Elise Walters, a devout Christian, woke up every morning with one thought: "I want to die." Despite repeated prayers and counseling with standard spiritualizing remedies to "willpower" her way to wellness, Walters agonized every day with depression. (For reasons of confidentiality, the names of some people on antidepressants have been changed.)
Don Timons, a top executive in an evangelical organization, had a reputation for a bad temper that led to lashing out at coworkers. For Timons, a decade-long depression expressed itself in an anger he felt unable to control. Repeated confessions of repentance for his inappropriate outbursts accompanied repeated pleas to God for help with his rage-to no avail.
Three weeks after having been prescribed the antidepressant Prozac, Timons felt an underlying change that mushroomed into a transformation "akin to how I felt during my conversion experience." Not only did the depression lift, so did the uncontrollable anger.
Walters had a similar experience. A few weeks after taking Prozac, she says, "I felt like living again. And I began to experience God like I never had before."
Can it be that a pill can do what the Holy Spirit or human will could not? Why is it that a drug influencing the levels of a certain neurotransmitter can have such dramatic results in people when prayer and good intentions seem to have been inadequate?
These questions naturally lead to another: Can a pill bring us closer to God? Carlos Ramirez believes so. Diagnosed earlier this year with depression, Ramirez has been on Prozac for eight months. "It totally revolutionized my relationship with God. For years I had pleaded with God to change me. My depression was having a destructive effect on my marriage and on my ability to trust God. I can say now not only is my marriage more stable, but I feel closer to God than I ever have."
Prozac was introduced to the world in 1988 and has since raised obvious questions about depression and the unregulated use of antidepressants. But the drug is also a metaphor for advances in biopharmacology that are enabling scientists to pinpoint the chemicals and areas in our brains where our different personalities, quirks, and abilities are defined and to potentially adjust them based on our personal needs or wishes.
With such biopharmacological methodology in place, Christians must ultimately address a hard question: Are Prozac and similar antidepressants potentially a shortcut for people to feel good without the character-forming discipline of faith and religious belief?
Prozac's popularity is due to its remarkable success in curing clinically depressed patients. Prozac and its fraternal drugs, Zoloft and Paxil, use a flouxetine compound that helps the body increase its levels of serotonin. Serotonin is the neurotransmitter that has been linked with feelings of well-being. Depressed individuals typically have low levels of serotonin available to their brain cells because of its rapid absorption by other cells throughout the body.
Although earlier antidepressants have been as effective as Prozac in treating depression, Prozac has comparatively milder and fewer side effects-which may include edginess, nausea, insomnia, weight gain, and failure to reach orgasm during sex; the side effects of the older antidepressants include dryness of the mouth and eyes, sensitivity to bright light, blurry vision, constipation, anxiety, weight gain, cardiovascular problems, and various sexual dysfunctions.
Sixty to 80 percent of clinically depressed patients benefit from Prozac or similar antidepressants. ("Clinically depressed" means those who have a variety of symptoms, including low self-esteem, deep sadness, eating/sleeping/ sexual disturbances, or suicidal feelings.) It is not surprising, then, that, with 17 percent of the population suffering from major depression at some point in their lives, nearly 1 million Prozac prescriptions are filled each month in the United States alone.
Sales for Prozac reached $1.7 billion worldwide in 1994, making it one of the ten best-selling drugs in the world. Five million people are on Prozac in the U.S., and 10 million people worldwide. And the potential for more people taking Prozac is great. It is estimated that two-thirds of people with serious depression go untreated. In the past few years, the Federal Drug Administration has given approval to use Prozac for obsessive-compulsive disorder as well. Physicians are also using Prozac as part of the treatment for related illnesses, such as compulsive overeating.
Should Christians use Prozac?
Prozac's dramatic effect on people's lives raises a key question for many Christians: What is sin and what is biology?
Karenne Bloomgarden, 43, an entrepreneur and gym teacher, was diagnosed with depression and attention deficit hyperactivity disorder (adhd). As a child, she got into trouble regularly for her rowdy behavior and did poorly in school. After being put on Zoloft for depression and Ritalin for adhd, she told Time magazine, "I had 38 years of thinking I was a bad person. Now I'm rewriting the tapes of who I thought I was to who I really am."
With Prozac we once again find ourselves revisiting the old debate of nature versus nurture. Are individuals biochemically determined, or are they able to accept the ethical responsibility for their behavior? The answer to this question defines our basic concepts of sin, personality, soul, redemption, prayer, and suffering. Consider the man described in psychiatrist Peter Kramer's book Listening to Prozac. The patient was clinically depressed and addicted to pornography. Once on Prozac, not only did the depression lift, he also lost interest in ogling pictures of naked women. Prozac does not only help lift depression, but, as a result, it often helps people have better control of their behavior.
Kramer also documents how some of his patients became gregarious, better lovers, and more successful at climbing the corporate ladder. "Prozac seems to give social confidence to the habitually timid," he writes, "to make the sensitive brash [and] to lend the introvert the social skills of a salesman." In fact, one of Kramer's patients even describes himself as "better than well."
These powerful potential benefits actually make many Christians suspicious of the drug. Some fear that Prozac will make them less human or less sincerely Christian, and thereby out of God's will for their lives. Sylvia Swanson, 32, has found relief from her long struggle with depression by taking Prozac, but she still expresses some concern about using the drug: "I'm sometimes afraid that in this process I might stray too far from the path and that God won't take me back."
Others worry that Prozac might lead them to do something wildly uncharacteristic, like becoming violent or committing some criminal act. Though several court cases have cited Prozac as being a motivator behind episodes of violent acts, including murder, the drug has never been medically or legally proven to trigger such behavior. Says Victoria Murphy, a representative for Eli Lilly, Prozac's manufacturer, "Those types of claims are simply attempts to diminish one's personal responsibility for his or her actions."
Ultimately, the primary concern for Christians is not what Prozac will do to them but the whole idea of relying on a miracle drug for emotional and psychological well-being rather than on the God of miracles.
Most Christian practitioners do not have a problem with using Prozac to treat severe depression. David Wolfe, a Christian philosopher who pastors a small community church in rural New England, has helped his parishioners think through the issues Prozac raises. He counsels that it is no more shameful or weak to accept psychoactive medication to attain a return to mental health than it is to do so for physical problems such as ulcers. "God loves us and wants us to function optimally as persons so we will be better equipped to do his will," he says.
Archibald Hart, dean of the School of Psychology at Fuller Theological Seminary, agrees: "The human discovery of God's creation is what science is all about. For example, God has created substances from which we make anesthetics. This is a wonderful gift from God. As is Prozac."
Ted Lorenc, a Catholic family practitioner, believes Prozac should be viewed as spiritually neutral at worst and as an aid to spirituality at best. "I don't see it as a threat to Christian spirituality," he says. "If someone has 'innate spirituality,' Prozac will not replace that genuine relationship with God. If, on the other hand, depression is repressing that spirituality, Prozac may help lift part of that block."
Dangers and doubts
Christians, however, also agree that Prozac should be approached with carefully defined parameters. For example, Hart and bioethicist Nigel Cameron at Trinity International University are cautious about the use of Prozac. "If a person is clinically depressed, it is no different than giving insulin to a diabetic," says Hart. "But I don't believe it should be used on mildly depressed people or to enhance performance."
The danger many see is that doctors will agree to prescribe Prozac too readily. In one extreme case, in the town of Wenatchee, Washington, Dr. James Goodwin was dubbed "the pied piper of Prozac" for having prescribed the antidepressant to more than 600 people in a town of 21,000. In justifying his actions, he told a tv interviewer, "I think all human beings, on some level, have some degree of depression."
On a recent Oprah Winfrey Show about Prozac, the audience responded vehemently against the panelist who suggested that the person who took Prozac to mask the pain of losing a pet kitten was making a mistake. "We have a right to not feel bad!" yelled one audience member.
Karen Maudlin, a clinical psychologist in Wheaton, Illinois, worries that the problem of treating everything with a pill is that one may miss out on the real causes of depression, anxiety, and sin in a person's life. "If a timid person who wants to be more assertive at work takes Prozac without dealing with the issues that make him timid, the message becomes the opposite of what we try to do with therapy, which is to understand the emotional issues that make us behave in certain ways," she says.
While some patients on Prozac and related drugs are exhilarated over their transformations, others end up with serious existential questions. Francisco Morales, 35, a biochemistry doctoral student, suffered from severe obsessive-compulsive behavior before taking Zoloft and has found the drug affecting his relationship with God in an unforeseen way. "I've become almost too comfortable with my sinfulness," says Morales. "It's such a heady thing feeling so free. There are days I feel hedonistic; it's like being on vacation from the person I used to be." And Tracy Thompson writes in the Saturday Evening Post that despite the wonderful changes the drug brought into her life, she wonders, "Who am I? Am I my mechanical self, no matter how unhappy that may make me? Or should I swallow this pill, achieve tranquility, and risk obliterating some essential part of me?"
Thompson's concern is worth exploring, especially for the Christian. When we seek to eliminate those parts of our psyche that suffer, are we removing an "essential" part of who we are or of what God is using to transform us?
Prozac can be abused, says Diane Komp, a Christian physician at Yale Medical School and author of Hope Springs from Mended Places. "Almost every branch of medicine sees abuses," she contends. "For example, cosmetic surgery is important to treat sustained serious burns; but it is the same technique used for tummy tucks and face lifts."
While it is one thing to change the shape of one's nose or the color of one's eyes, changing one's psyche for motives of personal enhancement raises entirely new issues regarding the value of suffering and our society's growing assumption that angst of all kinds must be purged.
The crucible of pain
As Christ's sufferings on the cross revealed, pain is often a vital component of determining what is profitable in life and faith. "In The Road Less Traveled, M. Scott Peck says that mental illness is the avoidance of necessary pain," observes Komp. "You have to ask what is necessary pain, unnecessary pain, and pain in-between. Does medication take away enough pain to allow a patient to do necessary work? Or is it just used to dull pain?"
Adds Hart, "Suffering is a way in which God helps us get in touch with who we are. Discipleship is long and narrow; there are no shortcuts."
The key question remains: Is Prozac being seen as a shortcut? Hart and others insist that part of the Christian understanding of spiritual maturity is that God does not always take us out of the purifying fire. In fact, growth often comes from learning how to deal with painful aspects of life. "Simply taking Prozac to deal with emotional pain builds no character," says Hart. "It can be the emotional equivalent of using steroids." Indeed, spiritual growth cannot happen independent of character development and discipline, which are regularly forged in the crucible of pain.
But is "toughing it out" with emotional problems the only option for mature Christians? What is the role of willpower and prayer for those trying to overcome depression, low self-esteem, and self-defeating habits? Can drugs like Prozac be part of how Christians cope? Dan Van Ness, an evangelical leader who has taken Prozac to treat depression, says, "A diabetic without insulin cannot will himself to health. And a person who is depressed because of chemical imbalances may not be able to will himself to constructive behavior."
Adds Lewis Smedes, an ethicist and theologian who recently retired from Fuller Theological Seminary, "God often uses different methods to release in us the will required to take the constructive step. He knocks Saul off his horse, an angel appears to Mary, and a scientific breakthrough like Prozac frees people from paralyzing depression. We often need God's intervening hand to help us do what we cannot do on our own."
Prozac and the soul
For Smedes and others, Prozac's power is proof of the embodiment of the soul. "So often we think of the soul as an inhabitant inside the body but not of the body," says Smedes. "But we have seen how we can affect the soul by whacking at the body. And we know that a good night's sleep can be good for one's soul: with it one wakes up more hopeful, and without it one becomes grouchy and pessimistic. Our souls are what is related to the transcendent, but that involves our whole being, including body and mind."
Many Christians using Prozac say that it has helped them experience in their hearts what they have believed in their heads: that there is a God who can touch every area of life, including the emotions. But these stories do not mean that Prozac has a power that prayer does not, asserts Hart. "When someone has a successful appendicitis surgery, we don't say that the surgery was more powerful than prayer. In that sense, the advent of Prozac could be considered an answer to the prayers of many hopelessly depressed Christians."
And so, the same issues that emerge in dealing with other gifts from God, such as money, sex, power, and freedom, must also apply in how we relate to Prozac. Christians in earlier times and cultures have also had to confront issues regarding the integration of their faith with contemporary technology and events. Prozac is one of those powerful technologies that Christians today must learn to relate to with discernment. As Paul writes, "All things are permissible, but not all are profitable" (1 Cor. 10:23). Determining what is profitable demands spiritual wisdom and sometimes strenuous reflection.
So, will Prozac replace religion? "If religion is only to make people happy, then Prozac can replace religion," says Smedes. "But if religion is to bring people into contact with ultimate reality, then Prozac cannot. Happiness is a bonus, not the end goal."
Adds Van Ness, "Just about anything God gives us can take the place of religion and become a substitute for dealing with God, but this is not a reason to avoid falling in love-or taking Prozac. We can deify Prozac and its effects as we can deify everything else."
Clark E. Barshinger and Lojan E. LaRowe are a husband-and-wife team in private practice at Cherry Hill Center for Counseling and Psychotherapy in Lake Zurich, Illinois. Andrs Tapia is an associate editor with Pacific News Service. The three are coauthors of Haunted Marriage: Overcoming the Ghosts of Your Spouse's Childhood Abuse, which will be released by IVP in October.
SIDEBAR p. 36
Sylvia Swanson, a 32-year-old securities analyst who has struggled with deep-seated depression since she was in junior high school, discovered an unimaginable freedom in her life after going on Prozac. But the drug has also changed her ideas about Christian spirituality.
God has used Prozac to change my life, but it's ironic that before Prozac I was more accepted in church. I always did what other people expected me to do. I frequently faked my spirituality. I seemed to be doing great on the outside, but inside I felt like life was not worth living, and I resented God for it.
Religion-the rules and expectations of spirituality-actually gave me an external structure to compensate for my lack of internal stability. I needed someone in authority telling me what to do. But as the fog of severe depression lifted, I started making independent choices that were not always met with people's approval. For example, now I don't go to church every Sunday. I used to not miss a single service, not because of a true desire to be with God, but because of my fear of others' disapproval. Now I go because I truly desire to be in God's presence. So, in the sense that I no longer feel the need to fake my spirituality, Prozac has replaced religion for me-though it has not replaced true spirituality.
SIDEBAR p. 37
From Obsession to Love
Since taking Zoloft, an antidepressant similar to Prozac, Francisco Morales, 35, has found relief from his lengthy battle with depression and obsessive-compulsive disorder (ocd). But, says Morales, he has also been forced to re-evaluate his relationship with God.
Before Zoloft, I obsessed about being perfect. Whenever I felt I sinned, I couldn't shake the obsession of how bad I was and that it was up to me to forgive myself. Of course, I couldn't, and I always ended up trapped in feelings of guilt and anger. Once Zoloft kicked in, I found I could simply accept that I was not perfect; I was at peace about my sinfulness and accepted the fact that only God, and not I, could save me.
On the other hand, living without ocd has lowered my drive to deal with my sins. I've had to ask myself, Why am I a Christian? I now realize that before Zoloft, much of my motivation to follow Christ was out of a desperation to feel good about myself. But if I can now feel good without God, why follow him?
Zoloft put me in a position where I needed to decide again whether I wanted to follow Christ and determine why. I've concluded that I want to follow him because I love him, not because of what he can do for me. In that way, Zoloft has helped me arrive at a more mature view of my Christian walk.
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