This Demon Only Comes Out By Prayer and Prozac

Matthew Loftus is a family doctor who lives with his wife Maggie and his daughter Naomi in Baltimore , where they are blessed to be a part of New Song Community Church. He aspires to finish his novel and to teach medicine overseas. You may follow him on Twitter @matthew_loftus if you’d like.

“It’s a chemical imbalance.”

You may have heard or said those words before in reference to mental illness. I have done both myself a number of times in my practice as a primary care doctor. One good example of opening the conversation about them can be found here from Ed Stetzer; one of Stetzer’s explicit goals is to decrease shame and stigma against mental illness by locating the pathology of mental illness in neurobiology and then asserting the need for medication to rectify the dysfunctional biology. As Christians across the world grapple with the modern understanding of mental illness, it is helpful to not only understand what these imbalances are and how medication might address them, but also to challenge a point of view that reduces mental illness to a mere malfunction of biology.

The impetus behind the use of the words “chemical imbalance” is good. After all, confining mental illness solely to the untouchable realm of feelings and thoughts is not only ignorant of biology, but also of orthodox anthropology. Furthermore, such a harsh dichotomy happens to be extraordinarily ineffective in the lives of most sufferers of mental illness. You may or may not have heard of an excellent book that sought to make clear the theological importance of our physical bodies; affirming that deficiencies or excesses of certain chemicals in our brains play a role in mental illness is an important step in the process of rightly treating our bodies as part of the created order. In turn, the judicious use of other chemicals to rein in the torment and harm caused by mental illness is as much a part of using our God-given power to exercise dominion over the earth as is carefully using pesticides on our crops so that more people can eat.

However, saying “you’ve got a chemical imbalance” does not go far enough and, paradoxically, can often take us too far in the wrong direction.

Assigning mental illness solely to such imbalances is inadequate firstly because it underappreciates the complexity of neurobiology. For example, we know very well that people with depression have lower serotonin levels (most potently demonstrated in studying the brains of those who have committed suicide.) Selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Zoloft raise serotonin levels in the brain. However, while many of the measurable effects of SSRIs on neurons can be seen within hours of first taking the drug, the effects of these medications are rarely appreciated until at least 4 to 6 weeks, making it far from clear that raising one’s low serotonin levels is their sole useful effect. Furthermore, the fact that any of these medicines has roughly a 30-40% chance of working in isolation on the first try is evidence that any “imbalances” we discuss are less like our car’s windshield wiper fluid and more like our food’s soil. When dealing with even more complex illnesses like bipolar disorder (which responds to a wide range of medications that are also effective for epilepsy) or schizophrenia (which involves a greater variety of neurochemical pathways), it is clear that the language of “chemical imbalance” is simply a starting point.

Secondly, while it is obvious that there are many aspects of brain biochemistry that we cannot consciously control, there are many others that we can. The choices we make shape our physical bodies– including our brain structure and genes. This is most apparent in the cycle of addiction, wherein an addict’s brain is often demonstrably altered to have a minimal response to normal pleasurable stimuli and to require greater and greater doses of the drug of choice to not feel agonizing withdrawal. However, as we learn more about the bodies that God has given us, we see that chronic stress and traumatic events (often caused by the sin of others) can shape the brains of children with immature decision-making ability in ways that last for a lifetime. Thus, there is a reciprocal relationship between our environment, our bodies, and our feelings. Both our moods and our decision-making abilities are shaped by constant internal decisions and external stimuli.

The most potent example of this principle is the case of a sexually abused child who overeats not only to soothe the excess quantities of stress hormones that may or may not be predisposing them to depression later in life, but also to appear less attractive to their abuser. Even without immediately jumping to the conclusion insisting that the government must do something (as part 3 of the article linked above does), it is clear that we must jettison any simplistic understanding of the complex interaction between brain and body as a matter of individuals choosing to either sinfully wallow in mental illness or righteously embrace freedom in Christ. Similarly, we must also not succumb to a materialistic view that defines people stuck in mental illness solely as victims of circumstance.

We go too far in the wrong direction in this manner when our appreciation for the power of pharmacology to help guide our brain chemistry into a more ordered pattern becomes a helpless veneration of medicine. I have seen this, too, in my practice– patients who have been trained to believe that their own efforts to calm their nerves or pay attention are useless when compared to the power of Xanax or Adderall. The danger of these medications is that they are powerful enough to abrogate our efforts; as prescriptions for these (and similar) medications continue to dominate the market in a way that disquiets many clinicians, a sense of restraint and discipline is necessary for all parties involved.

Health is a discipline. The bodies that God has given us require care and attention to maintain in a way that fits the pattern he established for our being; while our appetites can sometimes be helpful guides to our needs, they are often magnified or minimized by sin in such a way to lead us astray. Whether we are choosing certain foods, actively exercising, or avoiding other substances, our health requires active management and control.

These individual choices are also clearly shaped by our environment, from the simple unavailability of fresh vegetables in certain neighborhoods to the more complex changes caused by chronic stress described above. Disciplines, while individually practiced, are shaped by the communities that we live in and the values we collectively affirm. Wendell Berry points out that “autonomy” is a false cure for our modern ills, saying, “Healing is impossible in loneliness; it is the opposite of loneliness.” When we do not pay heed to the disciplines– either individual or environmental– that shape our health, the breakdown of our bodies is attended by the breakdown of our minds and spirits.

In regards to mental health, it is often said that “food is the most overused antidepressant and exercise is the most underused antianxiety medication.” A variety of well-designed studies have borne out the efficacy of behavioral interventions for a variety of mental illnesses, demonstrating that our power over mental illness is not limited to pharmacology. That said, anyone who has ever seen a loved one struggle to take medication for mental illness can see that even the act of using pharmacology’s power (and bearing its side effects) is itself a discipline. Even more telling are the studies that show that some of the sickest people who burden emergency rooms with repeated visits see great improvements in their physical and mental health when they are brought into closer personal contact with caring people and housed.

Talk of health as a discipline or health choices as being shaped by culture brings to mind the issue of personal responsibility, which is a useful rallying cry for helping oneself feel less perturbed about the suffering of others, but by definition cannot be embraced as a corporate policy. Personal responsibility is clearly a component of discipline, but it is not the only one. For those who are struggling with mental illness, it is imperative they are approached first as persons with dignity whose ability to make rational decisions and take responsibility has been impaired– whether by themselves, by another, or by the happenstance of neurobiolog. Once this relationship of trust and respect is established, we can walk with them through both the personal and professional interventions necessary to learn or rediscover the skills that attend to personal responsibility.

Similarly, shame can be useful; the things that people with mental illness say and do when swayed by the winds of their depression or mania are often a powerful motivator to change their behavior when they feel ashamed of them. While we want to rightly eradicate the effects of shame that keep people from seeking help and being honest, it is possible to strain out a gnat and swallow a camel if we take the language of “chemical imbalances” too far and put personal responsibility out of reach for those who suffer from mental illness.

In the end, both the people who wish to eradicate shame from mental illness and those who wish to use it as a hammer for every health-related nail they see will find themselves in conflict with a holistic worldview that embraces the continuity between physical existence, knowledge, indiscernably complex emotions, and meaningful spirituality. The bodies that God created us with are prone to the corruption of sin in ways that science can both illuminate, abet, or help to heal– but only if we can appreciate the full complement of healing means that He has given us.

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  • GinaRD

    Really good piece. I think you’re missing a hyperlink, though — I don’t see Stetzer’s piece actually linked anywhere.

    • http://menliketreeswalking.blogspot.com/ Matthew Loftus

      fixed! Thanks for noticing.

    • jamesfarnold

      GinaRD,

      This was actually my fault. I didn’t import the post correctly and lost all of the links. They have now been corrected. Thanks for bringing it to our attention!

      -James
      Editor

  • Gabi Vehrs

    This is excellent. I am bookmarking this article for the next Christian I meet who denies the interaction of the soul, environment, and brain health on mental illness.

    Matthew, Do you have resources for counseling that address all these factors–a kind of whole person counseling?

    • http://menliketreeswalking.blogspot.com/ Matthew Loftus

      Thanks Gabi! I appreciate the kind words. If you are in the Baltimore/DC region, Safe Harbor Christian Counseling is an organization that I respect and trust. I have been influenced by the Christian Counseling & Education Foundation (ccef.org, though sometimes I think they are overcautious about medication.) Still, they have a lot of great materials to learn more.

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  • Karen Butler

    I agree with so much in this article and appreciate its tone and intent. I am enthusiastically supporting any approach that seeks a “holistic
    worldview that embraces the continuity between physical existence,
    knowledge, indiscernably complex emotions, and meaningful spirituality. -

    However, the science you cite is flawed, and it produces the very stigma you note.
    And because I have watched loved ones struggle, and I myself have struggled — and oh how I wish there was a silver bullet for these disorders, and no stigma attached! — I regret that I have to agree with members of the the Council for Evidence-based Psychiatry who write in this months Lancet Psychiatry, http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2970297-4/fulltext

    “The record of this brand of psychiatry is poor. As David Kingdon and Allan Young2have put it: “Research into biological mechanisms of mental and
    behavioural responses has failed to deliver anything of value to
    clinical psychiatrists and is very unlikely to do so in the future.”
    Similarly, Arthur Kleinman3 has predicted the current biology-based model of academic psychiatry will be ruinous to the profession due to its consistent failure to deliver.

    Peter Gøtzsche, director of the Nordic Cochrane Centre, has dealt with the counter-evidence on the specific issue of antidepressant prescribing.4
    He shows how Nutt and colleagues have succumbed to the tendency to
    minimise harms and exaggerate benefits in a way that puts patients at
    risk and leaves them without access to balanced information. And in
    terms of stigma, the evidence consistently finds that it is the idea
    that mental illness is like any other illness that is most likely to
    lead to stigma5 and so to more potential pain and suffering for patients.”

    And Robert Whittaker explains well the mechanism behind this paradoxical effect of the increase of stigma with the promotion of the disease narrative for mental disorders when he writes, http://www.psychologytoday.com/blog/mad-in-america/201011/the-successful-creation-societal-delusion-and-the-increase-in-stigma-it-h

    “… it is easy to see why the chemical-imbalance story leads to negative attitudes
    about people struggling with mental illness. It tells the public that
    people with a psychiatric diagnosis have “broken brains,” and that their
    moods and behaviors are governed by faulty brain chemistry. This is an
    understanding that separates the “mentally ill” from the rest of
    society. The “mentally ill” are different from “us.”

    Now imagine what societal attitudes might be if the public were told that
    the biological causes of major psychiatric disorders remain “unknown”
    (which would be a scientifically accurate message.) That conception of
    mental illness suggests that it may be possible for anyone — faced with
    certain environmental stresses or setbacks in life — to suffer a
    severe bout of psychiatric distress. Readers of Shakespeare might sum it
    up this way: To be human is to have the capacity to go “mad.” That is
    an understanding of “mental illness” that evokes a sense of our common
    humanity, and a sense of a shared vulnerability to mental suffering.”

    The Lancet authors state that the broken brain narrative is all “good marketing manipulating poor science.” And you perpetuate that kind of science when you assert unequivocally — “we know very well that people with
    depression have lower serotonin levels (most potently demonstrated in
    studying the brains of those who have committed suicide.) — when
    in fact, according to London College clinical researcher and practicing
    psychiatrist Dr. Joanna Moncrieff, “Evidence on serotonin comes
    principally from studies of serotonin receptors and ‘serotonin depletion’ studies. Results of studies of the serotonin 1A receptors in living subjects are contradictory, with some
    finding lowered levels of receptors in people with depression compared
    to those without (6,7), some finding no difference (8,9) and some
    finding raised levels (9,10)! Post mortem studies of receptors in the
    brains of people who have died by suicide are similarly inconsistent
    (11,12,13).
    From,
    http://joannamoncrieff.com/2014/05/01/the-chemical-imbalance-theory-of-depression-still-promoted-but-still-unfounded/.

    I urge you to explore more deeply the science behind the Critical Psychiatry Network. Dr. Moncrieffs blog and books, especially “The Myth of the Chemical Cure” would be a good place to start. It is not a polemic. She is an academic researcher, and cites the necessary studies to back her claims.

    I am sorry to be so lengthy in this response, but there is no simple way to counter your claims without looking like a rabid ‘pill shamer.’ Thank you again for the clear compassion you show here towards sufferers. I hope you will follow the research on these links, and soon drop the mythic language of ‘chemical imbalances’ altogether. I would rather be She-From-Whom-Seven-Demons-Was-Delivered than one of the unfortunates accepting the ‘broken brain’ narrative whose brains are *permanently* damaged by Prozac.

    • http://menliketreeswalking.blogspot.com/ Matthew Loftus

      Karen,
      Thanks for responding and sharing those links. I sympathize greatly with CEP, as they seem to have the sort of skeptical attitude towards overdiagnosis & overprescription that I favor. I think they are probably a bit too quick to make some of the statements they make (mixed or inconclusive evidence is not the same as evidence that things don’t exist or work.) Also, I think that the evidence around trauma affecting biology is still pretty decent, which I’m more interested in getting people to think about.

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  • hautzeng

    I am training for the pastorate and this is an important issue for me. I don’t understand your use of the title though. Are you implying that the demoniac would have had chemical imbalances similar to what we now see in some supposed mental-illnesses and that psychotropic drugs are not the solution?

    • http://menliketreeswalking.blogspot.com/ Matthew Loftus

      To be honest, the title wasn’t trying to make any sort of nuanced point, but mostly to imply that most mental illnesses have physical & spiritual components and many will require both physical & spiritual means (not just limited to prayer and Prozac, obviously) of healing.

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  • Brandon Coulter

    I started taking Lexapro about 6 months ago and it has been a game changer. No, it didn’t cure my sinfulness (no medicine can do that) but it has helped me out so much. My lows aren’t as low anymore and I thank the Lord for that. I think some people (not you by any means, Matthew) write without considering their potential audience. Some of these recent blogs could be devastating for someone with depression to read. If guilt and shame are the result of reading these pieces, then they are doing them wrong.

  • OPCer

    I get so upset when Christians say, “There’s no such thing as mental illness,” so this article is a breath of fresh air. I can understand not wanting to minimize our responsibility regarding sin, but mental illness clearly exists.

    My family has a history of insomnia, poor memory, depression and schizophrenia. I myself have experienced depression and bizarre physical and mental reactions to chocolate that I can repeat (test scientifically) by eating it again (http://www.psychologytoday.com/blog/your-brain-food/201011/chocolate-the-good-the-bad-and-the-angry). This, and reactions to other foods, have lead me to recognize the role nutrition (and probably metabolism) plays in mental health. As nutrition begins to work its way into medical school curricula, I’ll be interested to see how mental illness gets treated in the future. Less by adding chemicals (pills) maybe and more by a change of diet and exercise **in some cases**.

    For myself, I’ve noticed that I feel much better mentally when I stay on the paleo diet. The absence of carbs makes me feel less groggy and therefore helps with the overall outlook of each day.

    Anyways- thanks for the great article!

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  • Kathleen

    This article reflects much of my own views/conclusions through the lenses of my Christian faith and what I have encountered through my own and others experience. It is still a difficult path to tread between illness and wellness and to be as realistic as possible in the circumstances for both the person affected and those around them.
    It may even be that those who succumb to mental illness are super sensitive individuals whose spirits have been crushed by the world. Weakness in itself is not the same as sin.
    We are very much part of an individualistic society, where as we are instructed that no man is an island.