It’s usually as you’re going into a severe mental illness that involves loss of logic, and after you’ve started coming out of one with treatment (such as psychosis), that a person will have the understanding and the cognition to ask this question. This is the question you can’t really ask when you’re in the midst of it, because to be severe enough to feel the need to ask the question – to really think your personhood might be gone – you will be so severely compromised you won’t be able to think logically enough to ask the question. It’s a question that comes up when someone is in the mid-stages of dementia and they know what kinds of symptoms they will encounter in the future. Psychotic symptoms are not as well known, and it’s more common for someone to slip into psychosis and not know what’s happening, and then lose awareness and insight, so this is why fewer people with psychosis ask this question in the beginning stages of the illness than those with dementia.
It’s also a question those in the mental health field or family members of the mentally ill may ask. The person they once knew can really seem to be fragmented, or nearly gone completely, and they may ask how God views that person in an ontological sense in such a condition.
Human beings have a lot of opinions and philosophies about personhood. But what does the Bible teach about what personhood is, and whether it can be lost, and if so at what point this occurs?
I remember feeling a sense of worthlessness while psychotic (this can be psychological and this feeling can also be due to biochemistry and not be psychological in origin. I think I had mine from both sources), but I didn’t know I had a psychotic disorder. I think my mind was really trying to ask whether I’d lost value due to psychosis, but I wasn’t aware I had psychosis so I couldn’t fully frame the question. I knew something really wrong had happened to me though, that felt like a death of the self. I was very sad and weighed down with a sense of loss.
It wasn’t until I’d come out of psychosis with lithium, but still had a few delusions and symptoms I struggled with left over like dissociative symptoms, that I started to fully ask this question and study into the Bible to see what it said on the subject. I didn’t really believe I’d lost value, but I wanted to have a “thus saith the Lord” to confirm the position that seemed right and that really seemed like it must fit with God’s character of love. I needed to know for sure.
Many severe mental illnesses (SMI) cause a fragmentation of the self. You feel like your psyche is in pieces. You may also feel like part of what makes up the self is missing, or disjointed, arranged in the wrong alignment. This happens because our brain is what makes up our self. It composes all of the attributes and functions and perceptions that give us self-hood. When these parts of the brain aren’t operating according to how they were designed and they malfunction, experiencing reduced blood flow, connectivity problems between the regions, problems with neuro-signaling, excess inflammation, and problems with electrical impulses being too high or too low, it isn’t just a superficial malfunction like when a computer malfunctions. Since a human being is a deep and spiritual being, when that person’s brain malfunctions, all the deep desires and wants and psychology of the person also suffer malfunction. Thus someone with a SMI suffers terribly, and not superficial pain, but deep psychological pain.
The brain is a magnificent creation of God, and when malfunctioning, it can create a reality that is nothing short of terrifying, at times being incredibly creative and dark at the same time. It’s common for people with psychosis to see and hear the types of things fitting for a horror film, the high adrenaline and inflammation giving them a bad trip. They are also highly creative individuals, and it’s not just the conscious parts of their brain that are creative. They have heightened creativity in the unconscious, involuntary brain responses too. This means the hallucinations and delusions can be highly creative and dark at the same time.Tactile hallucinations can cause a person to feel things like being physically attacked and having all the sensations of actual combat, even though it’s all in the mind and isn’t actually happening.
Not only can one be trapped in a terrifying world of thinking people are trying to kill you when you’re paranoid and seeing and feeling actual people present in your own home assaulting you, but you can also have deeply psychologically painful “round square” delusional ideas, such as nihilistic delusions. These delusions warp and twist reality so that the things most important to you – your salvation and the salvation of the world and of your family – can become written as a tragedy that there is no escape from. For instance, one can believe they have died and are already in hell, and there is no way back to make a choice for Christ and go to heaven. Unable to use logic, the person cannot deduce that this isn’t true. This can go on for months or years.
You can also lose access to the parts of your brain that make you you. Moral perception being the most important and biggest one. You may have been someone who cared much about living a life pleasing to God, doing the right thing, and leading others along the path to life. Then over time you develop a SMI and suddenly you’re manic and very ambitious, but you have no moral compass. You’re sleeping around and drinking and smoking and never want to talk about God, or when you talk about Him you speak about Him with delusional ideas that do not make sense. You undergo a complete personality change, and not only this, but you lose the ability to remember and discern that you ever believed there was a moral law. Right and wrong seem like arbitrary concepts to you. You think when you formerly believed in them that you just weren’t seeing things right.
It’s also common in psychosis to give up all the things one used to love and to begin to refer to these same things in a kind of symbol language. You may forget who you are and may think you’re someone famous who symbolically represents you.
With dissociative symptoms you may lose memories from the past and may experience black outs in the present where you do things and don’t remember what experiences you just engaged in. You may come to and be in a different city, doing something strange. You may be violent while dissociated. If you have a lesser form of dissociation you may just never feel connected to other people or to yourself. You may seem like a stranger in your own body, or it may feel like you are possessed and other people are controlling you. The world or people in it may look robotic, or you may feel like a robot or some other sense that isn’t what life in this world really feels like.
You may enter this robot world (or another distortion in perception) and not come out of it for years. You can feel isolated from the world, other people, and even parts of yourself.
It is a very lonely and troubling and isolating existence, and can be very terrifying.
With cognitive symptoms you can struggle to do basic tasks like figure out how to play a CD on your computer. This can make the world seem really intimidating and life can feel frustrating beyond measure, along with very defeating. If this goes on a long time the natural reward center in your dopamine pathways won’t operate right because these pathways rely on small, daily victories and successes in order to function properly and motivate us. So you may lose motivation and feel like you can’t be successful at much of anything. This is kind of a chicken and egg situation because SMI can also cause a reduction in dopamine, which can make it hard to have problem solving skills, and then you stop having any daily accomplishments, and then the lack of feedback through those dopamine pathways causes you to be even worse at problem-solving and to have even less motivation.
The way back for these symptoms is often to raise dopamine and improve cognition with supplements (gingko biloba and cat’s claw are two herbs that are excellent at improving cognition and motivation), and then as it goes up and you find yourself more able to accomplish things, begin having little daily successes every day and use success to re-wire your brain to have more success.
No matter how severe you or your loved one’s condition, people are made in the image of God. This fact does not go away. Even when someone loses the capacity to understand right and wrong completely, while their time in this world to choose Christ has ended (it can resume if they are effectively treated and the symptoms reduce enough for them to have moral perception again), their worth isn’t something that ends. Being in God’s image isn’t something that is an isolated part of us; it’s our whole person that is in God’s image.
It is not just one’s moral perception that makes them in the image of God, but their body also, their whole organism.
I’ve heard people give the argument that our body isn’t in God’s image just our brain and our capacity to understand right from wrong. This is really what it means to be in God’s image, to have a mind that functions like God’s mind and can understand the deep truths in His Word. What this argument does is it divides a person into parts. Part of you is one thing, and part of you is something else – not sure what. But personhood in the Bible is our whole being. In the garden God formed clay and breathed into it the breath of life and the man became a living soul, or being. This shows us that what makes someone a soul, or a being, or a person, is their physical body infused with God’s life-giving power. If one has a physical body, and that body is alive by God’s power (and isn’t dead) then that person is a living soul, they possess personhood.
If our physicality isn’t like God and in His image (and only our brain functioning is, which really doesn’t make sense because the brain is a physical thing so if our physical body isn’t in God’s image then our brain wouldn’t be either and wouldn’t function like a brain made in God’s image), then it actually follows that God was lying when He said He made man in His image. Because God didn’t specify and say “man’s brain has been made in my image but not the other parts of him”. (This would have actually made His creation not good had he done this; to be partly in God’s image and partly not would be an immoral design on God’s part. God can have animals that are fully not in His image, and He can have man who is fully in His image; but He cannot have beings that are partly in His image and partly not; this would be degrading to such a being if it say had the brain of a man and the body of an animal or other lesser creature). No, the statement “in the image of God made he them” is the statement “the whole being (all parts) of the man and of the women has been made in my image”.
What this means is it isn’t just our moral capacity that gives us value, but our whole body, our whole self, our whole person. When someone in late stage dementia has nearly lost all cognitive functioning and their brain has severely atrophied, we don’t treat them like they are not a person anymore. And rightly so. As long as there is life in that beating heart the person holds the full amount of worth of a person in God’s eyes. God doesn’t give worth out in degrees. You aren’t worth 50% of a human being’s worth if you have 50% brain functioning, and you’re worth 100% of a person if you have full mental capacity. If you’re human and you’re alive, you hold full worth in God’s eyes, the same as the most intelligent people in the world with the best brain health, even if you have severe mental handicaps. All human beings are equal to God.
We run into serious problems if we separate a person’s personhood from their whole selves. One of the big reasons abortion has so much support is because people don’t see a developing body that is very much alive as holding the same value as a fully developed body with reasoning ability and cognitive capacity.
Just as the dying elderly person retains their value and personhood as long as there is a spark of life left in their body, so the developing baby in the womb holds personhood and value as soon as the spark of life begins for that baby, which is at conception. It’s at conception that God infuses the embryo with life and it’s God’s power that forms that child in the womb. The child has personhood from day one, because personhood according to the Bible is being in God’s image and possessing a living body; it’s not something we have when we have full cognition and it’s not measured by mental capacity.
It’s also for this reason that I believe that someone on life support is still a person. What a lot of people don’t know but which is very true scientifically is that if the brain were to fully die, the body would begin to decay and smell within hours. Thus if someone can be hooked up to life support and live for weeks or months, they do still have a tiny bit of brain activity that may not be picked up by the EEG. The person may have no higher cognitive powers, but if they can be kept alive by machines, their brain is actually alive because true brain death would result in the person decaying before our eyes, smelling, and becoming a corpse.
Many of these people on life support do eventually fully die, and start to decay and smell and have to be taken off machines and buried, and sometimes the family chooses to take them off support before full death happens, when the person shows no brain activity on the EEG, because such a person isn’t going to recover and regain brain function, and doctors know this. They are not quite dead, but they also aren’t going to recover function either at that point.
Until they decay and smell and the machines can no longer keep them breathing and their heart beating, I believe they are alive, and I believe they are a person and have personhood, as I believe the Bible supports this position, but whether to keep them alive using extraordinary means is another question entirely. If it’s going to cost the family tens of thousands of dollars to keep the person hooked up to machines for several weeks while they slowly die, it may not be doable to keep them alive. It could bankrupt the family and put them into a dire state; or if insurance is covering it it could bankrupt our nation. And withholding extraordinary means to keep someone alive is not the same thing morally and conceptually as directly going in and taking a person’s life. The latter is murder; the former does not fit the Biblical criteria and definition for murder. In many countries with less advanced medical technology, such a person would die naturally quickly, and this wouldn’t even be a question.
Whenever I drive by rest homes I always want to salute. Because there are so many of our older men and women experiencing dementia which is the battle of a lifetime, and they encounter it late in life when they are at their most frail and weak condition. It takes great courage to do that. This is something we should respect them for. The person in psychosis suffering terribly should likewise be respected and encouraged and valued, not treated as less-than.
We hold great value. It’s not value that can ever be diminished or taken away. Even if our actual brain function diminishes, our worth remains in tact and never diminishes and can never be erased.
But this is not the philosophy of the world, which idolizes intelligence and ability and beauty. In the world’s view if you lose any of these things or they diminish, your value does go down. This philosophy can be a temptation to the Christian entering or recovering from a SMI. If we adopt the world’s views on this, it can lead to us mistreating ourselves, or worse perhaps believing life is not valuable or worth living if our brain function is compromised, and resorting to suicide.
The population that has the highest suicide rate is elderly men. They are losing functioning physically and often mentally as well and older men with a worldly mindset often do come to this false conclusion that they’re value has diminished or that life has no purpose or meaning because of their loss of function. They can’t see purpose in sticking around to develop full dementia and suffer and die from it. They feel they are a burden to their families.
Since 80% of people over the age of 75 develop dementia and since it is serious illness involving atrophy of the brain and eventual death (although in the earlier stages supplements and treatments can actually lessen the disease or in some cases even reverse it Link to the dementia summit), it’s crucial that Christians know what the Bible has to say about personhood, as Satan will tempt many of them – especially men – to end their suffering in the early stages of the illness to prevent future suffering.
The truth is it is murder to commit suicide to escape dementia worsening. The right thing to do is to take supplements and do your part early on – especially before you get older, but also in older age – to reduce your suffering, but it’s never ok to end your life to escape suffering. As Christians we can only use moral methods to solve problems, never immoral ones, especially one as immoral and final as suicide.
There’s been a strong societal push to legalize euthanasia for physical illnesses involving great suffering that will end in death, and even more recently in Canada, for physical illnesses that involve great suffering that do not end in death, and most recently in Canada, to legalize euthanasia for mental illness and mental suffering. It’s shocking and alarming how fast these new movements are gaining traction. Canada will allow euthanasia for mental illness starting in 2024.
God has the authority to end a person’s life if He so chooses and thinks best (all His choices are made from righteous principles with our best good in mind), but no human being has that authority. The cross reveals that God’s motives for giving His own life and for taking life is always 100% loving and good. For us to take human life is for us to commit murder. The level of suffering the person is experiencing doesn’t have any bearing on whether murder is murder. It’s not as if killing someone whose suffering is a level 5 is murder, but killing someone whose suffering is at level 10 is not murder. This is illogical and makes no sense.
Suicide is a tragedy. Euthanasia is a double tragedy, because both the doctor and the person enlisting his assistance in death are committing murder and putting themselves out of alignment with God and His Spirit. The family is also often involved so they become guilty too if they support in any way the murder. Then there is a powerful impact on society at large because suicide has contagion. Anytime there is a suicide in the media, or in one’s hometown, rates of suicide go up. The truth is someone’s suicide tempts other vulnerable people to do the same. It is not a harmless act; its effects ripple through society. If the family and society at large, doctors, etc. paint assisted suicide in a positive light, this further tempts vulnerable people.
These are not solutions for the Christian. Jesus told us in this world we would suffer. The fact the woman was cursed with pain in childbirth is a constant reminder that it’s through suffering that great joy is made possible – through the suffering of Christ who came from the woman, and our own patient endurance under suffering – that the war against evil is won and sin and sorrow and suffering are ended for all time. There is no other way. All will suffer in this life, some much more than others, but if we remain true to God through suffering and allow Him to overcome evil through us, we will share in His eternal joy when He comes again. This is the great purpose of life, honoring Him in this world. If someone is slipping into dementia, they must honor God as long as they have moral agency, and trust Him to keep them as they slip into symptoms so severe that they no longer have moral autonomy, and then pass away. It then becomes the role of the family and care-takers to care for the person with dementia, and to ensure they do not harm themselves or others or become erratic and walk the streets and do other things that are then outside of that person’s control when they slip into the severe symptoms of the later stages of the illness.
When it comes to psychosis, the person usually slips into it much earlier in life. Most people come out of psychosis with antipsychotic medication – 2/3rds do – so there is great hope for this condition. If one also adds supplements and natural protocols to their treatment they can increase their chances of coming out of psychosis and they can come more fully out and reduce symptoms more than with meds alone. Some people find they can eventually taper off medication altogether with natural treatments, or take less medication (under a doctor’s supervision of course).
1/3rd are treatment-resistant to medication (again, with adding in natural protocols to their treatment, this number is likely less). If such is the case, it’s important to always treat that person as a person. The parts of their brain that make up the psyche and the self may be fragmented and confused, but there is still a self there, and that person is suffering terribly. Treat them with the dignity and respect and kindness worthy of their personhood. Never treat them as a non-human object even if they are severely compromised in brain function. Sometimes the person with the SMI can be abusive verbally and physically because the brain inflammation drives them to paranoia that causes them to think you’re trying to kill them, or they just lose control altogether. Unfortunately resources for long-term in-patient care for people with treatment-resistant psychosis are hard to access. In some cases the family member can be taken into a nursing home. Sometimes the person is accepted into a long-term psychiatric hospital stay, but this is really rare. It’s much more common that they are kept for a short time and then released. We actually really need nursing homes for young people with treatment-resistant psychosis.