Medical conference explores mental health, fertility, gender

The Converging Roads conference, organized by the St. John Paul II Foundation in collaboration with the Diocese of Columbus, Catholic Medical Association (CMA) of Central Ohio and Ohio Dominican University, was brought to the diocese for the third time on Saturday, April 5.

The Pontifical College Josephinum hosted the biennial conference, which was last held in April 2023, in the Jessing Center on campus. The event brought together physicians and physician assistants, nurses and nurse practitioners, medical students and residents, clergy and religious, and individuals interested in learning more about medicine and health care ethics. The regional conference offers continuing education for health care professionals, equipping them to practice the highest ethical and medical standards of their profession.

Speakers at this year’s Converging Roads conference in Columbus, “Virtue in Medicine,” presented on various topics, including a Catholic response to depression and suicide, restorative reproductive medicine (RRM) and care for infertile couples, and approaching gender dysphoria with mercy and charity.

Dr. Anthony Isacco, Ph.D., a fellow for the St. John Paul II Foundation, discussed rising depression and suicide rates. Isacco is a professor of graduate psychology at Chatham University in Pittsburgh and director of training for the doctor of psychology, or Psy.D., in counseling psychology program.

Isacco likened depression to the “common cold” of mental health. He said depression is a normal human emotion in response to certain events, such as a death or loss of a relationship. A person exhibiting a clear-cut, marked change, such as isolating themselves while previously attending social events, however, suffers a different type of depression.

He discussed major depressive disorder, which can be a depressed mood or loss of interest and pleasure that endures two weeks or longer, is accompanied by impairment and distress, and unable to be explained by something else. The disorder also includes symptoms such as weight loss or gain and hypersomnia or insomnia.

He explained that multiple factors can cause depression. Environmental stressors, biological and genetic factors, and vulnerability or poor coping mechanisms can all be causes.

Isacco also spoke about suicide, which, he said, has climbed at a steady rate for several years with a slight dip in 2019. Women are more likely to think about suicide, he noted, while men are more likely to carry it out.

He said individuals who commit suicide often have a mental illness, including major depressive disorder, borderline personality disorder or post-traumatic stress disorder. Many have a history of abuse, neglect, conflict or parental psychopathy. He also noted that individuals who commit suicide often have an impulsive personality type.

Hopelessness, he said, can be a better explanation for suicidality than depression. When experiencing hopelessness, a person feels as if they will not experience position emotions again or an improvement in their condition. It includes pessimism about the future and decreased motivation. People often turn to suicide when they are experiencing feelings of hopelessness and helplessness as an escape, and feeling they have narrowed options.

Isacco also described the difference between agency thinking and depressive thinking. Agency thinking, he said, is a person thinking “I have other options that I can put into practice.” Depressive thinking, however, is when a person feels they have no options or control.

In such cases, he said, hope is needed, and it is possible to be instilled in anyone. He listed three goals: a relational connection, a good assessment and a plan.

In addition to needing a strong social connection – somebody to share deeply with – he said that an assessment is needed to determine risk factors, including suicidal ideation, intent, plans or means. Protective factors should also be assessed: social support, coping skills, what brings a person hope and their spirituality or religion.

Isacco said a plan is equally important. The patient should write a plan for moving forward and assume intrinsic ownership or autonomy. He noted that autonomy in most cases is not good but is necessary in this case.

He added that medicine and therapy in tandem together is shown to be most effective. He explained that many people suffering a mental illness want a “quick fix” through medicine but not the difficult psychological work, which is needed.

A panel on RRM and care for infertile couples was also offered during the conference. Panelists included Dr. Kyle Beiter, M.D.; Dr. Elizabeth Stovicek, M.D.; and Elizabeth Christy.

Beiter, an attending obstetrician gynecologist (OB/GYN), provides RRM to couples at Reply Fertility, based in Durham, North Carolina. Beiter was previously an OB/GYN hospitalist at Fairfield Medical Center in Lancaster. 

RRM is a science-based, ethically-sound approach to fertility care that seeks to identify and treat underlying causes of infertility. It works with the body’s natural reproductive function rather than artificial reproductive technologies that bypass the natural processes of conception.

Stovicek, a practicing physician in emergency and palliative medicine, serves at Cleveland’s MetroHealth Hospital. She graduated from Ohio State University College of Medicine, and she is a member of the American College of Emergency Physicians and the American Academy of Hospice and Palliative Medicine.

Christy serves as coordinator of communication and events for the diocesan Department of Evangelization and Catechesis. She has a background in labor and delivery nursing, serving for 20 years at hospitals in central Ohio. She received a master of science specializing in nurse-midwifery and is a certified nurse-midwife.

The panel answered a series of questions, anonymously submitted by attendees, regarding Natural Family Planning (NFP), contraception and fertility.

“Good ethics lead to good medicine,” Beiter explained.

Panelists were asked about ethics regarding prescribing artificial birth control to patients as Catholic health care providers. 

The panel explained that hormonal birth control thins a woman’s endometrial lining, resulting in a loss of embryos.

Christy shared the importance of having face-to-face conversations with patients, giving them a truthful answer and witness to why, as a Catholic, prescribing contraception also contradicts the Catholic faith. She encouraged Catholics in health care to be brave and do what is right from the beginning of their career, rather than try and correct it later.

As an emergency medicine physician, Stovicek sees patients in the emergency room who request contraception. When patients want a contraceptive, she said, she takes it as an opportunity to explain that fertility is a sign of the body’s health. She also explains her moral and medical objections with patients.

Stovicek addressed the importance of understanding the body on a deeper level. She said there can be many underlying causes of health issues. Women experiencing abnormal symptoms are often told by medical providers that their symptoms are normal.

The panel explained that NFP can be particularly helpful for women who suffer chronically, such as from heavy or painful menses, in understanding the root cause of their symptoms. Beiter noted that hormonal birth control is often used as a “Band-aid fix” for a larger issue.

He explained that NFP, a method used to achieve or postpone pregnancy by observing natural signs and symptoms of fertility in a woman’s cycle, is not a contraceptive. The Catholic Church teaches that “periodic continence, that is, the methods of birth regulation based on self-observation and the use of infertile periods (in a cycle), is in conformity with the objective criteria of morality. These methods respect the bodies of the spouses, encourage tenderness between them and favor the education of an authentic freedom” (Catechism of the Catholic Church, 2370).

Dr. Paul Hruz, M.D., Ph.D., associate professor of pediatrics and associate professor of cellular biology and physiology at Washington University in St. Louis, spoke about gender dysphoria. He served as chief of the Division of Pediatric Endocrinology (hormone-related health conditions) and Diabetes at Washington University from 2012 to 2017. He is also a member of the university’s Disorders of Sexual Development Multidisciplinary Care Program.

Hruz said there can be different contributing factors to gender dysphoria, and treatment should be directed toward understanding the contributing factors in an individual.

Historically, he said, the understanding of gender dysphoria was largely influenced by or result of psychological factors. Health care providers sought to identify and address underlying psychological difficulties.

“What’s happening now in our current society is the premise that, when this discordance occurs, the problem is not with the mind that’s proposed to be functioning normally – that the body itself is at fault,” he said.

“If one accepts that premise, based on ideology, then the hypothesis actually makes sense. So that, if that’s the cause, then health will be restored by changing the appearance of the body to conform to one’s gender identification. But we have to actually ask the question: Is that a valid hypothesis?”

He said current society’s hypothesis has led to the “affirmative model of care” in the United States, and psychological care is seen as optional. Stages of the affirmative care model include puberty blockers, introducing cross-sex hormones and surgically manipulating the body through a bilateral mastectomy or breast augmentation.

“Within our profession, there’s been a muting of any criticism of this model and often claim that this is what’s the preferred approach,” Hruz said.

“What very few people understand is that these guidelines that are being put forward are based upon the lowest quality of evidence that we have.”

He said systematic reviews from the Scandinavian countries of Finland and Sweden that pioneered the research concluded that the data is insufficient to be considered beneficial.

Hruz said there are many limitations. Studies are often done in small sample sizes and follow patients for short durations of time. 

He recognized that bias exists in any type of study. In the field of transgender medicine, it can be particularly problematic. 

Some studies used selection biases, telling prospective study subjects the purpose of the study, and observational bias, looking at data in a selective manner, particularly by beginning with a conclusion in mind and trying to find data to support that conclusion. “That’s very poor science,” Hruz explained, “but if you read many of the papers that are done in this area, that’s exactly what’s going on.”

Social affirmation, or calling an individual by their preferred name, pronouns and supporting a change in the way they present themselves to the public, often precedes medical intervention. Hruz presented data that found 94 percent of individuals who are socially affirmed will go on to later stages of medical intervention. Data showed that unaffirmed individuals are more likely to realign to the gender identity of their biological sex.

He also addressed a common claim that a sex transition will prevent an individual from committing suicide. Hruz shared additional data from Sweden on “cause mortality” in individuals decades after receiving affirmative care. Data showed that affirmative care did not fix the problem.

“The actual data showed that, after being affirmed in this way, the rate of completed suicide – not just suicidal ideation but completed suicide – remains almost 20-fold above the background population,” he noted.

In response, Hruz encouraged “listening over speaking” to people experiencing gender dysphoria. He said they are likely not ready to be showered with data and statistics. Being patient and asking questions can be helpful, as well as sharing beliefs without being defensive.

Hruz said it is important to acknowledge that individuals experiencing gender dysphoria suffer. A charitable response can be sharing in the suffering with them while putting boundaries in place.

During the conference, the CMA of Central Ohio honored local individuals and organizations with awards.

St. Gabriel Catholic Radio (Columbus AM820, Scioto FM88.3, Athens FM106.7) received the Pope St. John Paul II Culture of Life Award. The award honors an organization that exemplifies the values promoted by the CMA.

The St. Mother Teresa of Calcutta Service to Medicine Award for a non-physician was awarded to Michele Faehnle, nurse advisor for the diocesan Office of Catholic Schools and school nurse at Columbus St. Andrew School. Faehnle previously served as a labor and delivery nurse at Mount Carmel Health System.

The St. Luke Faith & Reason Award for a medical trainee was bestowed upon Mary Hyland, a student at Ohio State University College of Medicine and co-president of CMA Students & Med Students for Life. Bill and Shelley Perez and family received the Holy Family Award for exemplifying values promoted by the CMA.

The St. Gianna Courage in Medicine Award, which honors a physician, was given to Dr. Alex Rakowsky, M.D., who works at Nationwide Children’s Hospital. 

The St. John Paul II Foundation, based in Houston, is a national Catholic apostolate proclaiming the Good News about life and family through education and formation. The apostolate offers three primary initiatives: Converging Roads for health care professionals; Together in Holiness for spouses; and Clergy Initiatives, including the Shepherd’s Heart conference for priests and seminarians, and Servant’s Heart for deacons, diaconal candidates and their wives.