By Rev. Dr Simon Jooste
Christians suffer in this life. This is because they live in a fallen world, but also because of their cross-bearing identity with Jesus Christ. Depression is one way that believers hurt. The difficulty for Christians – who see humans as both body and soul – is that depression cannot always be neatly traced back to a physiological cause, as is the case with, for example, cancer. There is no definitive empirical test for depression. In other words, a depressed state of being is the result of a complex interplay of the physical and the spiritual. Hence, wisdom dictates that the ethics of alleviating depression should consider both its physiological dimension and its spiritual dimension. Furthermore, attention must be given to the moral complexity of treating depression that has increased considerably with the rise of various anti-depressant medication options.
It is beyond the expertise of this author and the scope of this essay to adjudicate ethical questions within the medical community around the use of anti-depressants. For example: are anti-depressants more effective than a placebo? In light of relative ignorance about certain aspects of the brain, what are the long-term effects of anti-depressant use? Are doctors over-prescribing anti-depressants because of the monetary incentives from big pharmacological companies? (I do not imply that such bio-ethical questions are morally inconsequential for Christians.)
I, therefore, make four assumptions. First, medical science has shown that our thoughts, feelings and actions are inextricably linked to brain activity. Second, advances in medical science have proved anti-depressants to be relatively safe and effective when administered under a doctor’s supervision and under certain circumstances. Third, anti-depressants alter the chemical balance of the brain to alleviate depression. Fourth, it is unclear whether anti-depressants change innate personality or inhibit the full range of emotional expression.
In this article, I consider whether it is right for a Christian to use anti-depressants to treat depression. All human beings are responsible to image God in a moral and dignified manner as mortal creatures living in a broken world. It is not easy to do this in our modern culture of narcissism and therapy, which encourages the abuse of medicine. The calling of the Christian extends beyond the ethics of a common humanity. The disciple of Christ suffers by virtue of living in a fallen world, but also because of her baptism into the death of Christ. Like Jesus, believers suffer first and then glory. Suffering and death are, paradoxically, God’s means of accomplishing and furthering salvation. In light of the body-and-soul components of depression, and in view of the Christian vocation of suffering, the use of anti-depressants invites careful reflection. In this series, I argue that in some cases it is appropriate to incorporate medication such as Prozac into a holistic approach to treating depression. I set forth my case in four parts.
First, I show how depression is part of the plight of humanity broken in body and soul, but not without God’s mercy extended through health care and the cross. Second, consideration is given to the call of the Christian to, and benefit from, a life of cross-shaped suffering. Third, I argue that the Christian mind must guard against a theology of glory clothed in the therapeutic narcissism of our age. Finally, I set forth a recovery programme grounded in the sacred means of the church and the God-given helps of modern medical science.
For the purposes of this essay, “depression” excludes those suffering from a clear separate medical condition such as Alzheimer’s and dementia or substance abusers. Instead, drawing on Scripture and the Diagnostic and Statistical Manual of American Disorders, 5th edition (DSM-V), depression understood henceforth is a complex interplay of body and soul that significantly impairs an individual’s ability to love God, himself and his neighbour as a divine image-bearer. Among the nine symptoms set forth in the DSM-V diagnostic criteria, of which at least five must be present for diagnosis, the depressed person may experience weight loss or gain, insomnia, inability to concentrate, fatigue or suicidal thinking. The presence of such symptoms may also be accompanied by, or be the cause of, an array of maladies with a spiritual dimension, such as an inability to pray coherently, inordinate feelings of guilt or lack of joy.
Simon Jooste is the pastor of Reformed Church Southern Suburbs.
This is an edited version of an essay that was first published in the Stellenbosch Theological Journal 2018, volume 4, number 1.