By Rev. Dr Simon Jooste
Just as God uses the churchly means of Word and sacraments to justify and sanctify sinners, he also uses all kinds of broader social means to uphold and sustain a common humanity. Like civil government, the institution of medicine is providentially used by God to extend a measure of health care to all humanity where no one escapes the atrophy of aging and death.
Before considering medical intervention, wisdom dictates that there are some reasonable and practical avenues to explore first. A minister, friend or doctor may notice issues of general health, personality or lifestyle that could 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 colour one’s world in shades of grey. In addition, a difficult job or living arrangement can be the culprit of depression. Hence, a change in lifestyle, to the degree one is able, or a trip to the doctor to uncover hypothyroidism may help lift depression. For some, however, the black cloud still remains.
In the same way that God uses means – including the very physical (cf. sacraments) – for spiritual growth, He has also mercifully made medicine such as Prozac available for our temporal bodily well-being. Doctors are to be sought out as God-ordained physicians of the body. Consideration of Prozac assumes the depressed individual is making every effort to be “in the way of” spiritual means and has explored the common sense avenues already mentioned above. Of preliminary importance, are some more pragmatic matters surrounding the administration of the likes of Prozac? For example, the side effect/s of taking Prozac may be so adverse that to continue would be irresponsible. Another concern is the cost of the drug. If an individual does not have health insurance, it may not be wise to take on the financial burden of paying for the medication.
In addition to these less theoretical considerations, sanctified reason dictates that an individual who is prescribed Prozac should be monitored by the church, family and broader covenant community. With the ethical contours of spiritual vitality mentioned above in mind, certain critical questions arise, including: 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 to 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 neighbour, and thus bring glory to the Lord?
The complexity of depression and the psychosomatic effects of Prozac require much thoughtful reflection and prudence on behalf of both the depressed and loved ones. Although there is no formula and each individual case of depression is unique, over time it may become apparent that spiritual renewal is being hindered to such an extent that a reduction in dosage, if not discontinuation of Prozac altogether, is called for. On this note, and of foremost importance, is the Christian responsibility to evaluate anti-depressant treatment in view of the cruciform and eschatological realities that life, health and death are not ultimate. This tension raises the possibility of abbreviating or even foregoing an anti-depressant altogether, despite the potential resultant ongoing suffering.
In certain cases, Prozac can be a mercy from God to help alleviate the incapacitating physical and spiritual 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 handicapped children concentrate sufficiently on the clock (to keep his job), and the former prisoner of war to sleep through the night. In other words, Prozac can aid an individual in returning to a base-line of functionality again: a state of being where faith is freed once again to feel the symphony of emotions found in the Psalms, to love one’s neighbour, 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. With time, hopefully Prozac may be discontinued, if not the dosage reduced. Ideally, Prozac is neither the first line nor the long-term source of restoration for the depressed.
Ethical questions around the use of anti-depressants require careful answers from Christians. As God’s image-bearers living in a broken world, we suffer in body and soul. In turn, the remedies for our pain cannot always be easily slotted as physical or spiritual. What is more, Scripture makes suffering a critical feature of Christian identity, as well as integral to the accomplishment of salvation. Therefore, I have tried to demonstrate that ethical reflection on the use of anti-depressants requires both common wisdom and cruciform wisdom. While the depressed believer may indeed emerge from the dark abyss without medical intervention, invariably some do not. In such cases, the disciple needs manna from heaven and medicine, the means of grace and an anti-depressant.
Ethical tension and debate around a Christian’s use of anti-depressants are indicative of numerous other difficult ethical questions facing the church in a technologically advancing and increasingly secularised post-apartheid South Africa. Do we as Christians have the biblical and theological categories to provide wise answers to questions around matters ranging from stem-cell research to casting a political vote? If it is true that the Bible does not have specific answers to all of life’s problems, then could it be that adjudicating the moral insights and practical goods offered by medical science and other fields of human culture are best done through a re-appropriation of a kind of natural theology rooted in God – more specifically, through the updated and refined rubric of God’s natural law and two kingdoms?
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.