Tuesday, January 20, 2009

From the Ensign: " Awake My Soul!: Dealing Firmly with Depression" (or When CBT and LDS collide!)

It could be a really lame joke: a psychologist and an LDS bishop run into each other in front of the monkey cage at the zoo and get to talking. Eventually their discussion turns to matters of the heart and soul and becomes quite heated. The psychologist pulls out Darwin's On the Origin of Species and claims that human emotions are a result of environmental conditioning causing biological and physiological changes. The bishop pulls out his triple combination and responds that all are children of God and that emotions are the gateway to the Spirit. Finally they throw their books at each other in disgust and stalk away. That evening as the zookeeper checks all the cages he notices the monkey reading two books. "Whatcha readin'?" he asks. With a grim face the monkey looks up and replies, "Oh, I'm just trying to figure out if I'm my keeper's brother or my brother's keeper." (Har, har, har.)

Or it could be a REALLY old, and slightly frustrating (it mildly offended me and a couple parts made me laugh out loud), Ensign article.

Today's "From the Ensign" article is taken from the August 1978 issue and is entitled, "Awake My Soul!: Dealing Firmly with Depression". To me this article is representative of how so many, many, many LDS people view depression and how Latter-day Saints should deal with it. Basically, it is a strange mish-mash of cognitive behavioral therapy techniques and LDS doctrine.

The main thesis of the article (as evidenced by the title which implies that depression is no more than a naughty child) is that depression is something that, if dealt with firmly enough, can be "fixed." The article is written in a discussion format where the supposedly depressed person says something stereotypical (i.e. “I feel so out of place at church. Everyone there but me seems to have his life in order. Everything is hopeless.” ) and the author replies with some sage advice and some scriptures.

So what does the author recommend? Well, CBT, or as he puts it,
"Basically there are two approaches. The first way to attack depression and feelings of inadequacy is to try to change what you’re doing so that you’ll feel better about yourself. The second way is to try to change your feelings about yourself so that it will be easier for you to do things differently."
Here's a more specific breakdown:

Idea #1:

"Each of us has many voices within, criticizing and praising, encouraging and discouraging, desiring and warning, reasoning and disregarding. We’ve all wondered at some time which voices were from the Lord and which were from Satan, which came with us from premortal life and which we’ve acquired since birth. . . For years your personality may have been growing in one direction. Now you must help it grow in another direction. You cannot easily erase those destructive voices from the past, but you can recognize what they do to you and turn them off. You can rid yourself of these voices by replacing them with positive feedback and experiences that will build self-esteem. The Lord has promised that our weaknesses can become strengths and that 'all things shall work together for [our] good' if we search and pray. (Ether 12:27, D&C 90:24.)"

*What I liked: We're owning up to the voices in our heads! Yay, us! And we are starting to challenge those voices.

*What I didn't like: The author, who has already stated that this has little to do with sin, says that some of those voices come from Satan. I've had numerous people mention ideas like this one to me when I talk about depression and I hate the implications. It always cause a frenzied thought process: Satan is living in my head? I mean, considering the fact that Satan can't be anywhere in my life that I don't let him (at least that's what my Seminary teacher told me. Wait. What are you saying? Life is more complicated than that? Well, crap. Don't tell my Seminary teacher.) then I must have let Satan in my head--which must mean I want him there? AAAAAH! I AM insane! I'm sure the people who say this don't mean it that way, but that's the way I always process it. I prefer to think of the crazy gal in my head as a neurological misfire. That seems to knock the wind out of her. With the Satan line, the crazy chick is only encouraged. If the Satan-in-my-brain logic works for you, more power to you. I'm just saying maybe we should be a little more careful with how we toss it around.

Idea #2:

"It’s one thing to face up to our weaknesses and work on them. It’s another thing to dwell on them. The gospel teaches us to take charge of our minds as well as our bodies. Suppose you’re thinking about a mistake you’ve made. Ask yourself: Is this helping me deal with the problems I’m now having or is it making me feel more inadequate? If it’s dragging you down, push it out of your mind or crowd something else in front of it. The apostle Paul told the Philippians that he knew he wasn’t 'already perfect,' but at least did 'one thing': 'forgetting those things which are behind, and reaching forth unto those things which are before.I press toward the mark for the prize of the high calling of God in Christ Jesus.'(Philip. 3:12–14.) . . . Nowhere in the scriptures do I find any license to punish myself. President Kimball [taught] us that we are punished by our sins. That’s punishment enough. It’s much better to reward ourselves for what we do right. This helps us focus on our strengths and moves us more in that direction; punishment focuses on our weaknesses and doesn’t teach us any new behaviors."

*What I liked: The self-flagellation impulse is strong in people with mood disorders. Whether it's mentally berating oneself or holding back from pleasurable experiences or self-mutilation like cutting or eating disorders, there is a strange relief that comes from punishing oneself. But, wait! The scriptures and the prophets have told us that's wrong. We don't believe in penance; we believe in the atonement of Jesus Christ and the grace of an almighty and all-loving God. It's not our job to punish. It's our job to lean on Christ and try to do better.

*What I didn't like: I think the author seriously underestimated how hard it is to redirect the depressed brain. I wish he had included some suggestions on how to "crowd something else in front of it." Usually the only way I can accomplish this is to read or turn on the TV. I'm curious how you all crowd things out. For me, the harder I try to NOT think about something the more intensely my brain focuses on it. Redirecting can be tricky and I wish there was more detail here.

I guess my biggest beef with the article was that it seemed to focus so heavily on managing the symptoms instead of dealing with the cause of the symptoms. Then again, the article was written in 1978 and depression was not well understood. We have a lot more information now and it is probably unfair of me to judge this article by today's information--which is why I tried to present both sides. This article has a lot of good advice, but I hope that we can also use it as a jumping off point to grow in our understanding instead of one more thing to make us feel like we aren't trying hard enough.

Or we could use it as an excuse to tell really lame jokes ;)

Anyway, to end on a positive note, here are some other good tips:

1. Be aware of your feelings. Recognize when you begin to feel depressed, discouraged, and uneasy. Many times a person feels down but doesn’t know why. As soon as you recognize depression, trace back the chain of events that led to it.

2. What event cued these feelings? Was it something you did? Something you didn’t do? Something someone else did? Something that disappointed an expectation?

3. Then ask yourself, “What does this event tell me about myself?”

4. Then challenge those negative voices. [You'll] know what to do to have a better experience next time.


Charlotte said...

Excellent analysis of the article! I think this was a great pick - you are so right that so many of our leaders (and us!) were raised to believe that mood disorders were something you could fix if you just tried hard enough. I am so glad you broke this down for us. I think you are right.

Breakdown said...

Whenever I get into a kind of depression I usually try to analyze it enough to realize that there is very little I can do about it. (this leads to some very interesting monologes) then I try and put off thinking about (usually through the use of video games, playing with my kids, finding something funny to read, watch or write, or hyping myself up to do something that I've been putting off) it until the problem resolves itself or the worst part is over.

Courtney said...

At first I was really upset by this article then you said it was posted in 1978 and it clicked. I just couldn't believe how they tried to make it sound like you could just turn depression off. Like if you were just trying harder or being better you could push the depression out, and almost implying that depressed feelings and emotions and thoughts were from Satan. Great now we are evil because we are crazy! I just wonder how an person enlighted from God can write stuff like this. I always assumed articles placed in the Ensign were done so by inspiriation, but then one would wonder why it is that inspiration changes when outside information changes... God should be all knowing at all times, not just when science catches up.

Laura said...

Those are good suggestions Breakdown! Thanks :)

Courtney--I think it's important to distinguish between a Church publication and the mind of God. The Ensign is NOT scripture--especially not the parts written by people with little authority and limited stewardship. This article was one of those. The guy had been a bishop (read: not trained in therapeutic techniques or psychology or, for that matter, in theology)and that's it. I guess you could think of him as a lay minister. This guy wasn't speaking for God. He was speaking for himself and his knowledge was pretty limited--probably because of when he lived. But I think his heart was a in a good place. I don't think he was trying to willfully stigmatize depressed people. I think those same things are also true for the editors of the Ensign. I've run into to one or two of them in the bloggernacle and, I gotta say, they are people just like us.

So you're right. God is all-knowing all the time. But since this life is a time for us to learn He has to let us bumble through with our limited resources and knowledge--just like you have to let your children learn through trying different things and, sometimes, screwing up.