Using Psychiatric Medications Wisely: How Christian Theology Can Help
Warren Kinghorn, M.D., ThD., Associate Research Professor of Psychiatry and Pastoral and Moral Theology, Duke University Medical Center and Duke Divinity School
Medications to treat mental health problems (psychiatric medications) are deeply ingrained in American culture: one in five American adults and over 6% of American adolescents are prescribed psychiatric medications, and sales of psychiatric medication exceeded $70 billion in the US in 2010. But as sociologist David Karp and others have shown, psychiatric medications are narratively salient: they emerge from and also reinforce particular narratives of the self, body, and agency in relation to unwanted experience and behavior. In this presentation I will explore how Christian theology and practice might be an important source of wisdom with respect to the use and prescription of psychiatric medication. First, I will explore five prevalent conceptual barriers to wise use of psychiatric medication – individualism and internalism, self-body dualism, self-symptom dualism, epistemological deference to the neurosciences, and externalization of agency. Second, I will recommend correctives for each of these five barriers that emerge from a Christian vision of humans as creatures who are connected with the broader creation, who are embodied souls and ensouled bodies (Paul Ramsey), and who, as wayfarers journeying to God, are bearers of meaningful emotional and cognitive experience. These correctives can salvage narratives of psychiatric medication use from the disenchantment brought by technological and reductionistically biological narratives of medication use. Third, with these correctives in mind, I will propose four questions that might guide moral reflection on the appropriate use of psychiatric medications: Will taking medication draw me closer, or push me away from, my formative communities? Will taking medication distance me from my body, or render me more hospitable to my body? Will taking medication cause me to view my experience as a “thing” apart from me—and is this helpful or unhelpful? Finally, will taking medication support and encourage my agency? Finally, I will consider—and invite the audience’s reflection on—the way that these questions might inform the interaction between clinician and patient at the time of decision about medication use. Decisions about the use of psychiatric medication are often made in contexts of vulnerability, crisis, and/or uncertainty, and so moral considerations of medication use must be framed in a way that is sensitive, helpful, and freeing, and that does not perpetuate shame, stigma, or isolation among people who are experiencing mental health problems.
Medications to treat mental health problems (psychiatric medications) are deeply ingrained in American culture: one in five American adults and over 6% of American adolescents are prescribed psychiatric medications, and sales of psychiatric medication exceeded $70 billion in the US in 2010. But as sociologist David Karp and others have shown, psychiatric medications are narratively salient: they emerge from and also reinforce particular narratives of the self, body, and agency in relation to unwanted experience and behavior. In this presentation I will explore how Christian theology and practice might be an important source of wisdom with respect to the use and prescription of psychiatric medication. First, I will explore five prevalent conceptual barriers to wise use of psychiatric medication – individualism and internalism, self-body dualism, self-symptom dualism, epistemological deference to the neurosciences, and externalization of agency. Second, I will recommend correctives for each of these five barriers that emerge from a Christian vision of humans as creatures who are connected with the broader creation, who are embodied souls and ensouled bodies (Paul Ramsey), and who, as wayfarers journeying to God, are bearers of meaningful emotional and cognitive experience. These correctives can salvage narratives of psychiatric medication use from the disenchantment brought by technological and reductionistically biological narratives of medication use. Third, with these correctives in mind, I will propose four questions that might guide moral reflection on the appropriate use of psychiatric medications: Will taking medication draw me closer, or push me away from, my formative communities? Will taking medication distance me from my body, or render me more hospitable to my body? Will taking medication cause me to view my experience as a “thing” apart from me—and is this helpful or unhelpful? Finally, will taking medication support and encourage my agency? Finally, I will consider—and invite the audience’s reflection on—the way that these questions might inform the interaction between clinician and patient at the time of decision about medication use. Decisions about the use of psychiatric medication are often made in contexts of vulnerability, crisis, and/or uncertainty, and so moral considerations of medication use must be framed in a way that is sensitive, helpful, and freeing, and that does not perpetuate shame, stigma, or isolation among people who are experiencing mental health problems.