16 October 2006

Depression and medication

Following my own experience with depression in the late spring and early summer, I was interested to read this article by Fr. George Morelli, Overcoming Depression: Cognitive Scientific Psychology and the Church Fathers. There are good things in the article, including the isolation of the eight cognitive distortions occurring in the mind of someone suffering from depression. Fr. Morelli suggests cognitive therapy and spiritual intervention as means of trying to alter these distortions.

Yet something is missing. Apart from the author's single reference to the possible need for "psychopharmacological treatment" in some cases, nothing more is said of the role of medication in the treatment of depression, anxiety disorder and similar conditions. This is not an inconsequential omission. Why might Fr. Morelli see fit not to discuss this element? The obvious answer is that he is merely a psychologist and not a psychiatrist, with the medical component thus lying outside his field of competence.

Nevertheless, I wonder whether there is not more at work here. Could the inattention to medication be rooted in a defective anthropology playing up the cognitive at the expense of the corporeal? I have heard of more than one case in which well-meaning Christians have advised those suffering depression to wean themselves off medication on the assumption that "dependence" on it is the sign of a defective spiritual condition. However, I doubt very much they would extend this same counsel to a heart patient needing medication to survive.

When I was going through the worst moments in May and June, I found it difficult to feel gratitude to God for his blessings to me, because everything appeared in such a negative light. I had to struggle to thank God on a cognitive level while feeling exactly opposite. This was the most vexing element of my depression. Was I undergoing an internal spiritual struggle? Most certainly, yes.

However, once I was on a high enough dose of the medication, I began to feel dramatically better, freshly aware of the joys of life and the grace of God. I could then much more easily feel grateful to him for all his gifts, including my wife and daughter, my work at Redeemer, and faithful friends and family who prayed for me during those dark weeks. Did the medication tip the balance in the spiritual struggle? Did it help to bring my emotions into line with my cognitive grasp of the world? It certainly seems to have done so, yes.

I find Dooyeweerd's philosophy especially helpful here, because, rather than assuming that spiritual struggles take place in a creational vacuum, he recognizes the different levels in which everything functions. According to his modal analysis, the biotic is foundational for the affective/psychic mode, which is in turn foundational for the logical/analytical mode. This suggests to me that in my case the medication altered the biological component by raising the levels of serotonin in the brain, making it possible for my emotions to return to normal, which then brought my thought processes back into line. Could it work the other way round, namely, attempting to change one's emotions, and ultimately one's physical health, by addressing the thought processes? That's what cognitive therapy is all about, and I understand that it can be effective. Nevertheless, in my case healing worked upwards from the more basic level rather than working downwards, as it seems to do in some cases.

This would appear to indicate that spiritual battles do not occur in a platonic realm of ideas separate from the tangible world as we experience it. As in Job's case, physical infirmity can be the occasion for the afflicted to doubt God's love for them, thus precipitating a crisis of faith. Conversely, addressing such infirmity may help to resolve such a crisis, though I, along with many others, can testify that the grace of God does come even in the absence of good health and a receptive emotional state.

Is this analysis less spiritual than one relying on, say, the power of prayer alone? I don't think so. Nevertheless the complex interconnections between the various aspects of the human person raise issues that would seem, at the very least, to require further reflection.

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