The conversation with the pastor usually begins with hesitation. A member of the congregation pulls you aside after service or asks if you have some time during the week, and tells you, with the sort of half-ashamed disquiet that people reserve for things they’re not sure they’re allowed to do, that they’ve just started taking an antidepressant. Their doctor recommended it. Their spouse encouraged it. They’ve been tired for a long time in a way that sleep doesn’t fix, and sad in a way that never lifts when the circumstances improve. They filled the prescription, and they’re scared.
“Is this okay?”
Look deep in their eyes, and you’ll often see a hidden, more pressing question:
“Am I failing somewhere I should be succeeding?”
The reality is, they’re not asking about pharmacology. They’re asking whether the medication is a subtle admission that their faith wasn’t enough, that their prayers didn’t work, or that the slow, sanctifying work of the Spirit has somehow stalled in them, forcing them to resort to chemistry to finish the job grace was supposed to do. They desperately want you to tell them they haven’t failed. They also want you to tell them the truth.
In my experience, the church tends to offer one of two typical responses:
“Of course you should take it. It’s just medicine. You wouldn’t refuse insulin for diabetes or a cast for a broken arm, so why refuse an antidepressant for depression? The body is fallen, the brain is part of the body, and modern medicine can be a gift. Take the pill and get on with your life.” The answer is a shrug of uncritical enthusiasm. It is kind, and it isn’t exactly wrong, but it’s spiritually unfulfilling.
Or:
“Have you really tried prayer? Are you in the Word? Are you in community? Perhaps what you and your doctor are calling depression is a spiritual condition in want of a spiritual remedy, and reaching for a prescription is outsourcing to chemistry what God intends for the realm of sanctification.” This is a frowning moralistic suspicion. It takes the spiritual life seriously, but in precisely the wrong way. It places further burdens upon an already suffering person and ignores that the body is every bit as real as the soul.
Both answers come too quickly. They flatten a dynamic that has greater dimension than either admits. Instead of whether to take the medication, the better question is what kind of a thing the medication is. Thankfully, the church has an older, wiser vocabulary for that.
Our English word “pharmacy” comes from the Greek pharmakon, and pharmakon in classical Greek carried a meaning that our modern vernacular struggles to accommodate. It meant remedy. But it also meant poison. The same word that labeled the doctor’s draught also named the assassin’s chalice. A pharmakon was a substance that acted powerfully upon the body, and whether it acted for good or for ill depended on the dose, the context, and the condition of the one who received it.
Pastors are not in the business of dispensing medical advice, and we should be the first to say so. But we are in the business of pointing people toward the only Physician whose medicine never wounds.
Ignatius of Antioch, writing to the Ephesian church around AD 110 as he traveled under Roman guard toward his own martyrdom, referred to the Eucharist as the pharmakon athanasias—the medicine of immortality.[1] This medicine, the body and blood of Christ, is the one pharmakon that heals without poisoning. It’s the one remedy that carries no shadow. Christ is the only medicine that is wholly, uncomplicatedly good.
This is a significant theological claim. The deepest sickness in any human being is not chemical or circumstantial. It is the sickness of a soul that has turned away from its maker and cannot heal itself, and there is exactly one medicine for that sickness, administered in exactly one place, by exactly one Physician. Every other healing, including the healing offered by an antidepressant sits downstream from this one. Earthly medicines are pharmaka in the ancient sense; genuinely healing and genuinely limited, capable of doing real good and real harm, often in the same person, sometimes at the same time. They are a gift, and often they should be used. But none are the ultimate medicine. They were never meant to be.
Recovering this posture frees us from both distortions at once.
It frees us from moralism. If earthly medicines are pharmaka, gifts that genuinely heal within their own limits, then taking one is no more a spiritual failure than wearing glasses or setting a broken bone. Basil of Caesarea said as much in the fourth century, teaching that medicine had been given by God as a model for the cure of the soul, and that the Christian who needed it should employ it gratefully, with an eye to the glory of God rather than a nervous suspicion of the gift.[2] The believer who needs and takes an antidepressant is practicing a form of creaturely care. Gratitude is an appropriate response.
It also frees us from uncritical enthusiasm. Because these medicines are pharmaka in the dual sense, they can harm as well as heal. They can flatten affect, dull conviction, mask grief that ought to be grieved, or quiet symptoms whose noise is trying to tell us something. Pastors who only ever encourage the indiscriminate acceptance of antidepressants abdicate something the church alone can offer. It is the church who helps people discover what their suffering means, what it might be asking of them, and what God might be doing in and through it.
Therefore, recovering this posture also leads to a better pastoral response for the fearful church member:
“This medication could be a real gift, but it also has its limits. Use it gratefully, but keep doing the harder, slower work of being a soul in a physical body within the body of Christ, surrounded by others who know you, pray for you, encourage you, love you, and will sit with you through everything the medicine cannot reach.”
Pastors are not in the business of dispensing medical advice, and we should be the first to say so. But we are in the business of pointing people toward the only Physician whose medicine never wounds. The pharmakon athanasias—the medicine of immortality, the body and blood of Christ—is the one remedy a soul ultimately needs. Everything else that is pharmakon carries all the benefit and all the limit which that word implies. A church that knows the difference can offer something that goes far beyond the gift of the prescription pad.
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