Recently, there was a post on By Common Consent which explored the potential mental illnesses George Albert Smith. My thesis chair penned a response to the post, drawing on some of his experience in psychology. He has consented to having his response posted here. Be aware: this is not a polished essay. Dr. Gantt is, so to speak, “shooting from the hip,” and as such, his arguments have not been revised, poured over, etc. Truthfully, this reads much more like a transcript of one of his classroom lectures (where he simply speaks his mind) than any of his published works. Without further ado, I turn the time over to Ed Gantt:
Recently, a dear friend of mine posted a link here on facebook to a blog post by Jonathan Stapley at By Common Consent, a popular Mormon blog. The brief post was on Mental Illness and the life and struggles of President George Albert Smith. Before reading further, it would be a good idea for you to check out the post. It’s pretty short and so won’t take much of your time.
Well, perhaps needless to say, at least to those who know me, I was much less than impressed by Shapley’s post, finding it misleading (though perhaps not intentionally so) in a number of ways. I was originally just going to let the whole thing pass. As a professor of psychology, I encounter things like this constantly and so long ago learned that I can’t respond to everything that is misleading and annoys me, I just don’t have the time or energy. I also wasn’t terribly keen on taking a controversial stand on a topic of deep significance and which hits close to home for a dear friend for fear of maybe giving some offense. However, when some other friends asked me what I thought about the post, and when I noted the overall adulatory response to the post in the comments section of the blog, I decided I had to put some thoughts down and at least be on record as quite strenuously objecting to the claims Stapley makes.
Please note that what follows is by no means an exhaustive analysis – there are a number of additional issues that could or should be treated but which I opted to skip. Neither is this as scholarly as it probably should be – I could make it so, but at the cost of increasing its inaccessibility to the general reader and at the cost of considerable time that I do not currently have.
There are, as I see it, a couple of key problems in the post that need to be addressed.
First, on fairly flimsy evidence, the author (Jonathan Stapley) is reading back into President Smith’s life a disorder whose diagnostic criteria is often so expansive and vague (purposely so – but that’s a different cynical point I won’t make here) that it is easy to see it wherever anyone wants to see it. This sort of thing is somewhat akin to those homosexual activists who wish to claim that Abraham Lincoln was gay because he occasionally shared a bed with other men (something that was, by the way, common in his time) and because he didn’t always get along swimmingly with his wife. If you want homosexuality to be pervasive, then you can find it everywhere you happen to look – no matter how unjustified the inferences.Same goes for mental illnesses.
Anyway, what the article that Shapley references actually shows – though almost no one will actually read it because they will just take the Shapley’s interpretation at face value – is that George Albert Smith was never a physically robust individual, very sickly, and had many medical problems of a persistent, frustrating, and exhausting nature. However, he was also a very energetic and active man who took his apostolic and family and communities duties very seriously and frequently overworked himself – thus exacerbating his physical maladies.His wife, too, suffered from numerous physical problems and was in need of much assistance with the family, something that her husband could seldom provide due to his extensive travels and other duties. This was , unsurprisingly, something about which he often felt troubled because of his inability to provide the kind of supporting presence he felt was needed and for which he was responsible. Further, the author of the Journal of Mormon History (Mary Jane Woodger) notes that George Albert was “Well known for his sensitivity and compassion, he too-easily took on other’s burdens. At one point he confided to a stake president, ‘Even when things are normal my nerves are not very strong and when I see other people in sorrow or depressed I am easily affected.’”
So, what we have is a man who is overworked, possessing a deep sense of obligation but not sufficient time or physical health to fulfill his obligations as well as he feels he should, who is also possessed of a deeply compassionate nature and, thus, acutely feels the pains and sorrows of others. That his energy would flag at times, perhaps even for long stretches, that he would often be saddened, pensive, frustrated, and emotionally exhausted is no surprise. However, to hastily diagnose the man as a depressive with a mental illness is to make a serious leap that quite probably misunderstands both the man and the disorder. If George Albert Smith was suffering from the mental illness of depression, then so was Jesus Christ and many other great and compassionate people. Just because one happens to be a poor wayfaring man of grief does not mean that one is a depressive.
In the end, it is much too much of a stretch backward in psycho-historical diagnostics to ascribe Elder Smith’s problems to “clinical depression.” Just because his case may look like modern clinical depression from 30,000 feet (so to speak) and from a century after the fact, does not mean that it was the same thing at all. Indeed, the journal article itself notes: “Of course, diagnosis becomes increasingly murky and uncertain, the further back in time one goes” (p. 127).
Interestingly, the author of the Journal article on President Smith’s “breakdown” spends most of the article citing contemporary physicians opinions on the apostle’s physical ailments. This is very tricky business and must be undertaken with considerable care and plenty of caveats. When Woodger does discuss the mental dimensions of the apostle’s case, she cites first an emergency room physician (Dr. Kirk Gilmore) for the diagnosis of depression. However, even more interestingly, Woodger states that while the physician cited felt certain that George Albert experienced depression, “he leans toward seeing it as ‘secondary depression’ caused by his lengthy ‘chronic illness’ and complicated by his ‘frail constitution’ and oversensitivity to diet” (p. 128). Further, she writes that Dr. Gilmore “discounts ‘emotional or mental illness’ because George Albert ‘was not irrational, hallucinatory, nor delusional” (p. 128). Yes, you read that right! The author who Stapley cites in his blog post as providing evidence that George Albert Smith suffered from depression in fact argues exactly the opposite.
A few pages later in the article, Woodger notes the appraisal of clinical psychologist Ford McBride, who suggests that “George Albert may have experienced a panic attack or a major depression” (p. 130). That’s a pretty big “may have” – but not a surprising one to get from a clinical psychologist when said psychologist has been asked to suggest a possible diagnosis of a person who lived a century ago and about whose particular case we have relatively limited information. Furthermore, Dr. McBride’s explanation of George Albert anxieties in terms of the causal presence of a “double-bind” situation (i.e., the harder he worked, the sicker he got, but the more he rested, the less work he got done and then the guiltier he felt about not getting work done) is really pseudoscientific and circular. In short, the double-bind explanation holds that our anxieties increase when we find ourselves in anxiety increasing situations. How, one might ask, might it be known that a person is in an anxiety increasing situation of the double-bind sort? Well, if that person’s anxiety is increasing would be the answer. See the circularity?
So, after reading Woolger’s article carefully, as well as having already studied George Albert Smith’s life and trials in some depth, I would say that what we are really looking at here is a person who was saddened and frustrated by his all-too-often inability, brought on by physical frailty and persistent illnesses, to perform the duties and responsibilities he felt he must perform. Coupled with a deep sensitivity to the needs and sufferings of others, this often left him feeling sad, inadequate, and worrisome. Such is not, however, depression as understood in psychiatric or psychological circles today. Rather than being evidence of pathology of any sort, it is wonderful evidence of normality, spiritual sensitivity, and basic goodness. It is a good thing when we do not medicate people for such things. I fear the day when compassion is reduced to pathology.
Now, onto my second, more philosophical concern with the post: The author’s much too confident assertion that “we live at a time when we can all safely view mental illness as a biological problem, like cancer, that needs to be treated.” Though offered as a statement of fact, such a claim is not, in fact, a fact, but in reality a highly controversial assertion for which there is only good evidence if you first assume to be true the very thing you are asserting to be true. That is, only if you first assume (as many in contemporary psychology and medicine do) that psychological events are really only biological in nature are you then certain that mental illnesses are primarily biological problems. The circularity of the reasoning should be obvious. That, however, is not the most serious problem here. The most serious problem is the notion that biology accounts for psychology. When one assumes that abnormal psychological events or states are in reality just the products or manifestations of biological events or states, one must then also equally assume that normal psychological events or states are in reality the products or manifestations of biological events or states. And, thus, in quite short order you have dismissed the reality of human agency, morality, and meaning. After all, if one is not responsible in any meaningful way for one’s depressive thoughts and feelings because they are the result of non-rational biological causes that are mechanical and deterministic in nature, and over which one can exert no control, then one is also not responsible in any meaningful way for one’s non-depressive thoughts and feelings because they too must be the result of non-rational biological causes that are mechanical and deterministic in nature, and over which one can exert no control. So, for example, if I feel that everyone I love really hates me and is disgusted by me, and those feelings and thoughts are really just the product of underlying brain states or some dysfunction in neurochemistry, then feeling that everyone I love also really loves me is likewise really just the product of underlying brain states or some dysfunction in neurochemistry. And, if that is the case (in both instances), then neither of those sorts of thoughts or feelings really reflects how things really are – they simply reflect something my brain happens to be doing, as series of thoughts and feelings it happens to be creating for me.
So, then, one might well ask: what status does my emotional, social, psychological life really have? Answer: Illusion. Nothing we feel or think is real or truly reflective of real relationships, meanings, or our active participatory involvement in the world. Rather, all our percpetions of such things are merely the byproduct of the underlying operations of the meat and chemicals that somehow are sufficiently complex and powerful to produce them in me. If my thought that God must hate me is really just a depressive symptom brought on by some neurotransmitters actions or absences in the limbic system of my brain, then the thought that God loves me and has answered my prayers is also just a non-depressive symptom brought on by some neurotransmitters actions or absences in the limbic system of my brain. Does God really love me or really hate me? Who knows? It doesn’t really matter anyway because your thoughts and feelings – whatever God’s thoughts and feelings might be – is simply determined for you by your underlying biological condition.
I was interested to see that the journal article makes mention of George Albert Smith’s famous dream in which he met his long-deceased grandfather, who asked him: “I would like to know what you have done with my name.” As most LDS acquainted with the story know, George Albert responded: “I have never done anything with your name of which you need to be ashamed.” Now, in the article, Woodger – as a presumably faithful Latter-day Saint – takes this dream at face value and does not in any way seek to explain it in terms of biology or psychopathology. However, the dream occurred to George Albert in 1909, in the midst of one of his “repeated sinking spells” (p. 140). Contemporary medical and psychological explanations would likely assert that the dream was either (1) nonsense generated by the random firing of synapses during sleep or (2) symptomatic of the man’s depression (because of his pathological obsession with being thought to be a good man, dutiful, responsible, and worthy). In the end, however, it doesn’t really matter which explanation is offered here, both of them reduce the dream, its contents, and revelational reality to nothingness, the meaningless byproducts of underlying brain functions. Elder Smith met no one, saw nothing, received no revelation whatsoever, on this model. Rather, he simply interpreted a bit of brain-dreaming that was either simply the product of normal brain functioning during the course of sleeping or the byproduct of a biologically based and induced depressive condition.
While the journal author does not – and presumably Shapley wouldn’t either – interpret the dream in either of these ways, not doing so simply reflects intellectual inconsistency and arbitrariness. If the brain is the source of our thoughts and feelings and dreams and disorders – then this powerful dream by Elder Smith is in fact meaningless. I am reminded of Ebenezer Scrooge’s initial response to the visitation of his former business partners Jacob and Robert Marley. Scrooge refuses at first to believe his eyes when the two ghosts appear, taking them to be hallucinations or a nightmare, explaining them by suggesting:”You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of underdone potato. There’s more of gravy than of grave about you, whatever you are!” If the biological story of our psychology is, in fact, the way things are – as Stapley suggest, then George Albert Smith’s night time vision of his beloved grandfather had “more of gravy than of grave” about it. You simply can’t have it both ways. Either our biology is the source of our thoughts and feelings, dreams and disorders OR such things are better accounted for in some other way. You can’t with any logical consistency claim that our brains ONLY cause our disturbed thoughts and feelings and that something else is the source of all the thoughts and feelings we find acceptable. After all, how in the world would a brain know how to tell the difference and decide which is which, what is normal and socially acceptable and what is pathological?
Of course, this should not be taken to mean that brains and brain functioning, especially dysfunctioning, plays no role or has no consequences for our psychological and emotional life. Brains that are not functioning well, or which are damaged in some way, do in fact contribute to our experiences of ourselves and others. Brains, however, rather than being the causes of our thoughts and feelings, are better thought of as providing context and constraint on such things. That is, if my brain is not functioning properly, there are going to be constraints on my capacities and consequences for my experiences. A consequence or a constraint is not, however, the same thing as a cause. Indeed, it is exactly the opposite.For example, if my knees are broken, I cannot play ice hockey – or, at least, I cannot play it at all well. Knees are a necessary condition for the playing of ice hockey and a consequence of having damaged knees is an inability to do something I otherwise would be able to do (i.e., play hockey).
Brains are much the same in this regard. If my serotonin activity is very low, or I lack required levels of hormone production in my central and peripheral nervous systems, then I am going to have a very hard time being ecstatically joyous or energetic, or even just “feeling” normal. I just won’t have the basic energy to do or experience such things. That does not, however, mean that my lethargy and my feelings of being “down in the dumps” are caused by my serotonin levels. Rather, my serotonin levels and lack of proper hormone production leads to a general physical malaise that I am likely to interpret or understand as sadness or fatigue. And, if such things go on long enough, I might well start to understand my situation in terms of depression. I might even get so tired of feeling the way I do that I begin contemplating suicide. However, at no point did my brain or my hormones or my neurotransmitters cause me to think or feel any particular thought or feeling. It was, rather, my own active, agentic participation in my own experiences brought about my suicidal thinking and depressive misery.
Now, this does not mean, of course, that my interpretation was constructed out of “whole cloth” or is “merely subjective” nonsense that I am just making up. My interpretation of myself, my experiences, and relationships is very real and very much occurring in the context of my (perhaps dysfunctional) embodiment. Nonetheless, be that as it may, at no point is it logically justified to claim that my brain is the cause of my thoughts and feelings.It is, however, quite justifiable to say that as an embodied moral agent I am actively taking up and making sense of my experience –experience that has a profound and very real biological context.
At this point, I think it is absolutely central to state as emphatically as possible that in objecting to a biologically reductive and deterministic account of psychological events or states, such as depression, I am not in any way suggesting that the brain does not matter or is not involved in such things. It most certainly does and most certainly is. (I apologize if I am being slightly redundant here, but I am so often unnecessarily misunderstood that I want to be very clear – even at the cost of being somewhat repetitive.) My concern is that Stapley’s blog post parrots the overconfident assumptions of contemporary medicine, psychology, and scientific naturalism by suggesting that biological explanations of psychological phenomena, such as depression, are sufficient in nature – that is, that one only needs to appeal to biology to offer a complete explanation of mental illness, and nothing else really matters. This, however, is seriously flawed – though commonplace – reasoning. I would argue that biology matters to our psychological, social, and relational lives, but not exclusively. That is, biology is a necessary condition for psychological life – both normal and abnormal – but it is not sufficient to explain that life.
A quick example to illustrate my point: The human eye is absolutely necessary for vision.Without the eye, one simply cannot see anything at all. This does not mean, however, that the eye is the cause or source of vision. Eyes do not make us see things, but they are nonetheless absolutely required for us to see anything at all. Just because you have well-functioning eyes does not mean that you will be able to see something – you could for example have blindness originating in a dysfunction optic nerve. But, if you are able to see something, then you must have well-functioning eyes to do so. Similarly, then, one’s brain does not cause one feel suicidal or worthless (or, for that matter, ecstatically happy at the return of loved one who has been long absent). Nonetheless, one must of necessity have a functioning brain in order to feel suicidal or worthless, or to feel anything at all. Brains matter in deep and profound ways, they just don’t matter in the way that much of contemporary science, culture, and psychology think they do (i.e., as primary causal agents).
A further point that needs also to be emphatically stated here so as to avoid another common misunderstanding: Arguing for the central and inescapable role that moral agency plays in all human existence, in cases of so called “mental illnesses” and otherwise, is not the same as asserting that severe depression is just a matter of conscious, deliberative choice – as though one could cease feeling suicidal by consciously turning on the “happy switch.” To say that one has actively and participatorily engaged in the construction of one’s own depressive life and experiences is not to say that one was simply walking down the street one day and, after carefully weighing of the costs and benefits in a rational manner, opted to feel miserable. Likewise, it is seldom the case that one simply opts for happiness and “June and Beaver Cleaver” normality in one moment of free, rational choosing amongst alternatives. The story is obviously much more complex and multifaceted than that.
Nonetheless, agency and responsibility, as well as meaning and morality, play a key role in our active, agentic interpretations of our world, ourselves, our bodies, and our relationships. Further, our capacities as moral agents are not divorced from or in competition with our physicality and embodiment. Rather, to be a moral agent is to be an embodied being – and bodies have consequences. To say that (1) human beings are fundamentally moral agents capable of choosing, as well as actively participating in and constituting their worlds of meanings and experiences AND that (2) the brain is not the cause of our agency, our thoughts, our feelings, or our psychopathologies IS NOT to say that the body is irrelevant to our agency or that our ability to rationally deliberate and choose always reigns supremely over the conditions of our embodiment. Moral agency, intricately interwoven with embodiment, culture, and history, is clearly a matter of much more than simply the cognitive capacity to choose from a list of lifestyle alternatives abstractly presented to our intellect as though a series of items on a Chinese menu.
Given the above two qualifications, it is time for one final qualification: Criticizing biological accounts of mental illness and arguing that an understanding of human agency is vital to any viable understanding of human nature, normality, and/or psychopathology, does not mean that I think persons who are being severely (or even marginally) depressed are in any way “faking it” or aren’t really undergoing painful and powerful emotional, psychological, physical, and relational experiences. It is perfectly permissible to accept people’s actual experiences without adopting whatever indefensible explanation of those experiences happens to be currently passing for scientific truth. The theories we tend to generate in medicine and psychology, especially when informed by a naturalistic worldview, are highly objectionable, often patently false and misleading. Those who suffer, however, are our brothers and sisters and deserve our respect and most compassionate understanding. Of course, they only deserve that respect and compassion because they are so much more than their brains, they are eternal beings who are literally the offspring of a Heavenly Father who has imbued each of them with moral agency and given them a world of moral meaning, relational depth, and spiritual purpose in which to realize themselves as his offspring. I have no doubt that President George Albert Smith would have wholeheartedly agreed with this sentiment. I am not at all convinced he would have agree with the naturalistic assumptions and explanations of human life and suffering that have so taken hold of our science and our culture in these latter days.
There is much more that could and should be said about the issues I’ve raised here – e.g., the role of medication in the treatment of “mental illness,” the problematic nature of using the medical metaphor of “illness” to addressing the social, moral, emotional and spiritual problems of life, etc. – but that will need to wait for another time.
—Edwin E. Gantt, PhD