Is it ethical for a Christian to treat depression with anti-depressants? A careful answer from Simon Jooste, Part 1
Our friend Simon looks at this serious question in detail, and concludes that in specific circumstances, it is appropriate to use anti-depressants as part of a holistic approach to treating depression — provided that the sacred means inform these secular means. He looks at four aspects of this question and his answer:
- Depression in light of the Fall
- The Christian life of suffering
- The ‘therapeutic narcissism’ of our age
- The godly wisdom which draws on both sacred and secular means
We’ve really enjoyed Simon’s previous contributions to C or C, and hope that this essay will provide food for thought and purposeful Christian reflection. Here’s part 1:
Christians suffer in this life, not only because they live in a fallen world, but also because of their cross-bearing identity with Jesus Christ. Depression is one way that disciples of Christ suffer. With the advancement of medical technology, there is an ever-increasing range of psychotropic drugs available for treating the symptoms of depression. Arguably the most advanced are the selective serotonin reuptake inhibitors (SSRIs), of which Prozac is the most well known (and will be used as representative of this class of drug for the purposes of this essay). Since its release in 1986, Prozac has become the “most widely prescribed antidepressant in medical history.” (1) It has been known to elevate mood and even make some feel more than well. The medical community has been divided over biochemical changes in the brain relative to depression and Prozac. These facts have led many to raise concerns over whether laws, knowledge, and ethical practices are lagging behind in this new medical technology. (2)
Is it ethical for a Christian to take Prozac for depression? In this essay I argue that, in specific circumstances, it is appropriate to incorporate Prozac into a holistic approach to treating depression, provided that sacred means inform the secular. In navigating the ethical path that advocates a cautious use of antidepressants in treating depression, this essay is divided into four parts. In the first place, depression is contextualized in light of the Fall. Secondly, the Christian is called to and benefits from a life of suffering. Thirdly, the Christian must guard against the therapeutic narcissism of our age. Finally, it is argued that godly wisdom for restoration can draw upon both sacred and secular means.
For the purposes of this essay, “depression” excludes those with a history of significant mental illnesses such as Alzheimer’s and dementia. (3) Instead, drawing on the Diagnostic and Statistical Manual of American Association, 4th edition, the inner pain of depression can be described as, but not limited to, the experience of five or more of the following symptoms:
(i) Depressed mood most of the day; (ii) markedly diminished interest or pleasure in all, or almost all, activities of the day; (iii) significant weight loss when not dieting or weight gain; (iv) insomnia or hypersomnia nearly every day; (v) feeling physically restless or slowed to an extent that is observable to others; (vi) fatigue or loss of energy nearly every day; (vii) feelings of worthlessness or excessive or inappropriate guilt; (viii) diminished ability to think or concentrate; (ix) recurrent thoughts of death, recurrent suicidal thinking without a specific plan, or an actual suicide attempt. (4)
Thus, the term ‘depression’ used henceforth is of a more serious and crippling nature than normal sadness, and adjectives such as ‘major’ or ‘clinical’ are useful.
Sin, Suffering, and Bodily Flourishing
Had Adam passed his probation in the Garden he would have entered into a state of eternal embodied bliss (WCF VII.2). The story did not end that way. Instead, since Adam’s failure to keep the covenant of works, sin and death have ravaged body and soul ever since (WCF VI.2). Things are not the way they are supposed to be. (5) All of mankind now suffers to some degree.
By the grace of God, the story did not end east of Eden. Shortly after the Fall, God promised that he would once again restore a congregation of mankind to a state of eternal bliss and happiness (WSC 20; HC 57). Yet, while that process of recreation and restoration has been guaranteed and set in motion by the coming of Christ, God’s people still await its consummation (Mk. 1:15; Rom. 8:19-25; 2 Cor. 4:16; Rev. 21:1-4). In the tension of this already-and-not-yet age, God’s people wrestle to make sense of suffering (cf. Job; 2 Cor 12). In the case of depression, it is assumed to be a function of a mysterious combination of physical and spiritual causes, for we are body and soul creatures. (6) Physical causes stem from living in this fallen world and include fatigue, stress, disease, etc. (7) Spiritual causes arise from sinful responses to living in this fallen world as well as God’s loving chastisement. (8 ) In turn, it is assumed, though the medical community is divided, that depression can result from a chemical imbalance in the brain (brought on by physical and spiritual causes).
In this in-between age, God has provided medicine as a mercy by which some degree of bodily flourishing can be restored and can reasonably be extended to the treatment of depression. Prozac is a candidate for inclusion here. It is assumed that Prozac can both alleviate adverse physical symptoms resulting from depression as well as correct chemical (serotonin) imbalances in the brain. (9) Before an explicit consideration of Prozac for depression, wisdom is to be informed by the believer’s vocation of suffering, as well as guarded against the idolatrous pursuit of medicinally induced ‘happiness’.
- Quoted from: http://www.prozac.com, accessed 05-15-08.
- President’s Council on Bioethics (U.S.) and Leon Kass, Beyond Therapy : Biotechnology and the Pursuit of Happiness, 1st ed. (New York: ReganBooks, 2003), 214. I don’t pretend to be a medical expert and have written this essay as a theologian from a confessionally Reformed perspective. In addition, I assume as Biblical the ‘two kingdoms’ arguments used in this essay. In dealing with ethical questions surrounding medical advancement, there are few explicit biblical guidelines to which to appeal. There is not much to be found in the church fathers either.
- This category would also include bipolar disorder and schizophrenia and assumes a degree of brain damage. Excluding these illnesses does not imply ambivalence on my part, a lack of moral culpability for the sufferer, or the cause having no spiritual component.
- Depressed mood or loss of interest or pleasure being one of the symptoms to qualify (American Psychiatric Association. and American Psychiatric Association. Task Force on DSM-IV., Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv, 4th ed. (Washington, DC: American Psychiatric Association, 1994), 161-64.)
- Cornelius Plantinga, Not the Way It’s Supposed to Be : A Breviary of Sin (Grand Rapids, Mich.; Leicester, Eng.: Eerdmans ; Apollos, 1995).
- Eward T. Welch, Blame It on the Brain?, ed. Susan Lutz, Resources for Changing Lives (Phillipsburg: P & R Publishing, 1998), 44-48.; WLC 17; Louis Berkhof, Systematic Theology, 4th rev. and enl. ed. (Grand Rapids: Wm. B. Eerdmans, 1969), 191-201.
- Pastor and medical doctor Martyn Lloyd-Jones acknowledged the range of non-sinful physical problems that may induce depression. He also pointed out that certain melancholy personalities have a natural predisposition toward depression and that throughout history the best of Christians have been afflicted with this distemper (David Martyn Lloyd-Jones, Spiritual Depression: Its Causes and Its Cure (Grand Rapids: Eerdmans, 1965), 18-19.
- Persecution for one’s faith would include both physical and spiritual causality. Some theologians, like Jay Adams, have been less sympathetic to physical causes of depression and wants to locate much of blame and remedy in the spiritual realm (Jay Edward Adams, The Christian Counselor’s Manual (Grand Rapids, Mich.: Baker Book House, 1973), 375-83.)
- Furthermore, as a baseline starting point, it is assumed that Prozac does not adversely and irremediably remap the brain, and in most instances has manageable side-effects.