Prozac and the Promises of God
The Christian Use of Psychoactive Medication
ABSTRACT: Suffering touches both our bodies and our souls, and so too should our solutions to suffering. Many Christians rightly have approached psychoactive medications with caution, worried that such prescriptions might smother deeper spiritual issues. But helpers committed to a holistic, God-centered approach to treatment can learn to see medications as a gift from God and as one potential source of help as they ask, “What seems wisest for this particular person with these particular struggles at this particular time?”
Basic familiarity with psychoactive medications is increasingly valuable for pastors, counselors, and other helpers in the church. We live in a time when more and more problems in living are attributed to brain-based dysfunction. Medication is touted as an important (if not the most important) aspect of treatment within the psychiatric community. In popular street-level understanding, it is often the treatment of choice.
Christians remain divided on this issue. Some would say that medication is often appropriate, viewing it as a God-given tool to relieve mental suffering. Others are more cautious, recommending medication only in more severe situations. Still others regard the use of psychoactive medication as a “cop-out,” arguing that a basic posture of gospel-centered obedience is all that is really necessary. Who is right? How should we think about this important issue?
Certainly, it is important to speak with our health-care providers about the biomedical aspects of these medications, including the research-based evidence for their effectiveness (or not), side effects, and available alternative treatments. We should be well-informed medically. But as Christians, we also need a biblically based philosophy to guide the use or nonuse of psychoactive medications.
Foundation: Body-and-Soul Anthropology
How should we assess the use of psychoactive medications from an explicitly biblical perspective? After all, you won’t find “Prozac, Uses Of” in your Bible’s concordance! The best starting point is to remember that God created us as body-spirit creatures (Genesis 2:7; Ecclesiastes 12:7; Matthew 10:28). We are physically embodied, spiritual beings created by God to honor and worship him. We are simultaneously body and soul. There’s never a time we are not spiritually engaged. And there’s never a time we are not bodily engaged. This means that attention to both physical and spiritual aspects of our personhood is mandatory in the care of others. It is profoundly dehumanizing to ignore the “heart” — our moral-spiritual disposition (Proverbs 4:23; 27:19) — and the responsibilities that go with it. And it is profoundly dehumanizing to ignore the body and the strengths and weaknesses that go with it.
With this foundation informing what follows, I will discuss four biblical perspectives that should shape our approach to psychoactive medications. You will notice that each biblical perspective is balanced. This reflects the nuances of God dealing with us as body-spirit image-bearers and the varied ministry priorities that are simultaneously in play as we engage in one-another ministry.
Relieving and Redeeming Suffering
Biblical perspective #1: Relief of suffering and growth in Christian character in the midst of suffering are both important.
When the kingdom comes in Jesus Christ, you see God’s heart with regard to suffering in two ways. First, it is God’s design to relieve the suffering that arose as a result of the fall. Consider how Mark 1 describes the activities of Jesus’s ministry: teaching, exorcisms, healing those with various diseases, prayer, and cleansing a leper. Peter put it this way to Cornelius:
God anointed Jesus of Nazareth with the Holy Spirit and with power. He went about doing good and healing all who were oppressed by the devil, for God was with him. (Acts 10:38)
Clearly, a mark of the inbreaking kingdom is the relief of suffering. As the Christmas hymn “Joy to the World” reminds us, Jesus “comes to make his blessings known far as the curse is found.” Relief of suffering is good and necessary. This is in fact where history is going; in the new heaven and earth there will be no crying or pain (Revelation 21:4). So, when we seek to bring relief from suffering now, we are keeping in step with God’s plan of redemption. As the Puritan Jeremiah Burroughs said, contentment is “not opposed to all lawful seeking for help in different circumstances, nor endeavoring simply to be delivered out of present afflictions by the use of lawful means.”1 I believe medications can certainly be one of those lawful means. There is nothing inherently wrong with seeking relief from present suffering.
“There’s never a time we are not spiritually engaged. And there’s never a time we are not bodily engaged.”
Still, you see a second strand of teaching in the New Testament: God’s design to redeem the experience of suffering for believers because of their union with Jesus, the Suffering Servant. Paul calls this participation in Jesus’s sufferings (Philippians 3:10 NIV). By virtue of our being in Christ, God is at work in the midst of our suffering, conforming us to the image of Christ. This is the very gateway to experiencing his resurrection power and glory. Many New Testament passages showcase this central teaching, including Romans 8:16–25, 2 Corinthians 1:8–9, 2 Corinthians 4, 2 Corinthians 12:9–10, Philippians 3:10–11, Colossians 1:24, James 1:2–5, and 1 Peter 4:12–13.
Former seminary professor Richard B. Gaffin Jr. sums up these passages this way:
It is so natural for us to associate suffering only with the delay of Christ’s second coming and to view suffering only in the light of what we do not yet have in Christ; but when this happens, we have lost sight of the critical fact that in the New Testament, Christian suffering is always seen within the context of the coming of the kingdom of God in power and as a manifestation of the resurrection life of Jesus.2
In other words, God is at work redemptively in the midst of our sufferings by virtue of our being united with the One whose suffering ultimately led to resurrection and glory.
So, while relieving suffering is a kingdom priority, seeking mere relief without a vision for God’s transforming agenda in the midst of suffering falls short of God’s design for flourishing human life. Another way of saying this is that we should be glad for symptom relief but simultaneously look for the variegated fruit of the Spirit: perseverance in the midst of suffering, deeper trust in the Father’s love, more settled hope, love for fellow strugglers, gratitude, and more.
What does this mean with regard to the use or nonuse of medications? Don’t be too quick to cast off suffering as though immediate relief from trials is the only good God is up to. And don’t think it’s more “spiritual” to refrain from taking medications, as though character refinement through suffering is the only good God is up to. He is interested in both relief of suffering and refinement of character. We don’t choose our suffering in some masochistic way. Yet we are called to a life of walking in the footsteps of our suffering Savior. Christ teaches us a cross-centered and dependent lifestyle in all situations (Luke 9:23).
Gifts or Gods?
Biblical perspective #2: Medications are gifts of God’s grace and medications (like any gift of God) can be used idolatrously.
I believe it is right to view the development of psychoactive medications as a good gift from God, an extension of the ruling and stewarding function he gave to humanity at creation (Genesis 1:26–28; 1 Corinthians 10:31). At its best, scientific discovery explores God’s world in all its astounding complexity and seeks to alleviate some of the misery we experience as fallen creatures in a fallen world. As such, we should receive medications gratefully and humbly, but not forgetting the One who has given the necessary gifting and wisdom to scientists and physicians to discover such remedies. Ultimately, he alone upholds all things with his righteous right hand (Isaiah 41:10).
“How a person responds when the medication works — or doesn’t work — reveals her basic posture before God.”
Sadly, however, I have met people who are better evangelists for Prozac than they are for the living God. Rather than viewing medication as simply one component of a full-orbed, God-centered body-soul treatment approach, they view it almost as if it were their salvation. By definition, this is idolatry: attributing ultimate power and help to something other than our triune God (Jeremiah 2:11–13). If a person believes that what ultimately matters is fine-tuning the dose of his Paxil, and finds discussion of spiritual things superfluous or irrelevant, that’s a problem. Gifts are not meant to become gods.
How a person responds when the medication works — or doesn’t work — reveals her basic posture before God, her place of ultimate hope. Thanksgiving and a more fervent seeking after God in the wake of medication success say one thing; a lack of gratitude and a comfort-driven forgetfulness of God say another. A commitment to trust God’s faithfulness and goodness in the wake of medication failure says one thing; a bitter, complaining distrust of his ways says another.
So, we should receive the gift but look principally to the Giver. Whether a medication works or not, God is always working on behalf of his people.
Motives Good and Bad
Biblical perspective #3: A person can have wrong motives for wanting to take medication and a person can have wrong motives for not wanting to take medication.
Often, the most important issue in the use of medications is the attitude of the person to whom you are ministering. It’s not that psychoactive medications in themselves are either “good” or “bad.” Rather, how a person views and handles this potential treatment makes the difference. Motives matter. I’ve talked with people who want a referral for medication immediately without really wanting to examine their desires, fears, thoughts, choices, and lifestyle. And I’ve talked with people who resist the recommendation to consider the use of medications for self-oriented reasons. Let me elaborate on these two scenarios.
What are problematic reasons for wanting to take medication? One reason is a demand for immediate relief coupled with doubt about the benefits of looking at potential underlying issues. I remember meeting once with a young man with a recent history of anxiety associated with public speaking. Some of the things he said pointed to underlying tendencies toward people-pleasing and a fear of failure — much to work with from a gospel perspective! But he was not interested in biblical counsel. He was not interested in a gospel perspective on his struggle. Rather, he had made an appointment for the sole purpose of obtaining my recommendation for a provider who could prescribe an antianxiety medication.
A second questionable motive for wanting to take medication involves caving in to the pressures of others. Family and friends may push for medications due to their own discomfort in seeing the suffering of their loved one. Sometimes the pressure reflects a selfish desire to have their loved one back to normal so that life would be easier for them.
“What seems wisest for this particular person with these particular struggles at this particular time?”
But there also exist problematic reasons for not wanting to take medication. Resistance to medication can be an issue of pride and self-sufficiency: “I should be strong enough without medication.” Or the more spiritualized version: “I should be able, by trusting God more, to do this without medication.” Another reason could be fear of disapproval and judgment by others: “What would people think?” Yet another concern is shame: “There’s something seriously wrong with me if I have to take this medication.”
Despite some who struggle with these aberrant motives, many people sincerely want to grow in Christ in the midst of their mental suffering and simply wonder about the pros and cons of medication. Many rightfully wonder about the potential side effects of using medication. These thoughtful persons remain open to starting — or not starting — medication, which is a wise posture before the Lord.
One final note: Unless you have a license to prescribe medications, you will not be recommending per se that someone take (or not take) medications. The decision to start a medication should be made in consultation with a trusted physician. It is appropriate for a pastor or counselor to suggest such a consultation or assessment, although many people have already seen their physician by the time they discuss matters with their pastor.
Interdependence of Body and Soul
Biblical perspective #4: Christians pay attention to the complex and mysterious interface of body and soul, particularly the influence of our bodily constitution on our spiritual life.
As I mentioned earlier in this article, Scripture treats us as unified beings, having both spiritual and somatic aspects.3 Given that we are fully integrated, body-and-spirit (heart) creatures, it is not surprising that bodily strength or weakness affects us spiritually and vice versa. I’ll focus on the influence of our somatic condition on our spiritual lives.
Here’s a simple example. Let’s say that for various reasons outside your control you have had poor sleep for the last week. You’re exhausted. You find it difficult to concentrate. You also find that you are more prone to grumbling and impatience. You see life through a grey lens. And then you get two great nights of sleep in a row. Suddenly, your world is sunnier. You have a new vitality, both physically and spiritually. Patience and kindness require far less effort. What just happened? A physical “treatment” — sleep! — influenced your spiritual life. The heart issues of grumbling and irritation have become less prominent. That’s not necessarily a bad thing; we are called to be wise stewards of our bodies. Getting a good night’s sleep is important. But in a time of “plenty” (sleep-wise), we shouldn’t forget our sinful tendencies toward anger and complaining that were revealed in our weakness. Being tired does not give us license to treat others poorly. At the same time, we ought not invite greater bodily stress so as to provoke and test our own hearts, as if we are responsible to arrange the conditions for optimal spiritual growth. This is our Father’s business, “mingling toil with peace and rest.”4 We don’t choose suffering as if pain in and of itself is noble.
How does this relate to the use of psychotropic medications? Improving someone’s symptoms (of anxiety, for example) doesn’t necessarily address underlying fears and desires that may be present. Might one feel better? Yes. Again, this may not be a bad thing in itself — remember Jeremiah Burroughs’s earlier comment about seeking relief. But does the person retain the zeal to address the spiritual struggles underlying the anxiety now that those tendencies are less visible in day-to-day life? If perfectionism, a quest for material success, and a dread of failure underlie your anxiety in a new job, are you willing to tackle those bent desires first and foremost? And is there a commitment to address the situational factors that contribute to the experience of anxiety? For example, if your anxiety is associated with unrealistic demands at work, are you willing to address this situation with your boss? In my experience, mature believers do indeed remember what they saw in the mirror and continue to take their soul to task in thought, word, and deed (James 1:23–25) even if they do use medication. They do recognize the importance of assessing and changing situational stressors, on or off medication. But I have also known people who, after improvement in their symptoms with medication use, assume that no further work is required.
“Whether on medications or off, the goal is always to help a person grow in love for God and for neighbor.”
Conversely, there are situations, albeit more extreme, when not using medication may make it more difficult to address a person’s spiritual life. I counseled a young woman in a demanding graduate program who presented with insomnia, depression, and severe anxiety. She could affirm intellectually the promises of God, but it was like her soul was coated in Teflon; the truths of Scripture seemed to slide right off. While this disconnect is true for all of us to some degree, it seemed particularly prominent for her.
After several meetings, I saw how much her ongoing exhaustion from the insomnia was part of a vicious cycle. On the one hand, you could say that her insomnia, which was anxiety-driven, was a fruit of her fear and unbelief; as such, it should be the primary target of ministry. On the other hand, you could say that her bodily exhaustion was making it much more difficult for her to respond in a faith-filled way. Both are appropriate avenues for ministry. In the end, I thought that seeing a physician for a short-term course of sleeping medication might be beneficial to break the negative cycle she was in. In fact, that was the case. As she slept better, it wasn’t as if her problems magically melted away. She still struggled with anxiety. But she was able to internalize spiritual realities and truly begin to engage with God, addressing issues of perfectionism, legalism, and fear of man, which were root causes of her anxiety and despair.
Think of it this way: Using medication in select situations may be analogous to calming the surface waters to allow for deep-sea exploration. You can’t have a diving expedition if there is a gale on the surface of the water. Situations in which such calming might be helpful include (but are not necessarily limited to) the hallucinations and delusions of psychosis (whether associated with schizophrenia or mania) and severe or unremitting anxiety or depression, particularly if associated with suicidal thoughts and plans. These extreme cases are more clear-cut in their need for additional wise medical input. But we live in a culture that doesn’t tolerate any hint of rough seas but yearns for the comfort of glassy calm waters. (I know that’s my temptation!) This contributes to the overuse of psychoactive medication in some who want only a quick fix; they don’t really want to taste the fruit that comes from persevering through choppy waters.
Can taking a medication actually assist in sanctification? Yes, in the same way that adequate sleep can assist in sanctification! It’s not that you can buy holiness in a pill, but using medication in certain situations may impact the body positively, allowing for a greater spiritual flourishing.
Putting It All Together
Given these biblical perspectives, what should our attitude be toward the use of psychoactive medications? I hope you have seen that there is not a clear-cut, right-or-wrong answer. There is no universal rule that we can apply to all people at all times. There is no simple algorithm. Rather, the use of these medications is a wisdom issue, to be addressed individually with those to whom we minister. There will always be a mix of pros and cons, costs and benefits to carefully consider related to the body-soul image-bearer seeking our input. We must ask, “What seems wisest for this particular person with these particular struggles at this particular time?”
Often, addressing the person’s suffering takes place without the use of medication. Yet, in some cases, after asking that question, we will recommend an evaluation by a physician to consider the use of medications as part of the holistic approach to the struggle. Such an evaluation might also uncover primary medical problems masquerading as psychological disorders. For example, in someone with new-onset severe anxiety, especially if not clearly tied to situational factors, a physician would likely check thyroid levels since an overactive thyroid gland can be associated with physiological symptoms consistent with anxiety. In that case, primary and specific treatment for the thyroid condition is warranted, not an anti-anxiety medication.
I’m most likely to recommend a medical evaluation when any of the following occur: (1) symptoms are severe and unremitting, (2) symptoms are not abating despite the person’s responsiveness to pastoral counsel, or (3) there is a high risk of suicide.5
“Sinners will always need mercy, grace, and forgiveness. Sufferers will always need comfort, hope, and the will to persevere.”
I encourage you to develop a relationship with a trusted and wise psychiatrist who shares your strong biblical convictions and can provide consultation for these kinds of decisions. Such a person may or may not exist in your locale. Well-trained, clinically savvy psychiatrists whose practice is governed by a robust biblical worldview are indeed few and far between! A family physician or internist with extensive experience in the use of psychoactive medications may be another option. The point is that pastors and other wise helpers don’t make these decisions on their own; close communication with medical providers is essential.
Often enough, people come to me already on medications; the choice to start or not start them is a nonissue. This is generally because their primary care physician has prescribed such a medication, but they may have already seen a psychiatrist as well. But usually, even on medication, struggling people have realized that psychotropic drugs do not solve all their problems. They still need help to reconcile conflict, or to walk in faith not fear, or to address any of the multitudes of other problems that bring people to counseling. There’s plenty to discuss apart from talking about the utility or nonutility of their medication. Whether on medications or off, the goal is always to help a person grow in love for God and for neighbor.
Let me illustrate with an orthopedic analogy. I liken the use of medications to the use of crutches, and I don’t mean that in a pejorative sense. A person can experience many different injuries to the legs that don’t require a set of crutches. He may have visible pain. He may have a limp initially, but the problem is self-limited with forms of treatment other than the support of crutches. Here I might think of milder experiences of depression, anxiety, and obsessive-compulsive disorder, for example, where medication (like the crutches) might not be needed.
Others require crutches to assist them after experiencing a more significant injury or surgery. They use them for a season while their bodies recover. Here I might envision a fairly severe postpartum depression or severe panic attacks treated by a briefer course of medication. Still others have a more significant disability and may need to use crutches for an extended time or perhaps for life, if the disability is permanent. Here I think of problems such as schizophrenia and bipolar disorder, where the disordered brain is having a stronger influence on the expression of mental health than other contributing factors, and therefore long-term use of medication seems warranted.
Then, there are times when someone may be relying too much on his crutches and it actually impedes progress. I experienced this as a teenager when I broke my ankle. After the cast was removed I was told to bear weight “as tolerated.” But I didn’t tolerate it very well! I continued to use my crutches for an extended time because putting weight on my ankle caused pain. At my follow-up visit, my orthopedist told me to throw away the crutches and learn to bear weight, despite the pain. It was hard work, but I learned again to walk without the aid of crutches. The bottom line is that all musculoskeletal problems are different, and it takes wisdom to know when the additional support of crutches is necessary and, if so, for how long. The same is true of psychoactive medication.
The analogy is imperfect, of course. It’s easier to determine if someone can walk unaided or not. It’s far more challenging to assess what a person can or can’t do in the midst of emotional suffering. We will always struggle to find a wise balance between attention to the spiritual and physical aspects of our personhood. Sometimes in retrospect we’ll conclude that we should have recommended the possibility of medications earlier. Other times we will decide that medication wasn’t the wisest choice after all. But we can be sure that whether medication is part of the total ministry approach or not, God sovereignly acts, and “is able to do far more abundantly than all that we ask or think, according to the power at work within us” (Ephesians 3:20). He will accomplish the redemption that he has begun in us.
Walking in Wisdom
God provides an abundance of counsel in his word to develop a godly perspective on psychoactive medications. Recognizing that we are body-spirit creatures, Scripture wisely balances various aspects of personal ministry, giving attention to both somatic and spiritual factors in the care of those God has called us to shepherd. This means that we neither exalt nor disregard the role of psychoactive medications. Medication can be an appropriate and even necessary part of someone’s care, depending on the specific nature of a person’s struggle.
Even if we do view psychoactive medication as a potential piece in a comprehensive ministry approach, we always seek to bring the riches of Christ’s redemption to bear upon people’s lives. Sinners will always need mercy, grace, forgiveness, and supernatural power to love God and neighbor. Sufferers will always need comfort, hope, and the will to persevere. Ultimately, these blessings are found not in a pill bottle, but in the person of Jesus Christ.6
For an extensive treatment of biblical anthropology, see John Cooper, Body, Soul, and Life Everlasting: Biblical Anthropology and the Monism-Dualism Debate (Grand Rapids, MI: Eerdmans, 2000). For a summary, see Michael R. Emlet, “Understanding the Influences on the Human Heart,” Journal of Biblical Counseling 20, no. 2 (2002), 47–52. ↩
Carolina Sandell Berg, “Day by Day and with Each Passing Moment,” Hymn #676, Trinity Hymnal (Atlanta: Great Commission Publications, 1990). ↩
Suicide assessment is a learned skill and should involve the input of wise and seasoned counselors. The goal with a seriously suicidal person is to ensure safety and stabilization, which may require emergency psychiatric consultation and hospitalization. For further details, see Aaron Sironi and Michael R. Emlet, “Evaluating a Person with Suicidal Desires,” The Journal of Biblical Counseling 26, no. 2 (2012): 33–41. See also S.C. Shea, The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors (Hoboken, NJ: John Wiley & Sons, 2002). ↩
For further exploration of these issues, see Michael R. Emlet, Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses and Medications (Greensboro, NC: New Growth, 2017). ↩