Catholic Medical Quarterly Volume 71(2) May 2021

Book Review

How to Feel Good and How Not To.
The Ethics of Using Marijuanna, Alcohol, Antidepressants and other Mood-Altering Drugs

by John-Mark L. Miravalle. Sophia Institute Press

Reviewed by Dr Pravin Thevasathan

Feeling good book coverHow ought we judge the phenomenon of chemical mood alteration? Is it always immoral? The author combines philosophy, theology and science to masterfully respond to these and similar questions.I was pleased to note that the author does not exclude the possbility of antidepressant use in cases of clinical depression. He rightly points out that just because we don't know how they work, that doesn't mean they don't.  There are any number of medications out there for which we don't know how they precisely work.

The author notes that antidepressants treat the symptoms of suffering, not the cause. Also, there is a real concern that they may be over-prescribed. A colleague told me of a deprived area in a certain town where he found many single mothers to be on antidepressants when the problems were most frequently social.

And sometimes suffering, as the author puts it, needs to be accepted as part of the human condition. It is there for a purpose. So much depends on how we deal with the suffering granted to us. I found the author's discussion of human suffering especially helpful. Suffering is best understood in the context of what we are here for: union with God. This union is our purpose, our delight. Suffering as such is not evil. The way we deal with it may be.

It is not sufficient to treat the symptoms of suffering. We need to get to the cause. Certainly in this part of the world, psychiatrists have become diagnosticians, people who gather symptoms and offer treatments based on the findings. I have mixed feelings about this. Psychiatrists who in the past looked for causes often got it wrong. Another problem is that psychiatrists tend to be signifi­cantly less religious than their patients.
The depressed person is suffering from disordered sorrow. Antidepressants are there to help him regain a sense of reality so that he can proceed to deal with the causes of his sorrow. I would argue that there are times when root causes may not be found. In bipolar disorder, for instance.

The author notes that for Aquinas, bodily passions start in the body and end in the soul while psychological passions start in the soul and end in the body. In the first case, a chemical change in the body leads to depression. In the latter case, some psychological trauma leads to depression. It would appear that Aquinas is referring to what we used to call endogenous and reactive depression!

There is a real moral difference between the mind altering effects of antidepressant use and cannabis use. If antidepressants bring the person back to reality, cannabis use can be a flight from reality. It produces disordered delight and is thus sinful.

What about alcohol? This is not without moral risk. Deliberate drunkenness is seriously sinful as it inhibits the intellect's capacity for truth and the will's capacity to freely pursue what is good. But when we consume alcohol to nourish, hydrate and delight ourselves and others with something excellently made, we are using these drinks in a genuinely recreational way. Moderate use of alcohol is not sinful. I am sure the author will agree that for some individuals, even moderate consumption is best avoided.

In summary, a very fine read.