Biology, Destiny, and the Soul; or, What am I, Really?

Note: this is the first installment of a planned three-part series on the interaction between the body and the spirit. Today’s essay deals with the effects of external biological factors on moral agency and personality; future installments will deal with our bodies’ effects on the same, and the effects of both on our relationships with God.

How much of what we often consider essential parts of our characters – personality, intellectual capacity, or moral inclinations, for example – is truly, essentially us? How much is neurochemistry, or hormone function, or even interaction between brain structure and the environment? In other words, where does the body leave off, and the spirit begin?

About four years ago, a doctor put me on an antidepressant to treat my lifelong chronic insomnia and depression. The medicine worked like gangbusters; suddenly, I could sleep, and the nearly constant despair and dissatisfaction with which I had always struggled disappeared. According to my physician, my body has some sort of major dopamine shortfall; the medicine provides that dopamine, or something close enough for government work.

The thing is, my medicine affects more than sleep and mood. Almost everything else has changed, as well. Dopamine imbalance affects anxiety (and, consequently, tolerance for risk-taking, and desire for social contact), energy level, ability to read others’ social cues, and general attention span. When I began taking the medication, I became a very different person to the one I’d been a week prior. I became much more social. I stopped worrying over everything. I was remarkably more productive. I had to relearn all my basic interactive skills – my interpretation of others’ affect was suddenly much less biased toward negative conclusions. My emotions were muted. I developed quite a lot of intellectual focus – after years of fooling around professionally, I suddenly decided I wanted to go to graduate school. I studied to prepare for the GRE, I began devouring my husband’s professional library, and I generally made up for my half-hearted, sleep-deprived undergraduate education. I was successful, as well – I’m starting my Ph.D. program in about a month. Pre-medication, I would never have done more than dream about such things.

That got me thinking about my body and my spirit, and the line that separates them. My medicine makes it easier for me to be righteous – I find that empathy and charity for others come more easily now, and my faith in God is easier to keep. But that doesn’t necessarily make theological sense. Such things are supposed to be the domain of the spirit, and not of the body. Doesn’t the spirit run the show? For that matter, are we not beings of free will? What freedom of choice do I have if my most basic decisions – whether and what to eat, whether to treat my husband kindly or cruelly, whether to speak or to remain silent – are strongly determined by my biology? If they are determined by a pill? And they are.

In my college neuropsychology classes, I read a lot about the way that brain injuries and disease could influence personality and behavior. I learned that pleasant, well-adjusted, moral people could become nasty, could lose their understanding of or motivation for moral behavior, could even become adulterers, because of brain injury. I learned about Huntington’s disease. I learned about the way neurological illness could change people.

Until my own experience with psychiatric medication, though, I was able to fit all this information into the idea of free will. I thought that God surely took individuals’ mental states into account when He judged them. A person who suffered schizophrenic delusions and paranoia, for example, must be judged according to the choices she made based on the world she lived in, delusions and all. Phineas Gage must surely be judged by his choices at the height of his accountability, before his brain injury.

Now I know better. My illness changed not only the conditions in which I make choices, but my very ability to make those choices, and the criteria by which I make moral judgements. Prior to my treatment, I had no idea that I was sick. I took full responsibility for my behavior, but my physical condition was such that sometimes, I became so withdrawn that I could not generate behavior for which to be responsible. As an adult, I believe I was occasionally nearly catatonic.

The experience has shaken my sense of myself deeply. What merit is there in righteousness, for myself or for the God who helps me to be righteous, if it’s determined by a pill? I suppose we could say that God gave me the pills, and thus made me capable of moral agency. I can accept that. It raises its own problems, though. First, the theological dilemmas: what of all the people through the ages who existed under conditions like mine but who received no pill, and no agency? Why did they live beyond the moment required for them to receive physical bodies? And what does all this say about the idea that we are in any sense co-eternal with God? How can that be, if we are such very created beings?

There is another problem with the idea that God gave me medication in order to further my progress. I’ve actually taken two different medications over the last two years – the first thing I tried wrought such improvement in my mental and physical health that my doctor never investigated other treatments. Unfortunately, it wasn’t safe for pregnancy or breastfeeding. When I began fertility treatment last year, I tried a different medication. It worked perfectly.

It also changed my personality. While both medications regulate my mood and my cognitive function in similar ways, they affected my emotional (and consequently, my moral) landscape very differently. As I mentioned above, the first medication had a pronounced dampening effect on my emotional life. I’ve heard this described as an undesirable side effect of first-generation antidepressants, but given the emotional volatility I’d coped with before, I welcomed it. It certainly made my moral reasoning different, though – my judgments were influenced more by utilitarian calculation than at any other time in my life.

The second medication does not dampen my emotions. If anything, it makes them more intense; it certainly makes them more nuanced. (I remember my distress when I realized that I had begun to feel multiple emotions simultaneously – elation and anxiety, for example, or happiness and grief. I know such complexity is typical, but it wasn’t something I had experienced much). As a result, I find myself more concerned with the experience and needs of individuals than I was two years ago; this has necessarily influenced my moral calculus.

We are left with this problem, then: not only does medication make me more capable of agency, different medications bias my agency in different ways. Whatever we may say about that part of me which is eternal, we cannot say that it is the agent behind my choices.

And so I ask: what is the core of my being? What am I, really? What are any of us?

Comments

  1. What are we? We are stardust.

    Thanks for the post. I was thinking about this recently, after researchers used neurons to operate a robot, and when they switched the neurons, they said the robot’s personality changed. I wondered how much of my personality is spirit, and how much is brain.

    I’ve concluded that some of our spirits were given physical shells that are more receptive than others. For some, communicating with God may be like walking across a street, while for others it’s like wading through mud. And we can’t tell one type from the other by looking at them.

    Your experience is a strong argument for not judging others, because two people from identical backgrounds can have different brains, bodies, and horomones. We can do the best with the physical, chemical, and emotional attributes we are given, and leave the rest to God. I cannot look at the dividing lines recited in D&C for the three degrees of glory and apply them to anyone on earth, because I do not know how I would be doing if I was in their shoes (or body), or how they would be doing in mine.

  2. This line of thinking reminds me of Barbara Ehrenreich’s objection to the idea of an immortal soul, as expressed in her book Nicked and Dimed. She asks, does the immortal soul retain the personality, character traits, etc, that we die with? If so, then heaven must look a lot like an Alzheimer’s ward, with large numbers of extremely irascible, forgetful, and sometimes even juvenile people being cared for by ministering angels. Or does our soul instead retain the personality, etc., associated with our intellectual peak in life? But if that’s the case, then everyone who has passed that peak is, soteriologically speaking, already dead.

    This idea seems to me to have some force, just exactly because it is so hard to define any trait of our souls that is not at least biologically conditioned. At the very least, the life of the unencumbered spirit must be an inordinately strange thing.

  3. I have thought a bit about this and I typically view agency as a vector and that the magnitude changes over time. If agency exists, which I do believe it does, it is empirically constrained. I also think that the concept of the resurrection being part of the atonement is critically important. We are never fully free or fully sanctified until our bodies are renewed. As you say, something as fundamental as the capacity to empathize – a prominent capacity in Mormon views of Christ – is biologically constrained to the point of impossible in around 1% of the population.

  4. MikeInWeHo says:

    While I love Barbara Ehrenreich, she’s at her best when she sticks to economics and social justice. Her argument for human soul-less-ness struck me as a bit weak as best I recall. I imagine our soul to be the sum of our pre-mortal, mortal, and (eventually) post-mortal existence, not just a snapshot of who we are at a particular point.

    This is a wonderful post, Taryn. What role do you think memory plays in all this? What exactly are our memories?

  5. JNS, yup on the inordinately strange thing. Something without emotions or cognition, perhaps completely lacking in agency or perhaps truly and completely a free agent.

    J. Stapley, yes, I think that makes sense. The Atonement can’t be separated from the Resurrection.

    MikeInWeHo, since we can lose our memories, they can’t be part of the most essential core of ourselves. Beyond that, I’m not sure.

  6. Taryn,

    It is at this intersection of brain chemistry and action that I think the gender essentialists have a point. Given that men an women do have measurable differences in brain chemistry, how do we handle agency? Testosterone is stongly associated with aggression, for example.

  7. Gerald Smith says:

    Concepts as you give here help me think that we do not have libertarian free will. Rather, as spirits we have an agency that is often dampened or limited by physical issues and a veil of forgetfulness. I think we will all be amazed and grateful for the atonement, when we see just what it actually heals us of and from.
    Imagine going through your depression without medication, and then to have Christ’s atonement to heal you and restore you to your original spiritual personality? Wouldn’t that be an amazing and wonderful experience?
    I think that the atonement is an on-going thing that stretches back into the premortal existence to save us in our first estate, and will continue saving us long after we’re resurrected.
    Perhaps part of the Spirit World and resurrection is to help us get back in touch with our true spiritual selves, and how our physical resurrected bodies will be managed at that time?

  8. Mark IV, I think you’re right. Taryn and I were talking about this recently, related instead to oxytocin. The point was that she very likely has more than I do, and therefore that she gets some sorts of neurochemical payoffs for taking care of our baby that I don’t get. Where gender essentialists perhaps go wrong is in assuming that social practices and institutions ought to mirror our biochemistry. Should I care for our child less than Taryn simply because I may not get as much of a neurological payoff from it as she does? Suffice it to say, the answer is not obviously positive.

  9. Taryn,

    Your post presents a valuable exploration of things that I had no notion of prior to my own experience with depression and medication.

    In seeking answers to “what am I?,” I found that meditation enabled me to explore that question directly.

    One approach practices perceiving everything that comes into our awareness, just as it is. As an object of perception, whatever comes into awareness definitionally isn’t the “subject” that is perceiving. Such an approach sets aside — as the ground of identity — memory, knowledge, emotion, feeling, and ego, as all of them are objects of perception.

    What’s left? What can’t be perceived? Perception itself.

    There is a way, I think, of living freely, wholeheartedly and compassionately from that stance, but it’s quite a different approach than we’re accustomed to.

  10. Taryn,

    This is an important post and lies at the heart of the Atonement. Thanks.

    “What am I, really?”

    In my eyes, I am a child of God – and each and every other person is a child of God, as well. At the most basic level, nothing else matters to me. He is my Father; I am his Son; you are my sister; end of story.

    “We believe that (we) will be punished for (our) own sins, and not for Adam’s transgression.”

    Since I have no idea what I inherited as a direct result of the Fall (through no choice of my own), or what part of that inheritance I can or cannot change (what truly is within my control independent of that Fall), I am glad that our theology emphasizes an individual judgment based on our efforts and provided by a merciful judge.

    Slight threadjack, perhaps:

    I can’t know perfectly even what I am capable of doing and being in this life, so I try very hard not to hold anyone else to a standard I think they individually should live. I accept, embrace and teach general, collective standards, but I have no idea which individuals can or cannot live them – or, more accurately, live them without varying degrees of supervision or societal/communal control. That simply is something I do not know, so while I support the communal standards (and penalties for the violation of them), I do not condemn those who fail to live them.

  11. Carlos U. says:

    Mere Christianity, ch. 10-Nice People Or New Men

    “But if you are a poor creature-poisoned by a wretched upbringing in some house full of vulgar jealousies and senseless quarrels-saddled, by no
    choice of your own, with some loathsome sexual perversion-nagged day in and day out by an inferiority complex that makes you snap at your best friends-do not despair. He knows all about it. You are one of the poor whom He blessed. He knows what a wretched machine you are trying to drive. Keep on. Do what you can. One day (perhaps in another world, but perhaps far
    sooner than that) he will fling it on the scrap-heap and give you a new one.
    And then you may astonish us all-not least yourself: for you have learned your driving in a hard school. (Some of the last will be first and some ofthe first will be last.)”

  12. This blog post is almost to complex to commment on but here goes so I have to “hang my hat” on the atonement.

    My understanding of our final judgement is that we will be judged fairly and that with Christ as our judge the judgement will be fair.

    So somehow thru the grace and power of the atonement Christ will be able to sort thru all the issues that you raise like mental illness, brain injury, bad upbringing etc.

  13. I think the main thing I learn from reading your experience is that judgement is best left to Christ. As your post shows, sometimes we ourselves don’t even know why we act, think, or feel the way we do, let alone what might influence others. I don’t think our agency necessarily disappears if our particular chemistry is not ideal for our bodies, but if we truly knew how brain chemistry affected all our decisions and perceptions, then we might be a lot more impressed with the good in all of us and a lot less critical of the mistakes. Like you said, you didn’t even know you were sick – how many others might also be in the same situation? Could it be all of us?

  14. #11 – Thanks, Carlos. I am going to quote that in another discussion elsewhere.

  15. Excellent post. I left my first marriage once I realized that I was in actual danger–as was my daughter, and that my husband would not be able to change. Later, I came to believe that he was not fully responsible for his actions, but that there were chemical issues he was dealing with, and which will be healed beyond this life. I was not required to stay with him or to attempt to heal him; that would happen without me. As I watch my son work brilliantly with his depression, I see his ability to cope with some very difficult genetic challenges. Where once I despaired, I now marvel at him–with entirely different expectations. I marvel at my great great grandfather, who died of a self-inflicted gunshot wound, when I see how strongly he worked from within the depression which incapacitated him for years at a time. All of this reinforces my view that this life is kindergarten, the veil of soul-making, the preparation for whatever comes next–and the hope that our burdens will actually be lifted. It’s more than the “pie in the sky after I die,” but the belief that we are learning things about love and empathy and compassion NOW which will be the basis of everything we become later.

  16. Taryn, thanks for a fascinating post. I don’t have anything profound to add but my own lifelong struggle with depression has definitely made me ask the same kinds of questions. As you say, who is the real me–the unmedicated me, or the medicated me? And if the medicated me, which medicated me….

    I have to say every time I’ve come out of depression, or had a spectacularly un-depressed day or two for whatever random biochemical reason, I’ve been absolutely shocked at how GOOD I feel, how much energy I have, how much I can accomplish. Ironically it’s at those moments that I feel most resentful. Is this how “normal” people (like my almost freakishly energetic and productive husband) feel all the time?? I ask myself in amazement–and why on earth can’t I just feel this way all the time? I always have to grit my teeth remember that people who aren’t depressed have their own trials and limitations that I wouldn’t necessarily want to exchange depression for. At least depression is familiar. I know it thoroughly, by now, and I’ve slowly slowly learned to manage it better and better. Or that’s what I tell myself when I get really frustrated at what seems like the injustice of it all.

    Anyway, great post! I’m looking forward to the next two in the series.

  17. To all who’ve discussed the Atonement as a corrector of the physical things which shape our actions: yeah, I’m down with that. My question, though, is what the facts which lead us to hope that this is true say about us. what is our most essential core? What is our spirit, and what is its purpose?

    If we argue that the body somehow fetters our spirit’s agency, it goes both ways – as Adam E. suggests above, our positive choices are as biologically determined as our negative choices. So our righteousness isn’t actually righteousness. We aren’t really progressing.

    I learned as a child that the soul is the union of the spirit and the body. Perhaps we have given too much weight to the spirit as the free-willed agent; perhaps our body is the agent, fettered though it is, and the Atonement will make it perfect, thus making our free will perfect? And perhaps the spirit is more akin to God’s breath in us, our spark of light?

    Okay, that was just unsubstantiated speculation. What are your thoughts?

  18. Mrs. Peacock says:

    What a great post – thank you for this. My story is very similar to yours. I transitioned off of antidepressants a year ago and feel like Charlie in Flowers for Algernon.

  19. Margaret, wow. That seems like a really good conclusion; I may just adopt it.

    ZD Eve, yes, I know what you mean.

  20. Taryn, you’ve raised some questions that I have also wondered about, as I have a close family member who was recently diagnosed with depression issues, and he has struggled with the concept that if “men are that they might have joy”, what does it say when his happiness comes in the form of a daily pill?

    I think the concept of the atonement in all of this is key. I have had a different perspective on agency and some of the obvious physical or emotional handicaps some people have to deal with in this life. The atonement covers for those things that are not our fault. And yet for me, the beauty of the atonement is that the help we need from it can come without waiting for it to be applied at the end of this mortal life.

  21. I should add that the atonement can, but not always come to our help in this current life. Unfortunately, working right now, and I need to develop this thought more deeply.

  22. Somewhere in Foucault (a theorist I’m not always crazy about by a long shot, but I love this one) is a statement about how Western metaphysics has it exactly backward, and that instead of the body being the prison of the soul, the soul is the prison of the body. I sometimes experience depression as that kind soul-entrapment–even as my twenty-first-century awareness of biological processes dimly recognizes that according to the medical model what I’m experiencing and identifying as my soul-disease IS my body, the malfunctioning of brain processes in some unimaginably complex and deadly feedback loop with my environment. (As to how all this translates into spiritual terms, frankly, I haven’t the faintest.)

    Of course the whole body-soul or body-mind dualism, already bizarre enough in its implications, quickly jumps the rails and plunges headlong into the valley of multiplying metaphysical entities, what with our material spirits and co-eternal-with-God intelligences and such. ;)

  23. MikeInWeHo says:

    re: 5
    How can we know if we’ve “lost” our memories, or they’re merely veiled for now and will be returned to us later. I believe there’s evidence that we retain lots of memories from earlier in life that we can’t consciously access, for example. Maybe it’s all still there somewhere, our entire past, and we’ll get it back someday.

  24. My father in law is in the last stages of Alzheimers. I have not seen him for many months, but my wife who has traveled to see him in a care center and to help her mother tells me that in a real sense “He is no longer my father.”

  25. #23: I’m where you are: It think my memories are a big part of what is now me. I feel it’s like it’s like hitting “delete” on our computer. Somewhere, it’s still in there on the hard drive.
    On drugs: I need my tablet for my day. I think it is an okay thing to do, if it helps. But let’s not forget the 60s, where a line was crossed: using drugs to find oneself, only to loss oneself.

  26. I debated whether or not to share the following experience, but it won’t leave my mind, so I hope it helps someone, somehow:

    I once gave a woman a blessing who was suffering from depression and other related issues. I had no idea of this at the time; she simply called and asked for a blessing.

    In the blessing, I remember distinctly hearing her be told that the greatest source of her pain in this life would never go away – that she would struggle with it until the day she died. (Again, I had no idea what the source was. I figured it was some physical ailment when I thought about it at all.) I also remember distinctly hearing her be told that the joy and freedom she would experience in the next life would be even more exquisite than the pain she would feel here. It was a powerful blessing, and I walked out of her house feeling grateful for the blessing of having been the voice.

    Years later (after we had moved away), I was back in town visiting, and I mentioned her blessing to her and asked how she was doing. She told me that she had been crushed by it and had decided to not ask me for a blessing ever again. I asked why, since the promised blessings had been so great. She looked at me with a perplexed look and asked what I meant, so I explained my memory of the blessing.

    Her face registered shock, and she said to me, “I never heard the statement that I would be blessed. When I heard that the source of my pain would not be healed, I was so crushed that I tuned out the rest of the words.”

    That experience taught me more about depression and other related issues than anything I have ever studied. She had carried an additional burden with her for years after receiving that blessing. She had seen that “blessing” as a “cursing” – and that “understanding” wasn’t at all her “fault”. It wasn’t anyone’s “fault”; it simply was what it was – the reaction of a woman caught in the middle of depression.

  27. Oh, and my son’s insulin is no different in my mind than the pill someone takes for depression. They both are wonderful blessings.

  28. I don’t mean to offensive with this question, and I am overstating my point by asking the question in this manner, but what do we need the atonement for if the right drug can fix the problem? We teach that the atonement can transform us from the natural man into a new creature, but even our rudimentary understanding of neurobiology and chemistry can eliminate or transform many of our worst qualities. Imagine what the psychiatrists of the future will be able to do. If the right drug can make me kind, loving, patient etc. then where does the atonement fit?

    I realize that forgiveness of sin through the atonement is another question entirely.

  29. Single Sister says:

    My mother had a severe (untreated) depression her whole life. At times it was horrifying to live with that kind of anger and grief and despair. Depression runs in our family, but it was still a shock to me to find myself battling it a year ago. I refused to take medication for a long time, but I got a blessing and re-read my PB. Both times I was clearly told to “follow medical advice”. So I have started the medications and feel better. Have all of the feelings gone away? No, but I feel better able to cope with them now. Those things that used to make me collapse into bed and hide, I can now face. God gave me this issue to face up to and deal with, and I am doing that with His help and yes, with medications. I am also diabetic. Would I stop my medication because I have been told at Church that God can heal? Nope. I have faith that one day I will be healed of both maladies – but it may not be in this lifetime and in the meantime I am going to follow Heavenly Father’s admonition to me to also follow my physician’s advice.

  30. Taryn this is an interesting post. I have spent most of my adult life pondering these ideas. I have come to the conclusion that there are three parts to us. The scriptures refer to them as the carnal man, the natural man, and the child of God. These parts could also be called: The spirit, which is deeply embedded, almost asleep within us, but is the most powerful part of us. Probably could be considered similar to what psychology would call our subconscious mind. The body, which is not us at all, but very much like a horse a cowboy/girl must ride. It has it’s own attitudes, desires, and urges, and will test the spirit in every way, for this is it’s job. And thirdly we are a soul, the most conscious part of ourselves, the spirit and the body combined. This is what most people think they are.

    As far as the medication is concerned, alcohol can create a powerful effects on a person as well, yet we have spiritually been counseled not to use such. The medication can removed much resistance to common perception for people. Is it a virtue or a vice? I think our choices will determine that. I am not trying to condemn anyone for taking medications, but we can shift our perceptions in many ways. What is the true impact on us by experiencing that shift? Depends on us.

    Great post. Thanks for sharing.

  31. This post is the essence of my entire blog. Your question is thought provoking certainly and I don’t know if a measly comment can do it justice, but here’s trying. I personally don’t see why biology influencing behavior means we don’t have agency. Certainly, at some point in dementia or delirium, agency ceases to have much meaning. Where that is God only knows.

    Here is the trick, the brain has the ability to build itself. We call it neuroplasticity. We know that engaging this ability physically changes the brain. For example cognitive behavioral therapy, works about as well as medication. Often, we need both, the medicine to quiet the monster so that our mind can get to the real work, but I digress.

    I don’t think having a tendency or drive to do something a certain way or to make certain choices means we don’t have a choice in the matter. Your argument, taken to the extreme would say that certain men aren’t responsible for what their libido or their anger drives them to do. I don’t buy it. It makes certain choices harder for certain. But by asserting our will, the choice becomes easier over time. This is what learning is all about. I think it is what putting off the natural man is all about.

  32. We’re still missing an important component that complicates things even further. Our social experience certainly affects our moral agency. I tend to be a constructionist and generally see that as more important than biology. But, being one who suffers from severe depression, I know that biology plays an important role.

    I have often wondered about agency. I don’t recall ever believing that the spirit is in control of our agency. I’ve always assumed it was our mind and body. The medication I take that keeps me from feeling suicidal gives me the control of my body that I need to have agency. Yet that still doesn’t account for my social experience — the things I experienced growing up and continue to experience that make me who I am. Or how about the social structures that limit opportunities and agency? Sometimes I wonder how much agency any of us really have.

  33. Taryn,
    Great post, I typed a long, wordy comment that got lost in cyberspace or the spam filter somewhere. I have blogged on this very subject time and again, as recently as last week. The best answer I can come up with to your question was posted here.
    I don’t know where agency stops and dementia or delirium begin, but I do know the line exists. The difference between influence and compulsion was important enough a war in heaven was fought over it.

  34. I’ve sometimes felt that I’m just inherently less spiritually inclined than certain others, but I’ve been reluctant to latch on to the idea because I’m afraid that when I die God will just tell me I was being bad:). Nevertheless, I still harbor the hope that it is some insurmountable handicap that prevents me from tearing up during the ward Christmas program. And the idea does give the admonition to not compare ourselves to others some extra punch.

    Has anyone read the book The God Gene? I haven’t, but when it was published I remember being upset about the idea of spirituality and the human desire for transcendence as chemicals or processes in our brain, developed through evolution for some species beneficial purpose. It seems like science can chalk up so much of “individuality” to biology and environment that this free-will core becomes difficult to believe in.

    But c’mon, if you don’t believe in free will, what is there to believe in at all? So I’ve thought a lot about the nature of our pre-organized selves, and I’ve had my ideas, but when I reflect back I’m pretty sure they’re all derivative of all the nerdy science fiction I’ve read over the years.

  35. Eric Russell says:

    Whatever we may say about that part of me which is eternal, we cannot say that it is the agent behind my choices.

    Interesting stuff, Taryn, but I think this is a bit over the top and not supported by even your previous comments. There’s no question that both our environment and our biology deeply influence both our choices and even our decision-making process. I think the important part of the claim that agency makes is that we are capable of doing other than what we do in any given situation. It is pretty difficult to demonstrate that, in any given choice, you could not have chosen otherwise than what you chose.

    In any case, speaking to the post as a whole, I think what is ultimately at stake is not the set of choices, but the will. I understand that you speak of changes that seem to be made to the will itself, but there is nonetheless a baseline will which informs our choices. To put it another way, I do not think the changes that one undergoes with the medication actually makes one a better person, rather it simply raises the bar for the will. When good choices become easier to make, then one must make even better choices, so to speak, to demonstrate an equally moral will.

    I don’t think there’s a theological dilemma anywhere here because God has always been clear that people are at different starting lines. I think Christ addresses this with the Parable of the Talents.

  36. ZD Eve, I think I know what you mean here:

    Of course the whole body-soul or body-mind dualism, already bizarre enough in its implications, quickly jumps the rails and plunges headlong into the valley of multiplying metaphysical entities…

    But please explain it, as I’m having some difficulty with it. Sounds interesting.

    Bob (#24), I think that equating drug therapy for neurological illness with recreational drug use is really problematic. People who take medicine for psychiatric conditions – well, they’re in a situation which is directly comparable to diabetics who take insulin. Any attempt to draw connections between that and “finding oneself” through drug use threatens to confuse physical illness with moral weakness, given that we tend to see recreational drug use in such terms.

  37. Ray, wow, great minds think alike, huh?

    That story about the blessing really does capture the way mental illness can affect our perceptions.

    Gary, I’ve worried at that question myself – if I can be made closer to perfect with a pill, do I need Christ to make me new? Maybe there will some day be a better pill. Good thing I’m still a sinner, so I don’t let such thoughts go to my head :).

    Rondell, I too have doubted that we truly have agency in this life. Hark to Margaret Young!

    Doc, that’s the thing. If we believe we chose to come here, we cannot conclude that our will comes entirely from the physical world. But this world can so override our will – it’s a conundrum.

    Rand, the thing is, my body doesn’t produce enough dopamine to function as it should. Either I have a shortage of it, or perhaps the cells in my brain responsible for soaking it up and using it are inefficient and must be flooded with it in order to function as they should. The analogy to alchoholism doesn’t work because, well, no one starts out needing alchohol. We avoid the stuff so that our brains won’t rewire themselves around it, thus making us dependent.

    Eric, I disagree. Taking my own case into account, there are indeed times at which I have been unable to make decision other than the ones I went with – those times of near catatonia. I chose to sit silently, staring into the ether, avoiding social contact, even snapping at my husband when he tried to talk to me. Because such things hurt. And I judged myself for it when I was more able to function. However, I now understand the mechanics of my brain better – I made that choice because it was literally all that was available to me. The neurochemical deficiency in my brain caused my brain activity to slow down. We can say that, if it was the only choice available to me, it wasn’t really a choice. But then we’re left with another pressing question – why was I given a body which interfered with my agency to such an extreme extent? Under such conditions, I couldn’t develop as an eternal moral being.

    Regarding your second and third paragraphs, though (different moral baselines, the parable of the talents), good thinking. But the basic question still remains: what is my spirit? What’s it for? Is it the agent, or simply the motivating spark? I do think it’s a question, rather than a dilemna.

  38. I’ve loved this converation, but as we’re packing for a move and I need to get going on it, I have to sign off now. Feel free to continue amongst yourselves.

  39. Taryn, oops, I may have gotten myself in over my head with that remark! I wasn’t trying to say anything all that profound–just that the whole traditional mind-body dualism gets even weirder in Mormonism, since we have spirits and bodies, but believe that our spirits are material as our bodies are, but just finer matter. And then we have (maybe!) intelligences, whatever those are. So we have three-piece system instead of a two-piece system–and even the two piece system has all kinds of problems.

    So when something goes wrong, such as depression, what part of the system has broken down? Clearly the whole system is involved and impacted, but when attention to the physical (an antidepressant) clears up problems that manifest themselves in mental, emotional, social, and spiritual realms, what does that mean?

    I have no idea. I just think it’s an intriguing–and unsettling–puzzle, and it does raise all sorts of complications to classical notions of free will, and ideas of selfhood.

    Anyway, I hope I made slightly better sense this time around! (I think, if I’m reading you right, I’m just echoing much of what you’re saying in your original post.)

  40. Davis Bell says:

    I know that I am breaking any new ground here, and I didn’t have time to read all the comments above, so forgive me if I’m repeating anything.

    A few years ago I observed my mother’s father descend into the abyss of dementia. He was an old-fashioned guy, tough and occasionally harsh, but as chivalrous and decent and hard-working as they come — sort of the archetypal Greatest Generation guy. He rasied a large family, served in the Church, and worked for many years in a physically demanding job.

    As his eyes grew milky and his connection to reality grew more tenous, he also became vulgar and crude. He tried to pick fights in grocery stores. He made comments to women that had his true self heard issue from another’s mouth would have ended in a fistfight. He was, in short, not himself. This and other experiences caused me to ponder the questions you pose above.

    Here’s what I think: Just as the spirit gives life to the body, the body gives the spirit a point of connection to the physical, terrestrial world. Think of Satan’s hosts who possessed the swine: without a body they were in the world but not of it. They couldn’t make noise or touch the ground or run off a cliff.

    I believe that the brain is the mechanism through which the spirit and the body connect. I don’t know enouch about brain science or chemistry to go into further detail than that. I simply think that all those firing neurons and electronic pulses are the spirit expressing itself to the body.

    Now, because our bodies are created from the dust of a fallen world, they too are flawed. As a consequence, no one’s personality or actions are a pure or whole reflection of their spirit. Unfortunately, some brains are less perfect than others. I believe that the extent to which the brain is flawed is the extent to which the spirit is limited in expressing itself through the body.

    My grandfather’s brain was old and tired and increasingly flawed. Its connection to his spirit decreased over time to the point that, while his spirit still gave life and animation to his body, it reflected very little of the true nature of his spirit. I believe that depression and other conditions that have to do with brain chemistry are similar.

    So, who is the “real you?” Nobody knows. It’s the “you” that most closely resembles your immortal spirit, but which one that is is anybody’s guess. Unfortunately, the ability of your spirit to express itself is limited by your brain chemistry. The little pills you take change that chemistry, and so the expression of your spirit come through differently with each one.

    Anyway that’s my overlong and not terribly clear take.

  41. ZD Eve, I don’t think the tripartite model really can be considered the normative Mormon view. A view, definitely, and one championed by B. H. Roberts and Truman Madsen; but one also vehemently opposed by many others. That said, Mormon spiritual materialism does pose some fascinating questions.

  42. Stapley, although I’m no historian, from what little I’ve seen, I’d definitely agree that the idea is controversial and certainly doesn’t (and probably shouldn’t) play a large role in our current teachings. To a certain tongue-in-cheek extant, I was just trying to make our view of body and soul as weird as I possibly could just to make the problem as complicated as possible. ;) I mean, wow! Tripartite soul and spiritual materialism? Good times!

  43. Ah. I’m following you, now.

  44. Fabulous post. This touches on one of my biggest problems with religion in general, and (although I’ve only just now realized it) frequently rubs me the wrong way with many Mormons as well. (Standard caveat, for those who haven’t seen me before: I’m a lapsed Methodist who married into the Church; I’ve met quite a lot of very nice people there and very much enjoy reading my Hugh Nibley books, but organized religion isn’t really my bag.) The idea that people are always, always responsible for their actions; that our agency is complete and total; that people choose whether to be righteous or sinful, or rich or poor, or happy or sad; is so completely and thoroughly wrong in my mind as to drive me a bit mad when I hear people assert those sort of arguments. (I think many don’t even realize that’s what they’re doing; it just doesn’t occur to people that someone’s problems with their life, their faith, or their behavior might be caused by depression or other neurological conditions, not low church attendance!) Much of my attitude on that score stems from years spent working in health care, particularly among the disabled, the elderly, and those with traumatic brain injury. There’s a pernicious idea that if you can’t see someone’s illness, or attribute it to an event (brain injury), then surely their lives must be completely within their control. Surely prayer can save them! If only they would take the Sacrament, become Temple worthy, get righteous all would be well! In many wards (as in many churches of many kinds, of course), there is no partial credit. There is no assumption that those who fall short may still be doing all they can with what they have.

    Anyway, it’s not my intent to beat up on the Mormons. Like I said, it’s a problem I have with religion in general, and the attitudes I decry above are common to True Believers of all stripes. I note that no one has asserted anything close to the positions I’ve complained about, and I’m awed that so many quality replies have followed this spectacular post. (In fact, I feel kind of bad posting this at all.) If my wife’s ward consisted of all you folks, I think I’d be able to hang. (Well, not for three hours. But an hour, maybe!)

    P.S. So who’s up for discussing the genetic roots of homosexuality? Just kidding!

  45. There’s been a line of thought in my family for a few generations that about all we really choose is whether we’re going to be good or evil, or at least better or worse than we might be. Put the neurobiological argument above together with sociological role and institutional theories and I think this becomes pretty darn convincing. I’m not seeing a whole lot of originality in the life decisions of people around me…

  46. Banky, as to the last question: Just about everyone here – over and over and over again. :)

    This is a very personal issue for me, and Banky’s comment leads me to share the following:

    I have mentioned this in a tribute post to my father, but my mother has a rare form of schizophrenia. Growing up, all we knew was that she needed “sleeping pills” to function properly.

    My mother was an amazing example of Christ-like love and acceptance throughout my childhood. I never heard her raise her voice in anger; I never heard her say anything (not one word) negative about anyone else. She was amazing. She was active and aware and fully-functioning in the life she (and my father) built for her. Nobody other than my father and her own parents and siblings even knew there was anything wrong with her, since mental issues were not discussed openly at that time.

    A few years ago her medication finally stopped working. For the few months it took to find a new combination that would work for her, she was a totally different person. She was paranoid; she had horrible hallucinations; she swore without provocation, using words we didn’t even realize she knew. Once the medication was adjusted properly, she was back to her normal condition – a sweet, incredibly spiritual woman.

    “My mother” is the woman I knew while properly medicated, not the monster she became without it. She had a degree of agency during those years that was absent when her meds stopped working. During those months, she literally could not control her mind or her actions – and what came out of her mind and her mouth would have horrified her if she had been aware of it. She literally was not accountable during that time – not at all.

    I don’t pretend to understand mental illness, nor do I pretend to understand how such illness interfaces with agency and the interaction of our spirit and body. That is so far beyond my ken that I would be shooting in the dark at a moving target if I tried. All I know is that we have been commanded to judge not, and that I have been told I will be judged as I judge others. I know how desperately I desire mercy and meekness at my own day of judgment, so I try as hard as I can to be merciful and meek myself.

    Again, thank you, Taryn, for this post. To answer Banky directly, if we truly understood the Atonement better, I think we would understand this issue better – and much of our stress and guilt and heartache would melt away. If we also allowed for those who can’t understand it better (for whatever reason), much of the pressure we tend to apply also would vanish – and we would be more able to accept and love others and ourselves for who we are amid our struggles, not just who we will become once those struggles end.

  47. #34: Certainly many used drugs for “recreation” (too many) in the 60s. But many also used them for “mind expanding”/ “mind freeing”, for trying to reach an “inner self”, or finding suppressed creativity.
    Sadly, solders used them in the war to suppress fear, depression, or guilt.
    All cultures have use drugs for things other than “physical illness”. These uses were not just “moral weakness”.

  48. Eric Russell says:

    that people choose whether to be righteous or sinful

    Banky, of course people choose whether to be righteous or sinful. Such states are willed by definition. If a given action is not willed, then it’s not a sin.

  49. I don’t really have much to add except for one of my favorite quotes from Jane Eyre:

    We are, and must be, one and all, burdened with faults in this world: but the time will soon come when, I trust, we shall put them off in putting off our corruptible bodies; when debasement and sin will fall from us with this cumbrous frame of flesh, and only the spark of the spirit will remain,–the impalpable principle of life and thought, pure as when it left the Creator to inspire the creature: whence it came it will return; perhaps again to be communicated to some being higher than man–perhaps to pass through gradations of glory, from the pale human soul to brighten to the seraph. (Bronte, Charlotte. Jane Eyre. New York City: Airmont Publishing Company, 1963. pg. 59.)

    I don’t agree with all of the theological implications, but I think Bronte’s conception of the spirit and understanding of the flesh might be spot on. By the way, I also love the C.S. Lewis quote from Mere Christianity in comment #11. I think agency can only be measured contextually and that only God reason can truly see the full context.

  50. Taryn,
    How do I get some of those pills? :) They sound pretty miraculous.
    Great post. I really like the questions you bring up. My mother has struggled with depression almost her entire life. Her medications are another struggle entirely.
    Although I’ve tried not to judge her actions based on her depression/medication, I haven’t ever thought about it that way.
    For me this is in a similar category of theodicy. Why is there bad? Why are some people more capable of choosing right?
    I guess the jury is still out, of course, but I’m leaning toward multiple mortal probations. I would feel better knowing that the next life could be a lot more difficult than this one. (or a lot easier, I guess)

  51. The Right Trousers says:

    This is fascinating. In my year of medication so far – which changes me quite a bit – I’ve never once been bothered by the “What’s really me?” question. (I’ve wondered, but never been bothered.) I wonder if it’s because we’re really discussion a different question, one I found out how to answer shortly before I was diagnosed.

    Maybe the question we’re really asking is, “How will I be judged?” The discussion keeps drifting that way.

    I have ADHD, which seems severely underrepresented in the discussion so far. It seems most people know something of the cruel tricks depression can play. As for ADHD, most people are aware of hyperactivity and inability to focus (usually it’s forgotten that it’s only on anything not stimulating)… but that’s not even half of it. And that part doesn’t seem to have moral weight in people’s minds, unless it keeps you from holding onto a job.

    I was going to make this long, but I realized it would end up *way* too long. This is the short version.

    Social unawareness: It’s awfully difficult to have true Christian charity when how other people must feel usually doesn’t occur to you.

    Irritability: A floor full of toys and other such chaos shouldn’t drive a full-grown adult to temper tantrums that frighten his children three times a week.

    Impulsiveness: It’s hard to avoid wrongdoing when *not* doing it simply doesn’t occur to you at the time.

    We’re also prone to addiction and addictive behaviors of all kinds. And as people with depression obsess over feelings of guilt and thoughts of suicide, people with ADHD tend to obsess over more… stimulating things. Push them away repeatedly and they repeatedly come back. Sing a hymn and they get associated with the hymn. “Our thoughts will condemn us” strikes many of us with awful fear and dread.

    It’s nearly impossible to determine on our own that it’s not just a moral failing – a lack of self-control – especially when others attribute it to that. Trying for some self-control by putting away distractions often makes ALL of it worse.

    So here I was on the same thesis chapter after four months, and ALL of it was worse. My sweet, sensitive five-year-old son started to insist that he didn’t want to be a man when he grew up. I felt like I was turning into a monster, and I dreaded it continuing for the rest of my life. I would alternate between being angry with God for making me this way, and pleading with him to reach down and change me.

    I hadn’t stopped praying. One night, on a whim, an impulse, I asked if there was any way he could possibly be happy with me. The answer was an immediate, unequivocal YES. I was overcome with a feeling of pure joy – elation, delight, ecstasy even. It was staggering. I lay on my bed for hours puzzling about how it could be true.

    It was this more than anything that got me to a doctor. If God is so darned happy with so much *backwards*, I reasoned a few weeks later, there must be something wrong with me. Short story shorter: the rest is much like Taryn’s experience. Medication pretty much fixes everything, and I am SO looking forward to the resurrection. It’ll be even better.

    I think we Saints spend too much time trying to figure out how to judge ourselves. And we FAIL. “What’s really me?” seems like more of the same, though it’s also an interesting metaphysical quandary to muse over. “You are what you think when there’s nothing to think about” is another. We often use the fruits of the Spirit as a personal standard of judgment. And so on, and so on.

    Honestly, we need to stop. “Judge not” and “judgment is mine” apply just as well to ourselves as to others. I learned first-hand that it’s better to leave it to God. He knows me better and he loves me more.

  52. This is an topic is an important point to make again and again and that so often gets lost in our culture of quick fixes (like, If only you’d read the scriptures more you wouldn’t feel this way’. We really are connected to physical, evolved bodies. I remember on my mission I met a recent convert who was taking medicine to manage his manic-depressive episodes. He felt inspired by someone in the ward that he should quit his medicine and that the atonement was enough to straighten him out. A book by a temple president named Babel, or something close, convinced him that if he really had faith he would stop his treatment–the atonement was enough. He did and ended up with a three month stay in the Veterans hospital.

    We would never tell someone without glasses that if they had faith they could see perfectly without them if they would give them up. We recognize vision correction is based in physical impairments. We need to recognize that some brains need ‘glasses’.

  53. The Right Trousers says:

    Hear, hear. I don’t know why we think our brains are under our sovereign control, when no other part of the body is.

    Back on the topic: The personality change is an odd thing. I’m two different people every day. (I prefer to think of myself as my morning personality.) It’s given me a greater appreciation for the range of human experience. You really never know what’s going on inside someone’s head. We barely know ourselves.

    As far as the spirit’s role in all this, I think it’s much more limited than I had supposed before. I wouldn’t be surprised to find out that the body does nearly everything.

  54. A child who is born with an obvious physical or mental handicap is not expected to use agency the same way a “normal” person is. I truly believe that most of us are handicapped in ways that are not yet recognized, probably because we are “made from the dust of a fallen world” as someone said earlier. We do the best we can with what we have and the Atonement makes up the difference. That’s the whole point of it.

    Btw, I have a handicapped child and am not trying to put anyone down.

  55. Banky,

    I’m sorry when you “hear people assert those sort of arguments” that it drives you “a bit mad.” It’s too bad you don’t realize that these people are not always responsible for their actions. That their agency is not complete and total. That you judge them too harshly.

  56. Depression and addiction have riddled my family and my life. As I’ve pondered nature/nurture, the need for the atonement, free-agency, the whole ball of wax, I’ve taken great comfort in Alma 7:11-12.

    11 And he shall go forth, suffering pains and afflictions and temptations of every kind; and this that the word might be fulfilled which saith he will take upon him the pains and the sicknesses of his people.
    12 And he will take upon him death, that he may loose the bands of death which bind his people; and he will take upon him their infirmities, that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor his people according to their infirmities.

    If I’ve suffered it, he’s suffered it. If you’ve suffered it, he’s suffered it. It is an infinite atonement, physically and spiritually. Thank God!

    I don’t know how all of the pieces fit together to make us who we are. I don’t know how much of the evil or good that I choose I will be held accountable for or be given credit for. I do know his judgement will be merciful and right.

    I just do the best I can do on any given day to choose right as I perceive it. Some days the results are pretty unimpressive. Some days I do better. Either way I have to trust that God understands, forgives, and ultimately will heal us all.

  57. hungry leopard says:

    Taryn, Do you mind if I ask what medications you’re using? I’m only curious because my symptoms sound remarkably like yours and I really need treatment. I’ll give you my email address if you’d prefer responding off-line. thanks very much.

  58. Ditto what Jami said.

    It is interesting to me that we really only know our own thoughts and feelings. We each filter life through our own unique lense.

    As we experience trials, we definitely have a greater capacity to empathize with others that have the same or similar trials. As we interact with others, we can gain some insight from their perspective, but I don’t know if we can ever really say “I know exactly how you feel.” The only one that really can do this is Jesus Christ, since, as has been mentioned, he has paid the price for our sins and has also felt the pain of all of our infirmities, disappointments, etc.

    It is comforting for me to know that we will be judged not only for our works but also the desires of our hearts and that the perfect Judge knows our hearts completely.

  59. Hungry Leopard, no problem. I currently take Sertraline, which is the generic for Zoloft. My previous medication was Nortriptylene (sp?), which is the generic for Pamelor.

    There are a bunch of different, but related, antidepressants; I believe they all work on the same brain circuits, but different people respond more or less usefully to different meds. The norm is for someone to try out several over a few months – whatever works best, with the fewest side effects, is what you go forward with.

    If you could use any more information, email me at serenityv at gmail.com – I’m glad to talk about it.

  60. Touche, Trevor! However, the hitch there is that I don’t profess to subscribe to the teachings of the Gospels. I’ve made no pledge, implicit or explicit, to not judge others. Tongue well in cheek there, of course – there’s a reason most of the fundamental moral lessons in the Gospels show up in most other religions & philosophies – they’re good lessons, and I need not believe in the Atonement to recognize that fact.

    Anyway, I’d like to repeat my profound thanks for all the posters who have shared their (often extremely personal) stories. I think it speaks highly of this site specifically, and the modern Church in general, that so many folks feel comfortable embracing ideas that are still somewhat taboo for many people.

  61. I wonder by what melding of ideas this concept of human agency has arisen that assigns full responsibility for exercising agency to the individual. It seems to have gotten tangled up somehow with the belief of individual accountability for sins. Or maybe it has become watered down with advertising’s “You can choose from a variety of colors to suit your individual tastes, needs, and budget” brand of human agency. I don’t know. But some of the expectations we seem to have about agency appear to me to paint us into corners, or sometimes, applying them, we paint others into corners.

    I wonder this, because of the statement in #52: “A child who is born with an obvious physical or mental handicap is not expected to use agency the same way a ‘normal’ person is.” This statement seems to place expectations for exercising human agency fully upon the child. But because we suppose the child somehow lacks capacity or judgment, we suspend in the same statement our expectations of what’s possible for that person in a strange act of grace: “You are not expected to use agency the same way a ‘normal’ person is.”

    IMO, cases like the severely disabled child — and any number of other overwhelming circumstances — demonstrate that human agency is a shared and not a wholly individual responsibility. Saying a person can’t exercise agency in a “normal way” points up the need for others to exercise their agency in a way that works to open up possibilities for those who can’t open up their own prospects, for whatever reason. That is, under such conditions, why shouldn’t those who do operate in a “normal way” – or maybe even in a better-than-normal-way, if such a thing is possible — step in and act to widen someone else’s prospects? Wouldn’t that be a natural extension of the advocates’ human agency?

    Sometimes it appears to be more socially acceptable for a person to drink to the point of drunkenness than it is for a person to suffer a disability or other dilemma like debilitating depression. Bars and other venues offer taxi rides for people who are drunk, or advertisements urge members of a party to choose a designated driver whose responsibility is to act in the behalf of those who are impaired.

    We accept the necessity of “designated drivers” for impaired drivers so as to keep prospects open for better outcomes for the impaired ones as well as anybody they might come in contact with whose prospects such drunken drivers’ actions could dramatically change. And we admit the necessity of “designated drivers” for sufferers of head trauma, for instance, because it’s understood head trauma victims can be combative, uncooperative, and incapable of acting for their own good. Paramedics take over and act to keep a head trauma victim’s prospects open. They’re the first responders, the “designated drivers,” whose job is to stabalize the victim as much as possible for transport to an ER doctor who will then similarly act to keep the victim’s propsects open. In such cases, the responsibility for human agency appears to be readily shared. This doesn’t appear to always be the case with the disabled or people who suffer other overwhelming dilemmas. Sometimes others act to extend their agency to the person in trouble, but often they fall back on the “It’s your responsibility” stance, effectively abandoning the person in peril: “You don’t read the scriptures enough,” “You don’t attend church like you should,” etc., or other rhetoric that throws up its hands in exasperation, such as “God did this, he’s the only one who can fix it.”

    In the case of disabled children or others suffering some constriction of what’s considered to be “their” agency, what we might be doing when we say that people who are not “normal” can’t do this or that is admitting the impairment of our own judgment and understanding of what’s possible. In other words, in making such pronouncements, in a bit of mirror logic we might just be remarking on our own limits where our own “normal” human agency is concerned.

    The Parable of the Good Samaritan demonstrates very well, I think, the principle of the “designated driver” or the principle of shared agency. One man discovers another suffering overwhelming trouble, his prospects shrinking by the minute, and in an act of agency “covers” him and acts in other ways to open possibilities for him, thereby restoring the man’s prospects so that he might regain his own will and means and go his way.

    Sorry about the long comment.

  62. PGK, I agree that as an advocate for a disabled person, especially an intellectually impaired person, we must use our own agency to reinforce that person’s. In my own daughter’s case, she has sufficient accountability to be a baptized member of the church and has taken to heart all of the values she has been taught in Primary and YW. Still, I need to provide a backstop for her when she ends up in a position where peer pressure could confuse her into behaving inappropriately. She does the best she can and I know in her case it is enough.

    More to the point of the original post, I don’t think that someone who has a physical issue which prevents a perfect interface between body and spirit is fully accountable for the results of choices made while the connection is bad. I thank God that medication has been found to help with some of these problems and I hope and pray that even more progress will be made in the future. In the mean time, surely we should use our own agency to help others who need it. I think that is called the ‘pure love of Christ’.

  63. Noray, thank you for explaining your point further.

    “I thank God that medication has been found to help with some of these problems and I hope and pray that even more progress will be made in the future.”

    Amen.

  64. The Right Trousers says:

    Cure depression and ADHD and you’ve cured the world of half of all drug abuse. I’d love to see that.

    Taryn, Sertraline is primarily a *serotonin* reuptake inhibitor. It only weakly effects dopamine reuptake – that accounts for only 1% of its action. Dopamine “shortfall” is considered as being primarily responsible for ADHD, and serotonin for depression. This is vastly oversimplifying, of course.

    I don’t want to turn you off from your doctor – if he’s prescribed the right stuff you’re okay. This is really for hungry leopard and anyone else considering getting some help. General practitioners (and many psychiatrists!) generally know how to prescribe medication properly, but don’t always know what it does. Do your own research, especially if your doctor tells you something that doesn’t click.

  65. The Right Trousers,

    Yes, you’re right – suffice it to say that I tend to simplify when I explain it to people. I’m foggy on the details, but the one apparently affects the other – if the dopamine were my only issue, and if it were severe enough to cause all my symptoms, I’d have Parkinson’s, wouldn’t I?

    I actually spent 20 years misdiagnosed as ADHD because both systems are out of whack, and my attention and impulse control issues masked my depressive symptoms for the doctor who oversaw my treatment as a child. I can’t remember all the details, but the medication I”m currently on has multiple effects, possibly because I’m really, really sensitive to it. We know the sertraline is (probably) affecting both systems, because my childhood treatment with Ritalin only affected the symptoms which are, nowadays, suspected to be related to dopamine. When I take the sertraline, it controls all my symptoms.

    I’ve had the same complicated diagnosis from several physicians, though – I should use antidepressants to treat all my symptoms. My current psychiatrist, who actually seems to know an unusual amount about the neurology (especially in comparison to the GP who started me on medication a few years ago) says that we can’t know what’s truly happening without poking around in my brain, but she still thinks that based on my symptoms, my problem is primarily dopamine-related, but that my seratonin issues affect the way I process dopamine. :)

    Sorry, I kept it simple for my post. I probably shouldn’t have done so; the last thing I want to do is contribute to misunderstandings about the way depression works.

    I should note that in my experience, you’re correct about physicians’ general understanding of the chemistry involved. Or, for that matter, this type of illness in general. Most seem to look up the symptoms, find a drug for them, and leave it at that – it’s a shame that we don’t all have insurance which allows us to go to well-trained specialists, but as you say, the important thing is that people get appropriate treatment, and for simple problems, that’s enough.

  66. The Right Trousers says:

    Ah, you’ve got one of the tough cases. I’m *so* glad you found something that works and a psychiatrist who really knows her stuff. That’s rare. I got lucky and found a GP who was willing to learn.

    I think simplifying is good. People’s brains seem to turn off upon reading two or three unfamiliar terms. I usually stick to the dopamine explanation for myself without bringing up serotonin. (Ritalin, which has little action on serotonin receptors, makes me crankier. Adderall, which has more, makes me less cranky.) You might be able to get away with explaining that your case is unusual and leave it at that.

    Thanks for the post and the attention you’ve given in the comments.

  67. My son was just diagnosed with dysautonomia, and he has trouble with attention and focus as well as depression and anxiety. The doctor has put him on zoloft + a beta blocker + klonopin. The issues discussed here sound so much like his problems that I wanted to bring up dysautonomia for discussion, and see if people have heard of it or considered it. It’s a malfunction of the autonomic nervous system, and my son was diagnosed by tilt table test.

    Apparently, if I’m understanding it correctly, his blood pressure doesn’t respond as it should to changes in body position, like standing up from a sitting position or sitting up when he’s been lying down. So what ends up happening is he gets bursts of adrenaline to compensate, and this gives him heart palpitations and general anxiety. The constant state of high adrenaline makes him exhausted and unable to focus, concentrate, or remember things. He just quit going to school his senior year in high school and stayed in bed. He’s also depressed and suicidal.

    He started the medicine today. I hope and pray it will make him feel better. In so many ways he’s not himself. I can’t wait to meet him when he is.

  68. Thanks for this post, Taryn. I’ve wondered a lot about these kinds of questions. One of the more disconcerting things for me in my own mental illness history was realizing that—after a lifetime of believing that happiness was contingent on spiritual faithfulness—that my moods frequently go up and down in a way that is almost completely independent of such things. I still remember waking up one morning some years ago and feeling exuberantly happy and enthusiastic about life—and being struck by the fact that these remarkably good spirits (which turned out to be an episode of hypomania) had descended upon me even though I was slacking off at all the things I thought I was supposed to do to achieve such a state, like church attendance and scripture study and so forth. I had transformed into a friendlier person, one more able and willing to help others, one with greater desire to do good—and this with no moral effort on my part. Alas, it didn’t last. But like you, the experience caused me to re-think some of my assumptions about agency.

    We often talk about the will as if it were this neutral and independent faculty. But I appreciate the Augustinian insight—which I think can also be found in the Book of Mormon—that the will itself can be corrupted, can be inclined toward evil (or toward good). I want to find a way to talk about agency which doesn’t approach the will in a radically decontextualized and isolated way, as is so often the case, but rather takes into account the ways in which it is embedded in and shaped by biological and social factors.

    I also don’t know what to do with that perennially perplexing question of the self, of identity. The self, I suspect, is better described as a process, as something dynamic and continually under construction, rather than a static, fixed, substance of some kind. But what then, I wonder, is the continuity between the self I am enacting now, and the “me” that somehow existed in a premortal realm? It’s baffling enough to try to pin down the link between my current self and my five-year-old self—what does it mean to say that the two are in some sense the “same” person—let alone the link between who I am now and some person in a life before this one of whom I have no memory, and whose relation to my physical body remains mysterious. Well, I’m not really getting to any point here, but I’ll be interested to see your future posts in this series.

  69. Thomas Parkin says:

    Just when I want to quite the bloggernacle, there are several great discussions across a few blogs … including this one.

    I love the first half of Sec 93. From verse about 30 and through several it talks about the relationship of the body and spirit. Among those verses is this statement “All truth is independent in that sphere in which God has placed it, to act for itself, as all intelligence also …” The part of that I would concentrate on is “that sphere in which God has placed it.” This is not the promise of unlimited freedom that God never can put bounds on, we are completely free but only within a “sphere”, and God sets the bounds of that sphere, at least initially. There is no guarantee that everyone’s sphere begins or remains the same the same (the comment on the parable of the talents is very apt) – only that everyone is placed.

    It seems to me that the promise of genuine gospel living is an overwhelming tendency to expansiveness … of our sphere. Alma ties goodness to expansiveness when he says “the word is good, for it beginneth to enlarge my soul…” But that doesn’t mean that there aren’t influences outside our control that can tend to constrict us even as we are genuinely living the gospel. Among those things are dimming intellectual and physical capacities due to age and illness. Similarly, we might have it in our cards to experience events that significantly augment the room in which we can move that isn’t directly connected to gospel living.

    We tend to equate the spirit with our identities. The pseudo-Jungian James Hillman took this view to a kind of extreme is his book “The Soul’s Code.” He takes it that everyone has a soul in which one’s perfect route to happiness is expressed in inherent talents and personality. The problem is like the one expressed, if an accident can radically alter one’s set of talents or personality then to what degree can these be a matter of essential spirit? We also tend to equate our emotional life with the spirit, even though our emotions happen in our bodies, as well – or at least our emotions are experienced by us through the filter of body processes that can be out of sorts or tampered with in any number of ways. A blue guitarist might be called “soulful” but a civil engineer rarely is. (But we become sad, we do not become sadness.) In all this we might be profoundly narrowing a truer vision of what we are not only potentially but also essentially. We may bring a lot more to the table then we tend to think – we may be a lot more than an artist, or thinker, or a physical being, or whatever smaller thing we reduce ourselves to. We might be underestimating our spirit – but always overestimating the sphere of freedom in which we are placed.

    ~

  70. Brilliant conversation, all. Thank you all for talking here. Is there another part to this discussion coming?

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