The alarming rise in "diseases of despair" is reducing life expectancy in the U.S. Could there be a spiritual solution, and if so, how can people of faith help?
Steve Austin wasn't supposed to be depressed.
He was about to celebrate his son's first birthday. He had a fulfilling job as a youth pastor in a Southern Baptist church in rural Alabama. He was married to a woman he loved. He believed in a loving God who was personally involved in his life.
He tried to kill himself anyway.
On the day that Austin crushed a fistful of pills and stirred them into a cup of hot tea, he almost became a statistic in what has been called America's “epidemic of despair.”
Deaths of despair — from suicide, alcohol abuse and drug overdoses — have caused life expectancy in the U.S. to decline for two consecutive years, even though fewer of us are dying from heart disease and cancer, according to the National Center for Health Statistics.
More than 142,000 of us died from drug or alcohol overdoses or suicide in 2016, and more than 1 million did the previous decade, according to a November report from the Well Being Trust and the Trust for America's Health, which predicted that such deaths could rise by 40 percent in Utah over the next seven years.
And religious faith, long seen as an important component of mental health, doesn't guarantee that believers won't succumb to despair, as Austin's suicide attempt shows. That's one reason that some churches are offering programs about mental health for individuals and families in their congregations, and medical doctors are starting to talk about suicide and addiction in terms historically reserved for philosophers and theologians.
“I think it important that we have a conversation about despair, as a contributing factor, not a cause-and-effect factor,” said Dr. Patrice Harris, a psychiatrist in Atlanta and chair of the American Medical Association's opioid task force. “But we also have to ask, 'What do we mean by despair and what are we talking about?'”
'A sickness unto death'
A century before two Princeton University researchers declared a "despair epidemic" that is killing Americans in unprecedented numbers, a Danish theologian and philosopher described a condition that he believed affected everyone and could culminate in "a sickness unto death."
That condition was despair, and Soren Kierkegaard believed it to be a spiritual affliction. Writing in 1849, he ruminated, “If there were nothing eternal in a man, he could not despair.”
Kierkegaard, of course, wasn't privvy to the burgeoning body of research that has shown how neurological and hormonal deficiencies can push a person into a downward spiral that ends with an overdose or suicide. Nor could he foresee the economic challenges and rapid social changes that some social scientists and doctors believe are behind the troubling spikes in diseases of despair.
Anne Case and Angus Deaton of Princeton University have been writing about despair deaths since 2015 and identify financial insecurity — driven by stagnant wages, the loss of pensions and income inequality — as one cause.
In a paper published in 2017, they argued that despair is cumulative. Young people with limited education who struggle to enter the workforce accumulate disadvantages over the course of several decades, not only economically, but in their health and family outcomes.
Harris, too, agrees that it's not usually one single thing that results in persistent despair, which is commonly defined as the absence of hope.
But not everyone who faces socioeconomic hardship becomes suicidal or addicted. Those who do, often have brains that are predisposed to addiction, which is why substance-abuse disorder has been labeled a disease since the 1980s, Harris said.
"This is important because, for years, people had thought people with substance-abuse disorders had a moral failing or a character flaw and that they could just pick themselves up by their bootstraps," Harris said. "But these diseases are complex. They have psychological contributors and there are social risk factors. But there is absolutely no question that substance-abuse disorders are considered medical disorders, medical diseases."
When the faithful despair
The medicalization of despair has helped to chip away at the stigma of mental illness and made people realize that it can't always be “prayed away.”
But churches are also starting conversations about subjects that are “the common colds of mental health” — depression, anxiety and addiction — said the Rev. Bill Roth, minister of congregational care at Myers Park United Methodist Church in Charlotte, North Carolina.
Roth's church is conducting a five-part speaker series on mental health during Lent, with topics that include the church's role in mental health, what parents should watch for in their children, and suicide prevention.
“Like it or not, it's still a taboo; you put the AA people in the basement, you whisper if someone goes to a psychiatric unit. If they have a nose job or a heart attack, full disclosure is fine, but if it's psychiatric, you have to whisper. So one of our goals is to reduce the stigma of mental health,” Roth said.
Pastors may also want to take a look at the characteristics of God that they're preaching about, some research suggests.
Researchers at Baylor University in Texas have studied how people see God — distant or close, judgmental or beneficient — and found that people who see God as authoritarian and detached are more likely to suffer from anxiety and depression.
“If you believe that God created the world and quit, why would you bother to do things like pray? (In that way of thinking) God doesn't respond to prayer,” said James Ellor, a professor in the School of Social Work at Baylor.
Ellor said that almost all chaplains that he has surveyed believe in a benevolent God, but at least a third of people sitting in the pews subscribe to the idea of a judgmental God who may or may not help them with their problems, contributing to a pervasive sense of hopelessness.
“(Pastors) need to be clear about who God is. We need to be talking about how God can be helpful,” Ellor said.
Church members can help, too, especially with "fringe" members of a congregation, described by Ellor as those who attend worship services but haven't developed meaningful relationships by attending small-group sessions and church programs. People of faith need to be noticing these people and "wrapping around them with emotional support," he said.
'People stay silent'
Austin, who is no longer in the ministry, now works as a wellness coach and reaches out to help others in despair through a blog called Grace is Messy. He agrees that a harsh, Old Testament vision of God contributes to depression. “If we believe in a God of fear and retribution, when we face hard times, it feels hopeless. It is hopeless,” he said. “But these days I begin to understand that God is love.”
Austin, who is married and has two young children, grew up attending what he describes as a fundamentalist Christian church in rural Alabama, a church that was not just a place to worship but the center of community life.
“In that world, we say faith, but I think we mean certainty, and that is certainly the opposite of faith. Faith is trust in what we can't quite grasp,” he said.
“As long as your life is clean and neat and black-and-white, that works very well, but when, as my grandmother would say, something upsets the apple cart, those black-and-white answers don't always work.”
Austin's apple cart was not just upset but destroyed when he was molested at age 4 by a teenage neighbor. He told his parents, but they didn't get help for him, thinking he would just get over it. “Like any good Christian, their answer was, 'let's just pray about it,'” Austin said.
It wasn't until he was a high school senior that Austin started having flashbacks and panic attacks that he was unable to resolve, which eventually led to his decision to kill himself.
Away from home on a business trip, he mixed what he thought would be a fatal cocktail of pills into a cup of tea, then drank it and waited to die. Instead, he awoke in the hospital the next day, and began an agonizingly slow process of recovery, aided by counseling and medication.
Today, Austin speaks and writes openly about his suicide attempt, hoping that his story will help others.
"I wrote a post about it on my blog, not expecting anything. The responses from around the world blew me away. That experience showed me that people are desperate to no longer feel so desperate."
He hopes America will one day be a place where people can mention that they're on a medication for mental illness as casually as saying they're taking a new medicine for cholesterol.
“The truth is, mental illness as a disease is no different from heart disease or cancer. But because of the stigma, people stay silent. It keeps regular churchgoers hiding in the pews. That's what I did," he said. "Even after I became a youth pastor, I would take my medication in a stall in the bathroom, because I thought people would think less of me if they knew I was taking medication for my mental illness.”
Harris, in Atlanta, confirmed Austin's belief about the importance of people speaking out. She noted that many family members are choosing to acknowledge their loved ones' struggle with depression or addiction in obituaries. "That has helped with the stigma. But we also have to watch the language we use" when talking about people suffering from diseases of despair, she said.
Kierkegaard for today
Kyle Roberts, a Kierkegaard scholar and the Schilling Professor of Public Theology and the Church and Economic Life at United Theological Seminary of the Twin Cities in Minnesota, said the Danish philosopher and theologian can still speak to people suffering from despair today.
Kierkegaard believed that we all have despair, “we just may not be conscious of it.”
“Those who are in despair but not conscious of it may live their lives aesthetically, pursuing frivolous pleasures.” These may not just be “sex, drugs and rock and roll,” but even seemingly positive obsessions like intellectual pursuits.
A Lutheran, Kierkegaard taught that despair was the outcome of being unable to accept one's position with regard to God, and of “misrelations” between the self, others and God, caused by sin.
Applying 19th-century theology to 21st-century conditions is tricky, Roberts said. “We are more aware today than Kierkegaard was in his day of the way chemical imbalances work, how psychoses can impact our lives, so there is a danger in terms of taking Kierkegaard too far in terms of application, where everything becomes spiritual, rather than seeking treatment for mental illness or medical imbalances,” he said.
But some scholars have suggested that Kierkegaard's proscriptions could be an antidote to our tendency to overmedicate or overdiagnose “what actually oftentimes might be more spiritual conditions or conditions that can't be overcome by medical treatment.”
“Sometimes the real problem could be that we haven't developed our personalities or looked within ourselves for spiritual resources to overcome what might actually be internally sourced problems. There is something to thinking about Kierkegaard as a guide," he said.
'An all-in proposition'
Meanwhile, Harris welcomes the efforts of churches to help as the nation confronts an epidemic of despair that currently shows no sign of abating. "This is an all-in proposition, as to who should be involved," she said.
The November report from the Trust for America's Health and the Well Being Trust predicts a 60 percent increase in deaths from alcohol, drugs and suicide by 2025 if trends continue. But since then, the groups' projection has been adjusted to a 100 percent increase. The nonprofits have called for a national "resiliency strategy" to help Americans better cope with despair.
"We need to be able to address pain in the multiple ways it presents," Benjamin F. Miller, chief strategy officer for The Well Being Trust, said. “It seems like we're just discussing numbers here, but these are people's lives.”