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Conclusions to a Christian Approach to Prozac: By Simon Jooste, Part 3

5 June, 2008

Towards Restoration by Sacred and Secular Means (1)

The Christian is not to be conformed to the world’s pattern of thinking (Rom. 12:2). Yet, it is particularly tempting to bow the knee to the pharmacological fruits for therapeutic narcissism and its pragmatic ethic, especially when the billows of suffering roll in. Prozac can be a tempting easy fix. Where does the depressed Christian look for restoration? The theology of the cross directs the Christian to the means of grace as the fount of comfort, the place where true identity, reality, and destiny are proclaimed afresh each Lord’s Day. In turn, sacred means aid in discerning wise use of secular means, such as Prozac.

Ministry of Word and Sacrament

Through his ordinances, especially the Word, Sacraments, and prayer, Christ communicates the benefits of redemption (WSC 88). In the Word, the depressed are built up in holiness and comfort, through faith unto salvation (WSC 89). In baptism, the depressed are assured of their ingrafting into Christ (WSC 94). In participation in the Eucharist, the depressed feed unto spiritual nourishment and growth in grace (WSC 96). The depressed and the saints (on behalf of the suffering) pray in the power of the Spirit for increase in faith and healing.

In turn, the church, created by the Word and sacraments, becomes a balm of comfort to the distressed, each member doing his and her part. In accordance with the Word, the elders are to pray over the depressed (Js. 5:14-15). The minister, as the trained physician of the soul, is to be sought out for private counsel and prayer. The community of believers is called to show compassion and carry the burdens of the weak (Gal. 6:2; 2 Cor. 1:4). (2)

Some, who avail themselves of the spiritual means offered by the church, may invariably emerge from the pit of depression. Often, under the ministry of the Word, roots of sinful thinking and behavior are exposed, or a season of spiritual testing passes.a season of spiritual testing passes. (3) Others, no matter how spiritual, may continue to linger in the valley.

Sanctified wisdom in using secular means (4)

Common reason dictates that there are some practical (general revelation) avenues to explore before considering the medicinal option. A minister, friend, or doctor may notice issues of lifestyle that may be causing, if not exacerbating, depression. For example, stress and lack of adequate rest can lead to a dejected spirit. Poor diet and lack of exercise has been known to cause, if not accentuate, the ‘blues.’ Chronic pain can color one’s world in shades of grey. In addition, a difficult job or living arrangement can be the culprit of depression. A change in lifestyle, to the degree one is able, or a trip to the doctor can help lift depression. (5) For some, however, the black cloud lingers. In the same way God has used means, even physical (cf. sacraments), for spiritual flourishing, he has mercifully made medicine, such as Prozac, available for our temporal bodily well-being. (6) Doctors are to be sought out as God-ordained physicians of the body, and that only. Consideration of Prozac assumes the depressed individual is making every effort to be ‘in the way of’ spiritual means and has explored the common grace avenues already mentioned.ual means and has explored the common grace avenues already mentioned. (7) Of preliminary importance, are those practical concerns surrounding the administration of Prozac. For instance, the side effect/s of taking Prozac may be so adverse that to continue would be irresponsible. (8 ) Another concern is the cost of the drug. If an individual does not have insurance, it may not be wise to take on the financial burden of paying for the medication. (9)

In addition to these more practical considerations, wisdom teaches that an individual prescribed Prozac be monitored by the church session, family, and broader covenant community. With the four pillars or ethical contours of spiritual flourishing mentioned above in mind, appropriate questions may be asked. Such include,

  • Is Prozac an accomplice to numbing the conscience to sin and encouraging self-sufficiency instead of a life of faith?
  • Is Prozac increasing the temptation to bear fruits of the flesh (direct violations of God’s law) instead of fruits of the Spirit (virtue)?
  • Is Prozac helping obscure the reality of the Christian life as being one of suffering and cross bearing?
  • Is Prozac inhibiting a person to love God and his neighbor, and thus bring glory to the Lord?

The complexity of depression and the psychosomatic effect of Prozac require much wisdom and prudence on behalf of loved ones. While there is no formula, and each individual case of depression is unique, over time it may become apparent that spiritual flourishing is being hindered to such an extent that a reduction in dosage, if not discontinuation of Prozac altogether is called for. (10)

In an ideal case, Prozac can be a mercy from God to help alleviate the incapacitating physical symptoms that accompany depression, while allowing the spiritual life to flower once again. As one remembers that the physical and spiritual are intertwined, hope is that Prozac can help the depressed mother to get out of bed for church on Sunday, the father of five to concentrate sufficiently on the clock (so as to keep his job), and the ex-POW to sleep through the night. In other words, Prozac can aid an individual in returning to a base level of functionality again. A state of being in which faith is freed once again to feel the symphony of emotions found in the Psalms, to love one’s neighbor, to have the capacity to suffer when called upon, and to prayerfully orient one’s life to the glory of God. Prozac is neither the gospel nor a means of grace. (11) With time, hopefully Prozac may be discontinued, if not the dosage reduced. (12) Preferably, Prozac is neither the first line nor the long-term source of restoration for the depressed. (13)

Conclusion

Neuroscience is a young field and the expansion of medical technology is astounding. (14) The use of antidepressants share in common with other medical advances difficult bioethical questions. While not claiming to be a medical expert, I have nonetheless made a theological argument for Prozac assuming that physical and spiritual causes can effect some unfavorable change in the chemistry of the brain, thus creating a depressed state. This essay anticipates confirmation by the medical community of this assumption, thus providing much needed care to suffering individuals in specific and controlled cases. However, should science disprove any relation between brain chemical levels and depression and/or reveals adverse long-term effects of antidepressants, the holistic approach to restoration argued here does not commit the Christian to using Prozac. In the meantime, wisdom informed by sacred and secular means, coupled with sensitivity to culture’s therapeutic narcissism, permits cautious use of drugs like Prozac.

  1. It is assumed that the Bible attests to the fact that because Christians no longer live in Apostolic times, God does not ordinarily heal physical illness miraculously, but through common grace means. However, realizing that depression can have a spiritual dimension, it is assumed that God can, through sacred means, heal.
  2. There are no doubt other things that the body of Christ can do for a depressed individual. Such include singing of psalms and hymns to lift the spirits, just being present during difficult times, and meeting physical needs (like providing meals). Ed Welch has provided some very helpful personal spiritual exercises to help combat depression in Edward Welch, Depression: A Stubborn Darkness –Light for the Path (Winston-Salem: Punch Press, 2004).
  3. Dr. Martyn Lloyd-Jones provides a helpful diagnostic list for spiritual depression in Lloyd-Jones, Spiritual Depression: Its Causes and Its Cure. It is fair to say that just brain chemistry may be effected by physically and spiritually caused suffering in this life, thus encouraging depression, the spiritual joys derived from spiritual means can also effect brain chemistry, and thus help lift a person out of a depressed state.
  4. Secular means defined as common grace gifts, including the fruits of scientific discovery, available to all (as distinct from special grace means mentioned above). See Abraham Kuyper, Lectures on Calvinism (Grand Rapids, Mich.: Eerdmans, 1931), 110-41.
  5. Proverbs and Ecclesiastes provide practical wisdom for living. Among other things, diligence is rewarded and ceaseless toil to be avoided (Prov. 10:4; 12:27; 13:4; Eccl. 2:11, 22; 4:6.) It is assumed that a psychologist or psychiatrist may be sought out (with care and the counsel of the church session).
  6. The Bible is not to be read as a medical journal or a comprehensive reference for solving issues of medical ethics. Some have taken a Biblicist approach to medical ethics and in so doing ignored the wealth of knowledge to be harvested from the common grace realm to the detriment of the sick (cf. John M. Frame, Medical Ethics: Principles, Persons, and Problems (New Jersey: P & R, 1988).) For those concerned about how the likes of Prozac can potentially alter one’s state of mind (elevate mood), it is interesting how the stimulating effect of caffeine is generally considered permissible, and how the Bible encourages “strong drink for the one who is perishing, and wine to those in bitter distress” so that they might “remember their misery no more” (Prov. 31:4-7; cf. Eccl. 9:7; 10:19.)
  7. I realize that a suicidal individual may make a profession of faith but have a sparse history of churchgoing and lead a destructive lifestyle. In this case, the individual may need Prozac for immediate stabilization, if not hospitalization.
  8. For example: some patients experience an inability to sleep well while on Prozac. Most doctors would work with a patient until a drug with the most tolerable combination of side effects is found.
  9. Again, if the individual is suicidal, cost should not be a factor. The church deaconate, family, or friends might be sought out for financial aid.
  10. For suicidal individuals and those with severe (excessive) bodily symptoms associated with depression, continuation of Prozac, even in light of spiritual ‘loss’ is the way of wisdom. In this instance, the higher good is to be pursued.
  11. It is one thing to supplant the gospel with Prozac and quite another for someone to admit he needs something to make him well enough to pray (Gordon Marino, “The Pharmaceutical Option: Job on Prozac,” Christian Century 120, no. 16 (2003).)
  12. Granted there is oversight from a doctor.
  13. I realize there will be exceptions. Prozac might need to be administered immediately for the suicidal and a highly traumatized individual may require long-term treatment.
  14. President’s Council on Bioethics (U.S.) and Kass, Beyond Therapy : Biotechnology and the Pursuit of Happiness.

Selected Bibiliography

Adams, Jay Edward. The Christian Counselor’s Manual. Grand Rapids, Mich.: Baker Book House, 1973.

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.

Bauman, Zygmunt. Liquid Modernity. Cambridge, Malden, MA: Polity Press; Blackwell, 2000.

Berkhof, Louis. Systematic Theology. 4th rev. and enl. ed. Grand Rapids: Wm. B. Eerdmans, 1969.

Degrazia, David. “Prozac, Enhancement, and Self-Creation.” In The Hastings Report, 34-40, 2000.

Frame, John M. Medical Ethics: Principles, Persons, and Problems. New Jersey: P & R, 1988.

Horton, Michael S. Too Good to Be True: Finding Hope in a World of Hype. Grand Rapids: Zondervan, 2006.

Joel Shuman and Brian Volck, M.D. Reclaiming the Body: Christians and the Faithful Use of Modern Medicine. Edited by David S. Cunningham and William T. Cavanaugh, The Christian Practice of Everyday Life. Grand Rapids: Brazos Press, 2006.

Kramer, Peter D. Against Depression. New York: Viking, 2005.

—. Listening to Prozac. New York, N.Y., U.S.A.: Viking, 1993.

Kuyper, Abraham. Lectures on Calvinism. Grand Rapids, Mich.: Eerdmans, 1931.

Lasch, Christopher. The Culture of Narcissism : American Life in an Age of Diminishing Expectations. New York: W.W. Norton & Company, 1991.

Lloyd-Jones, David Martyn. Spiritual Depression: Its Causes and Its Cure. Grand Rapids: Eerdmans, 1965.

Loewenich, Walther von. Luther’s Theology of the Cross. Minneapolis: Augsburg Pub. House, 1976.

Marino, Gordon. “The Pharmaceutical Option: Job on Prozac.” Christian Century 120, no. 16 (2003): 18-20.

Meilaender, Gilbert. Bioethics : A Primer for Christians. 2nd ed. Grand Rapids, Mich.: W.B. Eerdmans Pub. Co., 2005.

Plantinga, Cornelius. Not the Way It’s Supposed to Be : A Breviary of Sin. Grand Rapids, Mich.; Leicester, Eng.: Eerdmans ; Apollos, 1995.

President’s Council on Bioethics (U.S.), and Leon Kass. Beyond Therapy : Biotechnology and the Pursuit of Happiness. 1st ed. New York: ReganBooks, 2003.

Rieff, Philip. The Triumph of the Therapeutic: Uses of Faith after Freud. [1st ed. New York: Harper & Row, 1966.

Stapert, John. “Curing an Illness or Transforming Self? The Power of Prozac.” Christian Century, no. July 13-20 (1994): 684-87.

Valiunas, Algis. “Sadness, Gladness-and Serotonin.” Commentary 121, no. 1 (2006): 59-63.

Welch, Edward. Depression: A Stubborn Darkness –Light for the Path. Winston-Salem: Punch Press, 2004.

—–. Blame It on the Brain? Edited by Susan Lutz, Resources for Changing Lives. Phillipsburg: P & R Publishing, 1998.

Wilson, Eric G. Against Happiness : In Praise of Melancholy. 1st ed. New York: Farrar, Straus and Giroux, 2008.

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