In the Culture but not
of the Culture:
Experiences of
LDS Women with
Depression
Kristine J. Doty, Ph.D., LCSW
Danna Lindemann, B.S.
Heather Hirsche
Introduction
• Experiences in the ER and Clinical Practice
• John and Jensen’s 2009 study
– Correlation between religiosity and
perfectionism in self-identified LDS
students at UVU
• Focus on LDS women
• Research Question: What is the experience
of active adult LDS women diagnosed with
depression?
They want to be heard.
“When Marybeth called me yesterday, I went
‘Oh, hallelujah!’ I have been praying for you for
years! ‘Please God, let someone get into this
[subject] and see that it is real, that it isn't fake,
that it isn't just women who are selfish or
women who are on the fringe of the church or
don't have a testimony or aren't serving. Let
that pain that we feel, that emptiness, let
someone speak for us, finally!"
Amy, 41
Methodology
• Exploratory Qualitative
Phenomenological study (N=20)
• Snowball sampling / Flyers at grocery
stores
• Research team –
– Principal Investigator – LCSW
– Total of 6 student researchers (5 LDS)
across various stages of the project
Participation Criteria
•
•
•
•
Women between 18 and 65
Willing to be interviewed and recorded
Active in the LDS church (self-defined)
Diagnosed with depression by physician
or mental health professional
– Those who were self-diagnosed were not
interviewed
Semi-Structured Interview
• Six topics explored:
– Religious activity
– Experience with depression (diagnosis)
– Current treatment
– Contributing factors
– Religious / Cultural influence
– Coping strategies
The Interview
• Interview length: 25 min. to 2 hrs.
• PI performed all interviews with student
researcher taking field notes and
observations
• Professionally transcribed
• Pseudonyms assigned to all participants
Coding and Analysis
• At least two readers per transcript
– PI and one student researcher
• Each reader coded independently with
the audio files using open and axial
coding methods
• Used grounded theory to identify
emerging themes
• Met as a team to flesh out themes
Demographics
•
•
•
•
Self-defined level of church activity
Age: M=39 (Range: 21-63)
Ethnicity: 19 Caucasian; 1 Latina
Marital Status:
– Married (13); Single (3); Divorced (3);
Widowed (1)
• Number of Children: M=3.3
• All residents of Utah county
Literature Review
• Perfectionism and Depression
– Ashby, Rice, & Martin (2006); DiBartolo, Li,
& Frost (2008); Nepon, Flett, & Hewitt
(2011).
• Religion and Mental Health (LDS
specific)
– Edgington, Richards, Erickson, Jackson, &
Hardman (2008); Williams, Belnap, &
Livingston (2008).
Literature Review
• Religious-Context Specific
Perfectionism
– Craddock, Church, Harrison, & Sands
(2010)
Results
• Three Emerging Themes:
– Contributing Factors
– Coping Strategies
– Treatment
Contributing factors
•
•
•
•
•
•
•
•
Anniversary of death
Body image
Multiple crises
Children’s choices
Spouse’s addiction
Divorce
Self-blame
Health problems
• Pressure to marry
and have children
• Single motherhood
• Financial concerns
• Postpartum
• Unworthiness
• Raising children with
disabilities
Top 5 Contributing Factors
• 5. Genetics (7)
“Mostly it's the genetics. It really is. I'm not a
‘woe is me’ person. I can tell when I'm
depressed because all of a sudden I start
getting flashbacks of any dark thing that ever
happened.”
-Alice, 63
• 4. Being a victim of abuse (11)
– sexual, physical, spiritual, and/or emotional
“When I was in the middle of my sophomore year of
high school, I was molested by three boys in my
ceramics class. And that kind of tipped me over the
edge and I tried to kill myself after that. I felt like my
parents kind of gave up on me. They kind of stopped
worrying so much about me and just started ignoring
the fact that I was never home. I got into some more
heavy drugs and got extremely sexually active with
boys and girls because now I was this person, this
unclean, dirty thing.”
-Megan, 21
• 3. Family of Origin issues (12)
– All 12 women mentioned issues with mother
“My mom [is] very religious, too, and LDS. As a kid I
never felt like I was living up to her religious
expectations even though I was trying really hard to,
but she struggled with … you know anything that
would be contrary to the LDS church. It’s hard for me
to see her point of view and it seems like nothing is
ever good enough or up to her expectations
religiously, so even though I know she’s happy with
me I still feel like she doesn’t think I’m up to her
expectations.”
-Sarah, 28
• 2. Feeling judged by others (15)
“I feel like everything is judgmental. I have
never seen people judge so harshly on
clothing, hair, the things that [others are]
doing. But that's what Utah is. I don't get it.
What's wrong with me? What am I doing so
wrong? For some reason, people just judge
me really harshly. I don't know why. I just
have come to the conclusion that it's Utah,
and I hate it here.”
-Traci, 26
• “I'm not [at church] for the people that are
there. I'm there because Jesus died on a
cross and the gospel was restored through
Joseph Smith. That has nothing to do with
the fact that I had two horrible marriages, my
mom's dead, and I'm dirt poor. [My
circumstances have] nothing to do with the
fact that I believe that the church that existed
in the Bible is on the earth today. I believe
that. I have to follow it. I have to do what I
believe. But is it easy? No.”
-Connie, 33
• Toxic Perfectionism (15)
Defined as: an otherwise healthy, strong
religious commitment, and associated desire to
achieve religious ideals, combined with
perfectionistic concerns about “falling short” of
those ideals – and the perceived personal and
spiritual consequences of doing so (Craddock,
Church, Harrison, & Sands, 2010).
“We have this idea in our mind of what we
should be: to be a perfect mom or whatever.
Being a stay-at-home mom is very difficult for a
lot of people, myself included … then you also
have these expectations of what you should be
doing to be the Molly Mormon or the perfect
little homemaker … I think that's a lot different in
other cultures.”
-Sharon, 47
“With reading scriptures and praying I feel like
sometimes I don’t want to pray because I’m not worthy
to pray, does that make sense? Like I don’t feel like I’ve
lived up to what I should be doing that day and so it’s
hard for me to want to pray ‘cause some days I feel like
[God’s] not happy with me.
“If I’m not reading my scriptures then I feel like I’m not
doing what I should be doing and that I’m not keeping
all of the commandments, so it makes me feel like my
self-worth goes down. So even those little things make
me feel lower than they should. There’s all those
morals and standards that you want to live up to and
want to be like, so it’s hard when you don’t live up to
your expectations or others expectations.”
-Sarah, 28
“A lot of my triggers were that I liked to be the best at
everything. In high school, I was a straight-A student in
school, I was in the national honor society and president
of a club…In church, I wanted to be the super active
one that everyone thought had it all together.
“I wanted to do everything and I wanted to do
everything fantastically well. I think it for sure fuels [my
depression] because no one's ever going to hit that. It's
like the unobtainable. No one is ever going to be
perfect. Logically I know it's unobtainable, but you are
still pushing for that.”
-Haylee, 21
“When you're depressed, you just do anything to not
feel it. So you think perfection is the answer. ‘So if I
have the perfect body, if I had the perfect looks, if I
had the perfect kids, the perfect house, the perfect
whatever, the perfect spirituality, if I somehow just
loved to serve and I never felt like I was being
burdened by doing this, then everything would be
okay and I wouldn't have depression.’
“But I think that everyone with depression kind of does
that. In the LDS church it's like, ‘I feel depressed’
and it's like, ‘Oh, you must not be righteous. Maybe
you should go serve somebody, and then you would
be.’”
-Lindsey, 32
Where does this
perfectionistic attitude
come from?
“But it's just something we do to ourselves.
That's not coming down from the prophet; it's
not coming down from God. That's just us
comparing ourselves to each other and having
that perfect standard.”
-Lindsey, 32
“[Perfectionism] is definitely a culture thing…I talk to
people and I know people who live outside of Utah…
and they talk about pressures, and I don't feel the
same pressures. It’s a crazy phenomenon going on
down here. One of the things that I have a hard time
with is even general conference talks and the
scriptures and the things we’re studying, they're
saying, ‘Do your best and God will do the rest’. That's
kind of what you hear. Then you kind of hear this
cultural thing where it's super-competitive, where you
need to do better than your best because everyone
else is. So then you have to keep up with them and
you hope God does the rest, but wouldn't it be
awesome if you could just do it all yourself?”
-Haylee, 21
Cognitive Dissonance
Doctrine
Culture
Coping strategies
• Exercise (10)
• Spend time with
family/friends (7)
• Stay busy
• Sleep
• Accept the situation
• Work in the garden
• Natural remedies
• Motivational tapes
•
•
•
•
•
•
•
•
Take “me” time
Bubble bath
Watch TV or movies
Read
Write poetry
Positive self-talk
Serve others
Temple, scriptures,
prayer
“Writing and reading, I just love literature. When I get
really depressed, though, I would write about
depressing things. Yeah, the poetry was great and it
was beautiful and it was like ‘Wow, this is really good; I
can express myself!’
“Helping other people is a huge one for me. Giving of
myself to make somebody else's life better. I think that
anybody, I mean, no matter how depressed you are, if
you can feel like you're benefiting or contributing in
some way, because everybody has something to
contribute, every single person.”
-Megan, 21
“Exercise helps quite a bit. In college that’s
what I majored in and so I’d have a lot of
exercise classes and I think what got me
through college was exercising and just having
that outlet. I think reading, or sometimes just
watching a movie, or it could be taking time for
myself definitely helps too…writing in my journal
helps a lot, talking to a friend about anything
seems to help too. I like baking as well, so
that’s sometimes my outlet: if I can’t go
anywhere because of the kids, I bake.”
-Sarah, 28
• “When I stay productive, that is currently the
biggest contributing factor to managing my
depression. And then keeping with the faith,
as it were. If I go to the temple a lot, that
helps. If I study the scriptures instead of just
read them, that helps. Getting enough sleep
helps. When it's warm outside, it helps.
Being hopeful, but not staking my happiness
on chance, or the agency of other people.”
-Kim, 25
Religious perspective
• Spiritual coping strategies (prayer,
scripture reading, priesthood blessing,
temple attendance, fasting) used by
less than a third of participants (6)
• Two mentioned multiple spiritual
strategies (i.e. prayer and scripture
reading)
• The atonement was mentioned only
once
Role of Jesus Christ
in coping or healing
• Jesus Christ/Savior/Redeemer was
referenced briefly and descriptively in
only half of the interviews
• Jesus Christ/Savior/Redeemer applied
personally was discussed by only three
• No one described an active use or
application of the atonement
Treatment
• 14 diagnosed by M.D.
• 6 by mental health professional
• Treatment options: medication and/or
therapy
Medication
“I am on Wellbutrin, and I am on Celexa. I
found out inadvertently that I really, really need
the Celexa. My anxiety level went up. I have
never really felt like I had anxiety. I was like,
‘okay good, let's get back on Celexa.’ It makes
all the difference. But yeah, I would be just a
lump of nothing without my antidepressants. I
don't think I could function.”
-Alice, 63
“I tried a bunch of different medications like
Lexapro and Zoloft. I don't know, just a bunch.
None of them did anything for me. They all
made me kind of, just numb.”
-Megan, 21
“I talked to my physician at the time and he
said, ‘Well you’re suffering from depression.’
Right away it was, ‘Let’s put you on medication.’
There was no ‘Let’s talk to someone about talk
therapy in conjunction.’ It was, ‘Let’s put you on
medication.’”
-Maria, 33
Therapy
“I went and saw a psychiatrist. I don't know, I
think it was probably two or three years ago.
I was having a hard time with family. A really
hard time… He tried to put me on different
kinds of medication and it didn't work, but I
think just the talking really helped more.”
-Lori, 36
“[My doctor] didn't recommend individual
therapy, he recommended group therapy. I
think individual therapy helped a lot. I did
marital counseling when I was married. Then I
had individual therapy. I think that helped.”
-Connie, 33
“Actually, I owe a lot of [my healing] to my
therapist. We used a lot of different techniques
and homework assignments. We had a lot of
good challenge activities. It got to the point
where it was just like, ‘I don't care what people
think about me.’
“It was a matter of taking the relationship
between me and everybody else and focusing
on the relationship between me and God. ”
-Haylee, 21
Social Acceptance of
Medication vs. Therapy
• Ward newsletter
• Student in a class
Medication vs. Therapy
• 19 used medication, 7 were on 1+ meds
• 10 sought therapy
– 1 saw LDS bishop for counseling
– Cost and time were prohibitive factors
– A few did not like it or felt it was not helpful
• All 20 cited situational factors as
contributing to depression; only 7 cited
genetics or organic factors
Clinical Implications
• Three Levels of Treatment
– Low: medication only
– Medium: medication, therapy, selfadministered behavioral and spiritual
interventions
– High: medication as necessary, therapy,
and spiritual interventions focused on the
atonement
High level of Treatment
• Focus on treatment should be 3pronged:
– Medication to return to functioning, then
weaned off if possible
– Therapy (necessary to reframe thoughts
and reinterpret life events, particularly LDS
culture myths)
– Spiritual interventions and support
(priesthood counsel and blessings,
atonement, scripture reading “homework”)
Recent statement on
therapy
• Supported as long as interventions are
evidenced based.
• Therapy should be “wisely coordinated
with priesthood leaders.” (Oaks, 2012)
Treatment Model
Medication
Client
Therapy
Spiritual
support
In conclusion
“Now when I see women who I even think
are depressed, it's like, I know what to do
for them. They need to be listened to,
they need to be loved. They need to be
validated.”
- Amy, 43
Any questions?
If you have any questions regarding
our research, please contact:
Dr. Kris Doty at
Kris.Doty@uvu.edu
or Danna Lindemann at
dannalindemann@hotmail.com
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Craddock, A. E., Church, W., Fleur, Harrison, Sands, A. (2010). Family of
origin qualities as predictors of religious dysfunctional perfectionism.
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