Not in my right mind

Yesterday I underwent a routine but invasive medical procedure recommended for people when they get older. In addition to pain relief, I was put under sedation, I think for the first time in my life. The nurse told me that the sedation would put me into a “twilight” state, but as it turned out, I remained alert – or thought I remained alert – through the procedure while feeling only occasional mild discomfort. It gave me the opportunity to watch on the screen what my innards looked like and ask questions of the doctor. When it was over, they wheeled me to the recovery room, and I called my wife to tell her it was time to pick me up. She answered the phone and told me that she was already on her way. I was surprised that she was already driving over, and my wife informed me that I had called her a few minutes previously. Huh? Sure enough, my call log showed that I made a call to her a few minutes prior, but I had no memory of doing so. Then my wife was sitting in the recovery room with me. Time had been passing like scenes in a movie – jumping from discrete event to another rather than a slow continuous flow. My wife told me afterward that I reported to her four times the outcome of the procedure. Everything seemed quite ordinary to me, except that it was a little difficult for me to focus, as I would otherwise feel if fatigued. My wife said I spoke slowly and in a monotone, with pauses between statements, but otherwise exhibited no cognitive impairment aside from not remembering.

In the recovery room, I used my phone to look up the sedative, and I read that one effect was inhibition of new memories. So apparently I had been saying and doing things of which I have no memory. Was that really me if I don’t remember? But if it wasn’t me, then who was it? And in this sort of situation, am I responsible for what I say and do? I was told not to sign any legal documents the day of the procedure, but am I absolved of accountability before God?

Anyone have thoughts on the connection between responsibility and mental state, either induced by drugs or as a natural condition?

Legally, not guilty by reason of insanity is a valid plea. I never really understood that, as I always thought mass murderers are obviously insane. That’s not the type of insanity we’re talking about though.

Being “out of your mind” when you did something does seem to be possible. Not being able to remember doesn’t make you out of your mind per se, but if you happened to kill somebody while asleep, the plea would probably work if you could convince the jury you were asleep. It’s been known to happen.

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A problem with KJ is its mistranslation of adam, and similar words.

After this experience, you’d probably enjoy Augustine’s discussion of dreams and moral culpability. it’s in his Confessions. Glad you’re through it. It will be my turn in the next couple weeks. Love,

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Joseph - as you indicate a bit further down in your reply, what you’re describing here is a fair description of sleep walkers.

The tendency to sleepwalk seems to have a genetic component - it can run in families. It does run in my mother’s line.

At family reunions, sooner or later the subject of conversation will run to a rehearsal of the epic sleep walking episodes of previous ancestors and new episodes among the current members.

The nocturnal activities are more common in childhood. My brother and I roamed around the neighborhood in our pajamas. Sometimes we’d wake up a neighbor, asking if their children could come out to play. One lady supposed my parents were having a party and had missed the fact that my brother and I had “escaped.”

That brother’s sleepwalking extended into his teens. One night Dad was roused by the doorbell at 3 AM. It was a policeman, escorting my brother - naked except for his whitey tighties. And, he was still “out of his mind” though cooperative. The patrolman had noticed a man climbing out of a window! Fortunately, he was sound enough in his judgment to quickly decide that my brother was “out of it.”

Aunt Selma was epic! Her nieces didn’t want to overnight with her, because she’d be roaming the house all night in her nightgown.

Aunt Dorothy went into her bathroom one morning and found a window shade in tatters almost as small as confetti. In the night, she’d arisen, taken a double-bladed razor blade out of her husband’s razor and had spent - how long? a couple of hours?? - reducing the shade to tiny pieces.

Joel - you’re fortunate to have retained enough of your sanity to comply with directions from the doctors, nurses, etc. If you got one of them to sharing experiences (unlikely) they’d probably had plenty of wild stories to relate about patients being out of their minds under anesthesia.


Well this discussion kinda reminds me this video recorded by a wife of her husband waking up from anesthesia. There is one mild language but is otherwise quite funny and representative of the bizarre effects of anesthetics.


I will have a look at that. My inclination is to think that one’s true self comes out in dreams and when disinhibited by drugs – as they say, in vino veritas.

Yes. I seem to have remained myself through the experience. I wasn’t convinced about my memory loss until I spoke to my wife in person, but she said it was just like me to respond to that realization by immediately looking at the paperwork to see what drug I was given and doing a web search on my phone to find out its effects.

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Not all drugs are behavioral disinhibitors, some cause completely uncharacteristic behavior and I have serious doubts about anything called the “true self” which only exists in the realm of fantasy or dreams, which ever the case may be.

My cousin is a law enforcement officer that was in a terrible car accident while responding to an armed robbery and shots fired call. His whole lower body was crushed by the cab of a semi truck that cut him off as he went to pass with full lights and sirens. After numerous surgeries and a medically induced coma he woke up and was a totally different person. He was telling his wife to just leave and was acting totally crazy. The doctors initially were chalking it up to the stress of his accident and suggested this was his “true self”. But his wife fought for her husband and got him on different meds, and it was a world of difference. He doesn’t even remember half of what he said to her and could never account for his behavior. But just a soon as the right meds were found he was back to his normal self. By the way, despite the major damage, and more than a year in a wheelchair, he is back to full-duty police work.


Yes, and I have read reports about personality changes due to brain tumors and injuries, etc. But if how a person acts can be fundamentally changed by medication or physical trauma, is that person no longer accountable for their actions? And perhaps speaking of the “true self” is too Platonic, but if the physical determines the mental, what does it mean to have a soul that can exist apart from the body until the Last Day?

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To say that the physical determines the mental is too far, but to say that the mental is very much connected to your physical brain is a sure thing. Thus the physical has a large impact.

But, we are embodied souls, not embodied “mentals” for lack of a better word. When we lose consciousness we don’t lose our soul. If you want to call the soul the true self, in some sense, fine. But the lines and connections between soul and body and thought are quite a morass.

As to your question, I do think there are times our bodies are not under conscious control and therefore, though we may in some sense hold people accountable for what their body does, they are not responsible.

Dreams are the inverse, where our thoughts are sometimes more, sometimes less under our control. Just as you were more “conscious” and under control than the man @Krlamb1 spoke of while on meds, and a case could be be made you would be more responsible for your actions, so a man can be more or less accountable for his dreams or even his waking thoughts. (I’m thinking here of intrusive temptations from Satan.)


Remembering is one thing. Deciding is another. If the effect of the drug only impairs memory, then of course one is responsible and culpable. Reminds me of the question about sexual assault on college campuses. Alcohol-induced blackouts are a real thing but it doesn’t absolve anyone of a crime. The man who commits a crime while under the influence is guilty of more than just being under the influence.


I know in the US legal system you can plead insanity and sometimes avoid a conviction. But in the Old Testament case law do we see anything but strict liability (i.e., you’re guilty if you did it, doesn’t matter what reason)? Time and again you see things like,

If a man takes the life of any human being, he shall surely be put to death. - Lev 24:17

Now there is the distinction between murder and manslaughter based on intent…

But if he pushed him suddenly without enmity, or threw something at him without lying in wait, or with any deadly object of stone, and without seeing it dropped on him so that he died, while he was not his enemy nor seeking his injury, then the congregation shall judge between the slayer and the blood avenger according to these ordinances. - Num 35:22-24

But I don’t see biblically how you would get from conviction for manslaughter to acquittal due to lack of knowledge, intent, mental capacity, etc. The whole reason it is manslaughter is just because there wasn’t that intent etc.

Today we acquit the guilty.


Another relevant example to this discussion is Alzheimer’s. Relevant in the paradigm of soul, body, and culpability. Often those with this disease say and do things completely uncharacteristic of them as a person. Again, it’s hard for those that live with them not to take such behavior personally or as sin; Satan temps those loved ones sometimes to believe that this is really the person’s true self despite decades of living together to the contrary.

I was trying to think of an example in scripture that would counter the “true self” paradigm and or at least address the issue of diminished capacity and therefore culpability.

I actually think the instances of demonic possession speak to this distinction quite well. In each instance I can think of, the person possessed is not treated as guilty for specific crimes, even though they are physically the ones acting baselessly. There might be instances where the person somehow rendered themselves vulnerable to demonic possession, by I don’t think that actually changes the culpability of the person for stuff done by the demon.

As to the issue of mere intent, the manslaughter distinction still requires negligence, not merely the circumstance of a death inadvertently caused by another.

It’s all very interesting to think about.

I’m by no means an expert, but my understanding of the insanity plea is that it doesn’t actually get the defendant off the hook. Often those who successfully plead insanity are forcibly institutionalized for longer than the prison sentence they would have served had they plead guilty. And these (at least in Federal jurisdiction) have no right to habeus corpus or other remedies to challenge their confinement.

According to Wikipedia, the insanity defense is used in less than 1% of cases and of those only about 25% are successful. To me this almost makes it a non-issue. What’s much more unjust, IMO, are the light sentences for those who were found guilty.

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Good point about Demon possession.

Also, @danielmeyer, the biblical manslaughter distinction and the fact that capital punishment is not required any longer is a good example of showing how very important it is for intent and other factors to be taken into account. Reasoning by inference along those lines is precisely how we got to the idea that under rare circumstances it is appropriate for people to be acquitted.

The fact is that God commands that some men who have killed others not be punished with death or even even thrown in prison for life. They were apparently allowed to live a normal life in a city of refuge. That is not to say that today we are denying man’s responsibility all over the place, but this is a question of how to handle the real exceptions. We’re not talking about affluenza here. :slight_smile:


It seems to me that Saul was not absolved of culpability for his assaults on David even though he was oppressed by an evil spirit.

True, but it also doesn’t say that he was possessed. Not 100% sure there is a distinction there, but I think there is.


My late father battled prostate cancer for about 12 years. He died at age 61. Lots of treatments. Several rounds of chemo; experimental therapies, etc. Had incontinence following his prostate removal. Had an artificial sphincter installed which helped a lot, but was still a challenge for these last years of his life. Lost the ability to be physically intimate. In and out of disability for side effects of treatment. Endless pressure to play his cards right financially with HR and stuff to keep his job and not get fired, not sacrifice end of life benefits for my mother, etc.

Through all of this, I witnessed my dad imperfectly, but genuinely cast himself upon Christ. I remember visiting my parents one time around year 7, and my dad was sitting in his recliner. He was considering Matthew 19:11-12, grappling with his physical predicament, leaning on the sovereignty of God. I don’t remember my dad ever complaining about any of this during those 12 years. He soldiered through it well, and with faith.

He had his “chemo brain” days, where he couldn’t think or speak well, and his temperament for conversation would be shorter than usual. But he was never angry with people – just frustrated at his inability to keep his mind focused. Sometimes he would abruptly leave a conversation in a way that was surely rude, but to those who knew him, there was lots of room to forebear.

Anyway, during those last 2 years, he was diagnosed with a brain tumor. This led to surgery about 8 months or so before he died. The surgery went well, and he came out of it thankful to God to be alive. But he was never quite the same. A few weeks later, a new brain tumor was discovered, not far from where the old one was. Evidently it was of a nature that it hid itself pretty well. Dad began doing some treatments, but ultimately it was decided not to operate on this one.

During those last weeks of his life, he became very critical and surly. He had kind of a short fuse, and didn’t have time for civil conversation. He was very lucid during these weeks. He was able to have conversations, and put thoughts together. It wasn’t like he was in the fog of pain medication or anything. He seemed to be willfully, deliberately, and thoughtfully nasty.

During his treatments, his system was (again) compromised, and by this time he was already very weak. He ended up in the ER with a breached bowel, and passed away a few days later of sepsis. While we did all share our good-byes and prayed with him before he descended into the oblivion of pain medication, my dad’s last words in this world were impatient and angry – toward me, toward nurses, etc.

I wrestled with the topic of physiology, moral culpability, and end-of-life behavior for awhile. Nothing that occurred during those last weeks caused me to doubt my father’s salvation, as though the faith he exhibited, and the work I saw God do in him those 12 years was all a farce. What I think I came to see in those last days was something more like the death throws of his flesh. My father still possessed indwelling sin, leftover from decades of sinful patterns of thought which had not been drawn out and scraped away by the Spirit of God. He died a work in progress, and that seems about the best any of us will be able to say. I believe my father was a man in Christ, and his old man was about to be dead for good. In a very short time, he would see Christ for who he is, and sanctification would be finished.

I don’t believe that my father’s physiology in any way removed him from the culpability for his sin. His sin was very real in those final days. But I couldn’t help but be caught up in a stunning reminder of the good news that is the Gospel – that the blood of Christ cleanses us from every sin; whether committed in ignorance, or in willful rebellion. The only hope I could have for my father was the power of Christ.

I came away concluding that we ought to be very cautious about judging someone’s salvation based on the sins they commit toward the end of their life. Let’s be honest, if any of us could see the sin in each other’s hearts at any given time, we would be very hesitant to voice confidence about anyone’s status before the Lord. But man, thanks be to God in Christ Jesus, whose righteousness is ours through faith! Yes, sanctification must be evident in our life, but it will never be complete in this life.

But when all was said and done with my father, and I was left here considering my own life, and my own inevitable death, my heart was stuck on Ecclesiastes 12:1-8.

“Remember also your Creator in the days of your youth, before the evil days come…”

May I be found putting sin to death so that if it should be my lot to suffer in my physical body toward the end of my life – when my powers of speech, and of reason begin to fail me – I may be found controlled by the Spirit, and not my flesh.


Here’s the case of my late mother.

Sometime during my middle childhood and during her middle age, my mother developed paranoid delusions. But there were no voices in her head, no tales of abduction by aliens, no claims of being Joan of Arc, no hallucinations, and no bizarre behavior. Instead, she simply insisted that people she interacted with, and especially family members, said things and did things and believed things that never happened and weren’t true. In the early years her delusions were selective and ordinary and not obviously false unless one had personal knowledge that the facts were otherwise. My mother insisted that there was nothing wrong with her, and not once in my life was I ever able to shift her beliefs the slightest distance no matter what reason, persuasion, or threats I might apply. She stubbornly held onto her delusions no matter what destruction she brought on herself and her family, and the destruction ended up being enormous. By the time I reached my late 20s, my mother could no longer manage to deal with ordinary life and spent the rest of her life homeless.

It was not until the last six months of my mother’s life that she received any psychiatric evaluation. This occurred in the hospital, after she had been brought in suffering serious health problems. My mother insisted that she did not have a certain severe health problem and attributed the symptoms to a cause that was visibly untrue (I spare you the grotesque details). Any layperson would have judged my mother to be crazy for denying what was obvious to the eyes, but two different psychiatrists deemed her as mentally competent. Since my mother was unwilling to undergo any mental health treatment, nothing could be done.

From the perspective of psychiatry and the legal system, it is clear that my mother was viewed as responsible for herself and her decisions, despite her delusions. Perhaps that’s the way it should be, since there are people out there who think the Christian faith is a delusion and would like to force Christians into “treatment”. But was my mother responsible before God? My aunt and uncles, her sister and brothers, seem to view my mother’s mental illness as something that came upon her that she couldn’t help. They remember my mother from her younger days and never met her in her later days. I’ve tended to view things differently, having seen my mother’s mental illness develop first hand.

My aunt and uncles say that my mother grew up in a Baptist church and professed faith as a teenager, but I never saw her exhibit any interest in the Bible or Christ. Our family briefly attended church, and then for a couple years my mother just dropped me and my sister off for Sunday School, which my mother told me was for the purpose of giving us a moral upbringing. One time, before she had become homeless, I tried sharing the Gospel with my mother, and she told me to stop because I was making her angry by getting close to telling her she was a sinner and deserving of hell. Indeed, my mother had always been very self-righteous, and I do not ever remember a time when she admitted to doing wrong or making a mistake, except once or twice when she immediately shifted blame to someone else. So quite some time ago I developed the theory that my mother’s delusions were the mechanism by which she excused herself from failure and preserved herself as the perfectly innocent victim of the malice of others. I hypothesized that my mother’s steps along that path were small at the beginning, but eventually she trod a deep rut that she could not escape. Could she have chosen a different path in the beginning, and thus avoided mental illness? Or did mental illness unavoidably descend upon her, rendering her helpless and not culpable?



I’m sorry that you had to live through that. Indeed it sounds very similar to my own present experience. I won’t go into the details. But, generally, what you are describing, I would not classify in the same manner as drug induced disinhibition, or as you likened it to the displayed “true self” of the dream world. I think the experts were right to find her competent. Mental health is not merely a measure of a person’s success at self care but is practically a measure of a person’s behavioral acceptability. In this post modern world so much more is acceptable than decades past. But from a biblical counseling standpoint, what you are describing is just wrong thinking. It’s an emotional spiral that starts with discontent, moves toward resentment and bitterness. Of course these things affect her perceptions of the world, but this is not something that merely happened to her, she has reacted and failed to stand upon the truths of scripture. This no different than my own mother. If they were truly believers and members of a church that practiced biblical counseling and discipline, perhaps their situations would’ve developed differently, but I think we can trust that God’s plan for both of our mothers is not the plan B.


Sorry for your experience, brother. As I read that, I could picture a particular person in my life who closely resembles what you described of your mother.

I am reminded of the nature of sin. I find that we can sometimes settle in to thinking of sin in terms of isolated incidents. That is, we look at a particular act that was just committed and identify it as a sin – singular. Then we pursue confessions and apologies and forgiveness in order to reconcile that particular sin and move on. And that’s true. Individual sinful acts are definitely sinful, and they should be dealt with in their particularity (Luke 17:3-4).

But then there is the nature of indwelling sin; how sin begets sin; how unrepentant sin comes to sear the conscience to the point where we lose the ability to even register our sinful patterns. It’s the judgment that Romans 1 speaks of; how God gives us over to our sin in continuous degrees as we refuse to turn to him. Then it comes to be realized that sin is not so much about isolated actions as it is a corruption of Adam’s race, always snowballing from bad to worse apart from the intervention of grace.

It sounds like your first hypothesis is the one consistent with how the Bible describes sin to work, as opposed to mental illness “unavoidably descending on her,” rendering her a hapless victim. Then again, it seems to me that our race is so ravaged by sin that I am not prepared to refute the idea that a person may possess physiological, genetic defects that serve to stack the deck against them for certain sins in their life.

Yet even so, we know God is righteous and just, and all will be accountable for their own sin before him. How blame is ascribed to each particular sin in the courts of heaven, though, I expect is less cut and dry than we might think, when we consider the generational nature of sin.