Brainsick

How Physiology and Theology Teach Us Compassion for the Mentally Ill

This essay is dedicated to those who must journey through what Elder Holland once called the “battered landscape of the soul,” and to those who, though not suffering from mental illness themselves, journey alongside those who do.

As a cancer doctor, I frequently face the weighty prospect of shepherding people toward death. When one of my patients faces a terminal diagnosis, sympathy and commiseration come intuitively from loved ones and friends. When, finally, the patient gives up the ghost, a resigned peace often settles over those left behind.

I wish we could treat those who suffer from mental illness in general, and those who die by suicide specifically, like we treat those who have cancer. My hope is that this essay will help those who suffer from mental illness—and those who love the sufferers—to see mental illness as a tragedy of malignant physiology, not an immoral or cowardly act. I believe our theology can lead us to precisely this approach. To see why, let us begin by thinking about what a body is, what a body does, and what role the brain plays in all of this.

Doctors first learn to understand the body mechanistically. Our understanding of the functioning of the heart provides a quintessential example. At base, the heart pumps blood through two parallel circuits: one to the lungs to pick up oxygen, and one to the body to distribute it. As with anything else in human physiology, there are a thousand ways this can all go wrong. When the pump of the heart slows: fluid can swell the legs and buttocks; blood can seep into the lungs, making breathing labored; and, in severe cases, the entire body can fail within just a few minutes—a testament to the heart’s irreplaceable and central physiologic function.

All of these problems fall under the umbrella of what doctors call “heart failure.” This paradigm—recognizing the effects of a “failing” organ—can extend, too, to other organs; kidneys, livers, and even the intestines can “fail.” Never once during all my years as a doctor, however, have I heard any medical professional, in any setting, for any reason, refer to a patient as having a “failing” brain.

I think the roots of our failure to talk of “brain failure” come from a particular philosophy of the body that predominates in broader Western culture but that has also seeped into LDS culture and even into our popular theology. This is because the brain—alone among the organs—has a deep philosophical, even theological, valence. How we think about our brains has a great deal to say about our understanding of who we are, who God is, what the universe is like, and how we relate to the world around us.

At least conceptually, after all, the brain seems to be the body’s seat for consciousness, agency, and will. By contrast, no one supposes that anything happening inside the kidneys involves an act of conscious will—we do not tell those whose kidneys are failing to “try harder.” But any time anything goes amiss with the brain, we remain haunted by the prospect that that malfunction might be traced to inadequate will or even misshapen character, rather than a problem with that lump of tissue that the bony skull so carefully cradles.

Please don’t misunderstand—I am not suggesting we abandon ourselves to brute biological determinism. Our view of the brain can fall anywhere along a spectrum—from a belief that we mentally determine every aspect of our emotional and mental functioning to a system where we believe will and agency do not exist at all, but constitute only a mirage. Clearly, our theology stipulates that we posit some role for will and consciousness in the functioning of the brain. But that’s just the thing: I fear that our desire to safeguard a robust conception of agency blinds us to a theology that is both physiologically accurate and more compassionate toward those who suffer.

For these reasons, I believe it matters deeply—for our conception of ourselves, of God, and of our own agency and even eternal destiny—that we recognize this: the brain is an organ. And, as such, it can fail just as surely as a heart or a liver or a kidney can. I see this fact in patients whose liver or kidneys fail. I see it in patients with severe infection. I see it as a consequence of cancer. And I even saw it once in a patient I cared for in the hospital who lost her glasses and her hearing aids. Within 24 hours (no one knew they were gone), she became wildly delirious and had to be sedated. When her husband returned two days later and gave her back her “eyes” and “ears,” her mental status normalized within thirty minutes. This may seem a strange example but I use it for this reason: in this patient’s case, there was no issue with the rest of her body—no infection, no worsening of her cancer, no hormonal imbalance—the only thing wrong was that her brain had been deprived of its customary ability to accept and interpret sensory data. This startling medical scenario allows us to recognize just how fragile a thing the brain can be—and how easily, for any of a thousand reasons, it can cease to function well.

When we arrive at this recognition, and we encounter a loved one who is depressed, or manic, or otherwise suffering from the ravages of mental illness, we can picture a brain that is simply malfunctioning, like a heart that can no longer pump, or a liver that can no longer filter. In the same way we would never suggest to a patient with heart failure that they just “try harder” or “breathe better,” can I suggest that we consider treating those whose brains are betraying them with an ever-greater outpouring of help, compassion, aid, and love—but without a trace of pity, condescension, or shame?

After all, speaking of mental illness, President Reyna Aburto wrote:

“Black clouds may also form in our lives, which can blind us to God’s light and even cause us to question if that light exists for us anymore. Some of those clouds are of depression, anxiety, and other forms of mental and emotional affliction. They can distort the way we perceive ourselves, others, and even God. They affect women and men of all ages in all corners of the world.”

And speaking even more specifically of those who die precisely because that organ—the brain—has betrayed them, Elder Renlund said:

“There is an old sectarian notion that suicide is a sin and that someone who commits suicide is banished to hell forever. That is totally false. I believe the vast majority of cases will find that these individuals have lived heroic lives, and that suicide will not be a defining characteristic of their eternities. I believe Heavenly Father is pleased when we reach out and help his children.”

Taken together, these words from our church leaders remind us that while we mortals can never fully sort out just what part of our mental faculties can be attributed to the neuronal firing of a physical organ versus the metaphysical problems of will gone awry, we do not need to sort it out because we are not called to judge—only to love. In this of all matters, won’t it be better for us to simply offer those who suffer the benefit of the doubt? To assume that they battle against the demon of physical affliction just as surely as a loved one succumbing to cancer?

I was reminded of the importance of coming to this understanding when reading the memoir of a man who, with no warning, was diagnosed in early adulthood with bipolar depression after a series of devastating episodes that upended his own life and those of his family members:

“Like the lepers of old, the mentally ill are assumed to be worthless to society and, in most ways, carry a net negative in their personal balance sheet . . .

So what do you do with the lepers of today, the bipolar? How do you think about them? Do you participate in gossip about them? Do you make judgments about their behavior? How much do you know about them really? Do you find ways to include them? Do you understand when they do not want to be included? Do you probe into personal areas that are none of your business? Are you part of their support structure or part of the problem yourself? How do you react to the lepers of today–the mentally ill?”

Part of what makes these tragic words so lamentable is that the restored gospel offers us a deep, nourishing, and succoring theological well from which to draw—a well overflowing with life-giving waters.

For example, Lehi teaches his son Jacob that there must “needs be” an “opposition in all things” (2 Ne. 2:11) in order for the universe to have meaning and if redemption is to come to humankind. I do not pretend to know every facet of what these phrases mean. But for the purposes of this discussion, I understand them to mean this: Just as cancer is woven into the very biologic processes that allow a human to grow into a human, the seeds of mental illness lie dormant in what allows us to have functioning brains—and even transcendent consciousness—in the first place. Brains that function beautifully in most circumstances can malfunction tragically, chaotically, and inexplicably in other settings. In other words, we need not invoke misused agency to explain a brain gone awry—that is simply the way brains work (and sometimes do not) in a universe necessarily defined by opposition.

But beyond such existential questions, what the gospel tells us most convincingly and resoundingly is that our Heavenly Parents have attuned themselves to the mournful frequencies of mortality and match our tears with their own. But beyond this, the effect of living in the light of the divine presence is to attune our hearts to those same frequencies—especially to the ones we need so we can better understand those we love. After all, when Enoch sees God weeping, the miracle is not solely that Enoch experiences the epiphany of seeing the truth of God’s vulnerable heart; no, the real renaissance comes because in being privy to God’s vulnerability, Enoch himself also becomes that vulnerable:

And it came to pass that the Lord spake unto Enoch, and told Enoch all the doings of the children of men; wherefore Enoch knew, and looked upon their wickedness, and their misery, and wept and stretched forth his arms, and his heart swelled wide as eternity; and his bowels yearned; and all eternity shook (Moses 7:41).

When we come to understand the brain as an organ, and mental illness as a “failure” of physiology—but not of character or morality—then we can move past the ingrained temptation to condemn those who suffer and die from mental illness. We can, with Enoch, allow our own hearts to “swell wide as eternity.” In this peculiar case, a better understanding of physiology turns out to catalyze a deeper degree of Christian empathy.

This essay is an excerpt from a longer version published at “On the Road to Jericho" where Tyler Johnson and guests publish regularly on matters of discipleship and faith. To receive the column in your inbox, first subscribe to Wayfare, then under “manage subscription” select “On the Road to Jericho.”

Tyler Johnson is an Associate Editor at Wayfare and Stanford medical oncologist. He podcasts at The Doctor’s Art.

Art by Daniel Ridgway Knight.