I’ll never forget a short car ride I had with a friend — a former returned missionary from our faith who had stepped away from the church, left his wife and was living a life centered, by his own admission, on the pursuit of more sexual fulfillment. In the car, this 40-something man made an unapologetic pitch for his brave new lifestyle, saying: “Jacob, there’s so much more pleasure you could be feeling in your body!”

He’s right, of course. The internet today is flooded with videos showing men and women in a thousand different scenarios and storylines — some sappy romance movies, others far more explicit — arriving at a moment where the audience is cued for what happens next: one looks at the other with longing and for a few moments, the audience becomes transfixed in a proxy act of transcendent pleasure.

Most of these millions of videos have little to no overt narration. But the overriding message still comes through clearly enough: “this is really what life is all about.”

If you’re looking for the highest sweetness of life, in other words, this is where viewers are encouraged to find it: more and more sexual pleasure. After all, finding our highest pleasure and personal happiness is really the point of everything, isn’t it?

The erotic path: ‘Men and women are, that they might have intense pleasure?’

Some of the most influential voices in contemporary culture now frame erotic experience, in particular, as a kind of higher path that unlocks the true sweetness of life. More than simply a source of pleasure, sexual fulfillment has been increasingly highlighted culturally as a pathway to authenticity, liberation, self-discovery, and even transcendence.

For instance, psychologists and sexologists like Esther Perel and David Schnarch have argued that erotic experience can reveal a more authentic self, unlock neglected dimensions of identity, and offer a kind of aliveness that ordinary routines cannot typically provide. Writer Audre Lorde has likewise described the erotic as a source of deep feeling, knowledge, and power.

In pop culture, historical dramas full of pornographic scenes such as The Tudors, Outlander, and Bridgerton, have swept away large audiences into the same thesis1 — portraying erotic desire as a transcendent pathway of self-discovery, liberation, and personal fulfillment. Other lessons include:

• Passion as liberation and proof of being alive. Sexual desire is portrayed as a way to break free from restrictive social expectations and discover one’s authentic self. Intense attraction becomes an escape from routine, emotional flatness, and a predictable life.

• Erotic fulfillment as personal fulfillment and a guide to truth. Sexual fulfillment becomes a measure of whether one is truly living well, rather than one part of a meaningful life. Strong desires are treated as revealing one’s deepest identity—even when following them conflicts with promises, responsibilities, or existing relationships.

‘What tells me I’m alive’

Plenty of other dramas likewise popularize the idea that erotic intensity can reveal a truer self than the safety and predictability of an established relationship. In one infamously explicit series, the online script shares a voiceover narration from the female protagonist who says:

“I just need to feel it again. What? Some small piece of that magical interconnected, love bubble rush. It was such a high!....Appetite, desire, those are the things that tell you you’re still alive. Otherwise, what’s the point?”

Similar things have been said about drug highs, of course, and other intense escapes. In this case, though, rather than one dimension of human experience, sexual passion and intense desire become a privileged route to the good life — as though feeling most intensely were evidence of living most fully.

Shrinking a soul, hollowing out a life

One of my questions is what this actually means for those who eat this stuff up — which is a lot of people.

The implications seem pretty clear when you think them through. When a story repeatedly presents erotic intensity as the moment a character feels most authentic, most free and most alive, it invites viewers to embrace exactly this in their own emotional world — chasing sexual pleasure and fulfillment as a pathway of relief, sweetness and self-discovery.

In this way, any of us — and people we love — could be ushered into a narrow world where a fulfilled, valuable life is measured primarily by the intensity of what we feel instead of by who we are and the depth of our love for others.

But are we sure that pleasure pathway doesn’t actually work? Plenty of people are chasing it to find out. You tell me: When you look in their faces, what do you find?

In my experience, not joy. And that’s the great contradiction here. What if the pursuit of intense sexual pleasure actually leads to something far less than the highest happiness people can have — which must come in a very different way?

What’s it really all about?

Instead of proclaiming intense pleasure as the reason we’re here, the prophet Lehi had a different message for his sons in the Book of Mormon: “Adam fell that men might be; and men (and women) are, that they might have joy.”

In the Book of Job, we glimpse an ancient past where men and women “shouted for joy” upon learning of the opportunity to come to earth with so much learning and becoming. Something pretty awesome was going to happen by coming here, it seems.

I’ve been fascinated in my personal study lately to better understand the fundamental difference between all this pleasure at our fingertips and the truest, sweetest joy also available. My interest comes from seeing how often the former is being touted and pursued as “what it’s all about.”

But what if that’s not true? And what if many of us end up missing out on something WAY BETTER?

That’s exactly what I believe is happening. For the sake of a deeper conversation about this all, consider seven scriptural ways that true joy diverges fundamentally from even the sweetest forms of physical pleasure.

True joy vs. incredible pleasure: 7 major differences

1. A joy neither temporary or transitory

When the intense pleasure ends — be that a binge with food, porn, sex, drugs, alcohol — the sensation passes. And it’s over — passing away almost like a dream, leaving us still hungry for something more.2

But that’s simply not how true joy works. As President Russell Nelson once taught, it’s possible to “feel joy regardless of what is happening — or not happening — in our lives.”

This was an aspiration of ancient Christians, with Paul saying, “rejoice evermore” and James encouraging: “when troubles of any kind come your way, consider it an opportunity for great joy.”

There are many other similar words of encouragement,3 along with repeated experiences of shouldn’t-be-feeling-this-way joy.4 Monique and I have experienced this kind of growing joy in our family, even amid Emma and Olivia’s health challenges.

Bottom line: this kind of joy is not dependent on an absence of difficulty. On the contrary, this very struggle is tied in a profound way to the emergence of more sweetness. “In this life I shall have joy,” Adam says in scripture, connecting that to their eyes becoming opened in a fall away from God — with Eve also describing this painful knowledge of good and evil as connected to “the joy of our redemption.”

Rather than being a deterrent to happiness, then, our entrance into this complicated, messy life is central to the experience of joy. And there’s something about experiencing the painful opposites of life that helps us know how to recognize both the bitter and the sweet.5

2. A joy also not always immediate

One of the selling points of intense pleasure is its availability now. Not so with incredible joy, which can never be marketed with the same slogan.

“They that sow in tears shall reap in joy,” writes the psalmist — with another psalm stating: “Weeping may endure for a night, but joy cometh in the morning.”

“Ye shall be sorrowful, but your sorrow shall be turned into joy,” Jesus says — comparing the eventuality of sweetness among his followers to one of humanity’s oldest rituals: “A woman when she is in travail hath sorrow, because her hour is come: but as soon as she is delivered of the child, she remembereth no more the anguish, for joy that a man is born into the world.”

“Ye now therefore have sorrow,” he continued. “But I will see you again, and your heart shall rejoice, and your joy no man taketh from you.”

3. Coming not from a substance or behavior — but from a relationship

“In thy presence is fulness of joy,” David declared of the Lord. Christ’s arrival was also famously announced by the angel, “I bring you good tidings (good news) of great joy, which shall be to all people.”6

Scripture speaks of the “joy of the Lord” (Nehemiah), “joy in the Lord” (Isaiah), the “joy of thy lord” (Matthew) and the “joy of his Lord” (D&C).

“The love of God is better than anything else I’ve ever experienced — even better than romantic love,” Alicia Williams once told me.7

“Call on the Lord, that your souls may be joyful,” restoration scripture encourages. “I don’t know how other people get charged up but for me it’s really coming in the presence of God and enjoying him that’s a type of joy that lasts,” taught Pastor Francis Chan. “Like if I can get that time and really be focused in the morning it really does just go throughout the whole day.”

“In this world your joy is not full, but in me your joy is full,” Christ taught early Saints in Missouri and Ohio who were being driven from their homes — with the Book of Mormon describing Lamoni’s experiences where “light had infused such joy into his soul.”

“He is the source of all joy,” President Nelson continued, “We can feel this at Christmastime when we sing, “Joy to the world, the Lord is come.” And we can feel it all year round. For Latter-day Saints, Jesus Christ is joy!”

4. Compared with ‘whatever you feel like’ pleasure, joy is closely tied to aligning ourselves with a higher way of living

More than just a correct understanding of God, Joseph Smith taught that true faith depended upon “an actual knowledge that the course of life which he is pursuing is according to his will.”

The same alignment appears to shape our experience of joy as well. King Benjamin taught his people the “commandments of God, that they might rejoice” and then reflected on the “happy state of those that keep the commandments.”

The angel who announced Christ’s birth to this same ancient American king would go on to explain the humble, outward-facing discipleship that would allow these people to “always rejoice, and be filled with the love of God.”

“Lift up thy heart and rejoice, and cleave unto the covenants which thou hast made,” the Lord told early Saints — more than once. This echoes the frequent reassurance from Christ in the New Testament, where he says 5 different times “Be of good cheer” — including when he said: “In the world ye shall have tribulation: but be of good cheer; I have overcome the world.”

5. Instead of pursuing any pleasure regardless of physical consequences, deep joy is closely tied to a deeper union between body and spirit

Central to all of the most intense physical pleasures is some kind of sensation that the body allows us to feel — often (but not always), despite the fact that it’s hurting us physically and distancing us from our deeper emotional, spiritual core.

This is night and day different from true joy, since there appears to be something about the spirit uniting with the body that also sets the stage for deeper joy. For instance, restoration scripture states that “spirit and element, inseparably connected, receive a fulness of joy; And when separated, man cannot receive a fulness of joy.”8

Death, of course, is the ultimate separation of spirit and body — something that comes to all, regardless of what you believe. Yet our bodies and spirits can also obviously become estranged in this life. Maybe that’s why a fuller expression of fasting (which I experience as emptying myself from anything in my life not of God), is synonymous in restoration scripture with our joy being “full.”

6. Rather than finding pleasure from others, joy is closely tied to bringing more sweetness to those around us

The intense pleasure available in society today has a transactional quality to it: see how much money you can get from people around you, see how much thrill, comfort and pleasure you can get — especially sexually.

That is just the opposite trajectory from where true joy comes in a spiritual sense — neither from a party life nor a monastic life of contemplation, but instead from bringing more goodness, truth and delight to others.

“If your joy will be great with one soul that you have brought unto me into the kingdom of my Father,” declares restoration scripture, “how great will be your joy if you should bring many souls unto me!”

Christ tells a story of the shepherd who “layeth (a sheep) on his shoulders, rejoicing” and then throws a party as a vivid illustration for what “joy shall be in heaven” over one person turning their life back to God.

One sign that something truly from God has been shared — and with the “spirit of truth” — is simply the sweetness felt where “both are edified and rejoice together”

This leads to a rippling effect, with new joy awakened in someone else, which then sparks even more joy in the one sharing. Alma talks about “declar(ing) the truth, that we may have rejoicings in the joy of our brethren.”9

That joy of sharing sweetness certainly includes the home, as John suggests there is “no greater joy than to hear that my children walk in truth.” And Ecclesiastes encourages readers to “live joyfully with the wife whom thou lovest all the days of the life.”

The life of drawing upon redemptive truth personally — and then gathering together with others who are relishing the same — is portrayed by Isaiah as a sweet fount of unending happiness:

• “With joy shall ye draw water out of the wells of salvation” (Isa. 12:3).

• “Therefore the redeemed of the Lord shall return, and come with singing unto Zion; and everlasting joy shall be upon their head: they shall obtain gladness and joy; and sorrow and mourning shall flee away.” (Isa. 51:11).

• “For ye shall go out with joy, and be led forth with peace: the mountains and the hills shall break forth before you into singing, and all the trees of the field shall clap their hands.” (Isa. 55:12).10

What you really want

Why think about this at all? Because of all those times we feel seduced by intense imagery of the party-life-ecstasy projected on every side — bodies thrown at bodies, to the point we feel strongly tempted to say: “Maybe that’s what it’s all about — and maybe that’s what I really want?”

It’s not. However intense the pleasure paraded before our eyes may look, we all want something better than a titillation that is transitory-and-temporary, experience-dependent, body-estranging and relationship-using.

We want something that lasts — beyond just an episodic experience. And something that draws both our souls and the hearts of those around us closer together.

Imagine what it would be like for the internet to be flooded with videos showing men and women finding deep, exquisite joy in abundant community and life together. What would that even look like?

This is certainly not what’s flooding the internet today. But the real deal is different and can change us all if we let it, which brings us to one final characteristic of true and lasting joy.

7. The clincher: Joy so amazing you have to be changed to receive it

Another selling point of intense pleasure is that anyone can have it now….right here.

That’s super different from what has been called a “fullness of joy”11 — something so good that it’s beyond normal human capacity to even experience.

“Eye hath not seen, nor ear heard, neither have entered into the heart of man, the things which God hath prepared for them that love him,” Paul taught. Rather than impossible to experience, however, this ancient apostle makes clear this is something that can be revealed to those who are ready.12

Peter similarly taught that we can “rejoice with joy unspeakable — with the author of Hebrews also describing people being “filled with that joy which is unspeakable.”

“Just as the Savior offers peace that “passeth all understanding,” President Russell Nelson taught that God “also offers an intensity, depth, and breadth of joy that defy human logic or mortal comprehension.”

So what is it that we actually want? On one hand, we can continue to chase pleasure without fulfillment, excitement without lasting joy, and the appearance of being satisfied without actually being nourished.

Or, we can set our feet on a sure path towards a sweetness, joy and happiness that surpasses anything we could imagine for ourselves.

Notes:

Sharlee Mullins Glenn is weary from hearing stereotypes about “repressed” Latter-day Saint women — perceptions she has encountered over the years as the founder of Mormon Women for Ethical Government.

It’s much less common for people to be aware of the church’s “actual doctrine regarding gender and leadership,” Glenn said at a recent Faith Matters Restore conference, emphasizing how the Church of Jesus Christ “clearly teaches that there is full equality between man and woman.”

She cited Elder Ulisses Soares of the Quorum of the Twelve Apostles as teaching, “The restored gospel of Jesus Christ proclaims the principle of full partnership between woman and man, both in mortal life and in the eternities.” And Glenn spoke of how this “divine pattern of collaboration” between men and women is reflected in many different aspects of the gospel and church teachings, including the faith’s emphasis on councils, acknowledgment of Heavenly Parents, the creation of Adam and Eve and the ministry of Jesus Christ, Paul and Joseph Smith.

A new initiative developed by Latter-day Saint women and men in close collaboration, “Serving Together,” celebrates these teachings — while brainstorming practical ways to live them out in day-to-day ministry as lay leaders and members of The Church of Jesus Christ of Latter-day Saints.

Living out a theology of collaboration

“(When) we bring both perspectives together, we get a better perspective,” President D. Todd Christofferson said in 2025, referencing women and men working together. “We get closer to the divine perspective.”

In the same interview, President Dallin H. Oaks emphasized the need to keep improving: “We have not always been wise in using the great qualifications and powers of the daughters of God. … We have work left to do.”

“We have a beautiful theology,” conference co-presenter Amy Watkins Jensen underscored. “We love our church and our community. The Church of Jesus Christ of Latter-day Saints can be a light on the hill in modeling collaborative partnership and united leadership for the world.”

“We have a lot going for us already,” she said. “But we have challenges to overcome to get there.”

Practicing the ‘divine pattern of collaboration’

Glenn paused at the conference and expressed her gratitude for the Church’s bishops, stake presidents, elders quorum presidents and other male lay leaders, who she said “serve so selflessly and often at great personal sacrifice. And their wives, who are often the unsung heroes in this whole scenario.”

“No one asks to be a bishop. No one lobbies or campaigns for the position. It requires countless hours of unpaid and often unheralded labor. And most serve with tremendous humility, inspiration and genuine love for their congregations. We thank you,” she said.

“I think that most church leaders, both male and female, would like to experience full partnership in their callings, but many don’t know where to begin,” Ben Behunin, a stake president in Salt Lake City, told me. Since being called, he’s been exploring additional ways to help male and female leaders serve together well.

He’s learned from this new initiative additional ideas that have helped him recognize there are still many ways in which men and women can be better partners in the church.

“As a leader, I can be more sensitive to not only hearing women’s voices but (also) making sure that we’re implementing their ideas,” Behunin said.

Other ways to improve

Tarisai Mchuchu-MacMillan admitted feeling nervous putting her perspective forward as a newly called stake Relief Society president in Cape Town, South Africa.

When she shared concern about one way sisters may potentially be overlooked, her feedback was received positively by other local leaders — which she said “affirmed collaboration” and reminded her the Lord is involved in his work.

“How do I prepare sisters as they serve with the brothers who they co-serve with, who are their co-members in the Lord’s kingdom?” Mchuchu-MacMillan reflected.

The tool kit includes reminders of prophetic teaching, such as earlier clarification by then-Elder Oaks of the Quorum of the Twelve Apostles that “Men are not ‘the priesthood’” and discouragement of abbreviated expressions sometimes used, such as “the women and the priesthood,” or “we’d like to thank the priesthood for administering the sacrament.”

“The blessings of the priesthood, such as baptism, receiving the Holy Ghost, the temple endowment, and eternal marriage, are available to men and women alike,” he explained.

There are also references in the tool kit to handbook updates: “You could help ward members better understand the expanded stewardship of Relief Society presidents and Elders Quorum presidents since the 2019 policy changes and encourage sisters to counsel with their Relief Society president rather than their bishop when appropriate.”

Other reminders focus on areas people may not think about. For instance:

• “Encourage members to acknowledge, thank and pray for all ward leaders and not just the bishopric.”

• “Encourage both Elders Quorum and Relief Society to select talks given by women as the basis for Sunday lessons.”

And there is encouragement for women to participate more fully in council and class opportunities by sharing inspired feelings:

• “Practice being in tune with the Spirit so you can show up as a full partner in moments of counseling and decision making.”

• “When you are prompted by the Spirit to contribute in Sunday School or another meeting, raise your hand. Trust that others can benefit from what the Spirit is communicating through you.”

Drawing on the full strength of a ward

Bethany Brady Spalding, who contributed to the project, described a practical side of deepening male and female collaboration. “Everything that we do at church is as volunteers. And when we have stronger partnership, things just go better.”

Rachel Bates serves in Behunin’s stake as stake Young Women leader. She described the impact of “being a trusted and valued member of a team” in seeking revelation, sharing ideas and “showing up to support each other.”

“More information helps inspiration, and we also all really become friends as we serve together,” Bates said.

This new tool kit also includes questions to spark reflection for male leaders, such as:

• Do my assumptions, habits and leadership practices reflect a genuine belief that women are essential, inspired, and authoritative participants in the Lord’s work?”

• “Am I actively encouraging the sisters in my ward or stake to bring their strength, their conviction, their ability to lead and their wisdom to their participation in the Church?”

And women are likewise asked:

• “Am I bringing my whole self — including my strengths, my conviction, my ability to lead, and my wisdom — to my participation in the Church?”

Doing even more good together

Far from a “nicety,” Jensen said that greater involvement of women is about increasing “mutual flourishing.”

“My connection to God, my love of Jesus got stronger as I practiced deeper collaboration in our ward,” she added. “Partnership is not a courtesy — it’s a revelation strategy.”

Glenn cited one recent study from Northwestern University, which found that teams made up of both men and women consistently produce more “innovative, impactful” results.

Mchuchu-MacMillan hopes that by practicing these collaborative skills in her stewardship, the sisters in her stake will “be able to find enjoyment and belonging in His Church, in becoming His beloved daughters in their full identity, fit for His kingdom.”

“There’s so much to gain and really nothing to lose,” Behunin said, “by enabling the women to do what they feel inspired to do.”

These other creative and specific ideas about collaboration have sparked “more harmony, partnership and mutual satisfaction” in his stake, he said. “It has already proven to be a great unifying blessing in our stake.”

Four years ago, I wrote in Public Square Magazine about imagining a mental health system “centered on learning and growth” as part of a series on the worsening mental health crisis in America. With wise counsel from my wife, Monique, I’m considering here what this same broader paradigm shift could specifically mean for maternal mental health in the U.S.

Few events in recent memory have drawn as much attention to maternal mental health as the heartbreaking Lindsay Clancy case — with many people weighing in on what the larger take-away should be. For instance, Nicole Kumi, a postpartum mental-health expert, told CBS News: “the duty is on the system to revamp, and I feel like this case is going to put the system in a place where they have to act. Changes have to occur.”

Sounds good, but what changes? And how exactly does the system need to be revamped?

Much of the commentary I saw focused on proposals to make the existing system more efficient and encourage people to trust it more.1 Two examples:

• Psychiatrist Jennifer Payne told the Boston Globe, “The reality is, these gaps exist in the entire health system” (referring to limited supervision by Clancy’s doctors after making a prescription). She then added, “Anybody who’s prescribing a medication should follow up with that patient,” but patients can seek care elsewhere, “and nobody’s tracking that.”

• Veerle Bergink, director of the Women’s Mental Health Center at Mount Sinai Hospital in New York, tells The Guardian that the primary problem is a lack of formal understanding about “postpartum psychosis” which does not yet exist in diagnostic classification systems. “We’re really in the middle ages here.”

The same article emphasizes how “treatable” postpartum psychosis is, stating: “Response to treatment with lithium and electroconvulsive therapy ‘is excellent.’”

Better follow-up and more accurate diagnostics could surely make a difference. But is this really what Lindsay Clancy lacked — a better diagnosis, another prescription for lithium and maybe some electroconvulsive therapy?

What these commentaries seem to miss is that Lindsay Clancy had no shortage of psychiatric treatment (30 prescriptions involving 13 medications), diagnoses (five, not counting postpartum psychosis)2 or supervising doctors (six providers in the months before the tragedy).

Are we to honestly believe that more diagnoses, more medications and more attention from additional providers were the missing ingredients in her failed care?

Listening to mothers themselves

Rather than asking only professionals within the existing system to direct needed changes, this is an especially important time to listen to mothers themselves. Over the past decade, some researchers have interviewed mothers about what they need to thrive, while others have collected first-person accounts of women navigating postpartum depression and anxiety. For instance:

• In 2014, British researchers interviewed 17 women who had experienced emotional difficulties during the first year after childbirth to explore how they understood their distress and what they needed. In addition to the shock of adjusting to motherhood and unmet needs for support, many women described feeling ignored or rushed by healthcare professionals. Others expressed appreciation for a compassionate provider who listened without judgment.

• A 2015 British interview study found that most of the 17 women did not identify with the concept of postnatal depression. They described forms of distress that they felt the healthcare system failed to recognize. One takeaway was an appeal to recognize a broader range of emotional experiences, rather than relying on depression-focused screening alone.

One particularly valuable study, published in 2020, involved interviews with 30 new mothers. The researchers began by noting that previous literature had “identified a gap between what experts recommend and what mothers desire during the postpartum period.”

• Social support came up over and over: “I think someone to talk to is the biggest one. Because I just―I don’t know. I had so many doubts and whether I was doing the right thing or not or trying to figure out the right thing to do for a lot of different scenarios. So yeah, just helped me to be able to talk about that to somebody.”

• One mother described the value of having more realistic expectations about infant crying: “I think me being calm and knowing that he’s okay and if he cries, just going through the checklist. Did he eat, did he sleep, did he poop? If he had all his things, then maybe he needs one extra feed or a little bit more sleep or whatever. But … if he did everything today, then he is good.”

• One mother who felt exhausted by being constantly around her baby said: “I’m like her favorite person right now, so that is difficult when I’m like, ‘Just take the baby.’ And then in the morning, [my husband will] bring her downstairs, and she just wants to come back to be with me. I’m like, ‘I love you so much, but go away. I need like an hour, or like five minutes, or a breath.’”

The study identified a wide range of factors influencing mothers’ well-being:

Mothers are clearly navigating a broad range of factors that can affect their postpartum well-being.

Our usual approach to maternal mental health

Listening more closely to mothers could change a great deal, especially because their accounts suggest that they need something beyond treatment as usual.

Over the past three decades, psychiatric treatment—particularly antidepressant use—has increased substantially across a wide range of demographic groups in the United States. But few groups of people take more antidepressants than women.

By 2002, women’s antidepressant use had tripled compared with 15 years earlier. Over the following two decades, it doubled again — with women consistently using antidepressants at roughly twice the rate of men, with these medications prescribed to nearly one in four women over age 60.

That increase is evident in young women:

(In this analysis from 1999-2013, antidepressant use among Swedish women ages 15–24 nearly quadrupled across these 14 years, rising from about 14 daily users per 1,000 women to 52 per 1,000.)

The increase also includes pregnant mothers:

(Note: Antidepressant exposure during pregnancy continued to rise after 2008. By 2014–2018, about 6% of women reported taking a medication for depression or anxiety during the first trimester, compared with 3.7% in 1997–2001. The changing patterns of antidepressant use during pregnancy are also evident in this graphic).3

By the way, virtually no one, myself included, disputes the potential stabilizing value of antidepressants in some cases, for a certain period of time.4 Whether the risks of doing so in pregnancy are outweighed by the benefits, however, remains a sharply contested question.

What’s less contested, however, is this: we as a society have turned to these medications as a first and primary source of relief for most people facing depression, including pregnant women, even though we know there are other things that could likely be emotionally relieving.

Given that, we all know what usually happens when women speak with a mental health or medical professional about feeling anxious or down. They walk away with a prescription, often without receiving adequate support for the other factors affecting their well-being.

Another approach to maternal mental health

Imagine if psychiatric treatment were not the automatic first step. Instead, pregnant women could be offered a range of supportive interventions that target the wide array of mental health risk factors connected to bringing a baby into the world.

Years ago, after developing a general inventory of depression risk factors, I began work on a similar inventory focused on postpartum depression. It was Cheryl Tatano Beck at the School of Nursing, University of Connecticut who first developed in 2002 a Postpartum Depression Predictors Inventory, which identifies 13 general areas that can set up a pregnant woman to struggle with depression:

1. Marital/relationship status

2. Socioeconomic status

3. Self-esteem

4. Depression during pregnancy

5. Anxiety during pregnancy

6. Unplanned/unwanted pregnancy

7. Previous history of depression

8. Social support

9. Marital/partner satisfaction

10. Major life stress

(After delivery, three additional domains were added):

11. Child-care stress

12. Infant temperament

13. Maternity blues

Beck did amazing work, although her inventory was based on research from the 1990s. By 2026, approximately 2,500 scholarly articles had explored risk factors for postpartum depression. Although subsequent studies found Beck’s inventory impressively predictive of later depression, more recent research highlights other areas of vulnerability that could strengthen this inventory, including intimate partner violence and sleep struggles. As most women know, simply not being able to sleep after a baby is born can be a psychic shock.

In addition, there are several protective factors that help women guard against postpartum depression. These include: parenting interventions, doula support, breastfeeding support, physical activity and overall nutrition and diet.

The larger point is to establish a broader foundation for a lifestyle-oriented approach to maternal mental health — one centered on learning and growth.

To focus on learning and growth means acknowledging fundamental wholeness and potential, which sharply contrasts with how many feel in our mental health system today.

A different first step

Imagine if mothers experiencing emotional distress were first invited to explore these 20 areas,5 identifying both their existing strengths (“you’re lucky to have a supportive partner and lots of social support”) and the circumstances that might be making things harder (“all this financial burden isn’t helping you” — neither is your history of poor sleep and little physical activity”).

Based on conversations like this, any woman could be supported in crafting a custom-designed emotional wellness action plan for her pregnancy. Rather than centering the plan on a single intervention, this approach would draw on a range of research-informed strategies, including:

1. Strengthening connection with your partner

2. Creating safety in your relationships

3. Building confidence and self-worth

4. Learning from your emotional history

5. Developing skills for managing anxiety

6. Working through difficult pregnancy feelings

7. Finding ways to ease financial stress

8. Lightening an overwhelming daily load

9. Building a strong support network

10. Reconnecting with meaning and purpose

11. Making space for rest and renewal

12. Preparing emotionally for postpartum changes

13. Preparing for birth and recovery

14. Building confidence in parenting skills

15. Learning to respond to your baby

16. Getting support with breastfeeding challenges

17. Protecting sleep and nighttime rest

18. Keeping your body safely active

19. Nourishing yourself with healthy food

20. Building skills for difficult emotions

Two confirmatory lists

These practical growth options for a personalized emotional-wellness plan correspond nicely to the many actionable influences on mothers’ well-being identified in that 2020 interviewing study, including:

• Accurate locus of control and limiting inappropriate self-blame

• Attitude toward learning and adjustment

• Bond with baby

• Child temperament

• Emotion regulation

• Financial and material resources

• Gaining firsthand experience with parenting activities

• Giving oneself credit for successes

• Insufficient time for task demands

• Internal aspects of engagement with social support

• Keeping baby in a routine

• Knowledge access

• Maintaining aspects of life outside of parenting

• Mother’s self-knowledge

• Physical home environment

• Prioritization of self-care

• Sleep and fatigue

• Social pressures

• Strategic planning and time management

• Support from others

• Understanding baby

• Workplace flexibility and understanding

This range of action steps also maps onto many of the areas identified in the innovative “Barkin Index of Maternal Functioning,” pictured below.

Consider how much more reassuring and helpful this comprehensive approach could be than hearing, “Well, it looks like you meet the criteria for depression. Let’s start you on something and hope it works!”

Certainly, each of these areas of learning and growth has a cost: effort, time, and investment. But none of these approaches has the same range of possible side effects associated with antidepressants, some potentially serious (especially for the babies).

Learning and growth as an engine for healing

What might this broader approach mean for women like Lindsay Clancy — and for the many other mothers who struggle emotionally during pregnancy and after childbirth? We cannot know whether a different approach would have changed her story. But we can ask whether our current system is giving mothers the full range of support they need, especially when they bring histories of trauma and other vulnerabilities into pregnancy.

As psychiatrist Bessel van der Kolk argues in The Body Keeps the Score, medications can help people find their footing in the present, but they don’t necessarily teach the lasting skills of emotional self-regulation. That distinction matters. Medication can be essential, especially in severe distress. But relief from symptoms is not the same as learning how to navigate them.

After decades of expanding psychiatric treatment, we’re still hearing calls to do more of the same: identify more conditions, prescribe more medications, and supervise treatment more closely. These things matter. But they leave a larger question unanswered: Where are we helping mothers build the skills, relationships, and everyday conditions that make healing possible?

Imagine a maternal mental health system that does both: treats serious illness when needed while also helping women strengthen relationships, find support, protect their sleep, build parenting confidence, and learn to work with difficult emotions.

Mothers need more than treatment for what’s going wrong. They need support in building what helps life go right.

Let’s listen more closely to pregnant women, mothers, and anyone else struggling emotionally. They need more than medication and supervision alone: they need support that can help them find deeper healing, peace, and joy.

For more on this broader approach to mental health, check out my book with Clay Olsen published this fall: “Recovering Hope: Science-Based Tools for Long-Term Healing from Depression, Anxiety, and Addiction.”

Notes:

3

4

When it comes to long-term antidepressant treatment which has been rising, more concerns have been raised about the counterintuitive effects many women experience from antidepressants.

Credit: The Book of Mormon Squad

Every student of psychology, social work and family science takes some kind of a human development class — a field that has long focused “almost exclusively” on the earliest changes of childhood.1 From Piaget’s cognitive stages to Harlow, Bowlby and Ainsworth’s attachment theories, those rapid changes between infancy and toddlerhood to adolescence have been an understandable preoccupation among scholars historically.

Less frequently, there have also been thoughtful examinations of middle and late adult development, such as Erik and Joan Erikson’s adult stages of “life cycle” development. In his “Lifelong Development Theory,” Paul Baltes also pushed back on the idea that “the five or six decades after adolescence yield little to no developmental change at all.”

According to Baltes, not only is development “not completed in adulthood, it encompasses the entire life span, from conception to death.” From this view, all stages of the life span contribute to human development, with no one period holding supremacy over another.

From lifelong development to eternal progression

Latter-day Saints may be particularly interested in this focus on lifelong development since, in our belief, individual growth and learning continue far beyond the borders of this life.2 What our faith calls “eternal progression” highlights a vast developmental timeline that extends from long before birth to far after death — with earthly experience acting as both a central engine of change and decisive trajectory-setter in the direction of that change.

“Whatever principle of intelligence we attain unto in this life, it will rise with us in the resurrection. And if a person gains more knowledge and intelligence in this life through his diligence and obedience than another, he will have so much the advantage in the world to come.” (D&C 130)

Rather than “created from dust” (ex nihilo), members of the Church of Jesus Christ cherish the conviction that we lived before we came here in loving family relationships with adoring Heavenly Parents. In some way not fully understood, these exalted beings provided spirit bodies for the substance of our fundamental “intelligence,” which Joseph Smith taught was “co-eternal” with God.

“Intelligence is eternal and exists upon a self-existent principle … The intelligence of spirits had no beginning, neither will it have an end.” (Joseph Smith, King Follett sermon)

Rather than vanishing one day in an inevitable annihilation — or existing in some suspended vacuum of frictionless, harp-playing living — we understand the “spirit world” into which all humanity eventually arrives to be a place of additional learning and growth, continuing what the earth itself was intended to be: an incredible education designed to move us towards exciting possibilities.

“That which is of God is light; and he (and she) that receiveth light, and continueth in God, receiveth more light; and that light groweth brighter and brighter until the perfect day.” (D&C 50)3

“The whole mortal existence of (humanity) is neither more nor less than a preparatory state given to finite beings,” Brigham Young once taught — “a space wherein they may improve themselves for a higher state of being.”4

“The object of this existence is to learn,” President Young taught on another occasion, “which we can only do a little at a time.”5 He elaborated that God “gives a little to his humble followers today, and if they improve upon it, tomorrow he will give them a little more, and the next day a little more.”6

For Latter-day Saints, then, earth really is a great schoolhouse — created principally for our growth, learning and testing.7 When Jesus comes to restore the earth’s “paradisiacal glory,” that growth and learning will enter a different phase as the human family heals and finds sweet reconciliation and rest.

Where do we end up?

At some point, a final judgment will take place — one that believers across the Abrahamic traditions anticipate as a time of great deciding. Usually, that future differentiation is portrayed as a bifurcated and ominous up-or-down, right-or-left separation between people bound for heaven and hell alone.

But the apostle Paul hinted to his Corinthian readers at something more. A short while after describing his glimpse of “the third heaven,” he taught:

“There are also celestial bodies, and bodies terrestrial: but the glory of the celestial is one, and the glory of the terrestrial is another. There is one glory of the sun, and another glory of the moon, and another glory of the stars: for one star differeth from another star in glory.”

While this has been interpreted differently throughout Christian history, Joseph Smith’s 1832 revelation interpreted this passage as referring to different “degrees of glory” in future heavenly worlds. In a sweeping vision, the prophet shared the following glimpses:

• There will be individuals whose “bodies are celestial … whose glory the sun of the firmament is written of as being typical.”

• And also “bodies terrestrial” — those who are of “the terrestrial world” — who “differ in glory as the moon differs from the sun.”

• And there will be those of “telestial” glory, “which glory is that of the lesser, even as the glory of the stars differs from that of the glory of the moon in the firmament.”

This is what we believe Jesus meant when he said: “In my Father’s house are many mansions. If it were not so, I would have told you.”

And to be very clear, each of these will be wonderful places to be. None involve pitchforks or eternal torment. In a poetic rendering of the vision over a decade later in 1843, Smith described the lowest “telestial region” as “mingled in bliss” — while elaborating:

“And thus I beheld, in the vision of heav’n,
The telestial glory, dominion and bliss,
Surpassing the great understanding of men —
Unknown, save reveal’d, in a world vain as this.

And lo, I beheld the terrestrial, too,
Which excels the telestial in glory and light,
In splendor, and knowledge, and wisdom, and joy,
In blessings, and graces, dominion and might.

I beheld the celestial, in glory sublime;
Which is the most excellent kingdom that is —
Where God, e’en the Father, in harmony reigns;
Almighty, supreme, and eternal, in bliss.”

So much good ahead! So much, in fact, that we apparently don’t even have the human capacity to conceive of it mentally or emotionally quite yet.8

In 2023-2024, Presidents Russell Nelson and Dallin Oaks spoke more about all of this — with a plainness and directness that has been exciting.

Although these doctrines are uniquely associated with Latter-day Saints, others besides Jesus and Paul have spoken about similar things. In Rabbinic Judaism, the Babylonian Talmud describes seven distinct heavenly “firmaments” and names each one. And one of my dear evangelical friends once told me in private that he had a sacred experience where God showed him the reality of multiple heavens.

Human development as eternal progression

The question taken up here is this: what would a study of human development look like if these divergent heavenly possibilities were taken more seriously?

My friend Thomas McConkie sought to bring insights from adult development to Latter-day Saint praxis years ago. Here, I’m attempting something of the reverse: sketching how Latter-day Saint teachings about eternity could impact everything else people believe about development.

In a short introduction like this, outlining a few possibilities is all that can be accomplished. But instead of just imposing some theology on top of human experience or social science, done right, this should capture something valid about existing, real complexities of human development already seen around us — and inside us.

For people like me who believe these teachings about multiple heavenly possibilities to be eternal truth, that’s exactly what I have anticipated — that these insights could clarify changes happening all around us, all the time.

And maybe you could start to glimpse something I now see in the faces and lives of wonderful people all around me: the kingdoms of glory already forming right before our eyes.9

What kind of human being do you want to become?

If this earth is ultimately designed to shape us into different kinds of human beings, clearly we are all — every one of us — still in process. That’s why developmental language is important to keep provisional and formative, leaving wide-open so many fresh possibilities for everyone to make continued choices, moment by moment.

That’s really what I’m trying to offer here: something that clarifies for any of us — each undeniably and infinitely precious — what kind of a human being we truly want to become.

Here are 10 potentially pivotal insights human development could take from an expansive appreciation of multiple heavens to come:

1. Profound and ‘mighty’ changes are possible

I once asked a neighbor who didn’t share my faith, “have you ever experienced someone change fundamentally?” “No,” she said — explaining that she’d never witnessed that in anyone’s life.

That seems a pretty fair stand-in for secular theories of adult development today. If you’ve never witnessed a mighty change, why would you even see it as possible?

You wouldn’t. But it is. The Lord promises Ezekiel “a new heart … and a new spirit” — something he described in person in Jerusalem as being “born again.” Paul later called this “walking in a newness of life.”

Christ seems to know well how challenging this reality would be for our taken-for-granted ways of thinking. Because twice, we hear:

• “Marvel not (don’t be surprised) that I said to you, ‘You must be born again,’” as Christ said in his conversation with Nicodemus.

• And likewise, the Lord said to Alma the Younger: “Marvel not that all mankind, yea, men and women, all nations, kindreds, tongues and people, must be born again; yea, born of God, changed from their carnal and fallen state, to a state of righteousness, being redeemed of God, becoming his sons and daughters. And thus they become new creatures; and unless they do this, they can in nowise inherit the kingdom of God.”10

For those who like to believe that God’s fullest expression of love sounds something like “you’re wonderfully perfect, just the way you are” — the idea that such a profound change is not only possible, but expected-and-essential, could perhaps feel unsettling.

But for the many who dearly yearn for more peace and love in lives of continued heartache and loss, the prospect of a new heart, new mind and new life can feel thrilling. I love the stirring image in John’s revelation of the living God saying “I make all things new” as he dwells among His people in a future day of peace.

Developmental takeaways

A view of lifelong development that takes kingdoms of glory seriously would have to take this possibility of a “mighty change” as legitimate — not something to be ignored.

Developmentally, this means we should perhaps leave more room than many conventional theories do for major disruptions over time in the course of our lives. Instead of just becoming more of what we already are naturally — “That’s just who Frank is!” …. “That’s just Angela being Angela.” — this holds out the possibility of any of us becoming someone radically different, for better or worse.

In his faith development theory, James Fowler did acknowledge the “possibility — always present — of interventions of extraordinary grace” classified under the “rubric of conversion” — which made it “difficult to speak simply or solely of faith as a developmental matter.”

In sum, a theory of development grounded in eternal progression would need to account not only for gradual maturation, but for moments of profound reorientation in which the whole trajectory of a life distinctly changes.

2. Our ability to see things can expand or contract in dramatic ways

With the exception of a number of cognitive biases often explored in modern psychology, the secular insinuation often seems to be that human beings by and large see what’s around them clearly.

But scripture is adamant about just the opposite — describing eyes and minds that can be spiritually blinded when they have “turned away from the truth,” often due to the “craftiness of men” and the “god of this world.”

This happens as light and truth are taken away from people. As Alma tells Zeezrum in the Book of Mormon, “he that will harden his heart, the same receiveth the lesser portion of the word … until they know nothing concerning his mysteries.”

At some point, people’s eyes can become “shut” or "closed” in a veritable “blindness of their minds” or “blindness of their heart” — to the point that even while “seeing many things” they “observe not,” the brilliant Isaiah says, with eyes that “see and (yet) see not.”

This process can thankfully go in the other direction too, with eyes being opened to see more than any of us ever saw before. Alma continues: “he that will not harden his heart, to him is given the greater portion of the word, until it is given unto him to know the mysteries of God until he know them in full.”

Paul similarly speaks of attaining the “mind of Christ” — opposite to a natural mind that “receiveth not the things of the Spirit of God,” for as the ancient apostle says, “they are foolishness unto him: neither can he know them, because they are spiritually discerned.”

Developmental takeaways

I find it fascinating to consider a fundamental ability to see that is tied so intimately to who and how we are becoming. Others have raised similar insights over the years:

• French writer Anaïs Nin once said, “We do not see things as they are, we see them as we are.”

• Anthony de Mello likewise said: “We see people and things not as they are, but as we are.”

• Harvard developmental psychologist Robert Kegan authored the 1982 text “The Evolving Self: Problem and Process in Human Development” — fascinated by how our ways of making meaning change as we mature through adulthood. He once wrote that “Our meanings are not so much something we have, as something we are.”

Far outside the theological realm, these others have recognized how becoming a different person can profoundly change how reality is experienced and interpreted.

It’s fair to say this cognitive insight alone — were it more widely embraced — could further revolutionize our understanding of human development. Imagine if more people could appreciate how seeing reality clearly, rather than mainly a function of methodologies, tools and technical procedures, may well be a matter of how we live and who we are becoming above all else.

This would mean that development involves not merely accumulating information or getting better at processing it — but instead, becoming the kind of person who is capable of seeing more. This would also mean taking seriously the potential of stepping back developmentally in ways that make us less capable of recognizing reality, including stirring truths and beauties once visible to us.

3. Our ability to feel and desire things can also expand or contract profoundly

All of what someone feels, wants, desires, loves, hungers for, and ultimately wills can also shift dramatically from this view. Just as minds can be blinded or opened, hearts can become hardened, closed, or turned away. They can also become softened, opened, enlarged, and changed.

“What are we here for?” Brigham Young once asked. “To learn to enjoy more, and to increase in knowledge and in experience.”

That “mighty change” Alma highlighted is more specifically a “mighty change of heart.” Later in the same book, the prophet Mormon described how deeper fasting and prayer led an ancient people to “wax stronger and stronger in their humility, and firmer and firmer in the faith of Christ, unto the filling their souls with joy and consolation, yea, even to the purifying and the sanctification of their hearts, which sanctification cometh because of their yielding their hearts unto God.”

Developmental takeaways

What would it mean to our broader understanding of human development to appreciate that the human heart — desires, appetites, cravings, longings — can also shift profoundly and fundamentally, for better or worse?

Among other things, this would make the development of desire itself a central object of study: not simply how people learn to work with variations in what they want, but how what they want can actually change.

Rather than neutral choosers who construct themselves from scratch, however, all human beings, according to British philosopher Charles Taylor, naturally live within frameworks of value that socialize and invite us to consider what is worthy, higher, lower, admirable, shameful, beautiful, etc.

The heart interacts constantly, in other words, with everything else around us. The complexities of human development, in this view, must include the gradual formation of the heart — what becomes attractive to us, what gives us pleasure, what we love, and ultimately what we are willing to live and give our lives for.

4. Our day-to-day choices are decisive in determining so much of our developmental trajectory — including the ultimate direction

So, how do these deeper patterns of heart and mind actually change? After emphasizing how central being “born again” is, Jesus then told Nicodemus something so critical that is easy to miss: “light is come into the world, and men loved darkness rather than light, because their deeds were evil.”

If we live and choose something over and over, we’ll eventually start to love it. That might be common sense to many of us — and it’s how Christ explained that our hearts and loves come to change as well.

Our choices impact more than just what we love, though. “Mortality is a master class in learning to choose the things of greatest eternal import,” President Nelson taught. “Far too many people live as though this life is all there is. However, your choices today will determine three things: where you will live throughout all eternity, the kind of body with which you will be resurrected, and those with whom you will live forever. So, think celestial.”

More than just a particular kind of heart we are choosing, this modern-day prophet, whose witness changed my life, explained in his 99th year that we’re also gradually choosing the kind of body and relationships we will one day enjoy forever.

Developmental takeaways

Bottom line: We’re again in the process of becoming different kinds of human beings. This recognition of a kind of eternal evolution taking place, moment by moment — choice by choice — could clarify and focus so much of human development today.

It was the Scottish-American philosopher Alasdair MacIntyre who pointed out that we are not simply making isolated choices — but ultimately becoming someone distinct through the unfolding story of those choices. As he wrote: “The unity of an individual life is the unity of a narrative embodied in a single life.”

All of this places agency much closer to the center of developmental theory. Rather than seeing development primarily as something that happens to us through age and circumstance, this could help us appreciate more in a developmental sense the thousands of seemingly small choices that form the person we eventually become.

5. We are either moving towards more light and goodness or less

At some point, we do settle into a way of being we are most comfortable and committed to — effectively choosing the life we want. But for now — in what Alma in the Book of Mormon calls our “probationary state” — the relentless challenges of this life still nudge most of us forward (or backward) — in one direction or another.

“We are to progress and improve every day of our lives,” Brigham Young once taught — with Joseph Smith also teaching: “If we are not drawing towards God in principle, we are going from Him.”

This changeability implies that the qualities we seek to develop fall on a spectrum — moving infinitely in both directions in an eternal sense (towards ultimate fullness or utter depletion). So, we can experience:

• A continued expansion of awareness and knowledge — or a contraction of the same

• An ongoing expansion of agency and power — or a diminishing of both

• A forever expansion of love and connection with others — or a gradual removal of this most sweet part of life

• A continued expansion of our ability to feel joy and delight — or a blunting of the same

That developmental scholar Paul Baltes once wrote in 1987 that “considerable diversity or pluralism is found in the directionality of changes that constitute” the development of an individual organism across the lifespan — “even within the same domain,” he added.

Harvard’s Richard Lerner similarly cautioned that “all-too-often growth, power, and unmitigated development are assumed to be good” — underscoring the importance of keeping in view the end or purpose of development.

To wit, Spencer W. Kimball once wrote, “You are sent to this world with a very serious purpose. You are sent to school, for that matter, to begin as a human infant and grow to unbelievable proportions in wisdom, judgment, knowledge, and power.”

Rising up or sliding down

For my purposes here, we can touch on two main directional trajectories: a progression from telestial upward to the celestial — and the opposite: a digression from celestial downward towards the telestial.

• From Telestial to Celestial: This is the pathway encouraged by prophets and angels alike: refuse to allow the “lusts of the flesh” to become our first love — instead, cultivating our mind and heart to attach to something higher, better and more joyful. Over time, what we repeatedly focus on and choose begins to shape what we love, until our deepest desires become increasingly aligned with God’s.

• From Celestial to Telestial: Although we all start off with heavenly possibilities, “trailing clouds of glory” as William Wordsworth said, every one of us can come to love something more than God and what God wants for our lives. That can be our body, the body of others around us, sexual pleasure, food, alcohol, music, money, power, accomplishment, etc. While any of these can be a good or natural part of life, once they take a preeminent place in our hearts, they can drag our development down precipitously.

Developmental takeaways

Developmentally, this appreciation of the constant, inherent change that Buddhists call “impermanence” further sets the stage for a theory of human development centered on the hundreds of choices we make every day in response to our circumstances, rather than only the circumstances themselves.

This also highlights the directional nature of change: not every change is growth, and some adaptations may move us further from flourishing rather than toward it. Thus, development could involve both increasing or decreasing capacities for awareness, agency, love, connection and joy.

Instead of only asking “How have I changed?” we may start to ask things like: “Is this change bringing me more in line with God” and “What ultimately am I becoming?”

6. It’s possible for a trajectory going one way to be reversed and move in the opposite direction

This insight is arguably the best news of all — the very truth that Christ says three different times in Latter-day Saint scripture should be a special focus of teaching and perhaps even the only thing we teach:

“Say nothing but repentance unto this generation….thou shalt not preach anything but repentance unto this generation.”

To secular eyes, this can feel like a big fat attempt to rain on the parade of feel-good affirmation and validation. But through sacred eyes, this feels a lot more like saying: “hey, we found a way to give everyone a ton more joy and peace and love — without any side effects!”

“Too many people consider repentance as punishment — something to be avoided except in the most serious circumstances,” President Nelson taught in 2019. “When we choose to repent, we choose to change! We allow the Savior to transform us into the best version of ourselves. We choose to grow spiritually and receive joy — the joy of redemption in Him.”

“Discover the joy of daily repentance,” he added. “Repentance is a blessing … a joyous opportunity,” he told a group of children on another occasion — explaining that it “means that every day you try a little harder and do a little more to become like the Lord Jesus Christ …. Just think every day, I get up, bounce out of the bed in the morning and say, ‘Oh, something wonderful is going to happen today. I’m going to be more like Jesus.’”

“Try a little harder to be a little better.” — Gordon B. Hinckley

Instead of a downer, I hope repentance can feel thrilling to my children. Yesterday doesn’t have to be the same as today! Just because Ebenezer Scrooge was a mean grump for so many years, doesn’t mean he can’t jump on his bed Christmas morning and start showering love on everyone around him.

The same is true for us, in real life.

Developmental takeaways

In secular social science, it’s often said that “the best predictor of future behavior is past behavior.” However true that often is, it sure makes life dull and boring to assume this about everyone around us.

Why can’t they change too? This is often missing from many models of development: the possibility of genuine reversal — a wild card that makes everything a lot more interesting. If any one of us can repent and change direction, then the developmental trajectory of a human life is never reducible to its previous years. Something refreshingly new can begin, no matter what yesterday looked like.

7. We can choose to stop developing

Although we may well end up arriving in a celestial or telestial way of living, there is a third option, of course: arresting our development so we land in more of a middle ground.

Instead of fully ascending into family-focused celestial ways of being, or deteriorating fully into a me-focused telestial life, a stoppage at the terrestrial is a real possibility — described in revelation as the “honorable men of the earth, who were blinded by the craftiness of men … they who are not valiant in the testimony of Jesus; wherefore, they obtain not the crown over the kingdom of our God.”

Among other things, the idea that this developmental outcome is ultimately in our hands underscores the enormous importance of each moment we have. Each breath. Each new day.

Two different ways of getting stuck

Development, again, is not something that eventually happens to us or runs its natural course. Where we go and where we stop is something we have a large say in — with two distinct possibilities worth keeping an eye on:

• Resisting full celestial living— plateauing at the terrestrial. A person may be honorable and genuinely good, yet resist the deeper surrender, covenant commitment, and transformation involved in celestial living. The Doctrine and Covenants also describes the terrestrial world as those who “received not the testimony of Jesus in the flesh, but afterwards received it.”

• Resisting full telestial living — stabilizing at the terrestrial. A person may also resist descending into a life dominated by sin and worldly desire, choosing instead to try and live honorably in response to the light they have received. The terrestrial then represents not the wholehearted consecration of the celestial, but also not a wholesale rejection of God and truth characterizing a telestial trajectory.

These are both real possibilities developmentally. But none of us have to allow our progress to stop! Consistent with her conviction in eternal progression, the brilliant Latter-day Saint poet and leader Eliza R. Snow taught in 1873: “We are never to come to a standpoint. We are to be progressing, and growing better. If we have done well to-day, we must do still better tomorrow.”

Developmental takeaways

Although change and development of some kind seems like a fairly constant reality, this highlights how plateauing, stabilizing and getting stuck are also real possibilities developmentally.

Among other things, this raises a deeper question about whether human beings can become so comfortable with an intermediate way of living that they cease reaching toward further transformation — or whether they continue opening themselves to greater light, love, commitment, and truth.

8. How we relate to bodies — ours and others — is consequential to our eternal development

In a secularizing modern world, it’s easy to see the body as something largely ornamental and mostly for our pleasure — be that our own body or someone else’s. But for Christians who affirm the bodily resurrection, the body is something very different.

“Don’t you know that your body is a temple of the Holy Spirit who is in you, whom you have from God?” Paul asked the people in Corinth, stating earlier: “If anyone destroys (violates/defiles) the temple of God, God will destroy him; for God’s temple is holy, which you are.”

This is why questions surrounding pornography, chastity, and fidelity matter so much to believers — along with how we dress, how we eat and avoiding substances that hurt our physical health.

None of this is about being a “prude.” All of it’s about doing our best to ensure our body is a place the Holy Spirit can dwell.

Paul takes it even further: “You are not your own. For you were bought with a price. Therefore glorify God in your body and in your spirit, which are God’s.”

The flesh-faith connection

That’s why Paul, like all Christians and many other believers, speaks so seriously about sexual immorality: “Every sin that a man does is outside the body, but he who commits sexual immorality sins against his own body.”

Most sins involve pain inflicted on ourselves. But betraying chastity usually also involves hurting others severely, as collateral damage from chasing more and more of our own pleasure. As I’ve written about recently, pouring your heart and attention into pornography also literally changes who you are — just as the process of turning away from it often corresponds with a change in who we are too.”11

Developmentally, we could say that those who choose to center their lives and hearts around sexual pleasure as their highest transcendence become someone different from those who “bridle all your passions.”12

The closer people come to worshiping their own body — and good feelings they can stir up in that body — the farther they are from worshiping God and wanting to have any relationship with God at all.13

Becoming different bodies

Much like our minds and hearts, our bodies can also profoundly change as we develop in one direction or another. “They who are of a celestial spirit shall receive the same body which was a natural body,” restoration scripture says — noting that “ye shall receive your bodies, and your glory shall be that glory by which your bodies are quickened.”

Yet for those not willing to follow a celestial way of living, this won’t be the case: he or she “who is not able to abide the law of a celestial kingdom cannot abide a celestial glory.” In that instance, scripture says they will develop into something else — “enjoy(ing) that which they are willing to receive, because they were not willing to enjoy that which they might have received.”

Developmental takeaways

It was the French philosopher Maurice Merleau-Ponty who helped bring the body back into serious philosophical discussions about how we experience reality. Maybe human development needs to do the same?

Instead of only one domain within human development, alongside cognition, emotion and relationships, this may prioritize more how our bodies are the place where our deepest loves and loyalties are galvanized and made more permanent. How we inhabit, regard and treat the body surely plays an important and direct role in the kind of person we are all becoming.

9. How we regard others in relationships is also consequential to our eternal development

The ethic of “love your enemy” is one way in which the Christian tradition contrasts with other ideologies and faiths. But other traditions express similar ethics beautifully. I love Jewish writer Emmanuel Levinas describing the face of the other as an inescapable ethical summons14 — and Martin Buber’s call to encounter the other as “Thou,” rather than “It.”

I have also known enough tender and loving Muslim thinkers, from Eboo Patel to Asma Uddin, to appreciate how the ethic of love runs deep in Islam as well. In my Latter-day Saint tradition, we focus in relationships especially on ancient invocations against contention, prophetic calls to prioritize family15 and more recent emphases on peacemaking and bridge-building.

Levinas describes how our response to the face in front of us changes us. We become a different person if we take the truth we see in a suffering face, and yield to that by showing care and love. And in the opposite direction, a man who walks out on his wife and children becomes a different person — much like Harry Potter’s Voldemort splitting himself in half as he does violence to another person.

Developmental takeaways

What if human development could regard this ethic of care for others not simply as an evolutionarily smart way to preserve the species or an anthropologically wise way to reinforce the tribe — but as a literal method of transforming oneself (and everyone around you) into a different kind of human being?

We might then see relationships as life-changing instruments through which development happens. Every encounter with another person presents an opportunity to become more capable of love, patience, mercy and self-giving — or, conversely, more practiced in indifference, domination or grievance.

10. How we relate to God is the ultimate pivot point in our developmental trajectory

New York University’s Jonathan Haidt and colleagues have proposed a variety of different “moral foundations” that people have in their lives — including care, fairness, loyalty, authority and sanctity. Although this scholar’s primary focus has been pointing out how liberals and conservatives vary in these foundations, I was intrigued by Josh Coates and Stephen Cranney’s 2024 analysis of current and former believers — demonstrating how these moral foundations appear to shift when people step away from faith.

This made sense to me. If someone consciously decides to step away from a life focused on the reality of a supreme being — especially a god who cares enough about your development to outline a secure covenant path — then what happens next?

In many cases, it seems like moral foundations of sanctity, loyalty and authority drop out of one’s worldview considerably, at least in terms of substantial influences — while care and fairness take on more central prominence. In other words, life starts to revolve around your own feelings and how you see others being treated — rather than any summons external to you, including feelings or expectations God may have about your life.

How do we see God?

From this view, how exactly we come to relate to God in our hearts and minds has profound effects on everything else in our development. When Nephi asked his brothers, “Have ye inquired of the Lord?”

They responded, “We have not; for the Lord maketh no such thing known unto us.”

These were brothers who had prayed previously, at least a little. In fact, they had seen an angel and heard the voice of God. But nothing about those experiences ever appeared to catch their hearts quite like Nephi’s own experiences.

In our case, we might ask: Do we talk with Him, listen to him, trust him, follow him?

Or not? In other words, are we centered on God — or centered on something else?

When God issues a command in scripture — or through prophets — do we “live by every word that proceedeth out of his mouth” — or do we live by every thought that proceedeth forth out of our own heads?

How do we see God’s commands?

However unpopular the idea of obedience to God’s commands is today, the idea flows throughout all scripture. And Latter-day Saints understand it to be “the first law of heaven.”

This is the serious problem with all the popular, easy-on-the-ears hip Christianity that downplays obedience — minimizing the very thing that can supercharge people’s spiritual development: greater alignment with God’s will.

The grace to become

By the law itself, however, “no flesh is justified,” Lehi teaches his children in the Book of Mormon. “Or, by the law men are cut off. Yea, by the temporal law they were cut off; and also, by the spiritual law they perish from that which is good, and become miserable forever.”

Our freedom and redemption, this ancient prophet then explained, come “in and through the Holy Messiah” who can “answer the ends of the law, unto all those who have a broken heart and a contrite spirit; and unto none else can the ends of the law be answered.”

“Wherefore, how great the importance to make these things known unto the inhabitants of the earth, that they may know that there is no flesh that can dwell in the presence of God, save it be through the merits, and mercy, and grace of the Holy Messiah.”

I love that verse!! Among other things, this reflects Søren Kierkegaard’s emphasis on Christianity not simply as something we believe or claim, but as a new relationship with God through “a transformative process of becoming.”16

Becoming — not just believing

“In contrast to the institutions of the world, which teach us to know something, the gospel of Jesus Christ challenges us to become something,” then-Elder Oaks taught in 2000. More recently in 2023, he reiterated: “The gospel of Jesus Christ challenges us to become something,” before adding:

“The Final Judgment is not just an evaluation of a sum total of good and evil acts — what we have done. It is based on the final effect of our acts and thoughts — what we have become.”

Rather than ominous anticipation of a final judgment, I believe this awareness can fire us up to make good use of all our time. “Human beings are expected by their Creator to be actively employed in doing good every day of their lives,” Brigham Young once taught — “either in improving their own mental and physical condition or that of their neighbors.” He called the “principle of increase, of exaltation, of adding to that we already possess, is the grand moving principle and cause of the actions of the children of men.”17

Developmental takeaways

If this theological vision is correct, then our deepest developmental questions may ultimately be relational: What — or whom — is my life becoming organized around?

Our answer to that would not merely characterize our present identity. Over time, it would also help explain the kind of person we are becoming and, ultimately, the kind of existence we are preparing ourselves to receive.

What’s your heaven?

I love asking people this final question. For some, walking their dog in the mountains really does seem to capture something about their true heaven. For others, the quasi-transcendence of drinking and partying is much closer — or watching performative intimacy on a screen.18

But there are others for whom the greatest joy is found in something else entirely: lifting others up, strengthening them, teaching them — bringing them joy — be that young children in a home or neighbors all around them.

That’s the life I have gradually and deeply come to love over time — a life of joy, peace and love that shocks me more and more each passing year. I’m convinced no human-designed pleasure fantasy could ever top it.

If all the foregoing is true, then how seriously we take these questions really may shape the details of everything else. “A man’s idea of the significance of the words ‘eternal progression’ will largely determine his philosophy of life,” taught President David O. McKay. “The great secret of human happiness lies in progression.”


Notes:

That’s definitely not how reunions — especially a high school one — feel to everyone. For complicated reasons connected to stretched-thin modern lives and hurtful experiences in the past, a reunion like this can feel like the very last thing someone wants to do, even if they had the time and proximity to get there.

“Hell no, I will legit never go to a high school reunion,” one of my old friends responded during our attempt to let everyone know about the gathering.

Still, even for the many with some challenging memories of high school - isn’t that all of us?? - I made my best case for going to a reunion this summer. After all, what better chance to work through weird trauma in high school than by having new, positive experiences?

Those painful experiences don’t stop at high school, of course. And by a 20- or 30- or 40-year reunion, no one has their eyes closed to the heartache of life ….divorce, death, depression, anxiety, chronic illness, suffering children.1

For all these reasons, I respect why, for some, it feels safer to keep their distance from these kinds of gatherings.

Credit to Timothy Fisher for this and most of the other photos below, as well as for the video.

Making sure everyone knows they are remembered

I admit that I’d usually rather stay close to home with family. But there’s rarely another chance like a reunion like this to reconnect with so many old friends and make new friends you never got the chance to meet years ago.

What made this reunion different from any other for me was being part of the snowball recruiting effort involving 50+ people reaching out to let old classmates know.2

“I didn’t know anyone remembered me,” I heard multiple times. Even if they couldn’t make it, it felt good to let old classmates know they were invited, and remembered — and wanted.

But even for a guy like me who is a sucker for reunions, I was overwhelmed by the emotional experience of this one. Every once in a while, as we’d contact someone new, an impression would come — felt as much as heard — of how precious this person (and every person) was.

Overwhelmed by goodness

“I had so much fun seeing everyone — my heart was overwhelmed with their goodness,” Misti McSwain wrote afterward.

That sense of people’s goodness only expanded as I got to see classmates’ faces in person and embrace people whom my brain had long filed away.

Kody Knighton and I went to elementary school together. I remembered him as a tall friend with the flat-top who never said a whole lot, but was a steady fixture throughout my childhood. I was delighted to come across his picture online — and even more excited to get a chance to give him a hug at our “40 year elementary school reunion” and spend time in person - laughing together, complaining about politics and trading glimpses of kids facing health challenges.

Viewmont High School classmates who also went to elementary school together. I’m convinced memories from elementary school friends are filed away in a different, earlier part of our brains!

‘So much to love’

On the way to the 2nd night of the reunion, I listened to a line from Elder Gérald Caussé’s recent talk that captured my experience so well: “There is wonderful depth—so much to love—in every soul.”

That’s not just a cute line. It’s the truth. I know it in my bones — having felt it, over and over, even just at my high school reunion.

Paul Farnsworth and Robbie Boyle take a picture together

On the second night, I stood around watching people leave — but I didn’t want to go yet. There was something here I couldn’t quite place that felt so joyful.

The love of God has been described as “the most desirable above all things” and “the most joyous to the soul.”

In a small way, it feels like a reunion provides a small taste of what God feels — so much love, for so many precious people.

Kevin Wood in the middle was my first “best friend” in Kindergarten. And Josh Hiller on the right ended up being one of my BYU roommates. So good to see these guys!

And maybe, even a glimpse of heaven itself3 — which Latter-day Saints describe as a continuation of friendship and family forever.

Anticipating this future heaven, Joseph Smith said in 1843, “That same sociality which exists among us here will exist among us there, only it will be coupled with eternal glory, which glory we do not now enjoy.”

From left to right, Diana Rogers Glissmeyer, our Senior Class VP, Barry Beutler and Sasha Nalder Fisher talking at the reunion.

That might explain why the day after the reunion ended — when so many of my classmates were clearly exhausted by all the work and planning and talking — recruiter extraordinaire Alan Christensen changed the name of our reunion committee text thread to “40-year reunion.”

He and I are ready to go! And why not? Feeling that kind of love, who would ever really want that to end?

Group shots of the picnic the first night and the more formal event the second.

A photograph of Lindsay Clancy and her children circulated during the trial.

Lindsay Clancy, the mother who has been on trial for the murder of her children in Massachusetts, yearned to find healing and feel better: “I want help. I want to be well,” she wrote in her diary.

But instead of getting well, she got treatment. A lot of it.

Although it’s unclear how many medications the young mother was taking at the time, The Boston Globe noted that the court recorded prescriptions for 13 different psychiatric medications from six different providers during the five months before the tragic January 2023 deaths of her three small children.

That includes:

• Sertraline (Zoloft)

• Fluoxetine (Prozac)

• Trazodone

• Mirtazapine (Remeron)

• Lorazepam (Ativan)

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Buspirone

• Zolpidem (Ambien)

• Diphenhydramine (Benadryl)

• Lamotrigine (Lamictal)

• Quetiapine (Seroquel)

The first four are classified as Antidepressants, the next four are used for anxiety — including three benzos — then two Sleep/Sedating Medications on top of that, one “mood stabilizer” and an antipsychotic.

Lindsay became increasingly reluctant and apprehensive about taking psychiatric medications, as the trial made clear, especially after experiencing troubling side effects that made her wonder whether the treatment was helping.

According to prosecutors, there was also a note in her phone days before the tragedy that said: “Medication stole my motherhood and my life … prescription medication stole me from my own body.”

Note: None of what I’m reviewing here constitutes medical advice about your own situation. If you or someone you love have been prescribed any of these medications, this should not change what you are doing. Remember, it can be dangerous to taper off a medication quickly, something that should only be done gradually and with support. Mental health and medical professionals can be a significant help in navigating these things. Talk with your doctor about any concerns you notice in your own treatment.

Listening to ‘intrusive thoughts’

As recounted by a psychiatrist in The Free Press, Lindsay Clancy began having suicidal ideation and experiencing “intrusive thoughts” and “auditory hallucinations” telling her that she was “damaged” and would “not be the same,” and that “the only option is to die.”

She acknowledged in December 2022 that she was experiencing thoughts of harming her children to both her husband and mother (each of whom testified to her being a wonderful mother previously). And a month later, as Clancy would recount later, a loud, demanding male voice told her over and over, “This is your last chance. You have to kill the kids so you can kill yourself.”

Clancy said she entered “a dreamlike state” and watched herself act, feeling as if she had “no choice.” Weeks after the crime, Clancy shared with a hospital chaplain that voice “told her that if she did not follow the command, neither she nor her children would be safe.”

According to psychiatrist Phillip Resnick, Clancy felt she had to “obey,” “She felt that her body was taken over by an external force, where she was in a dream state and did not have control of her own body,” Resnick told the jury. “It was almost like she was a puppet and someone else was pulling the strings.”

“Go to God, baby,” she allegedly told each child in the horrible moment. In the psychiatrist’s words, she was “acting on a deranged belief that her kids would suffer so greatly without her that they needed to die.”

Resnick said that Clancy genuinely believed she was protecting the children by taking them with her to heaven. Consistently, Clancy told the hospital chaplain a week after the killings: “I am so glad my children are safe.”

Other stories like Lindsay

Years ago, I encountered a group of parents who had banded together after similar experiences of someone in their family — a son, a daughter, a spouse — who had committed horrific and uncharacteristic acts of violence while taking some kind of psychotropic medication.

They created websites like this one, with close to a thousand stories of horrifying family violence across the U.S., Canada and England between 1990–2011 at the hands of someone taking an SSRI medication — including 232 stories where a child was the victim (and another 100 murder-suicide stories involving parents and children).1

Here are just two examples:

• One father describes how his behavior changed dramatically in a short period: “Over a 3-week period, I changed completely from being a loving, caring and nurturing father of 2 beautiful children to taking the life of my beloved son Ian, in a calm, organized state of delirium-psychosis.”

• Steindor Erlingsson likewise recounts how a few days after starting his SSRI antidepressant, “terrible thoughts came into my mind. I wanted to harm my wife and newborn son. Every time I saw a knife or thought about one an incredibly strong urge to injure them erupted.”

I’ll never forget a story of one father who killed his young daughters — especially because his wife was adamant during the legal process that this was completely opposite and uncharacteristic to his true nature.

This is, of course, a small subset of people who receive treatment. We don’t know why this happens. And the vast majority of people taking antidepressants and other psychiatric medication will not harm themselves or others.

But these stories seemed plausible to me because I had interviewed a close friend who told me that, after starting Prozac while struggling emotionally, he noticed his paranoia shoot up considerably. When he went back to the doctor to share concern with this shift, my friend described how the doctor recommended a higher dose. As his medication increased, my friend told me his paranoia increased to the point that he wrote out a “hit list” of people he wanted to knock out in a blaze of glory at work.

As alarming as this was for me to hear, thankfully it was alarming to him as well. He noticed what was happening and began tapering off. As soon as he did this, the paranoia went away — and so did the thoughts of harming other people.

What medications have been connected to acts of violence?

These are not secrets to our regulatory agencies or researchers either. Five different antidepressants were in the top 10 list of medications associated with violence, as the Massachusetts Nurses Association reported in 2011.

The authors of the original study concluded that their analysis provides “new evidence that acts of violence towards others are a genuine and serious adverse drug event that is associated with a relatively small group of drugs.” That includes one medication to help people stop smoking (Varenicline) and antidepressant SSRIs (selective serotonin reuptake inhibitors) which were “the most strongly and consistently implicated drugs.”

Swedish researchers later found in 2020 an “increased risk of violent crime during SSRI treatment in a small group of individuals” — a risk they found persisted during treatment and in a number of months afterwards.

British scientist David Healy is a prominent researcher on adverse drug effects like these. On his drug-safety website summarizing the research, it states, “Prescription drugs can cause violent or aggressive thoughts, acts, and behaviors, or can trigger behaviors like alcohol misuse or other substance abuse that ends up in violence, or can cause a disinhibition that leads to violence” — then says:

“It is important to find out if there is a connection between these thoughts and your prescription so that adjustments can be made.”

Dr. Dee Mangin, Data Based Medicine’s Chief Medical Officer and a professor in the Department of Family Medicine at McMaster University in Canada, is quoted as saying: “Violence has not traditionally been seen as a medical problem, but the range of drugs now linked to violence has grown, including drugs used in smoking cessation, dermatology, asthma, weight loss, insomnia, and behavior.”

Appealing for more study

It’s data and stories like these that have led parents to gather with professionals who have noticed the same concerning pattern. About 8 years ago, several of these supportive professionals wrote a public letter about “what appears to be strong evidence of a significant correlation, and in some instances, an actual causal relationship, between the use of prescribed psychoactive drugs and the commission of violent acts against oneself or others.”

To back up their concern, the letter-writers referenced individuals “who have a family member incarcerated for committing a violent act while under the influence of a prescribed psychotropic drug and persons who have survived their own suicide attempt” — along with “parents who took the lives of their own children while on psychiatric drugs and others who were plagued by thoughts of doing the same.”

But how will anyone pay attention to this, they wondered — given the deep trust vested in these medical professionals involved in prescriptions. They also noted that “little or no attention has been offered by major mainstream media to a possible connection between an ever-increasing use of prescribed psychoactive drugs and instances of mass violence and/or increasing suicide rates.”

Their big hope as an initiative was to encourage Benedict Carrey, a New York Times reporter, to write an article or series shining a light on these experiences and the perspectives of those involved — something that could amplify their “concern about the probability that there is a close relationship between ingesting prescribed psychoactive drugs and violence against oneself and others.”

This team of family members and scholars were also “advocating the need for a government-financed investigation of the reality, nature, and consequences of such a relationship undertaken by persons of integrity who are independent of the pharmaceutical/psychiatric complex.”

Little awareness, little action

So, did anything ever come of these efforts?

Carrey had reported in 2008 about a shooter at Northern Illinois University who was taking antidepressants, stating “Over the years, the antidepressant Prozac and its cousins, including Paxil and Zoloft, have been linked to suicide and violence in hundreds of patients.”

But I’ve never seen sustained reporting on the issue across other major news outlets. Nor was there a corresponding public cry for action or research or steps forward — as confirmed by two people I contacted who were involved.

I personally find the possibility of drug-induced violence a compassionate one for families who are left behind to pick up pieces — something to help them make sense of what can feel wholly senseless.

Lindsay’s fault — or something messing with Lindsay?

Returning to Lindsay, her defense attorney Kevin Reddington has argued that the prosecution’s portrayal of her as a calculated, cold-blooded killer ignores the profound mental deterioration that preceded the killings.

I agree. No one disputes how evil and cruel the killing of children is. But many of the social media influencers and cable news hosts screaming about how “evil” Lindsay is seem to also be laying aside the extensive evidence of her mental deterioration.2

Combined with abundant evidence that she was a good mother, as vouched by her own husband, it seems likely future juries would similarly be ready to mostly acquit (which almost happened here).

My friend who served as a public defender for people on death row worked to tell the “whole story” of someone leading up to a crime. I believe a loving God similarly accounts for all the factors, in a way that allows both justice and mercy.

I foresee a day in the eternal future when Lindsay embraces all of her children tenderly and say “I’m sorry! You know I really always did love you!”3

That’s when her full healing will come. In the meanwhile, I’m glad Lindsay has received so much support.4 She’s going to need it, as she will undoubtedly suffer terribly over what she did for the rest of her life. .

Shouldn’t it give us some compassion to understand the full severity of what someone was suffering at the time of a horrific act?

When young parishioner took his life in approximately 1527, Martin Luther insisted on digging the man’s grave within the church yard (when tradition stipulated he shouldn’t be buried there).

“Such persons do not die by free choice or by law,” he said, “they do not wish to kill themselves but are overcome by the power of the devil.”

“They are like a man who is murdered in the woods by a robber,” Luther analogized." “‘tis the devil who has put the cord round their necks, or the knife to their throats.”

One more story

Tatiana Morales writes about her own experience with a similar rollercoaster of symptoms during a period when she was prescribed around fifteen medications over a three-month period by five different doctors, including Klonopin, Ambien, Remeron, Trazodone, Buspar, Prozac, Lithium, Librium, Seroquel, Propranolol, and medical marijuana—many of which Lindsay Clancy was also prescribed.

And similar to Lindsay, Morales writes, “despite the medications, I didn’t get better—instead, I only got worse.”

Morales described insomnia as “the worst mental and physical torture I’d ever known” — explaining: “What people don’t understand about insomnia is that it isn’t just the occasional struggle to fall asleep at night. When you’ve struggled with severe insomnia, like Lindsay and I did—I’m talking one to four hours of sleep every night for days, weeks, even months on end—the way you interpret reality shifts.”

“The less sleep I got, the more distorted reality became,” she writes. “I felt so dizzy that the words I read on my computer seemed to float off the screen. The world around me felt dull and gray. I was irritable, pessimistic. I suffered from panic attacks daily. The bright lights from the TV were enough to throw me into a rage. I was angry, even violent—mostly towards myself, other times towards benign household objects.”

Yet concerns she was having got brushed off by one doctor as “psychosomatic.” The author asked, “Why are some psychiatrists so reluctant to believe that medications can, sometimes, cause serious damage?”

Morales acknowledges those who insist Lindsay’s problem wasn’t overmedication, but instead switching medications and not “giving them enough time to work.”

In her case, she said, “I came to the realization that no external medication was going to fix what was ultimately an internal problem. I had been on-and-off psychiatric medications since I was sixteen years old, but nothing had really changed. I had tried every big-name antidepressant, and yet, I was still depressed. I was still anxious. I had tried every sleep med, but I still wasn’t sleeping. What if it wasn’t psychiatric drugs that would fix me?”

From there, Morales embarked on what she called a “spiritual journey” — including learning to meditate. “It wasn’t easy—in the first few weeks, whenever I sat down to meditate, it was as if my brain was writhing around on the floor in pain—but after a while, with a lot of hard work, I managed to reset my nervous system.”

“But while I got better, Lindsay Clancy never did,” Morales notes. “Instead, on January 24^th, 2023, she did the unthinkable.”

“While it’s easy for me to say I wouldn’t ever do what Lindsay did, the truth is, when I was most ill, I became someone very different, someone who was capable of flying into uncontrollable rage. And while I don’t know if Lindsay’s mistreated mental illness exonerates her from her actions, at the very least, it should be taken into heavy consideration.”

Notes:

My boys squirm around on the couch. Sometimes they stand on their heads in the middle of family scripture study — or randomly wander off from dinner without any explanation.

That’s not because something is wrong with them. It’s because they are energetic boys in a world that’s still brimming over with fresh possibility. Rambunctiousness is one reason boys are two to three times more likely to be diagnosed with “ADHD” — first introduced in 1980 as simply “ADD” (Attention Deficit Disorder).

In an attempt to calm down children, amphetamines had been used experimentally since the 1930s, when one psychiatrist reported “remarkably improved school performance” in half the children he medicated.

By 1988, with the growing use of the stimulant methylphenidate (Ritalin), researchers in a L.A. Times story, “Use of Drug to Calm Children Rises Sharply, Study Reports,” described a noticeable shift taking place: “Medication treatment for hyperactive children in the United States has emerged from its minor treatment role in the 1960s to become the dominant child mental health intervention in the late 1980s.”

Reasons more parents have been looking for another way

Some parents of attention-struggling boys and girls have resisted — for at least 3 reasons:

1. Short-term side effects. Officially listed side effects for the most commonly used ADHD medications vary:

• For methylphenidate (Ritalin and Concerta) and amphetamine products (Adderall and Vyvanse), short-term effects can include dry mouth, decreased appetite, nausea, stomach/abdominal discomfort, occasional vomiting, constipation or diarrhea, increased sweating, tremor/shakiness, palpitations or feeling your heart beat, dizziness, headaches, insomnia or other sleep disturbance, irritability, anxiety, or other mood changes. Nosebleeds (epistaxis) have also been reported. These medications can also increase heart rate and blood pressure.

• The “nonstimulant” atomoxetine (Strattera) can also commonly lead to decreased appetite, nausea or other gastrointestinal symptoms, headache, dizziness, vomiting, constipation, urinary hesitation/retention, dry mouth, tiredness or sleepiness, and sometimes other sleep problems. More infrequently, some children can experience suicidal thoughts and liver injury.

• Guanfacine (Intuniv) and clonidine (Kapvay) also commonly cause sleepiness/fatigue, dizziness, headache, dry mouth, constipation, stomach symptoms, and lowered blood pressure or heart rate. Clonidine can also cause irritability, insomnia, or nightmares.

A 2017 review of ADHD medications for children and adolescents across 5,837 participants found statistically significant increases in blood pressure and heart rate with amphetamine (Adderall) and atomoxetine (Strattera) over the short-term — emphasizing that the longer-term picture remains unclear. And a 2025 systematic review likewise found ADHD medications can affect blood pressure, pulse, and other cardiovascular measures in the short-term — with the authors again noting that trials were generally too short to paint a settled picture of long-term cardiovascular safety.

These shorter-term concerns are the first reason many parents have begun considering other options. What we know about the longer-term picture has been another influence.

2. Long-term, counterintuitive worsening in symptoms. Relevant longer-term data has been slow in coming. In 1995, for instance, a decade after these medications became more widespread, NIMH researchers in arguably the first long-term study of ADHD medications acknowledged that “long-term efficacy of stimulant medication has not been demonstrated for any domain of child functioning.”

By 2007, a 3-year NIMH follow-up study found that core ADHD symptoms were reduced in children in the first year — as many parents have witnessed. But the surprise came later. At the end of three years, researchers noted that “medication use was a significant marker not of beneficial outcome, but of deterioration. That is, children using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.”

The same study later reported that counterintuitively, by the end of six years, medication use was “associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,” and with greater “overall functional impairment.”

3. Long-term outcomes in other areas. Other concerns exist about the long-term impact of ADHD medications. For instance, medical summaries acknowledge that ADHD medications taken for years can contribute to slowed growth, a well-known challenge on these medications, along with a potential increase in obesity.

A 2022 study found that Ritalin leads to an 18-fold increase in depression, which decreased when kids stopped taking the medication. More concerning, a 1996 study found that 11% of children treated with stimulants developed bipolar symptoms within four years. A 2001 bipolar depression study likewise found that two-thirds of the adolescent patients hospitalized for mania at the University of Cincinnati Medical Center had been on stimulants “prior to the onset of an affective episode.” Stimulants, the researchers concluded, may “precipitate depression and/or mania in children who would not have otherwise developed bipolar disorder.”

The same medical reports confirm more serious effects that can include psychotic symptoms or significant cardiovascular problems. One study found stimulants leading to hallucinations and other psychotic experiences in 62.5% of kids. (More recent evidence found that teens and young adults taking Adderall were more than twice as likely to develop psychosis or mania, with those on high doses were more than five times as likely).

This helps explain why some parents have been resistant to medicating their child for attention issues.

But wait, don’t the immediate benefits for focus outweigh these risks?

Many parents believe these ADHD medications have benefitted their children with focus, especially in the short term. And there are plenty of clinical studies conducted that demonstrate exactly this: some short-term benefits behaviorally.

But the picture is a little more mixed when we focus on more systematic studies done without any industry funding. Bob Whitaker, an award-winning journalist I’ve interviewed, reviewed in 2013 independent studies from Canada, Oregon and Australia, each of which found worse academic outcomes among children taking the medications.

For instance, a study by the Oregon Health and Science University involving investigators from 13 universities concluded in 2005: “There is no good-quality evidence on the use of drugs to affect outcomes related to global academic performance, consequences of risky behavior, social achievements, etc.”

Another 2010 study in Western Australia followed children on ADHD medications over 10 years, and found that medicated children were much more likely to be identified by teachers as performing at below age level. Their overall conclusion was that: “medication does not translate into long-term benefits to the child’s social and emotional outcomes, school-based performance, or symptom improvement.”

More recent evidence raises similar cautions. For instance, a 2014 study found that ADHD medications may increase school drop-out rates among children. And an impressive 2022 study by scientists at the University of California, San Diego (and Irvine), Florida State University, and Penn State College of Medicine compared medicated and non-medicated children with attention struggles in terms of academic performance, reporting: “Although it has been believed for decades that medication effects on academic seatwork productivity and classroom behavior would translate into improved learning of new academic material, we found no such translation.”

“Medication had no detectable impact on how much children learned from academic units of science, social studies, and vocabulary,” they said, before concluding: “Our failure to find an effect of stimulant medication on the learning of individual academic curriculum units raises questions about how stimulant medication would lead to improved academic achievement over time. This is important given that many parents and pediatricians believe that medication will improve academic achievement; parents are more likely to pursue medication (vs. other treatment options) when they identify academic achievement as a primary goal for treatment.”

Bottom line: Although families may still experience a positive improvement for these child on these medications, that may not be guaranteed.

So, what else can be done for these children?

One of the most formative moments in my graduate education was attending a conference in Chicago where the presenter, an older psychiatrist with decades of experience, had reviewed some of this same disheartening data about the longer-term trajectory of children taking these ADHD medications.

As he finished, a hand shot up in the back: “But hold on, if we’re not putting these kids with ADHD on these medications, what else can we do?”

I’ll never forget the stunned look on this seasoned physician’s face. The question stopped him in his tracks for a moment, but after a pause he said with energy in his voice: “All of life! Nature and relationships and art and play and reading and food and sunlight ….”

The implication was clear: Since when did we decide that stimulant medication was our only option for helping children navigate attention struggles?

The hundreds of factors that shape attention, young and old

Inspired by this presentation, I dove into an in-depth project in 2012 with Jeffrey Lacasse, a social work professor at Florida State University — mapping every risk factor for inattentiveness we could find in the research literature up till that year.

Sorting through thousands of studies, we identified several hundred that were relevant, distilling the findings into themes for an inventory that could be reviewed by parents. You can check that out and download it here:

Attentiveness Inventory Referenced

1.04MB ∙ PDF file

Download

Download

To be clear, not all of these factors listed are classically defined “risk factors.” We didn’t want our focus to be that narrow, so we also included associations and correlations noted in the literature.

Our purpose, then, was not to establish causal mechanisms claiming “this is why ADHD happens” — as much as to paint the broader picture of the dizzying variety of influences that shape the development of all of our levels of attentiveness over time.

Creating your own family plan to nurture attention

My hope was that with this knowledge, parents and families could create their own plan to nurture attention in the right direction over time. In addition to the risk factor literature itself, there are lots of encouraging studies to guide you. For instance:

• A 2008 UCLA study found that adults and adolescents with ADHD who took a meditation class experienced improvements to attention, “cognitive inhibition” (better ability to stay focused despite distractions) and other self-reported ADHD symptoms

• Another striking 2009 study by researchers at my alma mater, the University of Illinois, Urbana-Champaign, found that a 20-minute walk in a park improved attention in children with ADHD, with an effect size comparable to those reported in studies of methylphenidate (Ritalin).

Although there’s been some fascinating evidence that CBT therapy can be especially helpful to adults struggling with attention, something else is needed for children aged 4–12. The best research centers on something called “behavioral parent training,” which teaches parents practical strategies — such as consistent routines, positive reinforcement, and clear consequences — to help children struggling with attention function more successfully at home and school.

One 2023 summary of 27 studies of behavioral parent training found “sustained improvements” in various outcomes, including ADHD symptoms — with the authors concluding that “behavioural parent training has longer-term benefits for children’s ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.”

Stanford researchers pointed out last year that this kind of family/behavioral therapy should be the first thing to try with young children struggling with attention — noting with concern that 42% of 3- to 5-year-olds studied were given stimulant drugs before therapy could even be attempted. As they state, “Clinical practice guidelines recommend medications as second-line treatment in cases with substantial dysfunction or lack of response to behavioral treatment.” Yet, they add, “more than one-third of patients lacked sufficient time for an evidence-based behavioral treatment before starting medications.”

It’s important to remember that even children with ADHD can pay attention in some contexts. For instance, remove that distracted child from a math class and put them in front of a video game. What happens? Attentiveness is just fine. This suggests a socialization problem that can be gradually improved over time, rather than an inherent biological impairment that must be directly intervened with or ultimately just “lived with.”

Related to this, researchers have repeatedly found that the youngest children in a classroom are significantly more likely to receive an ADHD diagnosis and be prescribed stimulants. That highlights an important influence of comparative age — especially of being slightly behind other children developmentally (again, a socialization, experience and training question, rather than a matter of underlying pathology).

My take: If you see your child’s attention as a training ground, rather than a disease to manage, you’ll naturally work towards long-term improvement, instead of just short-term symptom control.

In this way, instead of measuring whether someone is deficient or not, it would be better to think of attention (for all of us) as gradually changing over time on a spectrum. Depending on so many different factors, we could then measure how our attention is shifting over time.

Anything new in the last 15 years of data?

Because it’s been almost 15 years since that review, I did a deep dive this weekend on anything else that’s come up in the years since. What I’m finding is mostly confirmatory of that earlier picture, with a few expansions and clarifications. In chronological order, with key take-aways bolded:

• A 2019 meta-analysis of dietary patterns found healthy dietary patterns associated with lower ADHD risk and unhealthy dietary patterns associated with higher ADHD risk — concluding: “a diet high in refined sugar and saturated fat can increase the risk, whereas a healthy diet, characterized by high consumption of fruits and vegetables, would protect against ADHD or hyperactivity.”

• A 2022 systematic review/meta-analysis of 70 studies and nearly 4 million participants found children exposed to adverse childhood experiences (abuse, neglect, family violence, household mental illness, household substance abuse, economic adversity, incarceration, bullying, other violence) had approximately 1.68 times the odds of ADHD compared with those without such traumatic exposure. More adversity was associated with greater vulnerability.

• A large 2022 CDC systematic meta-analysis across 69 studies found associations between ADHD diagnosis in children and maternal preeclampsia, pregnancy complications, neonatal illness, lower Apgar scores and lack of breastfeeding.

• A 2022 CDC systematic review of 59 longitudinal studies found associations between ADHD and negative/harsh parenting, maltreatment, divorce/single parenting, parental incarceration and child media exposure, while sensitivity/warmth was inversely associated with ADHD outcomes.

• A 2023 meta-analysis involving 81,234 children found that more than two hours/day of screen time was associated with higher odds of ADHD.

• A 2023 analysis of more than 1,800 studies found “evidence of a significant role for some pollutants, in particular heavy metals and phthalates, in the increased risk of developing ADHD symptoms.”

• A 2024 Swedish study looked at 2.48 million children, included more than 1.77 million full siblings — and found a small association between prenatal acetaminophen (Tylenol) and ADHD.

• A 2024 meta-analysis of 796,157 mother-child pairs found elevated ADHD symptoms among children whose mothers experienced antenatal or postnatal depression — although only a few of the studies examined maternal antidepressant use.

• A 2024 systematic review of 28 longitudinal studies found that children with more ADHD symptoms were more likely to develop problematic digital-media use, all of which predict later ADHD symptoms.

Looking for research collaborators

There are hundreds of other, smaller studies out there that I haven’t had time to review — including research in modern media that has evolved well beyond what we found in 2012. That includes a lot more data on problematic digital-media use, gaming, social media, highly stimulating/rapid-switching media, etc.

If there were any others interested in collaborating, it would be nice to review the last 15 years of data more closely to update this ADHD child/adolescent inventory — along with the adult version that we developed separately.

You don’t need to be a “researcher” — just need to have some time, even just a few hours on weekends would work. With the right team, we could probably pull this off by Christmas or springtime.

One more note — so much depends on measurement

In 2002, Eli Lilly released atomoxetine (Strattera), marketed as the first “non-stimulant” treatment for ADHD. This was exciting since many parents don’t like the idea of medicating their child with a stimulant drug in the same class as amphetamines. And this new medication was marketed as “superior” to other ADHD medication in their side-effect profile.

But my colleague Shannon Hughes, in collaboration with the brilliant David Cohen at UCLA, analyzed all 73 industry-funded trials submitted to the FDA as part of the approval process for this and other related medication. What they found was that the number of measures used in the clinical trials to track any positive effects was substantially more comprehensive than those to identify adverse events (often only a self-report from parents).

In other words, much like I’ve written about regarding antidepressant side effects, the official safety profile of this ADHD medication — now represented on packaging, safety insert and clinical reports — comes from studies that appear exceedingly careful to track any possible improvement from the med, and not so much with possible adverse effects.

I end where this began: With hundreds of documented influences on attention, you’ve got many adjustments to consider. Is it time to come up with a more sustainable plan for improving attentiveness in your own family?

Last night, I got to spend an hour with some teenagers getting ready to start school again — talking about how to navigate stress, sadness, fear and anger with more mindfulness.

“Do you ever kneel down to pray - and instead, just think, think, think?” I asked them.

For those of you who have prayer as a regular part of your life, maybe you can relate.

Just more thinking

I woke up on a recent morning with so much on my mind. As I knelt to pray, I found my mind churning over everything — first, what the schedule needed to be that morning, then something that happened the previous day, then….

“Wait. What am I doing?”

Although my body — from the outside — looked like I was communing with God. On the inside, I was really doing just that: thinking, thinking, thinking, thinking.

Especially as the world gets more tumultuous and our individual lives carry more stress, it’s pretty natural that our minds are inclined to process all this over and over and over.

Which is what could make prayer so refreshing … a moment to not just be drowning in our thoughts - a time to actually press beyond them and connect with something thrilling outside and beyond them: the living God.

But what if we really struggle to know how to actually do this in practice - with our thoughts all over the place, like a “monkey mind?”

Singing

Sometimes first thing in the morning, I’ll have a song come to my mind. It’s becoming one of my favorite ways to start the day to sing quietly words of praise, gratitude, and worship, while everyone else is sleeping.

Have you ever tried singing alone, just you before your God?

On a practical level, verbalizing words like this in song helps ground my mind and remind me it’s not just me and my thoughts. Spoken language seems to cue my brain that I really am reaching for someone else outside of myself — a living God who has “filled me with his love” and peace on so many occasions in my life.

Speaking

Speaking out loud the words of my prayer has a similar effect on my mind. While I know silent prayer can be just as powerful, maybe this is one hidden advantage of verbalizing a prayer — again signaling to our brains that we really are speaking with someone else. We really aren’t alone in that room.

“Prayer is an expression of the heart. And we can pray silently. We ought to pray silently,” said Elder Jeffrey R. Holland in 2025, a member of the Quorum of the Twelve Apostles in The Church of Jesus Christ of Latter-day Saints. But then he added, “there is something about saying the words — and for me, saying them out loud.”

Redirecting

It’s worth pointing out that part of this is a totally normal part of prayer. The idea that our brain is going to be perfectly focused on anything is just not the reality of the human condition. As Jon Kabat-Zinn has often taught, it’s “in the nature of the mind to wander” — comparing it to the waves of the ocean coming in and out.

He then speaks to the expectation some have in meditation that their thoughts will somehow just stop: “If you try to make your thoughts stop during meditation (or prayer, I would add), you’re just going to give yourself a big headache.”

As the teenagers and I discussed, when we notice our thoughts wander off during prayer, it’s not a problem. Because in that moment you can gently and firmly bring your attention back to where you want to direct it: redirecting it to the living God.

Over and over, when the mind wanders, we bring it back. That’s meditation. And it seems to be a built-in, natural part of prayer too — along with lots of other parts of life (reading, talking, listening, writing).

Waiting

In that same conversation, Elder Holland returned to something he had said previously over the years — that if we wait till the very last moment of the day to pray when we’re exhausted to say our prayers, it might be only a “half-hearted prayer out before we tumble into bed.”

“Consider moving that prayer up to earlier in the evening, when you are alert and attentive and can make it more powerful,” he said. “Prayer time ought to be quality time, not just time that happens to be left over when everything else is done — the last gasp of the day, so to speak.”

If we make sure our prayer is “good time, high-priority time,” the apostle added on another occasion, then we can “really have that communication.”

I’ve found the same thing applies in the morning. Rather than assuming prayer has to happen in the first groggy moments of the day, what if we did a little stretching first, splashed some water on our faces, or went outside for a minute … waiting a little bit until our brains come online.

Walking

Pastor Francis Chan gets outside first thing in the morning — with a discipline of not checking his phone first. That’s when he starts his conversation with God — in a time that he says is his favorite time of the day.

More like a deeply reassuring hug than a superficial ritual?

I want to be able to say the same thing — to relish my time with God that much. To feel his love, his joy and peace so much that I have to tear myself away to move on to other things.

Rather than the reverse: having to tear my heart and brain and thoughts away from so many other things to spend a moment with the living God.

It’s been three weeks since we started an experiment as a family: a screen-entertainment-free rest of the summer. Although I anticipated we’d learn some cool things along the way, I’ve honestly been shocked by the activities that have “come out of the woodwork”—things that had been more or less dormant, almost extinct, in recent years.

That first night, for instance, we started playing Rummikub for the first time in years. Then we played again the next night—and every night the following week—until we had a running, ferocious competition.

Later that week, the boys ended up playing darts and asked Dad if he would join their tournament. We had a blast together.

After the first week of the experiment, I told Monique that it had been one of the sweetest, most enjoyable weeks I can remember in our home.

It has been fascinating to see the kinds of activities that began to re-emerge after being nearly extinct—completely unplanned and without any specific input or direction from Mom or Dad. For instance:

• My three youngest sons decided to see who could build the biggest house of cards using some of their old basketball cards.

• My youngest son found a riddle book around the house, and the boys gathered around listening as he posed one riddle after another.

• Joseph started making creative new desserts for the family, including one recipe he spotted on a display at the grocery store.

• We still used screens for educational purposes, like getting updated on all the reasons Lebron chose the 76’ers (!!) and the boys reaching their 900-day Duolingo streak. One night, two of my sons spontaneously decided it would be fun to learn some popular songs on the piano. So, they looked up sheet music online and spent the evening running back and forth between the computer and the piano, practicing their favorites.

Running the numbers

During the summer, children’s average recreational screen time typically increases by about 45–55 minutes per weekday—working out to roughly 3.5–4.5 hours per day, compared with 2.5–3.5 hours during the school year. Teenagers typically spend even more daily time with screen-based entertainment.

Over a typical 10-week summer, this means:

• A child will spend approximately 240–260 hours on recreational screen time.

• An average teen will spend approximately 300–370 hours on recreational screen time.

That’s enough time to read roughly 30–70 chapter books, play 120–240 baseball or basketball games, practice a musical instrument or another skill long enough to become quite proficient, bike 2,500–3,700 miles, or enjoy 30–46 full eight-hour days hiking, camping, swimming, traveling, serving, or simply making memories with family and friends.

None of this means recreational screen time has no value. Much of it is enjoyable, and some of it is genuinely beneficial. But adding up those hours helps illustrate the scale of the opportunity. Across an entire year, an average child spends roughly 1,100 hours and an average teen about 1,500 hours using screens primarily for entertainment.

Withdrawal effects

I don’t want to paint a naïve picture here. This experiment hasn't always been easy. Resistance resurfaced a few times when they missed their usual media.

One of my sons (the last to agree to the experiment) said, “This is why I didn’t want this!” He added, “I did feel a little forced into this” (we wanted to do it all together, and wouldn’t start if he didn’t join).

On other days, I found myself feeling some regret too. There were moments when it would have been nice to just watch something so I could take my mind off the burdens of real life.

For instance, when Utah’s Pioneer Day came around, it got a little weird. We all had the same thought: Uh-oh... this is when we’d usually zone out even more. What are we going to do?

So we went to paint pottery instead. Then we came home and had a slumber party with sundaes.

We’ve got a short-list of movies we’re looking forward to seeing together when the experiment ends (which conveniently coincides with when they'll only cost $3 to rent online)—especially The Mandalorian & Grogu and Michael (Jackson). And we’re going to formally celebrate the end of our summer challenge on my son’s birthday at the end of August, when he wants to see the new Spiderman.

But the nice thing is there’s a specific thing we’ve heard about and want to watch, which feels different than the … “can we watch something, Mom” question that has consumed so many “free” afternoons and evenings before.

More fun, not less

Overall, though, one outcome is clear so far at the halfway point: this experiment seems to have generated more fun, not less. I’ll have to do a little “post-survey” at the end.

But for now, it’s been fascinating to see the shifts in our home: activities that have quietly disappeared over the years suddenly reappeared, as if they'd been waiting patiently for enough attention to return. Also:

• We’ve played basketball even more than usual and have read together as a family more than normal.

• My oldest son finished an online class, and I’ve watched my two oldest sons read more than I remember.

• Monique organized a trip to Willard Bay, and I’ve organized a neighborhood softball game.

• This past week, my three youngest boys started making homemade versions of Monopoly such as “NBA Monopoly,” complete with their own money, cards, and game boards. Across multiple days, it’s been so fun to see them spending many hours pouring focused time into customized game boards that we’re excited to play soon.

“I love it,” Monique told me. She especially likes not being constantly pressured about “when do I get to have my media time?!”

It’s like we’ve watched an entire ecosystem of forgotten family life begin to re-emerge—games, creativity, conversations, competitions, music, reading, and spontaneous adventures that had slowly been crowded out without us even noticing.

What about your own home?

Theoretically, I know any or all of this could happen in our home—or yours—even while an unchecked flow of digital entertainment continues. But practically, I think we all know that’s not very likely. We simply don’t have enough time and attention to do both.

The good news is that a “revival” doesn’t seem to take all that long. We started to see a flowering in just a few days…and new layers keep being added.

Who knows what we’ll decide for the rest of the school year. We’re trying to make decisions together, through a “family council” like we’ve been encouraged to try in our faith.

There are still a few weeks left in the summer. Are there experiences like this waiting to be rediscovered in your own home?

Whether or not you have children at home, this is something you could try yourself—even if only for a few days or a week. It could also be an experiment at any time of year. Summer is just one option.

Do you even know what might happen in your life, your relationships, or your home if you temporarily removed recreational screen entertainment?

Might be worth a try.

Note: I asked my boys’ permission for the use of any photos that include their face—trying to keep most images more general. I try to be sensitive about their privacy. “I don’t care,” Joseph told me. “Maybe I’ll become famous.” (:

UPDATE: On the day I posted this article, the boys proposed having a “bakeoff” - with three of them making different desserts based on recipes they looked up.

Joseph has started making his own cookbook with recipes he’s tried and wants to remember.

For two days, we watched them sitting them around and reading different facts about animals, countries, the human body….

The last two days, Joseph has asked if we could “go on a walk” … I was dumbfounded, “what did you say?”

I can’t stop thinking about reading. Partly because every time I drive down the street, my neighbor Pam Budge is sitting on her porch reading another great book. And partly because I rarely find anyone else doing the same.

Meanwhile, we’re all fretting about a trembling democracy, fragmenting communities, disintegrating families, a crisis of attention in young people and accelerating cognitive decline in the rest of us.

Clearly, there’s no one solitary contributor to all this destabilization, but that doesn’t mean there aren’t some broad patterns to take very seriously.

The screen takeover continues

Ever since the 1960s, when 90% of American families owned a television, scholars like Harvard’s Robert Putnam (“Bowling Alone”) have been measuring signs of worsening community fragmentation.

Now, screens have conquered even more territory—colonizing every pocket, purse and hand. By 2015, roughly two-thirds of American adults owned a smartphone—with the last decade being an entirely new experiment in what it means when our lives are interrupted by a screen-check roughly once every 5 minutes (at least 100 times a day, or more)—including within 10 minutes of waking up for 85% of people.

During this time, lots of attention has gone to what our screen-mediated lives mean—with special attention given to the alarming impact of social media on young people, in particular.

The ‘end of reading’?

Lost in all this has been an enormous casualty: the slow and tragic death of reading.

I’m not trying to be dramatic here. I’m trying to be real. Check out the stats I review in my Deseret News commentary published this weekend—then, tell me I’m overreacting?

If you still think this is too much hand-wringing about “understandable evolutions sparked by the next phase of technology development” then please read this longer masterpiece by Rose Horowitch in the Atlantic: “The End of Reading is Here” (there’s also an audio version you can listen to).

My own focus has been considering the spiritual consequences of collapsing reading rates. “If the written word can spark encounters with sacred realities, what happens when we lose the ability and interest to read anything deeply?”

Here’s a key paragraph from near the end:

If short-form videos have trained the brain to expect a dopamine hit every few seconds, should it surprise anyone if the quiet of prayer and the black-and-white pages of scripture come to feel largely inaccessible and “boring,” despite their promise of opening a communion with the living God?

‘I’m done ceding my brain’

None of this means you and I should be resigned to these relentless, insurgent cultural forces—“well, kids today just don’t like to read … and I can’t even finish a book myself. Oh well.”

No way! In a 2026 New York Times commentary, Georgetown scientist Cal Newport wrote, “I’m done ceding my brain—the core of all that makes me who I am—to the financial interests of a small number of technology billionaires or the shortsighted conveniences of hyperactive communication styles.”

“It’s time to move past fretting about our slide into the cognitive shallows,” he continued, “and decide to actually do something about it.”

In my follow-up analysis, “Learning to read (again) as a way to reclaim and deepen faith,” I tried to summarize some of the best known ways to regain our capacity to read deeply.

Protecting precious time

I wanted to share more here about what our family is trying to do about all this. We’ve already had a reading hour at the end of the night for years now—one of our favorite hours of the day, when Monique and I take turns reading to each of the boys. More recently, Monique and I are finding some success at reading more together at night as well.

Ever since hearing Arthur Brooks’ caution about how phone-first mornings are “neurocognitively programming your brain for the whole day,” I’ve also been doubling down on my encouragement for our boys to make the first hour of the day also “screen-free.”

In a faith context, it was C.S. Lewis who taught years ago that the “real problem of the Christian life comes where people do not usually look for it. It comes the very moment you wake up each morning.” That’s when, he said, “All your wishes and hopes for the day rush at you like wild animals. And the first job each morning consists simply in shoving them all back; in listening to that other voice, taking that other point of view, letting that other larger, stronger, quieter life come flowing in.”

A summer retreat at home?

Although we’ve made some progress, we still find that, as a family, screen entertainment finds a way to intrude into the fabric of most days and moments—“can we watch something??”.... “please, just 5 more minutes of video games!” The one exception is Sunday, when we’ve done pretty well at taking a day-long break from our usual screen-related distractions.

But earlier this summer I was intrigued by writing from Clarissa Mull and Michaeleen Doucleff about the effect a summer distraction break—a “screen-free summer”—had on their families. With my son taking a summer class and my own need for screens in my writing, however, “screen-free” didn’t seem realistic for us.

It’s never been about screens or no screens, as far as the research is concerned. It’s about how we use screens. Even social media is connected with better outcomes when people use it for connection, rather than for passive scrolling.

The World Cup and NBA Finals were over, with the highlights we enjoyed in both. So last night, Monique and I proposed to our boys that we try a distraction-free last 6-weeks of the summer by taking a mental break from our usual screen entertainment.

For any online classes, Duolingo and other learning—as well as work, service and connection with others—screens were still great to use. And “this obviously wouldn’t be a forever thing either,” we clarified: “just an experiment, to try and see what happens.”

The first response was visceral—“No!!” blurted out my 11-year-old—who immediately began making what he called “protest” signs.

His little brother soon followed suit.

Then their wise mother weighed in, “What if God is trying to speak to us, but we can’t hear him?”

We watched part of a talk by President Russell Nelson from 2018 where this Latter-day Saint leader shared: “Oh, there is so much more that your Father in Heaven wants you to know.”

I’ve been sensing lately that there’s more God has in store for us too as a family, but we’re just not ready for it. “The world is too much with us,” my Mom used to read to us growing up.

“Getting and spending, we lay waste our powers”—so much so that the beauty around us “moves us not.”

“We have given our hearts away,” William Wordsworth underscores.

I’m tired of giving my heart away to things that don’t matter! I’m hungry for something more. To feel more peace, power, joy and love….all the good stuff.

As we told our boys, what if this sacrifice of Youtube shorts, Netflix, NBA highlights, social media scrolling, Ryan Trahan and video games, could give us enough space to actually hear God’s voice in our lives?

“So, what would be the reward?” they asked about this proposed summer plan. We’ll definitely have some kind of a fun celebration at the end, but the real reward is something way better than more ice cream or an amusement park. More of God’s peace, joy and love—which Nephi declared is “the most desirable above all things.”

Finally, one of our boys said “okay.” Then another said, “all right.” Then the youngest, who had created the second protest sign, crumpled it up dramatically, and declared, “I’ll do it!”

With his three brothers now on board, our last son said he’d pray about it. (:

I’m excited to see what happens. As my stake president, Shaun Peck, often says, “let’s see what God has in store.”

I just returned from a family trip to Nauvoo, Illinois, where 180 years ago, the man I’m named after was physically paralyzed and driven into poverty with his young family after they were forced to move a 3rd time due to the hatred of their neighbors. Before they could gather all their crops and farming supplies, their farm was burned by people who eventually drove all Latter-day Saints from the state of Illinois and country as a whole.

Buried in 1846 in a mass grave on the Iowa trail, Jacob Hess was one of millions of believers who accepted aching sacrifices for the truth they followed – demonstrating a courage that is rare today, even among the many who like to use those words “truth” and “courage.”

Monique has read to our boys Mark Twain’s history of Joan of Arc and I’ve been amazed in the strength of people I read about in Foxe’s Book of Martyrs. As Hugh Latimer nd Nicholas Ridley were about to be burned at the stake in 1555, Latimer was overheard saying: “Be of good comfort, Master Ridley, and play the man.”

He then makes the well-known prediction that they would, by God’s grace, light a candle in England that would not be put out.

We reverence these people’s lives for a reason – Hus, Tyndale, Bradford, Rogers – passing down their lives and teachings as a treasure for the generations. Twain highlights the “miracle” of Joan’s life during a time he calls “the brutalest, the wickedest, the rottenest in history since the darkest ages”:

She was truthful when lying was the common speech of men; she was honest when honesty was become a lost virtue; she was a keeper of promises when the keeping of a promise was expected of no one; she gave her great mind to great thoughts and great purposes when other great minds wasted themselves upon pretty fancies or upon poor ambitions … she was unfailingly true to an age that was false to the core….she was of a dauntless courage when hope and courage had perished in the hearts of her nation.

At the same time we’ve been discussing these incredible stories as a family, I’ve been noticing how often words like “integrity” and “courage” are being used by people disparaging and condemning faith online, who say things like:

• “People are stepping away because of their integrity and honesty to the real truth they’ve found about that horrible religion.”

• “Rejecting family and tradition may be the epitome of courage.”

• “Leaving the church is about following conscience enough to move forward with integrity.”

Based on language alone, one could be forgiven for believing you were reading the words of someone making soul-level sacrifices for higher truths while embodying stirring integrity. But you don’t even have to look that close to realize you’re dealing with something very different.

This comes across in at least three ways.

1. Embracing truth, or undermining it?

Although some of these prominent influencers are also fond of representing themselves as enlightened – having “both eyes opened” – in many cases, they’re actively attacking and undermining truths generations of Christian witnesses suffered and died to defend.

This denial and discrediting isn’t so easy to see when they are so often publicly using a language of seeking truth. But for many prominent influencers, it’s clear they are actively undermining faith in a pattern that is predatory more than anything else.

This is functionally the opposite of the martyr tradition – which centered around bringing sacred truth to light, strengthening others’ faith and sharing it with the world.

2. Standing apart from popular norms, or going along with them?

The martyrs were brutalized in their day precisely because they stood against the moral and intellectual currents of their own age. By comparison, modern narratives promoted about faith transition often encourage not greater estrangement from prevailing culture but greater harmony with it.

Even though plenty about integrity and courage may still be woven into this rhetoric, the practical endpoint often end up being embracing philosophies and lifestyles that are widely popular with the world, rather than standing up for truth “not of this world” that many cultural elites predictably hate.

In a day and age when wearing a costume from another culture can raise questions about misappropriation all this seems to me a legitimately wrongful appropriation of the historic and sacred tradition of courageous truth-tellers as a cloak or masquerade around what’s actually going on.

3. Accruing enormous personal costs, or attractive temporal benefits?

The personal cost of early believers was enormous – even to giving up their own lives. It’s true that for many who step away from faith, there can be significant, aching personal costs, as my friend Betsy VanDenBerghe wrote about for Deseret News.

But when it comes to the loudest voices who actively disparage faith while representing themselves as advancing truth, something very different is taking place.

Indeed, some of the most influential voices have built organizations with substantial audiences, conferences, books, podcasts, and donor support – along with plenty of revenue. As one commentator noted, “the more faith they shake, the more money they make.”

What courage is – and isn’t

Is courage shown in a willingness to be authentic or in remaining true when that becomes costly?

While modern authenticity culture often points inward, true sacrifice and courage point away from self. As G. K. Chesterton taught, “a martyr is a man who cares so much for something outside himself that he forgets his own personal safety.”

Earliest Christians were admired because they showed a willingness to hold firm to truth at a tremendous personal cost – reflected in the word martyr, which means “witness” in the Greek (μάρτυς, martys).

These martyrs weren’t courageous because they changed their minds. They were courageous because they remained faithful despite extraordinary cost.

Integrity quietly lived

Walking the streets of Nauvoo, I was lifted by the quiet faith behind the lives of those who gave up so much – among people who didn’t often speak out about integrity. Like many other pioneers, Jacob and Elizabeth didn’t leave any journals.

These people instead demonstrated courage – burying children, walking away from homes, crossing frozen rivers.

Even giving up their lives.

There are many who step away from faith, of course, who do feel in their own minds and hearts that they are doing so out of a sense of personal integrity, along with a willingness to make hard sacrifices. I’m not denying the reality of those feelings, or the goodness of the people experiencing them.

There is clearly an inner forcefulness people must have to be willing to sacrifice all they once experienced within a faith tradition like our own – and reject all they once knew and believed within it. Some would go so far as to call that a kind of bravery and courage – or integrity.

But are we too quick to use those words? The overarching narrative making sense of faith disaffection comes from somewhere. Rather than simply descriptive of faith dissolution, personal narratives are adopted and taken from available rhetoric.

And the most active proponents of questioning faith are keen to recast disaffection as an inevitably noble act that embodies courage, sacrifice and integrity.

If it’s true courage you want to hear about – or sacrifice and integrity – go back to the stories of people who embody it most.

After refusing to recant, Jan Hus was burned at the stake in 15th century Germany. But he first wrote urging believers, “Seek the truth, hear the truth, learn the truth, love the truth, speak the truth, hold the truth, defend the truth until death.”

Words like integrity, sacrifice, and courage belong first to these stories – people who endured ridicule, loss, imprisonment, exile, and even death rather than betray what they knew to be true.

History has already made that clear. And we should be careful before borrowing that language for something altogether different.

When we think of the American Revolution, we often picture famous men—Washington crossing the Delaware, Jefferson drafting the Declaration of Independence, soldiers enduring the bitter winter at Valley Forge.

But for my Hess family’s ancestors John and Catherine, this historic Revolution wasn’t a chapter in a history book.

It was their childhood.

John entered the world on January 31, 1767, in the rolling farmland of Derry Township—then part of Lancaster County, Pennsylvania—into a family that had already crossed one great divide.1 Barely fourteen years earlier, as I wrote about last year, his father Frederick had likely endured a dangerous Atlantic crossing in search of land, religious freedom, and a fresh beginning.

His son John would never know the old country. To him, Pennsylvania was simply home. But to his parents, America was still a remarkable gift they had sacrificed dearly to obtain.

Two years later, on October 25, 1769, Catherine was born farther southwest in Washington Township, on Pennsylvania’s increasingly rugged frontier—in a place that was officially a part of British Colonial America.

Neither child could have known they would soon witness the final years of Britain’s American colonies. Within a decade, everything they knew would change.

John’s Pennsylvania

John’s family lived among prosperous farms settled largely by Scotch-Irish Presbyterians and German immigrants. Wheat fields stretched across gentle hills, cattle grazed in rich pastures, and churches served as the center of community life.

Although peaceful by the late 1760s, the memories of frontier violence were still fresh. Only a few years earlier, during Pontiac’s War, terrified refugees from western Pennsylvania had streamed eastward after devastating raids. John’s parents had watched neighbors organize local militia companies and keep muskets close at hand.

Security was never taken for granted. As John learned to walk and speak, another conflict quietly gathered strength—not on the frontier, but between Britain and her colonies—triggered by the Stamp Act (1765) and then the Townshend Acts (1767) the year John was born—which unleashed growing resentment toward King George III.

The famous October 31, 1765, front page of “The Pennsylvania Journal and Weekly Advertiser,” displaying skull-and-crossbones to protest the British Stamp Act, which took effect the very next day.

Adults debated politics in taverns after church meetings while newspapers carried troubling reports from Boston. At home, however, John’s parents belonged to a small German Baptist Brethren congregation that emphasized simple living, peace, and wholehearted devotion to Christ. Those convictions likely shaped how they experienced the coming Revolution—surely making it more emotionally complicated than others living through these events.

Catherine’s frontier

Catherine’s childhood began in a different landscape. Washington Township, in what later became Franklin County, lay much closer to the edge of settlement. The forests stretched westward toward the Appalachian Mountains, and beyond them lay territory still fiercely contested during the years following the French and Indian War.

Life demanded resilience. Families cleared forests by hand, built log homes, raised livestock, and depended heavily upon neighbors.

Even after the French threat had ended, uncertainty remained. Stories of raids and frontier fighting were common conversation, and nearly every household knew how quickly peace could disappear.

The war arrives

When the first shots of the Revolution were fired at Lexington and Concord in April 1775, John was eight years old—and Catherine was five.

Neither carried a musket. Yet the war entered their lives immediately, since men from both communities joined local militia companies. Neighbors disappeared for weeks or months at a time.

Church services increasingly included prayers for the Continental Army. Every harvest suddenly mattered, since Pennsylvania's farms became one of the Continental Army's greatest strengths. Flour, cattle, horses, wagons, blankets, and clothing all flowed eastward to feed and equip the struggling army.

Children often helped fill the gap left by absent fathers and older brothers. John’s own parents likely faced difficult choices in this regard. Like many Brethren and Mennonite farmers, Frederick appears to have believed deeply in caring for soldiers with food and shelter while refusing to take up arms himself.

Frederick’s other son and John’s brother, Henry, was listed as a “non-associator,” showing evidence the family was not willing to fight.

Broadside soliciting recruits for George Washington’s Continental Army, 1775 – Connecticut Historical Society

For a boy of eight or nine, watching his father quietly follow his conscience in such divided times could have become one of his earliest lessons in courage.

A world turned upside down

The year 1777 brought the Revolution startlingly close, when British troops captured Philadelphia. This forced the Continental Congress to flee first to nearby Lancaster and then to York—bringing the nation’s government within a day’s ride of young John’s home.

Overnight, the quiet farm country of central Pennsylvania became a vital artery of the Revolution—part of its logistical lifeline. Supply wagons rolled through the region carrying grain and livestock toward Washington’s army.

Rumors traveled even faster. Would the British march farther inland? Would Lancaster fall? Would their farms become battlefields?

No one knew. When Washington’s exhausted army settled into winter quarters at Valley Forge, farms across central Pennsylvania became essential to its survival. Flour, grain, livestock, and hay flowed eastward from counties like Lancaster, where John was growing up.

Although he was nearly a hundred miles away, the hardships of Valley Forge reached into his community through constant demands for food, wagons, horses, and labor.

Growing up too soon

Most children measure time by birthdays. John and Catherine likely measured theirs by the progress of a war:

• John turned nine the year the Declaration of Independence was signed.

• He was ten when Philadelphia fell.

• Eleven during the terrible winter at Valley Forge.

• Fourteen when news arrived of the victory at Yorktown.

• Sixteen when peace was finally declared in 1783.

“Freeman’s Journal,” October 24, 1781. Patricia D. Klingenstein Library, New-York Historical Society, Newspaper Collection.

Catherine’s memories would have followed a similar rhythm. Her earliest recollections were not of an established nation, but of a people becoming one.

Their generation never knew childhood without uncertainty.

Building a new nation

When peace finally arrived, John was a young man of sixteen. And Catherine was thirteen.

The country surrounding them had changed forever. They had been born British subjects—and they entered adulthood as citizens of the United States.

The forests remained. The farms still needed tending. Yet the government above them, the flag they saluted, and the future they would build together belonged to an entirely new nation.

In time, John made his home in Washington Township, where Catherine had been born. Six years after the war had ended, they would wed in 1789 at 22 and 20 years old—raising their family among the same valleys and ridges that had shaped Catherine’s childhood, eventually settling on what became known as the Middour Farm near Quincy.

They had experienced both hope and sorrow after the war’s ending. As the new nation found its footing, John’s older brother Jacob had died in 1786 at only twenty years old. We do not know the cause. Whether illness, an accident, or some lingering consequence of the difficult years surrounding the Revolution, the loss surely impacted the family. Years later, John would name one of his own sons Jacob.

When John died at the Middour Farm on April 29, 1819 at age 52, he left behind more than land or a family name. He left a legacy he could scarcely have imagined as the world of his childhood slowly disappeared around him.

The British colonies of his birth were gone. His parents and grandparents who came from Europe had long since passed away. His beloved brother Jacob had been gone for decades.

Yet the nation that had grown up alongside him endured. John had been born the son of immigrants in Britain’s American colonies.2 He died an American citizen, leaving children and grandchildren who who would know the Revolution not as an epic memory, but as their own family history.

Catherine after John

In 1828, according to research by Naomi P. Hebbert in 1973, nearly every surviving child signed deeds settling John’s estate—a final family gathering preserved not in letters or diaries, but in courthouse records. One by one, you can imagine sons and daughters signing deeds acknowledging their portions and relinquishing any further claim to the family farm, allowing it to remain intact for the next generation.

John’s death did not appear to end Catherine’s stewardship of the family farm. Court records show her actively managing her dower rights for several years afterward before transferring them to their son John. Even in widowhood, she remained at the center of the family’s affairs.

The Hess children largely remained rooted in the valleys where they had grown up. Several daughters had married nearby: the Middours, the Whitmers, the Snowbergers, the Shoaffes, the Goyers. They weren’t scattered across America. They were still neighbors—suggesting a tightly knit Pennsylvania farming community (although some did leave, like Jacob mentioned in the final section below).

Catherine, for her part, lived until 1846, dying at age 76—another 27 years. After John’s death, she appears to have spent her later years in the household of her daughter Barbara and son-in-law Jacob Middour—the very farm that remains in Middour family hands today.

During those years, Catherine no doubt raised younger children, watched grandchildren arrive, and saw America transformed. By the time she died, she had seen a generation of Hess children raise families of their own.

Catherine appears never to have remarried. Whether by circumstance or choice, she remained John Hess’s widow for another twenty-seven years.

During that time, she watched grandchildren fill the farmyard where her own children had once played. Roads improved, canals linked distant states, railroads began crossing Pennsylvania, and the young republic she had watched being born grew into a confident nation.

The America Catherine left in 1846 would have been almost unrecognizable to the little girl born a British subject in 1769.

Catherine and John’s descendants become Latter-day Saints

During this same remarkable period, Joseph Smith had helped restore the Church of Jesus Christ—and was murdered 2 years before Catherine died.

John and Catherine’s son, Jacob, became one of the early converts to The Church of Jesus Christ of Latter-day Saints in 1834, along with his wife and young children after moving to Ohio.

Catherine would have been about 64 years old. We don’t know what she thought. Did she rejoice? Did she worry? Did she understand?

History is silent. But she almost certainly knew.

Less than a quarter century after Catherine’s death and nearly a century after Frederick Hess crossed the Atlantic seeking the freedom to worship according to his conscience, John and Catherine’s grandson, John W. Hess, returned as a missionary freely preaching the restored gospel to the same Pennsylvania valleys where John and Catherine had built their home.

Carrying an expanded gospel message from the one his grandparents had cherished, John walked roads they had traveled, visited communities they would have recognized, and preached within sight of the farms where the Hess family had first taken root nearly a century earlier.3

It was a remarkable homecoming. The grandson returned not simply to his ancestors’ land, but to the place where their story in America had begun.

There are desperate men and women everywhere, of all ages, who genuinely want something to stop in their lives. Alcohol. Drugs. Overeating. Overspending. And porn.

So, they understandably focus on it. And fight it. And try to control it….exasperated and sad when it keeps coming back – like a never-ending nightmare.

Primed for porn

As long as our gaze is fixed on the isolated problem – how to resist it, how to overcome it – don’t be surprised if that nightmare continues for another couple of months or years, even many years.

But what if our gaze expanded? For instance, let’s face it: If your life is driven by distraction, saturated by screens, self-absorbed in fantasy, organized around pleasure, running away from discomfort, spiritually unanchored, isolated, cynical, resentful, chaotic, exhausted, physically depleted, emotionally wounded, quietly sad, and lacking a noble purpose, why wouldn’t you be more prone to chase whatever stimulating escape you can find?

Of course, there are plenty of people who are lonely, depressed, exhausted, spiritually adrift, and never develop compulsive patterns. But generally speaking, a life like that sets people up to struggle.

‘This is about our whole self’: Reordered to something higher

The opposite is also true. Imagine a life oriented in the reverse direction of all of the above … what then?

A “free-hearted” person is not merely someone who says no to porn – but instead, someone whose whole life is being reordered toward something better and something higher.

Matt Dobschuetz’s book, “Porn Free: Becoming the Type of (Person) That Does Not Look at Porn,” prompts a fundamentally different, whole-life approach to healing from pornography struggles – or anything else compulsive for that matter.1

My friend, therapist Jill Manning knows the difference between deep recovery and more superficial, behaviorally-managed abstinence. What the latter person doesn’t understand, she told me in a recent interview, is that lasting healing ends up touching every part of life – how you think about relationships, time, love, the body and even spiritual matters.

“We’re not just stopping something or removing something,” she said. “We are replacing it with different relational behaviors, different patterns of lifestyle, different attitudes. This is about transformation and changing hearts — not just addressing an isolated piece.”

“This is about our whole self…..We’re not just here to renovate or fix up a part of you.”

If this has been a struggle for you, ask yourself: am I becoming the kind of person for whom porn makes increasing sense? Am I becoming the kind of person for whom porn becomes less and less congruent with who I am?

Searching your own heart

To help people answer this question for themselves, I’ve been working on a typology built around precursor patterns making it more (or less) likely for someone to use pornography – drawing on two different lines of evidence:

• First, available risk and protective factor studies that reveal patterns of greater vulnerability (or protection) to compulsive pornography use, something Clay Olsen and I spent lots of time on when we were developing Fortify years ago.

• Second, patterns across narratives from men and women who have actually found lasting freedom.

To be clear, this is not some kind of a “good person/bad person” contrast. It’s instead simply a discernment tool to help people gain insight on the many levels of lifestyle patterns and life experiences that lay the groundwork for either a continued compulsive struggle OR the incredible sweetness of lasting freedom.

Also, fair warning: If you struggle with something like this, part of you is going to hate and fight this. Why? Because it’s so much easier to think and believe and assume that recovery is all about finding the secret sauce or silver bullet answer to “get you to stop that one harmful behavior!”

Wouldn’t that be nice to just quietly stop the habit, and not have to look at anything else going on in your life? Here are the 15 ways recapped:

15 ways of being priming someone for the incredible joy of lasting freedom

1. A person who relishes connection with people

2. A person who also treats energy, time and money as precious enough to use carefully

3. A person who allows their life to be ordered and who values steadiness and consistency

4. A person who cares for their body and physical health - sleep, food, activity

5. A person willing to practice disciplining appetites, impulses, urges and cravings

6. A person not afraid of reality, including when it’s really hard

7. A person continuing to learn and grow in lots of different ways

8. A person who keeps turning away from wrong and being accountable about actions

9. A person willing to share heart and challenges with trusted individuals

10. A person who prioritizes the needs and suffering of others in how they orient their lives

11. A person who possesses their soul in patience and kindness

12. A person not scared of silence and stillness – and who begins to appreciate them

13. A person who taps into the love, peace, joy and power of God

14. A person who delights in truth and goodness overall

15. A person who sees divinity in themselves and others

Let’s dive in.

15 ways of being priming someone for the incredible joy of lasting freedom

1. A person who relishes connection with people

Have you ever met someone whose presence is tangible and sweet – and who you can feel in your bones relishes you? It’s wonderful to be around those people – but even more wonderful to become one yourself.

Imagine everyone you know feeling that same thing – “wow, I loved that time with that guy….I can’t wait till I get to talk with her again.” For that kind of person, the unique dreams and hopes of someone else are precious to them – as are the goodness and unique qualities already present in that same imperfect person.

• How close are you to being this kind of a person already?

• If you feel distant, what’s one step you could take to reach for – and “practice” – this way of being? Sometimes just making a little more time – not booking it so tight – can help your body ease up to be able to be more fully present with someone.

• Pray for this gift – even with “all the energy of your heart” – to be able to share pure love, true love. Once you receive that heavenly capacity, everything else changes for the better.

2. A person who also treats energy, time and money as precious enough to use carefully

One of the biggest vulnerabilities we’ve found in studying both substance abuse and pornography addiction is how people use their time and money. But why would that matter? Maybe because wasting time – like wasting money – is indicative of something deeper going on.

A willingness to lay aside important, meaningful matters, for whatever passing distraction or pleasure catches our fancy. “I want to do that! I want to have that! Now!” Can you see how that’s the same kind of ‘spirit’ driving any addictive-compulsive pattern?

Interestingly enough, then, even if you are still struggling with bigger issues, beginning to approach time and money not with scarcity, but with a grateful attentiveness, can “prime” you for a life of freedom.

• Do you set a schedule and try to keep it? If not, what kind of calendaring system could help you get started this week?

• Do you know how much money is coming in – and where it’s going? Rather than feeling like you have to figure out every dollar and penny, try just calculating two things: total funds coming in each month + total fixed payments that must be made monthly. The difference between those two will be a perfect place to start being more attentive.

3. A person who allows their life to be ordered and who values steadiness and consistency

Closely related to seeing money and time as precious resources is a larger sense of order in how we live overall. In the absence of that order, we eat whatever we want, spend whatever we want, and do whatever we want. By contrast, an ordered life is oriented around larger questions: What should I be doing? Who do I have obligations to support? What does God want for me – even right now?

Compare that with a life of following whatever we want whenever we feel like it…. And if we don’t? Oh well. Can you see how much that sets us up for more serious compulsive patterns?

• How “chaotic” does your life feel – meaning, pushed and pulled here and there? Imagine how it would feel to have this start to change.

• How much do any of these words feel like they describe your life today: steadfast, diligent, grit, resilience, persistence? What would it take to become more of that kind of person?

• How much do you scaffold your daily life around custom-designed structure and boundaries?

4. A person who cares for their body and physical health - sleep, food, activity

I inadvertently left this off the original list, but I shouldn’t have! There’s plenty of evidence for residential, ripple-effects from taking care of our body on increasing our self-control, emotional strength and capacity to resist craving and temptations. In fact, the act of choosing to eat well, to sleep early, to get physical activity, is an exercise in the some of the same muscles of discipline needed to choose to turn away from online filth and instead turn towards the sweetness of true love.

But you and I don’t need to see all that evidence. Because we know from our own experience the wonderful impact of a good night’s sleep, a healthy email and a blessed minute or two or 20 of physical activity.

• How well are you taking care of your physical body right now? Low priority? Or something you’re really able and willing to do on a consistent basis?

• What adjustments could you make to start doing more of that? Getting to bed a little earlier? Eating a little less sugar or caffeine? Moving around a little more?

5. A person willing to practice disciplining appetites, impulses, urges and cravings

Notice the language: “willing to practice disciplining” – which is very different than “disciplined!!” As we’ve been discussing already, impulses come to all of us to eat and drink whatever feels good, to watch or look up anything that feels interesting, to sleep as long as we’d like, to say whatever we want. In some of our worst moments, we immediately follow strong, passing thoughts and feelings – blurting out whatever comes to mind, clicking on any video that looks interesting, checking our phones all the time, and eating whatever we darn well please.

Quite apart from pornography specifically, this way of living exercises and primes all the same dopamine-spiking brain pathways that sexual compulsivity will be glad to dominate. But what would happen if we “practice discipline” in other areas of our lives – not just in time and money management, but also in family communication, in our diet and physical activity and yes, also in how many times we check our phones, check the news, or “take a break” to surf YouTube or social media?

This kind of life is about orienting yourself to something higher than immediate feelings and becoming a person with a deeper center – or a higher focal point. But the fact is, for some people – and let’s be honest, for many of us, at some point in our lives – there is nothing higher or deeper than the immediate pleasure they might feel.

Do you have something higher than your own pleasure and deeper than your own impulses around which you can orient your life?

When you think about learning to resist impulses and appetites, does that feel freeing to you – or oppressive?

What other appetites generally speaking, would you say drive parts of your life and days? Does food, drink or other substances preoccupy your mind and heart – what else?

6. A person not afraid of reality, including when it’s really hard

Reality is not always so easy for many of us – especially when life circumstances seem really hard. So it can take some courage to just stay with what is real – especially when surrounded by so many opportunities to jump ship and chase an escape.

It doesn’t even take hard things in our life to be intrigued by the allure of endless chances to chase distractions, pleasures, entertainment. Pain adds afterburners to that temptation. It takes tremendous courage to just stay and be present – and not run away – when things are really hard.

Pema Chödrön, author of “The Places That Scare You,” points out how rare it is to be encouraged to “move closer, to just be there, to become familiar with fear….the advice we usually get is to sweeten it up, smooth it over, take a pill, or distract ourselves, but by all means make it go away.”

It takes a kind of courage to do otherwise, and to stand in your life. Although it can take some practice, people find a new kind of delight when reality has become more interesting than fantasy. You really can find out for yourself the joy that comes when real-life presence is more satisfying than stimulation and more beautiful than counterfeit comfort. When that happens, pornography gradually loses its power because reality has become enough.

• When you look at your life as a whole, how often are you running away from what you feel inside? Answer honestly – all of our hearts need that kind of honesty.

• How often do you quit to do something more enjoyable when you feel overwhelmed by a task?

• What would it take for you to discover that pain doesn’t have to be an emergency, loneliness and boredom don’t have to be pushed away, and discomfort can actually be a teacher? When you learn this, urges become information rather than commands. Your freedom begins the moment suffering no longer dictates the next choice.

7. A person continuing to learn and grow in lots of different ways

Once you’ve graduated high school or college, the joke goes, there’s no need to read any more books. It’s not really a joke though – some people really do conclude “I’m good – just the way I am….why waste time trying to learn something more, or develop a new skill?”

That kind of arrogance blinds us to so many lessons that could enrich our lives with a little more humility and curiosity. People who find lasting freedom never stop learning and growing, especially when they’re struggling – but also afterwards. “How long can rolling waters remain impure?” Joseph Smith once said. In fact, they don’t…not for long. Because flushing our mind and heart with new truth and beauty and growth and goodness, has a way of dislodging even the most stubborn residue and old clutter.

• Do you enjoy learning new things? If so, how often does that happen? If you’re not interested and open and curious about learning new things, why do you think that is?

• Are you growing in different dimensions of your life, apart from whatever appears to be directly related to compulsivity? If not, why do you think you’re resisting growth?

• Laying aside, again, anything explicitly tied to sexuality, what areas of growth and learning does your heart feel drawn towards – or your mind curious about?

• What steps could you take to bring to pass more learning and growth in your life – classes, books, mentors, practices that could help awaken new progress in your heart and mind overall?

8. A person who keeps turning away from wrong and being accountable about actions

Closely related to daily learning and growth is the ancient practice of turning back towards goodness and God, when our hearts have drifted somewhere else.

Rather than just feeling bad, I like to think of repentance as a kind of mindfulness practice. Just like the mind wanders – and we can bring it back, over and over again. So also, can our heart wander … over and over.

Bring it back. Gently and firmly. Over and over again. To a place and Person that can actually nourish that heart – and bring it to its highest happiness.

• Can you still tell inside when you’ve made a choice that is wrong? If that’s hard to answer, why do you think that sense has been dulled – and what can you do to begin to rehabilitate it?

• Are you tempted to simply say, “Oh, this is just going to be my life?” or “this is just who I am?” Resist that! And don’t give up hope for lasting healing and change.

• How focused are you on your own heart and need to change – versus fixating on what others need to adjust to make your life more comfortable and blaming them for what you are feeling?

• When was the last time you felt the burden of sin lifted off of your shoulders – and replaced with sweetness and peace?

• Do you see a trajectory of genuine progress in your repentance – OR are you settling into a pattern of going right back to the compulsion, soon after you’ve made sincere commitments? Realize there’s something called false repentance – and it’s worth taking seriously

• Do you see any signs in your life of false repentance – what Charles Sturgeon warned as “a repentance that needs to be repented of”?

9. A person willing to share heart and challenges with trusted individuals

It’s possible to be connected with people, even many people and “close friends” – without ever really going there in sharing what’s really going on in our lives. Do you know what that’s like?

The opposite is not becoming an open book for everyone – or pouring out all the difficulties of your life on social media. The true opposite is having a few trusted friends whom you do more than simply trust in theory. You show that trust by letting them know what’s really in your heart – confiding in them any challenges you’re really facing.

The fact is that most free-hearted people have not found purity alone. They have cultivated relationships where truth can be spoken, burdens can be shared, and repentance can be supported. They understand that secrecy is where bondage grows, and honesty is where freedom begins.

And that’s why they do not normalize hiddenness or double lives. They are willing to be known in the places where healing is most needed.

• How often do you keep secrets from people you love?

• Do you sometimes use lies to protect yourself – and try to protect others too?

• What would it feel like to no longer live hidden – where someone knows your real story.

• What would this kind of sharing and transparency look like in your own network of friends? Who would that include – and how would it work?

10. A person who prioritizes the needs and suffering of others in how they orient their lives

Most people who have been teenagers know what it’s like to orient most every minute of each day around our own needs and desires. But then we’re supposed to grow up, right?

Only many don’t – with an increasing number of adults willingly and proudly adopting what used to be reserved for “narcissists” – “I need to be more focused on my happiness – and what’s going to be best for me!

The opposite of this is living a life of meaning, purpose and service – getting outside of ourselves in some of the many ways there are to lift people around us.

• How much of a sense of meaning and purpose do you currently have in your life?

• What could it mean – and what would it take – to have a life organized not around a particular impulse, but instead around creating, building, serving, loving and giving? Can you feel the energy even a sentence about that life gives off? In a life like this, porn gradually becomes irrelevant because life has become too meaningful to leave.

11. A person who possesses their soul in patience and kindness

Anger is fuel on the fire of addiction – and something that compulsive patterns likewise fuel. This is something people struggling with alcohol have taught in the AA Big Book for many years:

“Resentment is the ‘number one’ offender. It destroys more alcoholics than anything else. From it stem all forms of spiritual disease...We found that it is fatal … If we were to live, we had to be free of anger.”

But when we get in a dark place, anger becomes almost second nature – lashing out at anyone or anything that we don’t like or who makes us feel uncomfortable. A life of that kind of “aversion” is a life of suffering, period.

The opposite is a life infused by gratitude, patience and long-suffering – where we are “not easily provoked” like Paul taught the people of Corinth.

• Do you struggle to get along with others – and find people wanting to get away from you?

• How often do you inadvertently come across as aggressive to others or controlling?

• Do you often feel irritated by others and get annoyed by small things?

• Are you tired of a life driven by so much anger? How much are you willing to yield to receive something better?

12. A person not scared of silence and stillness – and who begins to appreciate them

It’s become increasingly common to have people who can’t be alone with their own thoughts – who have to “have some noise on” around them. Our fast-paced society trains our brains in this direction, one short-form video at a time.

• Are you still able – and willing – to read a book? If not, when did you lose that capacity – and what are you willing to do to gain it back?

• How often do you “practice” being still? Are you willing to start – if you knew, really knew, you could regain this capacity?

• When you’re around other people, how present are you able to be with them?

13. A person who taps into the love, peace, joy and power of God

That boring question “are you religious?” misses out an even more important question: In all your experiences pursuing faith or spirituality, how often did you tap into a deeper love, joy or peace?

If not, can you blame people for stepping away from faith? And for those who experience this otherworldly peace, joy and love – wild horses couldn’t drag them away from that faith.

• If you haven’t felt this kind of transcendent peace and joy from your connection with God – or love too – why do you think that is? Do you tend to feel deeply in other parts of life, or do you tend to not feel as much?

• If this isn’t something you experience with God, where do you tend to feel most in your life? For many people, this can be about discovering a new source of comfort, love and connection – as well as confidence and power.

14. A person who delights in truth and goodness overall

When Jesus spoke to Nicodemus, he said, “And this is the condemnation, that light is come into the world, and men loved darkness rather than light…”

The seeds of people’s stuckness were embedded in their own heart. They wanted the darkness – and “loved it” – seemingly more than anything else God could offer them.

That’s a little frightening, but a clear reality for many people today. But it doesn’t have to be. Even if your heart longs after some of that darkness, you too can become someone different: a person who loves light and goodness.

• Searching your own heart, how much of your own desires are tied up in goodness and light – compared with darker passions?

• If there was a way to fall in love with light and goodness more, would you want it?

• How would your life change if the deepest desires of your heart could also change? By the way, if you’re worried about the impossibility of “forcing yourself to feel” a certain way – stop worrying. This is work God can do in you. And as John taught, even “If our hearts condemn us, we know that God is greater than our hearts.”

15. A person who sees divinity in themselves and others

When you look inside, do you see something divine – and infinitely precious? How about when you look at others around you?

As long as women are seen as a “piece of meat” – and largely worth how they look, don’t be surprised if you relate to the many people around you out of that core instinct.

It’s possible to come to see and feel otherwise. But not by analyzing. This is another gift you need to receive.

• When was the last time you remember looking at someone and being struck by the beauty of their heart and spirit?

• When it comes to attraction, do you know how to pursue a “whole-souled attraction” towards someone else?

A whole-life approach to recovery

This isn't just about porn.

This is about the kind of human being you're becoming.

When you look at all the questions above, notice that we’re not asking about pornography anymore. We’re asking about all of your life.

That’s huge, especially because pornography almost disappears from center stage – just like it needs to in your own life.

• Instead of “How do I stop looking at porn?” this is about “What kind of life am I quietly becoming and cultivating?”

• Instead of fixating on what is wrong, this is about getting more curious and focused on: what is growing?

• Instead of asking, “How much are you struggling with pornography?” this is about exploring “What kind of person are your daily patterns quietly training you to become?” – pouring attention into how the deepest relationships in your life are being formed? (with everything else – including pornography – becoming one downstream expression of that larger developmental story).

This shifts the focus from eliminating a symptom to cultivating a life. Instead of regarding pornography as the primary issue, this treats pornography as one visible indicator of a much deeper developmental trajectory – one reflected in formative dynamics operating beneath the surface of your life that you may not have noticed before – at least not in their relationship with compulsivity.

Maybe that’s the greatest shift of all. Recovery isn’t finally about becoming someone who no longer looks at pornography. It’s about becoming someone who has discovered a richer way to live. Someone whose loves have been reordered. Someone who is increasingly captivated by what is real, beautiful, true, and good.

Pornography (like alcohol, drugs and many other fixations) may once have seemed irresistible – but over time it simply becomes out of place in a life that is filling with something better.

It’s about becoming the kind of person whose heart is steadily being reclaimed by truth, love, beauty, service, courage, and God. As those deeper loves grow stronger, pornography doesn’t simply become forbidden – it becomes increasingly foreign.

That may be the most exciting thing about lasting recovery: not merely the absence of compulsion, but the presence of a new heart.

Other related work:

We usually talk about pornography in terms of right and wrong, healthy and unhealthy, addictive or not addictive. Those are all important questions. But there is another question that I believe matters even more: What kind of person does pornography train us to become?

What many may not realize is that pornography does not merely show us something. Over time, it teaches us to see differently, desire differently, relate differently, and live differently. Like every repeated habit of the heart and mind, it forms us. The question is: How?

That’s what I explore below: not merely what pornography does in a moment, but what recurring pornography use appears to make of a man or woman over time.

‘This is just who I naturally am’

This inquiry may sound strange to those who believe our desires simply reveal who we already are —and that whatever we feel, want, crave, or choose should be welcomed and celebrated as our authentic self.

But what these people are missing is that we human beings are not only expressing ourselves. We are also becoming ourselves.

Every repeated choice leaves a mark. Every place we direct attention, every private ritual or indulgence, every focus we return to again and again teaches the heart what to love, the mind what to expect, and the body what to seek.

Pornography is no exception. Instead of merely consumed and then forgotten, this highly intensive media trains. It habituates. It forms.

So more than simply asking “Is pornography wrong?” or “Is pornography addictive?” I think we need spend more time exploring: What kind of human being does pornography viewing shape over time?

Rather than just speculating, I offer below some data-driven answers to the question, thanks to the work of my late colleague Gary Wilson, who I wrote about for Deseret News after his passing (“The atheist who warned the world about porn addiction”).

This remarkable man poured the final years of his life into an incredible website, “Your Brain On Porn” that changed the public conversation about this issue and still remains today among the best repositories of the available evidence.

Based on the preponderance of research detailed there, here are seven things we can safely say about the kind of human being that recurring porn use produces:

1. A human being who is sadder and more anxious

2. A human being who is less able to show love

3. A human being who is more willing to be aggressive and treat women poorly

4. A human being who is more isolated

5. A human being who is more confused and less able to see reality clearly

6. A human being who is less connected with spiritual practices and God

7. A human being who is less emotionally free

In order to make clear how much scientific backing this has, I dig into some of the relevant literature and hyperlink the studies so you can review them yourself. Then, I highlight a few larger takeaways at the end (skip there if you don’t need to see any of the research).

7 Ways Porn Shapes How a Person Lives

1. A human being who is sadder and more anxious

On his website, Gary Wilson noted that “over 85 studies link porn use to poorer mental-emotional health & poorer cognitive outcomes.” See for yourself, starting with depression:

• A nationally representative, cross-sectional telephone survey of 1501 children and adolescents (ages 10-17 years) found that “online seekers versus offline seekers are more likely to report clinical features associated with depression.” (2005)

• Pornography users “compared to nonusers, reported greater depressive symptoms, poorer quality of life, more mental- and physical-health diminished days, and lower health status.” (2011)

• “Participants in the cybersex group were more likely to report being depressed than participants in the addicted/no cybersex group.” (2012)

• “Adults who had watched an X-rated movie in the past year were ….less likely to report being happy with their marriage or happy overall.” (2014)

• “The ratio of depression was 2.8% in the subjects who used pornography less than 1 time/week, and was 14.6% in those with a frequency of more than 3 times/week.” The authors noted, “After adjustment with physical activity and sleep quality, the frequency of pornography use was still positively correlated with the scores of depression, anxiety and stress.” (2017)

• “Even after controlling for a variety of demographic factors, impulsivity, pornography acceptance, and the general perception of sexual content as pornographic, the accumulated total viewing of sexual content was still significantly linked to higher levels of depressive symptoms as found in previous studies. (Importantly, even those people who didn’t think the sexually explicit material they were viewing was “pornographic,” they were still more likely to report higher depression). (2018)

• “Depressive symptoms were associated with pornography use”—with associations that “held beyond age, gender, and moral disapproval” and “persisted stably over 2 years.” (2026)

• Among college students, compulsive porn use/problematic porn use was associated with depression. (2026)

Anxiety was more likely among porn users as well, such as one 2015 study that found compulsive porn users were “significantly more likely to report a history of anxiety problems.”

• “Cybersex compulsives and at-risk users … invest an inordinate amount of their time, money, and energy in the pursuit of Cybersex experiences with negative intrapersonal ramifications in terms of depression, anxiety.” (2005)

• “Frequency of viewing was significantly related to each psychosocial variable [depression, anxiety, stress, social functioning], such that more viewing was related to greater problems.” (2012)

• Individuals with compulsive sexual behavior reported “more depressive and anxiety symptoms, higher levels of stress, poorer self-esteem, and higher rates of social anxiety disorder” compared with those not engaged in these same compulsive patterns. (2013)

• Even though individuals with major psychiatric conditions were excluded, porn addicted subjects “had higher depression and anxiety scores.” (2014)

• “Hypersexual behavior was related to higher scores on measures of …both depressed mood and anxiety.” (2015)

• “Psychiatric comorbidities, especially mood, anxiety, and personality disorders, are the rule rather the exception for people with compulsive sexual behaviors.” (2016)

• “Those who reported pornography addiction …reported poorer physical and psychological health.” (2016)

• “Heightened depressive symptoms…”lethargy and amotivation,” “elevated social anxiety” all showed up as themes among porn users in a 2023 study.

• “Mentally and emotionally, Early Engagers (saw adult material for the first time around age 14 and began a regular viewing habit by age 18) reported the highest rates of psychological distress. They scored higher on screening tools for depression, anxiety, and suicidal thoughts than the other groups.” (2026)

These mental health associations show up among teenagers too:

• Porn use was associated with “low mood” and “unexplained anxiety” among adolescents. (2017)

• “Adolescents’ exposure to online pornography was associated with depressive symptoms.” This longitudinal study provides especially robust “empirical support for the long-term effects of intentional exposure to online pornography on depression over time.” (2018)

Bottom line: When junk media is where people spend their emotional energy, time and attention, they feel worse about their lives. This shows up in the correlations with self-esteem:

• Problematic Sexual Behaviors “was associated with worse quality of life, lower self-esteem, and higher rates of comorbidities across several disorders.” (2016)

• Nelson et al. (2010) suggested that higher levels of self-worth were related to lower pornography use patterns. The present study’s findings reinforce the negative correlation of self-esteem and pornography use.” (2017)

• “Multivariate analyses revealed that increased pornography use was associated with greater dissatisfaction with muscularity, body fat and height; greater eating disorder symptoms; more frequent thoughts about using anabolic steroids; and lower quality of life.” (2017)

• “Greater consumption of (sexually explicit material) was directly related to more negative body attitude and both depressive and anxious symptomology.” (2017)

• Among women, pornography consumption in the last month was significantly related with lower self-esteem. (2018)

Given all this, it should not surprise us to see the opposite pattern also appearing:

• Among young men, “those who did not use pornography (compared to those who did) reported … higher levels of self-worth and identity development regarding dating and family, and…lower levels of depression.” (2010)

• “Young people who do not have sexually explicit content on the Internet have a higher level general self-assessment than young people using this content with frequency several times a month. This translates into more confidence in yourself and a better opinion about yourself and a stronger sense of your own values.” “Test subjects shunned by erotica on the Internet are also characterized higher level of identity integration than other participants in the research.” (2018)

One qualification: Could all these problems be leading people towards porn?

It’s tempting to look at all this and say, “well sure, if you struggle with depression, anxiety, attention problems, isolation, sexual problems—wouldn’t you be more inclined to use porn?”

That’s true, of course, and certainly also happening. But it would be a mistake to dismiss the direct influence of porn on all these same areas. Both are happening. In fact, Wilson notes there are also “over 90 studies demonstrating internet use & porn use causing negative outcomes & symptoms, and brain changes.”

2. A human being who is less able to show love

“Over 80 studies link porn use to less sexual and relationship satisfaction,” Gary Wilson noted. Here are just a few examples:

• “Cybersex compulsives,” reports a 2005 study “invest an inordinate amount of their time, money, and energy in the pursuit of Cybersex experiences with negative intrapersonal ramifications in terms of depression, anxiety, and problems with felt intimacy with their real-life partners.”

• One 2014 study found that adults who had watched an X-rated movie in the past year were more likely to be divorced, more likely to have had an extramarital affair, and less likely to report being happy with their marriage or happy overall. The researchers also found that, for men, pornography use reduced the positive relationship between frequency of sex and happiness.

• “Problematic porn use was linked to far lower scores on lower sexual passion, sexual satisfaction & life satisfaction. In comparison, the group that scored highest on all these measures had the least problematic porn use.” (2019)

By contrast, getting porn out of people’s lives is correlated with an increased or returning ability to love:

• “Abstinence renders people more altruistic. Abstinence renders people more extroverted, more conscientious, and less neurotic.” (2016)

• “Students who do not use erotic sites, experience more social support, they feel more loved and accepted by relatives than their colleagues reaching for erotic content on the Internet. This translates into their more optimistic assessment of their future relationships.” (2018)

Both men and women are impacted

Every study Wilson found exploring the sexual/relational impact of porn with males demonstrated a negative impact. While a handful of studies report little effect of women’s porn use on their sexual and relationship satisfaction, he emphasized that “many do report negative effects” (check out his review of 45 studies focused on pornography’s impacts on female arousal, sexual satisfaction, and relationships).

Romantic attachment impacted

More than simply influencing the “feeling” in a relationship, the impact of porn appears tied to deeper attachment patterns:

• “Frequency of pornography use and problematic pornography use were related to greater gender role conflict, more avoidant and anxious attachment styles, poorer relationship quality, and less sexual satisfaction.” (2014)

• “Men’s frequency of pornography use was …positively linked to negative affect indirectly through romantic attachment anxiety and avoidance, and …negatively linked to positive affect indirectly through relationship attachment anxiety and avoidance.” (2014)

Sexual function disrupted

Wilson covered “over 50 studies linking porn use/porn addiction to sexual problems and lower arousal to sexual stimuli” (adding that “the first seven studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions”). Here are a few examples:

• Compulsive porn users were “significantly more likely to report a history ….of sexual functioning problems (71% vs. 31%) with delayed ejaculation being the most commonly reported sexual functioning problem.” (2015)

• “Hypersexual behavior was related to higher scores on measures of sexual excitation, sexual inhibition due to the threat of performance failure, trait impulsivity.” (2015)

• Common themes included “subsequent decreased quality of sexual intimacy with real partners,” “reduced sexual drive when offline,” “diminished sexual functioning,” “reduced orgasm functioning and sexual satisfaction with real partners.” (2023)

3. A human being who is more willing to be aggressive and treat women poorly

More than 40 studies link porn use to “un-egalitarian attitudes” toward women and sexist views, according to Wilson. One larger 2016 review looked at 109 publications that contained 135 studies between 1995 and 2015, concluding:

Regular, everyday exposure to this content is directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

In another 2015 meta-analysis Wilson cites, “A Meta‐Analysis of Pornography Consumption and Actual Acts of Sexual Aggression in General Population Studies,” the authors examine 22 studies from 7 different countries and conclude:

Consumption was associated with sexual aggression in the United States and internationally, among males and females, and in cross-sectional and longitudinal studies. Associations were stronger for verbal than physical sexual aggression, although both were significant. The general pattern of results suggested that violent content may be an exacerbating factor.

So no, porn use hasn’t reduced rape rates, Wilson added. Remarkably, more than 100 100 studies link porn use to sexual aggression, coercion & violence. (See also his write-up, “Rape rates are on the rise, so ignore the pro-porn propaganda.”)

Three other relevant studies:

• One 2014 study found that “participants who were more physiologically aroused by and spent more time viewing the non-consensual sexual imagery nominated significantly later stopping points on the date-rape analogue task.”

• Among men in the UK, “those who reported pornography addiction were much more likely to engage in a variety of risky antisocial behaviours, including heavy drinking, fighting, and weapon use.” (2016)

• One 2019 study found porn viewing leading to “unethical behavior” in other areas (business)—which they explained as connected with “increased moral disengagement from dehumanization of others due to viewing pornography.”

This association between pornography use and aggression also appears among adolescents. For instance:

• “Compared to non-pornographic Internet site users, infrequent pornographic Internet site users were twice as likely to have abnormal conduct problems; frequent pornographic Internet site users were significantly more likely to have abnormal conduct problems.” (2009)

• “Mesch found that greater quantities of pornography consumption were significantly correlated with lower degrees of social integration, specifically related to religion, school, society, and family. The study also found a statistically significant relationship between pornography consumption and aggressiveness in school.” (2009)

In a 2012 review of the research, “The Impact of Internet Pornography on Adolescents,” the researchers state:

Collectively, these studies suggest that youth who consume pornography may develop unrealistic sexual values and beliefs. Among the findings, higher levels of permissive sexual attitudes, sexual preoccupation, and earlier sexual experimentation have been correlated with more frequent consumption of pornography…. Nevertheless, consistent findings have emerged linking adolescent use of pornography that depicts violence with increased degrees of sexually aggressive behavior.

They continue:

Girls report feeling physically inferior to the women they view in pornographic material, while boys fear they may not be as virile or able to perform as the men in these media. Adolescents also report that their use of pornography decreased as their self-confidence and social development increased. Additionally, research suggests that adolescents who use pornography, especially that found on the Internet, have lower degrees of social integration, increases in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers.

Narcissism and personality disorders

Two studies highlight the impact of long-term porn use on deeper elements of personality:

• “The hours spent viewing Internet pornography use was positively correlated to participants’ narcissism level. Additionally, those who have ever used Internet pornography endorsed higher levels of all three measures of narcissism than those who have never used Internet pornography.” (2014)

• More broadly, one 2018 study on internet use and “dark personality traits” found that “online sexual use” was related to dark personality traits (machiavellianism, psychopathy, narcissism, sadism, and spitefulness).

Gary Wilson asked, “How would these traits differ after an extended period of time without porn.”

4. A human being who is more isolated

Studies consistently find a connection between regular porn use and loneliness:

• “Results showed a significant association between Internet pornography usage and loneliness.” (2005)

• “Results from our analyses revealed significant and positive associations between pornography use and loneliness.” (2017)

• “It was further revealed that a significant direct relationship between loneliness and sexual compulsivity exists.” (2017)

• “Analyses also revealed that the higher the prevalence of pornography use, the higher the prevalence of sexually related online activities, and the higher the loneliness and insecure attachment orientations (anxiety and/or avoidance).” (2018)

Shyness also shows up: “Shyness was positively associated with solitary sexual behaviors of masturbation and pornography use for men.” (2013)

And individuals with compulsive sexual patterns also show “higher rates of social anxiety disorder” (2013) and “elevated social anxiety.” (2023)

This can show up in how adolescents connect with family members:

• “Lower levels of emotional bonding with their caregiver” among young people involved in porn. (2005)

• In relation to family functioning, “mutuality, communication and harmony were negatively related to pornography consumption.” (2012)

Interestingly, some of this may improve when pornography use stops. As one 2026 study reported: “We found that those individuals who did not use pornography or did not masturbate during the past year had significantly lower levels of mental distress and loneliness than those who did.”

5. A human being who is more confused and less able to see reality clearly

The number of studies linking porn use and poorer cognitive outcomes is striking, especially those focused on executive functioning. Wilson, who highlights altered prefrontal circuits and sensitization in porn addicts, called poor executive functioning in the presence of addictive cues a “hallmark of substance disorders” and a “key brain feature occurring in drug addicts.” This involves “hypofrontality” which is reflected in temporarily “decreased cerebral blood flow and reduced metabolic activity in the prefrontal cortex of the brain.”

Poor executive functioning is reflected in a number of studies:

• “Hypersexual behavior was positively correlated with global indices of executive dysfunction,” one 2010 study reported—in line with the fact that “patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex.”

• One study found men with cybersex addictive tendencies showing evidence of decreased ability in “exerting cognitive control over a multitasking situation that involves pornographic pictures”—suggesting this may “be one mechanism in the development and maintenance of cybersex addiction.” (2015)

• Problematic sexual behaviors (PSB) “was associated with ….deficits across several neurocognitive domains, including motor inhibition, spatial working memory, and an aspect of decision making.” (2016)

• Another 2016 study found that people with problematic sexual behaviors exhibited neurocognitive deficits, including poorer executive functioning.

  The authors conclude, “it is possible to trace the problems evident in PSB and additional clinical features, such as emotional dysregulation, to particular cognitive deficits.”

The most immediate consequence of such poor executive function is the classically poor decision-making associated with addiction, which a 2013 study found was worse “in the presence of sexually explicit images.” These researchers concluded that “sexual arousal interfered with decision-making.”

Struggles to remember and learn

• “German scientists have discovered that Internet erotica can diminish working memory,” Wilson summarizes from a 2013 study that found “working memory was worst during the porn viewing and that greater arousal augmented the drop.” They conclude: “Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with working memory performance.”

• Sexual arousal may also distract attention from consequential information: “Sexual arousal could reduce their attention and physiological sensitivity to monetary losses.” (2018)

• One 2017 study highlighted a “lack of a learning effect by the sexually compulsive group when they were sexually stimulated.” They added, “These data support the idea that sexually compulsive men do not take advantage of the possible learning effect from experience, which could result in better behavior modification.”

These same cognitive impacts show up with adolescent studies, including working memory:

“Our results showed diminishing memory capability on pornography addiction. Working memory is known to have an important role in maintaining goal-oriented behavior; therefore, our findings suggested that pornography-addicted juveniles may have a problem in doing so.” (2019)

Porn use also correlates with basic academic struggles:

• “Watching horror, action, or pornographic films was associated with lower test scores.” (2008)

• A longitudinal study over a six-month period found that “an increased use of Internet pornography decreased boys’ academic performance six months later.” (2015)

• Most students who are involved in pornographic activities do not do well in academics and most times even procrastinate their work. (2019)

For both adolescents and adults, the larger impact on concentration, focus and attention shows up as well:

• Visiting porn sites were associated with lack of concentration. (2017)

• A 2018 study found that “excessive Internet use has an impact on the development of cognitive deficits similar to those found in ADHD.”

• A 2023 study likewise found “cognitive deficits shortly after using pornography.”

• Compared with young adults without compulsive sexual behavior, those who struggled compulsively had higher rates of attention-deficit/hyperactivity disorder. (2013)

• “Due to the structural immaturity of the adolescent brain and relative inexperience, they are unable to process the myriad nature of sexual content online which may lead to attention problems, anxiety, and depression.” (2017)

6. A human being who is less connected with spiritual practices and God

Pornography use is often associated with a measurable thinning of prayer, worship, spiritual confidence, and religious participation—which has been documented largely by Samuel Perry, a sociologist at the University of Oklahoma. Here are several of his findings:

• Perry in 2017 found in “Does Viewing Pornography Diminish Religiosity Over Time?” that people who viewed pornography at one point in time reported “more religious doubt, lower religious salience, and lower prayer frequency” at at later time point compared to those who never viewed porn.

• His study among young Americans, entitled “How Viewing Pornography Shapes the Religious Lives of Young Americans,” explored “whether viewing pornography may actually have a secularizing effect, reducing young Americans’ personal religiosity over time.” Data over time show that “more frequent pornography viewing diminishes religious service attendance, importance of religious faith, prayer frequency, and perceived closeness to God, while increasing religious doubts”—an effect that holds for both boys and girls and is especially strong for teenagers.

• In another 2017 longitudinal report by the same team, married Americans who never viewed pornography prayed with their spouses more often than average, while moderate users prayed together less.

• In “How Pornography Use Reduces Participation in Congregational Leadership,” Perry reported in 2019 that the more frequently people viewed pornography at an earlier point in time, the less likely they were to hold a leadership role or serve on a committee in their congregation over the next six years—even after controlling for religious commitment and other factors.

7. A human being who is less emotionally free

I wish this point were the most obvious. But because of an ongoing, concerted effort to portray pornography and sex addiction as somehow “controversial,” it has become a fraught subject.

But it shouldn’t be. Consider how nearly all of the dozens of neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal) published on porn users and sex addicts support the addiction model, as Wilson made clear on his website.

Those findings, by the way, “mirror the neurological findings reported in substance addiction studies,” as Wilson underscored. Likewise, “over 60 studies report findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms (all signs and symptoms associated with addiction).”

Accompanying this evidence of addictive escalation to more extreme material, Wilson identified an additional 15 studies reporting withdrawal symptoms in porn users. For instance, one 2023 study found pornography users speaking about a “need for greater stimulation over time,” and shifting frequently to other kinds of images “typically to heighten or maintain arousal.”

Over 30 literature reviews & commentaries by some of the top neuroscientists in the world “all support the addiction model,” Wilson added—providing further confirmation.

Addictive features aside, there are also many studies documenting decreased impulse control associated with porn use. For instance:

• “Porn use increases impulsivity and may reduce certain executive functions (self-control, judgment, foreseeing consequences, impulse control).” (2017)

• “Erotica users…. exhibited more impulsive choice patterns …than erotica non-users did.” (2008)

• “The more pornography that participants consumed, the more they saw the future rewards as worth less than the immediate rewards, even though the future rewards were objectively worth more.” (2015)

• “Hypersexual behavior was related to higher scores on measures of …trait impulsivity.” (2015)

• “Subjects who do not use erotic content have a greater sense of self-control than their peers … who use from erotic sites several times a month and more often….It’s about greater control over your emotions.” (2018)

• “Impulsivity … (was) significantly higher in porn-using college students.” (2023)

Porn users are also more likely to experience other kinds of compulsive-addictive patterns. One earlier 2005 study, for instance, found more “substance use in the previous year” among adolescents using pornography. Other similar studies of adults found pornography use associated with:

• More “compulsive buying, pathological gambling, and kleptomania.” (2013)

• More “heavy drinking” and “using illegal drugs (and) gambling.” (2016)

• “More symptoms related to problematic drinking, cannabis use, and gambling” (2026) and “more alcohol abuse.” (2026)

The opposite pattern also appears: abstinence from porn may strengthen self-control and delayed gratification. As a 2016 study concludes: “Abstaining from pornography and masturbation increases the ability to delay rewards. Participating in a period of abstinence renders people more willing to take risks.”

Two important qualifications

1. Pornography is one of many influences

None of this is to suggest that deep sadness, anxiety, isolation, aggression, spiritual disconnection, or compulsive patterns have simple causes. Human beings are complex, and suffering rarely has only one explanation.

Nor is this meant to overwhelm or shame anyone who has struggled with pornography, especially those who are already weary of their own struggle. These people should be the most aware of how porn use has shaped their lives, but they can’t always see it after a certain amount of time.

For many of them, they start to fall into “this is just who I am” or “this is just how life is” or “people around me are just hard to deal with” or “God isn’t there for me”…little realizing how much porn may have shaped this all.

2. Family members, especially children and spouses, are also ‘trained to become’ different in concerning ways

Porn use also profoundly influences the kind of person surrounding people become as well, with many studies confirming concerning impacts on family members of someone using pornography. Here’s just one example:

“Current and previous partner pornography use were related to higher (eating disorder) symptomatology, adjusting for age and women’s reports of being bothered by this use. Partner thinness-related pressure and previous partner pornography use were associated with ED symptomatology both directly and through thin-ideal internalization, whereas current partner pornography use was directly associated with ED symptomatology.” (2019)

There’s so much more here that needs to be understood and explored, but outside the scope of this article.

Key points

I hope several conclusions are clear from the foregoing evidence.

First, pornography does not merely show a person something. Over time, it teaches a person to become someone.

Recurring pornography use, as illustrated above, forms human beings who are sadder and more anxious, less able to show love, more willing to be aggressive and treat women poorly, more isolated, more confused and less able to see reality clearly, less connected with God, and less emotionally free.

Second, as reflected here, the most serious cost of pornography may not be what sexually explicit material elicits in a moment, but what it quietly makes a person become over time.

Thus, it may be helpful to shift public discourse away from asking only, “Is pornography wrong?” and toward asking, “What kind of person is this training me to become?”

Third, I hope this insight could make a difference for those walking their own inspired path of recovery. Freedom is not doing whatever desire demands. Freedom is becoming the kind of person whose desires are increasingly ordered toward love and goodness, truth and transcendence—to become, as Matt Dobschuetz puts it, “the type of man that does not look at porn.”

The most important message

If you would like to become sadder, more anxious, more isolated, less capable of love, more willing to be aggressive, more confused about reality, less connected with God, and less emotionally free, the research suggests one reliable way to move in that direction: keep giving pornography your time, attention, imagination, and heart’s desire.

But if you want to become more whole, more clear-minded, more connected, more gentle, more loving, more spiritually alive, and more free at the deepest levels, then pornography is not merely a private habit to “manage.” It becomes a formative influence to resist.

Don’t give into despair—hope always!

The hopeful news is that human beings are not only formed by what has happened in the past. We are also formed by what we choose next.

The same heart and mind that can be trained toward escape, objectification, isolation, and compulsion can also be retrained toward beautiful presence, love, self-command, truth, and sweet communion with God.

If you know someone grappling, please encourage them to keep learning, keep growing, keep changing, keep getting up —and above all, keep being hopeful. Don’t give up! Lasting freedom can absolutely be yours. As my dear friend Vinny, likes to say, “if you knew how good deep recovery is, you’d put on your track shoes and race to get there!”

Pornography may shape a person over time, but it does not have the final word on who anyone can become—no matter how long it has messed with your heart and mind, or obscured a future of the sweetest joy, love and peace.

Don’t give up on lasting freedom until you find it. It’s time to “arise from the dust” and reach for the living God’s help to “shake off the chains with which ye are bound, and come forth out of obscurity.”

I’m doing a lot more writing this summer on non-obvious influences on an individual’s capacity to connect with God and experience anything transcendent at all. Thursday, I spoke with Pepperdine University scholar Jessica Hooten Wilson, who writes about the cultural forces leading an entire generation to lose interest in reading. What does it mean for your relationship with God when you lose the ability to be alone with sacred writing?

I’d welcome a chance to hear your own stories, either in writing or on a phone or Zoom interview this summer. Here are some of the questions I’m exploring—but maybe you see something else that might be missing?

Tell me if you’ve seen or experienced any of this before:

1. When an inability to read (via disinterest or impatience) hollows out faith

Have you noticed your own ability to read decreasing in recent years? If so, you’re not alone—this is common in our screen-based, smartphone-fixated society. A surprising number of Americans admit not reading much at all. If that applies to you, how do you think it’s impacted your own faith and spirituality, if at all? Have you seen others you care about stop reading? Have there been any accompanying changes in their spirituality?

2. When counselors inadvertently undermine faith

An inspired, qualified counselor can do miracles. But in collaboration with an excellent therapist in Georgia, I’m writing to educate people on signs that a counselor may be (often unintentionally) undermining faith. Have you ever seen that happen before? It’s subtle enough that we believe people are missing the influence almost entirely. But it’s there. No counselor comes from an unbiased, neutral position—and a surprising number of popular views in psychology today are like battery acid when it comes to active, vibrant faith. Very interested to hear any of your experiences.

3. When pervasive suspicion corrodes faith

Most people believe in some kind of conspiracy, which makes sense with the level of corruption in society today. But what happens when someone comes to believe there is malevolence and villainry around every corner? And what happens when our view of the world becomes so dark and sinister that the plain and precious truths of the gospel no longer feel all that relevant and exciting anymore? I’d love to hear any experiences you’ve had or observed.

4. When your faith is impacted because you ‘just can’t feel much’

One of my summer projects is a set of short meditations and accompanying monograph called “Feeling Again”—breaking down all the (known) reasons any of us can come to not feel much about life or relationships (or God). It’s astounding how many things can dampen emotion—from past trauma or acute betrayal, to current stress, an insane pace of life, continual distraction, chronic illness, certain medical treatment, addictive patterns, intense despair, anger or fear, meaninglessness and isolation. I’m curious whether you or someone you love has experienced a noticeable lack of feeling. If so, how have you handled that—and has it had an impact on your faith?

5. When you overcome doubts, instead of them overcoming you

In writing recently about overcoming doubt, I’m seeing a lot of misconceptions about what that means and doesn’t mean. Have you ever had an experience of your own in overcoming doubt about otherwise beautiful realities or truths—that, at the time, you may not have been able to see clearly? What did that involve and look like?

Thank you for sharing either below in the comments or by reaching out at jzhess@gmail.com. I’d be happy to jump on a phone call, but if you’re able to share your experience in writing, that would be amazing.

Since the recent Washington, D.C., summit on antidepressant tapering, I’ve been intrigued by the public discourse that’s taken place on how to make sense of it all. There’s a lot to be learned by sitting back and just watching a big discussion taking place — whether through formal “discourse analysis” or more of a basic content analysis, like the one I share below.

For the most part, bigger legacy media outlets continue not to take much of this very seriously. As far as many outlets are concerned, everything associated with RFK is a clown show — even when he happens to be raising some important questions. As a result, we see ominous headlines like:

• The Strange Alliance Trying to Remake American Psychiatry1 (New York Times)

• RFK Jr. Is Coming for Your Antidepressants (Daily Beast)

What I personally found most interesting was what ordinary readers were saying about efforts to encourage safer tapering. Drawing on a sample of hundreds of comments from a New York Times article on the recent “Mental Health and Overmedicalization Summit,” I decided to go deeper in exploring the many disagreements and significant complexity involved.

Across the many fascinating comments, three broader takeaways stand out:

1. There are many across the ideological spectrum who agree there needs to be more support and research for those curious whether gentle tapering from one or more psychiatric medications could be helpful.

2. There are also many others who can’t seem to get over the idea that this issue is now connected to Robert Kennedy Jr. and President Trump — with their frustration and fear seeming to overwhelm any curiosity.

3. There are many important questions being raised by people with concerns about this initiative and the approach being taken by this administration.

Within these broad brushstrokes, I break down sub-themes that seem worth highlighting, sometimes bolding a particular part of a quote that deserves special attention. You’ll notice again this is not a short-form article. Like the original report, I’m trying to put in-depth information in your hands, especially for those interested in the topic.

Where could your empathy and understanding most grow?

By way of preface, it seems to me having a broader grasp on the complexity of this conversation could provide more grounding and humility for anyone involved, no matter your view — maybe especially as you have a chance to hear out deeply a point of view you don’t share.

So consider skimming a little, and focusing on the parts that could benefit you the most. For instance:

• Firmly pro-medication: If you think the impetus behind this effort is naive, unscientific or even reckless, spend some time in section one below. You’ll probably come away with a little more empathy and appreciation for how some of this might be helpful.

• Firmly anti-medication: If you think the questions around antidepressants and tapering are simple, and simply a function of greed, power or ignorance, try skipping to the third section — where an assortment of really important concerns are raised about this initiative.

• Done with Trump/RFK: If you are so done with President Trump and RFK that you could scream — and sometimes actually do — the first section will be helpful to you as well — especially in seeing this isn’t just about conservative politics. It’s about people experiencing deep suffering — reaching out for some additional support.

• Supporting Trump/RFK: If you’re generally a supporter of President Trump and RFK and struggle to hear the kind of opposition they face without losing your cool, take a deep breath and work your way through the second section recapping people who are expressing their concerns about how this administration is going about this.

My own take-away is that the more sensitive and important a conversation is, the more grounded, humble and open to different perspectives we all need to be. Few conversations need that kind of a foundation more than this one. That’s what motivates me to share this in-depth tour of the public conversation happening. I have a feeling it could invite more humility, empathy and openness for anyone willing to listen in. It certainly did for me.

Three bigger themes in the conversation about safer antidepressant tapering:

1. There are many across the ideological spectrum who agree there needs to be more support and research for those curious whether gentle tapering from one or more psychiatric medications could be helpful.

There’s no shortage of people expressing appreciation for these efforts to learn more and provide support to those needing this kind of help. That starts with a number of people who shared their own experiences tapering off (or trying to taper off):

• “I was on anti-anxiety and antidepressants and still wasn’t feeling well. My psychiatrist said I would be on them for my entire life. I stopped taking them [note — this should be done gradually if you’ve been on for years] while starting up a strict exercise and nutrition regime. I’m much better now. I know I am prone to anxiety and depression, and if I ever stop exercising regularly or (start) eating poorly I will fall back. It’s like an assailant walking behind me and waiting to pounce. This is my incentive to explore all food options and understand how they affect my well-being. I frame it as an interesting, exciting journey to optimize my life.” (anonymous from Chicago)

• “I’m not a fan of Health Secretary Kennedy, but I agree with him on this. Fifteen years ago I was prescribed an SSRI with assurance that it is not addictive. I tried quitting at least three times over the course of the years. I did so very, very slowly and gradually reduced the dosage. Each time I had dreadful ‘rebound effect’. Look it up, if you don’t know what it means. It’s the worst state of emotion I ever experience and far, far worse than I ever felt before taking them. Truly dreadful. I don’t blame my MD prescriber because I assume he had been assured by the pharmaceutical manufacturer that their product was non-habit forming. Now I am resigned to taking the SSRI every day because the thought of going through that withdrawal and rebound again is truly frightening.” (CC, OR)

• “I slowly weaned myself off an anti-anxiety and depression medication about a year and a half ago after 20 years and am so glad I did. None of this is easy….. After so many years of taking meds and working on issues, the anxiety was resolved enough to leave the meds. The depression is a daily struggle and I’m not sure how much difference the medication made in the long run. It does dull you to a certain extent and the side effects are not all known. I’m grateful I was able to get off them but each person needs to make their own decision. This is an extremely personal and complicated decision. It would be nice to have a more holistic approach to everything in medicine. A lot of doctors in this country tend to just throw drugs at the problem and deny even the most basic of natural answers like diet, exercise, sleep, stress and vitamins, etc. A stronger social support system would help everyone.” (Anonymous)

It was interesting to see the different pathways to ‘feeling again.’ For instance, similar to this person describing how the medication “does dull you to a certain extent,” others recounted how gentle tapering had helped them be able to feel more again in life:

• “I have been on and off antidepressants most of my life. I recently stopped taking fluoxetine after taking it for about 6 years. It was like waking up from a dream, the medicine had blunted me emotionally so much. It helped immensely when I needed it 6 years ago, but taking it reflexively after its utility had declined was not to my benefit.” (Anonymous in San Francisco)

• “I finally got myself off of them a year ago and I can finally feel again.” (anonymous)

• A mother from New Mexico, Ana, writes: “I was on antidepressants through my college years, which blunted my emotions, made me act like a different person, lose interest in school and generally have a worse than bad time—a passionless, emotionless time where I drank heavily just to try to feel something.” She described the process of getting off the medications as “awful” — and how it took 2 years to “rebuild my sense of self and heal my brain.”

Then others pointed out that in their experience, the antidepressant had helped them feel again:

• “I’m 31. I’ve been on SSRIs since I was 16. When I experienced my first major depressive episode, I had a robust support system: friends, loving parents, engaged teachers, a fantastic therapist, and a personal trainer my parents hired to come help me exercise three times a week. Even though I had every type of support imaginable, I still could not crawl out of that cave. I felt like a ghost stuck in my own life. And then I started Lexapro. I still remember the feeling of the sun warming my skin the first time I went to the park a week or so after starting the meds. For the first time in forever, I could actually FEEL it. I felt like a little kid waking up from a nightmare in their mom’s arms.” (AM, South Carolina)

• “Back in 1992, Prozac saved my life. Over the course of several weeks my life went from solid gray to a rainbow. I’ve likened it to the scene in Wizard of Oz when Dorothy opens the door and the movie goes from black and white to color—only in slow motion. It basically gave me all of my emotions back; it was neither a happy pill nor did it blunt my feelings. Since then I’ve been on a number of different meds, benefiting from them all to one degree or another. Some have been difficult to get off of, most have not. I’ve also benefited from Transcranial Magnetic Stimulation, as well as Cognitive Behavioral Therapy.” (Michael Spence, San Diego, CA)

Others described being encouraged to taper too fast:

• “I think that starting the discussion on the overprescribing of antidepressants is helpful. I was prescribed one (and truly needed it) but I never felt that my primary who I met only once before actually explained my symptoms. After years of therapy, I tried to quit. The first time, I had such bad brain zaps. The second, I had to go back on in a day or two because my irritability was so bad. Now my third time I am finally getting more support. Each other time I was told to just take a pill cutter and cut my dose in half! [way too fast, according to the best research] My medicine was and is lifesaving, but we truly have a problem in America with how mental health is treated by medical professionals.” (Ann)

• “While I am concerned about some of RFK Jr.’s suggestions, I actually affirm him here. As a former psychiatric patient, I have had multiple experiences where psychiatrists would simply pull me off of a medication or tell me “You can stop taking the medicine” WITHOUT methodically tapering me or providing me tapering advice. This led to much worse mental and physical health struggles than before I took the medications. Paid professional tapering could save lives.” (Eli, California)

As reflected here, several expressed concern that people are getting on meds too quickly and tapering too quickly — both without awareness of the potential effects of doing so.

• “Many who receive these drugs don’t know how they were intended to be used, don’t understand the endpoints that were evidenced, and are too often not provided balanced contemporary information regarding affective disorders in making decisions. It’s honestly heartbreaking from the research side” (Another scientist, Maryland)

• “I observe that many patients abruptly discontinue their SSRIs or SNRIs without consulting their prescriber despite having been told about the risk of discontinuation syndrome. Verbal or written consent about side effects or potential withdrawal symptoms is important. However, I wonder how many patients really pay attention to what they are hearing or reading. That being said, informed consent should be provided for all medications as there are so many non-psychotropic meds that can cause significant untoward neurological effects.” (Ann-Marie, Maryland)

• “Discontinuing Benzodiazepines could use some much needed attention. Take them for a couple of weeks and you’re addicted. Some doctors don’t seem to know this. But they prescribe them anyway.” (Mowgli, from New Jersey)

Some expressed interest in considering tapering, but admitted being fearful of withdrawal effects:

• “Those of us who have used and benefited from SSRIs nevertheless know that withdrawal symptoms may be worse than those of the disease….I am now at a point where I feel stable and experiencing no real blues or any of the typical effects of depression. I would like to try to go off them. But, but, but, as I alluded to, I don’t want to face the withdrawal.” (anonymous)

• “I would love to quit my antidepressant, but I’m highly addicted to it. Even when I’ve tried to titrate off of it, I still get incredibly unsettling brain zaps. I truly hate it.” (Hank, Portland, OR)

Some admit feeling like they are in a situation where they cannot get off (at least, not with better help in how to gently taper over a longer period):

• “I take Celexa and Seroquel….I do not know why they put me on Seroquel, actually. But I’ve been on it for over twenty years and cannot get off it b/c I can no longer sleep without it. I’ve told my psychiatrist this (not the same one who put me on it who’s long gone) and he said with such a low dose that I’m on, it shouldn’t be a problem getting off it, but it is. It really, really is… in my case with a drug I have to take now and can’t get off and didn’t know the reason for the prescription in the first place it’s frustrating.” (hmsmith0, Los Angeles)

• “I have been on antidepressants for over 30 years and have found it very hard to taper off and discontinue them, even with doctor’s assistance, due to the extreme withdrawal symptoms. I would love some actual help. What is missing in RFK Jr.’s plan are accessible, affordable, medically sound methods to get people through the lengthy, painful pharmaceutical withdrawals and transition to viable, more organic alternatives. The lack of information here is a big concern.” (JJS, Boston)

Parents, families, and caregivers describe their experience having to navigate tapering for themselves:

• “This is fantastic news! Other countries are decades ahead of the U.S. medical establishment in training prescribers how to help taper patients. The dearth of info here is astounding. For those who choose to go off, they deserve doctors who understand deprescribing. I’ve been tapering my teen off an SSRI over the last 18 months. We are two months away from the finish line. Her psychiatrist and family doctor were utterly useless so I had to do my own research. Because of the work of Dr. Mark Horowitz I’ve been able to minimize her withdrawal symptoms. The practice of putting millions on drugs that cause dependency without support to safely get them off is absolutely criminal.” (KW, Evanston)

• “A big problem with SSRIs, SNRIs and benzos is people try to quit and even with what they think is a reasonable taper, often directed by a primary physician, find themselves slammed with unbearable depression and/or anxiety they mistake for their “real self” returning. It’s actually withdrawal, but they’re convinced they need the drug more than ever and return to it. I watched two close friends go through this. Withdrawal can be anguishing, even in measures, but can eventually offer more of a sense of pride and self-ownership than ever. See Benzobuddies online forum for indispensable support, they now include quitting antidepressants.” (gw, usa)

• “Many people I know who have been on antidepressants describe near debilitating experiences trying to get off them, with little to no help from their prescribing physician. The ‘brain zaps’ are very real, severe dizziness. It’s easier for doctors to refill and for people to continue taking these drugs rather than deal with the transition.” (Lan, California)

A variety of professionals describe welcoming better tapering information, slow taper protocols, and informed consent:

• “As a psychotherapist, I applaud this wholeheartedly” (DL, U.S.)

• “I am an LCSW, and I talk with clients about exactly this all day every day… social connection, exercise, less screen time, mindfulness, meditation, creativity. It’s a step in the right direction. I’d also say making it easier for people to get therapy would be really helpful.” (Stephanie Adams, Murfreesboro, TN)

• “As a psych NP, I rarely prescribe SSRIs. Statistically they do almost nothing for depression, once you include the many negative studies that the pharma companies didn’t publish….RFK Jr. is still wrong about most things though” (Mr. Wick, Ohio)

• “I am shocked by the number of children in our community who are in therapy and on medication…. In one case it is a mentally ill parent who needs help but the child, who once had an amazing facility with emotion is now rendered unable to empathize or access emotion.” (Mental health care professional, New York)

• People stay on antidepressants for decades because they start tapering down and have significant withdrawal symptoms. It’s not like a blood pressure medication where each week I’ll reduce my dosage by 25%. The tapering with antidepressants needs to be in tiny, minuscule increments. (this person encourages people to check out Outro Health — an online platform developed by leading researchers with physicians who will work with you using the safest hyperbolic method). (Debra, A social worker in ATL formerly in NYC)

• “After decades working as a therapist in the mental health system, I want to say, it’s about time (way past time!) that Americans get more accurate information about the side effects, discontinuation challenges and the need for very slow tapers — with knowledgeable doctors (most trust Big Pharma taper guidelines which are way too abrupt and still not well researched) — off SSRIs. I’m hoping the understandable concerns about Kennedy’s leadership at the federal level will not confuse or lessen the importance of the information being discussed. Our for profit Big Pharma system cannot be trusted to provide full and unbiased information so people can make the best decisions for their mental health with their doctors. MUCH more sound science, accurate tapering data and accountability is needed with pharmaceutical use especially in psychiatry.” (East Coast therapist)

Several people highlighted identifiable gaps in what people know — compounded by the natural confusion many people feel about the experience:

• Catherine from Denver highlights the clear need for more research: “Pharmaceutical companies should be required to do studies about how to taper off these medications as part of the approval process. Before they start these medications, patients should be informed about the issues they will encounter when and if they decide to stop taking them. Right now people who want to reduce or stop taking these medications have to figure out how to do it relying on anecdotal information from other patients. Not everyone wants to take these medications for the rest of their life.”

• Indigo from the Pacific Northwest admits it’s mighty hard to tell what’s really happening on a personal level: “These medications can exacerbate mental health issues too, and unfortunately the only way to tell if the medications are the cause is to stop taking the medication; and the only way to test is to increase the medication. Both are not ideal.”)

• And an anonymous commenter emphasized how unclear the larger picture continues to be: “There are a lot of anecdotes about both the helpful and harmful sides of antidepressants but notably very little on the aggregate effects. Are Americans being overprescribed, resulting in net harmful outcomes? Or do they actually need more treatment? Or are they consuming about the medically warranted amount? Nobody — not individuals, not doctors, not professors, not epidemiologists — seems to have a clue.”

• A commenter called “carmel fruit farmer” in NY wondered why people aren’t paying attention to the research that exists: “It is shocking to me that this research (showing the drugs are not generally effective long term) is widely ignored, but perhaps because they often bring short-term relief, doctors don’t suffer any consequences from prescribing an ultimately ineffective treatment.”

• “The difficulty many patients have stopping SSRIs (as well as SNRIs and tricyclic antidepressants) is underappreciated by general practitioners.” (JC, Brooklyn)

• David in Washington, D.C., shared his belief that there were “many hundreds of thousands of people who are hit by serious withdrawals from SSRIs which were never warned by their prescribers. Prescribers often then routinely attempt to blame these new symptoms on relapse and deny what patients are experiencing. I have personally spoken to hundreds of people this has happened to. This is a system failure.”

As reflected here, many of the positive comments were not anti-medication. They were pro-support. Commenters described being started on medication too casually, kept on it too long, given too little information about side effects, or left to figure out withdrawal on their own. They also often framed the initiative not as a reason to take medication away, but as a long-overdue attempt to give patients informed consent, individualized guidance and a realistic path off medication when they no longer need or want it. As reflected here and below, these people draw on their experiences to raise meaningful questions, such as:

• What would a trustworthy evidence process look like — especially when patient stories point in different directions?

• What evidence should guide this — anecdotes, population data, clinical expertise, patient experience?

• Are medication harms being addressed too late — after people are already dependent?

• Should tapering research, informed consent, and discontinuation planning be required before medications become routine long-term treatments?

How do we know who should stop? Susanna in Canada wondered: “It may well be that SSRIs are overprescribed, but he offers no empirical evidence as to who should stop and who should continue, and further, he wants to lump everyone in the same group…..It is difficult to know which cases need a short course and which are long-haul. Blanket pronouncements are likely to do a lot of harm.”

In other words: Can policy distinguish between overuse, misuse, underuse, withdrawal harm, and life-saving long-term treatment?

Some wondered whether we’ve been too quick as a society to ignore other ways to support those with depression:

• “I was depressed at some point in my life and after talking about it for 3 minutes with my doctor he immediately jumped to antidepressants. Not diet, not exercise, not social contact. But pills. This experience has been echoed by most of my friends. This country is obsessed with a quick pill to solve an issue. …Those are 99% of the time not the solution. Very few people have exhausted all the options that would make them require those pills.” (Bernard, California)

• “If your gut is out of balance, your mental health is too. Fixing your gut microbiome is a game changer. Also, express your feelings and thoughts, exercise, eat healthy foods, be of service to others.” (Frank, austin)

• “Instead of treating underlying situations like loneliness, social media induced distractions & anxiety, people are simply seeking solace in antidepressants. The next big thing that is already here is weight loss drugs. Anyone that has without an iota of conviction to limit eating, or make healthy choices in food and exercise is now jumping on the Ozempic bandwagon. I applaud Mr. Kennedy is at least trying to address this.” (Columbus, OH)

A self-described middle-aged woman from Massachusetts described her relief and excitement that more attention is being given to this: “As someone who has tried many psych meds and had withdrawal, I’m thrilled to see a push towards other things that have clear benefits, both short- and long-term: nutrition, exercise, social connection, & therapy (CBT, EMDR, DBT, IFS, ACT, ERP, etc., etc.). I’m (saddened) at how quickly providers reach for pills, multitudes of them. I have seen many people on 2, 3, 4 different psych meds — what on earth are providers thinking?!”

But a number of people expressed broader, more cynical levels of distrust in the system as a whole:

• “1 in 6 Americans take an SSRI, and the APA has the audacity to push back at the suggestion that they’re overprescribed.” (RGB, OR)

• “My wife is a Pharmacist and dispenses antidepressants to hundreds of patients each week. I can tell from our casual discussions (no names taken) that there is drug pandemic in this country. People are getting prescribed these mind altering medicines way too easily. A lot of them are often too young.” (Columbus, OH)

• “Pharma’s mission is to get you on their medications and make you life long customers.” (Richard, Boston)

• David from Washington, D.C., pointed out that “Over half of U.S. psychiatrists (55.7%) accept industry payments from pharmaceutical companies totaling over $340 million between 2014 and 2020.”

• “My gut tells me it’s possible that the system could be corrupted by profit-seeking pill manufacturers who get doctors to over-prescribe their medications in an arrangement that benefits both of them at the expense of patient safety and health. But I’d rather have regulatory decisions in this area made by qualified medical experts looking at data” (Christopher Walker, Tainan, Taiwan)

• “1 in 6 take SSRIs, Big Pharma has totally rigged the system. A tiny tiny amount of the population needs SSRIs. The rest, NO,” wrote Frank in Austin — pointing to 2008 research showing antidepressants barely outperforming sugar pills in trials.

• “Wow this caused me to sit up and take notice. The Trump admin of all people taking steps on the huge antidepressant overprescribing issue?? Seems like bizzaro world but here we are. This dirty secret is simple: it’s faster and more profitable for providers to just hand out pills than to dig deeper and find behavioral solutions.” (Ro, San Francisco)

• “Psychiatric meds are vastly overprescribed in North America and often without a psychiatrist involved or only briefly at the outset of treatment before you’re handed off to a family doctor and an LCSW. The reckoning can’t get here soon enough.” (AM, Canada)

• “The fact that (Kennedy is) not a doctor is a monumental qualification. The Pharma companies own this country.” (Swede, midwest)

Other related questions were raised — such as whether screenings catch struggling kids early, or create false positives and unnecessary treatment? And who decides?

“Regarding mental health screening- there are many clinicians who are advocating removing these screenings because of the very high number of false positives they produce. The screening process for many mental health conditions is very broad and subjective and can lead to the unnecessary drugging of children which carries its own risks.” (David, Washington, D.C.)

Some begrudging acknowledgment that Kennedy was at least right about this:

• “I find myself agreeing with Kennedy on this issue (for once), as research indicates that these drugs are not generally effective long term.” (carmel fruit farmer, NY)

• “I’m no fan of Kennedy, but there’s some truth to what he’s saying….there’s a point where many want to stop taking the medication, but it’s really really hard.” (Debra, A social worker in ATL formerly in NYC)

• “Kennedy may be off on a lot, but this topic isn’t one of them.” (Pum1917, Vancouver, BC)

• “I hate RFK Jr. He’s very dangerous. But I also think SSRIs are overprescribed and their risks (though not often life threatening) are not sufficiently discussed. The side effects are real. While I’m not advocating or suggesting Kennedy is right, there is truth in what he’s espousing.”

• “Even a broken clock is right twice a day. I wanted to hate this given RFK’s wild absurdities, but his quotes seem almost reasonable about using these medications as an option as opposed to the default treatment. They have a place (and they’ve had a place in my own life) but unfortunately he has a decent point here.” (Mike, nyc)

• “This is long overdue, so I applaud RFK on this though he’s mostly a crank. Almost 17% of the population being on daily psychiatric medications is a stat that should alarm all of us. The ease on which these prescriptions are doled out over the recent decades is nothing short of criminal negligence. These medications have their place in therapeutic care, but they are used and abused far beyond that. Providing resources to help people taper off of these is a great idea, hopefully there is actual substance and resources behind this proposal. Imagine if an adversary targets SSRI factories around the world. A widespread and sudden shortage would render many people incapacitated.” (Rory, Alexandria, VA)

• “Kudos to Secretary Kennedy. Taking a drug for too long can produce irreversible mental and physical adaptations.” (Sequel, Boston)

• “Sounds like a positive step. I believe several books have been written by people, particularly women, who thrived subsequent to weaning off these drugs. However, Big Pharma et al. won’t take such revisions lightly.” (David Cohen, Roslyn Heights, NY)

• “Great idea!...SSRIs are not suitable for anything other than temporary treatment if so. A recent Lancet study found them effective no more than 15% of the time compared to a placebo.” (Conservative Liberal, CA)

As you can see above, whatever reservations they may still have about the messenger, a striking number of commenters welcomed the underlying goals: more information, more informed consent, more attention to withdrawal, and more support for people who want to taper safely.

These positive comments were rarely simplistic endorsements of Kennedy. More often, they were qualified affirmations from people who had experienced the problem directly. Indeed, the most compelling positive comments were often personal rather than ideological. They came from people who had struggled to discontinue psychiatric medications, people who felt poorly informed before starting them, parents who had to research tapering protocols themselves, clinicians who had seen overprescribing or inadequate guidance firsthand, and patients who held two truths at once: these medications can be lifesaving for some and harmful, blunting, or difficult to escape for others.

2. Many other people can’t seem to get over the idea that this is (now) connected to Robert Kennedy Jr. and Trump — with their frustration and fear seeming to overwhelm any curiosity.

Even though the research and advocacy involved in helping support those tapering spans decades and even though those who have benefited from these efforts span every belief, political background or worldview, the fact that Trump and Kennedy (and Tucker) have been responsible for bringing it more into the public eye appears to irreparably stain the whole issue for many.

The strongest pattern here is a much broader political reflex, rather than simple disagreement about antidepressants, withdrawal, or overprescribing. Many readers seemed to interpret the entire initiative primarily through their distrust of Kennedy, Trump, MAGA and the current administration. That distrust often overwhelmed any curiosity about the substantive questions around long-term prescribing, withdrawal, informed consent or non-drug supports.

Some reflected a belief that nothing good can come from this administration — with their overt hostility towards RFK and Trump reaching a point that they openly acknowledge they cannot see anything positive or consider anything good coming from these efforts:

• “This man is a danger to society. He needs to resign. To my reckoning he has not one idea worth a salt.” (Steve Mason Ramsey NJ)

• “Lunatics and grifters, ALL of them in this administration,” writes KG in Louisville, KY. “RFK Jr. might have a couple of sound ideas regarding health and well-being every once in a while….A Magic Eight ball could guide U.S. healthcare policy just as effectively.”

• “Of all the truly ridiculous things that are going on in the United States under Trump, RFK Jr. being in a position of great power in the health care field is the most ludicrous and dangerous” (bstar, baltimore).

• “RFK Jr is the last person on earth I would take advice from on my medical care.” (JD, USA)

• “Why should we believe one word that comes out of the mouth of anyone in the Trump administration? They constantly lie, lie, lie. Kennedy is no different. He has an agenda and he will say what he thinks he needs to say, as well as take unilateral action, to accomplish that agenda. He has been a disaster for Americans’ health.” (JenD, NJ)

• “Kennedy has absolutely no business occupying the job he does. As is true with the entire Trump cabinet.” (Patient Zero, Portland, OR)

Others emphasize how this seemed to be another example of this administration rebuffing expertise — and speaking where they don’t have any credibility to do so. As reflected below, the administration’s questioning of other experts and push-back on other widely accepted conclusions leads many to feel deep suspicion about this seemingly happening again:

• Cynthia Andersen writes, “First off, RFK Jr is not a medical doctor and has no business in addressing medical issues. Like POTUS, he refuses to consult or acknowledge experts in the field.”

• “If RFK Jr. would stop practicing medicine without a license and promoting junk science and “junk scientists” we’d all be less depressed.” (Susan, Paris)

• “This guy has NO business dispensing medical advice!” (Debbie in NC)

• “Kennedy should keep his hands off our healthcare. He’s not a doctor or health professional of any kind.” (Steven Carters, Oceanside, CA)

• “Might as well take your health and medical advice from the first random person you meet on the street, for all this guy’s qualifications. Antidepressants save lives. RFK Jr.’s advice won’t.” (JLC, PNW)

• “Who is Bobby jr. to tell patients what they need or don’t need. That’s for one’s physician to decide.” (Wind Dancer, Cheyenne, Wyoming)

‘Even if antidepressant overuse is real, RFK is the wrong messenger’ some effectively say. For instance, one immunologist from Malvern, PA writes, “While Mr. Kennedy may be right about inappropriate use of SSRIs, I’d rather get my guidance from qualified mental health professionals.”

Implicit in these concerns is the question: Who decides when medication is needed — patient/doctor, or federal officials? How can the initiative support informed choice without becoming pressure, restriction, or interference?

“Only a patient and their psychiatrist may decide when and if it makes sense for the patient to discontinue psychotropic medications,” writes an individual from Maryland. “The remainder of this dialogue and numerous lay opinions is irrelevant.”

For some, they made clear their feelings that this administration is part of why they feel depressed: “I suspect that Kennedy is now a major source of depression for many people,” said Bodger in Atlanta. “I know that I get really bummed out when I see or hear or read or even think about him although I doubt that there are any pills that would help.”

There were many other similar sentiments:

• “With all due respect, does anybody really think that the right time to forego antidepressants is while Trump and his minions are running the country into the ground? As far as I can tell, we’ve never needed them more than we do right now.” (NT, Saint Paul MN)

• “Imagine the next 2.5 years under the Trump administration without antidepressants.” (VV in Connecticut)

• “Most people are probably taking antidepressants to survive this unhealthy political climate, managing rising costs/low pay, and the absence of meaningful healthcare” (EGT, NYC)

• “Just the idea of Kennedy makes me depressed.” (Jim London)

• “If we could throw out the Trump administration, that might enable a lot of us to throw out our antidepressants” (Todd, WA)

• “Here’s the deal: you and your administration step down and I will quit taking my antidepressants” (Seaskiguy, Seattle, WA)

• “The use of antidepressant medications should substantially ease up with the eventual demise of MAGA and the Trump Administration.” (Steve, Le Chien)

• “Guaranteed that the number of antidepressant prescriptions will drop precipitously once Trump and his minions, including Kennedy, Jr., are no longer in a position to ruin people’s lives.” (N christopher smith, virginia)

• “It will be so much easier for everyone to quit antidepressants when the entire Trump administration is a bad memory. Just the thought of it is a balm.” (W C Maddog, WC. Pa)

• “Americans are depressed, freaked out, and sleep-deprived because Donald Trump is in office.” (Portland)

• “I rely on antidepressants to help me cope with the constant stream of difficult and distressing realities we’re facing—cruel mass deportations, children being separated from their families, attempts to suppress free speech, efforts to silence the media, actors, and late-night hosts, economic instability, war, mass layoffs, the blatant enrichment of the President and his allies, the Epstein files, and so many other troubling issues.
  Antidepressants and therapy are the only things helping me maintain some sense of optimism—that things might eventually return to some form of normalcy, and that I’ll be able to move through the world without feeling weighed down by the level of hatred we’ve endured over the past two years. In the meantime I will gladly take my daily little blue pill!” (Debbie, Connecticut)

• “What Trump is doing is systematically raising anxiety and depression levels throughout the U.S. (and the world, for that matter) with his reckless aggression and threats to other parts of the world, his raising prices here through tariffs and energy, his wanton destruction of national treasures (selling and leasing public land for his whims or cronies’ profit), his authoritarian tactics, his suppression of democracy...and many other things to list here. And, because Republicans are standing by and doing nothing to ameliorate any of the effects of these policies. Those plummeting approval ratings? That’s where you’ll find anger, fear, and despair. I personally know people who have felt they will have no choice other than suicide when the Republicans cut Social Security and Medicare to pay off their tax cuts and wars of choice. And I’m a psychiatrist, by the way….” (Dumbstruck, Vermont)

• “Now we have more people feeling depressed and/or having a feeling of helplessness thanks to this very government.” (Opus, Cape Cod)

• “Psychotherapy and SSRIs are the two component glue that holds my sanity together. Recently, I’m having lots of sessions with my therapist that are focused on the overwhelming sense of dread whenever I remember that people like RFK Jr. exist and wield incredible power. My therapist, in turn, recently upped my meds.” (Rhode, Island)

• “Psychotherapy and SSRIs are the two component glue that holds my sanity together. Recently, I’m having lots of sessions with my therapist that are focused on the overwhelming sense of dread whenever I remember that people like RFK Jr. exist and wield incredible power. My therapist, in turn, recently upped my meds.” (Rhode, Island)

Again, some saw this as another example of this administration harming the American people:

• Val in New Jersey insisted this was another example of this administration “just continu(ing) to ‘pick’ on the people who they should be serving.”

• “RFK Jr. should mind his own business,” Mary in Indiana says. “I know what works for my own mental health not the government. He should work on himself before exploiting society.”

• “I’d be open to the conversation on if there is an overprescription crisis” writes Caitlin in Texas. But added, “These are life-saving drugs and these matters should be handled with care but this toddler is taking a sledgehammer to the system and hoping it works. It doesn’t matter to him who gets hurt in the process.” (Caitlin, Texas)

Given their deep hostility and distrust to the administration, many could only see the outcomes of this tapering as a possible disaster. For instance, Thurston Howell III in Los Angeles wrote that if this “ill-advised policy…causes a person who needs antidepressants to lose access, that person can become suicidal and/or dangerous and, at a minimum, lose interest in functioning appropriately and being productive. Stigmatizing them and jeopardizing their access to the drugs is both cruel and dangerous.”

In the wake of this all, some pushed back: wondering, are we really being fair with this proposal — or dismissing it reflexively due to our political passions?

A smaller number of commenters argued that many readers were rejecting potentially legitimate concerns precisely because the wrong political messenger had raised them. For instance:

• Bernard in California noticed this same theme: “Thus, anything RFK Jr says is automatically bad and dismissed. If he said apples were good, most people here would stop eating apples.”

• Elle writes, “Those of us who are desperately seeking a quick end to the current MAGA regime accomplish nothing when we launch ad hominem attacks on any and every Republican. Let’s lead by example, let’s be reasonable, let’s refuse to be cruel. If one or two good things can come out of this administration, that’s a win for us all.”’

Several asked why this is a ‘conservative issue’ — rather than a liberal one (which it’s been more so for decades) — and wondered what would happen if the politics were reversed:

• “MAHA has outflanked the Democrats. Being skeptical of big pharma should be a liberal issue. It was prior to 2020. 16 percent of people is too much to be on daily SSRIs. I was overprescribed them as a child.” (Sal from New York)

• “If RFK was a Democrat, this left wing readership would be cheering him on.” (Swede, midwest)

• “Something tells me if this was being pitched from a trusted left leaning outlet the reaction would be quite different.” (Reader, Tribeca)

Several wondered whether the outrage was inflated far beyond what reality called for — and wondered whether critics were too quick to condemn something with potential real benefits:

• “Psychiatric medications have a role in care, but we will no longer treat them as the default, we will treat them as one option, to be used when appropriate, with full transparency and with a clear path off when they are no longer needed,” Mr. Kennedy said. That actually sounds quite reasonable. But judging from the most liked comments here, one would think that he’s coming for your meds. (Rio Grande Valley)

• “Outrage over what? These recommendations are just calling for more information, safer deprescribing and informed consent. No one is trying to take your SSRIs away. Sheesh.” (Numa, Ohio)

3. There are many important questions being raised by people with concerns about this initiative and the approach being taken.

The fact that politics has clouded this conversation shouldn’t surprise anyone (is there a single issue in America where this hasn’t happened?). This abundance of hostility should not distract from a whole range of other important questions.

Many commenters were not simply defending antidepressants or attacking the tapering initiative. They were asking whether a legitimate concern about overprescribing and withdrawal can be addressed without reviving stigma, discouraging needed treatment, ignoring chronic illness, overlooking access barriers, or replacing one kind of one-size-fits-all medicine with another.

I attempt to summarize these thoughtful concerns below, in their own words — organized into a few broader areas:

First of all, many people described personal benefit they have found with their antidepressant treatment so far:

• “I have struggled with depression, my whole life. And I was born when there was no social media in fact in my childhood answering machines came on the scene. Fluoxetine was a lifesaver for me. I have now been escitalopram since the late 90s. I’m almost 71. Why in the world would I stop this medication?” (Darlene Moak, Charleston SC)

• “Prozac saved my life. I had terrible OCD since I was a child. I’ve been taking 20 mg (lowest dose basically) for much of my life. When I stop taking it…symptoms return….For me a low consistent dose works wonders.” (Dallas, TX)

• “For some of us, these meds literally are a matter of life and death.” (Linda K, California)

• “If you just suddenly stop, you increase the chances of some withdrawal symptoms. I have been on an SNRI for decades for dysthymia. It has made a huge difference.” (Jay, Canada)

• “Frankly, unless you have depression and/or anxiety and have taken an SSRI, you have no idea what you are talking about. For reference, I do exercise, eat relatively well, get treatment for sleep apnea, go to talk therapy once a week, have strong relationships, and take a GLP-1. I am very lucky to be able to do so. Regardless, I was prescribed Lexapro at 42, and it has literally changed my life for the better, even with everything else I am doing. So much so that I would never consider stopping the medication. For those of us who it works for, it is an absolute blessing and not something that should be discouraged.” (Name/location not captured)

• “Antidepressants saved my life and still do.” (Independent, Texas)

• “I thank God every day for the medical miracle they are to my brain. They are the difference between a life well lived and crawling under the blankets to “cope” with depression and anxiety.” (Too old for this, Boston)

• “Without my antidepressants, I would not be able to function in society,” says Sara Emerle in Albrightsville, Pa. “They give me a chance to live a life that isn’t defined by constant pain. That isn’t overprescribing; it’s medically necessary care….I don’t know what would happen to me without my medications.”

• “I am on antidepressants and they allow me to have a career! I can do my job and do it beyond well because my medicine inhibits my social anxiety disorder. ITS FOR MY MENTAL HEALTH!!!” (Sarah, North Carolina)

• “I started taking Lexapro shortly after (Trump) was elected the first time, and I honestly believe it saved my life. I was very skeptical about starting it, but my doctor, correctly, said that it would help me function a lot better in the world. I still have anxiety but it is now manageable, rather than crippling. I will take it for the rest of my life.” (BC, New England)

• “Whether it was a bout of ‘male menopause’, family trouble or far too much international travel thru changing time zones in a very short period of time or all combined, fortunately my good friend a Westchester Cty. NY Orthopedist recommended 20mgs/day of SSRIs. They did the trick and along with swimming every day, enjoying my work, family & friends, they helped put me back on track!” (NYer in the EU, Germany)

• “I intend to restart (antidepressants), as they help with the daily feelings of doom I have.” (Carla, CA)

• “There are medications, and there are medications. I had to try a couple of them before we found the one that worked for me. I’ve been on it for about 40 years, and I would never give it up. My life is so much better now, thanks to an SSRI that works really well for me.” (Not My Real Name, Monterey County)

• “I cannot possibly stop taking antidepressants while the state of our government is so despair-inducing. But seriously, why should I? I lived half my life weighed down by an enormous amount of childhood trauma. Antidepressants have helped me live more fully and comfortably — with almost no side effects. They may well have saved my life.” (Colleen, East Haddam)

• “I have gone from an introverted and seriously depressed young mother to an extroverted fully engaged grandmother over my 74 year lifetime of taking two different antidepressants. I would never jeopardize the joy I have found in my current life by quitting these wonderful meds! I also have never experienced any side effects.” (Merle Savedow, Philadelphia)

• “I had panic disorder in ‘98. I had three children, a wife and job. I struggled. No sleep for days. It was hell. I went to a GP and he had no clue. I decided to go see a psychiatrist against my wife’s wishes because of the stigma. After a short conversation, he almost immediately diagnosed my issue and prescribed Zoloft and trazodone for sleep. Helped almost immediately. I am now 72 and healthy, looking back on a successful career and three lovely grown children. Stable, no side effects, and steady state for 28 years. I have no complaints. Say what you will.” (Alaska Tom, Alaska)

• “These medicines have been a great benefit in my life….If you wanna quit them and try something natural, go for it. But, leave me alone to make my own choices. I’m functioning just fine and living a happy life.” (Bob McBobbybob, Arizona)

• “Prozac has saved my life. A few years later, my doctor added Topamax because it turns out I was BiPolar Type 2. Without these medications I doubt that I would be here. RFK, Jr. has no business interfering in anyone’s medical care, he is NOT a physician and my medical or psychiatric care is NOT HIS BUSINESS.” (txdoglady, Albany, Oregon)

• “Without antidepressants I would probably not be here today. I will not be taking mental health advice from a man who dumped a bear carcass in Central Park.” (Gaia, Earth)

• “These medications saved my life twice. Each time I was suicidal from PTSD/Anxiety/Depression. The meds along with talk therapy have made me the mostly functional 71 year old I am now.” (Oldgoalie, Michigan)

• “I have been on happy pills for over 40 years….I would have killed myself by now without them.” (Kris R, Sunny CA)

• “For years I struggled and Lexapro is the only thing that has helped me sleep through the night.” (Margaux, Denver Colorado)

• “There are those of us with serious, chronic mental illness, including major depressive disorder, that benefit from SSRIs. Nobody surveyed me when coming to these stigmatizing recommendations. In the years before I took SSRIs, my mental health flailed even with therapy and appropriate lifestyle choices. SSRIs stabilized me enough to level the playing field so I could do the work in therapy.” (Kristi, Knitting out there somewhere)

• “Antidepressants can be life-saving, and there should be no stigma associated with their use. No one would stigmatize a diabetic for needing insulin, or someone with a strep infection who took an antibiotic.” (EJ, Northern California)

• “I live with bipolar 2 and feel I am well cared for which include antidepressants which I will likely be in for the rest of my life. A life that will possibly be long because of the benefits of antidepressants.” (Eleanor Harris, South Dakota)

• “Millions of people are functional because of antidepressants.” (Wendy, Denver)

• “Antidepressants saved my life on three separate occasions. Each time, I was clinically depressed. Each time, I absolutely would have ended my life if not for Wellbutrin. No amount of exercise or sunshine or saunas or red meat or whatever else Kennedy wants to promote would have helped me. Each well-intentioned suggestion only made me feel worse; I felt guilty and at fault for my own depression. It was like trying to fix a broken bone by putting weight on it. Antidepressants are the cast for the broken bone. To suggest taking that away or lessening its use: it’s just appalling. By the way, each time, I was able to step down my dosing under a doctor’s care without adverse effects. Doctors know what they’re doing. Kennedy does not.” (ML, Here)

• “Wasn’t until my 40s with multiple severe life pressures that I finally got on an antidepressant and it changed my life for the better. I never plan to stop, nor should I based on the genetic testing.” (Spring, Portland, OR)

• “SSRIs and other psychoactive drugs saved my life by controlling the depression long enough for therapy to become effective.” (KMT, Illinois)
  “(Mental health) conditions run in my family and I’ve struggled with suicidal thoughts since my teens. The medication allowed me to go out in public and function when I could barely leave the home. It allowed me to get out of bed in the morning and go to work when I wanted to not go on.” (Philip G, Raleigh, NC)

• “(Antidepressants) saved my life. Taking them made me realize how “normal” people exist. I’ve been 20 years on the same one. Have stopped twice with no issues but the depression came roaring back after a decently long break. No major side effects. Not worth stopping — no upside and many downsides. Without them it’s likely I would not be alive. So read your books and studies and believe what you like, but I’m deeply grateful they exist and I have access to them.” (Grateful for SSRIs, Baltimore)

Some who found benefit acknowledged the complexities of treatment and the potential value of learning more about safe tapering. Mike Charlie from Montana wrote: “SSRIs helped me through an acute episode of depression. Maybe even saved my life. But coming off of them was awful. Nausea for weeks. Sleeplessness for what felt like months. I was determined to get through it because I didn’t want to go back and repeat any of the experience. For the long run, however, Cognitive Behavioral Therapy was the best 500 bucks I ever spent. Of course it wasn’t covered by insurance.”

Others described family members benefiting:

• “I have taken myself off antidepressants before. I can get through the withdrawal, that’s not an issue. But I feel so much worse when I am not on them. The article talks about emotional blunting. Some of us need our emotions blunted because anxiety and depression are painful,” said Jennifer from Ohio. She later added, “I need to be blunted emotionally because when I’m not, I have suicidal ideation.”

• “For members of my immediate and extended family, SSRIs have been life changing and are indispensable.” (WWRD, NYLON)

• “Antidepressants saved my mother from a life of constant depression. Every time she went off her meds, she relapsed. Every time she went back on, she came out of her depression within a few weeks. I am very grateful to medical science that she recovered her health, and my childhood and our family lives were also saved.” (WikiMart, Vancouver)

• “My husband has been on antidepressants for decades. It changed his life and most likely saved our marriage. This June, we will be married 53 years. If any moves are made where his medication is no longer covered by insurance or goes the way of birth control and is no longer available, I am sending him to live with you.” (Diana CA, USA)

• “Some people need to be on antidepressants, my 94 year old father in assisted living is on Lexapro and needs it to control his anxiety disorder.” (Wind Dancer, Cheyenne, Wyoming)

• “(Lifestyle approaches) work for me,” Chris T. from Boston says, “It doesn’t work for my partner, who is like night (darkness) and day (light) off and on his antidepressant. He could exercise, sleep, eat well, meditate, whatever, but that single once daily pill is the only thing that ever seemed to make a difference. People need to remember that these medications are actually life changing for some people.”

• “My mother’s anti-anxiety medication changed my life. A children’s hospital emergency room nurse, she did her solid best to keep two boys locked in the house away from all potential dangers she saw at work daily. I remember twice her getting ticketed for driving too slowly on the highway. After medication, I traveled to Italy to live with a host family for a summer — every summer. I ventured into the city regularly, alone and with friends. By 17 I traveled the East Coast by Greyhound with a couple friends with her permission. She got her first speeding ticket when I was 15 while attempting to rush my brother to his hockey game, a sport he was suddenly okay with him playing. She traveled to Italy with me when I was 18 and did not hyperventilate on the airplane. Her medication didn’t just represent a lifting of the veil of anxiety for her, it was freedom for my brother and I. I cannot speak to side effects, but she could have stood to be a little emotionally more numb if anything. The only side effect I noticed was that she appeared to be really living for the first time in my life and probably for the first time in decades in hers.” (George S, Maryland)

• “My children are both testimonials to the great benefits of these drugs. My son’s bipolar was terrible until he got the right drugs. I didn’t think he would finish high school at one time. Now he has a masters in computer science and is very successful. Thank God for these drugs!” (Linda, Chicago, IL)

• “Find out what meds work for you, or in my case, my son. He’s still here, and I am grateful for the medication.” (Jax, SC)

Others shared their general perception of the larger benefits:

• “For many people their antidepressants are like oxygen, they can’t live without them.” (Juan, Miami)

• “Antidepressants, while perhaps overprescribed and misused or abused by some, have helped millions of people function more optimally, productively, happily.” (Scratching, US)

Second, some raised concern about pressure some may feel from these tapering support efforts. Specifically, for people who experience depression as chronic, the focus on tapering and considering other things can feel off-putting — with a sense of ‘when are you getting off’ pressure unwelcome.

• “For many people, psychiatric conditions are chronic,” writes someone from New York, “so this is like telling type one diabetics to stop taking insulin! But go ahead, take ibogaine, peptides, creatine, beef tallow, raw milk, and go work on a farm, that’ll fix everything.” (Name not captured, New York)

• “If the initiative were solely about helping Americans who want to wean off these drugs, that’s actually a need area. But for those of us who have determined with our doctors that ongoing treatment is best for our long-term health? Stop trying to sell us on steaks and pull-ups.” (Alex, Virginia)

One woman from Fuquay-Varina NC insisted her condition will always require medical treatment: “I hate the psychiatric drugs I am required to take as much as I hate the opioids for my husband. But I have no choice to not take them. They help me manage a rather complicated, treatment resistant condition…..I believe in prayer, self awareness, therapy, exercise, nutritional support, and even holistic medicine. But you know what? At the end of the day, I’m still going to be bipolar 1….Meds will be required.”

Another individual in Chicago asked, “Why talk about it like depression is curable?” (reflecting the belief many have that depression is inevitably life-long).

Many people support better tapering information while insisting medications remain available:

• “Fine, help those who want to stop taking antidepressants. But for those of us who benefit from long-term antidepressant use, don’t do anything that will make it harder for us to continue to fill our prescriptions.” (Ken Cooper, Albuquerque, NM)

• “I’ve been utilizing SSRIs for decades, starting in my 20s when anxiety and panic were debilitating. I have been a very careful steward of my tenuous mental health…using meditation, exercise, therapy, nutrition, and many other modalities. And they have all been useful tools. But the medication has without question been instrumental in my stability and ability to live a normal life. I have tapered off at times, for pregnancy, nursing, or just to “see”. But I have been incredibly grateful for these meds and would have had a much more difficult life without them. Medical freedom means not dictating to me about my medication choices nor negating my need for them.” (PDurgin, Baltimore)

Third, it’s clear for some people that tapering doesn’t always leave people in a better place. Depending on the circumstances, withdrawal effects during tapering can be very hard:

• “I am in the midst of withdrawal from 17 years of SSRIs, and I also wake up every day very much wanting to die. The experience of withdrawal very often does go well beyond brain zaps and some flulike symptoms.” (AM, Richmond, VA)

There were a number of worries about negative consequences as people try to taper.

• “Sorry but suicide and suicidal ideation are far worse than withdrawal symptoms.” (Howard, Gloucester County, NJ)

• “There will be more suicides. I am a physician. Antidepressants work.” (SC, SC)

• “Without SSRIs some people will no longer be able to survive, and all the therapy in the world cannot fix that. I know. I will not return to the days of debilitating depression that does not respond to gimmicky self-help strategies or one hour per week therapy.” (Tula, Vermont)

• “Not long ago — in response to the effects of overprescribed opioids — the prescribing pendulum swung so far in the opposite direction it caused a rash of suicides and dependencies on dangerous street drugs from legitimate pain pts who could no longer get the necessary meds to manage life-altering chronic pain.”

One especially cynical observer, Ethan P from Austin TX insisted that “The road off SSRIs is self-medication through alcohol or heavier barbiturate style addiction” [not true — many experience being able to go off at a gradual pace, and learn other ways to navigate emotional distress]

Sometimes declining the additional assistance of antidepressants can also leave people in a harder place:

“I have a relative who declined antidepressants because she wanted to get through it herself. She had major depressive disorder, spent two years living in acute despair, and the despair slowly melted away over the next five years. She has never been able to work since and is now at retirement age. So Secretary Kennedy, did she make the right decision?” (Jay A, Edmonton Alberta)

Fourth, when the medications induce more depression, it can be really confusing:

“I believe that maybe SSRIs could help some people. I’m not saying that. It’s just that when they make you want to kill yourself more and the doctors tell you ‘that’s normal, it’s a side effect of the medication’ what’s the good of taking it if it’s supposed to make you want to kill yourself less?” (Ben, Missouri)

Some wonder: Are we confusing withdrawal with relapse — and how can patients tell the difference? When symptoms return after stopping, is that withdrawal, relapse, or evidence the medication was needed? Maybe these aren’t withdrawal effects after all?

So much of the focus in the withdrawal community is helping people recognize withdrawal effects, instead of assuming it’s all a return of depression. One man in Oklahoma, going by “Vadoret” — said just the opposite, encouraging more scrutiny of whether withdrawal is an accurate language for what may perhaps be a return of depression:

“In some people depression is a chronic medical problem that, like other chronic medical problems, necessitates ongoing treatment. I have never heard that recurring hypertension when antihypertensives are stopped, or recurring high cholesterol when agents for dialipidemia are discontinued, represent “withdrawal”. People understand that, if you stop treatment, the problem recurs. Sometimes nutrition and exercise are not good enough for maintaining a normal blood pressure and blood lipids, and therefore pharmacological treatment is needed (and can be lifesaving). In the case of depression….for some people, exercise, psychotherapy and nutrition are not enough, either. Then, antidepressants are indicated.”

Others shared similar sentiments:

• “Maybe his relative was “suicidal, every day” after stopping their antidepressant because they were depressed and needed their medication?” (Mary, Waterloo NY)

• “That’s not withdrawal nor an after-effect. That’s an indication that she needs to go back on SSRIs!” (Terry, Texas)

• “The fact that you cannot get off of it may suggest that you actually need it. Just like a diabetic patient cannot get off insulin. I wish you well.” (Evergreen, CA)

• Citing the ordeal of an unnamed family member who he said “was suicidal, literally every day” when she discontinued an S.S.R.I. after taking it for several years, Annie from British Columbia said, “It sounds to me as if the medication was HELPING his family member.”

• “If I have hypertension and decide to abruptly stop my medication then I will have a steep rise in my blood pressure. Why would anyone be surprised that someone who needs an SSRI becomes more depressed when they stop their pills?” (Richard Grossman, Portland, Maine)

Still others emphasized the potential role of withdrawal: “I believe the reason they are unpleasant to get off is because of withdrawal. In many cases, the behaviors are much worse than before one took the medication.” (Eli, California)

Fifth, several pointed out that relieving social, economic and political distress could really help people with depression. As reflected below, some asked: Are antidepressants being used to compensate for deeper social problems? Are medications being asked to solve distress that is partly social, economic, relational, or cultural?

This group shifted attention away from medication entirely, arguing that depression and anxiety are being driven by economic insecurity, isolation, political chaos, unaffordable health care, poor working conditions and social breakdown.

• “The best ways to fight depression would be to address the root causes. This includes increasing access to healthcare, education, and opportunities to leave unhappy environments whether they are families, workplaces, or neighborhoods.” (Eli, California)

• “If the government wanted fewer people on antidepressants they could do an awful lot more to make the country a better place to work and live. Just to start listing things....guaranteed health care, a law mandating sick leave and work breaks, paid family leave, and fully funded schools.” — RWWR, US

• “Want to get Americans off antidepressants? Give people universal health care, paid parental leave, free college education, free childcare for working parents, and stop policing our bodies or our personal choices and stirring up controversy for financial gain. Oh, and raise the minimum wage to a livable one. Amazing how that would work for so many.” (Karen, Bay area)

• “(Don’t) let the anonymous polluted rat-race maze world off the hook here: it needs renovating as surely as did the HVAC system in that 1990s brick schoolhouse. Our immune systems are overtaxed with pollution and our tissues and organs are inflamed with the stress of loneliness, rushing, overstimulation, and hypercompetition.” (Adam, Oregon)

• “If this administration actually did something to help people thrive perhaps we would see less depression. It will not improve anytime soon with the flood of layoffs happening due to AI coming on line throughout corporate America. Yes, kids should not be on social media and neither should many adults.” (Youth Wants to Know, San Francisco)

• “Nothing like losing your health insurance and drowning in bills to increase anxiety and hopelessness. Maybe our wonderful government could work on those problems instead of telling the victims to just tough it out.” (Howard Larkin, Willow Springs, IL)

• “If people had to work only one job to make ends meet, and basic needs like health care, child care, quality food and time/place for exercise were affordable, maybe less people would need antidepressants in the first place.” (JBL, Rochester, NY)

• “In the last few years alone, the NYT has reported Americans’ problems with: ultra-processed foods, obesity, alcohol, cannabis, phones, social media, pain medication, fentanyl, ADHD medications, and now SSRIs. It’s time we take a look at the broader picture — these are not isolated issues….This cannot be separated from the political and cultural environment. A society that feels it has lost all sense of agency, and is constantly promised some magic external force will help us, will keep desperately searching for more.” (AC, New York)

• “If our government truly prioritized Americans’ well-being and success, we would have guaranteed healthcare; family leave to take care of our children and loved ones; educational excellence regardless of zip code; fair wages with continued opportunities for growth; and stability in retirement and old age. Grotesque income inequality would not exist. No wonder people are depressed.” (EJ, Northern California)

Sixth, lifestyle interventions can be uniquely challenging and sometimes not show a noticeable effect. One individual noted they can take energy many depressed people don’t have:

“The idea that a severely depressed person can just hop out of bed, prepare healthful meals, go to the gym and hang out with friends is preposterous. Depression for many makes it impossible to get out of bed, shower, and be involved at all in the world outside of the decrepit misery in one’s head. To think otherwise indicates minimal if any knowledge of this awful potentially deadly disease.” (AB, NJ)

Others insisted they hadn’t been helpful to their own struggles:

• “I will not return to the days of debilitating depression that does not respond to gimmicky self-help strategies or one hour per week therapy.” (Tula, Vermont)

• “It’s not about therapy. I can go to therapy. It’s not stopping my social anxiety which paralyzes me at work. I’m wired this way. Therapy isn’t going to stop my face turning red, my thoughts from spinning, the panic that ensues. My medicine does it by balancing the chemicals in my brain.” (Sarah, North Carolina)

Seventh, others wondered: ‘Who will pay for the non-drug alternatives? Alternatives sound nice, but they are often unaffordable or unavailable — taking money that we don’t necessarily have.’

Said another way: ‘is it realistic to recommend therapy, exercise, nutrition, and social connection without making those supports affordable and accessible?’

These people point out that psychotherapy, exercise, social connection and nutrition are often expensive, inaccessible or unsupported by insurance, making medication the most realistic option for many people:

• “If they actually wanted fewer people to use antidepressants they would make therapy cheaper and easier to access. I don’t see that as part of the plan.” (Tom, Tampa)

• “Who exactly is going to pay for the alternate treatments? It is extremely difficult to find experienced and talented mental health practitioners who take insurance.” (AB, NJ)

• “As a psychiatrist told me, sometimes a prescription is all a patient’s health insurance will cover. Psychotherapy takes too long and costs too much despite often being beneficial.” (WTK, Louisville, OH)

• “By one token I hate to say I agree with RFK Jr. on anything but we do overprescribe many medications but the alternatives would include therapy while we have a severe shortage of therapists and have no plan to address it and most insurances will not cover ongoing therapy but have woefully short coverage limits, made worse by many Americans that will no longer be able to afford either insurance or the cost of counseling.”

• “Leave it to Kennedy and his MAGA/MAHA ilk to treat the symptom and not the disease. Access to good and affordable therapy is an insurmountable obstacle for so many. Perhaps addressing that should be Kennedy’s priority.” (Name/location not captured)

• “I take Zoloft to control my anxiety disorder. I also have done talk therapy. My Zoloft costs $8 for a 3 month supply. The talk therapy, with insurance, is $179 per weekly visit, until I hit my insurance plan’s $9000 deductible. Maybe if I could afford regular talk therapy, I’d go that route more often, but I can’t. Maybe fix the cost problem first, before just telling people that they should try talk therapy instead.” (Ann, San Diego)

• “Who is going to pay for all this talk therapy after they try to push everyone off their medications?” (Carson, Newcastle, WA)

• “Who’s going to pay for all of these patients to be in therapy? Not insurance companies, not the government. Both are constantly using loopholes to get out of funding mental health treatment and as a result many therapists are no longer accepting insurance or Medicaid/Medicare so they can make a living.” (Gregory, Chicago)

• “The non-medication treatments, primarily psychotherapy, are sometimes hard for people to access in practitioner shortage areas, with limitations imposed by insurance or even lack of insurance. Discontinuation symptoms from SSRIs vary and can be very much minimized with very slow and careful titration off the drugs but must be supervised by someone who is very familiar with that process, also often not always accessible to many due to limitations imposed by our healthcare system.” (PLO, Maine)

• “Therapy is really expensive, SSRIs are cheap and relatively safe.” (Sam, MN)

• “(This initiative) recommends psychotherapy, exercise, social connection, physical activity, diet and nutrition, among other interventions.” OK, but antidepressants are covered by insurance; most of the alternatives aren’t. My Medicare Advantage plan cut the wellness benefit in half this year. For people financially stressed in the Trump economy “golden age,” money for fitness, healthy food and psychotherapy co-pays aren’t in the budget. And people working overtime may be getting a tax break, but that leaves no time for social connection. I’m in favor of cutting antidepressant use, but let’s get real.” (Spucky50, Maine)

• “Overprescription happens because we do so little to fund other types of care!!” (DH, NYC)

Others raised worries about undermining confidence in meds and increasing stigma — pointing out that the very attempt to raise these concerns about overprescription and lack of tapering support, the reality of depression could be questioned — and the benefits many had experienced on antidepressants:

• “This sounds a lot like dismissing the reality and suffering of mental illness disguised as concern. Why not include people whose lives have been improved by SSRIs? ” (N’est Pas Une Pipe, Chicago)

• “There has been so much stigma and shame surrounding taking these medications, and the Secretary’s actions are reinforcing those beliefs. “It’s all willpower, mind over matter,” meaning, “You’re just not trying hard enough, what’s wrong with you?” (anonymous)

• “I live with bipolar 2 and feel I am well cared for which include antidepressants which I will likely be on for the rest of my life. A life that will possibly be long because of the benefits of antidepressants. My brother was diagnosed with bipolar 1 and his was a short and unhappy life in part because he rejected medication for his condition. He was not clear about much at the violent and horrible end to his life but this he made very clear: he did not want to live with the stigma associated with being a psychiatric patient. I believe this ridiculous contribution from MAHA would not even be considered if mental health care was not stigmatized and this contribution from our government serves mostly to feed that stigma. Stigma in mental health care is probably the greatest barrier among so many barriers to care. And stigma can and does kill.” (Eleanor Harris, South Dakota)

• “Antidepressants can be life-saving, and there should be no stigma associated with their use.”

• “My family has a long history of depression. In college, I began to feel hopeless and depressed for no reason. I couldn’t shake the feeling of defeat. I went to one therapist who told me it was normal to feel sad in college and that I should focus on improving my lifestyle. I tried. I learned to scuba dive. I joined clubs. I was studying abroad and diving in the South Pacific, feeling just as down and miserable about myself as before, when I realized I really needed help. I went to a real psychiatrist and he told me I had severe depressive disorder, based on a quantitative questionnaire. Later I was also diagnosed with anxiety and persistent depression. I have been medicated for a long time and now can keep the feelings of irrational hopelessness and despair under control. We can’t let RFK and his cronies stigmatize mental health care. No one should suffer years of unnecessary anguish just because some regressive fools want to bring us back to the “good old days”, when people suffered with lifetimes of untreated depression. He must be stopped.” (Dan, Vacaville, CA)

• “There’s enough stigma around mental health as it is. Discouraging people from taking psychiatric medications is dangerous to themselves and potentially to others.” (GA)

• “There are so many patients out there who struggle with the stigma of taking medication that could help them. I’m horrified. Antidepressants saved my life on three separate occasions. Each time, I was clinically depressed. Each time, I absolutely would have ended my life if not for Wellbutrin. No amount of exercise or sunshine or saunas or red meat or whatever else Kennedy wants to promote would have helped me. Each well-intentioned suggestion only made me feel worse; I felt guilty and at fault for my own depression. It was like trying to fix a broken bone by putting weight on it. Antidepressants are the cast for the broken bone. To suggest taking that away or lessening its use: it’s just appalling. By the way, each time, I was able to step down my dosing under a doctor’s care without adverse effects.” (ML, Here)

• “We can’t let RFK and his cronies stigmatize mental health care. No one should suffer years of unnecessary anguish just because some regressive fools want to bring us back to the “good old days”, when people suffered with lifetimes of untreated depression. He must be stopped.” (Dan, Vacaville, CA)

Still others asked: are primary care doctors overburdened or undertrained for psychiatric prescribing? In other words: Is the core problem antidepressants themselves — or a system where many are prescribed without enough psychiatric expertise or follow-up?

• “As to the use of psychotropic medications, it is important to remember that the overwhelming majority are prescribed by non-psychiatrists most of whose whole training on the diagnosis and treatment of mental disorders consists of a few weeks in medical school. If these medications are so dangerous, why not recommend limiting their prescription to psychiatrists who are actually trained in their use? Yeah, I know we have a severe shortage of psychiatrists. Why not attempt to address this.” (Steve, New York)

• “The overwhelming majority of prescriptions for these medications are written by non-psychiatrist physicians most of whom have little training in the management of mental disorders.” (Steve, New York)

• “GPs are not equipped to prescribe psychiatric medication. The problem of course is access to the appropriate specialist.” (K. Hebert, St. Louis, MO)

Some raised concerns about off-label uses of antidepressants. One individual described resisting such an off-label use:

• “I’ve had more than one doctor try to prescribe these drugs for me, not because of depression or anxiety but because of pain. Noped out of that real fast, I still have scars from their turning me into a drug addict with “opioids are a game changer in controlling pain”. Once you start this class of drugs they are difficult to stop. Been there, done that, ain’t gonna do it again.” (tjcenter, Lansing, MI)

Two others describe benefits they had received:

• “What sage advice does Secretary Kennedy have for those of us taking antidepressants to alleviate chronic nerve pain? Does he even know that this is a recognized use of these medications?” (Allen Nikora, Los Angeles)

• “I’ll stop taking my tricyclic ADs just as soon as you cure tinnitus…the number one problem for military veterans and first responders….There is almost a billion people on this rock with tinnitus — of varying degrees. People like me who have it bad would have it even worse without ADs and benzos for those especially bad days.” (Cutter, Earth)

It was interesting to see a final group that essentially asked, ‘what’s the big deal….Isn’t this obvious and already well-known?’ These people were perplexed at why such a discussion needed to happen in the first place. Some insisted that lifestyle interventions were also not unfamiliar to professionals:

• “There isn’t a single mental health professional or psychiatrist who doesn’t also talk about the importance of social connection, diet, and exercise.” (AC, New York)

• “Every physician knows that psychotropic drugs such as antidepressants have side effects, need to be carefully monitored and slowly withdrawn, and can be combined with psychotherapy, lifestyle issues, exercise, and nutrition. What he is saying is obvious common sense” (IN, NY)

Others insisted that the patterns of overprescription and withdrawal were already familiar to physicians:

• “It is well known that SSRIs need to be tapered slowly to avoid serotonin withdrawal.” (Dave, Arizona)

• “Like many medications, SSRIs are overprescribed for some who don’t benefit and unavailable for some who would.” (Jim, Louisville)

Still others described antidepressants as settled science that shouldn’t even need to be debated publicly. For instance, Sara Emerle in Albrightsville, Pa. writes, “The F.D.A. has made clear that approved psychiatric medications are safe and effective when prescribed and monitored by a clinician. These are not experimental or excessive tools; they are evidence-based treatments that help millions of people function, stabilize and survive. Framing them as a problem of overuse ignores what they actually do.”

Conclusion: The need for balance, space and wisdom

What I take away from all of this is how important it is to have a conversation where the range of different experiences and interpretations are being heard. In a small way, that’s what I’m hoping to do by attempting to feature so many of them here.

From that place, I’m convinced we’ll be in a better position to meet individual needs which vary widely, and to ask nuanced questions that account for competing concerns. For instance: How do we support tapering for those who need it without somehow discouraging those who genuinely need the same treatment?

Three final comments illustrate well this needed balance that effectively makes space for nuance and complexity.

First, Y. Tony Yang, a professor of health policy at George Washington University writes, “For years, some patients were told that it was easy to stop taking selective serotonin reuptake inhibitors — the most frequently prescribed type of antidepressant medication. That was too glib. Now, the pendulum has swung back, and we risk treating these medications as chemical handcuffs. That is too extreme.”

Yang argues, “The real scandal is not that Americans use antidepressants. It is that we have built a mental health system in which a prescription is often the only door that opens quickly. Therapy is scarce, primary care is rushed, and psychiatric follow-up can be hard to find.”

Secondly, a woman named Summer asks how do we make room for both stories: harmed by medication and helped by medication, stating:

“Some people need meds and therapy. Some people do great with just therapy, some people don’t benefit from therapy, others don’t have access to a good therapist, especially in rural areas so meds are a life line,” said Summer — before expressing concern that the “nuance is going to get lost and these policies could really harm people. Acknowledging the withdrawal and setting some guidelines for how to go off meds is a good place to start.”

Lastly, Ana, a mother from New Mexico, writes: “I was on antidepressants through my college years, which blunted my emotions, made me act like a different person, lose interest in school and generally have a worse than bad time — a passionless, emotionless time where I drank heavily just to try to feel something. Getting off of them was awful and I had to rebuild my sense of self and heal my brain over about 2 years.”

Ana went on to describe returning to antidepressants a decade later in the midst of postpartum depression and anxiety. “I used a low dose and found them to be exactly what I needed to survive those days and be a good mom. I was able to taper off easily after a year of use.”

She described other friends who found the same medications “necessary to make it through bouts of debilitating depression and survive suicidal ideation” — then added “I am so thankful these medications exist for them.”

“I hold both truths in myself and for others: antidepressants can be both life-saving and destructive for different people at different times. Doses should be conservative and patients should understand the possible side effects before starting and consciously reflect on their state of mind to make sure the medication is what is best for them.”

Twice in his first talk as President of The Church of Jesus Christ of Latter-day Saints, Dallin Oaks used a unique, even countercultural verb in discussing “doubt” and critical questions. After describing how even committed disciples “may sometimes have concerns about some historical, doctrinal, or social issues connected with the Church,” he said:

“I want to help all our members overcome present or future doubts. Whatever those doubts, the way to overcome them is to get closer to our Savior Jesus Christ.”

While encouraging listeners to be patient with difficult questions, seek help from others and strengthen their faith in God, this individual we Latter-day Saints hold to be a prophet later said:

“Increased humility draws us closer to Jesus Christ. This will help us overcome questions about the Lord’s doctrine. When we are humble, we can more clearly hear the Lord’s voice.”

“Overcoming questions about Christ’s teachings” … “Overcoming doubts.” When was the last time you heard anyone in modern American culture speak about skepticism in this way?

More likely, you’ve heard some of the many people who now talk about “honoring” your doubts, “respecting” your doubts, “making space” for your doubts, “being honest” about your doubts, “embracing” your doubts or “cherishing” your doubts.

In Hearing God, the late Christian philosopher Dallas Willard observed, “We live in a culture that has, for centuries now, cultivated the idea that the skeptical person is always smarter than one who believes.”

That’s how we modern Americans tend to think about “doubt”: hinting at its goodness and wisdom, while cautioning against any resistance to what we’re thinking or feeling inside.

Perhaps there’s some wisdom in this impulse. After all, a life of incessant resistance and fighting-to-overcome could wear out the best of us. There is, for any of us, a time to simply notice, watch and accept that something is present.

This may be especially true when we are prone to self-condemnation or riddled with fear over what we’re experiencing inside. Learning to just “be with” whatever is here, “without trying to fix or force it to be any different” can be such a relieving practice.

And that’s not the same as “resigning ourselves” to whatever we’re experiencing either, as we remind people in our mindfulness classes. It’s possible to approach doubt and other challenging emotions from a calm, wise place—without resistance or fear—but while still maintaining an intent to ultimately overcome something, rather than glorify it.

But why? And what’s so wrong with celebrating and trumpeting our doubts?

Not everything inside is wise

Part of the impulse behind the throw-the-door-open, open-arms-wide approach to doubt is the idea that anything felt or experienced inside must somehow be good, wise or insightful (and therefore, trusted and followed):

• Feeling angry at someone? Best to cut them off—establish those boundaries!

• Craving something else? Let’s find out how to get more of it—“obey your thirst!”

• Have a persistent thought or feeling? Go with it—above all, be true to who you really are inside!

In this way, people can become enslaved to anything they are feeling and thinking—without even realizing what is happening, and where this is all leading them.

The reality is that chasing passing pleasures, living out any thoughts and feelings, and instinctively separating ourselves from even slight discomforts: it all adds up to a less developed human being and one far more likely to be unhappy long-term.

Yet the many loud proponents of the doctrine that everything felt inside is good and wise like to fancy themselves as uniquely enlightened—positioning themselves as a contrast to more simple-minded voices in the past. One common plank of their teaching is to deny, undercut or distract from the existence of temptation and evil itself (using words like “nondual” or “scientific”1).

But they’re simply wrong about that. Evil does, in fact, exist. Sexual abuse and murder and war and inner torment cannot adequately be explained by materialist explanations of trauma, biology, economics, and social conditions. And because evil is a reality, that means lies also exist, and consequences from those lies.

Practically, this means our unsettled feelings and doubtful cynicism towards a particular truth claim should not automatically be treated as wise or trustworthy.

• Of course, sometimes these feelings may indeed be wise: especially when we’re encountering any one of the many pervasive and profound deformations of reality in our world today that masquerade as “sophisticated takes,” on TikTok, popular podcasts or anywhere else.2

• At the same time, I’m pointing out here that sometimes these feelings of doubtful cynicism may be legitimate signals of fear, pain, temptation, distortion, or something else that needs healing, correction, or direct resistance.

Yes, doubt and unbelief are normal things human beings experience3 and should be approached with compassion and empathy. But instead of only “making space” and “listening” to doubts that arise, this invites us to see doubt and unbelief as something to ultimately be dispatched, jettisoned and yes, overcome.

That’s an especially important word for anyone who takes scripture seriously. Here I write as a Latter-day Saint about the Bible and other books of restoration scripture. But even if you don’t identify as Christian, it may be of interest to know what these texts we consider holy actually say about doubt and unbelief.

All that God invites us to overcome

In the same moment he warned his apostles they would be scattered and one day killed, Jesus spoke of love, peace and joy to come. Then he said to his gathered apostles, no doubt at this point a little worried: “These things I have spoken unto you, that in me ye might have peace. In the world ye shall have tribulation: but be of good cheer; I have overcome the world.”4

Yet it’s not only Jesus who overcomes in scripture. John writes in the New Testament to “young men (who) have overcome the wicked one” and teaches that those “born of God overcometh the world.” The same apostle later begins the epic Book of Revelation with a series of distinct promises given by the resurrected Christ:

• “To him that overcometh will I give to eat of the tree of life, which is in the midst of the paradise of God” (Rev. 2:7).

• “To him that overcometh will I give to eat of the hidden manna, and will give him a white stone, and in the stone a new name written” (Rev. 2:17).

• “He that overcometh, and keepeth my works unto the end, to him will I give power” (Rev. 2:26).

• “He that overcometh, the same shall be clothed in white raiment … I will confess his name before my Father, and before his angels” (Rev. 3:5).

• “Him that overcometh will I make a pillar in the temple of my God, and he shall go no more out: and I will write upon him the name of my God” (Rev. 3:12).

Whether or not we overcome is apparently a big deal. But what exactly are we being encouraged to overcome here?

The text singles out specifically “deeds” and “doctrines” which God “hates”—repeatedly cautioning early Saints about being “seduced” by “fornication” and other destructive patterns.

We can do it, because he did

One reason I find this so encouraging is that I know what it’s like to experience the opposite: being overcome by the despair and darker patterns so abundant in the world. Paul likewise cautioned the early Saints in Rome, “Be not overcome of evil, but overcome evil with good.”

I can also say from experience how thrilling it is to experience God’s help to overcome any of this. And scripture declares far more delight to come. Christ again tells John: “To him that overcometh will I grant to sit with me in my throne, even as I also overcame.”

“Because Jesus Christ overcame this fallen world, and because He atoned for each of us, you too can overcome this sin-saturated, self-centered, and often exhausting world,” taught President Russell Nelson of The Church of Jesus Christ in a 2022 message referencing the same ancient promise from Christ to his apostles, along with more recent encouragement: “I will that ye should overcome the world.”

President Nelson continued:

“Because the Savior, through His infinite Atonement, redeemed each of us from weakness, mistakes, and sin, and because He experienced every pain, worry, and burden you have ever had, then as you truly repent and seek His help, you can rise above this present precarious world. You can overcome the spiritually and emotionally exhausting plagues of the world, including arrogance, pride, anger, immorality, hatred, greed, jealousy, and fear. Despite the distractions and distortions that swirl around us, you can find true rest—meaning relief and peace—even amid your most vexing problems.”

Cultivating the opposite of doubt

All this happens through exercising and cultivating the opposite of doubt within ourselves. “Through faith they shall overcome,” 19th century Saints were told. This echoes John’s vision of those who “overcame (the adversary) by the blood of the Lamb”—contrasted in the same text by those whom he foresaw as “overcome” by this same adversary.

The consequences of getting this right are enormous and personally consequential. Peter cautioned anciently “of whom a man is overcome, of the same is he brought in bondage.”5 And restoration scripture likewise describes the “sufferings of those with whom (the adversary) made war and overcame.”

Such suffering is real and piercing—and hardly recognized by those in the middle of it. But it doesn’t have to keep going! We really can be free of all of this, remarkably. Later in the book, right after being shown a future “new heaven and new earth,” where God would “make all things new” and “wipe away all tears,” the New Testament text quotes “he who sat upon the throne” as saying about that glorious day: “He that overcometh shall inherit all things; and I will be his God, and he shall be my son.”

Overcoming doubt

Are we sure this “overcoming” really includes doubt, some may still wonder. “After all, I keep hearing there’s so much wisdom in our doubts, which are a sign that a deeper process of spiritual transformation is taking place.”

In modern society, once again, doubt towards God and religion is more likely to be taken as an indication of “education” or “integrity” or “authenticity” or even “courage.”

Some other Christian teachers have pushed back on this idea. G.K. Chesterton has been attributed as saying, “When people cease to believe in God, they do not then believe in nothing, but in anything.”6 And C.S. Lewis suggested that to “see through” everything is, finally, not to see.

I want to close this essay with a short exercise illustrating how far removed the popular rhetoric about doubt is from scripture itself. In all my searching of prophetic writing from the Bible and the Book of Mormon, I literally cannot find anything to justify the feel-good rhetoric that treats doubts as a sign of secret spiritual sophistication. See for yourself:

1. Christ and his prophets sorrow to see unbelief and consistently call us out of it:

After being rejected in his home town, the record says Jesus “marvelled (amazed, surprised) because of their unbelief.” Later, he asked one of his closest followers, “O thou of little faith, wherefore didst thou doubt?” and lamented what he called a “faithless” generation.

Nephi described being “left to mourn because of the unbelief…ignorance and stiffneckedness of men”- adding, “for they will not search knowledge, nor understand great knowledge, when it is given unto them in plainness, even as plain as word can be.”

Likewise, President Oaks taught in that same address, “Those of diminishing faith and activity in the restored Church are a major source of concern to your prophet leaders. We love you, young and old, men and women. So does the Lord! God is relentless in His loving pursuit of each of you.”

2. We’re encouraged to ‘doubt not’:

Christ promised miraculous things to those who “have faith, and doubt not” and who “shall not doubt in (their) heart.” And after speaking directly to those “of little faith” about how much God watches over the small details of our lives, Jesus says plainly: “neither be ye of doubtful mind.”

He later said to Thomas “be not faithless, but believing.”

Paul encouraged people to “pray everywhere”—“without … doubting”—talking about father Abraham as an example of someone who did not “stagger” (waver) “through unbelief” at the beautiful promises made to him. And the same James who encourages those lacking wisdom to “ask of God” then reminded early Saints to “ask in faith, nothing wavering. For he that wavereth is like a wave of the sea driven with the wind and tossed.”

“Let not that man think that he shall receive any thing of the Lord.”

Restoration scripture channels this same invitation, with Moroni calling on readers to “doubt not, but be believing”—quoting Christ as saying “whosoever shall believe in my name, doubting nothing, unto him will I confirm all my words, even unto the ends of the earth.”

The text also describes moments of communion with the Living God that left people “nothing doubting,” bidden to “marvel not, neither should they doubt” and having such sacred experiences that there was not a living soul “who did doubt in the least.”

“Look unto me in every thought; doubt not” the Lord said again to Saints in more recent centuries.

3. Doubt is described as a particular state we need help to be delivered from and repent of:

Book of Mormon prophets describe the possibility of “fall(ing) into a state of unbelief”—as well as that same condition being removed: for King Lamoni, the “dark veil of unbelief was being cast away, and the light which did light up his mind … infused such joy into his soul, the cloud of darkness having been dispelled.”

The descent into a state of doubt can happen over time, and because of choices and actions of others, such as children whose “their unbelief and their hatred (was) because of the iniquity of their fathers,” entire peoples who “dwindled in unbelief because of the iniquity of their fathers,” and even whole generations potentially swept away into becoming “unbelieving and stiffnecked.”

This can be a gradual, societal process of “dwindling” in unbelief—even as a whole nation—a phrase that shows up repeatedly in the Book of Mormon. Others do not “dwindle in unbelief,” but instead “willfully rebel against the gospel of Christ.”

Regardless of how it happens, this veil of unbelief can again be pierced, with restoration scripture describing “unbelief and blindness of heart” as sins to be repented of—with ancient Americans coming to “fear because of their iniquity and their unbelief” once they recognized what it was. And the New Testament depicts a father asking Christ, “I believe; help thou mine unbelief.”

After his resurrection, Jesus “upbraided” (“rebuked” or “scolded”) his disciples for “their unbelief and hardness of heart, because they believed not them which had seen him after he was risen.”

And at the end of the American text, Mormon turns directly to “those who do not believe in Christ”—asking whether they will believe “in that great day when ye shall be brought to stand before the Lamb of God—then will ye say that there is no God?.... Do ye suppose that ye could be happy to dwell with that holy Being, when your souls are racked with a consciousness of guilt that ye have ever abused his laws?”

“O then ye unbelieving, turn ye unto the Lord, cry mightily unto the Father in the name of Jesus, that perhaps ye may be found … cleansed by the blood of the Lamb, at that great and last day.”

4. Rather than signaling more enlightenment, doubt can eventually lead to obscuring and blinding people from beautiful realities:

Isaiah spoke anciently of those who “understand not; and see ye indeed, but perceive not”—a prophecy Jesus later referenced as being fulfilled in people’s rejection of him: “For this people’s heart is waxed gross, and their ears are dull of hearing, and their eyes they have closed.”

In the new world, Jesus recalled what happened: “And now, because of stiffneckedness and unbelief they understood not my word.” This same process played out in the children of believing parents after King Benjamin, who the record says “did not believe the tradition of their fathers” and “did not believe what had been said concerning the resurrection of the dead, neither did they believe concerning the coming of Christ.”

“And now because of their unbelief they could not understand the word of God; and their hearts were hardened.”

Restoration scripture describes how otherwise good insights and truths can be “cast it out by your unbelief” and details how minds can be “darkened because of unbelief.”

Alma likewise describes how this can be a progressive, iterative process: “therefore, he that will harden his heart, the same receiveth the lesser portion of the word… until they know nothing concerning his mysteries” (with the opposite trajectory also available, with a person who “will not harden his heart, to him is given the greater portion of the word, until it is given unto him to know the mysteries of God until he know them in full.”)7

Paul likewise described how the “god of this world hath blinded … them which believe not” and also wrote how doubt can lead us to see everything through different lenses: “Unto the pure all things are pure: but unto them that are defiled and unbelieving is nothing pure; but even their mind and conscience is defiled”—in part, because “in works they deny him.”

5. Doubt leads to poor choices which can fuel even more doubt:

The cognitive consequences of doubt are especially significant, because we cannot see what we cannot see. But the implications go far beyond mental implications to behavior itself:

• Doubt naturally dilutes obedience, with restoration scripture describing those who “receive a commandment with doubtful heart, and keep it with slothfulness.”

• Alma describes how doubt can lead hearts to become calcified—asking the people whether they would “harden your hearts in unbelief” (this same phrase “harden their hearts in unbelief” shows up elsewhere in restoration scripture).

• Hearts rejecting God in doubt inevitably go elsewhere—with restoration scripture describing early inhabitants taught truth by their parents, until “Satan came among them, saying … Believe it not; and they believed it not, and they loved Satan more than God. And men began from that time forth to be carnal, sensual, and devilish.”

• In this way, hearts can change too—with Hebrews cautioning “Take heed, brethren, lest there be in any of you an evil heart of unbelief, in departing from the living God.”

• As minds, hearts and behavior all get tied up in the same doubtful stew, the New Testament underscores how stuck people become in their progress (which is how Latter-day Saints understand heavy words like “damn” and “condemn”). “He that believeth not is condemned already,” Jesus says, with Paul writing that “all might be damned who believed not the truth (and instead “believe a lie”) and who subsequently “had pleasure in unrighteousness.”

This is why I believe that when doubt takes over a life, it changes us into a different person over time.

6. Doubt constrains what God can do in our lives:

In the presence of doubt, great things are withheld—which could otherwise be given. This is first apparent in the Old Testament, when the Lord tells Moses and Aaron, “Because ye believed me not, to sanctify me in the eyes of the children of Israel, therefore ye shall not bring this congregation into the land which I have given them.” The writer of Hebrews later says, “So we see they could not enter in because of unbelief.”

“Because of your unbelief” Jesus likewise spoke of people unable to do miracles (other translations say “Because you have so little faith/because of the littleness of your faith”).

• The New Testament subsequently describes how Jesus “did not many mighty works (among some people) because of their unbelief”—something Christ recalled again in ancient America, describing how he could not show certain people “great miracles, because of their unbelief.”

• At the same time, the Book of Mormon describes miraculous deliverance among young people with “exceeding faith” who were taught to believe that “whosoever did not doubt, that they should be preserved by his marvelous power”—who had been “taught by their mothers, that if they did not doubt, God would deliver them.”

Yet the opposite also shows up in the Book of Mormon, with aching consequences following a departure from faith. When things got bad enough in ancient American society, Mormon describes how “there were no gifts from the Lord, and the Holy Ghost did not come upon any, because of their wickedness and unbelief.”

“The reason why he ceaseth to do miracles among the children of men is because that they dwindle in unbelief, and depart from the right way, and know not the God in whom they should trust,” this same prophet says, before entreating future readers:

“Behold, I say unto you that whoso believeth in Christ, doubting nothing, whatsoever he shall ask the Father in the name of Christ it shall be granted him; and this promise is unto all, even unto the ends of the earth.”

His son Moroni closes the book quoting Christ as inviting future readers to “Come unto me … and I will show unto you the greater things, the knowledge which is hid up because of unbelief. Come unto me …. and it shall be made manifest unto you how great things the Father hath laid up for you, from the foundation of the world; and it hath not come unto you, because of unbelief.”

“Behold, when ye shall rend that veil of unbelief which doth cause you to remain in your awful state of wickedness, and hardness of heart, and blindness of mind, then shall the great and marvelous things which have been hid up from the foundation of the world from you.”

“If it so be that I do not speak, judge ye,” the Lord warns. “For ye shall know that it is I that speaketh, at the last day.”

If miracles have ceased, Moroni later says repeatedly, “it is because of unbelief”—adding that “if the day cometh that the power and gifts of God shall be done away among you, it shall be because of unbelief.”

“And the reason why he ceaseth to do miracles among the children of men,” Moroni reiterates “is because that they dwindle in unbelief, and depart from the right way, and know not the God in whom they should trust.”

7. Doubt removes beautiful possibilities in our future:

In addition to limiting what God can do in our present lives, doubt fundamentally shifts what our ultimate future looks like as well, in at least three ways:

• There can be physical consequences: Jude recollects in the New Testament how “the Lord, having saved the people out of the land of Egypt, afterward destroyed them that believed not.” Nephi warns about the possibility that his people could “dwindle and perish in unbelief.” And Jacob describes being shown “that many of our children shall perish in the flesh because of unbelief.”

• There can be relational severing. Paul describes how groups of former believers can be “broken off” (or “cut off” in other translations) from the main body of faith “because of unbelief.” Restoration scripture also describes Christ reassuring how this same group who gets “scattered … because of their unbelief” can ultimately be “brought to a knowledge of me, their Redeemer.”

• Piercing future regrets are prophesied. Right after recounting a parable of the rich man who builds bigger barns and “layeth up treasure for himself, and is not rich toward God,” Jesus tells another parable of a servant who refuses to watch and prepare for the Lord’s coming, who ultimately appoints this servant upon returning “his portion with the unbelievers.”

Revelation’s forceful caution about destructive patterns includes warning to “murderers, and whoremongers, and sorcerers, and idolaters, and all liars” about painful future regrets awaiting them (which is how Latter-day Saints interpret imagery of fire and burning). Also included on that list: warnings to “the fearful, and unbelieving” (a caution repeated in restoration scripture).

“These things saith the Son of God, who hath his eyes like unto a flame of fire,” the apostle John relates.

These are not my words. They are what’s recounted in texts embraced as scripture by many millions today. As illustrated above, it’s difficult to find anything in scripture from both the old and new worlds that backs up the modern day glorification of doubt and belief as somehow spiritually transformative and developmentally enlightened.

Notes:

Cameron LaBar was 9-years-old when he was diagnosed by a New Jersey doctor with anxiety and OCD, and started on Paxil. For the next two decades of his life, continued, evolving medical treatment became an unquestioned feature of his life.

“I was always told that I had a chemical imbalance and that this was treating that,” he shared at last Monday’s “Mental Health and Overmedicalization Summit” in Washington, D.C. He heard this explanation from his doctor. And he heard it from his parents and other family members through much of his childhood. “I believed that I needed this and that I was treating something very targeted to help me to function.”

“I was never approached or never ever had a discussion about an off-ramp or (eventually) reducing these medications,” he added. Every night he would take them, he remembers. “But there was never a discussion of when is the finish line, you know, when am I done taking this? That discussion never happened.”

Cameron wishes it had.

‘Wait, so maybe this isn’t really who I am?’

At the time he was first diagnosed and prescribed medication, Cameron’s family had just moved to a new state and his father was working nearly 80 hours a week, leaving his mother to handle this scared 9-year-old boy and his four siblings. Reflecting back on the moment he began to feel paralyzed by fear as a child, Cameron talks today about the limitations in this early deliberation:

“I just don’t think there was enough conversation …to ask the questions of: What does his sleep look like? Is he sharing a room with a sibling who gets up way earlier than he does? What is his diet like? Did he just move somewhere to another state where he’s not outside and playing and in the sun as much as he used to be?”

“All of these different types of questions I don’t think were ever asked and it was just kind of like a very quick labeling from the neurologist that I had a problem and it was a chemical imbalance and it needed to be fixed.”

For the subsequent 26 years, Cameron has been on medication. After being treated for most of his life, Cameron reflected, “it took a really long time for me to realize that the things that I thought were character traits about me being tired, drowsy, forgetful, numb, indifferent to going out and doing things or to having friends or to starting a relationship—it took a really long time for me to end up figuring out that those weren’t character traits. Those weren’t parts of my personality … Those were side effects of a medication.”

This clash in interpretations is central to Cameron’s story. Two other examples of this:

• Cameron recalled a panic attack at a summer camp where he wasn’t getting enough sleep and consuming too much caffeine. When the doctor found out what happened, he left with another prescription—a Benzo. “There was no discussion of ‘Well, what happened at the summer camp?” (Moderator Kim Witczak interjected saying “this is very, very common where people go in with the side effects and they end up with another and it could be the drug side effect and they end up going out with another you know as you said another prescription.”).

• Cameron described previously trying to go off medication—and being told by the doctor to cut the dosage in half. This sudden and dramatic reduction, he said, “would throw me into such a severe panic and response and I would immediately go back up on the dose.” The doctor would subsequently reaffirm to him that these scary experiences, rather than a withdrawal effect, was “a part of your underlying condition and that you probably need the medication.” (Countering this automatic labeling of withdrawal effects as a “return of the depression” has been a core message of Peter Breggin and other authors over the last several decades).

Cameron eventually stumbled on videos from British researcher Mark Horowitz, one of the leading experts in tapering off of antidepressants, which he said, “helped me to understand that side effects are so common and that this isn’t, you know, it’s not a part of who you are necessarily.”

This realization prompted this man to initiate a measured, careful, gentle tapering process three years ago. Now 35, Cameron describes feeling better than he has in a long time—and on a lower dose than he has in a long time. “I’m down to about 7 and 12 milligrams of Lexapro.”

Cameron describes recently getting through a “really hard part of withdrawal” and now taking a break at his current dosage. “It’s probably going to take me another three, four or five years to get the rest of the way just given how these drugs work.”

Cameron had become accustomed to these many side effects—and the idea that they were not “some underlying part of who I am” has changed so much.

“It took me 20 years to find that out,” Cameron said. He admitted some deep frustration with that realization, as he continues to taper. “So trying to deal with that….I could have figured this out a lot sooner, right?”

“The way I’m functioning now, I could have functioned as a human being all along, right? I could have had friendships and I could have not been numb and I could have formed (romantic) relationships.

“I’ve missed a lot of life and a lot of my experience … I never got to experience the full range of emotions and feeling of being human. And that’s been really, really hard.”

(This is a screenshot. Watch the full talk on Cameron’s Instagram here)

Cameron was one of several patients who spoke at the summit, hosted by the MAHA Institute—along with researchers and other experts. Two of my own dear friends and colleagues spoke, from my two decades of interest in this topic since my dissertation on antidepressants.

I’d like to highlight ten other moments from the day-long conference worthy of attention. But not before highlighting two important qualifiers shared by Cooper Davis, the executive director of Intercompass Initiative—a nonprofit organization that helps people make more informed choices about taking and safely tapering off psychiatric drugs:

1. Not “anti-medication.” “I want to be clear, we are not anti-medication. We are just committed to true informed choice. And those things should not be confused. And we believe true informed choice is in fact a human right.” He makes clear the summit’s stated frame is not “no one should take medication,” but that when a medication isn’t working or people don’t want to be taking it anymore, they deserve a safer process to taper off.

2. Don’t ignore stories. “Too often when people speak about them, their stories are dismissed as merely anecdotal or unfortunate,” Cooper added. “But anecdotes are in fact evidence. Subjective experience matters.” Another speaker, Kim Witczak, likewise said, “These are not anecdotes. These are real lives.”

In what follows I recap 7 other highlight talks from the conference, taking the time to give the full context of why they matter. While this won’t be of interest to everyone, it will be important to a subset of people who have lived it. So I’ve chosen to go deep here, giving those readers the details they’ll want. You can click below to see the entire transcript—and here and here to watch the entire conference.

Mental Health and Overmedicalization Summit Transcript

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Note: None of this substitutes for medical advice. And it’s always advisable to make adjustments to medication with medical guidance and support. But it’s crucial to remember changes need to happen gradually—not sudden and dramatic.

1. ‘I was a child and I didn’t have the words to explain what was happening’ (and the dangers of fast tapering). Danielle’s story

Danielle Gansky was prescribed psychiatric medication at 7 years old. “I was far too young to understand what they were, let alone the lasting impact they would have on my developing brain,” she said. But in the second grade, a teacher noticed she was fidgety, distracted, and not fully keeping up academically—advising her parents to see a psychiatrist for an ADHD evaluation.

“I was quickly diagnosed, labeled, and medicated,” she said, recalling they told her she had a learning disability too. About her experience being prescribed ADHD stimulants like Adderall and Ritalin, she said, “I still remember how agitated and moody they made me feel. This was completely out of character for me as I was a happy, sweet, silly kid.”

“Adverse side effects were interpreted as new diagnoses and more drugs were prescribed to treat the problems that the medications themselves had caused. This spiraled into a prescription cascade of antidepressants, benzodiazepines, mood stabilizers, and antipsychotics all before my 10th birthday.”

“None of it ever felt right. But I was a child and I didn’t have the words to explain what was happening. And I didn’t have the authority to challenge it.

Throughout my teens, every drug-induced effect that made me feel terrible was blamed on my so-called underlying disorder.

As I got older, I found online forums of people describing their harms from antidepressants and began to realize the drugs might be the problem. But when she brought her concerns to a doctor and asked if the medications could be making her feel worse, the doctor insisted that wasn’t possible—and that, instead, this meant her OCD and anxiety were “getting worse” and that she “needed higher doses of the SSRI to treat it effectively.”

After college, at age 23 years old, she said “I wanted to see who I was underneath the chemicals.”

“Although I had been on antidepressants my whole life, all while my brain was literally developing, my doctor tapered me off in just 6 weeks,” she said, “which was far too fast.”

(She adds, “But my doctor wasn’t acting recklessly. He was following the standard medical guidance doctors are taught to use”).

What followed the rapid taper, she said, “was a severe full body neurological crisis, a non-stop living nightmare of physical and psychological torment and suffering I didn’t know was humanly possible. My brain felt like it was on fire. Waves of visceral terror and violent inner agitation ripped through me. I was crawling out of my skin for hours each day. I rocked back and forth in the fetal position on the floor, screaming in excruciating pain. Rage surged through me that was completely out of character as I’ve never (experienced) this type of anger.”

“I was always gentle and kind,” she added, but this rapid and dramatic taper “brought out a violence in me that never existed. My brain and body were malfunctioning, feeling like I was being poisoned. It was an attack on my nervous system. Simply being alive felt unbearable.”

When Danielle went back to her doctor and told him she was in withdrawal, she was told “antidepressant withdrawal doesn’t exist, that the medication was out of my system, and my symptoms were proof I needed the medication.”

“His credentials and expertise automatically outweighed my lived experience,” she now recalls, “and the very injury caused by the drugs was used to justify putting me back on them.”

After months of suffering, she recalls feeling she “had no choice but to reinstate the antidepressant even though I felt as though it was poisoning me.” But these neurological effects didn’t go away after re-instituting the medication and she’s experienced them for 7 years now—leading her to believe she had experienced a more of a “lasting injury to my brain and nervous system” caused, she believes, from the fast pace of tapering directed by her doctor.

And, of course, the original decision to put her on. Looking back now, she says “My completely normal childhood behavior was pathologized. I wasn’t in crisis. I wasn’t struggling or acting out. I was simply a fidgety, shy, sensitive little girl who didn’t fit the mold of how a child was supposed to behave in a classroom setting.”

“I went from being a vibrant, joyful, happy person who loved life to being chronically ill and disabled….My creativity, my intelligence, my emotions, everything that made me me was ripped away. I was bedridden and housebound for years. My 20s were spent grieving a life that I felt was taken from me far too soon, watching everyone else move forward while I remained stuck trapped in a body that felt like a prison.”

She’s still taking the same SSRI prescribed as a child, still struggling to come off due to severe debilitating withdrawals. Danielle is now tapering extremely slowly using “hyperbolic tapering” which is the safest method known. She reduces by just one tenth of a milligram, for example 53.6 milligrams down to 53.3—which is less than 1% decreases, because that’s all her nervous system can handle. Even those tiny reductions are challenging, she said.

“What happened to me is not rare,” she said. “My story is just one window into a much larger hidden public health crisis.” Rather than mere “withdrawal,” which she suggested can be a “misnomer,” inappropriately fast withdrawal can lead to “neurological injury that can persist for years and may be permanent for some. The suffering is so immense many people end up taking their lives in withdrawal.”

“It’s my life’s mission to make sure to create changes to make sure this doesn’t happen to anyone else,” she said. “My inner reality was dismissed at every turn”—noting that the medication label doesn’t warn you people that these drugs can “fundamentally alter your brain” to such a degree that tapering off can be difficult, even impossible for some.

Neither do the labels caution enough at the “loss of emotions and the ability to feel love leaving you.” She concluded by saying, “People have a fundamental right to full and honest information about the harms of SSRIs before they ever take them. When those risks are withheld, it is not just unethical. It’s a violation of basic human rights.

Danielle called for stronger warnings to patients about the true, life-altering and sometimes permanent risk. And she called for “federally endorsed evidence-based tapering guidelines so people can come off their antidepressants safely without risking a brain injury.”

“People need to be aware this can happen to them so they can truly make informed decisions,” Danielle later said. “We need evidence-based tapering guidelines to help people safely come off these drugs,” agreed Andrea Beckel-Mitchener, Acting Director of the National Institute of Mental Health (NIMH) - emphasizing a need to “broaden the evidence base of what de-prescribing is.”

Danielle’s story is a cautionary tale about how drug-induced effects are interpreted as new diagnoses, leading to more drugs: initial struggles → diagnosis → medication → adverse effects → more diagnosis/medication. In this way, childhood behavior can become lifelong medical identity.

2. Laura Delano’s stunning message: From hopelessness to beauty

I’ve known Laura for a number of years, and wrote about her awhile back for Meridian Magazine: “Your Urge to Die, is Really an Urge to Live Differently.” Her talk at this summit was the stand-out highlight.

Explaining her decision to found Intercompass Initiative, Laura Delano said “my decision to start ICI came after I realized that my parents and I had never actually made a truly informed choice” about her 14 years of treatment. “I grew up on psychiatric drugs, accumulating an alphabet soup of diagnosis through my teens and 20s. Over those years, as I carefully complied with my treatment, my physical health, creativity, sexuality, relationships, connection to God and nature and meaning and purpose, all of it was overtaken by medicalization.”

“I became a list of symptoms to be managed,” she said. “I was in endless therapy and admitted myself to many programs and hospitals. I was on two meds, then three, then four, then five. Along the way, life fell apart.”

“At age 25, told by my psychiatrist I was so severely mentally ill that I was now resistant to all treatment, I tried to kill myself. I am far from the only one.”

“Not a day goes by that I don’t thank my lucky stars I made it through alive and that I eventually realized this medicalized understanding of myself had become a prison.” After finding a broader way to think about it, Laura says she gradually tapered off “all the meds I’d been told I’d need forever to stay alive.”

That was 16 years ago. Today, she’s leading an international non-profit with her supportive partner Cooper, and raising beautiful children. Laura then defined “medicalization” as “what happens when we take complex human struggles and call them a disease. It’s the act of pathologizing natural, understandable, even common sensible responses to our individual lives and the broader world in which we live.”

“To be clear, questioning medicalization isn’t about denying suffering or denying that many people experience real benefit from psychiatric treatments,” she said, “especially in the short term. It’s about asking what our culture has sacrificed by telling generations of Americans that being human is a disease.”

“Millions of our young people now grow up convinced something is wrong with them. They’ve been taught to take their despair and self-doubt and loneliness, their shame and obsession and alienation, their struggles in friendship and romance, their fear and angst and grief. and translate all of these experiences into symptoms of incurable brain pathology requiring lifelong pharmaceutical use.”

Many have grown convinced, as she once was, Laura said, that “their life’s main purpose is symptom management with endless pills and therapy and programs. They are convinced the only way the depth of their pain can be seen, understood, and validated is through medicalizing it. They are convinced the only people qualified to help them are those with letters after their names.”

“And when they’ve done all this and their dysfunction and disability have only worsened, they’re told this means their illness has progressed—that the reason their psychiatric treatments aren’t helping is that their brain disease is just too far gone.”

“This is a story of hopelessness. And it’s a story that I and countless others have grown up believing in deeply.”

Laura then cited philosopher and social critic Ivan Illich who warned 50 years ago of the “deep harm caused when a culture becomes overly medicalized.” What he called medical iatrogenesis occurs when health professionals inadvertently “destroy the potential of people to deal with their human weakness, vulnerability, and uniqueness in a personal and autonomous way.”

“We are now living with these consequences. Tens of millions of Americans are convinced their suffering is a sign that they are permanently broken rather than a signal about the world they’re trying to live in—a world of screens and social media, broken sleep, too much stress, too little sunlight, too little movement, too little real food, too little solitude, too little face-to-face time with others in local meaningful community.”

Laura then cited off key statistics in terms of where we are as a country with mental health:

• Nearly one in four adults has a psychiatric diagnosis.

• 40% of high schoolers report being persistently hopeless with 9% attempting suicide.

• Suicide rates have climbed sharply across nearly every age group since the late 1990s.

• Nearly 50,000 Americans killed themselves in 2023, the highest number ever recorded.

• At the same time, nearly 65 million Americans are taking psychiatric drugs, including around four million children.

“We’re told this is a mental health crisis. But what if this crisis is in large part fueled by misinterpretation, by medicalizing struggles that were never medical to begin with and don’t have medical solutions?”

“Just as we have woken up to the misleading story sold to us by the pain management industry that all physical pain is a problem to be eradicated with safe effective pharmaceuticals that are not dependence forming; we are now waking up to the false promises of this industry of mental health—an industry that’s taught us emotional pain is a symptom to eradicate with safe, effective pharmaceuticals you’ll likely need for life. But if not, don’t worry. You can easily stop.

Laura’s talk was a challenge to this narrative she and other participants see as “deceptive.”

“For a long time, it’s been mostly patients sounding the alarm on overmedicalization—people who have lived its consequences firsthand, realized there was in fact a future beyond chronic illness and had no choice but to develop safe psychiatric medication tapering protocols because their doctors couldn’t or wouldn’t help them.”

“Prescribers are trained to put people on psychiatric medications, not help them safely taper off. They aren’t taught about the dependence forming nature of all psychiatric medications (not just benzodiazepines), or that the difficulties patients face when stopping their medications may well be withdrawal, not relapse.

They don’t realize that tapering slowly doesn’t mean over days, weeks, or months, but possibly over years. Patients had no choice but to develop some of the world’s most careful tapering protocols for themselves and build online communities to share them freely with one another because there was nowhere else to turn for reliable information.

(Check out Laura’s excellent 2025 book here).

Thank goodness this is now changing. Prescribers and mental health professionals are realizing that they, like us patients, have been misled by the quick fix promises of the industry they work in. They came to this work because they wanted to help suffering people and were not given the information they needed.

This is an information problem we are all in together. There are many out there who want to keep us divided. They want to polarize and politicize this conversation, making it about right versus left, patient versus doctor, us versus them, quackery versus science, pro- versus anti-medication.

We mustn’t let them. This should not be a war zone. This should be a community table where we come together to learn from one another and embrace vulnerability, humility, and curiosity. Working together to once and for all address this national crisis. We owe it to the 65 million Americans on these medications to build safe off-ramps that should have been provided all along for those who want or need them.

And we owe it to our children who hold the future of this country in their sweet, sensitive, impressionable hearts to remember what it means to be human. That emotional pain is part of being alive. That meaningful help comes in countless forms beyond a pill bottle. Only then will the world they’ve inherited begin to make sense again.

Based on Laura’s other comments at the summit, we might ask ourselves: Of the roughly 65 million Americans currently on psychiatric meds, how many of them have been meaningfully informed about how to come off safely at the end of that journey if they decide they don’t want to take them anymore?

3. Lauren Friedman’s pain of struggling to feel deeply and connect intimately

Lauren Friedman described living with a condition called post-SSRI sexual dysfunction. 50 to 70% of all patients taking these antidepressants will have sexual side effects—with these potentially enduring after treatment ends. What patients are not warned about is that these side effects can be permanent long after you stop the last drug dose. Um, and PSSD is not just low libido. It is a full nervous system injury in which you lose total sexual function neurologically through essentially nervous system damage. So, the hallmark symptom of PSSD is genital numbness. Yes. like complete loss of sensation in your genitals.

“I clearly hate to talk about this, but my clitoris is completely numb as if it’s the back of my elbow. I have no sensation internally. I’m 23 years old.”

Some lose the ability to orgasm, with no libido—which some experience, Lauren said, like “a sudden onset chemical asexuality.”

There can be a loss of emotional function as well—something Lauren has experienced. “Before this, I was a super emotional empathetic, loving, caring, like Sylvia Plath reading and resonating girl.”

But the day she woke up to this injury, she felt a profound shift internally in her ability to feel—something that has lasted for years. “To this day, I can’t feel love for my own mother, which is the hardest thing on earth. I can’t feel connection or love for my friends, or even pleasure in music (though I had been) a songwriter since I was a child. It was my outlet.”

Lauren calls the many kinds of love experienced in “central, intoxicating, worthwhile, and fulfilling parts of the human experience. These aren’t luxuries. And to remove someone’s ability to participate not just physically through sex … but to remove someone’s ability to emotionally connect with another human being is a crime.”

This grieving young woman then went on to allege that Eli Lilly, the maker of Prozac, withheld for too long their full knowledge of the likelihood of these kinds of effects. (The current FDA Prozac labeling does acknowledge that “symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment”—adding that estimates of SSRI sexual side effects in labeling are “likely to underestimate their actual incidence.” This warning language was added in 2011, 23 years after the medication’s release in 1988. Advocacy groups such as the PSSD Network point to Eli Lilly/FDA from 2011 as evidence that the company was aware of persistent sexual dysfunction reports years earlier).

Since this specific diagnosis hasn’t been called out on the label, Lauren said, “I quite literally had no way of knowing that this was possible or that this could happen to me.”

“Had I known that this medication had the capacity to cause permanent loss of sexual and emotional function, I would have sought after alternatives….But that decision was made for me.”

Throughout Lauren’s story, her grief and indignation are apparent—even if her words remain calm. She calls her condition “torturous,” “horrific” and “inhumane suffering” with “these things that are so central (to life are) able to be removed” (she also uses a heartbreaking language of being “sexually defunct and emotionally lobotomized”).

At one point, she alleges that “life is not worth living when you can’t feel it or participate in it”—which this author points out would be a dangerous idea to entertain for anyone experiencing one of many reasons why they aren’t feeling as much as they used to. Better to remember that things can still change and improve—and in the meanwhile, there are still important things to learn, experience and offer to the world.

Lauren frequently speaks of her condition as permanent and lifelong, but acknowledges at the end, “there is evidence that this may be reversible with intervention.”

“We’ve been blindsided, betrayed, and maimed by the industry that we were told and instructed to trust, and we trusted fully given we took these medications, and now we’ve been offered no way back to our lives or humanities.”

I feel so deeply humiliated and dehumanized to share to a group of strangers in the press and inevitably the internet…. I’m a senior in College of Vanderbilt. I go back in the fall. I’d rather my peers not know this about me because this is what the situation requires.”

“I’m here to ….show that these medications are far from benign. People deserve to know the truth.

Lauren’s testimony is intense, but the policy message is simple: people cannot give informed consent if a serious potential outcome is absent from labels and clinical conversations.

Admiral Brian Christine reiterated in another presentation, “The decision to prescribe SSRIs should always… come with a full understanding of both the benefits and the risk.”

“Many veterans don’t understand what they’re getting into,” said Derek Blumke about many vets being treated. “Their families don’t understand what they’re getting into.”

4. What does safe tapering actually look like (why linear tapering is a big mistake), by expert Mark Horwitz

Mark Horowitz is an associate professor of psychiatry who works in Australia and the UK and had his own experience coming off the medications. He began his presentation saying, “Many people have tried multiple times to stop um psychiatric drugs and very much want to get off them. Not everybody, but many. And the question is why do so many people find it difficult to stop?”

“The answer is not a lack of motivation or psychological dependence as some people suggest. The reason is that the way we currently stop these drugs is biologically mismatched to how they work.”

The researcher went on to explain that, contrary to what many people assume, there is not a straight line relationship between dosage and effects on the brain. “If you double the dose from 20 mg to 40 mg, it doesn’t increase the effect on the brain very much at all”—with even a tiny dose of 2 milligrams having about half the effect of 40 milligram.

He compares this psychopharmaceutical principle to a “game of musical chairs. It’s easier to find a spot at the beginning of the game. As there’s more and more drugs in the system, the receptors fill up, it becomes harder to find a spot, and you get diminishing returns.

This is the problem with a typical linear tapering plan often recommended by doctors and most guidelines: “you start off at 20 milligrams, go down to 15, 10, 5, 0.”

Although this looks gradual on paper, the first reduction from 20 to 15 is on the level of the brain, a “tiny little reduction.” Although the next reduction (15 to 10) looks equal, it’s actually twice as large in its physiological effect—with the third reduction (10 to 5) twice as large again.

The last reduction, from 5 mg to 0 milligrams, then becomes the hardest of all. He summarized, “So what looks like a gentle taper actually involves jumping off a cliff at the end.”

This corresponds to patient experience, where Horowitz says “the beginning of the taper is fairly easy or easier and they and they struggle most at the end.”

Here’s the alternative: “Instead of reducing by a fixed amount of dose, you reduce so that each step produces a similar change in the brain. And this requires smaller and smaller dose reductions. So that the final reductions are very tiny doses, much smaller than the currently available tablets or capsules, so that you’re not jumping off that cliff. You’re walking down it step by step.”

The name of this wiser, safer tapering approach is “hyperbolic tapering” because it follows the hyperbola of the graph as if you’re walking down the curve, he explains.

(I like to compare this to flying a plane—where you drop more quickly at first, and have to slowly edge into the last moments).

A good rule of thumb is to reduce by about 10% of your most recent dose each month, he explained—so the amount of decrease “gets smaller and smaller.”

This needs to be individualized, however, and adjusted depending on how people respond. “Some people can go faster, some people need to go slower. There are some recognized risk factors but the speed needs to be adjusted to the individual based on careful monitoring.”

That means holding, pausing or adjusting the taper if symptoms become difficult.

Importantly, Horowitz pointed out, the smallest dose available in most antidepressants still has about 80% of the effect of the drug’s maximum licensed dose. That explains why it’s not a good idea to just stop for good after getting to the smallest tablet. “People are often told you’re just on a small dose, you can stop it. And that’s never the case. You know, your body doesn’t know that you’re putting a small tablet in your mouth. It only cares about the effect on receptors.”

That’s a trap that people get caught in. But the good news is in a study of 900 patients who had almost all been unable to stop their drugs with the traditional taper recommended by their doctors, almost three-quarters could stop with this gradual hyperbolic approach to coming off their drugs. They experienced fewer withdrawal effects—and many could have even had better success, he believes with even slower tapers.

Why don’t more people understand this? Four reasons:

1. “Most clinicians are not trained to recognize withdrawal or to take medications in this way. As a result, withdrawal symptoms are often misinterpreted as relapse and treatment is continued unnecessarily.”

2. “Many clinicians are not accustomed to prescribing liquids or compounded medications required for this technique.” He explained it’s not possible to implement this approach well only with tablets.

3. “Most psychiatric drugs in the US are available as liquids or can be made up with smaller doses by compounding pharmacies”—noting that it “would be useful if the FDA were to mandate liquids or small dose tablets for all psychiatric drugs in the same way as car manufacturers mandate braks on cars.”

4. “Existing guidelines often only tepidly acknowledge withdrawal and do not provide practical detail. Clinicians are left without specific tapering schedules or strategies for managing symptoms. This is true of the recent American Society of Clinical Psychology guidance which avoids these major issues and offers no practical help for clinicians on the ground. This is what we tried to solve with the Maudsley deprescribing guidelines which offers advice to clinicians.”

Horowitz shared a few additional notes, starting with a few cautions:

• “Dosing less often, for example, every second day often backfires because it leads to wildly oscillating levels in the blood.”

• In a New York Times story on new deprescribing guidelines of American Society of Clinical Psychopharmacology, one expert pushed back on encouragement of “slow tapering” across the board—insisting that longer half-life drugs like Prozac can “generally be stopped abruptly.” Horowitz responded to this, saying “Just because the drug leaves the system in a few weeks is not long enough to let the brain reset. And in fact, these drugs have withdrawal risks almost as high as other drugs in the same class. So there is no free ride off these drugs.” (Anders Sorensen elaborated in his remarks, noting that having a longer half-life as a drug “just means that the withdrawal reactions are delayed not that they’re absent….Yes, it’s a good thing that a drug leaves the body a bit slower because again withdrawal is the drug leaving the body faster than the body can adapt…that doesn’t mean that there are no withdrawals whatsoever….Don’t follow that advice (to quickly taper). The hyperbolic curves …are exactly the same with Prozac as in any other SSRI).”

• When a medication is started, Horowitz recommended that “informed consent should include expected duration of treatment and a plan to review and potentially stop right from the beginning. Patients should not begin these drugs, assuming they are indefinite.” A treatment plan should include an end goal date—suggesting a regular six month medication review, comparing ongoing benefits vs. harm—and revisiting “a clear plan to continue or to stop.”

• “Health care systems are set up to start medications quickly but they do not provide the time, support or infrastructure to help people come off them safely.”

“To summarize, withdrawal is a physiological process that can be prolonged. Current tapering methods are often biologically mismatched to how these drugs work. Safer methods already exist based on aligning dose reductions with the brain’s response, such as hyperbolic tapering.”

“Knowledge about how to recognize withdrawal, distinguish it from relapse, and safely stop psychiatric drugs needs to be embedded in medical education as much as starting the drugs are. At the moment there’s a huge hole in education and service which is seen in escalating numbers of people on these drugs who cannot get off.”

5. Understandable reactions to difficult environments or signs of illness? Nick’s story

What happens when the system treats friction with broken environments as illness, Nick Taber asks through his story—arguing that many young people are having valid reactions to environments, while the system recategorizes those reactions as disorders.

With an estimated 21% of kids are diagnosed with a psychiatric disorder, this is a defining management of how children are being taken care of in modern society, Nick first notes.

Yet for many of these children, they are living in families that may be difficult or even abusive. Adults can also be embedded in contexts that feel insufferable. In that case, he said, “for many of us, we’re simply having valid responses to the environments we’re in.”

In a challenging situation like this, someone’s feelings and reactions to an “insufferable situation” too often “get recategorized as a medical problem”—which he says, denies reality and erases what someone is really experiencing.

“I can’t tell you how many people I know who had these mental health services done to them as kids and end up feeling like shells of themselves. And this was certainly my experience for a long time because, and this is the key, we have lost our internal signals that tell us where to go and what to do, that tell us who and what is safe and not safe, what we value in life, what matters, etc.”

6. Don’t guide long-term treatment based on short-term evidence. Anders Sørensen remarks

Anders Sørensen is a clinical psychologist from Denmark who pushes back on the claim that fluoxetine/Prozac can generally be stopped abruptly because of its long half-life. Much of his talk is repeated below:

“In 2018, a study was published in the BMJ asking one very simple question. Do parachutes reduce the risk of death when jumping from an aircraft? The researchers compared two groups, one jumping with and one without. The result, no significant difference between the groups. Parachutes, it seemed, offered no protective effect compared to those jumping without one. But there was one small detail hidden in the method section, which you of course always remember to read. All participants had jumped from an aircraft parked on the ground from an average of half a meter. And as the authors noted, one should be cautious in extrapolating their findings to real world high altitude jumps.

We might laugh at this silly study, but it stops being funny when you realize we’re doing something very similar in psychiatry today. Fast forward to 2025. A study in the American Journal of Medicine compared how long antidepressants were studied in the randomized trials we rely on compared to how long people actually take them.

The median duration of the trials was eight weeks, meaning that most participants had only been on these drugs for two months. And the median duration of real world use in the US, five years.

So we’re using short-term evidence to guide long-term treatment. And that gap matters, especially when it comes to dependence and withdrawal. Time matters because the body adapts.

If you alter brain chemistry for long enough, the body adapts, not overnight, but gradually over weeks and years and months. And the longer that adaptation has been building, the more sensitive it becomes to change and the harder it gets to come off the medication.

In many cases, that can mean tapering over years. Because when you then remove the drug or reduce the dose too quickly, the system is thrown out of balance. And that imbalance is what we call withdrawal. An imbalance between what the system expects and what it now gets at the lower dose.

Since 1997, SSRI withdrawal has been described as mostly mild and self-limiting, lasting a week or two, mentioning only a handful of the more than 80 reported symptoms. That’s what the guidelines say because they’re based on short-term trials far from reality.

So what happens in practice? People who’ve been on these drugs for years, decades, are tapered off as if they’ve been taking them for months. Often by aggressively having the dose, having again stopping. And when that goes wrong, which it often does, they call it a relapse of an underlying condition.”

People come away being told, “well, clearly you still need the medication,” Sørensen explained. So back on the drug people go, with symptoms resolved and an illusion they just learned something fundamentally concerning about their mental health.

Namely: your condition is worse than you think, the medication is demonstrably treating an underlying illness and needs to be part of your long-term experience. Little consideration is given to the possibility that this could simply be withdrawal. Withdrawal has to be ruled out first, before someone resigns to relapse—which can still happen, Sørensen said.

“The trick is to understand withdrawal symptoms for what it is: communication from a body trying to adapt to too big a change too quickly. …What’s confusing is that withdrawal from psychiatric drugs isn’t just physical symptoms. It’s not just dizziness, nausea, headaches, muscle pain, shaking, burning sensations, fatigue. I mean, it’s that too. But it’s also anxiety, insomnia, irritability, depressed mood, mood swings, brain fog, difficulty concentrating, intrusive thoughts.

Withdrawal can mimic relapse or new diagnosis for which there are also drugs. The symptoms overlap. And if you don’t recognize withdrawal, you will misinterpret it.” (This happens in research too, Sørensen explained—with any deterioration often counted as relapse making the drugs look incredibly protective).

If people don’t recognize withdrawal effects, they’ll misinterpret them, Anders explained. “And that’s how people end up on these drugs for years and decades.”

“When stopped, the withdrawal symptoms can be worse than the problems for which the drug was first prescribed,” clinical psychologist Gretchen Lefever Watson likewise said. “Clinicians commonly misinterpret those symptoms as evidence of a worsening condition or the emergence of a new condition.”

“People go in with the side effects and they end up with another… prescription,” Kim Witczak added. “You go in and you’re being told it’s your illness getting worse and there’s no discussion on even how to get off of them.”

Many doctors don’t know about these kinds of dynamics, Sørensen said, because they haven’t been trained to recognize it, let alone how to manage it with proper tapering.

This isn’t about addiction, he explained:

• “Just to be clear, this is not about addiction. Antidepressants are not addictive. We’re not talking about cravings or uncontrollable use or people chasing the high.”

• What he’s talking about is instead “physical dependence, a state of adaptation manifested by withdrawal syndrome that can be produced by abrupt cessation or rapid dose reduction of the drug. That’s it.”

• He described supporting people “through withdrawal reactions from antidepressants so severe you wouldn’t believe they come from a drug, prescribed drug, taken exactly as prescribed. But people aren’t told when they start, they’re not informed. It’s not in the guidelines. So, they find themselves facing unexpected withdrawal, not realizing (it).”

He noted a pattern evident historically:

• “This parallels what happened with benzodiazepines introduced first as safe and effective with minimal concern of dependence until decades later, dependence and severe withdrawal became undeniable.”

• “Then we saw it again with opioids, again aggressively marketed as safe and effective for chronic pain until we had an epidemic. The pattern is the same.”

• “A new drug is introduced, framed as safe and effective, and gets widely prescribed. Then people start having trouble coming off it. Then research begins to confirm what patients are experiencing. But that research is pushed aside, ignored because it challenges the prevailing paradigm.”

• “And then the cycle repeats with new safe and effective drugs until we understand this.”

• “For context, with benzodiazepines, it took over 40 years from when we knew we had the evidence to when it was formally acknowledged with the blackbox warning in 2020. And if we were to see a similar warning introduced to SSRIs just this year, we’ll only be looking at a delay of around a delay of around 35 years since the first report withdrawal began appearing in the 1990s. And today we’re still drawing conclusions from the ground about what happens.”

7. Secretary Kennedy’s remarks

Anything HHS Secretary Robert F. Kennedy Jr. says gets pilloried and automatically labeled as ridiculous by some people. I think that’s unfortunate, because if there’s one thing Americans across the political spectrum seem to be able to agree with, it’s that our health care system really has some challenges.

This is one of them: a wide onramp onto psychiatric meds, and a very hard to find off-ramp. Feel free to disagree with the Secretary here or on anything else. But as someone who started studying antidepressants almost 25 years ago, I can tell you he is 100% right in what he says in this short talk about mental health and antidepressants:

“The United States does not just face a mental health crisis. We face a dependency crisis driven by overmedicalization. The data is clear. One in six American adults takes an antidepressant. One in 10 children are on prescription medication for their mental health. 30% of college students report using psychiatric medications in the past year.

And in nursing homes, more than half of the residents are on prescribed antidepressants. That’s not a marginal issue. This is a system level pattern. Too many patients begin treatment without a clear understanding of the risks and how long they will stay on these drugs or how to come off of them.

And that’s not informed consent. We are going to fix it.

Today, the Department of Health and Human Services released a dear colleague letter issued by four of my HHS agencies. SAMHSA, CMS, HRSA, and ACF. It directs providers across the country to expand the use of evidence-based nonpharmacologic treatments and to strengthen informed consent and shared decision making.

SAMA, the Substance Abuse and Mental Health Services Administration will publish new data on prescribing trends and release guidance for clinicians and physicians. In June and July, SAMPS will roll out national training modules on psychiatric medication risks on tapering and deprescribing at more than 1,400 federally qualified health centers, community health centers across the country, which treat 39 million patients on how to do medically supervised tapering.

HHS will convene a technical expert panel to develop formal clinical guidelines grounded in evidence and formed by clinicians, patients and their families.

CMS, the Center for Medical, Medicaid, and Medicare Services is issuing billing guidance that allows clinicians to get paid for deprescribing work for the first time. They’ll be paid for care planning, for monitoring withdrawal, for coordinating treatment, and for tracking outcomes.

Psychiatric medications have a role in care, but we will no longer treat them as the default. We will treat them as one option used when appropriate with full transparency and with a clear path off when they are no longer effective.

Patients must understand the benefits, the risks, and the consequences of long-term use before they start, (when) they continue, and when they consider stopping. Without that information, consent does not exist. Right now, gaps in data, labeling, clinical guidance deny patients and physicians the full picture….

We’re also confronting a basic question. What happens when treatment does not work as intended? Some patients report improvement on SSRIs. Others report emotional blunting, loss of motivation, difficulty continuing use, and suicidal ideation.

I watched a family member get off of them after a couple years on them. And she was suicidal literally every day. She woke up every morning and said, “I don’t want to live.” And she said, “The only reason I’m staying alive is for you guys, for the family.” And that’s heartbreaking to hear from a family member. And I’ve heard that from hundreds and hundreds of people. The same story again and again.

(Withdrawal) can be severe. It can be prolonged. And for many patients, it’s completely unexpected.

And the physicians handle this by saying, “Oh, this is your original symptom, reasserting yourself. You need to get back on the SSRIs.”

And they get locked in a lifetime cycle that is uh that for many patients is absolutely cataclysmic. This is a system failure. We’re not going to ignore it.

And let me be clear. If you are taking psychiatric medication, we’re not telling you to stop. We’re making sure that you and your clinician have the information and support to make the right decisions for you. That includes a safe evidence-based path to tapering and discontinuation when clinically appropriate.

At HHS, we are building that path. We are giving clinicians the tools to guide patient safety. We’re giving patients the information to make informed choices because an informed choice is the only choice. Nearly 48 million Americans experienced depression last year. More than 48 million struggled with substance use disorders. These are not abstract numbers.

These are family members. These are individuals. These are people who other people love. That is the scale of the challenge. We are not going to solve it by defaulting to medication. We’re going to solve it by strengthening prevention, expanding non-drug treatment options, and restoring clinical standards that prioritize outcome over volume.

Dear readers — this is one of the most important things I’ve ever published. With roots that date back to my 2006-2009 University of Illinois dissertation on depression treatment, I’ve been thinking about this question for two decades now.

I’m sharing below a new Antidepressant Side Effect Checklist that I’ve been working on based on the latest research for public educational purposes. Before introducing it, I need to say more about why this question matters so much.

There’s a lot to say before introducing an Antidepressant Side Effect Checklist, precisely because of how much depression and anxiety hurt. I’ll never forget a young woman in her 20s comparing her experience with depression to earlier, vicious child abuse. This is what she told me:

“I have had beatings to the point of unconsciousness — ripped, broken, arms taken out of the socket — and that compares nothing… doesn’t even begin to be the pain that became every day, just right here [pointing to chest] — this thing that wouldn’t go away — that made it hard to breathe… I would rather have hours and hours of people beating me than to have been where I was inside. It hurt that bad… there were times I thought it would kill me — all on its own.”

That’s how intense and overwhelming depression can become. And it’s why it makes sense that someone facing this would do anything they can to find relief, stability, and hope. Whatever path someone chooses in that effort deserves understanding and support. That includes deciding to take an antidepressant — for as long as it feels helpful or necessary.

The purpose of this inventory is simply to offer greater clarity about the range of possible side effects associated with antidepressant treatment, so that families and individuals — young and old — can participate more actively in decisions about their care.

For some, that may simply mean continuing treatment with more awareness. For others, it might raise questions worth exploring over time with a trusted professional. In some instances, that conversation may eventually lead to considering cautious, gradual changes — with appropriate support and at a measured, careful pace. For many, no changes may be needed; instead, this may simply put language to experiences or confirm that their current approach is working.

As Jon Kabat-Zinn has taught, until we can see clearly where we are, we don’t really know where to go next. In my experience, many people are unaware or confused about antidepressant side effects — with little understanding about whether a headache or brain fog or sexual problem could be associated with their treatment.

Even so, greater clarity about this all doesn’t force any particular decision — nor does it require urgency. Expanded awareness simply allows wiser, more grounded decisions, which may support deeper healing over time. Whatever adjustments are made can happen gradually, without pressure — especially avoiding sudden changes without guidance.

Hoping this checklist is helpful,

Yours, Jacob

What’s really coming from what?

Since publishing a recent cautionary story about inadvertent treatment effects, I’ve been thinking more about how difficult it can be to differentiate between symptoms arising from emotional struggles like depression and the effects of medications many people now take as a first-line treatment option.

That confusion can really make a difference. A friend told me recently about piercing headaches that wouldn’t go away — headaches that she hadn’t experienced until recent years. Even though this woman was educated and bright, she hadn’t seriously considered that the antidepressants she had started during this same period might be contributing to her migraines.

That specific side effect is listed on 5 out of 6 FDA prescribing guides of the most common antidepressants. But my friend likely never heard about that possibility from her physician — nor did she read about it on her own. If she had picked up the pamphlet inserted into the package, she would also have little way of knowing that the “official” list of side effects may not capture the full range of what can occur, especially over the long-term.

This is another reason for the confusion: so many of these side effects naturally change over time in ways that can be unpredictable. Amid this uncertainty, strong biases can exert themselves. Psychiatrist Peter Breggin cautioned for decades how easy it can be to assume something unpleasant is coming from an underlying emotional problem, while taking for granted that something positive or pleasant is connected to the medical treatment.

Despite this confusion, I believe there’s a strong way to ground ourselves in this discernment. It starts with getting clearer about the full scope of side effects associated with a particular treatment. From my own renewed curiosity, I decided to gather the side effects submitted in the FDA approval process for the 6 most common antidepressants in use: Prozac, Zoloft, Celexa, Lexapro, Paxil and Luvox. These are each part of a group of classic SSRIs (selective serotonin reuptake inhibitors) — which were developed to inhibit serotonin from being reabsorbed in the brain, in an attempt to make more of that neurotransmitter available for someone struggling with depression.1

Supplementing with other data from post-marketing studies and consumer/patient forums, I’ve pulled the side effect themes together into a draft of a new checklist to assist those wanting to get a better sense of whether parts of their experience may be influenced by this particular class of medications.

That could be good news, by the way. If symptoms like headaches, dizziness, insomnia, or irritability are partly medication-related, they may be more modifiable than they seem.

In the wake of realizations like this, I’ve known many people who decided with their supervising doctor to make some gentle, thoughtful adjustments in how they respond to depression, and subsequently came to find a different kind of life experience (here’s one example).

A short-term symptoms focus

Virtually all of the mental health surveys I’ve ever seen are focused on symptoms of a particular emotional disorder — in this case, centered on the “depressed mood” or “loss of interest/pleasure” in life which are one of two conditions required for a clinical diagnosis of depression. In addition, at least three of the following need to be present: concerning shifts in weight/appetite, sleep, energy, cognitive ability, lack of movement, “feelings of worthlessness” and “recurrent thoughts of death.”

As the classic DSM depression profile, this constellation of symptoms must be present over a 2-week period and represent a “change from previous functioning.”

It’s here that our collective attention has been focused for nearly 3 decades: running through these criteria with a doctor, screening our young people, or taking a self-assessment ourselves. Often prompted by these kinds of assessments, an estimated 33–35 million Americans now take antidepressants annually (~13% of the adult population), along with roughly a million teenagers (~5% of the teenage total in the U.S.).

Given the vast scope of this public health intervention, it’s important to explore what happens next: understanding in greater detail the evolving range of effects people experience on the medications.

Yet after the investment in initial short-term studies designed for FDA approval, it’s striking how little sustained research has gone into careful evaluations of treatment experience over time, especially not in the long term. (I know, because over the years I’ve been collecting every long-term antidepressant study I can find).

For someone whose antidepressant isn’t going well over time, this can create some added confusion. That’s where one of my own dear family members was years ago. Medicated for depression, but feeling worse than ever.

After years of treatment, she was told that she was “treatment resistant.” Rather than looking more carefully at the treatment itself, she came away feeling that she was the problem — ‘guess I’m just even sicker than I thought?’

Another kind of symptom focus

We need to do better than that for the precious lives of so many amazing people facing emotional challenges. (In my experience it’s especially sensitive and deep souls who tend to hurt like this — Homer Simpson doesn’t get depressed).

For the many people — young and old — who yearn for a little more peace and happiness, I wonder: What could it mean if a little more attention went to appraising the full scope of antidepressant side effects potentially showing up in their experience?

For one, I believe we’d be closer to being able to see clearly what’s-coming-from-what in terms of our evolving emotional experience: Where is the pain coming from? And the sweetness too?

Just as that clarity could make a difference in important decisions about long-term trajectories of care, a lack of clarity on this question can surely complicate these same deliberations.

That’s my motivation in drafting this new “awareness tool” I’m laying the groundwork for introducing here. I hope this can be something to help suffering individuals or their loved ones if antidepressants have been a part of their recent life experience.

Illustrations generated with AI (ChatGPT), based on author direction

Some background

Twenty-five years ago during my doctoral program at the University of Illinois, I became fascinated with competing stories human beings tell about emotional pain — and the different ways they interpret and “narrate” depression, in particular. After interviewing people in Salt Lake City and Chicago for my dissertation on Prozac, I wrote 300 pages on the topic, including peer-reviewed articles on competing stories about the depressed brain, about whether recovery is possible and about what it means for medication to “work” for teens and children.

I later helped create two different online classes drawing on many of these same concepts and wrote a 2023 Deseret News article, “Is it me or my medication,” on this specific question I’m taking up today in more depth.

One of the biggest things I learned in all my research on the topic is how complicated this is all — not easy to tell what’s going on! Once someone is taking a daily medication that directly influences their emotion, a 3rd variable gets introduced that isn’t so easy to parse out. After all, whatever you’re experiencing inside is just what you are experiencing … how is someone supposed to tell whether it’s connected to medication or any of the hundreds of other (environmental, lifestyle, social, physical, spiritual) influences on their emotions?

It was the Boston College sociologist David Karp who first gave this question proper attention in his memoir of grappling with depression himself: “Is it me or my meds?”

My own study reinforced how challenging this question is for so many people. Yet outside of passing conversations, I’ve never had a chance to create anything specifically for people in the middle of this question.

What follows is shared as public scholarship to inform further conversations within families and the many helping support those facing these emotional challenges. It represents a synthesis of existing knowledge, and I welcome additional critique and feedback.

The development approach I took

Here’s how I created this antidepressant side effect checklist.

Understanding the basic scope of side effects

To understand the scope of side effects of any medication, a good place to start is the Full Prescribing Information (FPI) — an FDA-approved “package insert” for healthcare providers that compiles a drug’s safety profile based on data reported by the manufacturer.

After gathering both common and serious side effects in FPIs for the 6 most established SSRI antidepressants2 — Prozac, Zoloft, Celexa, Lexapro, Paxil and Luvox — I identified 22 different side effects that showed up across all six medications, along with another 7 that showed up in at least 5 of the medications.

Here is the 6-out-of-6 list of potential side effects (with some medical jargon converted to plain terminology):

• Feeling like you might throw up

• Diarrhea or loose stool

• Difficulty having bowel movements

• Indigestion or upset stomach

• Dry mouth

• Trouble sleeping

• Feeling very sleepy or drowsy

• Low energy or unusual tiredness

• Dizziness or lightheadedness

• Shaking, usually in the hands

• Feeling anxious or worried

• Feeling nervous or jittery

• Excessive sweating

• Not feeling like eating

• Decreased sex drive

• Delayed or difficulty with ejaculation

• Thoughts about self-harm or suicide

• Feeling suddenly much worse emotionally or more depressed

• Feeling unusually energized, impulsive, or out of control

• Unusual bleeding or bruising

And here is the 5-out-of-6 side effect list, based on these same six FPI guides:

• Stomach pain

• Throwing up

• Feeling restless or unable to relax

• Difficulty getting or maintaining an erection

• Severe restlessness or inability to sit still

• Symptoms of too much serotonin (confusion, sweating, fast heartbeat, shaking)

• Eye pain or sudden vision changes

• Headache

• Difficulty reaching orgasm

• Skin rash

As you can see, many potential SSRI side effects are not unique to individual drugs — they are shared across this class of medications. These SSRI side effects that have been identified as potentially happening in all six medications include gastrointestinal distress, sleep and energy disruption, neurological symptoms like dizziness and tremor, heightened anxiety or restlessness, sexual dysfunction, and a smaller but important set of serious risks affecting mood, bleeding, and overall system regulation.

This constellation of experiences forms a natural anchor point for any antidepressant side effect inventory. In fact, approximately 85% of the items in two of the main antidepressant symptom inventories already in use today map onto this same basic list of symptoms above: The 32-question Toronto Side Effects Scale (TSES) from 2002 and the 21-question Antidepressant Side-Effect Checklist (ASEC) from 2009 both largely draw from the same clusters of symptoms highlighted in FDA prescribing documents.

This only becomes a limitation if additional categories of side effects are not considered. For instance, neither of these earlier side-effect surveys explore the possibility of an antidepressant worsening depression, increasing suicidal thoughts, inducing mania, or prompting symptoms of “serotonin syndrome” (signs of too much serotonin). And like the FPI prescribing brochures themselves, neither of these other surveys considers the possibility of a drug-induced increased sense of hopelessness, worthlessness or loss of meaning.

Balancing side-effects with positive effects

Of course, antidepressant treatment also frequently elicit positive effects. In line with research submitted to the FDA for antidepressant approval, many people describe a reduction in depression symptoms (and sometimes in anxiety symptoms) that makes any of these known side effects potentially worth tolerating in an overall cost-benefit ratio.

That means lower scores on depression scales like the Hamilton Depression Rating Scale, with some modest improvements in sleep, appetite and energy also seen over 4–8 weeks among roughly half of patients during early weeks on an antidepressant, and a “remission” observed among many of these symptoms in about a third of patients during this same initial period.

These patients describe things like:

• “Relief from the worst intensity” for a period of time and feeling less overwhelmed with the pain becoming more manageable (“taking the edge off”).

• A better ability to get out of bed, work and engage in daily tasks, as well as improved sleep for some.

• Less constant worry or panic, and feeling more settled or calm

• Fewer extreme highs/lows and more predictable mood

• Sometimes an increase in motivation and a return of interest in life events

I heard these same kinds of reports in my University of Illinois antidepressant study, especially during the initial period of treatment. For most people I’ve spoken with, unfortunately, these benefits do not endure in the same way over time — underscoring the importance of longer-term research.

These initial positive effects have received enormous attention over the years — publicized and promoted for nearly two decades. By comparison, details on side effects have received relatively sparse public attention.

All this explains why more discussion is needed and, in my view, something more than earlier side effect inventories, which largely follow company-reported lists of symptoms.

Two kinds of additional data

There are two kinds of additional information important to consider in understanding the range of side effects on any medication.

The value of independent research

When side-effect surveys rely primarily on company-generated data, an important set of additional possibilities will likely be missed. This is intuitive to anyone who has watched a drug commercial with lovely video images, accompanied by a rapid voiceover running through a list of side effects.

It turns out even the list of side effects companies insert via pamphlet into a medication box is curated in interesting ways. For example, sexual side effects such as reduced libido, delayed ejaculation, erectile dysfunction, or difficulty reaching orgasm, are compressed into a single, more generic label of “sexual problems” in the official medication guides for Celexa and Lexapro.

To capture the wider picture of side effects, these company reports need to be supplemented with “non-official” sources. In addition to independent outcome studies, there is value in studying consumer/patient forums without any connection to industry or professional associations.

The value of patient forums

Consumer/patient forums can be uniquely helpful in identifying what might be missing from official symptom lists. While official sources — company and independent — define what is identified in research, patient forums reveal what is experienced.

While clinical trials capture frequent, measurable, short-term effects and physiologically clear outcomes, patient forums also do a better job capturing subjective experience, cognitive and emotional changes, identity shifts, earlier onset symptoms, changes over time (including long-term effects and withdrawal effects), or changes that are rare or spread out over time, and thus harder to pinpoint.

During her time on faculty at Colorado State University, my colleague Shannon Hughes joined David Cohen in comparing antidepressant side-effect reports on industry-funded websites (like www.webmd.com), with independent patient forums (like www.askapatient.com), which they found “capture real-world variability missing from trials.”

By comparing Lexapro side effects presented on these two different kinds of websites, they found:

• Professionally-controlled websites were more likely to feature symptom improvement, while consumer-controlled sites tended to share more details about symptoms worsening.

• Consumer sites were also more likely to share side effects that were “disrupting daily routines” and which involved “richer descriptions of effects in context.”

These researchers concluded: “Professional medication descriptions offer the advantage of a concise yet comprehensive listing of drug effects, while consumer reviews offer greater context and situational examples of how effects may manifest in various combinations and to varying degrees.”

Additional themes documented

As you can see, if we want to better understand the emotional, cognitive, interpersonal, and sensory experiences that most people consider central, we need to step beyond official side-effect lists to explore the broader picture of lived experience on any given medication.

Based on that broader analysis, here are some other potential antidepressant side effects that are commonly observed in patient forums and independent research:

• Emotional numbness or blunting

• Feeling less emotional range (less joy and less sadness)

• Feeling less awe, wonder, or being “moved” by meaningful experiences

• Reduced motivation or drive

• More apathy or less interest in things you usually care about

• Brain fog (feeling mentally dull or less sharp)

• Memory problems

• Reduced empathy or compassion for others

• Feeling more emotionally distant or disconnected from other people

• Less interested in being around others

• Inner restlessness or inability to sit still

• Extreme internal agitation and urge to move (“feel like I’m crawling out of my skin,” sometimes called akathisia)

• Internal vibrations or buzzing sensations

• Muscle twitching or jerking

• Ringing in the ears (tinnitus)

• Vivid dreams or nightmares

• Night sweats

• Temperature sensitivity (feeling unusually hot or cold)

• Jaw clenching or jaw tightness

These are all underrepresented in FDA “pamphlet inserts” or FPI “clinician guides.” I’ve included them in this new checklist below.

Two other areas of inquiry

In addition to this wider scope of side effects captured in patient forums and independent research, there are two other areas that make this checklist unique, summarized below.

1. Other kinds of non-SSRI antidepressants

After forming the original side effect list from the 6 most popular, SSRI antidepressants (Prozac, Zoloft, Celexa, Lexapro, Paxil and Luvox), I realized this list of potential changes mapped fairly well onto what’s known about other antidepressants too, with a few exceptions.

In order to make this checklist more generalizable to Wellbutrin and some newer antidepressants like Trintellix, and SNRIs like Pristiq or Cymbalta, I’ve added several potential side effects often associated with these newer medications:

• Increased appetite

• Weight gain

• Feeling unusually sleepy, sedated, or hard to wake up

• Feeling unusually activated, stimulated, or “amped up”

• Heart racing, pounding, or palpitations

• Unusual increase in sexual thoughts, desire, or arousal

• Mood swings or feeling emotionally unstable

• Blurred vision or other visual changes

• Changes in urination (more frequent, difficult, or unusual)

2. Withdrawal-specific changes

While many of these side effects show up in the normal course of antidepressant treatment (e.g., weight gain, sexual dysfunction), a surprising number occur especially when making changes to the medication, whether that is starting, stopping, or adjusting dosage.

These dosage-change-specific experiences include some of the most common antidepressant side effects like headache, nausea, loss of appetite, agitation, difficulty concentrating, insomnia, fatigue and restlessness.

But there’s a third category of effects exclusive to withdrawal or discontinuation — and not typically showing up unless someone attempts to come off their medication (especially if they do so too quickly, and without tapering gradually enough).

Many of the antidepressant side effects that occur during initial treatment — especially in sleep, mood, energy, and anxiety — can also reappear during withdrawal, often with similar intensity. A core list of changes that are specific to withdrawal have been included in a separate section of the checklist:

• Brain zaps / electric shock sensations

• Internal buzzing or vibrating sensations

• Dizziness triggered by head or eye movement

• Feeling off-balance or like you’re walking on a boat

• Sensitivity to light, sound, or motion

• Sudden emotional surges or swings

• Feeling detached from yourself or surroundings (unreal or distant)

• Visual disturbances (e.g., trailing images or delayed visual tracking)

• Symptoms that come in sudden waves or bursts

• Symptoms that worsen quickly when a dose is missed and improve after taking it

This smaller list of potential withdrawal effects represents a broader group of possible effects, with 187 withdrawal-related symptoms that have been observed in people discontinuing psychiatric medication generally, as compiled here by former patients.

Read this first

Before going further, it’s worth pausing for a moment.

This checklist is not a diagnostic or treatment tool, and nothing here is intended as medical advice. That means this isn’t a clinical tool designed to diagnose, assess, or guide treatment decisions on its own. Rather, it is intended as an educational and reflective resource — to help people notice patterns and generate questions they may wish to explore with qualified professionals, similar to many other self-guided mental health checklists out there.

Most of what’s included here is already known in different places — clinical documents, studies, and patient reports — but rarely brought together in one accessible format. As a synthesis of publicly available sources, clinical documents, and patient-reported experience that is translated into a practical awareness tool, my aim is to make existing knowledge more visible and usable to the general public.

The final list is intentionally broad — gathering many possibilities. Yet most people will experience only a small fraction of these, and often temporarily. The goal here is not to alarm, but to give language to experiences that can otherwise feel confusing or isolating. If something stands out, it’s simply an invitation to notice — not to act quickly or make changes on your own.

People’s experiences with medication vary widely, and no single pattern applies to everyone. For many people, two things can be true at once: a medication may provide meaningful relief while also introducing side effects that are easy to miss. This complexity is part of what makes clear awareness so challenging.

The complete checklist

You can access here the full 90-question Antidepressant Side Effect Checklist, along with a reflection section with some questions as you consider the results.

Antidepressant Side Effect Checklist

192KB ∙ PDF file

Download

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I’ve worked hard to use language and categories that are accessible and reflective of how individuals actually experience these side effects — minimizing medical jargon.

While other nuanced questions could be asked about each item, including whether a particular symptom was “Mild,” “Moderate” or “Severe” (or not present at all), I’ve made each question simply a “yes” or “no” to reduce the cognitive load and make the checklist more doable. (I’d welcome feedback on the checklist and how I can make it better: jzhess@gmail.com).

None of this, of course, substitutes for professional medical advice. If anything in this list raises concern, the next step is not to make any changes on your own, but to begin new conversations with people you trust, including qualified professionals. Rapid changes — especially stopping suddenly — can make symptoms significantly worse.

That’s why it’s strongly advisable to work with a trusted medical professional in supervising decisions related to medication. And virtually always (unless you’ve only been taking a medication for a few months) — even if your doctor is recommending that you “cut the dose in half” — a decrease in medication often discussed in terms of gradual, stepwise reductions (for example, small percentage decreases over time)3

This checklist expands the scope of antidepressant effects worth considering, compared with both standard side-effect lists in the FDA Medication guides/FPI documents and earlier inventories that are more narrowly focused. For instance, in addition to other inventories reviewed earlier, American psychiatrist John Rush and colleagues developed the Patient Rated Inventory of Side Effects (PRISE) in the early 2000s as part of the STAR*D research project. What started off as only 8 questions is now a 32-question survey — but is not publicly available, to my knowledge.

Many of these inventories are either two decades old or simply too limited in the scope of side effects they take up. Other tools like the UKU Side Effect Rating Scale were developed by Scandinavian researchers to be more comprehensive across all psychiatric side effects. But again, this was created in 1987 and is now almost as old as I am!4

Two follow-up questions

There’s a lot to consider here. Let’s walk through two other questions some people will have.

1. Okay, but how frequent are any of these side effects?

To see a checklist of all potential side effects in one place can feel overwhelming. And it’s important to address a significant misconception about the true frequency of any given effect.

Please remember, especially, that this checklist aggregates possible symptoms that can emerge (or not emerge) from antidepressant treatment. And when a side effect does emerge, it may often only emerge for a short time.

Other side effects, of course, can be for a longer duration too.

This is important to keep front of mind so this antidepressant side effect checklist is seen for what it is (“these might show up”) — and not over-interpreted as something it’s not (“this is what someone is going to experience on SSRI antidepressants”).

It’s well-known, of course, that side effects vary in frequency. What’s been less appreciated is how different estimates of these frequencies also vary considerably. For example, rates reported in clinical trials — often based on short durations and spontaneous reporting (“if you notice something happening, let the researcher know, okay?”) — tend to be lower, while studies using structured assessments or longer-term follow-up tend to find higher prevalence for various side effects.

For example, estimates of sexual dysfunction accompanying antidepressants range from 2-8% in company trial data, while more systematic research finds rates as high as 70%. Although that gap is especially dramatic, the difference between reported side effects observed in clinical trials and rates reported in real-world experience is consistently significant, as illustrated by this table below (ordered from smallest to largest difference):

As you can see, while some side effects — like tremors, nausea5, yawning and appetite changes — show somewhat similar rates across clinical trials and real-world reports, others differ substantially.6

2. Does this apply to teens?

A majority of these side effects in the checklist can occur in both adults and teens, who experience most of the same medication-related effects as older adults. That includes the core symptoms most commonly experienced: GI issues (nausea, appetite), sleep changes, fatigue, anxiety / agitation, and neurologic symptoms (tremor, restlessness).

Sexual side effects can also occur in teens, even those who are not sexually active. Some effects — especially restlessness, emotional changes, or disturbing thoughts — may be more noticeable and especially important to monitor in younger individuals. Teens also experience higher sensitivity to activation — meaning, they are more likely to experience agitation, restlessness, feeling “sped up” and behaviorally disinhibited.

This might explain why a risk of suicidal thoughts and emotional volatility is also higher for teens taking antidepressants (hence, the black box warning). This is especially true during initial treatment or when dosage is changed.

This may also explain why emotional and identity effects may be stronger for teens — e.g., feeling “not like myself,” emotional blunting and social/relational changes.

Two areas not included in the checklist

This tool does not attempt to be all things for all people, with two areas I’ve held off in including for now.

1. Pregnancy-specific changes.

There are several pregnancy-related adverse changes that can happen in expectant mothers taking antidepressants, as documented by independent studies and patient/consumer websites. Those include increased risk of postpartum bleeding, preterm birth (delivery before 37 weeks), miscarriage (also called “spontaneous abortion” in some studies), lower birth weight, and temporary newborn symptoms (irritability, jitteriness, feeding/sleep issues, mild respiratory distress).

Heart defects can also unfortunately occur, especially with Paxil in the first trimester, which resulted in a $1 billion settlement in 2010 that GlaxoSmithKline paid involving hundreds of affected families.

I’ve chosen not to include those in this checklist, because of its current length and because they would not apply to most people taking the survey. Here are the ten questions that could be added for the subset of women for whom they would apply:

Pregnancy-related changes

If you were pregnant while taking an antidepressant, or shortly after, did you notice any of the following? Note: these experiences can have many causes, including underlying health conditions or pregnancy-related factors.

1. Heavier than expected bleeding during or after delivery (postpartum bleeding) ☐ Yes ☐ No

2. Delivery earlier than expected (before 37 weeks) ☐ Yes ☐ No

3. Lower birth weight than expected ☐ Yes ☐ No

4. Pregnancy loss (miscarriage) ☐ Yes ☐ No

5. Newborn irritability, jitteriness, or unusual fussiness ☐ Yes ☐ No

6. Low blood sugar, low body temperature, or poor muscle tone in the newborn period ☐ Yes ☐ No

7. Feeding difficulties in the newborn period ☐ Yes ☐ No

8. Sleep difficulties or unusual sleep patterns in the newborn ☐ Yes ☐ No

9. Breathing difficulties or need for extra monitoring after birth ☐ Yes ☐ No

10. A diagnosed heart condition in the baby (especially if exposure occurred early in pregnancy) ☐ Yes ☐ No

2. Long-term changes

The majority of items represented in the checklist reflect the evidence arising from short-term research upon which FDA review is based. Drawing on the longer-term antidepressant outcome research available, another section could be added that addresses other changes over time in how people’s mood, recovery, and treatment experience evolve across years.

I’ve opted to not include these questions in the checklist as well, since there is relatively little known about the full extent of how treatment and biological effects evolve over time. But based on what we do know from available research, these questions below represent an accurate glimpse, generally speaking, of the longer-term trajectory of symptom and side effect evolution many people experience over time.

Long-term changes

Some people also notice longer-term changes in how their mood, recovery, and emotional experience evolve over time. Once again, these patterns may also be influenced by many other circumstances across a life trajectory.

1. Depressive episodes becoming more frequent or returning more quickly than before ☐ Yes ☐ No

2. Depressive periods lasting longer than in the past or feeling less able to return to your previous level of well-being after an episode ☐ Yes ☐ No

3. A more persistent, harder-to-change low mood (including between episodes) ☐ Yes ☐ No

4. Feeling more sensitive to stress or more easily triggered into low mood than before ☐ Yes ☐ No

5. Emotional range becoming more limited over time (even if initially helpful) ☐ Yes ☐ No

6. Feeling stuck at a partial level of improvement or that your emotional baseline has shifted in a way that feels harder to change ☐ Yes ☐ No

7. Feeling like your mood or functioning increasingly depends on continuing the medication ☐ Yes ☐ No

8. Medication becoming less effective over time (e.g., needing higher doses or initial benefits like relief, motivation, or emotional lift fading) ☐ Yes ☐ No

Still not so easy to tell!

With any serious exploration of antidepressant side effects, humility is called for — for many reasons. First of all, the effect of any particular medication is expected to change over time, especially with dosage adjustments.

Second, our emotions can be naturally influenced from many different sources. And it’s naturally easy, when reading a list like this, to see oneself in many items. But that doesn’t mean all the changes apply or are medication-related.

Depression itself, as highlighted above, can also generate many difficult emotional effects. This creates a three-way ambiguity, with a given symptom potentially arising from the condition, the treatment, or the process of coming off the treatment.

Bottom line: even when an association exists, it’s difficult to say for sure what arises from what.

Obviously, correlation is not causation. Yet that doesn’t dismiss the value of correlations, which can teach us a lot — as long as we approach them in the right light.

Similar to the FIBSER (Frequency, Intensity, Burden of Side Effects Rating), we might also ask: how confident should any of us feel about whether a particular change is connected to antidepressant treatment, compared with something else?

One of the clearest ways to tell whether a medication has been contributing to any of these side effects is to make an adjustment (with appropriate supervision), and then observe whether the specific side effect changes — asking specifically:

• Does the effect get worse after a dosage increase?

• Does it improve after a dosage decrease or tapering?

These are challenging questions. So, let’s be humble. But we should also be serious. If a medication were making life harder, would we recognize it?

Above all, remember that awareness doesn’t require urgency. It simply opens the door to more informed and thoughtful decisions — made at the right pace, with the right support.

Notes:

Illustration by our wonderful neighbor, Jerika Anderson

I’m sympathetic to those who hear talk of eternity or resurrection or atonement … and start to feel like they’re dealing with abstractions — something far removed from the daily realities of life.

I used to feel more that way too, until the agony of life finally found me — the despair, the darkness and especially the death.

All of a sudden, life after death became as concrete as the little girl I was no longer holding in my arms. And resurrection, rather than centering mostly around ancient, miraculous stories, also became about dreamed-of future days with our Emma — pushing her on the swings one day, right next to her sister Olivia.

Both healthy, happy, seeing, laughing and free of pain and seizures (a future where wrongs are made right, and as Joseph Smith told a grieving mother in 1854: “You will have the joy, the pleasure and satisfaction of nurturing this child, after its resurrection, until it reaches the full stature of its spirit” — with other mothers who had lost children likewise reporting “he told us that we should receive those children in the morning of the resurrection just as we laid them down, in purity and innocence, and we should nourish and care for them as their mothers.”)

This means a lot to us, because unless we’re given an unforgettable miracle, our daughter Olivia is not expected to live long. But our hope isn’t resting in any particular outcome — just as it isn’t dependent on brighter days we believe are coming in the future.

Christmas Day, 2025

A future to smile about

Don’t get me wrong: that future really does mean so much to us. It’s something we glimpse in the sweet moments that come and go in our own home (“Heaven is Christmas that doesn’t end”).

As a boy, I remember getting choked up watching that scene from “Field of Dreams” when Ray met his father as a young man. Now, though, it’s what happens next that I love even more.

When grown-up Ray asks his young-again-dad in “perfect form” (like all our loved ones will one day be): “Is there a heaven?”

“Oh yeah — it’s the place dreams come true.”

And then they throw a baseball together. When I see my brother Sam again — at that incredible family party of all parties — I’m totally planning to ask him to shoot some hoops with my boys.

No matter what hard things hit our family and our country in the days ahead, this bright future is a big part of why I’m hopeful, peaceful and happy. The “best really is yet to be!”

The source of my smile

But that future is not the only reason I feel hope. Because, once again, my faith rests on something more than an outcome — whether that’s how Olivia is doing now or in some glorious future.

My hope rests on the being of a person who rose from the grave a few years shy of 2,000 years ago — Someone I have felt personally thousands of times in my life: through staggering peace. Sweet joy. And incredible love… the kind that cannot be explained away as somehow coming from my own head and heart.

“If Christ had not come into the world … there could have been no redemption,” Abinadi taught in ancient America. “And if Christ had not risen from the dead, or (had) broken the bands of death that the grave should have no victory, and that death should have no sting, there could have been no resurrection” (here, he cites the prophet Hosea who lived 500 years earlier).

But then this man in chains before a wicked king shared what’s on my heart this morning too: “But there is a resurrection, therefore the grave hath no victory, and the sting of death is swallowed up in Christ.”

“He is the light and the life of the world; yea, a light that is endless, that can never be darkened; yea, and also a life which is endless, that there can be no more death.”

This echoes what Christ said about himself when he came into the world — reassuring Martha as she grieved her brother’s death: “I am the resurrection, and the life: he that believeth in me, though he were dead, yet shall he live: And whosoever liveth and believeth in me shall never die.”

“Believest thou this?” Jesus then asks.

I do! Some wonderful people in my life don’t. But I do.

That’s where my hope is anchored. That’s why I relish the beautiful song that goes, “He lives to silence all my fears, He lives to wipe away my tears, He lives to calm my troubled heart…”

And till the day I die, I’ll also sing, “I believe in Christ; he stands supreme! From him I’ll gain my fondest dream; And while I strive through grief and pain, His voice is heard: ‘Ye shall obtain.’ I believe in Christ; so come what may, With him I’ll stand in that great day.”

No song better captures my excitement about that future day of resurrection than “I Will Rise,” by Evangelical artist Chris Tomlin (notice the swelling chorus of angels near the end, joining the celebration).

One day, those unforgettable reunions will happen — finally together at Christmas and every other day.

For now, Emma gets to celebrate Easter with Sam and Mary, Mom and all my cherished grandparents. I’m certain they are not far — not at all (“Angels all around us”).

We’ve felt the sweet spirit of Emma very close lately, as Olivia continues to face so much.

But that’s the thing: we’re fine. We’re good. We have a peace that goes beyond anything that makes sense.

And you can have that too. Dismiss the loud and angry voices, and those dripping with grievance or total cynicism. And listen to the quieter, sweeter, truer voice(s) — especially that “still voice of perfect mildness” that will tell you what’s really true and good and beautiful.

Don’t trust anyone else to tell you the truth about reality!

That way, you’ll be able to smile, no matter what. And when things get uglier and sadder in America (or your own life and home), you can close your eyes and remember what’s coming.

It’s going to be good — so good. And we don’t have to wait till that future comes to relish it! As the angel told King Benjamin, if we receive the message prophets have shared from the beginning, and continue to today, we can “rejoice with exceedingly great joy, even as though (Christ) had already come among them.”

As we remember all our loved ones who have gone before us, we can say like Juba says in Gladiator about his friend Maximus: “I will see you again…but not yet!”