No wonder, then, that there has been some residual
ambivalence between those who minister to the spirit and those who
minister to the mind. Add to that a Western sensibility about pulling
yourself up by your bootstraps, plus a religious belief in the power
of faith to solve what ails you (not to mention the power of sin to
make you crazy), and what you often ended up with in Utah a generation
ago was confusion and uneasiness about mental illness.
But things have changed, say therapists and clergy, especially
in the past decade. "There's much less resistance than I have ever
seen from religious people of one ilk or another to sending someone to
a psychiatrist," says University of Utah psychiatry professor David
Tomb.
He attributes that shift to new brain research — proof that many
mental illnesses have biological and chemical components — as well as
to a general destigmatizing of mental illness nationwide. Members of
the Church of Jesus Christ of Latter-day Saints also point to a 2003
book by Elder Alexander Morrison, emeritus general authority of the
church and director of the Alliance for Unity. Morrison's "Valley of
Sorrow: A Layman's Guide to Mental Illness," which details his
family's struggle to help his daughter deal with chronic mental
illness, served as permission for many church members to finally admit
struggles of their own.
That doesn't mean that there still isn't plenty about mental
illness that perplexes the faithful. Mental illness is continuum that
encompasses both mild mood disorders on the one end and paranoid
schizophrenia on the other, and lots of murky areas in between — as
well as conditions and propensities that are even harder to
categorize. The death of a child can cause chemical changes in the
brain that lead to clinical depression in a previously healthy person.
Gambling addiction can be viewed as a mental illness or a series of
bad choices. And what about homosexuality? The American Psychiatric
Association says it is not a mental illness, but not everyone looks at
it the same way. Same-sex attraction is seen by some as a sin that
needs repenting, or a mental illness that needs therapy, or simply a
fact of life.
And what kind of help is acceptable for people with mental
illness? Will a secular therapist lead a person away from his faith?
Is medication the best therapy? Medication plus talk therapy? Should
spiritual counseling play a part?
Even mental-health professionals disagree about diagnoses and
labels and treatment. "There are people in the psychiatric community
who don't even think there should be psychotherapy," says Tomb about
psychiatrists who think medication is the only answer. "And there are
others who say, 'If Freud didn't say it, it isn't worth saying.' And
there are others who feel that the bigger issues are more important
than what you thought about your mother. And then there's the
cognitive-behavioral group."
Clearly all this adds up to a tall order for the average pastor
or lay bishop when a parishioner sits down some Sunday after church
and confides that he's been feeling depressed or anxious or obsessed
by feelings of guilt. And yet, more and more, clergy are faced with
church members who need help with mental-health issues.
Rick Hawks, a psychologist who is on the board of the Mental
Health Resource Foundation, extrapolates that if, as is estimated by
President Bush's New Freedom Commission on Mental Health, in any given
year between 5 and 7 percent of adults and children have a serious
mental illness, "in a normal LDS ward of 400 there would be 24 who
suffer each year from serious mental illness."
There was a time, not too many years ago, says psychotherapist
Dr. Jay Steineckert of ldscounseling.com, when bishops had "an
unhidden agenda" that said to their flock "if you're living the gospel
you should be happy, and if you're unhappy you must be doing something
wrong." Such a simplistic view of happiness "couldn't be farther from
the truth," he says.
Occasionally, Steineckert still hears about a bishop who tells a
mentally ill church member to pray harder. But the message from church
members such as Morrison and former LDS General Authority C. Max
Caldwell is that, as Caldwell recently said at the 2004 Utah Mental
Health Conference, "It could happen to any of us. . . . No occupation,
amount of money, church service or any other behavior can guarantee
any of us that our lives will be free from physical or mental
illness."
In his book, Morrison lists several myths about mental illness,
including "all mental illness is caused by sin" and "all that people
with mental illness need is a priesthood blessing."
"Without in any way denigrating the unique role of priesthood
blessings," writes Morrison in his book, "may I suggest that
ecclesiastical leaders are spiritual leaders and should not be
expected to take on the roles of mental-health professionals. Almost
all of them lack the professional skills and training to deal
effectively with deep-seated mental illnesses and are well-advised to
seek competent professional assistance for those in their charge who
are in need."
On several fronts, local groups are working to provide
mental-health information and training to clergy. Since late 2001, the
Utah chapter of the National Alliance for the Mentally Ill (NAMI) has
been holding training sessions for bishops, Relief Society leaders and
other members of the LDS lay clergy. Some of these regional meetings,
says NAMI Utah executive director Vicki Cottrell, have drawn as many
as 1,000 people. NAMI Utah has also contacted other denominations, she
says, but "they haven't gotten back to us."
But all clergy could benefit from more training, she says. "Even
if you have a master's in social work, do you really have a connection
with what a person is living with? What we're trying to do is open up
empathy for people living with this, and their families."
The group began holding the sessions, she says, "because so many
people were saying, 'My bishop doesn't understand what I'm going
through.' " As evidence of a lingering confusion about mental illness,
she points to questions asked at the sessions, particularly those that
equate depression and the "dark behavior" of sinfulness.
The Mental Health Resource Foundation, whose board members are
largely LDS but who hope to provide assistance to all religious
faiths, has a Web site with links and resources about mental illness
and is putting together a checklist for clergy. This list, says Elder
John Lasater, LDS general authority emeritus, would help clergy
evaluate whether a particular problem requires immediate medical
attention, spiritual counseling alone, or a referral to a
mental-health professional after the problem is "stabilized."
Salt Lake psychiatrist Dr. Gregory Ellis suggests that a good
role of thumb for clergy, when a parishioner confides about emotional
problems, is to "listen to what the past 10 days or two weeks has been
like." Has the person "been in that malady for most of the hours of
those past 10 or 14 days?" Is he doing something potentially dangerous
to himself or others? If so, he says, that's when a referral to a
mental-health professional is in order.
Sometimes, notes Ellis, a bishop or pastor or rabbi might need
to sort out whether a person who is consumed by guilt has a mental
condition such as obsessive compulsive disorder or clinical
depression, or whether the depression is caused by a disconnect
between a person's actions (engaging in premarital sex, for example)
and his belief system (which might teach that premarital sex is a
sin).
This is where things can get problematic, since moral values can
color a diagnosis and a prescription for treatment. When the questions
revolve around a patient's doubt about his religious upbringing or his
faith in God, things get even touchier. While a religious leader, and
some therapists, might see the issue as getting a doubter back on the
right spiritual track, others might prefer to let a client explore
that doubt.
"We want to make sure that members of the church get help that's
consistent with gospel principles," says Fred Riley, commissioner of
LDS Family Services. The church has 63 offices around the world,
including 11 in Utah, that provide counselors; it also has a list of
professionals it sanctions.
"People call me and ask me my religious preference," says Salt
Lake psychotherapist Christine Norman about both her Mormon and
non-Mormon clients. "They say, 'I want to make sure you understand the
issues.' " They worry, she says, that she's going to challenge their
core beliefs or pull them away from something that's important to
them. But all reputable therapists, she says, no matter what theory
they've been trained in, have been taught to work within the patient's
belief system.
University of Utah psychiatry professor Tomb says that LDS
bishops are happy to refer church members to him — "when I'm acting as
a biological psychiatrist" who dispenses medications — but are more
reluctant when he wants to do talk therapy.
Although, traditionally, psychotherapy has been a purely secular
endeavor, there is a growing subset of therapists who have added a
spiritual component to their work, says Salt Lake clinical
psychologist Janet Warburton, public education chair of the Utah
Psychological Association. These therapists are responding to studies
in the past decade that show the healing power of faith and prayer,
she says, even if it's not clear whether that healing results from
positive thinking, divine intervention or a feeling of connection to
something bigger than themselves. Therapists, she says, are now more
likely to ask their clients, "Do you have a religious belief system?
Do you find it helpful?"
"It's healthy to have spiritual support, whether it's from the
Zen Center or a church or a synagogue," says psychotherapist Norman.
Like mental illness itself, "spirituality" is a big umbrella
that includes not only God and church but what some might term
existential questions about purpose and meaning. The Utah-based SHIM
(Spirituality and Healing in Medicine) Foundation, says executive
director Dr. Jerry Sonkens, has defined the seven principles of
healing as faith, hope, purpose, social connections, a sense of
control, forgiveness and gratitude.
For the faithful, these elements are self-evident. Salt Lake
orthodox rabbi Benny Zippel of Chabad Lubavitch of Utah says he refers
his mentally ill patients to mental-health experts — but that's only
part of the solution, he says. He prays with his troubled flock, he
says, and studies the Torah with them. Healing, he says, requires "a
certain level of inner peace and spiritual fulfillment."
Prayer and scripture study are essential elements to healing,
for both the person suffering from the mental illness and the family
members who suffer along with him, echoes Lasater. "It reawakens in
the mind of the individual who they really are, and that there is
someone up there who really loves them. When you begin to feel
important to someone, that you are a daughter or son of God if you
want to put it that way, it makes the job easier." When it comes to
mental illness, he says, "we use every tool we can."
