I once received a letter from a woman informing me that her son, my patient, had died. Her letter was written to thank me for the way I had spoken to him about his addiction during his appointment in my clinic. She wrote:
“I know you only saw my son once but he felt so comfortable with you. He said I think he really cares for me and will help me get better. (sic)
“I was impressed that you treated him with such compassion, not judging him by his alcoholic past. You saw the person!”
This letter saddened me because my patient’s death was unexpected, but it also made my day. Seeing addiction as a medical illness instead of as a moral failing is important to me, and I love learning that I made a positive difference in someone’s life.
Addiction is a topic I have written about before, but I want to take a different approach to it this time, using it as a springboard for a related discussion. One of the characteristic features of the illness is a loss of self-control. An addict will keep using their drug of choice despite adverse consequences in their lives, including loss of educational opportunities, loss of employment, disrupted family relationships, and legal discipline.
But calling it a “drug of choice” isn’t entirely accurate, for two reasons. First, while there is usually choice involved the first time they use it, addicts do not choose which drug or substance their brain will most respond to. Usually this is discovered incidentally, experientially, the same way that doctors choose their medical specialty during medical school. Second, once an addict is in the throes of addiction, they really don’t feel like they have a lot of choice in the matter.
Hard-Wired
The brain of an addict seems to be “hard-wired” to respond in this unusual way when it is exposed to a drug of abuse. No one chooses to become an addict. This disease highlights an important question which has befuddled philosophers, theologians, and scientists for millennia. Simply stated, it is this: Do human beings truly have freedom of choice, or is our apparent freedom some kind of illusion? Neuroscience has flip-flopped on this question for the last few hundred years.
The spinal cord is full of reflexes, from the simple knee-jerk reflex to more complicated pain withdrawal responses and even gait pattern generators. One experimental model for studying reflexes is to surgically sever the spinal cord of an animal and then observe its limb movement patterns. Here is a video of a decerebrate cat walking on a treadmill, using only spinal cord reflexes. (If you are an animal lover or are strongly opposed to using animals in medical research, then please don’t follow that link.)
Reflexes give the simplest demonstration of the fundamental function of the central nervous system, which is 1) to monitor the body and the outside environment using the sensory system, 2) to use those sensory signals to decide on an appropriate response, and 3) to use the motor systems to send instructions to muscles and other organs to execute the response. This basic process is why a muscle twitches when its tendon is struck by a reflex hammer, why the pupil contracts when you shine a light at the eye, and why you suddenly drop a burning hot object from your hand, even before you consciously realize that it is hot.
The abundance of reflexes at all levels of the spinal cord and in the brain led scientists in various disciplines to suggest that all human behavior is governed by complex reflexes. Not just the knee-jerk and other relatively simple movements, but all human behavior, including complex social behaviors. Under this model, individual freedom of choice is merely an illusion, because what you may think you are choosing is actually the output of a complex algorithm computed in your brain purely by reflex.
The science of persuasion seems to support this model, as the techniques used by advertisers, seducers, politicians, and other persuaders often exploit psychological vulnerabilities to produce the desired response in their audiences. All the persuader has to do is trigger that behavioral “reflex,” and the behavior happens. If human beings are so susceptible to persuasion, then are we really exercising our free choice when we buy a certain brand or align ourselves with a political movement? Or are we simply drones under the influence of a persuader?
The Doctrine of Agency
The reflex model of human behavior doesn’t fit very well with what the scriptures teach about the doctrine of agency, which is that every human being possesses individual freedom of choice.
“Wherefore, men are free according to the flesh; and all things are given them which are expedient unto man. And they are free to choose liberty and eternal life, through the great Mediator of all men, or to choose captivity and death, according to the captivity and power of the devil; for he seeketh that all men might be miserable like unto himself” (2 Nephi 2:28, emphasis added)
This freedom to choose is a gift from God:
“32 The Lord said unto Enoch: Behold these thy brethren; they are the workmanship of mine own hands, and I gave unto them their knowledge, in the day I created them; and in the Garden of Eden, gave I unto man his agency” (Moses 7:32, emphasis added)
How important is agency to God’s plan? It is critical. The purpose of mortal life, in a nutshell, is to test us to see if we will choose to follow God and his plan: “And we will prove them herewith, to see if they will do all things whatsoever the Lord their God shall command them” (Abraham 3:25). If freedom to choose were merely an illusion, then what would be the purpose of testing us to see whether we will choose right or wrong? Without freedom to choose, the whole Plan of Salvation would have no purpose or point.
In fact, the rebellion of Satan in the premortal life, which triggered the “war in heaven,” was fought partly over the question of whether God’s children should be free to choose for themselves or whether they should be compelled to choose the right.
“3 Wherefore, because that Satan rebelled against me, and sought to destroy the agency of man, which I, the Lord God, had given him, and also, that I should give unto him mine own power; by the power of mine Only Begotten, I caused that he should be cast down;
“4 And he became Satan, yea, even the devil, the father of all lies, to deceive and to blind men, and to lead them captive at his will, even as many as would not hearken unto my voice.” (Moses 4:3-4, emphasis added)
The fact that there is evil in the world, that God does not prevent every wrong choice even when that choice inflicts suffering on others, is a testament to how important our agency is to God. It is one of the greatest gifts he has given us, and one of the only things that is uniquely ours. In the theology of The Church of Jesus Christ of Latter-day Saints there are few things more fundamental than the doctrine of agency.
Neuroplasticity and the Power of Choice
When science is in conflict with doctrine which has been revealed so clearly and consistently, you can bet it is the science which is wrong and not the doctrine. The reflex model of human behavior simply does not fit with what we know about the nature of human choice and the purpose of life. Over the past few decades there have been significant revisions to our understanding of how the brain works, and it turns out that the current model harmonizes pretty well with the scriptural teachings about agency.
Localization of function in the nervous system is part of what makes practicing neurology so fun and fascinating. For example, if a patient comes to the hospital with a stroke, a good neurologist should be able to determine with reasonable accuracy which part(s) of the brain are affected, using only the patient history and bedside neurological examination. This is because the various functions of the brain (language, movement, coordination, sensation, hearing, sight, spatial orientation, etc.) are organized in a fairly reliable way so that most people use the same parts of the brain to do the same things. And when you get a CT or MRI scan and find that the stroke is in exactly the place where you predicted it would be, it makes you feel pretty smart.
But there are exceptions, and you don’t have to practice neurology for very long before you start to find them. Sometimes the MRI scan surprises you, and you wonder how on earth a stroke in that location caused the symptoms or the exam findings you observed. The brains of people with early childhood injuries are particularly likely to break the rules of localization.
A major insight of the past few decades of neuroscience research is that the brain is much more variable and changeable than we used to appreciate. Understanding the brain’s plasticity helps us to make sense of many things that were previously mysterious, including diseases like addiction, and helps us to design rehabilitation treatments to make the best use of the brain’s ability to change. We are constantly experiencing the world, making choices, interacting with and moving through our environment, and communicating with others. All of these experiences, choices, interactions, movements, and communications actually change us, literally altering the structure of our brains every day.
There is truth in Ralph Waldo Emerson’s observation: “That which we persist in doing becomes easier, not that the task itself has become easier, but that our ability to perform it has improved.” This is true empirically, as we have all seen the power of practice to improve our skills. But it is also true in terms of brain science, as neural pathways which are often activated will strengthen themselves and become more efficient at their work, while neural pathways which are neglected will become weaker.
The brain is a fantastic, living, learning machine, and you can choose what to teach it! But be careful what you choose, because you will become the sum of your choices.
Revisiting Persuasion
If every human being has the freedom to choose between good and evil, and if the brain is a plastic, adaptable organ, then what is the proper role of persuasion? Does it have a higher purpose than just triggering behavioral reflexes to get people to buy your product or vote for your candidate?
Persuasion is a tool, and like all tools it can be used for good or for evil. The dark side of persuasion is deception, and the scriptures teach that Satan is the “father of all lies.” But God is “a God of truth, and canst not lie.” Because he loves us and wants us to become like him, God uses persuasion instead of compulsion. He says, “Learn of me, and listen to my words; walk in the meekness of my Spirit, and you shall have peace in me.”
Trying to influence someone so that they will voluntarily choose something requires altering their perspective and informing them of things they didn’t know before. If done honestly, then persuasion does not violate anyone’s freedom to choose, because it helps them to see the options and their consequences more clearly. Although this often involves rational argument, persuasion is at its core an emotional activity; the goal is to get someone to feel good about a choice or to feel bad about its alternative.
The process of conversion to the gospel is essentially a work of persuasion. Gospel teachers like missionaries and Sunday school teachers help people to understand the meaning and application of gospel principles using scriptures, examples, stories, and other teaching methods. When a person opens their heart to this message, then the Spirit of the Lord does the most powerful work of persuasion. “He that receiveth the word by the Spirit of truth receiveth it as it is preached by the Spirit of truth […] Wherefore, he that preacheth and he that receiveth, understand one another, and both are edified and rejoice together” (Doctrine and Covenants 50:21-22).
Joseph Smith wrote an inspired letter to the Church during the winter of 1838-1839 when he was incarcerated in the Liberty Jail. Within this letter is a guide to priesthood leadership within the Lord’s Church, contrasting the right and the wrong way. The purpose of gospel leadership is to help people choose to serve Christ and follow him, so that they can receive all of the great blessings he wants to give us. First he described the wrong way to do this:
“. . . the powers of heaven cannot be controlled nor handled only upon the principles of righteousness. That they may be conferred upon us, it is true; but when we undertake to cover our sins, or to gratify our pride, our vain ambition, or to exercise control or dominion or compulsion upon the souls of the children of men, in any degree of unrighteousness, behold, the heavens withdraw themselves; the Spirit of the Lord is grieved; and when it is withdrawn, Amen to the priesthood or the authority of that man” (Doctrine and Covenants 121:36-37, emphasis added).
Notice that there is no place for “control or dominion or compulsion” in the Lord’s work. This is not the Lord’s way, and never has been, because these heavy-handed methods trample on the doctrine of agency.
Now contrast that with Joseph Smith’s description of righteous gospel leadership:
“No power or influence can or ought to be maintained by virtue of the priesthood, only by persuasion, by long-suffering, by gentleness and meekness, and by love unfeigned; By kindness, and pure knowledge, which shall greatly enlarge the soul without hypocrisy, and without guile” (Doctrine and Covenants 121:41-41, emphasis added).
Persuasion is the very heart and soul of leading others in the Lord’s way, teaching with patience and serving with love. The Good Shepherd leads his sheep, saving our souls and healing our hearts with the gentle power of righteous persuasion.
Final Thoughts
As I mentioned at the beginning, the disease of addiction makes an addict feel like they have lost control over their lives, or that their “lives [have] become unmanageable.” But it is a disease which cannot be treated effectively until the patient wants to be treated. In other words, the patient must exercise their freedom of choice to overcome addiction. Step 3 of the Twelve Steps of Alcoholics Anonymous is really the turning point in the process: “[We] made a decision to turn our will and our lives over to the care of God as we understood Him.”
That may sound like a radical, desperate move, to yield your heart to God like that, but it is no different from what Lord requires all of us to do whether we are alcoholics or not. “Behold, the Lord requireth the heart and a willing mind,” he declared. “And ye shall offer for a sacrifice unto me a broken heart and a contrite spirit.” We must freely and humbly choose to follow Jesus Christ, and once we do he will shower us with help and blessings to guide us back to him.
Thanks to reader Ammon Johnson for suggesting the topic of this post.
Medicine and Faith 