Saturday, July 4, 2015

Addressing Depression from a Religious Point of View

I know depression is a concern to many people. Because I do research in this area, see patients, and am a man of faith I have a certain understanding of some of the misconceptions that exist regarding depression and faith. I have appended to these introductory comments a discourse I gave to a group of parents regarding depression. It was meant to open hearts to seeking help and to empathically approach depression from a stance of faith.

I was asked to talk to you tonight regarding the emotional well being of your children and will also touch briefly on physical health as it relates to the same. As you may know your children were asked what things would be helpful for their parents or leaders to talk to them about, or for their parents or leaders to understand. And a youth committee planned the topics for this evening. Several of the topics requested included: help our parents understand depression, talk about negative self image, talk about self esteem. In other words some of your children are concerned that they and their peers are feeling depressed or at the very least emotionally discouraged about some aspect of themselves. This was a large enough proportion of the youth that the stake presidency asked me to talk to you about this tonight. I was also planning to leave some time at the end for a brief question and answer session, so as I speak if you have a question come up, there will be a chance to respond to a few questions at the end.

A brief introduction to me and why I was asked. I am a fifth year PhD student in Clinical Psychology. One of my principal areas of expertise is depression. Most of my publications have been on depression or anxiety and how they affect the brain. I spend my days seeing patients who are depressed, and doing research on depression.

I want to begin first by discussing some basic information about depression, and then I want to put it into a gospel context and give you some direction about how you can best help your child or youth if they are facing an emotional challenge such as depression or poor self image.

Depression is more than having a bad day. It is a deep chasm. Major Depressive Disorder or MDD, which is what most people think of when they refer to depression, is a period of two or more weeks consecutively in which a person feels down or depressed most of the day nearly every day. Often this can manifest itself also as losing interest or pleasure from activities that normally are interesting or pleasurable. A concrete example of this may be the your son loves basketball, but suddenly tells you that he does not like it any more or that it is not any fun anymore, or that he wants to quit the team. This should be at the very least a sign that something is wrong and should spark some conversation about what is going on. This could simply be that they had a bad day, but you won’t know if you do not ask.

Other signs of depression include sudden loss of appetite, sudden increase in the amount they eat, or big changes in what food they eat. Sudden fluctuations in weight. Inability to sleep, or sleeping much more than is usual for them. I know teens like to sleep, but you know what is normal for you child, and any sudden change in sleep patterns is a warning sign. Another sign is difficulty concentrating or sustaining their attention. Also feelings of hopelessness or helplessness. They are more irritable, short tempered, or aggressive than usual. Difficulty controlling negative thoughts. And the symptoms that seem most scary to parents, feelings that life is not worth living or thoughts of suicide. Most people do not have all these symptoms, but a cluster of a few, which interfere with their ability to function well is what defines depression.

Depression can have a number of causes. Exhaustion. There are a lot of demands on our children to perform and be better and the best at something. When this is too frequent and is not accompanied by unconditional love and support then the stress can become overwhelming and lead to depression. Even if you feel like you demonstrate love and support, it is the perception of love and support that is most important. If your child is expressing that they do not feel like you are supporting them, ask them what support looks like to them or what you can do that would help them feel like they are being supported. And explain what it looks like to you. This frank discussion can be eye opening for both you and your child, and lead to a greater sense of support that can facilitate healing.

Another frequent cause of poor self image and depression in youth, particularly young women are social pressures. There are a lot of falsehoods perpetrated by society regarding how a woman should look. It is important to teach our daughters about good health, but good health is not measured by waist lines, bust sizes, and how much skin is shown off. A sense of self respect, respect for ones body, and the importance of making friends who accept you for who you are, will go a long ways in perpetuating good mental health. There is a reason that divine nature is one of the young women’s values. Knowledge that we are children of God created by him, and that this body whatever its measurements and proportions are, is a gift from our father in heaven, can bring identity and purpose into a youth’s life. We need to teach our children that physical attraction is not the only important quality to seek in others, either as friends, dates, or as spouses. These are lessons that need repeating.  If we teach them young, their expectations for perfection in image will be less, and they will be happier with themselves and others as they see them as more than just bodies, but minds and spirits. In a religious culture where we teach that striving for perfection is ideal, we run the risk of alienating our youth, if we fail to teach them to content themselves with the process of perfection rather than the product of perfection. This bridges both self image, and performance in their school and extracurricular activities. Perfection is the goal not our current state, and societies ideas of perfection are not God’s idea of perfection.

Another cause of depression can be familial or genetic. Depression and anxiety are highly heritable. However, there is no guarantee that if mom or dad are depressed that your children will be, but there is a greater risk of it happening. And the reverse is true as well, just because you have never been depressed does not mean your child will not ever face this challenge. As much as 25-30% of people are depressed at some point in their life. The most common age of onset of first episode of depression is between the ages  of 15-30. Young men tend to have their first depressive episode at younger ages, and women experience depression at twice the rate as men.

The last cause I want to briefly discuss is that when a youth makes a mistake they can feel a great burden. If that burden is left unrelieved it can fester into guilt and depression. I left this for last because I do not want you to have the mistaken idea that if your child is depressed or has a poor self image, or if they are anxious that they have done something wrong. Sin can lead to despair, but not all despair is the product of sin. If you discover your child has made a mistake. Be careful not to dwell in the mire, but direct them on how to get out. Tell them that hope lies in the atonement of Jesus Christ. Trust me they are probably beating themselves up more and are creating more guilt that you can produce with any lecture you can contrive. Give them hope, give them love, give them direction, do not give them guilt.

This brings us squarely into the spiritual aspect of emotional distress. Depression is often accompanied by a sense of helplessness, hopelessness, or negative thoughts about one’s self. Again, I reiterate that we can teach our children to find hope in Christ, to find comfort in prayer and the scriptures. It is through daily devotional activities that we avail ourselves of the spirit. That spirit can comfort, teach, and guide us. Whether we are a depressed teen or a scared parent of that teen. Through our faithful obedience to gospel principles we are given a portion of the spirit to comfort us and guide us. This does not mean we will not struggle, but rather often it means our burdens will seem lighter as we yolk ourselves to the Lord.

A talk I recommend everybody reads is by Elder Jeffery R. Holland from October 2013 General Conference called “Like a Broken Vessel.” In this talk he discusses his own struggle with depression. As a young father he felt overwhelmed. He had overloaded his life with too many obligations and sunk into despair. He found hope in Christ.

Elder Holland also taught us about other great men who struggled with depression: Abraham Lincoln, Winston Churchill, and the Prophet George Albert Smith struggled with numerous bouts of depression. If a righteous upright man like the prophet can be subject to emotional distress like depression, then who are we to expect that we or our children will escape it. It is not something that everybody will experience, but as I said before as many as one in four will experience depression at some point in their life.

We can see other examples in the scriptures: Elijah in despair asked God to take his life in 1 kings 19:4, Job who suffered grave circumstances and the loss of everything he had, was very depressed, but still maintaining hope in Christ.

My advice to you if you or your children face this obstacle is this. To start with openly talk to your children. Discuss their schooling and extra curricular activities. Ask them if they feel they are struggling to keep up. Sometimes it is necessary to cut something out so they do not burn out. If you discover they are depressed, or anxious to a degree that interferes with their ability to function on a daily basis, do not be afraid to seek help. Elder Holland in the talk I mentioned teaches us that just as God expects us to seek medical help for appendicitis, we are expected to seek out reputable people with certified training, professional skills, and good values to treat  our mental illnesses as well. There are a number of effective therapies, and medications that can help in treating depression. For depression, medications and therapies are roughly equal in efficacy and strength. The best results usually come with combined medication and psychotherapy. Therapy; however, continues to be helpful after it ends, whereas medications once they are stopped are no longer effective, and side effects are always a possibility with medications. Two common types of therapy are Cognitive Behavioral Therapy (CBT) which looks at the relationship between thoughts, behaviors, and emotions and teaches structured ways to challenge negative thoughts and rationally work through difficulties. Another is Acceptance and Commitment Therapy (ACT), which does many of the things CBT does, but works form the framework of encouraging an individual to live in congruence with their values and beliefs, and to commit to action that moves them towards their values. If your child is a worrier or has difficulty with self image to the point that it interferes with their daily functioning therapy can also be very beneficial for many of the same reason that it helps with depression.

Exercise is also another critical component to good mental health. When the body is healthy and happy, it is easier for the mind to be as well. When we exercise it releases a number of beneficial chemicals into the brain that elevate mood. It also causes the body to metabolize and break down chemicals produced when we are under stress. Exercise is almost as effective at treating depression as other treatments, and should be a component of treatment. Aerobic exercise or exercise that gets your heart pumping will help alleviate stress and depression. Depression; however, can make it difficult to motivate one’s self. This is one of the critical role that family can play in the life of someone trying to overcome anxiety and depression. To motivate and keep on track doing the actions that maintain good mental and physical health. If your youth is not depressed, but is feeling a bit down, or if they are feeling a bit overwhelmed and stressed, exercise is a great and immediate way to alleviate stress and tension and elevate mood.

I want to stress that not all treatments help every person equally. It is important to work with your doctors to find the right balance for your child to overcome their emotional challenges.

Maintaining good physical and emotional health is necessary to be able to serve an effective full time mission. As we prepare our youth to serve or as we prepare them for life in general it is important to stress good habits of eating, exercise, and taking the time to care for themselves physically and mentally. If they do not take time to be well, the will take time to be sick. Prevention and maintenance is always the best policy. Healing and repair always takes more time and is more costly financially, physically, and emotionally. As your children maintain good healthful habits it will be easier for them to act in confidence and have a healthier perception of themselves. When our bodies are not well maintained we are more likely to suffer emotional consequences, as our mental health is inextricably connected to our physical health.

Lastly you must rely on the spirit to guide you. Be worthy of it’s guidance and you will know how to best help your children in critical moments. Teach your children to rely on the spirit and they will be guided in the critical moments.

At this point I want to bear my testimony to you that Christ is our hope. He is our Savior. He has all power to heal and lift. In the name of Jesus Christ Amen.

Other Good Posts
How do I Work Towards a More Balanced Life 
You Have Your Hands Full: Children and Family Values

Monday, December 29, 2014

Ten signs of depression

Many people are ill informed regarding depression, or are not sure what is meant when the word depression is used medically. This is much more than feeling down or blue on a bad day. Depression is a relatively common disorder in which some one feels down or depressed for two of more weeks consecutively for most of the day. Approximately 20-25% of adults will experience at least one episode of depression in their life time. This is likely an under estimate due to the social stigma associated with feeling depressed. Depression is the leading cause of disability world wide and is the most common mental health disorder (WHO). Depression looks a little different from person to person. So what is depression? To meet criteria for depression, a person must have:

1. Depressed Mood

2. Anhedonia or sudden loss of pleasure in things you used to enjoy

They will also have some combination of the following:

3. Sudden, unintentional weight changes and appetite changes

4. Moving much more rapidly or slowly than is normal.

5. Insomnia or Hypersomnia

6. Chronic fatigue or loss of energy every day

7. Feelings of worthlessness

8. Excessive guilt

9. Decreased ability to think of concentrate and make decisions (indecisiveness).

10 . Thoughts of death or suicide

If you are feeling depressed or if a loved one is, there is hope. There are a number of therapies and medications that are effective in reducing depression. Additionally, increased exercise and changes to sleep habits are also beneficial for increasing mood.

No responsible person can recommend that depression is just a phase, or that a person experiencing depression just needs to pick themselves up by the boot straps and get back to work. I advocate hard work and patience, but once someone is in a pit, they often need a helping hand to boost them out of that pit. If you would not recommend that someone just will their liver back into good health, you should not recommend they just will their depression into happiness. It is true that there are some things a person can do at home to feel better such as exercise, sleep better, and eat healthy, but those are also recommendations for healthful physical living as well. These measures are invigorating and increase energy levels.

The aspect of depression that often makes it hard to snap out of it, is the constant depressive thoughts that many feel. Thoughts of worthlessness, thoughts that make you feel guilty, and thoughts that generally demean and attack you are what help to perpetuate the feelings of depression. It is primarily these thoughts that are the targets of psychotherapy treatments such as cognitive behavioral therapy (CBT).

Do not feel ashamed if you struggle with feelings of depression. Do not hide it from those close to you or your doctor. As you bring others in on what many feel is their secret struggle, you will feel the love and support you need to get better. You will receive the treatment necessary to break the self feeding cycle of depression. Talk to your doctor, a psychologist, or a psychiatrist. Your doctor can recommend you to a competent mental health professional. Psychologist can help you work through therapy and psychiatrist can offer you medications to help with depressed mood. The best response to treatment is in those who take medication and do therapy, and then exercise on their own where possible.

Here are some other posts you may be interested in: How do I work towards a more balanced life?, You have your hands full: Children and Family Values

Friday, December 26, 2014

How Do I Work Towards a More Balanced Life?

Park City Utah Ranch, Farm House, Green grass, MountainsDistraction is the bane of most of our existence. It is hard to remove the things that steal our time from our lives. But as we carefully weed out the things that provide only mere momentary reward, we can reach for higher goals and achieve much more. This is not to say that recreation does not have value. Wholesome recreation is a vital part of the human experience and provides valuable rest and opportunities to develop meaningful relationships. However, the constant drone of music, the electronic devices we tether ourselves to, and meaningless pursuits are far too pervasive in many of our lives. We waste the moment when achievements could be made and relationships enriched for a high score on a game, which will only be beat by someone willing to waste more time than we are. There is always someone willing to waste more time than you are.

A common concern for many people is how to maintain a good balance in their lives. A balanced life has been the goal of civilization since the days of Greek philosophy, and likely before that. Aristotle believed that happiness was derived from virtue. Virtue was defined as a habitual act of balance. That is he believed not in an unconscious decision leading to happiness, But habits of intellectual choice. He defined virtue further  as the mean between extremes (Nichomachean ethics). He taught that virtue or habitual action was learned or developed under the tutelage of great teachers. Therefore we can determine that good is only good if we choose consciously to perform the act. Also good done for the wrong reason is neither good nor bad, but rather mindless habitual action. This means in our lives we must choose to live a balanced life, and do so consciously, or we cannot participate in the good virtuous act of balance.

There are many competing demands in our lives. it is not easy to find balance, or to know what the mean between extremes is. We live in a world in which extreme behavior is portrayed as normal. The lines between balanced virtuous conscious action are blurred daily by the onslaught of factions who would have us believe that there is no good or that good is a relative construct.

Mountain, Diamond Fork Canyon Spanish Fork Utah, Green Mountain Blue Sky, rolling hills
Taking time for reflection is paramount in living a life of meaning and clarity; however, many people confuse reflection and rumination. Reflection is a thoughtful process weighing the merits, both good and bad, of a subject. Rumination is a concentration, focus, and even obsession over the bad that has happened. Reflection is a balanced approach allowing you to view the optimal course of action, rumination is lopsided, frustrating, and damming to all progress.

If you want to see success reflect on your strengths, recognize your weakness, and plan a realistic course of action to amend the deficits. If you want to end up angry, depressed, and anxious, ruminate over the bad things that have happened, declare them unfair, and wallow in your misery. Self pity while rewarding for a moment only leads to feeling worse in the long run.

Part of your reflective process should include prioritizing your life. Choosing priorities is not an easy task. The infinite competing activities available can skew the perspective of even the most clear thinking individuals. Therefore I will give you a useful tool to manage this process. It is called a pen and paper. This may take the form of a journal or just a sheet of paper on which to sketch a grid. The useful nature of journaling is easy chronicling of your thoughts collected into an easily accessible compendium. However if you are not particularly sentimental or well organized a slip of paper will do.

Begin by drawing a two by two grid. Label it across the X axis with non-urgent and urgent. Along e Y axis write non-important  and important. With this grid you can quickly place task and competing demands into the quadrants. Those demands that fall within the quadrant of important and urgent are likely the things that you spend most of your time focused on, or if you do not you should. Even in seeking balanced our obligations must be met. After all our children must eat, and our employer will not look kindly upon not coming to work because we were seeking balance elsewhere.

After the important urgent demands are met though you may be puzzled at what to do next.

Provo Utah Green Mountain Rock CanyonAlthough many things may have the appearance of urgency, if they're not important then we should consider if they are really worth our attention. Conversely the important things in life that seem not to be particularly pressing can escape us entirely leaving many might have beens if we are not careful. John Greenleaf Whittier said, "Of all sad words of tongue or pen, The saddest are these: 'It might have been!'" Do not let your life waste away seeking only after the immediate pleasures that life can dangle in front of you. In twenty years you are much more likely to regret not spending time with your family than not getting an extra half hour in at work. How many people in their old age think if only I had made and extra ten dollars that day back in my thirties. A much more likely regret is that you missed your daughter's first play.

Lastly we address the unimportant and non-urgent. These activities are very good at masquerading as important or urgent, as they are often more desirable and fun activities. These activities have their place in a balanced approach to life, but in excess lead to lasciviousness and avarice. A helpful idea for me, an avid workaholic, when contemplating the place of the less important and urgent is, ‘Do not run faster than you have strength.’ For those of you who have the opposite problem and cannot get motivated to get going perhaps you can find motivation in the eyes of a loved one when you sit down and ask them how their day was. Whether you are a workaholic or a sloth we all have moments in which we need to find the fine balance in life. A moments reflection can provide the clarity needed to decide what comes next.

Writing and Photography By Joshua Kirton

Other Posts: You have your hands full: Children and Family Values, The Capitol Building, Stewards of Spiritual Learning