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?