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From the Archives: Depression and Stigma, a rant.

Posted Jan 08 2009 4:21pm

First Published Feb. 3, 2008.

One of the tried and true nuggets of anti-mormonism is the fact that Utah has the highest per capita rate of prozac use in the country. Why is this, they ask and insinuation is clear. Something must be wrong with that religion. Ooh its beating people down. they’re repressed, look, look, they’re repressed. Here is my answer to such critics, if you want to know who is responsible for high rates of depression in the Mormon community, go take a look in the mirror.

I should start by saying that there are some reasonable sounding explanations for this. Mormons, active Mormons, anyway, don’t drink. As a doctor, if you want to know if someone is depressed, taking a drinking history is a good place to start. People self medicate with alcohol. With the Mormon prohibition of alcohol- part of the “Word of wisdom” self medicating is out, so it seems they go to their doctor and get real medication.

Today I don’t want to argue that or any other excuse because I think there is absolutely nothing to excuse. I reject the entire premise. All a lower rate of depression tells me simply that people are afraid to say they have depression. The fact that these statistics are being thrown in our face is exhibit A that stigma is the real problem.

I do feel that true recovery from depression has a spiritual side to it. It involves growing and maturing as a person. For me, it involved building a closer relationship with God. Depending on our level of spiritual understanding and maturity, religion can be either a help or a hindrance when it comes to depression.

However, depression itself is simply part of the human condition. When a loved one dies or you suffer a stroke, for example, depression is a normal response. Life is hard. It is full of disappointments and triumphs, peaks and valleys, trials and loss. Depression is a consequence of this simple fact, caused by a variety of complex factors, with no single model fully describing, explaining or predicting it.

In our society it is synonymous with failure. An excessive sense of failure, extremely low self worth, and excessive self criticism also happen to be causes/effects of the condition itself. So pointing fingers at Mormons, or religion, or atheists or anyone is not doing anybody any good, period. It is simply exacerbating symptoms and strengthening false assumptions.

No religion wants to admit when their community suffers from any kind of failure. Since we have defined depression as failure, the impulse of any religion or ethnic group is going to be to try burying and hiding the problem. This helps no one. I am sad to announce that this stigma does exists the Mormon community. The past few decades have seen great strides with somewhat improved training for Bishops, who after all are laymen, and emphasis on referral to mental health services once Bishops recognize the problem.

Beyond the Mormon community, the stigma exists in the Protestant, Evangelical, Catholic, and Jewish, and Atheist communities. It exists in the American community. It exists in families. I have heard from my own family how some of the content on this sight just couldn’t be read by them because it was too personal. The thing is, I now realize I have nothing to be ashamed of any longer. I don’t care if family reads this. I want to tell my story. The shame I once had is a major part of the problem.

Depression is taboo in our society and it has to stop. Depression is stigmatized by the very fact its epidemiology can be used to try to smear a religion. Most painful of all to me, this stigma is absolutely thriving where you would never expect it to, in the Medical community.

The worst thing you can do to someone who is depressed, with an overdeveloped sense of self criticism is blame them, blame their family, blame their religion. All that will ever do is drive the problem underground. This is what drives the next door neighbor to drinking in his basement, denying the problem, until one day, he has hanged himself in the garage.

Whether nurture or nature (clearly a combination of both) is the root cause, it is clear to me depression is part and parcel of the human condition. I don’t claim to know exactly why it affects some more than others. We can argue all we want about the causes of depression, but until it is okay to cry for help, the fact is we are driving people to suicide.

My medical community seems outwardly to understand this. They teach this. The medical model for depression is hammered into the curriculum. We are taught to treat it just as we would appendicitis or pneumonia. While I have acknowledged the problem is more complex than that, the medical model of depression should have one thing going for it. Theoretically, It should diminish the stigma and help others get treatment. This is what is so maddening about my experience.

It turns out that medical school admission is weighted toward the obsessive-compulsive side of the population. It advantages a medical student to be a perfectionist. We are graded and trained by perfectionists to be perfectionists.

After all, failure and mistakes in medicine can cost human life. However, you can still do everything right and still have patients die. Life and death are not within our power to control to the degree we would like to think it is. Nevertheless, fear of imperfection and weakness become an occupational hazard. We don’t like showing it, we don’t tolerate seeing it among our colleagues.

So as we move through the fierce training, exhausting hours, intense situations, steep learning curves, if we run into problems the knee jerk response is immediately remove you from patients to keep you from hurting anyone. Depression becomes this very deep, dark secret. So a culture develops where binge drinking is very common, particularly to “celebrate” after any particularly rough milestone in training. Every medical school out of necessity(Not voluntarily, it required laws) has a counseling office. They are busier than anyone would care to realize. Trips to their office becomes an exercise in stealth as we flee from the career killing eyes of the doctor rushing to or from the same place in the parking lot.

My first visit to the psychiatrist I was told that medical students will come in for help themselves or at the urging of friends, residents typically get dragged in by their supervisors, and practicing physicians will only get help if a spouse drags them in. In my experience this is totally true. It appears the more we buy into the culture we transform into somebody different. We become physicians. We must be invulnerable. We simply cannot admit to weakness.

Confidentiality is the Medical School counselor’s mantra. We need it to be safe. If we open up to other colleagues, they often become wary and suspicious. We second guess ourselves as part of the condition and then continue to get second guessed again on top of it.

If we open up to a training program, well lets just say its time to look at the pharmaceutical sales job. No refunds, no returns, no exchanges, your career is over. For me, getting help was simultaneously the best and the worst career move that I could ever have made. First I got better after having been nonfunctional and then I got branded, even as I became functional.

Summary- This much is clear to me, depression is part and of the human condition. I am not going to claim to know why some people are more susceptible to it while others are not. Nature and nurture clearly play roles. I will leave it at that. What we really need in order to address this human condition is more humanity ourselves.

I look forward to a day when I can tell whoever I want I have depression and it isn’t any worse than saying I have the flu. Clearly people are interested in the subject. All I have to do is look at the traffic to my site and the engine searches. I wish I could just attach my name to my story with no fear of consequence. We aren’t there yet. Then and only then, will society really be able to start healing everyone and addressing the problem.

   Tagged: anxiety, culture, prejudice, stigma   
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