Describing Depression: An Experienced Voice

After studying depression for three months, Christian filmmaker Ray Comfort thinks he understands the subject. After his research, he made a movie about suicide, called Exit, which is available on his website for $20. Yesterday, he told David Barton on Wallbuilders Live that after awhile the movie would be free on YouTube. I haven’t seen the movie yet, but judging from the interview, I have to question how well he understands depression.
Yesterday, I reviewed the Wallbuilders interview and found the advice offered by Barton and Comfort to be unhelpful and possibly harmful for some. For his part, David Barton said the culture promotes depression via acceptance of abortion and homosexuality. He added:

We’re promoting things that cause it we’re now saying, “Well, depression is fine therefore suicide is fine.”

I never heard anybody say that until Barton said it on his program.

Later in the interview Comfort seemed to blame lack of religious belief as a catalyst for depression. I intend to review the movie after I watch it.

What was missing in their discussion was any recognition that depression is a medical problem with a biological foundation. If anything, listeners could easily come away from that interview thinking that depression could be cured by having an evangelical belief system. Experience tells us that is not true.

Describing Depression

Depression as a concept is hard to pin down. What makes the subject difficult to grasp is that mood naturally flows between highs and lows. Sometimes are moods are depressed for no reason, but other times, there are negative circumstances which are hard to accept which gives rise to depression. Thinking through things rationally and with a long view can help to overcome those rough spots. However, suicidal thinking is most associated with chronic depression which is not a bad day or triggered by negative circumstances. This the more complex medical situation which Comfort and the Bartons don’t seem to grasp.

As I was reflecting on the Comfort interview and preparing to watch Exit, I came across the writings of a friend who experiences depression. I have permission from my anonymous friend to reproduce them here. I think they reflect and describe what it is to feel this kind of depression.

Occasionally, bouts of depression are triggered by obvious catalysts, like losing a job or loved one or some kind of overt trauma. Often, though, nothing is “wrong”. We’re not upset or sad or angry or stressed about anything particular, but our body is deploying hormones as though we’re being attacked.
It is these episodes that are most frustrating to the friends and family of people who have depression; they don’t know what to do to help because there’s seemingly nothing wrong. The victims of those moments find it doubly frustrating, as a silent, crushing dread slowly bears down on our souls, challenging us to find a name for it.

Mental pain is less dramatic than physical pain, but it is more common and also harder to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say “My heart is broken,” especially when there’s no obvious reason why or easy descriptors available.*

I don’t know what to do about these moments, how to describe them, or how to trace their causes. And while I can sometimes learn about them when my depression is on vacation, I’ve yet to overcome the moratorium on research it imposes when it’s at work full time.

But I know this: depression is a liar. It whispers that the world is uniquely bad in general and uniquely bad for me in particular. It tells me that the comfort of friends and annoyance of acquaintances are reinforcing, not alleviating, my problems. It inspires coping mechanisms like over sleeping, over eating, substance abuse, or other self-destructive behaviors that rob life of its joy. Depression only looks out for itself, and it lies to you to keep itself safe.

I don’t know what to do about it, and I can’t always find the energy to fight back. But depression is a liar, and it blinds me to what’s really true, noble, excellent, and praiseworthy. It’s hard, but I’m learning slowly not to fall for the lies, to hunt for companionship when I feel most lonely, and to know that what I’m feeling isn’t unique, even if I can’t describe it.

I can’t teach you anything about my depression, and I certainly don’t know anything about what you might be feeling. But we could all use a hand in the dark, particularly when there are so many cheap people offering cheap solutions to expensive problems. If you have a hand to offer, I’m sure you know someone who needs it, and if you need to take my hand, I’ll try to offer it when I’m able.

Our task is to make the whole world our hospital, to provide for the sick and bind up the wounds other people might have. Depressed people don’t know their treatment options or the extent of their diagnosis, but each of us can offer a small glimpse of healing to those who are most ill. I have nothing but thanks for those who have been my doctors, and I hope some day to repay the kindness.

Thanks to my anonymous friend for sharing these thoughts.
For depressed people, it doesn’t help to shame them because they have different beliefs or doubt God. What helps is what my friend describes: medical care, companionship, and a kind hand in the darkness.

*Inspired by C.S. Lewis, The Problem of Pain.

Depression is Not a Culture War Battle

One does not need to be a Christian to oppose suicide. People of all religions and none view suicide as a tragedy.

During his April 21 Wallbuilders Live broadcast, David Barton had Ray Comfort on to discuss his new movie about suicide, Exit. I intend to watch and review the movie but for now I want to advise readers to be wary. For the most part, the advice given during this episode about depression and suicide is not helpful and in fact for some could be counterproductive.

I want to start by saying that I think the guests on the program probably meant well. I especially picked up from Tim Barton that he wanted to be helpful, saying

Yeah, Rick, one of the reasons that we talked about this before here on this show is that this is something we want to do because- we don’t want to do anything that promotes obviously, this incredibly sad and really unbiblical position, that someone would want to end their life. So we want we want to promote that there’s hope, right?

Suicide is Not a Cultural War Issue

Good intentions or not, there is a troubling thread here which continues throughout the program. The hosts and the guest treats suicide like it is a culture war battle — Christians on one side and non-Christians on the other. The problem with this should be obvious. One does not need to be a Christian to oppose suicide. People of all religions and none view suicide as a tragedy.

Alas, David Barton makes depression about what he’s against and shames those who are on the wrong side.

David: You’re talking about how the culture is now present in things like suicide with the programs out there. Suicide so often stems from depression and Ray will talk about the rising depression numbers in the United States.

What’s interesting is the culture also promotes things that increase depression. For example, when you look at studies on abortion, women who have had an abortion have depression rates three to five times higher than everybody else.
You look at homosexuality. Homosexuals have depression rates three to five times higher than everybody else. So we’re even promoting things now that cause depression. We’re promoting things that cause it we’re now saying, “Well, depression is fine therefore suicide is fine.”

And it’s really not because there is a Biblical side. Depression really comes from being discontent with who you are or what’s going on. It’s not accepting yourself or not accepting the situation.

Barton confuses effects and causes. Being unhappy with oneself is most often an effect of depression. Simply advising a depressed person to accept yourself is like telling an unemployed person to save for retirement. The otherwise sound advice just increases the hopelessness.

Regarding Barton’s claims, there is evidence that depression is higher among women who have had abortion and yes, GLBT people report more depression. However, the matter of cause cannot be ascertained from these facts. Women who have abortions also have other stressors in their lives. For some, especially those who do not believe abortion is right, having an abortion may trigger depression. However, for others there is no link.

The picture with homosexuality is even more complex. The existing research does not confirm that being gay causes depression. When examining a correlation between two variables, variable A may cause variable B or vice versa. However, a third possibility exists. Another variable may effect both variable A and variable B. For instance, shark attacks and ice cream sales in a coastal town might correlate but clearly summer beach going influences both variables.

We know that women are depressed more than men. We also know from brain scan studies that the brains of gay males are more like the brains of straight females than straight males. It is reasonable to hypothesize that there might be a neurological basis for straight females and gay males to report more depression.

Barton wants to make depression about doing right and being on the right side of the culture war. I can assure Mr. Barton that Christian nationalists get depressed. Good Christians get depressed. Straights and women who have never considered an abortion get depressed. Portraying the causes of depression as being about believing the right Christian things is unhelpful and may drive some people away from getting the help they need. Worse, people who hold the “right” views but remain depressed can become even more hopeless. Over 40 years of clinical practice and teaching, I have encountered many Christians who want to give up because they do everything “right” without relief from their depression.

Ray Comfort: A Three-Month Expert

Apparently Ray Comfort is a quick study. After three months of study, he has all the answers.

So I studied it and after about three months of studying, writing a book, and doing a movie I came to the conclusion the world doesn’t know what it’s doing. They have no idea what causes chronic depression and they have no chance of a [against] suicide.

I’m bold enough to say, “We know what causes most chronic depression and we know the answer to it.” And that’s what we put in the movie. And we’re very excited. Our YouTube channel’s got 45 million views. This is a massive platform to reach the lost of the gospel. And we believe this is our best movie ever it’s called, “Exit” for obvious reasons.

The arrogance here is pretty thick. Evangelical circles are full of three-month experts. I intend to reserve judgment on the movie until I see it but I don’t have a good feeling about a person who thinks he has the subject of depression mastered after three months of study.

Atheism is to Blame or Is It?

The bottom line for Comfort in this interview (and perhaps the movie) is that atheism is to blame for increases in suicide. Comfort said:

I was reading recently where American Journal of Psychiatry said, “Religiously unaffiliated subjects, people who were Godless, had significantly more lifetime suicide attempts and perceive fewer reasons for living. Particularly fewer moral objection to suicide.”

So this generation doesn’t object to suicide. So we’re going to see, I believe, a huge increase in the future and the church has got to be ready for it. That’s why we’ve created this movement to train the church so they can see what they say. We’ve also created a study guide a video study guide that goes with it.

Indeed, Comfort gets the 2004 AJP report mostly correct. Here is the abstract from that study:

OBJECTIVE: Few studies have investigated the association between religion and suicide either in terms of Durkheim’s social integration hypothesis or the hypothesis of the regulative benefits of religion. The relationship between religion and suicide attempts has received even less attention.
METHOD: Depressed inpatients (N=371) who reported belonging to one specific religion or described themselves as having no religious affiliation were compared in terms of their demographic and clinical characteristics.
RESULTS: Religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation. Unaffiliated subjects were younger, less often married, less often had children, and had less contact with family members. Furthermore, subjects with no religious affiliation perceived fewer reasons for living, particularly fewer moral objections to suicide. In terms of clinical characteristics, religiously unaffiliated subjects had more lifetime impulsivity, aggression, and past substance use disorder. No differences in the level of subjective and objective depression, hopelessness, or stressful life events were found.
CONCLUSIONS: Religious affiliation is associated with less suicidal behavior in depressed inpatients. After other factors were controlled, it was found that greater moral objections to suicide and lower aggression level in religiously affiliated subjects may function as protective factors against suicide attempts. Further study about the influence of religious affiliation on aggressive behavior and how moral objections can reduce the probability of acting on suicidal thoughts may offer new therapeutic strategies in suicide prevention.

At first glance, it appears that religious belief about the immorality of suicide may be a protective factor against suicide. However, this is not the only study on the subject. Consider the abstract of this 2016 study reported in the Journal of Nervous and Mental Disease:

We aimed to examine the relationship between religion and suicide attempt and ideation. Three hundred twenty-one depressed patients were recruited from mood-disorder research studies at the New York State Psychiatric Institute. Participants were interviewed using the Structured Clinical Interview for DSM Disorders, Columbia University Suicide History form, Scale for Suicide Ideation, and Reasons for Living Inventory. Participants were asked about their religious affiliation, importance of religion, and religious service attendance. We found that past suicide attempts were more common among depressed patients with a religious affiliation (odds ratio, 2.25; p = 0.007). Suicide ideation was greater among depressed patients who considered religion more important (coefficient, 1.18; p = 0.026) and those who attended services more frequently (coefficient, 1.99; p = 0.001). We conclude that the relationship between religion and suicide risk factors is complex and can vary among different patient populations. Physicians should seek deeper understanding of the role of religion in an individual patient’s life in order to understand the person’s suicide risk factors more fully. (emphasis mine)

How are we to understand the different findings? I really can’t say. However, having studied this subject for many more than three months, I can say that contradictory findings are common in this field. What we can say is that being religious and believing in God isn’t a fool proof means of preventing depression and suicidal urges. Among some groups of people, religious beliefs are associated with fewer suicide attempts whereas for other groups (notably those who are depressed), religious affiliation is associated with more attempts.

What’s the Remedy?

Although Comfort doesn’t give many details about the movie, the hints he gives implies the movie is a way to get people to make decisions to accept Christ as Savior. After acknowledging that religious people get depressed, he seems to say depression will be lifted if you just belief the right things. Again, I will wait to see, but if there is nothing in the film about getting treatment with a message that depression can be managed by competent medical care, then it will be of little value.

There is one good thing I can say about the interview. Comfort and his hosts had some negative things to say about the Netflix series 13 Reasons Why. While I haven’t seen the series, I don’t like what I’ve read about it.

For more information…

Suicide and the Media
Preventing Suicide Media Resources
NIH website entry on depression
National Suicide Prevention Lifeline

Mercy Multiplied Is Subject of Slate Exposé

Mercy Multiplied (formerly known as Mercy Ministries) consists of several in-patient facilities which claim to assist young women recover from abuse, eating disorders, and various other mental and emotional conditions. On Sunday, online magazine Slate revealed unflattering and disturbing results of an investigation of the ministry through the eyes of several former patients.
If the reports are true, then Mercy Multiplied should be shut down.
These stories reminded me of the 1990s controversy over repressed memories and especially the Philadelphia area counseling center Genesis Associates. Former Mercy girls told Slate they were led to believe they had been sexually abused and involved in sex trafficking via imagery techniques. They claim that in counseling sessions girls were told by their counselors that God had reveal certain past abusive events. Residents were urged to cast out demons and refuse needed medications.
There seemed to be some similarities to the demon trials described by Mark Driscoll.
This morning, I asked Mercy Multiplied’s Director of Communication Jackie Quinn for a response to the Slate article but did not get a response.
One cannot know if these allegations are true or wide spread but it does provide a cautionary tale to people who are considering counseling to avoid these kind of techniques. I hope Mercy Multiplied will address the possible use of visualization techniques where false memories might be implanted.
From the mid-1990s, here are some clips of Genesis Associates from the documentary Divided Memories.
[youtube]https://www.youtube.com/watch?v=VWoxGEr0nmw[/youtube]
[youtube]https://www.youtube.com/watch?v=waBha5AOAyI[/youtube]
[youtube]https://www.youtube.com/watch?v=yZckrmKCzlU[/youtube]

American Psychological Association: APA Reps and Government Officials Colluded on Interrogation Techniques

The American Psychological Association just released the following press release regarding the involvement of psychologists in the Bush Administration’s interrogation techniques. For background, see this prior post (link).

July 10, 2015

Press Release and Recommended Actions: Independent Review Cites Collusion Among APA Individuals and Defense Department Officials in Policy on Interrogation Techniques

APA Apologizes for “Deeply Disturbing” Findings and Organizational Failures; Announces Initial Policy and Procedural Actions to Correct Shortcomings

WASHINGTON — The American Psychological Association (APA) today announced an initial series of policy and procedural steps in response to findings of individual collusion and organizational failures in the group’s activities related to the Bush Administration’s war on terror.
The actions come as the APA released a 542-page report produced by attorney David Hoffman, of the Sidley Austin law firm, detailing the relationship between various activities of the APA and Bush Administration policies on interrogation techniques. Mr. Hoffman was retained by the APA Board of Directors last November to conduct a thorough and independent review, and the APA cooperated fully during the eight-month process.
“The Hoffman report contains deeply disturbing findings that reveal previously unknown and troubling instances of collusion,” said Dr. Susan McDaniel, a member of the Independent Review’s Special Committee. “The process by which the Presidential Task Force on Psychological Ethics and National Security (PENS) was created, the composition of the membership, the content of the PENS report and the subsequent activities related to the report were influenced by collusion between a small group of APA representatives and government officials.”
The Hoffman report states that the intent of the individuals who participated in the collusion was to “curry favor” with the Defense Department, and that may have enabled the government’s use of abusive interrogation techniques. As a result, the 2005 PENS report became a document based at least as much on the desires of the DoD as on the needs of the psychology profession and the APA’s commitment to human rights.
“Our internal checks and balances failed to detect the collusion, or properly acknowledge a significant conflict of interest, nor did they provide meaningful field guidance for psychologists,” said Dr. Nadine Kaslow, chair of the Independent Review’s Special Committee. “The organization’s intent was not to enable abusive interrogation techniques or contribute to violations of human rights, but that may have been the result.
“The actions, policies and the lack of independence from government influence described in the Hoffman report represented a failure to live up to our core values. We profoundly regret, and apologize for, the behavior and the consequences that ensued. Our members, our profession and our organization expected, and deserved, better.”
In response to the Hoffman report, the Board initiated several actions and made additional recommendations to the APA’s governing Council of Representatives. The full list is attached.
The Board recommended that the Council:

Adopt a policy prohibiting psychologists from participating in interrogation of persons held in custody by military and intelligence authorities, whether in the U.S. or elsewhere, but allowing training of military personnel on recognizing and responding to persons with mental illnesses, on the possible effects of particular techniques and conditions of interrogation and other areas within their expertise;
Create a Commission to evaluate and recommend changes to APA ethics processes;
Adopt formal guidelines to ensure that all relevant policies are anchored in APA core values, including promoting human rights, human welfare and ethics;
Approve the substitute motion of Council New Business Item #23B, which clarifies the role of psychologists related to interrogation and detainee welfare in national security settings and safeguards against acts of torture and cruel, inhuman or degrading treatment or punishment in all settings.

The Board voted to:

Increase the organization’s engagement around human rights activities in collaboration with other organizations;
Collaborate with the Council to create governance constraints on elected and appointed APA officials;
Evaluate existing conflict-of-interest policies regarding financial, policy or relationship-based conflicts to ensure the policies are understood and followed;
Adopt clear procedures for appointing members to APA Task Forces and Commissions;
Create specific criteria for emergency action by the Board.

The Hoffman report concluded that some longstanding criticisms aimed at the APA regarding these matters were inaccurate. Most notably, Mr. Hoffman concluded that counter to critics’ claims of APA collusion with the CIA there was “no evidence of significant CIA interactions regarding PENS.”
Mr. Hoffman also said his inquiry “did not find evidence” that supporting the Justice Department’s legal rationale for approving abusive interrogation techniques was “part of the thinking or motive of APA officials.”
Additionally, the report confirmed that the organization’s 2002 change in its Code of Ethics was not the product of collusion. Mr. Hoffman “did not see evidence” that the revisions “were a response to, motivated by, or in any way linked to the attacks of September 11th or the subsequent war on terror. Nor did we see evidence that they were the product of collusion with the government to support torture.” As the organization has repeatedly stated, the ethics code was revised to provide a defense for psychologists when their ethical obligations on client confidentiality conflicted with court-ordered directive ordering disclose of confidential patient information.
“This bleak chapter in our history occurred over a period of years and will not be resolved in a matter of months,” said Dr. Kaslow. “But there should be no mistaking our commitment to learn from these terrible mistakes and do everything we can to strengthen our organization for the future and demonstrate our commitment to ethics and human rights.”

BOARD OF DIRECTORS ACTIONS AND RECOMMENDATIONS

The actions below were approved by the Board or recommended for consideration by the APA Council of Representatives in response to the Report of the Independent Review Relating to APA Ethics Guidelines, National Security Interrogations and Torture.

ACTIONS RELATED TO ETHICS OFFICE

Recommend that Council approves the establishment of a Commission comprised of psychologist members and non-members, as well as experts from other fields, to evaluate and recommend changes to APA Ethics processes (including, for example, the establishment of a Chief Ethics Officer), based on an assessment of current practices and procedures, as well as benchmarking with ethics processes of other professional organizations.
The Board will establish a mechanism for immediate oversight in the processing of filed ethics complaints including review of current adjudication and investigative procedures, and for ensuring transparency and accuracy in the disclosure of current ethics office practices.

ACTIONS RELATED TO PENS/PAST ACTIONS

Recommend that Council adopts a policy to prohibit psychologists from participating in the interrogation of persons held in custody by military and intelligence authorities, whether in the US or elsewhere, but allowing them to provide training to military or civilian investigative or law enforcement personnel on recognizing and responding to persons with mental illnesses, on the possible psychological effects of particular techniques and conditions of interrogation, and on other areas within their expertise.
Recommend that Council approve the substitute motion of Council New Business Item #23B.

ACTIONS RELATED TO ORGANIZATIONAL PROCEDURES

Council and the Board will collaborate to create governance constraints that address boundaries and appropriate oversight of elected and appointed officials, including Council, the Board of Directors, and boards and committees.
Council and the Board will collaborate to establish civility principles and procedures that promote respectful space for all voices and perspectives and define professionalism, including through the establishment of a moderator role for listservs.
The Board will evaluate conflict of interest policies regarding financial, policy or relationship-based conflicts, and other associated processes to ensure that the policy is understood and followed;
The Board will create clear procedures for appointing the members of Task Forces, Commissions, etc., by including a standard conflict of interest assessment and procedure for assuring needed content expertise;
The Board will create specific criteria and procedures for emergency action by the Board in keeping with the authority established in the Bylaws;
The Board will direct the CEO to ensure an appropriate balance of autonomy and oversight in the supervisory process with respect to financial decisions, business processes and standards, and other activities, and if needed, adjustments in the workloads of administrators that may constrain their capacity for oversight and supervision.

ACTIONS RELATED TO CHECKS AND BALANCES

Recommend that Council adopts formal guidelines to ensure that all relevant policies are anchored in APA core values, including promoting human rights, human health and welfare, and ethics.
Recommend that Council charge the Strategic Planning Advisory Committee with considering ethics, organizational restructuring, and human rights. This will assist in re-setting the organization’s ethical compass, and re-asserting our commitment to “do no harm” as a core value.
The Board will increase APA’s engagement around human rights activities and its collaboration with other organizations regarding these issues.

The full Hoffman report is available (PDF, 2.62MB) on the APA website.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA’s membership includes more than 122,500 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives.

Category: psychology