Living with Anxiety, Medication and Prayer
When Rob Culhane’s doctor prescribed an anti-anxiety drug for him, they both found themselves asking an important question: how would the medication affect his prayer? Writing for The Way, Rob describes the process of trying to answer that question and considers what he has learned about religious experience.
Just as I was leaving his consulting room, my doctor asked me a question. I had visited him to review the effects of an anti-anxiety drug that he had prescribed for me. As I left, he poked his head around the door and asked: ‘How do you think the new drug will affect your spirituality?’ Ever since Aldous Huxley took mescaline in the 1950s the relationship between drugs and spiritual experience has interested many and has never been entirely resolved. This question from my doctor, like the questions my spiritual director asks me, stuck in my mind and refused to go away. What effect does this medically prescribed drug, which reduces anxiety or depression, have on my life of prayer as a Christian? More particularly, does the influence of the drug enable or assist in genuine religious experience, or is it creating a false one which will disappear once I stop taking it?
Despite all that I may know about God being a God who gives us peace (John 14:27), a God on whom we may cast all our cares (Psalm 55:22) and one to whom we can present our requests and not be anxious about our future (Philippians 4:6), I suffer from anxiety. I am a parish priest, and several acute conflicts with parishioners and bullying by them have taken their toll on me. In the background there is also the influence of an accumulation of various historical events from my late childhood and early adulthood, which have conditioned my reactions in certain situations and contributed to my over-sensitised nervous system.
I know enough from my professional training to recognise some of the symptoms — and I also know, theologically, that we are not a bundle of discrete and independent parts which compose our humanity, but an integration of soul, spirit, mind and body in a person. What influences one part affects the others, as the apostle Paul aptly noted when making the analogy between our human body and the body of Christ, the Church. Our experience of the common cold, or lack of sleep owing to a crying baby at night, confirms this often ignored but real integration and interdependence of the parts of what we might call ‘the self’ with our bodies.
My anxiety affected my ability to concentrate and also my memory: I began to forget things and where I had left them. My forgetfulness added to a heightened sense of losing control of myself. Bodily, I felt increasingly tense, on edge and emotionally overwhelmed by trying to manage the simple tasks of daily living. Little events would trigger a disproportionate and unhelpful overreaction, sometimes of anger or profound sadness. Various ‘voices’ or memories and feelings associated with what I should have said, or what others had said to me, would be rehearsed regularly in my mind. In the early hours of the morning, when sleep had fled me, I would lie awake, replaying conversations from last week, or twenty years ago. Something had to be done. After many years of putting up with it, I made enough of the right noises for my doctor to hear and he concurred: it was time to try a drug therapy.
My Practice of Prayer
Before I began taking the drug, I found it virtually impossible to sit in my regular place to pray each morning. My mind would be constantly filled with swirling thoughts which made concentration difficult. My habitual practice of centring prayer had become a struggle, as a string of thoughts crowded in and displaced any ability to sit in God’s presence. Although centring prayer is undoubtedly a useful practice, my anxiety would often feed into and animate the repetition of the ‘prayer word’ or phrase used to return and anchor myself back in God’s presence, and this resulted in a heightened sense of agitation. Basically, the general peace of God, which underlies daily experience and gives a buoyancy to one’s outlook, had gone, and a feeling of brittleness and urgency had replaced it.
Once I began taking the drug, it seemed as if the voices and the sense of urgency or interiorised need to ‘push’ to get things done had receded and were separated from me by the introduction of a glass wall. This distancing was at first a little disconcerting, as I had become so accustomed to their presence as constant companions that I began to wonder whether I could function without them. Because the sense of urgency and the ‘interiorised push’ had been effectively disabled by the drug’s impact on me, I began to wonder if I had lost my ambition and desire to fulfil the plans I had made for the coming summer and then the next year. I felt at peace, however, even if these plans were not to come to fruition. My focus had shifted from an emphasis on long-term planning — with its attendant creation of struggle to achieve goals and the risk of disappointment — to the here and now.
The positive effect of the drug has been to dull the over-sensitive and wounded conscience that rehearsed worries, conversations and negative comments in the middle of the night. However, the negative effect has been to dull my sense of a yearning for God. This yearning had been ineffable, but rested just below the surface of everyday thinking; it acted like a weathervane, pointing me towards the God who, in my deepest self, I wanted to be with, to know and to experience. This sense of quest, of searching for God, a holy discontent with current religious practice and experience, has now been dissipated. In its place a warm emptiness fills the void, leaving me only partially content.
My sensitivity to God is only one half of what has been lost. The other half is my awareness of how this secular age smothers conversation about God in everyday life and corrosively eats away at our experience of God. Now I am often simply unaware of the ache in my heart for what is missing. My dissatisfaction with this world and the life of crass Western consumerism is now narcotized. The intellectual apparatus, fine-tuned from academic study, which acted like a Geiger counter frenetically analyzing everything, is now turned down. I feel as if I am flying without the cockpit instruments of intuition, experience and awareness or a compass that is set to true north. I am having to relearn what it is to discern without an automatic reliance on ‘gut’ response and re-engage with the classical rules and observations concerning spiritual discernment.
The drug has confirmed to me that it is unhelpful to identify intense, fervent prayer with authentic religious experience and to value it more highly than a duller and, to all appearances, prosaic and everyday prayer of struggle, quiet thankfulness and gentle joy. These fruits might be said to characterize the practice of contemplative prayer. The drug’s quietening effect now forces me to face the fact that sparks and skyrockets were no foolproof indication of the Holy Spirit’s interior work. But there have been additional side effects — not all of which are so helpful. The drug has muted the colour of daily life, with its light and dark shades. The gentle ecstasy of a golden sunset reflected on a street freshly washed by rain is now drained of its intensity and joy. Whereas it might have once moved me to tears, now it is bland. Music seldom affects my soul and I become quickly bored. Comedy is more likely to elicit disdain than laughter.
I have been forced to recognise how the spirit of Romanticism had infected my Christian experience. Romanticism celebrated the view that our personal experience, unencumbered by the weight of tradition or cultural authority, determines aesthetic value and validates truth. This spirit of Romanticism had given its affirmation to my over-anxious emotions, leading me to believe that they represented the truth of reality and the presence or absence of God. But it has been exposed by the drug’s quietening effect as a cultural accretion that had to fall away before I could find the light of clarity that I was seeking in the practice of contemplative prayer.
Even after taking the drug for many months, it has not entirely suppressed the cacophony of distracting emotional messages and racing thoughts when I attempt to settle into centring prayer. In this regard, I think my experience is now little different from that of a ‘normal’ person. It is part of the human condition that when we sit to pray — and by this I mean to open ourselves intentionally in surrender to God’s love — we become aware that we are in God, and God is in us (John 14:20), yet we also become aware of the chatter going on in our heads. Martin Laird describes this as being like an ‘… interior soap opera, the constant chatter of the cocktail party’. The difference between this self-talk before the introduction of the drug and ‘chatter’ and distractions now is that the former came with unhelpful emotional overtones, whereas the latter are just annoying irritations which come and go, as Laird describes it, like the clouds and mist passing the summit of a mountain. The ‘mountain’, that deep reality of God’s life in us, remains undisturbed by their passing.
Speaking generally, the emotional intensity that drove my prayer life has been quietened, but a number of nagging problems have emerged. To what degree is it God or the drug that is producing my contemplative experience? Am I experiencing the awareness of the presence of God in the deepest recesses of myself, or is it just the influence of the drug? How far can I consider my new experience to be a ‘genuine’ one? Finally, how can I interpret this new landscape in which I find myself, where I do not feel confident that I can recognise my new ‘self’ with any degree of certainty?
The subjective nature of prayer sometimes causes us to measure its value, either by standards of our own or by those of the authors we are currently reading. Some people try to locate themselves within the classical descriptions of the threefold stages of mystical transformation. Whatever the standard we apply, we may feel that our prayers are little more than the widow’s insignificant copper coins, thrown into the temple treasury (Luke 21:3).
But quiet prayers are noticed by God and are just as authentic as the intense, over-anxious ones which were my experience before the introduction of the drug. Whether they are considered genuine or not, warm or cold, they reveal the condition of our hearts to us as well as to God, even if they are no longer driven by the intensity of our emotions. Even if the words of our prayer are cool, or mumbled in sleepiness, God at least will know through the Spirit what our intentions were. As Michael Casey puts it in his characteristic Benedictine wisdom, there are seasons in prayer: summer, winter, the quiet joy of autumn, the energy of spring. But whether we feel arid or full of God’s grace so that prayer flows freely from a full heart, it does not matter. We should not allow ourselves, as he says, to ‘… be tyrannized by expectations about what we should be experiencing. If it is winter within, I should not punish myself for a lack of warmth.’
The arrival of this drug’s influence has meant for me letting go of any number of expectations about ‘what should be happening’, and learning to become acquainted with a gentler, quieter loving presence. It is like the experience perhaps shared between a couple in their twilight years: the fruit of their mutual sacrifice and determination to grow sweeter and more forgiving in their life together. I have had to reclaim the practice of contemplation as one which is fuelled by desire, not raw emotion—and it is desire for God. The analogy of the lover and the Loved is often employed from the bridal mystical tradition to talk about this desire and love for God. As a description of the interior life, this analogy is a helpful explanation of what is ultimately ineffable and unknowable to those who have not experienced it or who are unwilling to seek it, as it lies beyond the horizon of their awareness. It is a way of knowing God which is not reliant on emotions or moods and is certainly not a cognitive one, but one of a deeper awareness which arises from within the heart and leads to communion.
The emphasis within contemplative prayer is that one moves beyond mere words to recognise that ‘Prayer is not just dialogue; it is the first stage of surrender’. Or, as I once heard it described in a prayer workshop, it is ‘… lying in the arms of the divine, in a relaxed state’. Images and concepts in this approach to prayer are unhelpful as a way of knowing God because they maintain God as an object of the mind to be understood in intellectual and aesthetic terms.
My experience of anxiety had, to some extent, reintroduced the subject–object dichotomy through the domination of the ‘voices’ in my head. Their persistent commentary had introduced a threefold conversation: there was my conversation with God, now muted by the effect of the drug, and another between me and the ‘voice’ generated by my anxiety. It was this one which now dominated. The result was to shift my focus on to myself as subject and therefore to see God as an object, albeit one who was now remote, even hidden.
But our knowledge of God is not a result of the scientific method, by which the observer as subject seeks to gain control or mastery of the object. It is achieved by way of meditation on whom God is, a sensory perception and a participation in God’s love, which dissolve the dichotomy still found in much modern theological discourse. Yes, there is, as Thomas Merton notes, following St John of the Cross, a place for words and concepts but they should be used ‘after the fact’.
Beyond the Dichotomy
So where does this leave me? If the practice of contemplation offers an alternative to — and method of dealing with — the noise and intrusive thoughts which are a part of everyday life, particularly when I sit to pray, why did it not prevent me from having to take the drug in the first place? There is a simple answer to this question. First, the intensity of the attacks on me and their extended duration had destroyed my protective walls. Anxiety had laid siege to those walls and battered them until a breach was made, which was then carefully exploited for maximum effect. Basically, once my walls of resistance were breached, the anxiety set about destroying what self-confidence I had inside. Withdrawal to safety became a priority, and the drug has provided some respite while I come to terms with what has occurred. Second, the anxiety used against me the very prayer method that had formerly provided solace and a degree of peace and spiritual strength, by seizing control of it.
In the aftermath of the drug’s effect, one way I have looked at things has been to recognise that the object (God) and the subject (me) will remain an unresolved dichotomy if I continue to place a certain amount of emphasis on my moods, reactive emotions and feelings, and the internal conversations and commentary which accompany these feelings. Both the moods and the commentary can be misleading and are likely to give me a false impression about myself, God and life. As Martin Laird and others following the Desert Tradition have highlighted, the commentary running in our minds is not our true self but our construction of a false one in the form of stories we tell ourselves. Yet, these remain a part of me, even if they no longer dominate or intrude into the foreground of my prayer because of the medical effect of the drug.
In spiritual direction, a retreat leader identified this person governed by his past hurts and reactions with their commentary as ‘the historical Rob’. I had recognised this person for several years, and I expended considerable amounts of energy managing him each day before the introduction of the drug. I used to joke, but in all seriousness, that the first thing I had to do each morning was supervise and care for the ‘historical Rob’ before I was ready to engage with life and my ministerial responsibilities. The upside of the drug has been to reduce the amount of energy I devote to this process every day, but self-awareness and the monitoring of the inner life and life with God must remain basic practices for me, and for all those earnestly seeking to be disciples of Christ. The drug must never lead me to loosen my personal responsibility for myself, for keeping God’s commandments to love God and my neighbour. Remaining aware of our propensity for certain temptations is always necessary to avoid falling into sin, which risks sabotaging our professional and family life, and making a shipwreck of our Christian faith.
One way in which I have moved forward and away from the irresolvable dichotomy and my own false commentary has been to shift my awareness of God in Godself, and to become relaxed about what my perceptions of God might be. As Michael Casey highlights: ‘God is never totally present nor absent from our lives’. We are frequently left in the cultivation of contemplative prayer with a sense of unknowing, in which our hearts hear a call to move beyond the first states of the child–parent relationship with God, and to go deeper into contemplation as the place where our truest home will be found. We are restless, as Augustine knew so well, until we respond to this deeper calling which is issued by God as an invitation. We are drawn towards something which might be described as a ‘thirst’ or ‘need’. We continue on and ‘persevere, secretly sustained at a level deeper than feeling, with an inkling God awaits us ahead’.
My certainty rests not on resolving an unresolvable dichotomy (a fascinating subject for theological epistemology), but on God being God — a God who understands me even if I am uncertain about my own knowledge or awareness of myself. As the Psalmist writes: ‘O Lord, you have searched me and known me’. Thus, the focus of my attention must shift outside my self-enclosed world, with all its uncertainties, to God’s perception of me and knowledge of me.
Two twentieth-century authors who have expressed this struggle between uncertainty about their own motives, the reliability of their self-awareness and the question of whether they are even on the right path were both theologians, but they did so by way of poetry. Thomas Merton’s Thoughts in Solitude and Dietrich Bonhoeffer’s, ‘Who Am I?’ both articulate the bewildering experience that we may be uncertain about our motivations, where we are going and who we are, but that does not in itself matter, because God knows. There is not only simple trust in this awareness of God’s knowledge, but also the assurance that our desire to please God is itself enough for God because of God’s relentless grace: ‘the fact that I think I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you. And I hope I have that desire in all that I am doing.’
When I first read the Bonhoeffer poem, I smiled in recognition that this had been my experience too: ‘Who am I? They mock me, these lonely questions of mine. / Whoever I am, thou knowest me; O God, I am thine!’ I had eventually settled into the position that I had arrived in this place of not knowing God through my senses or moods, and whether this was from the effect of the drug or not did not in the end matter. Whether it came from the sensory and social deprivation of Bonhoeffer’s prison experience, or Merton’s intellectual perplexity or, in my own case, anxiety and its treatment, was of less importance than the recognition itself: that this was where I had come, and who I was now, and that God was present. But this presence does not take the standard form of an operating knowledge that might satisfy my restless mind, with its insatiable curiosity and need to indulge in endless commentary about my experience and perceptions.
My spiritual director, having patiently listened to my monologue about all the things going on in my life and the drug’s effect on it, got to the heart of the issue by asking me the classical Ignatian discernment question: ‘What is God’s desire for Rob?’ This was followed up by ‘What is Rob’s desire for God?’ My answer to the latter would be surrender to a God whom I will not know with the pinpoint certainty that my mind and formal theology demand, but whose life and presence are discerned interiorly.
The continuing and residual sense of restlessness, thirst, interior emptiness, desire and wistful longing are deep and powerful intimations which we hear in our hearts that we are seeking God. We learn to recognise this call and also its attendant cost: we will find no satisfaction until we encounter God in the daily practice of contemplation and in a lifestyle which provides the opportunity to be aware of God in our own lives and the wider world. Those responding to this contemplative call to prayer, silence and solitude will, as a consequence, guard their opportunities for silence like gold. They will also take the advice of the Desert Fathers and ‘guard the heart’ from distractions and unhelpful pursuits, emotionally laden conversations and mindless engagement with electronic devices which can over-stimulate our nervous systems and fill our minds with too many distractions.
The dampening effect of the drug on my sensory system, and my resultant questioning of authentic religious experience have led me to consider the diverse ways through which God’s love and presence might be mediated to me. The physicality of a place, memory of previous religious experience, the sacraments and reading scripture are just some. But one to which I wish to draw particular attention is the role that the liturgical prayers of the Church play in helping me focus on who God is and God’s intimate knowledge of us. Reading them I am often struck by the assurance they provide that, even if I am uncertain of where I am in the journey, whatever I may understand of myself and God, God does understand, and this provides great and sustaining comfort. These set prayers of our worship, too often recited without thought, were carefully constructed and draw our focus away from our own internalised, self-enclosed world, back into the spacious awareness of God’s presence and being with us.
The Culture of Anxiety
We live in a culture characterized by anxiety and over-stimulation. Both these features infiltrate the individual and may combine with the personal anxiety that he or she is experiencing from over-demanding work situations, life’s struggles and so on. The Church is not immune from these problems, as it often reflects the prevailing culture and imports its values unconsciously in an attempt to be ‘relevant’ to a younger generation. It should not surprise us, then, that we have over-functioning, anxious ministers, who produce anxious and task driven congregations of exhausted disciples of Christ.
Given this insidious and unrelenting undermining of our peace, the quietening effect of anxiety medication is not necessarily a bad thing, especially for ministers such as myself. My fear now, however, is not of professional failure or crashing out of ministry, but of settling for mediocrity as someone who is committed to following Christ and living each day intentionally in his presence and expressing this in a recognisable lifestyle. The regular practice of contemplation will often result in living in a place of discontent with everything, with our pathetic attempts at prayer, with feeling like a fraud. Yet there is also the awareness that no other option is really available for those who have found the pearl of great price than to devote their lives to its pursuit, because this is to devote their lives to God, who is found in Christ. It remains an ambiguous experience, an uncertain place to try to dwell, yet it is a call which is deeper than all the other vocations we might have heard and followed, even after we have heard God’s first call to come and follow God’s Son. It is the call to come home and find ourselves in God.
Rob Culhane is an Anglican priest in Melbourne, Australia. He is completing a mastership in Theological Studies at Yarra Theological Union, Box Hill, Melbourne, a member college of the University of Divinity, Victoria, Australia.
This article was published in The Way, 58/1 (January 2019). To find out more about and subscribe to The Way, please visit theway.org.uk.
 The drug is fluoxetine, 20 mg. It is a selective serotonin reuptake inhibitor (SSRI), which has become popularly known by its trade name, Prozac, although my particular brand is Lovan and may differ slightly in its composition.
 Aldous Huxley took mescaline in 1953 and was overwhelmed by the religious experience it produced. His account of this experience and reflections on it were published as The Doors of Perception (1954). An essay on the relationship between mysticism and use of mind-altering drugs then followed in his book Heaven and Hell (1956). They are often now published together in one volume: The Doors of Perception and Heaven and Hell (New York: HarperPerennial, 2009).
 1 Corinthians 12:12–27, especially 26.
 A question which naturally arises in this discussion is whether the drug induces or facilitates the arrival of a phenomenon described by St John of Cross, the ‘dark night of the soul’. The short answer is no. My love of reading scripture continues; my prayer might be flatter, but I continue in it. My love for God and neighbour remains intact. There is no sense of dereliction or abandonment, and no loss of ‘the senses’ we have of God.
 Martin Laird, Into the Silent Land: A Guide to the Christian Practice of Contemplation (Oxford: OUP, 2006), 15.
 Laird, Into the Silent Land, 89.
 Laird notes that judging the quality of one’s prayer is one of the three problems associated with distractions (Into The Silent Land, 85).
 These have been traditionally been identified as illumination, purgation and finally union with God, although there are, as both St John of the Cross and Evelyn Underhill have proposed, variations in the number of ‘stages’.
 Romans 8:26–27.
 Michael Casey, Towards God (Mulgrave: John Garratt, 1995), 125.
 Casey, Towards God, 51.
 This is often called the ‘apophatic’ approach to prayer and is particularly advocated in the anonymous The Cloud of Unknowing.
 Thomas Merton, Contemplative Prayer (London: Darton, Longman and Todd, 2005), 109.
 See Laird, Into the Silent Land, 115.
 James 1:13–15 and Hebrews 12:14–17 are just a few verses which offer a sharp and sobering warning about the way in which a person can become overtaken by temptation to sin and destruction.
 A point discussed in passing by Janet K. Ruffing, Spiritual Direction: Beyond the Beginnings (New York and Mahwah: Paulist, 2000), 99.
 Casey, Towards God, 123.
 See Augustine, Confessions, 1.1.
 Casey, Towards God, 126.
 Psalm 139:1–4.
 1 John 3:19–20. ‘We … will reassure our hearts before him whenever our hearts condemn us; for God is greater than our hearts, and he knows everything’.
 See Thomas Merton, Thoughts in Solitude (New York: Farrar, Straus and Giroux, 1999), 79, and Dietrich Bonhoeffer, Letters and Papers from Prison, translated by Isabel Best (Minneapolis: Fortress, 2010), 459–460.
 Merton, Thoughts in Solitude, 79.
 Bonhoeffer, Letters and Papers from Prison, 460.
 See Evagrius Ponticus, On Thoughts, n.38, quoting Proverbs 4:23.
 The Anglican prayer book has the ‘Prayer of Preparation’ which, as its title suggests, precedes the eucharist by preparing the person’s heart to become aware again of God’s extrinsic relationship to us, yet sets forth a declaration of God’s knowledge of us and our desire to love God: ‘Almighty God, to whom all hearts are open, all desires known, and from whom no secrets are hidden: cleanse the thoughts of our hearts by the inspiration of your Holy Spirit, that we may perfectly love you, and worthily magnify your holy name, through Christ our Lord. Amen.’ The source of this prayer, adapted by Thomas Cranmer, is the introduction to the Cloud of Unknowing. Another prayer of a similar type is the General Confession.
 See Stephen Pickard, Seeking the Church (London: SCM, 2012), 217 and 223.