagnosis. Such feelings have been verbalized to me over the last several years in a variety of examples. They have included:
- An acquaintance who sought information about the issues he might face in marrying a young woman he loved, as she had experienced bouts of depression since her early adolescent years.
- A male friend who passed through years of depression and soul searching as he did not marry but completed graduate degrees and established a successful career.
- A female relative who struggled with post partum depression for several months early in her marriage after a child was born.
- A fifteen-year old who despaired about her unhappy home life and parents’ destructive communication and the temptations of her friends to disregard church standards of behavior.
Depression does not confine itself to certain ages or to one stage of life or to one particular personality type. It can be experienced by any individual. We should be most concerned about understanding it when it does occur and providing support to those who experience its effects.
One of the challenges associated with depression is that too often it is associated with sin. It is true that wrong or sinful behavior can lead to feelings of depression, guilt and despair. However, it is not true that feelings of depression, guilt or despair occur in someone’s life because they have made wrong choices or committed sin. Many Latter-day Saints struggle with a sense of feeling judged by others, or often they judge themselves when depression occurs and they quickly associate such feelings with having sinned. We should be careful in reaching out to those who experience depression or in making judgments of ourselves that we do not confuse sin and its legitimate consequences with the different experience of chronic depression.
Why Does Depression Occur?
Where do the constant negative feelings that characterize chronic depression come from? Why do they trouble certain people? How can they be managed and reduced? Why does depression occur at all?
These are important questions that researchers around the world are currently studying. Much is being learned. But much is still unknown.
Depression has been linked to a combination of influences. Some of the main influences linked to depression are listed below:
- Genetic influences – Research shows clearly that there is often a genetic component to depression. Some individuals and family groups are simply more likely to undergo depression and the accompanying feelings of negativism or discouragement. Is there a history of depression or anxiety difficulties in your family or a family that you know? I have known families in which half to two-thirds of the adult children in a family have experienced moderate to severe depression at some point in their lives. Or other families where the pattern of depression experienced in adulthood has been seen in at least three generations. These types of patterns may indicate the underlying genetic influence that makes depression more likely in some cases. An awareness of whether family members in one’s own family, a spouse’s family, or the extended family have experienced depression can be helpful in understanding its occurrence in your own life or the life of someone you love.
- Biochemical influences – Have you ever heard the term “chemical imbalance”? It refers to the balance of certain biochemicals in the brain, typically neurotransmitters that transmit messages and affect everything from mood to thinking to activity levels. When the balance of such chemicals is affected in a person’s brain in a negative way, the resulting symptoms can include a wide range of difficulties. This can include symptoms associated with depression or other mental health challenges.
- Life stress influences – Experiences that people undergo can often act as triggers for depressive episodes in life. Difficult experiences that may bring on depression include many of life’s challenges or experiences. These include but are not limited to the following: Divorce of one’s spouse or divorce by other family members; loss of a job; death of a loved one; significant or violent physical trauma; physical, verbal, or sexual abuse; neglect; relationship difficulties; significant life changes; other kinds of trauma. Many of these occurrences may trigger stress and depression if they occur rather suddenly. They may also build up over time and the simple accumulation of stress in one’s life from a variety of factors can be enough to trigger the experience of depression.
Anger, sadness, discouragement, and other feelings are common in such situations. Comfort, guidance, and counseling from others is appropriate when such stresses are occurring, and are often critical to the person dealing with depression.
- Cognitive influences – The way you think about life and the events you experience can be linked in many ways to the experience of depression. Depression is characterized often by a negative, pessimistic, and troubled thoughts or interpretations of life events. Dr. Martin Seligman, a major researcher on depression in this area, has written, “Pessimism is an entrenched habit of mind that has sweeping and disastrous consequences: depressed mood, resignation, underachievement, and even unexpectedly poor physical health . . . America is in the midst of an epidemic of pessimism and is suffering its most serious consequence, depression” (The Optimistic Child, 1995, p. 7).
If you or someone that you know experiences depression due to one or a combination of these influences, it is critical to know that you can reach out for hope and help and needed resources. The Lord has promised, “there hath no temptation (or challenge) taken you but such as is common to man,” and He will “also make a way to escape, that ye may be able to bear it” (1 Corinthians 10:13). Depression is not an uncommon or impossible challenge to overcome-but it can be very challenging. Notice that the language in this verse of scripture actually says that you will be “able to bear it,” not necessarily that it will disappear or be cured. Different persons have different outcomes in their experience with depression. But the Lord has promised opportunities to receive His peace and overcome despair, and that is possible.
How to Deal with Depression – An Introduction
This article is already pretty long and we’re just getting started. It’s mostly been about the basics of understanding depression. It’s a big topic.
I asked a friend who had struggled with depression about dealing with it and she gave the following response:
“Sometimes the Lord lets people go through hell for long periods of time before there is any noticeable healing. Actually, He may have been carrying them the whole time, but with depression they could not feel any help from above.”
That’s an interesting insight. It seems easy enough to treat something like a cut when you can put a Band-Aid on it. But what can be done when you are hurting on the inside? Or when the hurt and sadness doesn’t seem go to away?
Images of darkness, hopelessness, or discouragement often overwhelm the feelings of those who struggle with depression. These feelings may lead them to feel as if they themselves were among the lost souls described in Lehi’s dream in the Book of Mormon, souls who spent time wandering in a “mist of darkness” (see 1 Nephi 8:23). Such darkness can seem pervasive and overwhelming to those who struggle with depression. But the Savior himself, Jesus Christ, is described in the Psalms as a “light in the darkness,” and one who is “gracious, and full of compassion, and righteous” (Psalms 110:4).
Have you ever felt as if you wandered in darkness?
Have you ever felt as if you were drowning in despair and anxiety?
Have you ever felt as if there were a hole in your soul that could not be filled?
Christ stands as a light to lead us out of the darkness, to dissolve our despair, and to fill our souls with hope.
I hope you will look forward to the articles ahead in this series, which will provide personal insights and possible resources to address the issue of depression.