Guest Post: Depression and the Spirit

[Note from the blog author, Quantumleap42: This is a guest post from a long time friend. They don't like to talk about their depression, especially not in public places, but after some prompting from me they agreed to tell about their experiences. They wish to remain anonymous so I will refer to them as Sidney, but if anyone has any comments or questions for Sidney please leave them in the comments or email them to me and I will pass them along to Sidney. Sidney's experiences and insights have taught me a lot about how to understand depression. Feel free to share this with anyone who might need it, or just with anyone because you never know what they are going through. This originally came from three different texts or letters Sidney wrote over several years. I provided some editorial revisions that Sidney agreed to, to combine the three texts and for clarity.]

I normally don’t read or comment on blogs and I hope that you will not mind posting this, but I thought I could offer some insight into this topic. It is just something that has been on my mind a lot lately. 

When I was a teenager I began experiencing severe depression, but I always thought it was normal. It never occurred to me that not everyone found it difficult to do basic things like get up in the morning. I remember laying in bed feeling like I hurt all over while also feeling like I had done something terribly wrong and I would never be a good person. I felt I was fated to end up somewhere in the Telestial kingdom, and would never be able to do anything righteous with my life. I felt like a perpetual sinner. The few times I talked to friends about it they would say they occasionally felt the same way. It never occurred to me that they only felt that way rarely, not 5-6 days a week for months on end. I still have the page in my journal where I wrote about the pain I felt and how I wish I could make it stop. No one ever saw that page.

Later when I went to college, and then on a mission, I was still dealing with my depression, but I didn't know that was what it was. I just thought I was tired, or I just had to be more spiritual, or I had an impure thought and therefore I had lost the companionship of the Holy Spirit. If I just tried harder then I wouldn't feel bad. I remember an Elder from my mission got sent home because he had bipolar disorder and was unable to function. I looked at him and thought I wasn't that bad so I couldn't have bipolar disorder or depression because the only people I had ever known who had depression were on 15+ medications and on suicide watch, or so it seemed. I thought I didn't have a problem because it wasn't that bad.

When I came home from my mission and returned to college I continued with my same problems. I felt that my mission had been a waste, my family was distant and friends never wanted to talk. I received some priesthood blessings that came at a very specific time when I was feeling my worst and the Lord told me that He was pleased with the work I had done on my mission and had accepted my offering. (Quantum was there for that blessing, though he was not the one who gave it.) It was just the thing I needed to hear.

About that time some basic training I received in a psychology class kicked in. What I thought were feelings of inadequacy and the withdrawal of God's Holy Spirit were actually a disconnect between my body and my spirit. I began to keep track of what I was feeling and when and after a few months I noticed a pattern. Like clockwork there were times when I would experience severe depression that had nothing to do with what I was doing. Even if I was reading my scriptures, saying my prayers, doing well in school and maintaining a good social life I would still hit rock bottom. These darkest days would be followed by a few days of intense euphoria where I felt superhuman. As if there were nothing that could stop me.

Eventually I was diagnosed with bipolar disorder, which means sometimes I am severely depressed and other times I have more energy than I know what to do with. With bipolar disorder there are two phases, a depressive phase, and a manic phase. I have experienced all parts of the spectrum.  Many people are familiar with depression and the depressive phase of bipolar disorder but few people talk about the manic phase, usually because in the manic phase the person is feeling very happy, energetic, and in many cases relatively normal, if just a little on the hyper side. Many people do not recognize that the manic phase is just as problematic as the depressive phase. They think, "Oh, they're back to their 'normal', 'happy' selves. There's nothing to worry about." To put it in terms that we can understand it is in almost all ways the exact opposite of depression. Just as someone has little or no energy when depressed, in the manic phase we have an overabundance of energy. In the manic phase, it is not just feeling like you have more energy, you do have more energy. In one of my more energetic manic phases I once managed to do 100 pull-ups (5 sets of 20, with a 30 second pause between sets).

Through my experiences I have learned about depression, emotions, and how they are different from feeling the Holy Spirit. I have learned that even in the deepest parts of depression I can still feel the Holy Spirit. It is a distinct feeling that can be felt through the cloud and pain of depression. The Spirit can be something that is difficult to feel at times, but it is something that can always be felt. One of the pernicious side effects of depression is that many times the feelings of depression are indistinguishable from the feelings of sin or the loss of the Spirit. Someone with depression can very easy assume, mistakenly, that they are somehow more sinful than others and that they cannot access the healing power of the atonement or have access to the feelings of the Spirit.

In those times I try to take stock and carefully consider my life. I remind myself that the Spirit does not withdraw for petty and inconsequential things. Even if I am committing some of the sins of omission I have learned that the Spirit still strives with me and more often than not my feelings result from depression and not a loss of the Spirit.

We all have to deal with feelings that come from our own bodies and from our own spirits and telling those apart is hard enough. So sometimes it can be even harder tell what are promptings from the Holy Spirit and what comes from ourselves. The hardest part is learning to tell the difference between the Spirit telling me that I have done something wrong and that I need to repent, and experiencing a feeling of biological depression. Over time I have learned to recognize the sweet, peaceful feeling of the Spirit that permeates everything he does. It is a very distinct and personal feeling that, when learned, can be recognized very readily, just as the flavor of mint can easily be distinguished from the flavor of oranges. But at first it may be very hard to learn to discern the feelings of the Spirit from our own feelings. 

When I learned to recognize the feeling of the Holy Spirit it became a very personal thing, and I could recognize it as being distinct from all other feelings, much in the same way that we might recognize a brother or sister or good friend as distinct from all other people. If we are not familiar with the Spirit then the feelings he brings may be covered over by our own feelings, including the feelings of depression, much in the same way that we may pass a stranger in the street and not give them a second thought. Even in the depths of depression I can still feel the promptings and peace of the Holy Spirit, though it has taken me years to learn to tell the difference between my own feelings and the feelings he brings. 

In some cases the problems of depression are enhanced because the person who is depressed does not only have to deal with their own feelings, but also with feelings brought on by evil or malicious spirits. Not all episodes of depression are caused by the influence of evil spirits, and not all people who experience depression will ever have to deal with the influence of evil spirits, but it is something that I have had to deal with and it is something that requires the power of the priesthood to overcome. When it comes to depression there is perhaps something wrong in the connection between body and spirit, and that misconnection will occasionally induce those who cannot have bodies to try to exploit that opportunity to gain some influence over the body. For those spirits who cannot have their own body, a body that is broken and not working properly is preferable to none at all, even if they have little or no control over it. 

In these cases it requires someone who is very much in tune with things of the Spirit to exercise their priesthood power and to remove the influence of these evil spirits. These spirits can both cause and exacerbate the problems of depression. Like I said, not all people who have depression are being influenced by evil spirits, but some are and it takes the gift of discernment to recognize the presence of these spirits. A bishop has specifically been called to exercise the spirit of discernment so they should usually be the one to recognize and help out in this matter, but I have found that my bishops were not always aware of this or even willing to attempt to help in this way. In these cases I have had to rely on inspired priesthood holders who were sufficiently in tune with the Spirit to recognize the problem and to help out. (If at this point you have in your mind some scene from the movie The Exorcist then you are understanding this all wrong. I am not talking about anything like that at all. The workings of the priesthood and of the Spirit are never creepy. They only provide peace, if not then something is wrong.) 

So the things that I have learned by experiencing depression are that I can still feel the Spirit, even if it is very difficult and it seems that I am “past feeling”. There can be something biologically wrong with my body that interferes with my feeling the Spirit, but even in the most extreme situations the Spirit can still speak to my spirit without a physical intermediary, such as my body, and the Spirit can always be felt and heard. Every once in a while it is not sin, nor a biological problem that creates or worsens my depression, but the influence of those who can never have bodies. In these cases prayer, a reliance on the Spirit, God and His priesthood can dispel these evil influences. 

When I am in my manic phase how I connect to the Spirit is remarkably similar to when I am in my depressive phase. Most people would see me in my manic phase and think it a good thing I am out of my depression, but the manic phase is just as dangerous. It warps my thoughts and makes me think things that aren't true. Just as depression gives me feelings of inadequacy and makes me feel like I have sinned, even when I haven't, my manic phase makes me feel superhuman, like I can do anything, and also makes me feel like I can do no sin.

So how does this affect how I connect to the Spirit? It is like turning up the volume on the radio. If there is static then turning up the volume will just make the static louder. If there is music then the music will be louder. If there is music and static then both will be louder, but in many cases when the static is minimal with the volume turned down, when the volume is turned up the static can override the music. It is the same with the Spirit. If I am feeling the Spirit when I enter one of my manic phases then the Spirit is amplified greatly. Some of my most spiritual and revelatory experiences have come when I was on my manic phase, but just as depression can override the feelings of the Spirit, the feelings of my manic phase can just as easily override the feelings of the Spirit. Going back to my radio analogy it is not just an increase in volume, but the frequency or the tuner also tends to drift in my manic phase so it is just as easy to lose the feelings and promptings of the Spirit when I am in my manic phase as it is in my depressive phase. The problem is I am on a high so it makes it hard to recognize that I have lost the sweet, peaceful, calming feelings of the Spirit.

Alma may have wished to be an angel to cry repentance to the whole earth, but when I am in my manic phase, I feel like I am an angel and I am going to do all of God's work myself. I feel so righteous I think I am good enough to be the prophet (someday). Those moments don't last long and I have learned that if I feel what I think are promptings of the Spirit while I am in my manic phase then I try to verify the same feelings and thoughts when I am not in a manic phase. I found that this deliberate approach to sorting my own feelings from the feelings of the Spirit has kept me from falling into error and mistaking my own feelings for promptings of the Spirit. I have frequently received assurances through the Spirit that God is aware of my limitations and takes extra care to lead me carefully to distinguish what He wants from the sometimes random noise that I can produce in abundance.

What I feel when I am depressed mimics the feeling of losing the Spirit, which is the feeling of having sinned. We must never mistake depression for sin. It is a feeling that is all too common among those who have depression. They feel they are not good enough, that they are a disappointment to God and others, and that they can never be righteous. That is not the Spirit. That is depression. The Spirit always brings hope, even when it chastises us for sin, it gives us hope and peace.

So those are my thoughts. I hope you do not mind me sharing them on your blog, but I have been thinking about these things recently and felt like sharing them. 

I ask that you not use my real name. For this subject I have to be careful since there is still a strong stigma against having these issues. Tell someone you have cancer and they will organize the whole Relief Society to bake dinners till the end of time. But tell someone you have bipolar disorder and they go tell the bishop that they are not comfortable with you being their children’s Sunday School teacher.

Thank you for your thoughts and prayers. I know my comments were rather lengthy but I guess it was just something I really felt like sharing.

[For anyone who wants to comment, you can post anonymously in the comments if you do not feel comfortable using your name or email account. Keep in mind that nothing I say should be taken as medical advice. I'm a astrophysicist not a psychiatrist. ;-) I encourage anyone who is experiencing depression/bipolar disorder to seek help from competent medical professionals.]

Mormon, Cumorah, Sihyaj K’ahk’ and the Entrada of 378 AD

The year is 378 AD and Sihyaj K’ahk’ has just seized control of the Petén Basin, the heartland of what we associate with classical Mayan civilization. But Sihyaj K’ahk’ was not a Mayan, he was in fact from Teotihuacan, which is located in the central Mexican highlands where modern day Mexico City stands today. The event which we currently refer to as the Entrada of 378 AD radically altered Mayan culture to the point that much of what we think of as "Mayan" started in 378 AD. Even 40 years later the significance of what happened in 378 AD was still being memorialized in stone and offerings were still being offered more than 250 years later at a shrine commemorating the event. The fact that we know so little about the Entrada is due to Mayan politics hundreds of years later that conveniently forgot about the huge event that made it all possible.

So what does all of this have to do with Mormon and the battle at Cumorah?

In the second half of the 300's there were several large wars between the Nephites and the Lamanites. Mormon outlines the major events of a war that lasted from 360-367 (cf. Mormon 3-4:15). The next and final war lasted from 375-385 (cf. Mormon 4:16-6:5). There some events recorded for which we do not know the year, but in either 378 or 379 the war takes a turn for the worse and many major cities are lost. As we read in the Book of Mormon, in the beginning of the year 385 the Nephites gathered in the land of Cumorah in a final defense and were defeated and hundreds of thousands killed. It would have been an immense moment in history that greatly changed the course of kingdoms and empires around them.

Apparently this major battle happened just seven years after the Entrada. This is significant because the Petén Basin is one of the leading candidates for the location of the Book of Mormon lands. If this was the location of the Book of Mormon lands then what we know as the Entrada happened in the middle of the final war between the Nephites and the Lamanites. But, as I have mentioned before, calendars are funny things, and a year isn't always a year.

If we assume that Mormon was using the standard Mayan long count calendar then a year, as recorded by him, would have been 360 days, rather than the 365(.24) days in a solar year. This means that a date of 385 recorded in the Book of Mormon may not have been 385 AD according to our calendar. If we account for this then 385 years in the Mayan long count would be ~378.5 +/- 1 years in solar years. Thus, assuming there was no mistake in the reckoning of the date, the final battle at Cumorah may have taken place in 378 AD, the exact same year of the Entrada that marks the transition from pre-classic to classical Mayan civilization. If this is the case then the Entrada was a transformative event in more ways than we now realize.

There is much we do not know about the Entrada. Scholars have only been aware of it for about 20 years, but as one scholar put it "the texts say almost nothing about the circumstances surrounding [the Entrada]." We still have much to learn about that period of history and there may be more than a few surprises left to find.

Duke Chapel

Just down the road from UNC is Duke University. The central attraction on Duke campus is Duke Chapel. It is an impressive structure and I highly recommend seeing it if you are ever in North Carolina. Currently it is undergoing renovations and will be closed until May 2016.

Inside the main entrance way. On one side are three "saints" of Protestantism, Girolamo Savonarola, Martin Luther, and John Wycliffe. On the other side are three "saints" of the South,  Thomas Jefferson, Robert E. Lee, and Sidney Lanier. 

Over the main archway are the three Bishops of American Methodism, Francis Asbury (center), Thomas Coke (left) and George Whitefield (right). Inside the arch, directly over the door is John Wesley, who founded Methodism.

What are the most commonly sung LDS hymns? DATA NEEDED

[Link to hymn form.]

This year is the 30th anniversary of the current LDS hymnbook. Because I love playing with data and numbers I was wondering what were the most commonly sung LDS hymns. There are a few people who have looked at the most commonly sung hymns at General Conference, but the hymns sung at Conference aren't always the same hymns we sing in church every Sunday. Someone at BYU did do an informal poll, but I wanted a slightly larger sample.

I plan on keeping track of which hymns are sung in my ward every week, but to get a larger sample I need data from other wards. So if you want to help out, at the very top of this post, and also below, I have a link to a Google form where you can enter which hymns were sung in your ward. You only have to enter hymn numbers to make it easier. So this Sunday when you go to church take note of the hymn numbers and enter them into the form. It should take no more than 15-20 seconds.

http://goo.gl/forms/NhCyYa9tXV

I am looking for hymns sung in any meeting. That includes Sacrament Meeting, Stake Conference, and Priesthood or Relief Society meetings. If you sing a hymn for Seminary or Institute you can enter that as well. If you can only enter data for one Sunday that is just great. But if you feel like contributing more to the data collection you can keep coming back every week and enter more hymns. I'll put a link to the form in the sidebar, or you can bookmark the link (like me), so you can find it easily. You can also collect the data in a text document or spreadsheet (maybe you are the person in your ward who chooses the hymns) and send it to me. I got 6 months worth of data from a ward in Australia because the ward music director kept a record of it and sent it to me. So what ever is easiest.

I plan on collecting data from my ward for at least two years (I have been collecting data for the past month and a half already). This ensures that I get data from Thanksgiving, Christmas, Easter, Pioneer Day and everything in between. I want to augment this a larger sample from other wards. I realize not everyone is a data nerd like me, so I set it up to make it simple so anyone can contribute, even if it is only for one Sunday. If you want to contribute more that would be great.

So why am I doing this?

Like I said, I like data, and I like numbers. Sometimes those numbers tell us things we didn't expect. I love the hymns, and this is one way that I can learn more about them and how we interact with the hymns. Some people may be curious just which hymns are sung all the time, and which one we never sing. This is intended to answer those questions. At some future date the church may decide to redo the hymnbook and it might be helpful to know which ones we sing all the time and which ones we never touch.

In a broader sense, and anyone who loves data and numbers like me knows this, if the data is there we will find some use for it, but if we never gather it we will never know what we can discover.

I should point out that the most commonly sung hymns may not be the most popular. There are constraints on time, or ability which may skew the numbers (one year in seminary we sang "Choose the Right" nearly every day because only one person could play the piano and that was the only song she knew well enough to play). Just because a song is not sung frequently doesn't mean people don't like it, or it isn't popular. So this may just tell us which songs are easy to sing and commonly known.

I hope you choose to help out. If you have any questions just leave a comment or email me at [the title of this blog]@gmail.com.

I will provide, or link to any updates to this project. Like I said, I plan on this being a long term project to get enough data. Please share this with friends and family (but try not to duplicate data with more than one person per ward), so I can get as much data as possible. Please.

The Heavens and God: Contain Vs. Sustain

"But will God really dwell on earth with humans? The heavens, even the highest heavens, cannot contain you. How much less this temple I have built!"

There was a small translation oddity that I noted while reading in 2 Chronicles in a passage where King Solomon is dedicating the temple in Jerusalem. At one point in the dedicatory prayer King Solomon asks if God will dwell on the earth, because if the heavens themselves are insufficient for God then how much more is a simple temple insufficient for God. This is where the translation gets interesting.

In 2 Chronicles 6:18 records, "The heavens, even the highest heavens, cannot contain you." [emphasis added]. Here the Hebrew word translated as "contain" is יְכַלְכְּל֔וּךָ. But if we look up how the word, its root, and derivatives are used in other verses we get a different sense for the word. The general meaning of the root word is "to comprehend, contain", while various roots are also translated as: endure, maintain, provide, provided, provided them with sustenance, provisioned, sustain, sustained, and sustainer.

The general idea is that the primitive root implies a measured container that can be filled with a certain amount of stuff. But in a figurative sense it implies providing a measured amount of sustenance, hence passages such as Genesis 45:11 are translated as "I will provide [וְכִלְכַּלְתִּ֤י] for you there, because five years of famine are still to come. Otherwise you and your household and all who belong to you will become destitute." Or Nehemiah 9:21 which reads, "For forty years you sustained [כִּלְכַּלְתָּ֥ם] them in the wilderness; they lacked nothing, their clothes did not wear out nor did their feet become swollen."

While the root form of word is translated as "contain" or "hold", for example, 1 Kings 7:38 reads, "He then made ten bronze basins, each holding [יָכִ֣יל] forty baths and measuring four cubits across, one basin to go on each of the ten stands.", all other variants of the word are translated as "provide", "sustain", "maintain" or some other variant of a similar concept, except for three instances relating to the same question asked in 2 Chronicles 6:18. Two of those are from the dedicatory prayer as recorded in Chronicles and Kings, and the other is uttered by King David when he is commanded to prepare to build the temple, the language of which is later mirrored by his son King Solomon.

It just seemed a little odd that a word which is almost always translated in the figurative sense as "provide", "sustain", "maintain" or some other variant, would be reduced to the literal sense as "contain" in the three cases where it refers to God. I just wonder on what basis the translators decided to go against the common definition of the word for those three verses and insert "contain" instead of "sustain". If we instead translate יְכַלְכְּל֔וּךָ as "sustain" we see that it changes the sense of the verse in such a subtle way that it can imply something very different about God.

"But will God really dwell on earth with humans? The heavens, even the highest heavens, cannot sustain you. How much less this temple I have built!"

In the first case the verse implies an extraphysicality to God which belies a particular view of God as incorporeal. While the second case simply implies that the heavens themselves are insufficient to sustain the majesty of God, and that an insignificant building would do no better. The first makes a metaphysical judgement on God, while the second merely casts judgement on the heavens and the temple. It is easy to see why so many modern Christians would not question the first translation, but the question to ask is if there is a basis for those ideas in the Bible, in the original autographs, or if those where ideas were introduced later and no one stopped to ask if they were correct, or if they fit with other, plainer scriptures.

Sometimes there are subtleties in translation that cause original meanings to be lost, and new ones to appear. Sometimes it is a small and seemingly insignificant thing, and that is why we must be careful not to take a particular word, or verse and draw conclusions from that which may not be correct.

Deep Study and Exhaustive Searches

"For mortals, therefore, the gospel is inexhaustible, because 

'the Spirit searcheth all things, yea, the deep things of God.'"

-- Neal A. Maxwell

Today I wanted to write about two seemingly unrelated topics, the Book of Mormon translation and plastic surgeons per capita in the the United States.

A few years ago I started a personal project to compare all quotes from Isaiah in the Book of Mormon with their corresponding Biblical texts. When I started I did not know what I would find and what I would learn. I decided to compare the texts side-by-side and keep track of all the variation that I found. From seminary and other places I had heard comments about there being differences between the two but I had never gone through systematically to compare.

It took me a while since I was going through verse by verse, word by word, comparing the two texts, marking the differences, similarities and formatting both into a side-by-side presentation. There were subtle nitpicky things that I had to deal with. I learned a lot, not just about Isaiah, but about other things like html formatting, Hebrew grammar, and where I could find many different Bible translations. I discovered that I liked the New International Version of the Bible better than the King James Version. I began to see patterns in the text and understand better what Isaiah was talking about.

Also by forcing myself to find and keep track of each variation in the text between the Bible and the Book of Mormon I learned to recognize interesting patterns in the variations. Some where minor, some were significant. While working slogging through the comparisons, and noting the most minuscule of variations, and at one point I remember clearly thinking, "These variations are not random. They are not mistakes. There is a reason and a method to them."

All of it taught me something about how Joseph Smith translated the Book of Mormon. Occasionally I read speculations by members of the Church about how they think Joseph Smith accomplished the translation, whether it was a tightly controlled translation, a loosely controlled translation, or even maybe Joseph Smith just drew on language that was common to him in order to render the text of the Book of Mormon.. Based on what I have learned many of the proposed theories are untenable. Before, when I read the different speculations I had to evaluate each one based on the quality of the argument. But after much deep study and personal familiarity with the Isaiah chapters in the Book of Mormon I can easily dismiss most of them as inconsistent with what I know about the text.

Based on my study I can say that there were two major influences to the text of the Book of Mormon that we have. The "translation" process, which was more revelatory than anything else, that came through Joseph Smith was a very, very, tightly controlled process, down to spellings, individual word placements and the rendering of certain phrases. There was no room for personal interpretation or variation on the part of Joseph Smith. But, and this should teach us something about God, everything else after that was left entirely to the discretion, the personal competency, hearing ability and handwriting ability of the scribes. If there were errors introduced by one of the scribes, those errors were not corrected. Once the revelation had been given, God did not attempt to correct what Joseph and Oliver had done. The translation process was in fact a two step tight-free translation process. It was tight in the initial revelation, and free and uncontrolled thereafter.

I can say this because I have spent time studying the text and keeping track of thousands of variations. I would not expect anyone to idly accept what I have to say just because I said it, because I only reached my conclusions after much study and an exhaustive search all quotes from Isaiah in the Book of Mormon. It was only after becoming familiar with the subtleties of variations in the text that I was able to some to my conclusions. There are other things that I learned that are difficult to explain because they would only make sense to someone who has also gone through the same experience and has seen the same things. There is some knowledge that is only available after studying a subject deeply.

So how does this relate to plastic surgeons per capita in the the United States? I'm glad you asked.

Recently I took a comprehensive look at all plastic surgeons in the US listed on the American Society of Plastic Surgeons website. There were a a few news stories circulating citing a story from 2007 that which found that Salt Lake City had more plastic surgeons than any other city and was therefore the "Vainest City in America". While many people questioned that conclusion and attempted to rationalize away or attempt to explain why the article from 2007 listed Salt Lake City as #1, I could only find one or two people who actually questioned the data. The problem was, in order to question the data you would need to have your own data and be able to demonstrate a different conclusion and most people have neither the time nor the inclination to gather that data. But I'm weird like that.

There is something about looking at all 1407 cities, towns and villages that had a least one plastic surgeon that allowed me to begin to see patterns in the data. By doing an exhaustive search I was able to learn things that I would not have learned otherwise. This includes things that have nothing to do with plastic surgery. For example, I learned how convoluted the system of government is in states like Pennsylvania, Maryland and Massachusetts. I also learned about how the US census aggregates their data. I also learned that Hawaii only has one incorporated city. I learned about little out of the way places like Edina, Minnesota, and Crestone, Colorado. There are things that I learned that I would not have learned if I had not done an exhaustive search. There was something about going through every single city that allowed me to see things that I would not have seen otherwise.

There are some insights and knowledge that are available only after deep study and an exhaustive search. Some of these truths are not easily communicated with those who have not also studied the topic deeply. In some cases the knowledge and insight can be stated in clear language, but others will not understand until after they have also put forth the effort to study it out in their minds and consider to its fullest extent.

This is a principle of learning that is careful, ponderous, slow, and takes great effort. Many in our modern world think that if the answer is not quick, easy, readily available, and effortless then it is not worth considering. But anyone who has learned something to great depth knows otherwise, and knows that the depth of knowledge is inexhaustible.

Is Salt Lake City America's Vainest City? Correcting Forbes

Background

In 2007 Forbes magazine published an article entitled "America's Vainest Cities" which dealt with how Americans have become obsessed with their looks and as a result were having more plastic surgery. Associated with the article was a list of the 10 vainest cities in America, according to their criteria which was largely based on the number of plastic surgeons per 100,000 adults. This was a fairly unremarkable list except for the fact that #1 on the list was Salt Lake City. That result caused a minor stir among some news outlets in Utah. Many expressed surprise, while others said in triumphant self-righteousness "I knew it!". But the furor quickly died down.

The article, and the fact that they ranked Salt Lake City as #1, would have been forgotten and only mentioned in the occasional blog post and local news article had it not been resurrected by a recent article published in Time. The article had the provocative lead "Believe it or not, the rise in Mormon breast implants and $100,000 Jewish dowries can explain why you're alone on Friday night."

While the article in Time dealt mostly with male to female ratios in Utah, it did cite the 2007 Forbes article to support its assertion that Mormon women in Utah were going to great lengths to attract a potential mate. As stated in the article, "A culture of plastic surgery has taken root among Mormon women." So according to the Time article, this "culture of plastic surgery" has resulted in Salt Lake City having the highest number of plastic surgeons per 100,000 adults, based on the Forbes data. This argument was not central to the Time article but it did support a major point.

The Time article has been getting a lot of traction lately with a few news articles and blog posts in response and numerous shares on social media. The first time I ran across the article I glanced over the assertion that Salt Lake City has more plastic surgeons per capita than any other city and did not think anything of it. The second time someone I know shared something that used the original Forbes article I stopped just long enough to do a simple calculation and determined that something was wrong with the original numbers from Forbes.

The Original Results

Below is the original top 10 "Vainest Cities" with the number of plastic surgeons and surgeons per 100,000 adults. The data comes from 2007.

Rank	State	City	Surgeons	per 100,000 adults
1	Utah	Salt Lake City	45	6.0
2	California	San Francisco	175	5.4
3	California	San Diego	115	5.2
4	California	San Jose	70	5.2
5	Florida	Miami	218	5.2
6	Kentucky	Louisville	41	4.4
7	Tennessee	Nashville	48	4.4
8	Virginia	Virginia Beach	51	4.1
9	New York	New York	591	4.1
10	California	Los Angeles	384	4.1

Even though the Forbes article also gave data about the amount of money spent on cosmetics, personal care, hair dye, and other similar items, the ranking was based entirely on the number of plastic surgeons per 100,000 adults. They acknowledged that Salt Lake City coming in first was surprising, but that did not deter them or raise questions about their data or methodology.

They explain their data gathering and methodology in the following way.

"To rank the cities, we collected the number of plastic surgeons in the country’s 50 most populated cities. We excluded residents under the age of 18, leaving out a small number of children and adolescents who undergo reconstructive or cosmetic plastic surgery.... We obtained the number of plastic surgeons in each city from the American Society of Plastic Surgeons, a membership organization that represents about 90% of all plastic surgeons certified by the American Board of Plastic Surgery."

If we look at the data from Salt Lake City, 45 surgeons and 6 surgeons per 100,000 adults means for their calculation they assumed that in 2007 Salt Lake City had a total adult population of 750,000 adults. According to the 2010 census 23.6% of the population of Salt Lake City is under 18, which means Forbes was assuming a total population of ~980,000 people in 2007. The current (2014) estimate of Salt Lake City's population is 190,884. Already we see there is a problem since Forbes was assuming a population almost 530% larger than the actual population of Salt Lake City. Using 2010 census data I checked how the other cities on the list fared.

Rank	State	City	per 100,000 adults	Under 18	"Apparent Population"	2010 Population
1	Utah	Salt Lake City	6.0	23.6%	981,675	186,440
2	California	San Francisco	5.4	13.4%	3,742,195	805,235
3	California	San Diego	5.2	24.0%	2,909,919	1,307,402
4	California	San Jose	5.2	24.8%	1,790,098	945,942
5	Florida	Miami	5.2	21.7%	5,354,161	399,457
6	Kentucky	Louisville	4.4	24.3%	1,230,936	597,337
7	Tennessee	Nashville	4.4	22.0%	1,398,601	626,681
8	Virginia	Virginia Beach	4.1	27.5%	1,715,728	437,994
9	New York	New York	4.1	24.0%	18,966,624	8,175,133
10	California	Los Angeles	4.1	23.1%	12,179,264	3,792,621

As can be seen in the table above the population used for the calculation in the original Forbes article is much higher than the actual population of the cities. Based on the numbers it would seem that Forbes used the 2007 metropolitan population which includes more than just the listed city. That would not be a problem, but based on their description of their methodology they were not considering metropolitan areas, but individual cities.

The next logical question is to check if the number of plastic surgeons in each city was accurate. I went to the web site of the American Society of Plastic Surgeons to check Forbes's numbers. For Salt Lake City I found only 15 surgeons with an address in Salt Lake City and a total of 47 for the entire state of Utah. There are a total of 26 plastic surgeons with an address somewhere in Salt Lake County but nowhere near the 45 reported by Forbes. I did notice that if I searched for a specific city then the American Society of Plastic Surgeons site returned results from nearby that city, though "nearby" is a relative term. A search for surgeons in "Salt Lake City" returned results from Ogden and Provo, which are both outside the Salt Lake City metropolitan area, but still "nearby". But further down the list are results from Idaho, Wyoming and Colorado. So assuming that the search mechanism on the American Society of Plastic Surgeons website has not been modified since 2007 it would be quite easy to find more plastic surgeons in a particular city than are actually in that city.

I have no insight into how the reporters did their search, but if they were using 2007 metro area populations then they may have rationalized using all or most of the results returned by entering a specific city into the search field. The problem with this is that they may have included plastic surgeons from as far away as Logan and St. George, and then only used the population of the Salt Lake City metro area. This would skew the numbers for all the cities in unexpected ways.

Corrected Results

With this in mind I decided to check all the cities on the Forbes list and also to expand the search to all cities, towns, villages, hamlets or Census Designated Places that had a plastic surgeon listed on the American Society of Plastic Surgeons website. For my analysis I used the total population from the most recent available estimates.

For cities over 100,000 people I used 2014 population estimates, for locations smaller than that I used the most recent estimates, which generally were 2013, but with a few exception for 2010 data and an even smaller number (~5) for which the most recent data was from the 2000 census. This covered a little more than 1400 locations in the US with populations ranging from 132 (Crestone, Colorado) to 8,491,079 (New York, New York). This included five military bases for which there is no population data.

Below I give the results for the original top 10 "Vainest Cities" as reported by Forbes, along with my count of surgeons in that city and a recalculation of the number of surgeons per 100,000 people.

Forbes Rank	State	City	Surgeons	per 100,000 adults	Actual Surgeons	Actual/100,000
1	Utah	Salt Lake City	45	6.0	15	7.9
2	California	San Francisco	175	5.4	50	5.9
3	California	San Diego	115	5.2	38	2.8
4	California	San Jose	70	5.2	11	1.1
5	Florida	Miami	218	5.2	47	10.9
6	Kentucky	Louisville	41	4.4	23	3.8
7	Tennessee	Nashville	48	4.4	31	4.8
8	Virginia	Virginia Beach	51	4.1	15	3.3
9	New York	New York	591	4.1	192	2.7
10	California	Los Angeles	384	4.1	45	1.1

As you can see when we only consider the cities and not the metro areas the rankings change significantly. Just in these cities Salt Lake City drops to #2 with 7.9 surgeons/100,000, while Miami moves to #1 with 10.9 surgeons/100,000. Also both New York and San Jose drop to last place with 1.1 surgeons/100,000. Just this small sample indicates that my new methodology will significantly change the results. If we just consider the 50 largest cities, not metropolitan areas, the top 10 become:

City	Surgeons	Population	Surgeons/100,000
Atlanta	51	456,002	11.2
Miami	47	430,332	10.9
San Francisco	50	852,469	5.9
Boston	36	655,884	5.5
Dallas	67	1,281,047	5.2
Baltimore	31	622,793	5.0
Nashville	31	644,014	4.8
Seattle	31	668,342	4.6
Austin	38	912,791	4.2
Houston	91	2,239,558	4.1

In this case Salt Lake City does not make it into the list of the 50 largest cities since it is currently the 124th largest city in the US. All of the other cities in the original Forbes top 10 are in the list of 50 largest cities in the US. If we include Salt Lake City despite its lower rank it would come in at #3. But if we expand our criteria to include all cities (and Census Designated Places) larger than 100,000 people then the top 10 changes with Scottsdale, Arizona leading the pack.

State	City	Surgeons	Population	Surgeons/100,000
Arizona	Scottsdale	40	230,512	17.4
Michigan	Ann Arbor	16	117,770	13.6
South Carolina	Charleston	17	130,113	13.1
Michigan	Grand Rapids	25	193,792	12.9
California	Pasadena	17	140,881	12.1
Georgia	Atlanta	51	456,002	11.2
Georgia	Savannah	16	144,352	11.1
Florida	Miami	47	430,332	10.9
Pennsylvania	Pittsburgh	33	305,412	10.8
Florida	Fort Lauderdale	19	176,013	10.8

In this case Salt Lake City comes in at #22 right behind Cincinnati, Ohio and Tampa, Florida. It even has a lower rate of surgeons/100,000 people than Metairie, Louisiana which is not even a city but is a Census Designated Place near New Orleans. As can be seen, only Atlanta and Miami are on this new to 10 from the previous top 10 where the selection criteria was limited to the 50 largest cities. This shows that as we go to progressively smaller populations the rate of surgeons/100,000 goes up. This means that a population limited sample, such as the one used by Forbes, even if they used correct numbers, would skew the results since the highest rates of surgeons/100,000 occur in the smallest population centers.

We can see this effect if we now include any population center with a plastic surgeon. Below are the top 10 population centers with the highest rates of surgeons/100,000 people.

State	City	Surgeons	Population	Surgeons/100,000
Colorado	Crestone	1	137	729.9
Maryland	Chevy Chase	20	2,824	708.2
Michigan	St. Joseph	1	276	362.3
California	Beverly Hills	89	34,658	256.8
Pennsylvania	New Castle	1	407	245.7
New York	Great Neck	21	10,088	208.2
New York	Lake Success	6	3,030	198.0
Kentucky	Crestview Hills	6	3,159	189.9
New York	Cooperstown	3	1,834	163.6
Pennsylvania	Lebanon	1	670	149.3

Here the highest population is Beverly Hills California with 34,658, but has 89 plastic surgeons for a rate of 256.8 surgeons/100,000 people. As an interesting #1 is Crestone, Colorado, a tiny community of 132 people. While the 89 plastic surgeons in Beverly Hills might tell you something about that city, the one plastic surgeon in Crestone only tells you that a plastic surgeon happened to open her practice there. As can be seen this list is dominated by tiny communities with very few plastic surgeons that presumably service a larger area. Then there are others like Beverly Hills, Great Neck, Lake Success, Chevy Chase and Crestview Hills that are suburbs of larger cities.

These extremely high rates of plastic surgeons/100,000 for extremely small populations indicates that a better selection criteria would be a limit on the number of plastic surgeons rather than a limit on population. To show this in graphical form I plot the number of plastic surgeons/100,000 people vs. population for the 50 largest cities, cities with more than 100,000 people and for all population centers.

If we consider the above graph there is no real trend, but when we extend it to all cities a distinct trend emerges.

This demonstrates the problem of using a population limited sample.

The Beverly Hills

Upon further inspection there are a few places that stand out from the rest. These are the ones I like to call The Beverly Hills. Beverly Hills, California is in a class of its own with 89 plastic surgeons, but there are several cities just like it with a small population, close proximity to a large metropolitan area and a large number of plastic surgeons. Below are 24 cities that fit the Beverly Hills classification.

State	City	Surgeons	Population	Surgeons/100,000
Maryland	Chevy Chase	20	2,824	708.2
California	Beverly Hills	89	34,658	256.8
New York	Great Neck	21	10,088	208.2
Florida	Naples	15	20,537	73.0
California	Newport Beach	47	87,273	53.9
New Jersey	Paramus	14	26,342	53.1
New York	Garden City	10	22,552	44.3
Kansas	Leawood	13	32,991	39.4
California	La Jolla	18	46,781	38.5
Virginia	McLean	18	48,115	37.4
Minnesota	Edina	17	49,596	34.3
Delaware	Newark	11	32,549	33.8
Maryland	Annapolis	10	38,880	25.7
Florida	Boca Raton	22	89,407	24.6
Florida	Sarasota	13	53,326	24.4
California	Palo Alto	15	66,642	22.5
Michigan	Troy	15	80,980	18.5
Maryland	Rockville	11	62,334	17.6
Arizona	Scottsdale	40	230,512	17.4
Georgia	Marietta	10	59,089	16.9
California	Walnut Creek	11	66,900	16.4
California	Santa Monica	13	92,472	14.1
Michigan	Ann Arbor	16	117,770	13.6
Texas	Sugar Land	11	83,860	13.1

Making this list are small cities that no one making up a list such as "Vainest Cities in America" would think about including but only show up when you look at all of the data. Cities like Edina, Minnesota; Leawood, Kansas; Troy, Michigan; and Chevy Chase, Maryland. Most are not surprising for anyone who lives near one of these places (I was personally not surprised by Scottsdale). I have included La Jolla even though it technically is part of San Diego, since it is, at least by this measure, the Beverly Hills of San Diego. Almost all of these cities have less than 100,000 people but a large number of plastic surgeons. If Forbes had wanted to do a real list of the vainest cities in America this would be a good place to start.

The Centers

Then there are a group of cities that I call The Centers. These cities are usually the center of metropolitan areas, have more than 100,000 people and are surrounded by smaller cities with few or no plastic surgeons. These cities obviously service more people than those who live in that city. These include cities such as Charleston, South Carolina; Albany, New York, Salt Lake City, Utah; Birmingham, Alabama; Chattanooga, Tennessee; and Houston, Texas. Some of these centers have a Beverly Hills next door (for example, Sugar Land, Texas for Houston), but others such as Salt Lake City have no other cities close by that contain a significant number of plastic surgeons.

There are a few notable outliers among the Centers that deviate from the rest to the point that they are almost Beverly Hills. Below is a list of cities that deviate significantly from other cities of comparable population that they can be considered Beverly Hills-Centers. Some of these cities have a Beverly Hills right next door, such as Houston with Sugar Land.

State	City	Surgeons	Population	Surgeons/100,000
South Carolina	Charleston	17	130,113	13.1
Michigan	Grand Rapids	25	193,792	12.9
California	Pasadena	17	140,881	12.1
Georgia	Atlanta	51	456,002	11.2
Georgia	Savannah	16	144,352	11.1
Florida	Miami	47	430,332	10.9
Pennsylvania	Pittsburgh	33	305,412	10.8
Florida	Fort Lauderdale	19	176,013	10.8
Alabama	Birmingham	22	212,247	10.4
Virginia	Richmond	21	217,853	9.6
Missouri	St. Louis	29	317,419	9.1
Florida	Tampa	31	358,699	8.6
Ohio	Cincinnati	24	298,165	8.0
Ohio	Cleveland	28	389,521	7.2
California	San Francisco	50	852,469	5.9
Massachusetts	Boston	36	655,884	5.5
Texas	Dallas	67	1,281,047	5.2
Texas	Houston	91	2,239,558	4.1

Properly Placing Salt Lake City In Context

When you properly place Salt Lake City in context it drops from 1st place according to Forbes to #499 out of 1407 cities, towns, villages, military bases and CDPs that have plastic surgeons. With its rate 7.9 surgeons/100,000 it may seem high compared to other cities of similar size. But it is a Center so it has more plastic surgeons than most cities of similar size. But even as a Center it does not rise to the level of being a Beverly Hills-Center since for Centers of a similar size the average is 7.7 surgeons/100,000.

If we consider Salt Lake County the rate drops to 2.4 surgeons/100,000 and for the entire Wasatch Front there are 1.7 surgeons/100,000. This compares with an average of 1.6 for the entire nation and about 1.9 surgeons/100,000 if we just consider urban areas. For the entire state of Utah there are 1.6 surgeons/100,000 perfectly inline with the national average.

Below I plot the results for all cities, The Beverly Hills, The Centers, the original top 10 from Forbes with corrected results, and Salt Lake City.

So rather than being a surprising result according to Forbes, Salt Lake City is rather unsurprising. Forbes's strange result that found that Salt Lake City had more plastic surgeons/100,000 than any other city is due to using a population limited sample, combined with some unclear counting that cannot be cleared up without input from Rebecca Ruiz who wrote the original article for Forbes.

If you would like to take a look at the raw data I used, here is a link to a Google Spreadsheet of the data.

The Geeky Extra Stuff

Congratulations on making it this far into my post. You are one in ten, as in probably only one person out of my total ten readers will make it this far. Because I am a scientist and not a journalist I feel compelled to explain the complications associated with my methodology.

The data from the American Society of Plastic Surgeons is not the cleanest data, nor is the search function entirely reliable. As noted above, if you search for a particular city it will return results from places other than that city, sometimes from a significant distance away. For example a search for Salt Lake City will return results from Sandy and West Jordan, but also as far away as Twin Falls, Idaho. Also I found that a search for a particular city did not always return all of the plastic surgeons associated with that city. But if you search by state and then sort them by city it showed all listed surgeons. This did not significantly affect the numbers and was rare but noticeable.

Some surgeons were listed more than once because they had more than one office. For one surgeon I noticed that she had five offices spread over a state. I counted each office as a surgeon. These cases were rare but noticeable.

Some surgeons had nonsensical addresses. For example, I found a "New York, South Carolina" with a New York City zip code. There were a handful of cases like this where the city and zip code did not correspond to state listed. By my count this affected nine out of 5129 surgeons. Some surgeons were listed twice with slight variations of the same address, so I only counted one surgeon.

There were others that had variations in their address that made it hard to determine what town, village or hamlet they were associated with. This was prevalent in Maryland, Pennsylvania, New York, Massachusetts and Connecticut.

Some listed the city they lived in incorrectly. This is different from listing the wrong state as noted above. For example, there were several surgeons who listed their city as "Crestview, Kentucky", but their zip codes and address indicated they were in Crestview Hills, Kentucky. Both Crestview and Crestview Hills are directly across the Ohio river from Cincinnati and are very small communities just a few miles from each other, but are distinct incorporated places. There were some other variations on names that were particular to the location. Other than Crestview this did not affect rankings.

Some listed their address to indicate a particular borough or neighborhood. For example, there were several listings for Queens, Brooklyn, the Bronx, Manhattan and Staten Island, in addition to addresses for just New York City. There was no overlap as far as I could tell (i.e. surgeons double listed), so when counting the total number of surgeons for New York I included all those that listed their city as one of the boroughs. I did not try to determine how many that listed their city as New York were in each borough, so the number of surgeons and surgeons/100,000 for the boroughs are lower bounds only. The same was done for other neighborhoods of major cities, such as La Jolla in San Diego, but only as far as was aware of it (sorry, I am not intimately knowledgeable about all neighborhoods in all major cities to the point that I know them by name, who do you think I am? Ken Jennings?).

Not all plastic surgeons had up-to-date addresses with American Society of Plastic Surgeons. A spot check indicated that this may affect ~2% of the surgeons listed, but that would not change the rankings nor classification of cities as Centers or Beverly Hills. I also only used data from the American Society of Plastic Surgeons (ASPS) but I did gather statewide data from the American Society for Aesthetic Plastic Surgery (ASAPS) which is another major society of plastic surgeons. Some surgeons are members of both but with a significant number being members of only one. In all states there were fewer members of ASAPS than ASPS, with the notable exception of Texas. Also interesting to note is Florida which had, by a large margin, a higher rate of ASAPS members/100,000.

While I tried to use either 2014 or 2013 data, for a few places that data was not readily available. For all cities with a population over 100,000 and for all cities that fall into the category of the Beverly Hills 2014 data was used. I have assumed that the number of plastic surgeons did not significantly change from 2014 to 2015.

State Stuff

I calculated the total number of surgeons in each state and calculated the number of surgeons/100,000. For both states and cities with more than about 300,000 there is a power law relationship where,

Surgeons = α Population^β

where β = 1.08 and α = 4.4e-06. [Edit: When I put this equation in I accidentally grabbed the wrong numbers from my Matlab output. The values for α and β are now correct.]

Surgeons/100,000 for all cities and states.

Total surgeons for all cities and states.

Answers to Random Questions

Q: Why do you care whether an article in Forbes from 2007 is accurate?

A: I don't. But lately some people (i.e. the Time article mentioned at the beginning) have been using the data to support dubious claims about Utah and by extension Mormons in general. I couldn't pass up the opportunity to undercut the support for that claim when the original data could be shown to be questionable.

Q: Don't you have better things to do?

A: As someone I know once said, "Some people eat, sleep and chew gum, I do genealogy and write...". I don't own a TV, nor do I have a Hulu Plus/Amazon Prime/Netflix account, nor do I have a gaming station. So for entertainment I look up random things on the internet and research stuff like this. It's what I do.

Q: What about all the other data in the Time article?

A: It may or may not be correct (the demographics definitely are correct), but some of the conclusions are not correct, especially those relating to plastic surgery and the statement "A culture of plastic surgery has taken root among Mormon women." My data seriously call into question that statement.

Q: Should Forbes retract their article?

A: I don't care. The original author has long since moved elsewhere, but if Forbes wants to issue a correction, by all means go ahead. If anyone in the Salt Lake City government cares enough about it they can ask Forbes to retract it. But I don't live or work in Salt Lake City.

Q: Are you really an astrophysicist?

A: Yes.

Q: Can I get your original data?

A: Yes. You can find it here in this Google spreadsheet. If you use it for anything make sure you cite your source (me, this blog). I always take points off from my student's lab reports if they don't cite their sources and I will do the same to you.

Q: Did you just threaten to take points off if I don't cite you?

A: Yes.

Q: Did I really just read all of this?

A: Yes. Yes you did.