SSRIs of Salvation

Can the crazy be saved?

I remember my first panic attack. Shivers began at the back of my head at the base of my skull, riding upwards on my scalp until resting at the top of my head, until it felt like I’d been hit by lightning. An utter sense of being dumbfounded seized me. All in all, it wasn’t a distinctly unpleasant experience, just something shocking, immobilizing and bizarre in ways I’d never felt before.

April_2007_lexaproAfter a couple of these, and some real depression, I went to the doctor, and went home with a little white pill. Sigh…….. Lexapro.

How can I describe a selective serotonin reuptake inhibitor to someone who’s never taken one? I felt planed. Planed like you plane a plank of wood — gone were the peaks and troughs, replaced instead by a steady smoothness to my day. Panic? Nope. Depression? Not really. I felt a fuzziness. I could see why I ought to feel anxious, or depressed, but I couldn’t muster up the drive to feel panicked or glum. All in all, it felt pretty good. At least, it felt better than the alternative. I couldn’t bring myself to feel much, though — no tears at sad movies, no real anger or even irritation.

After a while, though, I wanted to address the underlying causes, if only out of some desire to feel in control of myself and to well, get better. I also began to see that our ability to treat any mental illness, even fairly innocuous bouts of panic like mine, are extremely limited. Therapy and pharmacology in these fields are still guesswork, although many benefit. Withdrawal symptoms weren’t pretty — mood swings, occasional “brain shivers,” etc. — but they didn’t last long, and at last I was “myself”: my panicky, irritable, sometimes-depressed self. The fact is, I never was that ill. And I assure you, folks, I got better.

What are the promises of God to those who suffer because of sickness to their souls?

We read in the Book of Mormon concerning the resurrection of the dead,

The soul shall be restored to the body, and the body to the soul; yea, and every limb and joint shall be restored to its body; yea, even a hair of the head shall not be lost; but all things shall be restored to their proper and perfect frame. (Alma 40:23)

To the depressed, chemically-imbalanced and otherwise diagnosed, this sounds like hell. The fact is, I don’t WANT to be me in the resurrection; I want to be not-me, a happy me, one that doesn’t get moody and doesn’t say things he doesn’t mean and isn’t compulsive and panicky and…

Will Jesus balance the chemicals in our brains? Is this what he did when he cast out the demons from the lad, sending the swine of the Gadarenes over the cliff? Will our depression go away — or will “that same spirit which doth possess your bodies at the time that ye go out of this life… will have power to possess your body in that eternal world?”

I can understand having a testimony of the Resurrection — I have one myself. And I can understand having a testimony in the power of Christ to redeem us — I have one of those, too. But I don’t know what God can do with the crazies, with the people caught in weird destructive cycles, with those hearing voices in their heads, with those who just want it to end — not to go on for eternity.

If we believe in the Atonement, in the powers of forgiveness, and yet we feel miserable and we hurt ourselves or others because of our inability to change our brains, what then? Is our salvation then imperfect? What does the Gospel say about someone who needs not just Christ, but a pill to be happy? Is their faith too weak?

I’ve submitted this to be published anonymously; I don’t want my employers or future job prospects to get details of my medical history, and I don’t want to embarrass my friends or my family. Such is the stigma of this kind of treatment, despite the fact that millions of Americans are or have been on similar treatment, and millions more might benefit from it.

Comments

  1. “What does the Gospel say about someone who needs not just Christ, but a pill to be happy? Is their faith too weak?”

    I don’t think it says any more about their faith than taking insulin says about the faith of a diabetic.

    I think it a great blessing that the Church has moved beyond the “pray and read your scriptures” approach to dealing with chemical imbalances and has embraced psychology and psychiatry. I think, for many people, professional help and, when needed SSRIs (and the like), are God’s way of helping and answering their prayers.

  2. What does the Gospel say about someone who needs not just Christ, but a pill to be happy?

    I think this is incredibly important. In our history, examples of the sick not being healed are quite common. When it is being blind and not receiving sight, it is one thing, but in modern society, where life is pretty good, I think there is a tendency to not extend the same charity to the depressed that never has joy.

    The Church hierarchy is learning and growing as well.

    But to answer the question above, I believe that the resurrection will give us Christ-like bodies. Bodies, which I hope are quite prone to happiness.

  3. Steve Evans says:

    The problem, J., is that someone who is depressed or chemically imbalanced doesn’t distinguish between spirit and brain any more than you or I can do so. They just feel the way they feel. And so even the prospect of a “perfected” body doesn’t necessarily comfort, because for the depressed person the problem is in their soul.

    Fundamentally, under the best of circumstances, we don’t understand mental illness. In the church context, our tools are even more limited.

  4. I think it’s important to remember that who we are in this life is not all of who we are. We existed before being born. We don’t know anything about ourselves from the pre-existence.

    Mental illness runs on both sides of my family. I have two schizophrenic sisters, a crazy uncle, a crazy aunt, etc. My mom’s cousin’s official diagnosis is schizophrenia with psychotic tendencies. (Her letters are always fun to read.)

    One of my sister’s schizophrenia was much worse than the other sister’s—she hallucinated all the time. She tried to kill herself more than once because of her hallucinations. When she died, an autopsy had to be performed to determine if her death was a suicide (it was ruled natural causes, but we don’t know what the exact cause was). She made a lot of bad choices in her life (and not all because of her mental problems), but I have no doubt that when I see her again, she’ll be free of all that.

  5. “for the depressed person the problem is in their soul”

    Is seratonin reuptake a function of the soul?

  6. Ardis Parshall says:

    I just posted on a relevant subject:

    http://www.timesandseasons.org/?p=3828

    Not that my testimony will convince someone who is suffering, but it is relevant.

  7. Answer to first question is yes an emphatic yes.

    The “free part” of the atonement covers this.

    I also believe that Jesus will judge justly which sins the mentally ill person “owns” and which are the result of the mental illness

  8. Steve Evans says:

    Beijing, beats me. It has the capacity to make us happy — genuinely happy. So it clearly has a link and influence on our souls, yes — so much so that I would consider it inseparable from how we conceive of our souls.

  9. Steve Evans says:

    bbell: “I also believe that Jesus will judge justly which sins the mentally ill person “owns” and which are the result of the mental illness”

    bbell, there’s no clear separation to be drawn like that.

  10. My mom has epilepsy and has taken a little pill every day for years so she won’t have seizures. With the pill, she has no problems. Without it, she’d probably be dead by now (at the very least from having a car accident or something while having a grand mal seizure. I’ve always assumed that the problem with her brain will be healed after the resurrection. Someone with anxiety, depression, etc also has a “problem with their brain” that will be healed similarly. Of course, I don’t struggle with a mental illness, so I know it’s hard for me to understand that it’s difficult for someone with a mental illness to separate SELF and DISEASE.

  11. a random John says:

    I blogged about my brush with this sort of thing at Nine Moons.

    Having lost control once I think I have a small glimpse of what it might be like to have this sort of thing happen on an ongoing basis. For me it would be hell on earth.

    I’m glad that the Church is more open to medical treatment for mental problems. I remain concerned that our culture puts so much emphasis on will power that we still harm those that need treatment rather than a lecture.

  12. Ardis Parshall says:

    9, Steve, there may be. I attended the double funeral a few years ago of a cousin who had shot her 9-year-old daughter in the head before taking her own life. One of the speakers was a member of the Presiding Bishopric. His talk was one of the most hopeful, most comforting talks I’ve ever heard, cautioning us not to pass judgment on the mother in our ignorance of her mental state. He stressed that in fact God can and does judge between the actions we are accountable for and actions that may be the result of a diseased mind. He didn’t say that there were NO consequence for her action, only that there was a difference between acts done wilfully, knowingly, and with full control, and those beyond our understanding or control.

  13. Steve,

    One of the compelling notions of the Judgement is that Jesus will be a just judge. Lets not limit his ability to make the type of determinations that Ardis and I have posted about.

    He will be able to tell what sins a mentally ill person is responsible for and which they are not.

  14. a random John says:

    bbell,

    I’d be more comfortable with a statement that Christ will be able to tell to what degree a person is responsible for each of their own actions rather than to make it a binary situation.

  15. Steve Evans says:

    bbell, I guess I believe that our notions of accountability, along with our template of Christ’s judgment are inadequate and antiquated. I do, in fact, believe that Christ’s judgment will be just — but I don’t believe that we should attempt to dissect how that judgment occurs, even so much as to say that God will separate out the acts done “willingly” vs. those caused by mental illness. The human mind doesn’t work that way, and I don’t think that God’s judgment will, either.

    I agree with Ardis’ presiding bishopric member who implored us not to pass judgment based on someone’s mental state, but I don’t think that we (or God) will look at a person’s life and put their actions into neat little “accountable” and “unaccountable” boxes.

  16. Steve Evans,

    but I don’t think that we (or God) will look at a person’s life and put their actions into neat little “accountable” and “unaccountable” boxes.

    I think that already takes place with children dying before the age of accountability.

    As a bishop, I had to deal with the accountability of a young member of our ward with serious mental development issues. I had grave reservations about his advancement into the Aaronic Priesthood, but felt prompted to go ahead, and the SP agreed. Later advances to other offices in the AP followed, as I felt that he had some basic understanding of his duties, and he enjoyed performing them. However, I was not still serving when time to consider his advancement to the MP. His understanding at that level was drastically inadequate, but on the other hand, he had a testimony, and he was instrumental in bringing the gospel to the parents of one of his handicapped schoolmates. I saw in him a separation of his spiritual capacity from his mental capacity, and felt strongly that while limited in accountability, he was not limited in his ability to gain a testimony.

    I believe his limitations will not prevent him from advancing in the next life, and those problems will be removed.

  17. Steve Evans says:

    Kevinf, the notion that accountability magically appears in kids at age eight is one of the biggest common doctrinal errors IMHO. It’s extremely problematic from many perspectives.

  18. Steve,

    I agree that it is not a magic number, but a policy that standardizes the practice for our convenience.

    Accountability develops, as I attempted to point out with my example. But the doctrinal stance that children who die before the age of eight who have not been baptized are “saved” is pretty well established. Certainly, as I have seen with my own children, some are totally accountable at age six (eg, my daughter!), while I have had others (pick one of my sons, any of them) who may not have been fully accountable till much later.

  19. Steve Evans says:

    Kevinf, in the examples you gave — if your accountable six-year-old daughter died without baptism, it would be the fact that baptism was unavailable to her, and not her unaccountable nature, which “saves” her.

    And if your other kids weren’t accountable at age eight, did you baptize them at a later age? Why not?

  20. Ugly Mahana says:

    None of us know what separates spiritual and physical. Perception of what is around us, and indeed what is within us, comes through physical senses. And then that part of what is ourselves gives direction. Some of us are limited in the ability to act. This is obvious in cases of physical limitation. The lame, no matter how they wish to, may not be able to walk. Likewise the blind cannot see just because they want to. Although we can explain these problems scientifically, the problem could also be expressed in terms of the connection between the body and the spirit. The body does not respond to the spirit’s command to walk or see. It seems to me that mental illness may be characterized the same way. We know that substances affect our body- affect how we feel. Can we say that the body is unable to act on or convey properly the emotional intent of our spirits? And if this is the case, then would not that weakness automatically be lost in a glorious, perfect resurrection?

  21. Steve,

    Yes to the first question, and no to the second. Again, I agree that 8 is not a magic number, but one established as standard policy based on the doctrine of developing accountability.

    No argument that age eight is not some sort of hurdle of total accountability. Certainly my sons were accountable in many things by age eight (or earlier), but as to fully accountable? Hard to tell by their actions.

    I only was responding that we act in this one particular way as if there were an actual divide.

  22. If the physical process of seratonin reuptake is inseparable from how we conceive our souls, then why do you make a soul-body distinction in #3 that would leave a depressed person uncomforted by the resurrection’s promise of physical renewal?

  23. Steve Evans says:

    Beijing, I guess I simply don’t know. I don’t think that spirit/body/brain are all as separable as our “hand-in-glove” analogies tend to suggest. Perhaps our spirits are more affected by our bodies than we think, and vice versa? You tell me.

  24. Can the crazy be saved?

    My Mormon upbringing, steeped in the theology of Joseph Smith, concludes that everyone is saved (pretty much all go to heaven, there is no hell, unless you want to squeeze outerdarkness into the shape of hell).

    So, it would be no different for someone with a mental condition, be it that of normalcy, obsession with hierarchy, etc.

  25. There was a woman in the small branch that I grew up in who had been institutionalized from a very young age. She was about as crazy as crazy gets. We had suicide attempts during church meetings, barely lucid testimonies, age regression incidents during YM/YW. It continued for decades, until she passed away.

    She passed through several facilities during those years and each time it wasn’t long before the staff knew the members of our branch. One brother, serving as a home teacher, was even called to diffuse (successfully) a suicide attempt at the residential center.

    Her family and mental health care workers almost universally accepted that she was in much better shape when she was able to attend and participate in Church. Apparently the amount of medication she was taking was actually a function of her activity.

    Is her glorified state “crazy?” I doubt it, and by extension doubt anyone else’s degree of crazy is either.

  26. Mondo Cool says:

    I have worked in the behavioral health field for many years and have pondered this question many times. From my observances, those who seem to do the “best” are those who strive to follow what they hold to be good and true without using their “disability” as an excuse for their behavior. This goes from those with a single depressive episode to those who were prone to acute schizophrenic episodes. Those with “poor” value systems or those who do not honor their value systems are generally “sicker.” This, really is no different than the rest of us. As my mother has said, “Just because they have attention deficit doesn’t mean they have to be mean and rude.”

    Like so many others, those with mental health concerns often must rely on others – unsuprisingly, not like the rest of us. Instead of a wheelchair, or a seeing eye dog, or whatever, they need a valued and trusted support system to give tham a check and balance on their perceptions. And, they frequently need medication. But, because, like the rest of us, they want to “be like everyone else,” they may be reluctant to utilize both.

    Salvation, per se, is not the question (#24 above). For all of us, our heavenly reward depends upon our being valiant to what we know to be true and correct. Because I believe God is just, He will take our deficiencies into account in the Final Judgment. I’ll let Him be the Judge. My main concern is what I do “unto the least of these.”

    (I freely acknowledge I have generalized my terms.)

  27. “…but all things shall be restored to their proper and perfect frame.” (Alma 40:23)

    A perfect body and soul combined, will not be subject to death or disease of any kind, including but not limited to, depression or other mental/emotional disorders. Is HF sad when his children harm others and/or not keep his commandments? Yes. But this is not depression.

    We will be resurrected with guilt if need be, but there will eventually be a very clear line, provided by God, as to what was our fault, and what was a product of genetic ailments. (IMO)

  28. MikeInWeho says:

    I run a psychiatric program at a major medical center in California. About ten percent of my patients right now are LDS. The ones who are active in the Church seem to do a little better. They get well faster. While I can’t imagine that Mormons are any more or less susceptible to serious mental illness than anyone else, I get the sense that the structure and support of the Church can help a lot. It sure helps to be in a culture that stands against alcohol and drug use. I always encourage my LDS patients to get back into Church activity if they express any desire to do that. The right HT/VT can be life-changing.

    While the severely depressed may feel “soul sick,” I just don’t buy it. Christians used to believe epileptics were demon possessed too, now we know much better. The analogy to diabetes and hypertension is apt. These are real, chronic medical conditions.

    Evidenced-based psychiatry is advancing rapidly. The advances I’ve seen in the past 15 years are remarkable, especially in the area of treating people with psychotic disorders like schizophrenia.

    re: 9 I agree with Steve, Bbell. It’s rather clear that the seriously mentally ill have partial control over their actions much of the time. How can their behavior be parsed morally? Does the Lord sort all their sins into one of two columns, Culpable and Not-Culpable? Does a sin go into the second column if He decides it’s greater than 50% due to psychosis?

    It would interesting for someone to do a BCC post about personality disorders. THAT’s the area where tricky moral questions come to the fore.

  29. Personally, I don’t think these questions are tricky, at all. I’m sure that’s because my mother is one of the most Christ-like individuals I have ever known – when she is on her medication. When her “sleeping pill” no longer works, she is a monster. (schizophrenia) I think my father (her spouse of nearly 50 years and her supporter through 2 breakdowns) understands the Atonement and judgment better I do. Heaven won’t be heavenly unless my mother is the woman who was such an inspiration to her children as they grew – not the ogre we only saw years later.

    (As an aside, I believe there is a special spot in our Father’s heart for those like my father, who sacrificed his earthly ambitions and became both parents to his 8 children simply so his soulmate could avoid all stress and “be herself”.)

  30. #28,

    Its clear to me also that the mentally ill have quite a bit of control over their actions. There are plenty of mentally ill people who do not go about committing serious crimes or other serious offenses

    I simply believe that they will be judged with mercy with an eye towards their mental condition when sins occur. Its hard for us to understand how exactly the judgement process will work but I have confidence that it will be just.

    Here are some GA talks on the topic. The Ballard talk touches a bit on the idea that I have been espousing.

    http://lds.org/portal/site/LDSOrg/menuitem.b12f9d18fae655bb69095bd3e44916a0/?vgnextoid=2354fccf2b7db010VgnVCM1000004d82620aRCRD&locale=0&sourceId=6efa71ec9b17b010VgnVCM1000004d82620a____&hideNav=1

    http://lds.org/portal/site/LDSOrg/menuitem.b12f9d18fae655bb69095bd3e44916a0/?vgnextoid=2354fccf2b7db010VgnVCM1000004d82620aRCRD&locale=0&sourceId=a9e72ee01e31c010VgnVCM1000004d82620a____&hideNav=1

  31. Steve Evans says:

    bbell: “I simply believe that they will be judged with mercy with an eye towards their mental condition when sins occur. Its hard for us to understand how exactly the judgement process will work but I have confidence that it will be just.”

    But bbell, that’s not what you said before, esp. in your #7 — it’s a watered-down version at most. Which of your comments best reflects your real thoughts on the topic?

    I’m mostly just trying to give you a hard time on this one, bbell. I think that when it comes to describing an experience not your own, it behooves you to start with the most generous language possible.

  32. Senator Gordon Smith of Oregon, whose son Garrett committed suicide, describes a phone call he received from President GBH in his book “Remembering Garrett”. Unfortunately, I do not have the book in front of me to quote directly, but the conversation affirms that Garrett is no longer afflicted with the burden of mental illness. The book is definitely worth reading if you can find it.

  33. Kevin Barney says:

    My little brother (age 29) is autistic. When he was a boy he would go to church and everything was pretty much fine, or as fine as things could be under the circumstances. But he drank Diet Coke all the time. Some genius at church (this happened in Utah) told him that he couldn’t be a good Mormon and drink Diet Coke.

    From the very moment those words hit his synapses to this very day, two decades later, he has absolutely hated the Church, does not consider himself Mormon and has cut all ties with the Church.

  34. I’m pretty open about my (and my family’s) issues with mental illness and I’ve found that often when we rehearse these questions of whether or not and how real salvation is offered to the mentally ill it means we either want confirmation as to how bad or unbelieving we are or because we desperately want someone to tell us that what we secretly believe about ourselves as the most difficult to be saved is not really true. The issue is then getting over the self-hatred rather than the “medicated” salvation.
    My dad would not stay on Lithium for bipolar because he believed he could completely control through will-power his moods. He was wrong and I’m still dealing with the aftermath. (seriously, will I ever stop blogging about it?) I don’t think meds are the answer for everyone, but if you’re dealing with depression, panics, psychosis whatever it seems dumb to not try them.

  35. I HT a schizophrenic man — he tells people that he hears voices when he meets them. He was excommunicated from the church eight years ago. He’s never told me specifically why — and I certainly haven’t asked — but he has indicated that, at least in his own mind, it was because he chose to stop taking his meds. He got rebaptized and really wants to come to church, but the medication he takes keep him from really connecting from people, and he struggles to express abstract thoughts in discussions. But one thing he said once in a more lucid moment was that he thought the medication kept him from being able to make clearly moral decisions, the main one being whether or not to listen to the voices. It occurs to me now that the intersection between his concept of works-based morality and his schizophrenia is potentially disasterous.

  36. It would interesting for someone to do a BCC post about personality disorders.

    Are you offering, Mike? I’d be happy to see that.

  37. MikeInWeHo says:

    Sure, Ronan. I’d be honored to do a guest post at BCC. Don’t know how to contact anyone there. Track me down (I know you guys have the mysterious power….) if you want.

  38. ronan at jhu dot edu. Bring on the personality disorders, man.

  39. One of the great difficulties of being depressed is trying to understand what is you and what is the depression. It all feels like you, so personality in pill form (ssri’s and the like), feels like you are destroying/altering a portion of your identity. It’s fake (at least it feels that way). It’s not the “real” you.

    Apparently to be complete we need soul and body, but the addictions and thinking patterns in life seem to follow us in death (see scriptures quoted already).

    My own perspective is that we’ll die and have the same personal demons right after death that we had right before death. Slowly we’ll “progress” to the point where the demons are excised (and we’ll suffer for the sins for which we haven’t repented) and one day we’ll be whole, free from mental illness.

  40. One of the most comforting statements I ever heard was in a general conference talk by (of all people) Boyd K. Packer:

    While your temptations are greater than were ours, that will be considered in the judgments of the Lord. He said that “his mercies [are suited] according to the conditions of … men.” (D&C 46:15.) That is only just.

    (“To Young Women and Men”, Ensign, May 1989)
    http://library.lds.org/nxt/gateway.dll/Magazines/Ensign/1989.htm/ensign%20may%201989.htm/to%20young%20women%20and%20men%20.htm?fn=document-frameset.htm$f=templates$3.0
    I believe this applies to mental illness as well, based on what I have read by Elders Ballard and Morrison, among others. If my sweet autistic daughter (who I expect will always be “as a little child”) isn’t saved, then I don’t know who will be.

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