Introduction to Depression in Mormon Culture

Christopher Helfer [00:00:00] 1, 2, 3.

Vicki Winkle [00:00:07] Mormon Stories Podcast is a production of

Natasha Helfer Parker [00:00:09] the Open Stories Foundation. All donations to Mormon Stories are fully tax deductible and go directly towards keeping

Vicki Winkle [00:00:16] the podcast alive and towards building a

Natasha Helfer Parker [00:00:18] community of support for Mormons like you.

Vicki Winkle [00:00:21] To support the podcast or to join the community, please become a monthly subscriber today@mormonstories.org.

Natasha Helfer Parker [00:00:29] hello and welcome to Mormon Stories. This is Natasha Helfer Parker. And today I am very privileged to have with me two psychiatrists to help me with discussing the topic of depression. Depression seems to be a highly debated topic amongst Mormons of all different stages of belief. And I often see many people with depression in my own practice. And so I thought it'd be good to bring some people on that could help us just with basic education and thoughts and treatments and all the different things that we want to know about depression. So without further ado, I will go ahead and introduce my two guests. First, I have Dr. Christopher Helfer. And no, there's not a coincidence there. This is my brother. He's in the house. Hi, Chris. He's a fourth year resident at the University of Utah in the psych program. He graduated with his bachelor's in Spanish from the University of Utah and went to medical school at the American University of the Caribbean. Second, I have Dr. Vicki Winkle. Hello, Vicki.

Vicki Winkle [00:01:43] Hi.

Natasha Helfer Parker [00:01:43] And she is also a four year resident at the University of Utah in the psychiatry program. She graduated with her BS in Human Development from BYU and went to medical school at the University of Utah. Both grew up in the LDS faith. So I thought that was important just to be able to talk about some of these issues, just more from a Mormon perspective. So welcome to the program. Thank you so much for your time. I know your time is very valuable and I appreciate you guys both being here. I think where I'd like to just start and I don't care who goes first and maybe both of you can just kind of take turns off and on. But I'd like to start with the basic idea of what is a psychiatrist versus maybe a psychologist or a counselor or all these other kind of mental health terms that are out there. So just kind of to educate the audience on psychiatry and then also maybe you can touch on the fact that you're residents and what that means. Excuse me.

Psychologists, Psychiatrists, and Residency Explained

Vicki Winkle [00:02:42] Okay.

Vicki Winkle [00:02:42] Well, I think the important, one important aspect is that both psychologists and psychiatrists do a lot of the same type of work, which is therapy, talk therapy, and diagnosing and treating mental illnesses. I think the big difference is one is probably more biomedically oriented, which would be the psychiatrist who has a background in allopathic medicine, going to medical school for four years, kind of bringing that, I think, more scientific angle to mental illness. I think that would probably be the biggest discrepancy between a psychologist and a psychiatrist. And of course, a psychiatrist can prescribe medications and a psychologist does not do

Natasha Helfer Parker [00:03:39] so, at least here in the state of Utah. I know there are some licensed psychologists, maybe in other states that might be able to prescribe. We are in Utah right now.

Vicki Winkle [00:03:51] There are a couple of other states that have started to pass legislature allowing psychologists to prescribe medication if they have additional training and such.

Natasha Helfer Parker [00:04:01] And there's also nurse practitioners. Correct. That can in some states prescribe mental health medications.

Vicki Winkle [00:04:08] Yes, that's correct.

Natasha Helfer Parker [00:04:10] And Utah is one of them.

Vicki Winkle [00:04:12] Utah's 1.1state in which aprns can prescribe psychiatric medication. Psychologists as of yet.

Natasha Helfer Parker [00:04:18] And Nevada also is one, I believe,

Vicki Winkle [00:04:20] psychiatry medication in Utah. I don't know about Nevada.

Natasha Helfer Parker [00:04:23] Okay, I thought I had heard that, but maybe not. Okay, so any additional thoughts on that, Dr. Winkle? As far as differences between psychiatrists, psychologists,

Vicki Winkle [00:04:32] Really, I think Chris pretty much hit it, but it's. I think it's good that we went over it because it's a common question that we get. What's the difference between a psychologist and a psychiatrist? I think the most simplistic way to address that is that psychiatrists prescribe medication, just as Chris said. Psychologists do get a lot more specific training in therapy and in cognitive testing as well.

Natasha Helfer Parker [00:05:01] Right. Like some of the psychological testing. If you need to be tested for certain personality disorders or, I don't know, ADHD or things like that, they might go to a clinical psychologist. Okay, how about hitting on the. What does it mean to be a resident? For those who might not know that, Dr. Winkle, you want to take that?

Christopher Helfer [00:05:22] Sure.

Vicki Winkle [00:05:25] So when we refer to residents, we're talking about people who have completed medical school and then go on to complete more specialized training. So, for example, somebody might graduate from medical school and then go on to do training in pediatrics. And so you would say that that person is doing a residency in pediatrics,

Natasha Helfer Parker [00:05:46] but you're considered full fledged doctors at this point. MDs.

Vicki Winkle [00:05:50] Yeah. Once you've completed medical school, you have quote, unquote, MD behind your name, and you can prescribe medication under the supervision of an attending physician, which is someone who's completed their residency. So a resident is a doctor who's still in training, so to speak, somewhere between a medical student and an attending physician.

Natasha Helfer Parker [00:06:15] Okay. And a psychiatric Program, like at University of Utah is four years long. Right. So you, both of you are completing your last year of this training cut. Okay? So the next thing I guess I'd like for you guys to spend a little bit of time defining is depression itself. What does it mean to have a diagnosis of depression? What are you looking for to actually have that diagnosis be given to a person and maybe some of the,

Diagnosing Depression: Types and Symptoms

Vicki Winkle [00:06:50] I

Natasha Helfer Parker [00:06:50] don't know, easier ways to explain to the rest of us how this works in the brain and what's going on. So maybe if you want to kind of start with some basic ideas and if I have more questions, I'll go further.

Vicki Winkle [00:07:01] Sure. Well, I think you can use the term depression very broadly and use it to mean any phenomenon in which a person is so sad that it affects their life, it affects their ability to function. Within psychiatry, we have more clinical definitions of depression, and there are different types of depression that we talk about. We talk.

Christopher Helfer [00:07:26] We

Vicki Winkle [00:07:28] very broadly divide depression into two types, unipolar depression and bipolar depression. People have probably heard of bipolar disorder, and the main form of unipolar depression is major depression disorder. Within the realm of psychiatry, we talk

Vicki Winkle [00:07:49] about

Vicki Winkle [00:07:51] either one of those disorders being constituted by any number of symptoms. Sadness, anhedonia, which is decreased interest in what one normally would like to do or enjoy doing, difficulty sleeping, changes in appetite, inappropriate feelings of guilt, worthlessness. And when those symptoms seem to alternate in time with periods of increased energy, that's when we start to talk about bipolar depression. But most forms of depression are unipolar types of depression. We generally call that major depressive disorder.

Natasha Helfer Parker [00:08:34] We're just having the downside. The downside, exactly.

Vicki Winkle [00:08:40] But even if someone doesn't fulfill quote, unquote criteria for a major depressive episode or a major depression as defined by psychiatry's traditional way of defining things, we still consider that a clinically significant depression, and it's something that we would treat.

Vicki Winkle [00:09:02] Yeah, I agree. I think depression is kind of an ambiguous and kind of self, I don't know, kind of an inherent self defining term. I mean, people think of depression and they kind of can identify with what that means to them. And so, like Vicki was talking about, I think whether or not criteria is fulfilled per kind of our psychiatric bible or our reference, our book reference that we use for diagnosing mental illness, which is called the DSM Diagnostic Statistical Manual. Primarily in psychiatry, we treat symptoms whether or not those criterias are met. So if somebody's coming into a psychiatric clinic, it's because obviously they're not doing well, you know, Their level of functioning, whether it's socially, occupational, occupationally, educationally, is suffering. And it's a very painful experience. In order to seek out relief, either the patient or client themselves or family members will encourage them to come see a psychologist or psychiatrist to hopefully dissipate some of that pain. And I think typically these patients are struggling with despair, feelings of not being able to cope with life, feeling overwhelmed. They're totally demoralized. It's a pretty painful experience. And you can see that when clients come into your office, just.

Natasha Helfer Parker [00:10:46] You mean from their countenance as far as their body language and things of that nature?

Vicki Winkle [00:10:52] Yeah, both their body language, their. Their tone and their voice and kind of their. Their history. Their history is the most important part, typically in depression. And they can kind of express you through their history. You can kind of assess. Know where their normal level of functioning is, where they've been in the past and where they are now. And another part of depression that's important is kind of the lack of future hope. So that's kind of a classic red flag in depression that's scary both for patients and for clinicians is that there's no interest or hope or what we call future orientation. And so it's pretty, pretty grim.

Natasha Helfer Parker [00:11:36] And this is where, of course, suicidality can come in, and people are either maybe not starting to formulate a suicidal plan, but maybe at least are fantasizing about it.

Vicki Winkle [00:11:47] Absolutely, yeah.

Natasha Helfer Parker [00:11:51] And you talk about different types of depression. I talk about this with clients as well as usually there's a biological component, there can be a spiritual component, There can be a situation that has come up in somebody's life that causes depression. And then another thing that I talk about often, too, is depression is, I think, what we would consider a normal part of life, as long as it's for a certain duration. But then when does it become abnormal? So maybe you guys could speak about that a little bit. Different types and then the duration part.

Vicki Winkle [00:12:29] Sure. So the different. What was the first question? The different types of.

Natasha Helfer Parker [00:12:36] Yeah, like maybe what are the root causes for depression? You know?

Vicki Winkle [00:12:39] Right, okay. You were talking about spiritual components and biological components and situational components. Absolutely. Those all play into depression. We often talk about depressive episodes that people go through. And the way I often explain it is that different people have differing biological predispositions to depression. And it may take a minimal environmental insult for one person to experience a depressive episode, whereas it might take a significant environmental insult for another person to experience such an episode. For example, the death of a family member may Trigger an episode for someone. And we might consider that a severe environmental insult.

Natasha Helfer Parker [00:13:35] Which then at that point maybe normalizes the depression. Means obviously, kind of normal to be depressed.

Vicki Winkle [00:13:39] Exactly. And there's really no hard scientific way to know how biological someone's depression is, how situational their depression is, or environmental. I usually explain to people that depression is hardly ever either biological or environmental, situational. Usually it's a play of those two different factors. And then the spiritual component as well. There are these sort of, you know, for the sake of defining things as depression, Psychiatrists have set forth in the Diagnostic Statistical Manual time frames in which, you know, grieving may be normal. And at what point we would call it pathological.

Natasha Helfer Parker [00:14:33] And that makes it difficult because, you know, people will grieve in different ways. People will be depressed in different ways. So these time frames, although helpful at the same time, can seem maybe limiting for some person. Like when does a person go from being bereaved, which is somebody has died in their life, to a major depressive episode?

Vicki Winkle [00:14:54] Right.

Natasha Helfer Parker [00:14:54] Absolutely.

Vicki Winkle [00:14:55] I agree with you.

Natasha Helfer Parker [00:14:56] It's one.

Vicki Winkle [00:14:56] One of the inherent problems that arises when you try to put discrete limits on such phenomena is depression. And you try to define it in very specific terms.

Natasha Helfer Parker [00:15:07] Right. And at the same time, it can be helpful. The limits, I think, in the sense of, okay, well, you don't need to be feeling this way longer than two weeks. I mean, this isn't necessarily considered normal as far as just. I'm not talking about bereavement now. I'm talking about just a general depressive episode that people can know. Hey, if I've been down in the dumps for three months, maybe there's something going on here that I need to have looked into. That's not a nor. I don't need to be this down for so long.

Vicki Winkle [00:15:33] Right.

Physiological and Environmental Causes of Depression

Natasha Helfer Parker [00:15:35] All right, Dr. Helfer, anything you want to add to that as far as the different types?

Vicki Winkle [00:15:40] And yeah, I guess some terms that are used or coined frequently in psychiatry is pathological depression is often used. Or situational depression. And personally or in my mind, I feel like pathological depression does exist. And typically those are people that have struggled with low mood since childhood or adolescent through their young adulthood, and it continues to kind of haunt them.

Natasha Helfer Parker [00:16:11] Meaning that there's kind of a biological or genetic maybe.

Vicki Winkle [00:16:15] Yeah.

Natasha Helfer Parker [00:16:16] Or something going on that they were possibly born with.

Vicki Winkle [00:16:19] Possibly. And you know, what Vicki said, I totally agree with. It's hard to kind of differentiate between biological insults and environmental insults. And it's most likely combination of both. However, whether they are Primarily biological or situational insults or environmental insults. Whatever may have happened to a young child for that person to experience depression for most of their life or at least have recurrent episodes most of their life, I kind of see that as being a pathological depression. It's something that they are likely to struggle with lifelong. Despite getting treatment or seek out treatment, they tend to have relapses or recurrences of depression. Whereas a situational depression, in my mind can be a true emotional trauma or loss. Acute emotional trauma or loss, such as somebody dying or losing employment or losing your home.

Natasha Helfer Parker [00:17:12] Can you quickly make the distinction between acute and chronic?

Vicki Winkle [00:17:16] Yeah, I mean, I think that that's.

Natasha Helfer Parker [00:17:18] Well, just what those terms mean.

Vicki Winkle [00:17:20] Oh, acute or chronic? Well, chronic mean long term, so.

Natasha Helfer Parker [00:17:23] And acute being short term.

Vicki Winkle [00:17:25] Yeah, chronic pervasive long term and acute being a very short term or short

Vicki Winkle [00:17:31] term and intense, perhaps. I might add that more and more with emerging research that images the brain, we see that the brain actually anatomically changes with environmental insults. So the boundary between situational or environmental depression and biological depression has become more muddled as such research has emerged. So it's not always as simple as saying, well, this person, person's depressed because this happened to them versus they have a biological depression. We may need to start thinking about it more like this person has a biological depression because something happened to them.

Natasha Helfer Parker [00:18:12] Right. In other words, that this is now biologically affecting their brain chemistry, which is, I guess what I'd like for you guys to get into here shortly is what is going on in the brain kind of in layman's terms, because I think this is where a lot of people kind of, you know, will just snap out of it type of approach. Or people who don't have depression kind of have a hard time understanding why can't this person just be happy there is some biological component, regardless of why the depression started to begin with, that now is affecting. And like you're saying we can now tell what a depressed brain looks like versus a non depressed brain, right?

Vicki Winkle [00:18:53] Well, I think of a couple different things when we talk about the biology of depression. On one hand, we can talk about neurotransmitter deficiencies and dysfunctions in very simplistic terms. A lot of people have probably heard about a deficiency of serotonin belying depression. And that's why we call many of the antidepressants that we use are called selective serotonin reuptake inhibitors or SSRIs. They tend to act to increase available amounts of serotonin in the Brain and

Natasha Helfer Parker [00:19:24] serotonin is a hormone.

Vicki Winkle [00:19:25] It's a neurotransmitter, which is a type of molecule that's akin to a hormone, another type of molecule in the brain. Another. Other neurotransmitters that have been implicated in depression include dopamine and noradrenaline, adrenaline. So some antidepressants, such as Wellbutrin, may act to. Wellbutrin, for example, acts to block the reuptake of both serotonin and dopamine, making both of those neurotransmitters more available in the brain. Some antidepressants are augmented by medications that make more dopamine available in the brain. So you can think about one. You can think about a problem with neurotransmitters as being one biological problem that might belie depression. Another big problem that might arise in the brain, which can be linked to depression, are problems with actual brain anatomy. The brain is made up of different parts, so to speak, that have different functions. We talk about the hippocampus is having to do with memory, and the cortex of the brain is having to do with higher thinking and executive functioning. And depending on the sizes of these structures, a person might be more or less predisposed to depression or anxiety or any number of different psychiatric conditions.

Vicki Winkle [00:21:01] And, I mean, the skeptical part of me, you know, what Vicki says is completely relevant. It's found that medications that work on neurotransmitters elevate people's moods, such as serotonin, dopamine, norepinephrine. I think the biggest part about the brain is that it's kind of the last frontier and that we don't really know exactly what is happening happening, such as if somebody has a headache, do they have a deficiency in ibuprofen or deficiency in aspirin in there? And so, yeah, serotonergic medications and dopaminergic medications improve people's state of well being. However, is that the cause of their biological depression? They have a deficiency in a neurochemical. So, I mean, it's not completely a perfect kind of comparison between, you know, a headache and depression and ibuprofen and a serotonergic medication. However, you know, that's the. In my mind, it's hard to know what exactly is going on in the brain. And that's the exciting part of psychiatry is because it seems to be the specialty that least is known about. So a lot of kind of future research, a lot of what we call functional neuroimaging is occurring now with PET scans and functional MRIs that are helping us understand what is happening in the brain, the metabolism of glucose and anatomical structures, and what's deficient in volume sizes, etc. But I don't think we're quite there yet as far as knowing the biological root or the underlying mechanism of depression. I think if we knew that our treatments would be much more effective because although antidepressants are helpful, they are not a cure all. And they. There's another kind of depression called refractory depression, which is people that really don't respond to antidepressant medications, which would kind of minimize the theory of neurochemical depletions or neurotransmitter depletions or aberrancies, abnormalities in the brain. So there's a lot of different theories and various of these theories are accepted in the common medical textbooks, et cetera. But one of the exciting parts about psychiatry for me is that it's still kind of the unknown.

Natasha Helfer Parker [00:23:54] So with you kind of talking about that, it leads right into a lot of the resistance that I receive from clients. And I don't know if you receive these same types of resistances to take antidepressant medicine. You know, there, there seems to be some stigma attached to that still in this day and age. Even though it seems to be a pretty common medicine to take. It seems to be somewhat benign in the sense that it's not addictive or causing huge side effects, you know, that really are highly problematic. It can, we can talk about side effects later. But what would you say to people who would just say, well, you know, I just heard Dr. Helfer on this podcast and he said, we don't really know what the heck we're doing, so I'm not going to take an antidepressant. Like, how would you counter that as far as. Because I think most, at least the treatment. Best care. Best care treatment would still at some point include antidepressant medication.

Antidepressants and Standard Treatment Approaches

Vicki Winkle [00:24:49] Absolutely. That's the standard of care.

Vicki Winkle [00:24:52] Yeah, yeah. There's absolutely a lot of resistance to taking a medicine for depression. And it's true that we don't know how a lot of our medicines work. We have theories about how they work, and we know exactly what psychiatry.

Natasha Helfer Parker [00:25:09] And psychiatry in general.

Vicki Winkle [00:25:11] Well, in medicine in general as well. But in psychiatry probably especially, I mean, the whole notion that serotonin deficiency belies depression. Depression is after all a theory. We've never actually proven that or seen it in real time. But we do know that significantly more people get better from their depression than if they take an antidepressant than those who don't. So it's not that we don't exactly know what the heck we're doing, but we don't know how the heck it's working all the time. Another thing is that, I mean, I always tell, I always tell my patients, I'm not a pill pusher. It's a very personal decision for someone to take a medicine and everybody. There are a lot of different reasons why someone might be averse to taking a medication and it can represent very personal, cultural, religious beliefs for people and those things often need to be respected. Times when I really try and try and convince a patient to take a medication is when they're actively suicidal and I worry about their survival or their ability to just function as a person and carry out their day to day life. But most cases of depression that we, we see aren't that severe. Fortunately, however, does it have to be

Natasha Helfer Parker [00:26:51] severe to be on an antidepressant? I guess I just want to be very careful as I couch my audience that I know will be listening to this from all different spectrums of ideas and philosophies around antidepressants. I know there will be people who are listening to us who are currently on antidepressants or people who are listening to us who may be thinking about going on an antidepressant. There may be people who have, you know, very strong opinions on either side of this subject. So.

Vicki Winkle [00:27:16] Right.

Natasha Helfer Parker [00:27:17] I guess I don't want anybody who is listening to us to either feel like, oh my goodness, I shouldn't be taking my antidepressant because I guess I wasn't suicidal. Do you see what I'm saying?

Vicki Winkle [00:27:27] Yeah. I don't want to give the impression that antidepressants should be reserved for only suicidal people because that's not what I'm trying to say at all. And someone's depression doesn't have to be to the point of suicidality for it to be significant in someone's life. It can really affect someone's view of themselves, their ability, like I said, to function in life. And it's very appropriate for any given person to take an antidepressant if they feel that their depression is impacting their life quality. But like I said, it's a personal decision. Antidepressants do help with even mild to moderate depression. There was an article, there was a Reuters article in the popular public media this past year about questioning whether or not antidepressants actually do help with mild to moderate depression. It was based off of one study that wasn't the best study, to be honest. The thing is just the thing that I remind people is that improvements in depression are more apparent if somebody started out with a severe depression, for example, you might see a greater margin of improvement than you might if somebody had started out with a mild to moderate depression. But you know, I would recommend an antidepressant to anyone who feels that their depression is affecting them in any significant way.

Vicki Winkle [00:28:51] Yeah, I think Vicki's points were really excellent and I would agree with everything she just said. In my experience, I mean, it really does come down to personal preference. When I see patients that come into my office and they're seeking help and you know, I'll ask them, you know, what are your interests? Are you interested in medications or not? And kind of, you know, let them hold the reins and. Because I think that's an important part of treating mental illness. The brain is powerful, it's complex. And if they believe that taking a medication is going to take away from their mental well being, it's likely not going to be of benefit to have them take it. So typically if somebody expresses that they're not interested in pharmacotherapy or medications, then we'll either engage in talk therapy, psychotherapy, or I would refer them to a therapist if I don't have the ability or the time to do that myself. And that that monotherapy or single therapy of talk therapy is also extremely effective to treat anywhere from mild to severe severe depression as well. So there's options for different styles and personalities and characters and values to obtain really good treatment either way.

Natasha Helfer Parker [00:30:23] Okay, so we are in agreement, however, that at this point best standard of care practice would be combination of antidepressants, medication in conjunction with talk therapy. At least from the research that I've read, it seems like that's the combination

Vicki Winkle [00:30:44] that specifically cognitive behavioral therapy has been shown to be particularly effective with things like depression and anxiety in conjunction with medication.

Natasha Helfer Parker [00:30:54] Right, and cognitive behavioral meaning, of course, that we're kind of trying to change our thoughts and the way we think about ourselves and the world around us.

Vicki Winkle [00:31:00] Exactly.

Natasha Helfer Parker [00:31:01] Situations. Okay, so do you guys.

Christopher Helfer [00:31:03] No.

Natasha Helfer Parker [00:31:04] Are you aware of the statistics around antidepressants and the effectiveness thereof?

Vicki Winkle [00:31:10] Yeah. Roughly 70% of depressed people who take an SSRI. The type of antidepressant that I mentioned earlier, the selective serotonin reuptake inhibitors. I'm talking about Prozac, Zoloft. People may have heard of Celexa, Alexapro, Paxil, those types of medicines. 70% of depressed people will respond to those medicines, meaning that their depression will improve. That's versus 30% that respond to placebo. And then it's a lower percentage of people who actually experience remission of their depressive symptoms on an antidepressant, such as on an SSRI specifically.

Natasha Helfer Parker [00:31:54] In other words, all symptoms of depression are gone.

Vicki Winkle [00:31:58] Exactly.

Natasha Helfer Parker [00:32:01] Is it realistic that all signs of depression are gone? If you look at the list, I mean, I'm thinking of.

Vicki Winkle [00:32:07] It is realistic. It's realistic. And in fact, in psychiatry, what we aim for is to put a patient's symptoms into remission. And in fact, the research that's been done about the efficacy of various antidepressants has been revolved around this goal of remission of depressive symptoms. So there's a lot of research now going on about augmenting agents for SSRIs and how those might help, like Abilify. Abilify, Seroquel are part of a class of medication called atypical antipsychotics that can be used to sort of quote, unquote, boost the efficacy of an ssri. Wellbutrin is just a different type of antidepressant. It can be used to augment or boost the efficacy of an ssri, such as Prozac. And those things help further the chances that someone's depressive symptoms will go into remission. It's really what we aim for. We even have a phenomenon that we call refractory depression, which Dr. Helfer mentioned. We also call it treatment resistant depression. We say that if a person has, quote, unquote, failed two trials of two different SSRIs, they have treatment resistant depression. And from there we try various augmenting agents. And if they still don't go into remission, we try other forms of therapy.

Treatment-Resistant Depression and Electroconvulsive Therapy

Natasha Helfer Parker [00:33:46] Do we want to spend some time talking about maybe probably the most controversial types of treatment, resistant depression, which is my understanding is electroconvulsive treatment or therapy. Not sure what the T stand for, where the brain is being given some type of type of electrical shock. And I think that most people's perceptions out there is this is something that happened maybe in the 50s, but maybe don't understand that it's still occurring or this is still a treatment that.

Vicki Winkle [00:34:16] Yeah, I don't think any discussion of treatment for depression would be complete without discussing ECT or electroconvulsive therapy. It is historically a controversial mode of therapy, but it's also probably the most efficacious form of therapy that we know for depression. We do use it once someone has failed various modes of pharmacotherapy. If we consider their depression to be treatment resistant. So if they've tried different medications and nothing's working, we refer them for ect. And what ECT basically is, is the induction of a seizure in a controlled setting. And the very simplistic way that a lot of doctors describe this is we're setting the reset button on a computer, so to speak. We're turning. We're kind of resetting the brain. And most people, when they get ect, they'll go in and go under anesthesia while the seizure is induced. And they need to have several treatments for it to become effective. People's depression usually improves with this treatment, and then they usually need a certain amount of maintenance treatments in years after that. So I think you brought up a good point, which is that a lot of people have this concept of ECT which is somewhat inhumane. People think about the movie One Flew over the Cuckoo's Nest and how people are forced on a table and are shocked. People should realize that people who undergo ECT need to sign a consent form. And it's something that they do voluntarily, and it's something that they do under general anesthesia, and it's an effective way to treat depression.

Natasha Helfer Parker [00:36:25] Do you know the numbers behind the effectiveness of that?

Vicki Winkle [00:36:28] I don't know the numbers, but it's certainly more effective than the pharmacotherapy that we have for it.

Natasha Helfer Parker [00:36:35] And why don't we just go directly to that, since it seems to be more efficacious with. Is it mainly because of the stigmas attached or because it's more invasive of a procedure?

Vicki Winkle [00:36:46] It may be that it's more. It's not necessarily an invasive procedure, but it can be scary for people to undergo a procedure that's relatively unknown. There also sometimes can be long term problems with memory, and that might be a more severe side effect than most of the side effects of medication. Okay, so we take that seriously.

Vicki Winkle [00:37:14] And it's definitely more costly. Another point, you know, that Vicki brought up earlier, the inhumane kind of concept that people have of ECT because of, you know, social media. Yeah, that's really changed significantly. I mean, nowadays the psychiatrists that induce ECT encourage family members to be there in order to minimize that negative perception of what ECT is. Like Vicki mentioned, you know, the patient is placed under general anesthesia so they're not experiencing any discomfort. It's not the painful procedure. Some more common side effects could be headache after ECT or nausea and vomiting after ect. But it is a very effective. It's the most effective treatment we have for severe depression.

Natasha Helfer Parker [00:38:13] Can you explain the biology behind that? Or do we know? Or is this also one of those things where we just have tried it and it seems to be helpful, or

Vicki Winkle [00:38:21] it's another one of those things we can only theorize about.

Vicki Winkle [00:38:24] Yeah, it was an incidental finding. So a. It was incidentally found that patients that had epilepsy, which is a seizure disorder with concomitant depression, which is actually very common. It's common for patients that have epilepsy to have depression at the same time, so called comorbidity. And doctors that were treating these patients found that epileptic patients, when they went into seizures more frequently or on a regular basis, that their mood tended to improve. And so this is kind of an incidental finding, a historical finding that kind of evolved into induction of a seizure in order to improve people's state of mood or depression. But, yeah, there's no kind of scientific understanding of that kind of theorized in different ways. Like Vicki said, rebooting the computer or flooding of neurochemicals and electricity within the brain, there's some phenomenon that occurs that is incredibly effective in improving people's mood.

Natasha Helfer Parker [00:39:31] Okay, and what percentage of your patients would you say actually undergo this type of treatment compared to. Compared to people who just do the psychopharmacolo pharmacological route?

Vicki Winkle [00:39:47] A very small percentage of people whom I see on an outpatient basis undergo ect. You see it more commonly amongst inpatients, people that tend to be hospitalized for their depression. But most people in an outpatient psychiatry setting will respond to pharmacotherapy alone.

Natasha Helfer Parker [00:40:14] Okay, and I assume this is being done at the University of Utah as well as other clinics, or is it mainly only at the University of Utah here in Salt Lake City that in Utah?

Vicki Winkle [00:40:23] Salt Lake City is the only place I know of that does ect. Perhaps there are centers in St. George or other places, but.

Vicki Winkle [00:40:33] And it's done on a daily basis.

Vicki Winkle [00:40:35] At University of Utah, there's an ECT suite at both University Hospital and University Neuropsychiatric Institute.

Natasha Helfer Parker [00:40:43] And you say that people would have to go in for more than one session. So how many sessions would a typical person go in for?

Vicki Winkle [00:40:49] Generally, one round of ect, we call it a round of ect, requires at least the initial round, requires eight treatments, and then maintenance comes done one day

Natasha Helfer Parker [00:41:02] after another, or this is every other day.

Vicki Winkle [00:41:05] So generally, the first time someone undergoes ect, it's either while they're in an inpatient setting or if they have reliable family members to drive them to and from their appointments because people, like I said, need to undergo general anesthesia for the procedure. And then after their first round of ect, they generally go back. Is it six months to a year after every. Periodically. Every six months. Every year after. Yeah, as needed.

Natasha Helfer Parker [00:41:39] And how. When you talk about remission, how successful is it with that? Like, if you've gone through one round of act, are you pretty much cured for life, or is it.

Vicki Winkle [00:41:50] Generally, people require maintenance therapy. Maintenance ECT treatments, which would be about

Natasha Helfer Parker [00:41:57] what, like once a month or once every year?

Vicki Winkle [00:41:59] Once every year or once every six months. Okay, that's. That's my general understanding of it.

Vicki Winkle [00:42:08] And that's generalized because, you know, everybody's depression and response is going to be different, but. Yeah, yeah, that's kind of typical.

Vicki Winkle [00:42:13] There may be people who respond to one round of each alone and then have a remission of their symptoms.

Biology of Depression and Gender Differences

Natasha Helfer Parker [00:42:22] Okay. So going back, because I know we kind of tangented into antidepressant talk and medications and treatments, but I'd like to just kind of revisit a little bit again about the biology of depression and how it affects. So we do know that there's. It's a neurotransmitter issue, at least it seems to be. That's the main theory, is that.

Vicki Winkle [00:42:41] Yeah.

Natasha Helfer Parker [00:42:41] And so the brain is not. Not being receptive to the hormones that people produce naturally, or either people are not naturally producing those hormones to the level that they should be. Is that.

Vicki Winkle [00:42:53] Yeah. To certain molecules or neurotransmitters.

Natasha Helfer Parker [00:42:56] Yeah.

Vicki Winkle [00:42:57] Okay. They're not considered hormones, but. Yeah. Akin to hormones or molecules in the body.

Natasha Helfer Parker [00:43:07] Okay, so I'm using the wrong terminology than. As far as saying hormone.

Vicki Winkle [00:43:11] Right. It's kind of a neuromolecule or a neurotransmitter.

Natasha Helfer Parker [00:43:15] Okay. And they're not being receptive. The brain is not being receptive to those.

Vicki Winkle [00:43:20] They're not being receptive to those. Or not making enough of them.

Natasha Helfer Parker [00:43:23] Okay. Okay. So then some things I kind of quickly want to talk about that seem to be in, again, the researcher and the media is this seems to be more of a women's disease, at least that women are more apt to be diagnosed with depression than men. And now it seems like we're looking at men maybe just having different symptoms than women and that it's probably just as prevalent for men as it is for women. And maybe the comorbidity being that men are alcoholics or.

Christopher Helfer [00:44:00] Or,

Natasha Helfer Parker [00:44:02] I don't know, just kind of more the workaholics or dealing with their depression in ways that Women don't deal with it. This is very gender stereotypical, but some of the words. Our culture allows for women to cry and be sad and talk about their problems. And so it's pretty easy for a woman to come in and say, yeah, I'm depressed. But a man may not have that cultural permission. And so he's instead going to the bar and drinking or away his depression, or staying at the office and working away his depression or dealing with it in other ways. Do you guys hear much about that or.

Vicki Winkle [00:44:43] I don't know what the most recent data is regarding rates of depression

Vicki Winkle [00:44:52] as

Vicki Winkle [00:44:52] they differ between men and women, but I do know that historically depression is more common among women. Anxiety is also more common among women than among men. We do talk about symptoms differing between men and women in the clinical setting. Men perhaps having more traditional problems with decreased appetite, early morning wakenings when they're depressed. But I don't know any recent data regarding. I mean, I don't have any numbers to corroborate that last bit of information. And as far as alcohol goes, you know, it's possible that rates of depression are more similar than we think between men and women and that alcohol may account for that difference. But I don't know any data regarding that either.

Vicki Winkle [00:45:53] Yeah, I mean, as far as in our didactics and in our learning, that doesn't seem to be a focus point. Our traditional questions that are focused on depression to kind of seek out or give us clues whether or not somebody's depressed are exactly the same for men and women. So I don't think that there's been a clear cut understanding of men behaving or thinking or acting differently than women do within a depressive episode.

Natasha Helfer Parker [00:46:32] And might you see different types of emotional symptoms such as weepiness versus irritability or anything like that, or is that.

Vicki Winkle [00:46:41] I see those differences, but I don't know. I think they're just general differences that I see between men and women in general, and I'm not sure to what extent they represent phenomena specific to depression.

Depression, Anxiety, and Mormon Women in Utah

Natasha Helfer Parker [00:46:54] Okay, well, talking about depression and anxiety both being more commonly diagnosed amongst women, Mormon women seem to get a bad rap about this. Utah is continually the number one state for having people on antidepressants, it seems like. I think that research has been repeated and it still continues to be the case. Are you guys aware of that? Of that type? Of those numbers or.

Vicki Winkle [00:47:25] The last numbers I saw were a couple years ago and it did show that Utah was among the highest in terms of the number of antidepressants. Prescribed was the data that I saw.

Natasha Helfer Parker [00:47:35] So the correlation goes directly to, well, it's the Mormons then that need all these antidepressants. And I've heard a lot of people speak about this in a lot of different ways that I'm not sure are supported by research. But maybe we can talk a little bit about what some of those reasons might be that do exist within the Mormon culture culture as to why depression might be higher, but also maybe why it isn't that way. Maybe it's other factors that are affecting places like Utah or the West.

Vicki Winkle [00:48:06] Right. Well, this is a topic that I've noticed comes up a lot in conversation. And I think that at best people can speculate and make their own presumptions about whether or not the information we have can be directly, what am I trying to say? Generalized to Mormons and to Mormon women. Just because we know that there's a high number of antidepressants being described in Utah doesn't necessarily mean that Mormons as a people are more depressed than most people or other non Mormon people. And I think it's important to note that we have little to no research really specific to Mormons and rates of depression or Mormons and rates of antidepressant prescriptions. So really a lot of. I think what we might say about this is going to be speculative. Some people have suggested that antidepressants are prescribed more in Utah because people are seeking treatment more often than in other places. I don't know if that's true either. There's a lot of speculation again about those numbers themselves. But as far as, well, there's a

Natasha Helfer Parker [00:49:39] lot of non Mormons in Utah as well.

Vicki Winkle [00:49:41] I'm assuming that's another good point. And we have to remember that most of these research studies that are done are done in. Areas of the various states where there are centers for higher learning. And in Utah probably those numbers came out of Salt Lake City. It's been a long time since Salt Lake City has been predominantly Mormon. So it's another reason why we can't totally generalize those numbers to the Mormon population.

Religion, Mental Health, and Suicide Risk

Natasha Helfer Parker [00:50:15] So how about. Let me just talk a little bit about what I tend to see as far as in my practice. So again, this is all speculative, not research oriented. I give out the, the Beck Depression Inventory quite frequently for helping and assess especially the severity of depression amongst my clients. And it seems like the first half of that inventory is questions to do about worth, guilt, punishment, sense of self. And the second part of that inventory has a lot to do with you Know your appetite, your restlessness, your irritability. So it's not a clear cut, but I say the first page is kind of more emotional issues with depression. The second page is more like physical manifestations of depression. Right. Lowered libido, those kinds of things. It seems to me that the women who come into my office that are LDs, for the most part, the majority of them, not all of them, tend to score high on the. Those scores in that first page where they are saying, yeah, I don't feel good enough, I'm feeling worthless about myself, I'm feeling hopeless, I'm feeling, I don't know, not, you know, being punished usually by God. When I ask who are they being punished by God. And then there's very. And since most of my practice is LDS at this point, very few of my clients actually score high on the second page of that thing where they're talking more about irritability. And, you know, I'm not able to, you know, appetite issues, even sexual issues, don't score super high on that all the time. Although there's. It's a whole nother podcast, sexuality. But so it seems to me that. And another thing that I noticed quite often with the LDS women is in their suicide thing is it's very infrequent that they're actually scoring the last one, which means I have a plan to kill myself, I want to kill myself. But they are scoring somewhere in the middle, like a two or three, which means I wouldn't mind if I died.

Vicki Winkle [00:52:27] Right.

Natasha Helfer Parker [00:52:28] You know, and then when I asked them about that, I would say it's very, very high. Like 80, 90% of them are telling me, well, my family would be better off without me. So it's not even about their own escape, it's about, it's almost like their

Vicki Winkle [00:52:44] caregiving, the well being of others.

Natasha Helfer Parker [00:52:46] Yeah, they have in mind they're caregiving by removing themselves. Because I'm such a mess and I'm so bad and I'm not good enough for my family, I'm not a good enough mother, I'm not a good enough wife. So therefore they would just be better off without me.

Vicki Winkle [00:52:59] Right.

Natasha Helfer Parker [00:52:59] So even their suicidality is about others versus well, I'm just fed up with life and I really wish a truck would hit me or you know, I'm really tired or does that make sense? So these are things that now for me begin to be more Mormon centered issues like why is it that more

Vicki Winkle [00:53:17] culturally specific or more specific to Mormonism. Okay.

Natasha Helfer Parker [00:53:20] And again, this is Natasha Halford Parker's research, which is very unscientific.

Vicki Winkle [00:53:26] Well, again, I can only speculate about this, but I'm happy to speculate. As far as there was a lot of content in what you just said, but the first part seemed to deal with the first part of the Beck Depression Inventory, which you said deals with concepts of worth, whether or not someone feels worthless and guilt. And perhaps I think it's safe to say that in Mormonism, people in general hold themselves to a pretty high standard as far as how they believe they should behave and what constitutes moral and appropriate behavior. And so I think that it's also safe to say that the higher the standard, the more likely it is that someone might feel, well, what am I trying to say? The higher the standard, the least likely someone is going to be able to live up to that standard. If someone has a lower standard, they're going to be able to more easily live by that. So that means a higher chance that someone's going to fail themselves, for example, or feel like they've failed according to that standard. And I think that can lead more readily to feelings of worthlessness, feelings of guilt, than if somebody didn't have such specific rules to live by. Does that make sense? So I can see why perhaps that. I can see why perhaps those things are related in terms of the suicidality. It's also been my anecdotal experience that what we call passive suicidality is more common among Mormons. Not only among Mormons, but anyone who has a strong religious background. Most religions view suicide as a sin, and it's often their religious beliefs that prevent them from committing suicide. And so people will often end up with these notions of, yes, I'd rather be dead, I wouldn't mind if I died, but because it's a sin, I'm not going to do it. If I were to do it, it might mean that it probably means that I wouldn't go to heaven. So I see that as something specific to Mormonism that plays into the suicidality notion. I get what you're saying about the whole caregiving phenomenon. It's very common for Mormon women to be in the caregiver role. Traditionally. It's traditionally, staying at home to raise children has been the more noble thing to do in comparison with having a career. And that involves caring for others. And so Mormon women build their lives around taking care of other people. So it seems reasonable to me that even in a depressed Mormon woman's suicidality, her paradigm would be through the paradigm of a caregiver. As dysfunctional as it sounds

Natasha Helfer Parker [00:56:51] Sounds like a lot of research projects that need to be.

Vicki Winkle [00:56:54] Yeah, it does. There's plenty of room for BYU or University of Utah. Absolutely. I'm not sure why more hasn't been done other than that it can be a touchy subject. It's hard, I think, for some Mormons to hear other people say that, you know, their religion may have to do with their depression. I mean, that's something that's, it's a very sensitive thing to talk about, I think, for people.

Natasha Helfer Parker [00:57:23] Well, especially when there's such a catch 22 involved. You know, religion, I think has many positive aspects. It drives people forward in many positive ways. There's usually many wonderful things that come from organized religion, whether it's Mormonism or Judaism or, you know, whatever other organized religions are out there. At the same time, there can be these, like you say, expectations that are placed on members and when they can't or feel like they don't know, need them, then that's one of the kind

Vicki Winkle [00:57:55] of classic guilt or worthlessness and depression. Sure.

Natasha Helfer Parker [00:58:00] And I like what you said at the very beginning, inappropriate guilt, which seems to be something that I come across a lot as, you know, what are you feeling guilty about and why and what have you really done that's wrong? And most of these people can't really tell me any super heinous crimes or sins, but it's more that they're not meeting a certain.

Vicki Winkle [00:58:24] And you know, that reminds me of something you said earlier too, about people having this concept of a punishing God and they feel like God's punishing them. I've seen that in my practice as well. And I think that's unfortunate. I think it's unfortunate people have that concept of God. It's not generally what is taught in the Mormon religion. We're taught to believe that God is a loving God. And I wish that that were the more pervasive belief among the people, among the depressed people. I see.

Vicki Winkle [00:58:58] Yeah. I feel like it's hard to add anything to what Vicki has already said so poignantly. You know, as far as guilt and disappointment, those are core issues for depression. And it's seems like with the clients I've seen, that becomes a vicious cycle. Feeling guilty, feeling disappointed, feeling bad about yourself inherently will make you feel worse. As you feel worse, you're less motivated, you're less likely to be functional. Then you feel more guilty, more shame, and more disgust with yourself. And the next thing you know, you're in this self deprecating vicious cycle that's almost impossible to get out of. And so of course within religion there is, as Vicki mentioned, high standards. And of course guilt, shame and disappointment is likely to be a natural part of that experience. And unfortunately that at times can lead to something that's unhealthy.

When Leaving Religion May Support Mental Health

Natasha Helfer Parker [00:59:55] So then that brings up a question that I've been asked before is which I think is a very sensitive question to ask within the Mormon structure. Is is it ever healthier for somebody to leave their religion?

Vicki Winkle [01:00:12] Wow, that is a loaded question. You know that, that's one I never counsel my patients regarding.

Natasha Helfer Parker [01:00:27] Well, and I think it's almost inappropriate for any therapist or psychiatrist to actually tell somebody to either join or leave a church.

Christopher Helfer [01:00:33] Right.

Natasha Helfer Parker [01:00:34] In your perspective as far as just health versus non health, you know, there

Vicki Winkle [01:00:39] are times when I've thought to myself, I'd rather have this person alive than actively Mormon because I have met patients who have held themselves to such high standards that it's led to very excessive feelings of guilt and depression. So I suppose perhaps I would accept that at times people, people need to choose their own well being whether, whatever that means in terms of implications regarding their activity in the LDS Church. Like I said, I don't counsel people what to do in terms of their activity in the LDS Church, but I do try to let them know that I will regard them the same no matter what they choose. I think that's what most people need. They need to know that they're cared for and loved regardless of their church activity. Activity.

Vicki Winkle [01:01:47] I thought that was a really powerful statement. I'd rather have, you know, a patient alive than being actively Mormon. And you know, I think that can cross over to any faith or any culture or any work environment. I mean that is, I mean that's powerful statement for many situations. You know, if your job is creating that much unhappiness in your life, religion is creating that much unhappiness in your life. You know, to introspect and consider options that are going to be healthier for you. I mean, whatever it is in your environment that's creating that much dysfunction and unhappiness should definitely be reconsidered or at least thought of in a different way or approached in a different way. Maybe it's not as black and white as, you know, being in or being out of a situation, but perhaps, you know, approaching a bishop or approaching an employer and saying, you know what? My 60 hour work week isn't working for me. I'm gonna end up, you know, not being able to accomplish this. Is there any way that we could brainstorm some Other options here. And maybe that kind of analogy can be looked at within a religious perspective as well. Maybe it's just an intensity or a flavor of individuals that, you know, individuals bring certain aspects of themselves within a religion that can create either passivity or intensity within that experience. That could either be very healthy. Like you said Natasha earlier, there's so many positive aspects of organized religion or for some people, it may be a dysfunctional aspect of their life.

Natasha Helfer Parker [01:03:28] Yeah. And it gets complicated too when you look at, you know, people are obviously raised in different LDS homes. Right. With different perspectives, different intensities of expectation. So that all plays a part of it too. I think sometimes when people are choosing whether or not to stay in the church due to dysfunction of their own life, a lot of it isn't just their relationship with the church. A lot of it has to do with how the church or the gospel has been interpreted in their growing up type of atmosphere.

Vicki Winkle [01:03:59] Right.

Vicki Winkle [01:03:59] And crosses over into their relationship with their family and their sense of self as well. Yeah.

Natasha Helfer Parker [01:04:04] And their identity. I think one of the very unfortunate quotes from, I forget which general authority probably 20, 30 years ago now was that, you know, it's better for, for instance, a missionary to come home in a wooden box than it would be for him to come home dishonored. I think that we do unfortunately have those type of historical statements within our Mormon structure. And I think that, you know, we can, I don't excuse that any way we want to as far as, well, that was old fashioned or that was back in the day. But you know, those kinds of statements stick around for a while. And people obviously take what, what our general authorities and our prophets and seers and revelators say very seriously. And so it's those kinds of kind of historical context within our church structure that I think paves the way for some dysfunction as far as, well, you know, if I'm going to, you know, have sex on my mission or something, that would be considered horrendous, sin wise or something, I might as well just commit suicide or, you know, so it's things like that that I think people can take to an extreme. And then you add depression or you add obsessive compulsive, obsessive compulsive traits, things like that to statements like that and you can really have it. Things get complicated on your hands as far as keeping people alive, like you said.

Vicki Winkle [01:05:29] Mm.

Trauma, Spirituality, and Religious Institutions

Natasha Helfer Parker [01:05:32] Any thoughts? On my thoughts?

Vicki Winkle [01:05:35] Yeah, I think that are. They're really relevant. I mean, what was coming to my mind was a case that I heard A psychiatric case in Seattle, while you were speaking of that was a gentleman with a non psychiatric history, at least that he hadn't sought out any treatment for depression or psychosis or whatnot that had presented to his physician sincerely seeking out removal of his, of one of his eyes, thinking that he was sinning with his eye. And there's a biblical reference, well, better to remove your arm if you're sinning with your arm, or better to remove your eye if you're sinning with your eye. And I think that just shows the intensity or flavor that people's personalities can bring to religion, can really become extreme and rigid and rigid and scary. Whereas somebody that's kind of possibly more laid back or seen things possibly a little bit more gray or may have a wonderful experience within his religious experience or life and benefit from, from that. I mean. So yeah, when you're talking about intensities, I mean, that's kind of the most intense thing I've heard of as far as kind of a religious context.

Vicki Winkle [01:06:59] As far as.

Vicki Winkle [01:07:00] And this is a gentleman that was sincerely seeking out this procedure to be done. That's really sad. I think,

Natasha Helfer Parker [01:07:10] yeah, I think that this is a lot of things that we see. And again, couching this in the terms of dysfunction, right, because, because like you said, not everybody, like we've all said, not everybody who lives a religious life is severe or rigid in their boundaries or in their ways of living their religion. But there is that propensity for that or that possibility for that. And we, I think need to be aware of that as not only professionals, but as members of our community, as people who give talks in sacrament, as leaders within our own congregations, which of course, we're a lay ministry. So I think we need to be aware of these types of things and how messages can be interpreted. I usually use the form of, well, it's time to convert to something else. Even if it's within Mormonism, it's time to convert your ideas to something that will bring you what I think the message of the Savior is, which is, I think, like you said, Dr. Winkle, hope and love and positive. Right. That I think the Lord wants for us to have in our lives.

Vicki Winkle [01:08:11] Right,

Natasha Helfer Parker [01:08:14] okay, good. Kind of going along with this idea of religion, then I see a lot of kind of maybe stigmas about depression that sometimes can relate to spirituality or spiritual issues. Such as, well, if you would just pray more, if you would just live more righteously, if you would, you know, get up off your bed, you know, get up out of bed and get clothed and you know, then you wouldn't be so depressed. So it's kind of this idea of me just snap out of it, but with religious undertones. And I think this not only comes from people who live with people who are depressed, but also from the depressed person themselves, you know, that they will kind of like you said, Dr. Helfer, with the spiraling patterns.

Vicki Winkle [01:09:02] Right.

Natasha Helfer Parker [01:09:03] Well, I'm so bad, so then I feel like doing less, and that means I'm worse. And I can't believe I'm a bad mother or a bad father or bad bishop or whatever it is that they're feeling bad about.

Vicki Winkle [01:09:13] Sure.

Mental Health Stigma Within Mormon Communities

Natasha Helfer Parker [01:09:14] Do you want to talk about some of those stigmas and how realistic they are? Can people just snap out of depression and.

Vicki Winkle [01:09:22] Well, I definitely experienced those stigmas. I've had patients and friends who adopt this notion that if as long as they're living the standards of the Mormon Church, as long as they're keeping the commandments, they should be happy. I mean, primary children in the Mormon Church sing that song, choose the right way and be happy. And it's a very simple concept that's been that gets taught to Mormons since

Natasha Helfer Parker [01:09:56] childhood and which actually is based. Is backed up with some research. I mean, positive thinking and, you know, all those things that people have the ability to do those things, usually people are happy.

Christopher Helfer [01:10:07] Right.

Vicki Winkle [01:10:08] So the problem is when it doesn't work out that way, which it doesn't always. The reality is that it doesn't always work out that way. And you're probably right. Probably more often than not, it does work out that way. But for many people, it doesn't matter how hard they're trying to keep the commandments, they may still be depressed. And there may be any number of reasons. I mean, there's probably a number of reasons for that. But a big problem that I see with it. Well, two big problems. One is that it can really cause someone to feel guilty about the possibility that they're not keeping all of the commandments, and that only compounds the depression. And another problem is that it can impede someone from getting the help that they need for their depression.

Natasha Helfer Parker [01:10:57] Meaning I should just be. I'll just go read my scriptures. I'm not going to go get treatment.

Vicki Winkle [01:11:03] Right, right. It might keep someone from going to see a doctor or going to get therapy.

Vicki Winkle [01:11:15] Yeah, I guess I'm not very familiar with the LDS culture as far as what the perception of LDS members is regarding psychiatrist or psychotherapists or seeking out mental health treatment. I think that would be an interesting notion or

Natasha Helfer Parker [01:11:40] well, it is interesting that you mentioned that. I think that we've come, you know, both of you are fairly young. I believe you both are in your 30s. But if you go back to McConkie, you know, in Mormon doctrine, he actually calls out psychiatrists as. I don't know if he uses the word evil, but definitely along those terms. So mental health history and our LDS context does not go well as far as. I think that's changed a lot in the last 20 to 30 years.

Vicki Winkle [01:12:09] It's definitely changed.

Natasha Helfer Parker [01:12:10] But, but again, we have that historicity in our, in our quotes from an apostle, a pretty prominent apostle.

Vicki Winkle [01:12:18] Huh.

Natasha Helfer Parker [01:12:20] So I don't. Yeah, I agree with you, Dr. Helfer. I don't know how much. You know, again, another great research study. What are the current stigmas? Right. Of. Right.

Vicki Winkle [01:12:29] Well, I'm sure that's affected people's willingness to see mental health professionals. A lot of, you know, the generations that have gone before us really affect our beliefs and the way we go about things. What our grandparents tell us, what our parents tell us, and oftentimes what they believe, you know, is founded in these previous statements. Obviously that Statement by Elder McConkie wouldn't stand today and hasn't.

Natasha Helfer Parker [01:12:58] I mean, there's been a lot of more recent comments at general conference that where people have stated, you know, you should go see a professional if you're having trouble. Mental health professional, you know, I think that's a pretty wide umbrella that would include psychiatrists.

Vicki Winkle [01:13:14] Right. The fact that BYU employs a full time psychiatrist and wishes they had more. I happen to know that personally.

Christopher Helfer [01:13:24] So.

Vicki Winkle [01:13:25] Yeah. But I mean, there are these historical vestiges that seem to belie these notions that prevent people from getting the treatment that they need, which is unfortunate.

Vicki Winkle [01:13:39] Yeah. So going back to the stigmatization of mental health professionals, it sounds positive that culture is changing within the church. I think there's going to be a lot of, you know, personal differences between each member and their leaders and their bishop and what kind of encouragements or instruction they're going to get from their leaders. But I mean, I think that's probably a similar feeling or standard across religious, across religions in general. You know, how do religious people typically view psychiatry or mental illness, especially when

Natasha Helfer Parker [01:14:34] maybe a pastor or a bishop or some type of religious leader is saying, as maybe the counselor.

Vicki Winkle [01:14:41] Yeah, in essence, the therapist himself.

Natasha Helfer Parker [01:14:46] And some people actually do make a living out of that. I mean, there's such a degree as pastoral counseling or.

Vicki Winkle [01:14:53] Yeah. And I think that, you know, therapy is in essence a different type of Haven, because, I mean, there's a priest and there's a therapist and there's inherent differences within those office spaces. Sure, a priest can be some sort of therapist, but there's going to be some biases and some judgment that goes along with that. Whereas maybe in a therapist's office where if you're, you know, oftentimes religion isn't prominent factor for the therapist or isn't at least expressed as a prominent issue

Natasha Helfer Parker [01:15:39] like a place where it can be talked about, but it's not the primary reason why people are going to the therapist to begin with.

Vicki Winkle [01:15:47] They can possibly feel more free to talk about those religious issues, paradoxically, as you would think, that they would feel more comfortable talking to their priest or their bishop, whereas in essence, they may feel less judged or more open to speak about these things with a therapist.

Choosing Between LDS and Non-LDS Therapists

Natasha Helfer Parker [01:16:06] So this brings us kind of to this whole idea of is it beneficial to go see a non LDS therapist if you're LDS or an LDS therapist if you're lds? And this is a question I get again all the time. And I think there's pros and cons to both sides of that. Obviously an LDS therapist is going to have maybe some of the background or the culture. You don't have to explain what a temple recommend is or you don't have to explain what a mission experience is like or things like that. But at the same time there's maybe biases or things that the patient might feel either judged or like. They are only able to talk about certain things because. Because it wouldn't be couth to talk about. I don't know, the fact that they like to masturbate or maybe they're homosexual or things like that. If they're going to an LDS therapist, is that something that you guys either have thoughts about or have experience with or.

Vicki Winkle [01:17:02] Yeah, I think that's kind of a segue from where we kind of left off. Like what. What topics are people going to feel more comfortable talking about? How much benefit are they going to get out of therapist that is either Mormon or non Mormon due to those factors, those very personal issues that are shameful or perceived as disgusting, and whether or not they're gonna feel comfortable telling another LDS member those kinds of personal thoughts that are very kind of dark secrets to that person or if that would be more. Or if they would get more benefit from somebody that doesn't come from that background. And like you said, I think there's probably pros and cons to that. I think personally that they could get possibly more benefit From a. If somebody's Mormon or Catholic or Judaist, I think that they would at a different flavor and understanding of things, different perspectives from possibly a non Mormon or non Catholic or Judaist therapist. That's just personal thought that I have. Although you're the Mormon therapist and have a large LDS. Client base, I don't know what you feel about that as far as your experience with.

Natasha Helfer Parker [01:18:39] Yeah, I have mixed feelings about it as well. I think on the one hand, again, I know where they're coming from. I know the culture that they're coming from and the expectations that the church has of them. I'm not gonna probably tell them or guide them in ways that would go against what I know are their belief systems. Whereas another therapist might broach subjects or ideas or thoughts that maybe don't fall in line with what a Mormon feels is correct behavior. I think the other problem that I see is it doesn't matter much what I think about it. Many LDS clients that I try to either refer out if I'm too full or I can't see because maybe they're not on my insurance panel or whatever are not taking me up on my referrals, they don't want to go see a non LDS therapist. They feel safer within that construct. So. And not that all LDS people feel that way. I think some LDS people, like you say, prefer to go to a non LDS where they don't have to worry about that stigma or that judgment or things like that. So there's a lot in both camps,

Vicki Winkle [01:19:43] I think, and I think relatedness is an important part of psychotherapy. So, you know, whether or not the shoe fits. Right. And so a lot of relatedness is similarities, like can this person understand my point of view? And so obviously, you know, a Mormon therapist is going to have some relatedness to a Mormon member, but at the same time, that same therapist may have a very conservative base or a very liberal base and within that same religious construct may not be able to relate well. Whereas if you have a non Mormon therapist, that sense of relatedness is that, you know, that Mormonist Mormonism relatedness is completely out of the picture, which may possibly allow you to delve into the

Christopher Helfer [01:20:29] issues

Vicki Winkle [01:20:31] that although are relevant to the Mormonism, are just true issues that are created dysfunction, depression, anxiety in their lives. And I think that a non Mormon therapist would be able to engage and treat and provide relief for that patient as much or if not more than a Mormon therapist.

Natasha Helfer Parker [01:20:52] Yeah, and I think one, one thing that I've definitely come across is that People, many people will see me kind of as the second or third therapists in their life. So I'm not the first therapist. And many times they've been to a non LDS therapist and now they're coming to me, who I am, an LDS therapist. And they'll say, well, yeah, this non LDS therapist told me this and this and this, and there's no way I'm gonna do or think that. And I'm thinking to myself, oh, but I agree with that. So I think, you know, that's an issue too, is that I think sometimes, because in Mormonism, sometimes, sometimes we tend to talk a lot about the world outside of Mormonism almost as a, you know, like not be of the world or in the world or all those things we talk about, we separate ourselves from the outside world quite a bit. That if they don't like what they're hearing from a non LDS therapist, they'll just couch that to them not being lds. And then they're coming to me and I'm like, well, actually I think that that was good. Either advice or concern, correct information or correct treatment for whatever it is that they're dealing with. So that's a dynamic that I've come across about your thoughts, Dr. Winkle, and all this topic.

Vicki Winkle [01:22:08] Well, I'm remembering One thing that Dr. Helfer said, and that's that. Cleric leaders and therapists have different office space spaces in which people can address different issues that are important to them accordingly, where the tween shell meat often is found in an LDS therapist. And that might be beneficial for a lot of people. I do know a lot of people who feel more comfortable, a lot of LDS people who feel more comfortable seeing an LDS therapist for the reasons that you mentioned that, you know, they get it as far as their background. You don't have to do any explaining about how this or that plays into what's going on in their lives. And I get that and I respect that. I just feel like Dr. Helfer also mentioned that finding the right therapist for you is very individual. I often describe it to people like, finding the right therapist is like finding the right boyfriend or girlfriend. You may have to try a few before you find the right fit for you. It's got to be a good dynamic. And I'm not convinced that a common religion is always necessary to. In fact, I don't believe that a common religion is always necessary to good therapy. I have seen that. I mean, I have talked to people who I believe to be so conscious of whether or not they're Setting an example and representing the church well that that might impede their therapy work with a non LDS therapist. I've seen, I've known people who have been so self conscious about their behaviors that they might not feel comfortable sharing those with, with a fellow LDS person in therapy. I think it's just so individual to the person. What we do know from research that is helpful to people, cognitive behavioral therapy, it can be carried out by any given therapist from any given religion. So it's an interesting question and a relevant one, but I just think so case specific.

Natasha Helfer Parker [01:24:29] Yeah, it's. Well and this also goes to I think a concern that Chris, you brought up. As far as you know, are they, you know, even within your own faith you're going to have different types of therapists. You know, a more conservative therapist versus a more liberal one. And this is also a question I get a lot is what how do I handle it when maybe mental health practice goes against may some religious beliefs. So in other words, you know, a common one is, you know, by the Pediatric association sees masturbation as a pretty normal behavior, you know, that the church would, you know, talk about that more sinful behavior. Homosexuality is seen as a correct way of life. You know, outside in the medical community it's been. It's not a mental disorder anymore. That was changed in the 70s

Navigating Sexuality and Religious Belief in Therapy

Vicki Winkle [01:25:27] in

Natasha Helfer Parker [01:25:27] the church it's considered a sin. I could probably give four or five, you know, I'm a sex therapist so I. Some of the practices, you know, there. Some of the treatments for becoming orgasmic for instance, or vaginismus or you know, things like that are things that maybe lot of women wouldn't feel comfortable with because of their ideas of sexuality within their faith. How do you couch some of those issues with your clients? Does that come up maybe.

Vicki Winkle [01:25:57] How do you reconcile the way a therapist approaches any given issue when it contradicts what the client believes in, what

Natasha Helfer Parker [01:26:07] the faith structure believes in.

Vicki Winkle [01:26:09] Oh, that's a tough one. And I don't know that I've thought much about it, but one initial thought is that reconciling that for any given client in and of itself likely has therapeutic value. How are they going to go about handling advice from a therapist if it contradicts their beliefs? It might represent an opportunity for them to practice assertion in what they believe. Another way it can be therapeutic is that it might help them really evaluate what it is that they truly believe and to what extent do they believe it and to what extent does that particular issue relate to their depression or whatever reason it is for which they're seeing the therapist in the first place. I don't know if that makes sense, but those are some of my initial thoughts.

Vicki Winkle [01:27:04] Yeah, I think that's a huge dilemma for anyone that would find themselves in that dichotomy would, I think, would be extremely distressed by that. At the same time, you know, I think that's what psychotherapy is. It's a time for exploration. And the therapist is kind of, you know, the responsible one to create that exploration, that introspection that people can explore themselves, their thoughts, their emotions. And it's really up to that person to make sense of their life. A therapist can only provide. A journey education and hopefully support and understand the dilemmas that are created within that space. And that's the whole point. Psychotherapy, in my mind, is exploring those difficult dilemmas in life and trying to make sense of them and expressing those emotions that come along on the ride.

Natasha Helfer Parker [01:28:14] Yeah, well, thanks for broaching that topic. And I do feel. I mean, the reason why I bring it up is because a lot of these things, I think, do tend to be the reasons why I see what I, you know, what I term spiritual depression is when either practices or behaviors or thoughts or feelings don't mesh completely with the cultural religious construct that people were raised in and not knowing how to build a bridge between the two, specifically with such life choices as homosexuality or, you know, again, I can. I can list a lot of different examples. Okay, so totally tangenting here to some of my notes that we had briefly talked about, you know, Mormon reasons versus non Mormon reasons why there might be more antidepressants being given out in Utah or prescribed in Utah. And I think that one of you, before we started the interview, briefly mentioned some research on depression being more prevalent in places of high altitude.

Vicki Winkle [01:29:21] Yeah, that's correct. There's some recent research, actually, out of the University of Utah that correlates altitude positively with suicide rates. Meaning that the higher the altitude, seemingly the higher the rate of suicide in any given part of the world. And so when we talk about there being a higher rate of antidepressant prescriptions in Utah, perhaps it's related to this phenomenon having to do with altitude. Perhaps it has much less to do with culture than we really think. There are probably other factors of which we're unaware that have to do with that rate.

Natasha Helfer Parker [01:30:02] Yeah, I thought that was just kind of an interesting kind of random reason to be depressed. It is.

Vicki Winkle [01:30:09] The research is just emerging. But it's good research, and it's starting to be replicated and I don't know why that would be, why high altitude would be correlated with high suicide rates.

Natasha Helfer Parker [01:30:20] But another, again, I think speculation that has been made is that Utah seems to be one of the places where we have the most suicide rate. The higher suicide rate in young men under the age of, I want to say, 25, somewhere around there. And this has been correlated to possibility of homosexuality. Does that come up at all in your.

Vicki Winkle [01:30:50] I'm not familiar with those numbers. In fact, this is the first time that I've really heard that either.

Natasha Helfer Parker [01:30:56] Okay. I wonder if that. If that's an issue that comes up in your residency at all, is people who are homosexual and wanting to come out, or these young men who are being pressured to go on missions or marry in the temple or, you know, who want to do those things and have been raised obviously in the Mormon construct.

Vicki Winkle [01:31:15] It's obviously a relevant issue and one that we've seen and an important one. I'm not familiar with any research that that's been done specific to Mormons and homosexuality and suicide rates. But, you know, practicing psychiatry and doing therapy in Utah and just having friends in Utah and loved ones, you meet people who were raised in the Mormon faith who at some point come out and identify themselves as homosexual. And, you know, that's. That can. That may or may not be material for therapy, and it may or may not belie depression, but I think it's understandable when that issue does belie depression. It's one thing for someone to come out. I mean, that's a big deal for. For any given person. It's another thing to come out. If you've been raised in a family that views homosexuality as a sin, and if you yourself have adopted that paradigm that homosexuality is a sin, I think that only. That only adds to the issue of ones coming out. There are obviously issues having to do with wanting to be accepted and loved versus feeling rejected by one's own community or family. And I think that for. I think if any given person experiences rejection on the part of their family or their community, it can certainly be understandably a trigger for depression or anxiety and potential potentially suicidality.

Natasha Helfer Parker [01:33:13] How about you, Chris? Any experience for you?

Vicki Winkle [01:33:16] I haven't had any personal experience with that. I mean, as far as on an intimate level, I mean, sometimes rounding on the inpatient floor, there can be a severe depression secondary to those issues, but not necessarily. I've had intimate kind of psychotherapy time to kind of delve into those issues more carefully and sensitively. Typically on an inpatient ward, things are kind of more hustle and bustle. And it's not very private. And it's more a secure place for acute danger for people that are thinking of harming themselves or other people. And so, yeah, and I haven't had the opportunity to really experience that with a client, a patient.

Supporting Family Members Living with Depression

Natasha Helfer Parker [01:34:09] Okay, going then to this idea of. I think we've talked a lot about depression directly. What about family members who are living with somebody who is going through a major depressive episode? What kinds of ideas or thoughts or advice or, I don't know, just general help.

Vicki Winkle [01:34:36] I think that's really tough, especially if that, you know, if that family member hasn't experienced it themselves. It's that issue of relatedness. So, yeah, that expectation of snap out of it. What's wrong with you? I mean, I think that some of those feelings can be normative. You know, if you are a family member and your significant other or sibling or mother or father isn't functioning at a level that, you know, meets your needs or that you can just see as frustrating because it's not meeting their own needs. And I think that's an extremely frustrating position to be in. And I think some of those thoughts are going to be normal. And why can't he just snap out of this? Or why can't she just, you know, go to work like she was doing before? So I guess I wouldn't want to minimize those feelings because I think that's

Natasha Helfer Parker [01:35:31] part of the process or even vilify them. Like now they're the bad guy because they don't understand or they're not supportive enough.

Vicki Winkle [01:35:39] Yeah. So I think there's, you know, there's a balance there between understanding and empathy and trying to be supportive, because of course, that's what's going to elicit that person's recovery the most quickly. Love, support, a positive environment. Whereas if there's this kind of black cloud in the environment of kind of, you're a loser, you're a disappointment. This is untolerable or unacceptable. I really think that that's just going to exacerbate the issue or exacerbate the problem. The depression. That's a tricky, tricky place to be in.

Natasha Helfer Parker [01:36:25] It's a big balancing act.

Vicki Winkle [01:36:26] I totally agree with Chris. I think the most important thing is that you offer love and hope and acceptance to whoever it is that might be depressed. There's actually research that shows that if you demonstrate unconditional positive regard towards someone who's depressed, that that can be therapeutic for them. Not that we need research to actually confirm these things. To us. But it's true. Another thing I've seen is that sometimes family members of depressed individuals might try and take on more responsibility than they should or need to force for the individual's depression.

Natasha Helfer Parker [01:37:05] Kind of an enabling type of role,

Vicki Winkle [01:37:08] perhaps an enabling type of role. But also it can be self defeating for a family member to try and cure their, you know, their brother, their sister, their parent of their depression. It's usually, it's usually more complicated than that. And I think that it's unnecessary most of the time for people to beat themselves up trying to cure their loved one of the depression. Not that there aren't things that family members can do, but oftentimes it's more out of our hands than we realize. It's more up to the individual, up to maybe their therapy, their treatment. And again, I just want to repeat what Dr. Helfer said and that's that probably the most important thing we can do is let our loved ones know that we care for them unconditionally and just love them.

Vicki Winkle [01:38:09] Another, another aspect on that would be, you know, staying within a role is I think important, you know, whether if you're a wife of a man that's depressed, to maintain that wife role. You know, like as Vicki was saying, you know, to try and treat somebody starts complicating things and to become both a mental health provider and a wife is going to complicate dynamics and likely unlikely to be fruitful. And so, yeah, I would agree and kind of segue on what Vicki was saying is, you know, to maintain your role within a family, family relationship. I think that's going to be also

Natasha Helfer Parker [01:38:49] helpful and I'm sure it's frustrating, especially for clients when they have, I guess I'm thinking specifically in the spousal, but it may be in the child parent relationship as well, where the one person can clearly see that their loved one is suffering from a depressive episode, but the loved one themselves is not willing to get the help. And maybe this is where the man wants. Stereotypes fall in a little bit. I think it's difficult for men to admit that they're going through a depression. I think that that's more not as cultural, again, not as culturally supported for men to be able to say, yes, I'm depressed. And so a lot of times men will say, no, I don't need to go in. I get a lot of questions on my blog specifically about this. How do I get my husband to go see a sex psychiatrist or a therapist?

Vicki Winkle [01:39:39] I think another, yeah, going on, going with that is you know, the different perspectives and opinions within a relationship or within a family. So like, perhaps, you know, a wife is very. Is a believer of mental health treatment where. Whereas the other is not. And so that can bring about a lot of conflict.

Vicki Winkle [01:39:58] Yeah.

Vicki Winkle [01:39:59] How do you get that person into the office? How do you encourage that, that, you know, maybe they should take an antidepressant? And that can really muddy and complicate or even worsen the issue because obviously the relationship will start to struggle there. And I don't know if there's a perfect answer to that.

Natasha Helfer Parker [01:40:19] Right. Because people are putting almost the marriage as the. As the ultimatum. If you don't go get help, then I'm going to leave you or I'm going to.

Vicki Winkle [01:40:28] Yeah, that's a hard one. I've seen a couple patients in my office, men who said that they're only there because their wife had threatened to leave them. And I'm not sure that that's the best approach. But at the same time, I mean, I'm. I don't know that there's anything a wife can do to make her husband go in to get help. I mean, we can't control the choices or behaviors of anybody else but ourselves in the end. And so that's what makes. That's such a complicated and difficult problem for.

Natasha Helfer Parker [01:40:59] Right. And even though it may not be the best thing, at the same time, if you're dealing with somebody who's been depressed for 10 years and isn't willing to do anything about it, I guess at the same time that person, just like the person has the right not to go in for treatment. The other person has the right to say, well, I don't want to be in this marriage then.

Vicki Winkle [01:41:16] Right. I would never.

Natasha Helfer Parker [01:41:17] So those are very difficult.

Vicki Winkle [01:41:18] Yeah, they're difficult, difficult situations. And I would never judge anybody based on whatever decision they made in such a situation. I'm not sure how I would behave myself.

Natasha Helfer Parker [01:41:28] Yeah, they are very difficult. So talking about families, obviously there's a genetic strain to depression. Can we talk about that?

Genetics, Children, and Depression Across Families

Vicki Winkle [01:41:39] Yeah, slightly.

Natasha Helfer Parker [01:41:40] And depression seems to run in families.

Vicki Winkle [01:41:43] Absolutely. Like, just like most other medical and psychiatric illnesses, there definitely is genetic predispositions and a genetic role within all medical illnesses, whether that be cancer or high blood pressure, high cholesterol, schizophrenia or depression or alcoholism. So, yeah, that is. That's part of who we are as our ancestors. And that can be scary. I guess there's a sense of discontrol, possibly that people can feel if their father was an alcoholic, that can be very, you know, anxiety Provoking or if their mother was extremely anxious. There's not anything that they can really do preventatively other than, you know, live as healthy of a lifestyle as they can. But I think that that's a scary topic because it's kind of put you in a place of discontrol, which is an uncomfortable place for any of us to be in.

Vicki Winkle [01:42:52] I would just reiterate the things that Dr. Helfer said. Depression does obviously run in families, as has been shown. And I would just maybe add that it's important for people to be aware as to whether or not they have family members with depression, just so they can know what their own risk is. I think that sometimes families, depending on how conservative they are, may not want to talk about such things as mental illness, particularly if it runs in their own family. But I think that can only hurt generations to come because it might prevent members of future generations from getting help treatment if they need it. It's also, I think, important to be aware as to whether or not there have been attempted or completed suicides in the family because. Because that's been shown to put people, other family members, at risk for suicide and depressive episodes.

Vicki Winkle [01:44:02] Yeah, that's really good. I've seen. I've had personal experience with that where I've asked Mormon patients what kind of psychiatric history is in the family, and a somewhat common response is unknown. Kind of the unknown because of that or shame or.

Vicki Winkle [01:44:23] We don't talk about that in our family.

Vicki Winkle [01:44:25] Yeah. And so that's, I think, can possibly put, you know, greater risk of somebody's.

Natasha Helfer Parker [01:44:33] Right. And all of our journal writing that we're writing for posterity. We're writing all the positives. Right. We're not writing the things that maybe we've struggled with or. Right.

Vicki Winkle [01:44:44] We want.

Natasha Helfer Parker [01:44:45] Want to pass on the positives and ignore all the negative things that have happened or thoughts or feelings. No, I think those are really good points, I guess. Lastly, can you talk briefly about. I think most of what we've talked about is adult oriented. I think children and adolescents are also diagnosed with depression and maybe some of the differences that you see in the diagnosis of them. Or maybe we can talk briefly about this specialty. But. Though neither one of you are going into that specialty. But that there is a specialty within psychiatry for child and adolescents may just briefly speak about that as a resource for people who might be struggling with that.

Vicki Winkle [01:45:22] Sure. Like you mentioned, child psychiatry is not. It's not my area of expertise. Neither is it Dr. Helfer's, but we do get some Training in child psychiatry. And we both have some experience treating children for various mental disorders. Child psychiatrists generally, generally complete the same amount of training as Dr. Helfer and I have up until this point. And then they further their education by completing a fellowship in child psychiatry, which generally lasts for two years, and then they're board certified to treat children. General adult psychiatrists can also treat children, but just they have less training to do so. Child depression. Childhood depression often presents differently than it does in adults. Children may show more irritability or anger in their depression, may not know how to articulate it as well as adults. It's also treated with such medicines as SSRIs. And you know, it seems that there's a, there's a cultural phenomenon in the US in general, probably that people are more conservative when it comes to treating children with psychiatric medication. And I would just say that generally in psychiatry, treatment with medications reserved for kids who seem to have a significant impairment in their daily functioning or ability to, for example, function in school.

Vicki Winkle [01:47:17] Yeah, I think child. To be a child psychiatrist is to be somewhat a controversial title to hold. If you were to go about and talk to 10 random people on the street and say you're a child psychiatrist, I think you're going to get a lot of different emotive responses, anywhere from extremely displeased to possibly very happy. So I think that the stigma is probably taken a step further in child psychiatry. There's the aspect of, you know, people making decisions for a minor, parents in particular. You know, are these behavioral problems or these inherent kind of pathological problems? I think you, I think it's a, it's a tough profession. I, I think there's a lot of gray and there's a lot of brain psychiatry in general, I think there's even more gray in child psychiatry. I think that that's a very challenging role to fulfill. And at the same time, the child psychiatrists that I have worked with and known are doing their best to appropriately treat and help families and children that are, that are struggling and that are seeking out this treatment voluntarily.

Vicki Winkle [01:48:50] I should mention that a lot of mental disorders become more severe the earlier the onset. So if, for example, depression or schizophrenia becomes apparent during one's childhood or adolescence, it tends to become more severe later on in life. So in such cases, it's very important for a child to see a psychiatrist or a mental health professional. There's also research that shows that children who are treated with medication for their ADHD are less likely to develop substance use disorders as adults. So There are a lot of important reasons why children should get the treatment necessary in a timely way before adulthood.

Natasha Helfer Parker [01:49:35] One is in most either like you say, psychiatric or medical diagnoses. The earlier it's treated, the better the prognosis usually is.

Vicki Winkle [01:49:44] That generally is true. Yeah.

Natasha Helfer Parker [01:49:46] And a lot of these psychiatric disorders for children have implications socially and academically and can cause long term issues for people if they go untreated. So yeah, I think that's all very important. And I think it's interesting, Chris, that you speak about just the added stigma with that. And I think again when I see parents and maybe we can talk about this briefly, but I think for parents it takes a lot of courage to be able to see say yeah, there is something maybe wrong with my child who you know, I've spent all this time and energy and you know, the kind of the parenting stigmas. Oh, your kid is on, you know, an antidepressant. Of course the media causes a lot of issues I think with pointing out, you know, problematic, you know, problematic issues that come up with child medication and I don't know, what can you say to the parents out there who are dealing with some of these?

Vicki Winkle [01:50:48] Well, I think it's important for parents to realize that just because their child may have depression or mental disorder, that doesn't necessarily reflect on how good a job they've done as a parent. They haven't necessarily failed as a parent. In fact they probably haven't. And more instances that not these disorders do arise, especially when they become apparent that early they rise from. There is a heavy genetic component. Shall I say there are cases where, you know, parenting does have to do with a child's behavior. But when it comes to certain disorders, especially like schizophrenia, schizophrenia is heavily genetic and generally doesn't reflect on any parenting patterns. Depression is also pretty genetic and I would say similar things about that.

Vicki Winkle [01:51:51] Yeah, I think similar to adult dysfunction, I mean I think there's that level of distress that becomes apparent in parents lives when they're child is not functioning. I think that's a very stressful and frustrating place to be in. And I think that mental health has options and treatment that can provide relief to children that are abusing or addicting, abusing or depression dependent on drugs, who are depressed, extremely anxious, that aren't able to perform in school, that are extremely socially isolated. These are unfortunately problems that exist in childhood as well. So yeah, I would agree with what Vicki said and regretfully there's a large stigma attached to that kind of treatment.

Natasha Helfer Parker [01:52:54] Well, in tying this back into Mormonism I think that obviously family life is such an important foundation of Mormon culture and parenting is such an important aspect of us being righteous Latter Day Saints. And so if your child is having some type of a problem and now you see yourself as a dysfunctional parent, I think that's very prevalent among our cultures. Is kind of, again, inappropriate blue, sometimes appropriate, but even that, you know, I think sometimes parents, I guess there's blatant inappropriate, you know, like you're a drug addict yourself or something like that, and so you're neglecting your children. You know, that's kind of.

Vicki Winkle [01:53:35] Right. Or abusive. There are obvious situations, of course.

Natasha Helfer Parker [01:53:38] Right. But then there's, I think people who maybe are just a tad bit more too rigid or maybe not having appropriate discipline styles, but in general are doing a fairly good job. They could improve upon their parenting skills, I think. Who can't? We all improve in our parenting skills and yet they take this on as a very damaging part of their self worth since they have failed their children.

Vicki Winkle [01:54:03] Whatever the case, I think it's important for parents to just get their children in to be seen and treated if they see a problem that's affecting the child's quality quality of life.

Natasha Helfer Parker [01:54:15] Yeah, I agree with that wholeheartedly. And I think there's a lot of, like you said, child and adolescent psychiatrists who specialize and now there's play therapists who specialize in, you know, more the talk therapy approach. But children don't usually sit and talk to you, so they'll play with you and that's a good way to treat children, especially under the age of 12 and.

Vicki Winkle [01:54:36] Right.

Natasha Helfer Parker [01:54:36] So yeah, these are all good, good things. Okay, any closing thoughts? I think we've covered a whole lot of different topics and thoughts and ideas. I think there's probably a lot more we'd love to discuss, but in the interest of your time, I'll probably start closing this down. Any, I guess, closing thoughts as far as depression in general practice, messages of what you want people, you want people to hopefully think about themselves or others dealing with this.

Closing Reflections on Faith and Mental Wellness

Vicki Winkle [01:55:06] I would say that self deprecation is regretfully something that we all do. I think there's a large spectrum of intensity or severity. I think that religion can play a part of that. I wish that people could integrate religion into their lives so that it becomes more meaningful. Meaningful and enriches their life. That would be a happy, a happy story. If that's not occurring, I would encourage people to seek out a therapist, whether that's a Mormon or non Mormon therapist, to provide themselves A time for introspection and for creating some kind of meaningful journey exploring their emotions. Most people's lives are so hectic and so non stop that we don't allow ourselves that kind of time and we don't allow the vulnerability to. We typically don't give other people the opportunity to help us explore our lives that require some vulnerability on our part. And to be vulnerable takes a lot of courage. To go to therapy takes a lot of courage. I think that therapy has a lot to offer to everybody. Whether you are extremely depressed or whether you're just dealing with some mild anxiety and low mood occasionally. I would encourage people to. To seek out that option as a possibility to improve their lives. And as we talked about earlier, the shoe does have to fit. And typically we're all beginners when we start something and we're not very good at it. But to give it a good try, seek out that person that understands you, that can empathize with you and that can create a more meaningful and rich life for you and your family members and your relationship with your religion.

Natasha Helfer Parker [01:57:19] Thank you.

Vicki Winkle [01:57:20] Yeah, I would agree with Dr. Helfer. And I would also just say to anyone who's depressed that life doesn't need to be lived out in a depressive state. You know, life's meant to be enjoyed. And if anyone's depriving themselves of any specific treatments for depression and yet find themselves perpetually depressed, it may be time to think of a different approach. There are lots of different modes of treatment out there, pharmacologically or not.

Natasha Helfer Parker [01:57:59] Okay. Yeah. Man and woman are. That they may have joy. Right. And than that.

Vicki Winkle [01:58:06] That's right.

Natasha Helfer Parker [01:58:06] That one of our precepts. So thank you so much for your time. I appreciate you.

Vicki Winkle [01:58:11] Thank you for having us. It's been a pleasure.

Natasha Helfer Parker [01:58:14] Okay. Good night.

Vicki Winkle [01:58:22] Thank you for joining us today on Mormon Stories. Music today was provided by the Saber Rattlers. Check them out at saber-rattlers.com the Mormon

Natasha Helfer Parker [01:58:31] Stories logo was generously donated by StudioCase.com thanks for listening.

Closing Hymn

Christopher Helfer [01:58:37] Come, come ye saints. No toil nor labor fear but with joy wend your way though hard to you this journey may appear. Grace shall be as your day. Tis better far for us to strive Our useless cares from us to drive to the San Jo your hearts will swell well. Oh, all is well. All is well. Why should we mourn? I think our lot is high. Tis not so all is right. Why should we think to earn a great reward if we now shun the fight? Gird up your lo fresh courage Take our God will never us for sake? Soon we'll have tale to tell? Oh, all is well? All is well? Oh, all is well? All is well? And should we die before our journey's through half a day? All is well? We that are free from toil and sorrow too with the just we shall dwell? But if our lives are spared again to see the saints the rest obtain? I will make this chorus swell? Oh, I'll. All is well? All is well? All is well? All is well? All is well? Oh, all is well? All in the world? All in the way.

Transcript © 2026 John P. Dehlin. All rights reserved. Brief quotations are welcome with attribution and a link to mormonstories.org; all other use requires written permission.