Job on Prozac: the pharmaceutical option

Christian Century, August 9, 2003 by Gordon Marino

IN THE BIBLICAL story, God tests his faithful servant Job to see whether Job will stay devoted to God even if God takes everything away from him. Now you don't lose your family, health and possessions, as Job did, without falling into a terrible funk. It's possible, then, to understand Job's story as being about remaining true to God through a devastating depression. Suppose that Job had had a prescription for Prozac to help lessen his pain. Would it have been cheating to take a couple of tablets a day while God was tossing all manner of pestilence at him?

I suspect that if Job were around today, he would be strongly advised to get himself to a mental health clinic for a prescription. After all, the most important thing is to keep following the Lord. If depression prompts you to turn off the road, and Prozac keeps you on it, then don't think twice--take your pill.

In his Doctrine of Virtue, Immanuel Kant argues that we have an indirect duty to make ourselves happy, because when we are miserable we are less likely to fulfill our moral duties. Similarly, it could be argued that if I know that I lose faith in God when I am blue, then I have an indirect religious obligation to take medications that will protect me from depression.

In his recent book Finding God in Prozac or Finding Prozac in God: Preserving a Christian View of the Person Amidst a Biopsychological Revolution, Charles Biovin contends that Christians should not hesitate to use the new brands of antidepressants such as Prozac and other selective serotonin reuptake inhibitors--commonly referred to as SSRIs--as spiritual lifesavers. Biovin argues that even a casual study of the Old Testament reveals that the fathers of our faith might today be classified as reductionists who believed that the soul and body are one. The Hebrew prophets would have been quick to agree that melancholy is a physical malady.

While I am not as sanguine as Biovin about either the efficacy of SSRIs or the claims that they are physically innocuous, many people have found a balm in this new class of medications. A friend swears that Prozac saved her life. Other people attest that if it were not for antidepressants they might have died to the idea of a personal God. In a Christianity Today article, a woman states that while she was depressed she went to church only because she feared the frowns of other parishioners. However, after a few weeks on Prozac her motivation changed. "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."

As Biovin observes, It is perhaps this aspect of the Prozac revolution for persons of faith that is the most provocative. Not that it can enhance emotional or psychological well-being where prayer did not; rather, that it reveals to us more than ever just how inextricably interwoven the biochemistry of the brain is to who we are and how we relate to each other. Whether we like it or not, Prozac and its successors have become enmeshed in the fabric of day-to-day American life and cannot help but challenge persons of faith to reconsider the nature of spiritual well-being and renewal."

Things like Prozac, Alzheimer's disease and taking a few stiff drinks all remind us that biochemical changes in the body can radically affect the way we think and feel. Nevertheless, these reminders do not compel us to believe that our feelings are simply the echoes of chemical perturbations. The fact that physical interventions can alter our experience in systematic and predictable ways does not imply that all our experiences are reducible to physical causes. But Biovin is correct that perfervid faith in pharmaceuticals challenges traditional ideas about psycho-spirituality, perhaps in ways that should give us pause.

FOR ALL the fanfare about radical breakthroughs in neuroscience, we have no scientific reason to believe that our emotional lives can now be understood in purely physical terms. The relative success of the use of SSRIs in treating depression suggests that there may be some relation between neurotransmitters and melancholy; however, that is about as far as our current knowledge goes. In his comprehensive atlas of depression, The Noonday Demon, Andrew Solomon observes: "It is comforting to think that we know the relationship between neurotransmitters and mood, but we don't. It appears to be an indirect mechanism. People with lots of neurotransmitters bumping around in their heads are not happier than people with few neurotransmitters. Depressed people do not in general have low neurotransmitter levels in the first place. Putting extra serotonin in the brain does no immediate good at all."

More than a few who suffer from depression do not respond to medication but do respond to intensive psychotherapy. Serotonin aside, many people marvel over brain-imaging studies as though the MRI were a font of revelation. However, the fact that parts of the brain light up or fail to light up in depressed people is hardly proof that biochemical processes alone are responsible for depression. There are neurological correlates for every form of mental activity, and, as Biovin himself acknowledges, just because imaging studies show that religious experiences are correlated with activity in a particular part of the brain, it does not follow that that activity is the cause of religious experience. Whether or not depression is best understood in biochemical terms remains an open scientific question.