Fr. Alex Goussetis: Welcome to Family Matters. My name is Fr. Alex Goussetis, and today I’m speaking with Dr. Mena Mirhom. Our topic is “Medication & Mental Health: An Orthodox Christian Perspective.”

Dr. Mirhom is a board-certified adult psychiatrist. He completed his adult psychiatry training in the Mount Sinai Health System, and his fellowship and Columbia University, where he currently teaches public psychiatry fellows. He sees patients in private practice and is the director of an in-patient psychiatric unit. He is a member of St. Mary and St. Mark’s Coptic Orthodox parish in New York. He has presented nationally on the relationship between our Orthodox faith and mental health, and has authored book chapters as well as articles on the subject as well. Welcome, Dr. Mena!

Dr. Mena Mirhom: Thank you so much, Fr. Alex.

Fr. Alex: Some of the most beloved figures in the Orthodox Christian tradition combine faith in God and the exercise of a healing ministry. The Evangelist Luke was a physician. Saints such as Ss. Cosmas and Damian, St. Panteleimon, and the women unmercenary physicians Zenaida and Philonella are examples of widely venerated saint-physicians of the Orthodox Church. The recently canonized St. Luke the Blessed Surgeon continues this strong connection between faith and medicine.

However, there are growing voices of dissent that have arisen over the last generation or so regarding the harmony between people of faith and the medical community. Some of those issues include, one, those in which religious doctrines directly conflict with medical recommendations; two, those that involve an area in which there is extensive controversy within the broader society; and, three, settings of relative medical uncertainty in which patients “choose faith over medicine.” Perhaps as a result of this ongoing tension, the field of bioethics offers a vital platform to help dialogue these ongoing debates.

Let’s consider one perspective, that of our guest. Dr. Mena, how did you become interested in psychiatry as a career choice?

Dr. Mirhom: Well, Fr. Alex, I just want to start by thanking you so much for having me on. As you mentioned in your intro, for me, the interest in the career choice was primarily where I met God personally, in my own brokenness and my own vulnerabilities and my own struggles. One of the ways I was able to see God clearly was in the midst of being there with others who are also facing the same difficulty or facing challenge in their lives, and seeing that God was truly present in that setting. As you mentioned, the icons of saints that we look to, one or two of those are on my wall, and I always ask for their prayers. There can be a sacred moment that is present in the exam room or in the hospital room, where Christ truly is the Physician who is administering care, and that was one of the things that drew me to psychiatry in particular. I felt that there was a connection that you can have on a human level, but also see the supernatural presence of God in a special way.

Fr. Alex: That’s wonderful to hear, and I’m sure that plays such an important role in how you minister to your patients, how you interact with them, and instead of seeing a pathology, you see them as children of God, and I’m sure that really makes your work so effective. What do individuals or families need to consider when discussing pharmaceutical options?

Dr. Mirhom: I think there are three main things to consider. The first one is, as you were also mentioning in the intro, that, as St. James tells us, every good gift comes from God. The question here as to whether I should be choosing my faith or something else sort of sets up a false dichotomy that we in the Orthodox Church don’t see this way. We see it as: every good gift, every perfect gift that’s available to us, that’s around us, really has one source, and, as we pray also in liturgical prayers, we have one true Physician of our souls and bodies.

I had one friend of mine who’s a bishop once joke and say, “You know that God is the one who does all the healing, but sometimes you doctors try to steal some of the credit.” [Laughter] I said, “You’re right. That’s absolutely the case.” That’s why, when we have that as a framework to begin with, that this is a tool that comes from God, that’s number one. Number two, and very, very importantly, is that this tool does not replace any other tool. In the northeast, the past couple of days we’ve had an intense blizzard, and I was using a shovel to shovel out snow. It would be foolish of me to say, “Well, now I have a shovel. I’m going to throw out all my spoons. I’m just going to use this for dinner for the rest of my life.” Well, no: it’s one tool for one particular purpose, and it’s really helpful in the snow; it’s not going to help me for dinner.

Medicine is sort of like that in the sense that when these things are in harmony— In the research, there is a model that is used, which is the biological, psychological, social, and spiritual model of understanding the human experience. There isn’t one element of this that supersedes and covers all elements of the human experience, but, together, the harmony of them can bring true healing. And this is seen even in secular research. You’re able to show the impact of spiritual care, especially when you combine it with good psychological care and good social care and good biological care. So the idea here of number two is that this one tool does not replace the other. If I begin to take a medication, this doesn’t mean that I don’t need spiritual guidance; this doesn’t mean that I don’t need prayer or I don’t need spiritual care altogether. On the contrary, this can lead me actually to number three, which is that medication can literally be life-saving.

I’ve had patients who are Orthodox come and tell me, “You know, Doc, this is the first time in a long time that I can pray again.” And I say, “What do you mean by that?” They say, “I’ve had such distress. I’ve been dealing with such incredible, major depression,” for example, or debilitating anxiety, that really takes over your life, and that there’s a reason that, worldwide, the number one cause of disability is actually major depression. And when that’s dealt with, you now have a barrier that’s lifted that can literally save a life.

Fr. Alex: So in that particular case, the pharmaceuticals help to create a sense of freedom that was not possible earlier.

Dr. Mirhom: Exactly, and it allows—that freedom now allows us to take an additional step to meet God, to be able to pray. For another patient, they told me that the act of attending church was very, very difficult, but the pharmaceutical intervention made that more possible, that they were able to participate in the communion, in the community in general. So when it’s used as a proper tool in the context of all the other tools, there is significant liberation that can come with it.

Fr. Alex: I do want to emphasize and highlight your first point, about: it’s not either/or, that it is not “medicine or faith,” but historically in our faith there’s been a harmonious bond between the two, and I think that really has to be emphasized. For some reason, some of the voices that we’re hearing are trying to really create a chasm between the two, of pitting one against the other, as opposed to the harmonious way that they have been able to work together.

Dr. Mirhom: Yes, so much so that I’ve had patients—this will sometimes add almost an insult to injury, where you have a dedicated parishioner who is trying their very best, getting spiritual guidance, very disciplined, and saying, “Well, if I’m doing all these things and I still feel an incredible depression that is unrelenting, then I must not be a good Christian. There must be a defect in my faith. I must not be doing this right.” And then sometimes, unfortunately, as you’re saying, Father, that can be reinforced when someone says, “Yes, if only you were more careful in your prayers, or if you were to be reading this one particular book from the Fathers, you would understand the nature of the noonday demon, and you’d understand the patristic approach to how you can have healing.” And instead of saying you can have those things as well as seek professional care, they really do make it one or the other. And almost again even more, to the point where, if you were to seek a medication intervention, it would be a sin. I don’t know if you’ve come across that kind of thing, Father.

Fr. Alex: What I do come across—and I’d like to know what your perspective is—sometimes I hear kind of shame-based language, that it’s a weakness if I have to take some kind of medication, that it’s not only that I have a weak faith, but it somehow is a weakness that I’m not able to overcome, and there’s some kind of a shame base. I don’t know if you’ve come across that at all.

Dr. Mirhom: Absolutely, and one way that we sort of approach that, especially from our Orthodox faith, is to begin with sort of a non shame-based but humble approach of saying, “We believe that we’re all weak. We’re all in a frail human condition that requires many, many interventions to be able to attain and reach the full measure of Christ in us.” So in that regard, there is no shame or weakness in saying that we need help on one level or another. We begin with that foundation, but then we build on it and say, specifically when we’re talking about, let’s say, for example, the weakness of the body, when my pancreas is weak and I’ve been diagnosed with diabetes, I’m not going to shame my pancreas and say, “Gosh, what a silly organ. It’s not doing what it needs to. And now, out of abundance of weakness, I have to take insulin.” I mean, it certainly is a weakness and a fallen nature of the body, but it’s not something that we’re compounding shame with it.

For some reason, and understandably so sometimes, we miss this gap in mental health, knowing that, first and foremost, these are not just choices that people are making; this is an actual disorder. Oftentimes there is an actual neurochemical process that’s gone awry. Again, going back for us theologically is that God never created us this way. Adam and Eve were not created with a defect in their pancreas or their brain; there was this perfection in the garden, but we have fallen from that. And one of the ways that God is restoring us is spiritually as well as, at times, whether it’s insulin or it’s an SSRI for major depression or for serious mental illness.

Fr. Alex: Doctor, how do we integrate, especially in regard to our listeners—how to we integrate our Orthodox Christian faith into the decision-making process? Because each case is unique, each case does have to be looked at in its context, whether for themselves, whether for a family member. What advice or counsel would you give regarding that integration and harmony?

Dr. Mirhom: I would say one of the first things to think about, as you’re saying here, Father, is this is an individualized decision, and this isn’t a “one size fits all” for every single person who is struggling with one particular symptom, that medicine is right for everyone or medicine is wrong for everyone. But I would say one of the things that the Church teaches us in general is that there is, as Proverbs says, in the multitude of counsel there is wisdom, there is safety. So when we’re unsure, one important thing to be able to do is we seek spiritual counsel for wisdom, and perhaps we seek as well professional counsel for wisdom, and say, “I’ve had people tell me once or twice in the past, or more than that, say this is very difficult for me to understand whether this is a disorder or whether I’m just having a bad day.” And I explain to them, well, part of the reason it’s difficult for you to be able to decipher that is that there are trained professionals—it takes us a long time! [Laughter] It takes us a couple of years of training to help guide you to answer that question.

And most recently, as recent as yesterday, I saw an Orthodox patient who was telling me, “I’ve struggled with this question for many, many years, and I’ve finally gotten myself up to say: you know what, let me ask someone who does this for a living.” I said, “That was a very wise decision.” And the answer could be there: you don’t need medication at all. Perhaps the answer is: you need more of this particular practice. But one way that we incorporate our faith in the process is first by seeking wisdom. Secondly, after we seek wisdom, is that we’re taught to give God glory in all things.

I remember Fr. Thomas Hopko was talking in one lecture about how, even when a pharmacist is giving medication, he gives glory to God and prays for the sanctification of this medication, that it would be a blessing for someone who’s taking it. For me and the listener, we could be thinking in the same way. If I am to take a medication, I pause and I pray the same way I would before a meal, and I give God glory that there is something that is present that can be a part of my healing, that God has provided. Make no mistake, as we know from the book of Sirach, is that these medications are given to us from God for our healing. So that’s another element that we can incorporate God in the whole process: the decision-making prior, the therapy—each step, God is present and glorified in each step there. And to remind ourselves, as we are saying here, that there is a natural harmony in this process.

Fr. Alex: And to your first point, we start diagnosing ourselves. How clear-minded can we really be? We’re too close to the situation; we’re not trained. Again, I’m not suggesting that we just take at face value whatever a medical professional tells us, but at the same time in every other area of our lives, do we not look for guidance? Do we not look for expertise? Do we not look for people who are further down the road than we are to help us come to these conclusions and come to these points of being able to utilize the wisdom that surrounds us, correct?

Dr. Mirhom: That’s absolutely right. And oftentimes it’s understandable. There’s actually data that says for many people, the first time they’ll actually seek care from the onset of symptoms to the time that they see a professional, it could be an 11-year gap in that time, which is sad. So if you are in that position where you’re struggling with this decision to even speak with someone, and you’ve been putting it off for months and maybe years, you’re certainly not alone. This is actually more the norm than the exception. But my encouragement—I think yours as well, Father—is that if you do take this step and you say, “Well, let me get an assessment, and I’m not legally or spiritually bound by the assessment at all, but it might give a perspective.” It might be something that sheds some light, that says: You know what? What you’ve been experiencing is actually common and actually treatable, and life can be completely different.

I remember one patient who very recently told me, “I’ve been dealing with this for so many years that I never thought that things could be different in any way. I just thought that this was what life was like, and I haven’t laughed in years.” I thought that that was telling. It was almost hard to picture, but that was his experience. And he told me, “This is now very different for me, that I haven’t had that experience in years. I thought this was what life would be like forever.”

Fr. Alex: Doctor, as we are recording this podcast, we are experiencing the roll-out of the COVID-19 vaccines and all that that entails. What have been some of the responses that you’ve been hearing from patients and others about the roll-out, about people being open to the vaccine, not being open? What’s been your general observation?

Dr. Mirhom: My general observation has certainly been mixed. I actually was with some close family members this morning who got their vaccine, and in one couple, in this family member, it was actually illustrated the variation of responses. One person was overjoyed. He told me, “This is an amazing thing that— How did science create this?” and the fact that we can now have immunity. He was almost doing jumping-jacks from the joy of being able to have a vaccine that prevents this awful, life-threatening disease.

And in the same room there’s another member of my family who was very skeptical, and said, “Well, I don’t know if I can trust this, and I don’t know if— I’m very anxious about it and very worried.” And both of those reactions are perfectly normal. Our role in the medical community, or our task really, has been to try to encourage the one hand, the folks who are excited, who are hopeful, who are seeing this as a shot of hope and normalcy and being able to really save lives; and for the folks who are anxious and worried and concerned, to not speak down to them by any means, but be able to say, “Hey, your concerns are valid. It’s okay to be worried. It’s okay to be unsure.” But then to take the next step and say, “If you have questions”—it’s similar to what we were saying in sort of seeking wisdom and counsel—“speak to a trusted source.

I have friends whom I’ve spent maybe an hour speaking through the data with them. “Oh, you’re concerned about fertility. Let’s talk about the data on that.” “You’re concerned about how this might impact various areas of your life. Let’s talk about the data. We actually have very reassuring information.” But at the heart of it, really, is, again, giving God glory in all things, and that this is something God has given us as a gift, really, and we’ve invested in as a society, as humanity, but it’s a gift of hope that something can be different from where things are now, because things are in a very difficult position.

Fr. Alex: Great thoughts. Great observations, Doctor. Maybe if we can leave it at this point. There’s so many different perspectives and ways we can develop the conversation, but are there any—at least for the time being—any final thoughts, advice, you would want to leave our listeners on this topic?

Dr. Mirhom: Definitely. I think one of the things I’d love to leave our listeners with is: If you’re struggling with this question of: How do I know if what I’m experiencing is— Maybe I’m just having a bad day; maybe it’s been a bad week or month. Certainly we’ve all been having a tough year, since March of last year. What’s a guiding principle that I can use to decide whether or not I should speak with someone? And there’s a little—if you’ll indulge me with a little mnemonic here of the five Ds of distress, that might help answer that question for you.

These are five categories that the research tells us: if you go through this and you answer some of these questions, they can guide you—not diagnose, but guide you—into whether or not you should perhaps speak with a professional. The first D in the five Ds of distress is duration: How long have you been experiencing these things? Whatever distress you’ve been feeling, it’s natural of course for us to have one difficult day, two difficult days here and there, but if you’ve been feeling something that’s been distressing for weeks and months, perhaps even years, that’s the first red flag.

The second one is daily. This is an experience that you’re feeling one day here and not for another week, or is it something that you’re experiencing day in and day out: the frequency of it is just consistent and unrelenting—that’s another red flag.

The third one is depth. There are some folks who may be anxious or worried when there is a thought about politics, perhaps, or social issues, or many different things, but if there is a depth to your experience—as one patient called me last week and said, “I’m having these uncontrollable panic attacks, where I feel like I can’t catch my breath; I feel like I’m going to die, and I’m a young, healthy person”—that’s another red flag, that the depth to that experience that is perhaps much more than an average daily experience.

The fourth D of distress is duty. How does this begin to impact your life? If you’re beginning to see that this is getting in the way of work or school or your worship at church, your community, this is another red flag, that this is now getting in the way of life.

And then, lastly and most clearly, is danger. If at any point—and we’ve lost too many dear brothers and sisters to suicide—if at any point there are thoughts of self-harm, there are thoughts that are putting us in a place of danger, that is another immediate red flag, is that we should be seeking help, because, as we’ll wrap it all up and say: God has given us an incredible tool, that, when it’s used correctly and when it’s used balanced and when it’s used in the context of our Orthodox understanding, can be life-saving.

Fr. Alex: We have been blessed to be speaking with Dr. Mena Mirhom. Our topic has been “Medication & Mental Health: An Orthodox Christian Perspective.” Doctor, thank you so much for all that you’ve offered, food for thought for our listeners to consider, to not have to choose between faith and medicine, but finding that middle road of seeking the wisdom and help that you’ve offered to us. Thank you and blessings to you in your work and ministry.

Dr. Mirhom: Thank you so much, Father. I really appreciate it.