Perhaps it seems strange to consider how psychiatric medication relates to a person’s spiritual life. We expect that the drugs will make them feel better or maybe worse, but we are surprised to hear that it makes someone feel more or less spiritual. For many centuries, people have viewed experiences of suffering and healing through a spiritual lens; it’s a practice considered central to most of the world’s major religions. And yet, in the form of a psychiatric pill, this practice is quite unanticipated. I know this because nearly every time I tell someone about my work, their expression becomes confused, even uncomfortable.
In 2015 I completed a qualitative research study exploring the interrelationship between psychiatric medication and spirituality. The results of the study were recently published in a peer-reviewed journal. The results indicated that something unforeseen was happening which contradicted the oversimplified views promoted by psychiatry and the pharmaceutical companies. More importantly, they challenged established notions of how psychiatric medications actually work.
The key finding was that people were engaging spiritually with their prescriptions in ways that significantly impacted the course and outcome of recovery. Broadly speaking, people fell into one of two groups: one group found medication to be spiritually helpful and enhancing, the second group found it hindering or harmful to their spiritual life. The experiential wisdom of the participants offers hope for improving current treatment practices, and supports a paradigm shift away from the biological model.
For many, spirituality serves as a way of coping with life, particularly as a way to make meaning out of one’s experiences. Whether someone considers themselves spiritual or not, the need to make sense out of life’s difficulties is thought to be fundamental, a basic human drive. In contemporary Western cultures like the US and the UK, conceptions of spirituality have come to represent diverse and perhaps even eclectic points of view. It includes religion for some, but not all. In healthcare, there is growing recognition of the inevitable folly of searching for a universal definition of such a complex term. For the purposes of my study, spirituality was exactly what people said it was. Modern formulations of the spiritual oftentimes pivot on finding and being true to one’s authentic self. This can involve a process of confronting painful emotions, and learning ways in which to improve one’s life. A person’s desire for spiritual transformation can lead to seeking mental health treatment, which may include a prescription for psychiatric medication. Hence, once possible route to the unforeseen relationship.
To be clear, I’m not trying to debate whether medications work or not, or if they are an appropriate first-line treatment for emotional distress. The aim is to look at the particular ways that psychiatric medications work which create the conditions for perceived interactions with spirituality. Psychiatric drugs stimulate two kinds of side effects: the pharmacological and the non-pharmacological. Pharmacological or primary effects are enacted by the chemical properties of the drug. Non-pharmacological or secondary effects are generated by the unique ways an individual interacts with their prescription, but are not caused directly by chemical agents. A primary side effect such as weight gain or sexual dysfunction can easily lead to secondary effects, by impacting the person’s intimate relationships, self-esteem, or identity. My study identified spirituality as a non-pharmacological factor which can impact the course and outcome of treatment.
The complex nature of secondary effects is easily recognized by medication users, though rarely acknowledged by doctors and pharmaceutical companies. Because prescribers tend to view medication in the context of symptom relief, side effects are categorized in more general ways, which means that doctors often fail to detect the crucial subjective meanings that side effects can have for the individual. Psychiatry continues to promote the idea that the pharmacological agents alone are accountable for medication’s efficacy. Rarely acknowledged is the fundamental role of the person themselves, and how his or her unique interactions with treatment shape treatment. We need to rethink the significance of subjective response, not simply on humanistic grounds, but because it is having a critical influence on outcomes.
Some non-pharmacological effects are well known, like the placebo response. The placebo response is driven by the forces of hope and expectancy—oftentimes simply believing in the power of a pill initiates the process of healing. How spirituality impacts psychiatric medication use remains greatly underexplored. Both primary and secondary effects are known to generate emotional, cognitive and interpersonal side effects, and there are some compelling similarities between these and what participants in my study described as the spiritual consequences of their prescriptions. Ultimately, those categories did not capture what people saw as the spiritual side effects of medication, so the need for a new category dedicated specifically to spirituality was both necessary and appropriate.
Spiritual side effects (SSE) refer to any perceived effects concerning interactions between psychiatric medication and the spirituality of the user. SSE may be positive or negative, and they may be welcomed or unwelcomed by the individual. To the degree that people perceived medication to enhance their spirituality, it led to greater wellness and recovery. There were five primary ways that medication was described as spiritually enhancing: 1) increased feelings of connectedness to self, others, and the transcendent, 2) enhanced meaning and purpose, 3) inspired hope, 4) increased feelings of perseverance, and 5) increased participation in spiritual practices and activities.
When medication was perceived to be spiritually hindering or harmful, wellness and recovery were delayed. There were five main ways medication was reported as spiritually harmful: 1) disconnection to self, others, and the transcendent, 2) decreased sense of hope and a negative impact on spiritual beliefs, 3) discontinuation inspires spiritual growth (some people only recognized the presence of harmful SSE when they stopped taking medication), 4) interfered with healing, growth, and transformation processes, and 5) decreased access to spiritual resources and gifts. For many people, taking medication became part of their suffering, which eventually led to spiritual growth.
Now if all of this seems a little too neat and tidy, that’s because it is. It is beyond the scope of this article to really get into the complexity of the phenomenon. For people with a deeper interest in this subject, I have a book coming out this fall, published by Jessica Kingsley Publishers. The book relies on the participants’ own words and life experiences to explore the matter in great depth (actual names and identifying information have been changed).
The results of this study offer hope for improving current practice by encouraging a more complex understanding of psychopharmacology than we have been offered so far. What we’ve been taught about how these medications work—that they are biological interventions for biological conditions—limits our understanding. How individuals uniquely engage with their prescriptions—including spiritually—significantly influences the course and outcome of treatment. The next step forward is to recognize the value of individual variation, and to view it as an essential contribution to recovery. The one-size-fits-all approach of the biological model is out of sync with what the philosopher Charles Taylor has called the massive subjective turn of modern culture. It offers a generic view of our emotional lives is eerily emotionless.
We are living in rich times for rethinking the world. The larger narratives of science and medicine can easily overshadow the smaller narratives of individuals. What the participants in my study appear to be telling us is that the latest advances in neuroscience do not eradicate the human drive toward the spiritual to cope with experiences of suffering and healing. Whether scientists, researchers and doctors like it or not, some people are attaching deep spiritual meanings to the effects of medication, and it is impacting their perceived efficacy of that medication.
The question of suffering, and whether it can be adequately addressed at the level of receptor and transmitter, is at the heart of the psychopharmacology debate. Biological basis or not, the meaning of suffering remains a matter of genuine consequence, and, as part of a paradigm shift, that meaning should be determined by the individual. The fact is that for some people, these drugs are engaging and impacting upon some of the deepest and most sacred aspects of being human.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.