Mental Illness:

How many people in your ward are suffering from some form of mental illness? One? Two? None? Chances are good that your estimate is too low.

A major study by the National Institute of Mental Health suggests that as many as 20 percent of adult Americans suffer from a disabling mental disorder. The most serious and chronic of these disorders—schizophrenia, manic-depression, and chronic major depression—often require hospitalization and medication. In fact, serious mental disorders fill more hospital beds in the United States than cancer, heart disease, diabetes, and arthritis combined. But milder forms of clinical depression and severe anxiety can also disrupt individual and family lives and require professional treatment. (See “How Many Are Suffering?” p. 53.)

Many of us don’t realize how widespread mental illness is, partly because it shows few physical signs. “Victims of mental illness, for the most part, look normal,” explains the mother of a young woman who has been in and out of hospitals with depression. “They don’t limp or stutter. The scars are on the inside.” But many victims feel pain and confusion so great that life is almost unbearable. And family members of the victim often suffer grief and isolation as they struggle to understand the nature of their loved one’s illness and search for ways to help.

“Chronic mental illness can happen in any family,” says Tom Baxter, special assistant to the director of LDS Social Services. “Church members sometimes feel that if only they had lived the gospel better, these problems would not exist.” But this is not always the case, he says. “We now know that mental illnesses have multiple causes, including genetic and biological factors—factors we usually cannot control.”

Other factors, such as abuse, trauma, stress, unresolved conflict, or excessive guilt, can also contribute to or cause the development of some types of mental illness. Serious family problems may also contribute to the development of mental disorders. Current research suggests that many victims of mental illness have genetically inherited a biological predisposition for their illness—although not everyone who is predisposed will develop that disorder. Dr. Richard Ferre, chairman of the Department of Psychiatry at Primary Children’s Hospital in Salt Lake City, says, “Essentially every major mental illness—whether it be schizophrenia, major depression, autism, or attention deficit disorder—has biological underpinnings.”

This is not to say that we have no responsibility for our mental health. Sin—our own and that of others—does cause emotional pain. And if we are unable to forgive ourselves or someone else, or if we constantly dwell on our failures, disappointments, or past problems, we may be more likely to suffer emotional stress. We may also feel unnecessary distress if we constantly try to please others or if we try to meet unrealistic expectations of how attractive or successful we ought to be.

But there is a difference between ordinary discouragement or the sorrow created by sin and the problems resulting from mental illness. Indeed, many serious mental illnesses are just that—genuine illnesses that need to be treated as such.

We live in a time when victims of many mental disorders can find helpful treatments. Unfortunately, many individuals and families struggle alone with illnesses that can be treated. “It isn’t a sign of weakness to get the help you need,” says Dorthea C. Murdock of LDS Social Services. “It is a sign of strength to say, ‘I have a problem and I need help.’ Hope and help are available.”

The key to that hope is understanding. For the victim of mental illness, hope lies in being properly diagnosed and treated—the sooner the better. And for family members of the mentally ill, help comes best from those who understand the illness.

In this context, then, what are these severe disabling illnesses? How can they affect us and our families?

The illness that caused the sudden change in Scott Hausey is called schizophrenia. Of all mental illnesses, it is no doubt the most feared and the least understood. It strikes about 1 percent of the world’s population; in the average ward, it is possible that several people have schizophrenia. Most often, it strikes young people in the prime of life, between the ages of seventeen and twenty-five, with no regard for religion, race, socio-economic level, intelligence, or personal virtue.

Schizophrenia is not a “split personality” disorder, as is commonly thought. Instead, it causes the victim to feel “split” from reality. And it apparently does not result entirely from psychological factors—such as inadequate “bonding” with the mother—as was once commonly believed. By studying adopted children, researchers have found that the incidence of schizophrenia is clearly linked to the biological parents, not to the adoptive parents who reared the child. Extensive psychoanalysis and family therapy have proved not to be as effective in treating it as a combination of medication and supportive therapy.

Scientists do not know exactly what causes schizophrenia. But the chemical systems that regulate nerve impulses in the brain appear to be involved.

Whatever the exact cause, the manifestations of schizophrenia are alarming and sometimes bizarre. The sight and hearing of victims may become overly acute. They may not be able to carry on a conversation, for example, because the hum of traffic outside—a sound the brain would normally filter out—is almost deafening to them. They may hear the lawn mower or other inanimate objects “talking” to them. And they may think they are a famous person or have some special knowledge. Often these delusions have religious themes.

People with schizophrenia are no more likely to be mentally retarded than anyone else; in fact, some of them have superior intelligence. They are often painfully aware of the fact that people who were once their friends now avoid them, that family members may even be ashamed of them.

Unfortunately, not all victims of schizophrenia can be as successfully treated as Scott Hausey. Even with appropriate medication and treatment, as many as 25 or 30 percent are not able to function even marginally well. Prompt treatment is vital.

When Troy Keach began withdrawing from family and friends and resisting Church activity, his parents thought it was just a teenage phase. Then Troy began hearing the television communicating with him, and “his grades plummeted from A to Z,” his mother recalls. “When he reported a bad experience taking drugs, we realized we needed professional help.” Teenagers who are struggling with early symptoms of mental illness may be more vulnerable to drug abuse than their peers. On the other hand, sometimes parents of mentally ill teenagers who are not using drugs mistakenly attribute their children’s strange behavior to drug abuse.

Joan Keach remembers the early years of Troy’s illness as devastating—for herself, as she searched her memory for how she could have caused Troy’s problem, and for Troy. Today, her son remains “bitterly unhappy.” He lives in his own apartment, totally isolated from everyone except family. Every day he is tormented by the cruel, hostile voices in his head.

The heartache that Troy’s parents feel for him never completely goes away. They have remained close to loving neighbors and ward members, even though others are not always comfortable talking to them about mental illness. In the past several years, Brother and Sister Keach have made presentations in Relief Society and other classes to help inform people about schizophrenia and chronic mental illness. After one presentation, Brother Keach received several phone calls from ward members who made comments like “That sounds just like my grandson. Will you please talk to his parents?”

Depression is not just ordinary discouragement. But at one time or another, almost everyone has a small taste of what depression is like. After a major loss, such as the death of a loved one, you may temporarily lose your appetite, have difficulty sleeping, and find it hard to anticipate anything good happening in the future. This is a normal reaction to grief, and after a short time, you return to normal life.

But if these symptoms continue relentlessly week after week, the normal grief reaction may become clinical depression. If you are depressed, life seems flat and joyless, and its ordinary demands seem overwhelming. You may feel unable to get out of bed. You may even wish you could die rather than continue on in such misery. If you are like many people, you feel guilty for your inability to “snap out of it,” and so you try to wait it out rather than seek professional help.

This is unfortunate because depression is probably the most treatable of all mental illnesses. Perhaps 90 percent of depression victims can be helped. Therapy that teaches the patient to modify negative thought patterns to change his emotions is very helpful. Antidepressant medications are also quite effective. Priesthood blessings and prayer can lend spiritual power and aid healing.

Untreated, a depressive episode usually lasts between four months and a year. But don’t wait for a spontaneous recovery. While you wait, you may lose a job or damage a marriage. You and those who love you will suffer needlessly, and there is also the danger that without professional help the depression will become chronic.

Trying to wait out a severe chronic depression can even be fatal. Doctors estimate that as many as 15 percent of major depression victims take their own lives. (Dimitri F. and Janice Papolos, Overcoming Depression, New York: Harper & Row, 1987, p. 12.) Tragically and ironically, people with depression often make suicide plans just as their depression is lifting—when they are getting a little more energy but do not yet realize that they will ever feel better.

“Superficially, depression may look like a crisis of faith,” says Dr. Brent Petersen, a psychiatrist who specializes in treating families and children. “But it is not. Just telling someone in this condition to ’toughen up’ is not usually helpful.” Depression usually has multiple causes, including biological ones. In the depressed person, the brain’s delicate neurochemical balance has been disrupted. Recent studies indicate that, as with schizophrenia, a predisposition for some kinds of depression is probably inherited genetically. When this predisposition converges with a traumatic situation, a stressful life-style, or emotional conflict, depression can result.

Friends and acquaintances may feel frustrated when they try to cheer and reassure a loved one suffering from severe depression. Often the person is too fatigued and irritable to respond positively to such attention, and isolation and guilt increase on both sides. But a loving friend or priesthood leader who is willing to simply listen can be a lifeline. “I will always be grateful for a sister in my ward who was willing to listen to me during my depression,” says one woman. “She had also been through a depression, and she could reassure me from her own experience that the terrible blankness and hopelessness I felt inside would pass. Often the only way I could feel God’s love for me was through her compassionate, understanding friendship.”

Dr. Petersen, himself a bishop, recalls a bishop who complained to him that life shouldn’t be as difficult and full of disappointment as he was finding it. After being diagnosed and treated for clinical depression, the man’s perspective made a radical change for the better.

In some cases, medication may be needed. Exercise can also help alleviate depression. So can changing negative thinking patterns and exercising faith and love. Sometimes stresses created by longstanding emotional conflicts can trigger clinical depression. In many cases, resolving those conflicts early may help a person prevent a major depression.

“I’m grateful I was guided to a counselor who helped me understand how to apply some critical principles—forgiving others and developing trust,” says a sister looking back at a painful period in her life. “As I learned what was causing the conflicts in my heart, I discovered how to let go. Through the long, discouraging process, the witness of the Spirit gave me hope that the day would come when I would feel my share of happiness and peace.”

Children, as well as adults, can be afflicted by severe depression and other mental disorders. Dr. Richard Ferre of Primary Children’s Hospital in Salt Lake City tells of a ten-year-old boy who became profoundly depressed in the years following his mother’s death. When his father began to date again, the child withdrew, lost weight, and began having trouble in school. Dr. Ferre found that there was a strong history of depression on the mother’s side of the family. He taught the family how to help the child feel secure in his new family situation. He also prescribed an antidepressant medication for the child. The child eventually recovered.

Parents need to know that children who are clinically depressed are not usually able to identify their problem. Usually they begin to do poorly in school, become rebellious, or use drugs or alcohol. (See “Warning Signals of Mental Illness,” p. 54.)

Major depression is just one form of what doctors call major affective or mood disorders. Another serious form is manic-depression or bipolar disorder. The person with this illness may have periods of paralyzing fatigue, alternating with spells of agitated euphoria. In the “manic” phase, victims may have rushes of ideas and inflated pictures of their own abilities. In this phase, the victims may spend large amounts of money they don’t have and make unrealistic personal and business decisions. At the height of this phase, they may suffer a complete break from reality that resembles schizophrenia.

An estimated 25 percent of people with manic-depression commit suicide. Those who are difficult to treat spend much of their lives in the hospital. But doctors can prescribe a medication that can help control both the mania and the depressive symptoms.

Purely physical problems that can induce depression symptoms include hypothyroidism, diabetes, hypoglycemia, stroke, iron deficiency anemia, and temporal lobe epilepsy. For depression, as for all mental disorders, the key to hope lies in accurately understanding the nature of the problem and getting appropriate treatment.

Libby Salk was sitting in a restaurant with family and friends when, without warning, she felt a dull pain in her head. Suddenly, she became dizzy, and her heart began racing. “I felt sure I was going to pass out,” she recalls, “and thought I must be having a heart attack or some kind of seizure.” When she stood up, explaining that she thought she needed to go to a hospital, her legs almost gave way and her arms grew numb. Terrified, she wondered if she were going to die.

Libby was not in any danger of dying; she was experiencing her first panic attack. The attacks recurred over the next several months as Libby went to doctor after doctor, looking for an explanation for her problem. She became frightened of being in a place where she could not get help if she had another attack. Sitting in church or in a crowded theater became extremely stressful.

Even when she was not having a full-blown attack, Libby felt more and more anxious, sometimes even disoriented. She had trouble concentrating at work and found herself forgetting common words and familiar names. Over the next two years, she experienced a variety of physical complaints—from severe headaches to difficulty in swallowing. Occasionally, her heart would suddenly start racing in the middle of the night, waking her from a sound sleep.

“One particularly bad night, I called a dear friend from my ward,” recalls Libby. “I couldn’t explain what was wrong with me, but she sat with me through a long night when the feelings of fear and impending doom were almost more than I could bear.”

After several months of praying and searching for help, Libby was amazed to learn that a new member of the bishopric of her ward was a doctor specializing in the relationship between the mind and body. “I described my problem to him and asked for help,” recalls Libby. “That day he gave me a priesthood blessing that completely relieved my symptoms for several hours. This was a great comfort and gave me hope as I then followed the treatment that brought more permanent relief.”

Libby suffers from a panic disorder—one of several anxiety disorders that, together, affect 15 percent of the United States’ population. In some cases, panic disorder leads to phobias, as victims develop paralyzing fears of situations and things associated with past panic attacks. One woman had her first panic attack in the grocery store and in the car on her way home. The next day at church she had another. In a matter of weeks, she became terrified of leaving the safety of her home, where she could recover from an attack without embarrassment or danger. This disabling fear of leaving home, called “agoraphobia,” is extremely disruptive. People with agoraphobia can become unable to go shopping, keep jobs, or participate in church activities. The effect on the family can be enormous. Other common phobias include the fear of flying in airplanes and the fear of driving.

Some people do not have full-blown panic attacks or phobias, but suffer from a constantly high level of generalized or “free-floating” anxiety.

Researchers have found that anxiety disorders often involve a biological predisposition. When Libby Salk tried to describe her experience to her father, he confessed that he had had similar attacks since young adulthood, attacks that he had tried to deal with by drinking. As with other mental disorders, however, being biologically predisposed to an anxiety disorder does not mean that a person will necessarily develop that disorder.

For many, anxiety disorder may be triggered by a stressful or traumatic event. “Looking back,” says Libby, “I realize that I was living under an extremely high level of stress at the time of my first panic attack. For some months I had been worrying intensively over some difficult personal and family circumstances.”

Fortunately, help is available for anxiety disorders. Several medications are quite helpful in treating panic attacks and flee-floating anxiety. Behavior therapy can be quite effective in maintaining lasting changes and in dealing with specific phobias. Says Libby Salk, “I think if I had been wiser about not worrying so much and had been more willing to trust that the Lord was aware of and would help me and my family, I might not have felt the severe stress that seemed to trigger my problem.”

Only by understanding the struggles of those dealing with mental illness can we respond sensitively and helpfully. What are some of these struggles?

1. Denial. Mental illness is difficult to accept. People will often entertain any explanation for unusual behavior rather than accept that a loved one is mentally ill. Sometimes the denial is so strong that a person will consider divorce or leaving the family before accepting the reality that a member of the family has a mental disorder. In this stage of denial, the family would not appreciate inquiries about the victim’s mental problem.

2. Guilt. One mother whose son has schizophrenia recalls, “I spent the first year of my son’s illness searching for memories of what I could have done to cause my son’s problem.” It is never helpful, and usually not true, to say or imply that a child is mentally ill because his parents didn’t raise him properly.

3. Grief. For the parent of the severely mentally ill, there is a feeling of grief—of having lost the child whose future looked so promising. For the victim, there can be grief over lost jobs, lost friends, lost prospects.

4. Isolation—for both the family and the victim. “People don’t know what to say to us, so they don’t say anything,” says one father. Another tells how his schizophrenic son cries because his younger brother, embarrassed to be seen with him, will not take him to a hockey game.

   The victim of serious mental illness may also feel estranged from God. One man with schizophrenia says, “Every time I pray ‘Thy will be done,’ my suffering seems to worsen. This has caused me grievous difficulties in understanding the will and purposes of my Heavenly Father.”

5. Family and marital difficulties. Harold and Margaret Terney tell how their marriage almost ended because Margaret would tell others about their child’s problem at a time when Harold was still denying that there was a problem. Most parents agree that the issue of how to treat a mentally ill child is the most divisive element in their marriage. Even strong marriages sometimes need outside help to survive the strain.

   Siblings may not understand the illness of a brother or sister. They may resent the attention he or she receives and the inconvenience and shame they feel. Sometimes they feel their brother or sister is lazy or just manipulating their parents. Often, the afflicted child is extremely manipulative, but this is not the primary problem. Educating siblings can reduce resentment.

   Many families have found that support groups and supportive therapy can be most helpful. (See “For Information and Support,” p. 57.)

6. Times of crisis. Perhaps most difficult of all can be trying to get help for someone in the midst of a psychotic break. Sometimes the police have to be called. Parents must sometimes testify in court to have their children committed to hospitals for help. Trying to find housing for an ill adult child can be a genuine crisis.

1. Express love and interest to both the victim and the family. Remember that they are people with ordinary human feelings. Very few mentally ill people are violent; properly treated, most are not. In fact, they are usually withdrawn and inclined to harm themselves rather than others. The father of a young man with schizophrenia expresses gratitude that the elders quorum presidency in his ward recently stopped by and spent an hour talking to his son. The son was overjoyed when the elders quorum president, a busy father, invited him over for dinner. These caring expressions meant all the more because the young man has so few other relationships.

   Be willing to listen to family members of the mentally ill express their feelings. “It’s great to take a meal over,” says Dr. Richard Ferre, “but that avoids the problem of having to deal with someone else’s pain.”

2. Withhold judgment and increase acceptance. If a family doesn’t show up for a church activity, be understanding. If a child behaves inappropriately in church, welcome that child anyway. “It’s important to realize that each person has his own time, his own moment, his own struggle,” says Sister Dorthea Murdock. No one is immune to serious problems, including mental illness.

3. Give needed help. By really listening, you can learn what the true needs of a family are. Maybe a family needs someone to watch the other children while they take an ill child to the hospital in the middle of the night. In one ward, Relief Society sisters took turns taking a mother who could not drive and her mentally ill child to weekly doctor appointments.

If you suspect that a close friend or family member may be suffering from some form of mental illness, consider how you could encourage that person to get prompt professional and spiritual help. The bishop can refer members of his ward to LDS Social Services practitioners or to community resources for evaluation. Family physicians can also make referrals. Most communities have competent mental health professionals—including psychiatrists, clinical psychologists, and social workers—who can give help within the framework of Latter-day Saint values.

As we deal with mental illness, it is crucial to understand the nature of mortality. All of us know that joy is one of the reasons for our very existence, and we sometimes mistakenly think that life should therefore be easy. We think that if we are living righteously we should be guaranteed an existence free from tragedy and serious difficulty. “When I first became depressed, I wondered why I was having this problem when all my life I had done everything I could to live the gospel,” recalls one victim of a serious depression.

But in the same chapter where Lehi teaches that “men are, that they might have joy” (2 Ne. 2:25), he also teaches the critical importance of opposition (see 2 Ne. 2:11). Without knowing misery, he reminds us, we cannot have joy. (See 2 Ne. 2:23.)

Tragedy and difficulty are part of mortal life. When we understand this, we will be more willing to share our struggles with others. This sharing can lessen the isolation and shame we or our brothers and sisters feel when we encounter serious problems.

This understanding can also free us from self-pity. And then, as we turn our focus from our own pain to that of others, we can actually experience joy as we help lift burdens. “Having endured a frightening illness myself, I can now offer help and comfort to others who are suffering from something similar,” says one woman. “Being able to do this gives meaning to an experience that at the time seemed unbearable. Now I can better understand the pain of others, and one of my greatest blessings is to be able to offer understanding and help.”

The Spirit of the Lord can bless the lives of families who are dealing with mental illness. Some spouses and family members speak of comforting priesthood blessings they have received—and of subsequent inspiration to know where to find help; some feel they have been blessed with long-suffering and an increased measure of charity toward the afflicted loved one; some speak of a simple assurance that, although the day-to-day burdens are heavy, the Lord is aware of them and is sustaining them.

“There are no easy answers,” says one husband. “But our Father in Heaven doesn’t leave us alone in the struggle.”

• Schizophrenia—1 percent

• Major affective disorders (including depression and bipolar- or manic-depression)—4 percent

• Anxiety disorders and phobias—15 percent

• Total—20 percent

Mental illness, like other serious disorders, is marked by several early warning signals. Although each of us may experience one or more of these symptoms at one time or another, we should become concerned and get help if they persist or recur frequently.

—Prolonged or severe depression

—Undue, continuing anxiety and worry

—Tension-caused physical problems

—Withdrawal from society; isolation

—Confused or disordered thinking

—Hallucinations or delusions (may be of a religious nature)

—Unjustified fears

—Obsessions or compulsions

—Inappropriate emotions

—Substantial, rapid weight gain or loss

—Too much or too little sleep

—Excessive self-centeredness

—Loss of touch with reality

—Inability to maintain good interpersonal relationships

—Inability to cope with or overcome problems in school, at work, or at home

—Inability to manage everyday routines and responsibilities in school, at work, or at home

—Inability to take care of one’s personal needs

—Extremely immature behavior

—Negative self-image and outlook

(Adapted from Now at Last, pamphlet, The American Mental Health Fund, n.d., pp. 2–3.)

An association of family members of the chronically mentally ill, with groups in many cities throughout the United States, Canada, Puerto Rico, South Africa, and the Virgin Islands, can provide support and information. Write to—

• The National Alliance for the Mentally Ill

• 1901 North Fort Meyer Drive

• Suite #500

• Arlington, VA 22209

• Phone: 703-524-7600

The National Alliance for the Mentally Ill also has the following support networks:

• Sibling Network

• Forensic Network

• Homeless Network

For more information about mental illness, you can write to—

• The National Mental Health Association

• 1800 North Kent Street

• Arlington, VA 22209

• Phone: 703-528-6405