Bad medicine

The morning I gave birth to my third child I awoke to the harsh beep of an IV pump just as a bubbly, petite nurse opened my hospital room door. She wore a green surgical cap and mask, leaving only her dark brown eyes visible. But they glowed with kindness and confidence. My excitement grew as we discussed the plan for my son’s entry into the world. Any jitters I felt about the delivery stilled in the presence of my nurse’s obvious proficiency. I had no idea that in just a few hours, she would save my life.

Later that morning, a doctor came in to give me an epidural. It wasn’t until after he left me alone that I realized something had gone terribly wrong. Instead of targeting my pelvic area to control the labor pain, the medication raced through my entire body. It numbed my arms, lowered my blood pressure, and worse, made it difficult to breathe. I felt the room going dark and fought to stay awake. As a nurse myself, I knew the doctor’s mistake could kill me, and I was terrified. I begged God to save my life.

Suddenly my nurse appeared above me, her eyes now full of concern. She asked me a question, but I couldn’t answer. I simply lay there, helpless. She quickly turned off the epidural and gave me a rescue medication. It immediately made it easier for me to breathe, but the full effects of the epidural took several hours to wear off. Later that afternoon, I delivered a healthy baby boy.

I tried to forget my near-death experience in the delivery room, but eight weeks later it came back to haunt me. In the midst of an ordinary morning, snuggling my newborn and breaking up spats between the older two siblings, my heart rate spiked. It felt like a kick in the chest. I couldn’t catch my breath and the room began to spin. I spent the rest of the day in the emergency department, undergoing tests and labs, but doctors couldn’t determine what was wrong.

Over the following weeks, the heart-racing episodes became more frequent and intense. They woke me from sleep and often coincided with intense stomach pain and diarrhea. I was sent to follow-up appointments with specialist after specialist, but no one could pinpoint the cause. That’s when my doctors began to suspect the problem was with my mind: a common mental illness called postpartum depression.

Health experts and headlines warn us that America is in a mental health crisis. The statistics are grim: 30 percent of Americans report symptoms of anxiety and depression, and almost a quarter of Americans over the age of 18 are taking a mental health medication. But lost among the cries for increased awareness of mental health and access to treatment is an appropriate appreciation of the risks associated with the drugs that are often used as treatment. Meanwhile, modern medicine still struggles to explain the relationship between the mental, physical, and spiritual aspects of human beings—and thus often treats body and mind while ignoring the soul.

The result: Spiraling symptoms and medication pileups can trap patients in a vortex of never-ending illness that often masks the true underlying cause. That’s exactly what happened to me. And even though I hold a Ph.D. in nursing, I felt powerless to stop the chaos.

THREE WEEKS LATER, I was so sick that I couldn’t even get out of bed. Doctors referred me to a psychiatric nurse practitioner who is considered one of the nation’s top experts in postpartum mental illness. I hadn’t slept for more than two hours since the emergency room visit, and I visited with the nurse practitioner from home, propping my laptop on my legs. She said I had a “textbook case” of postpartum depression and postpartum panic disorder, a severe form of postpartum anxiety. She diagnosed my heart racing episodes as panic attacks. By this time, I was having dozens of them every day. I told her I didn’t feel sad or hopeless, but she explained that hormone shifts after birth can cause a chemical imbalance in the brain that leads to depression and anxiety.

She prescribed four psychiatric medications to help me heal: two antidepressants, Seroquel to make me sleep, and a benzodiazepine sedative to counteract the anxiety. She also recommended counseling. The diagnosis confused me because I hadn’t had any difficulty after the birth of my first two children. But I was desperate for answers and a cure. When I voiced doubts about taking the medications, the nurse practitioner said if I didn’t, I would end up in the hospital within a week due to lack of sleep. So I took them.

Since the late 19th century, psychiatrists and psychologists have debated the origin of mental illness, a condition broadly defined as problems with mood, thinking, and behavior that cause distress and impair daily life. At the heart of this debate is the nature of the relationship between the mind (the part of the person described as thought and consciousness) and the ­physical matter of the brain (the soft tissue including the nerves and neurons).

Proponents of the psychoanalytic model of mental illness, going back to the father of modern-day psychology, Sigmund Freud, argue that negative and traumatic life experiences are the root cause. That means treatment requires some form of talk therapy. Proponents of the biological model say problems with either brain structure or brain chemistry cause mental illness. That means treatment requires surgery—remember the infamous lobotomies of the mid-20th century?—or medicine.

The Food and Drug Administration approved the first psychiatric drugs in the mid-1950s. The time was ripe: The Cold War and threat of nuclear attack were stoking widespread fear and uncertainty in America. Meprobamate, the first sedative approved to treat anxiety, was marketed as “emotional aspirin.” Use of the drug became fashionable in Hollywood, and within a year it was the top-selling prescription medication in America.

In the mid-1960s, a new hypothesis of depression and anxiety led to the development of three successive groups of antidepressant medications. Each was developed to treat deficiencies in certain feel-good chemicals called neurotransmitters—deficiencies thought, but even today not proven, to cause mental illness.

ONCE I STARTED TAKING the prescribed medications, I felt both better and worse. I was finally able to sleep, and the panic attacks became less frequent and intense. But I also started noticing strange sensations in my brain. They felt like storms or electrical shocks and were at times nearly unbearable. I found it difficult to think and remember things, and sometimes my hands and feet twitched uncontrollably.

When I expressed concern about my medications to the nurse practitioner, she insisted I needed them to heal. She even gradually increased the doses over the course of several months. But four months after I started taking the drugs, I still felt so sick and weak that I couldn’t even care for my children on my own.

Psychiatric medications are notorious for having undesirable and sometimes dangerous side effects, and I was taking four at once. One was a serotonin reuptake inhibitor (SRI). Though they are the most commonly prescribed class of antidepressants, they can cause an array of symptoms that range from annoying to life-­altering. These include insomnia, headache, drowsiness, rash, vomiting, weight gain, and sexual dysfunction. Most troubling: This drug class is known to cause suicidal ideation, most often in children and adolescents.

I was also taking a benzodiazepine, the drug class most often prescribed for anxiety. Benzos, as they’re called on the street, can cause drowsiness, confusion, fainting, and tremors. If brain activity becomes so depressed that the patient stops breathing, they can also cause death.

In 2020, the FDA required benzodiazepines to carry an updated “boxed warning,” information on the drug’s dangers framed in a foreboding black box emblazoned on the drug’s packaging. A boxed warning is the agency’s most serious. Benzodiazepine users are warned about the “potential for abuse, addiction, and other serious risks.”

Like a dutiful patient, I was also taking AstraZeneca’s popular drug Seroquel. An anti­psychotic often prescribed for sleep, Seroquel is a real-life nightmare for many Americans. Seroquel was originally developed to treat schizophrenia, which occurs in less than 1 ­percent of the population. But after the FDA approved the drug in 1997, AstraZeneca began marketing it to doctors for a variety of “off-­label” uses, including treatment of insomnia, anxiety, depression, post-­traumatic stress disorder, and dementia. That increased the market for the drug exponentially.

Seroquel became a bestselling drug, generating billions in revenue. But then it was linked to the development of diabetes, heart arrhythmias, seizures, irreversible body movement disorders, and thousands of deaths. Since 2011, attorneys general from 38 states, along with individual patients, have sued AstraZeneca for irresponsible marketing and deleterious side effects. The ­company has paid over $1 billion in settlements. But the nurse practitioner didn’t tell me that.

North Carolina pediatrician Joan Perry remembers another patient who’d been placed on four different psychiatric medications for a long period of time by a local psychiatrist. The overload caused a flat affect (loss of expression and emotion) and inhibited the young girl’s ability to interact with others and her environment.

“Her mother described her like a little zombie,” Perry said.

Over several months, Perry weaned the girl off all four medications. Now she’s doing well and is able to fully participate in family life.

Perry, an adjunct faculty member at the University of North Carolina, has practiced in the rural eastern part of the state for 36 years. She pursued additional mental health training to treat children and adolescents when she noticed a great need in her area. She believes the overuse and inappropriate use of psychiatric medications is a problem.

According to Perry, both biological and experiential factors explain the genesis of anxiety and depression. “We all are born with specific DNA that programs how we interpret our environment,” she said. A person with a genetic propensity toward anxiety may have, for example, differing levels of brain neurotransmitters that cause him to initiate the fear-adrenaline reaction more quickly than other people.

Perry takes a judicious approach to prescribing ­psychiatric medications, with two caveats: First, she tells her patients (and their parents) that medication is not a permanent solution. Second, she tells them that medication will not solve the root issue and should be used in conjunction with other treatments, including counseling.

“Medication doesn’t change or rearrange your thoughts, but it helps treat your mind so your body will not respond in that exaggerated way,” Perry says.

Problems arise when doctors prescribe medications without making it absolutely clear to the patient that medication will not address the heart of the issue. Perry added that doctors often pile on medications in order to control behaviors, which leads to new problems due to the side effects.

DURING THE MONTHS I was so debilitated, I began meeting with a counselor I had known for 15 years. We talked about the physical and emotional challenges of having a newborn. But my near-death experience in the delivery room didn’t come up until I made a passing comment about it one day. When she prodded me for details, I told her the whole story. Her eyes opened wide in shock. “This all makes sense now!” she said. “You do not have postpartum depression. You have post-traumatic stress disorder from the delivery!”

As soon as she said it, I knew it was true. It was the only thing that made sense, given the vast difference between my recovery from the first two births and the last one. Post-traumatic stress disorder (PTSD) is an anxiety-related mental health disorder linked directly to a terrifying event. Ironically, repressing thoughts of the traumatic event is one of the hallmarks of PTSD.

After that, my husband and I started thinking differently about my illness and looked for new ways to treat it. Suspecting that my medications were contributing to keeping me sick, we decided I should stop taking them. Weaning off the medications was a scary process. I had a sudden burst of anxiety and irritation that lasted the entire withdrawal period. I battled nausea, pounding headaches, and an almost indescribable sensation of wanting to crawl out of my own skin to escape the chaos and pain vibrating through every cell in my body. But we were strengthened with the new knowledge that the source of my trouble was not some nebulous chemical imbalance but instead the result of a physical reaction to an emotionally disturbing event. I also started seeing a counselor who specialized in trauma-focused therapy.

James Porowski is a licensed psychologist with 30 years of counseling experience and a retired professor at Southeastern Baptist Theological Seminary. He specializes in counseling veterans with PTSD. Porowski uses a type of psychotherapy known as cognitive behavioral therapy (CBT). Through CBT, the counselor identifies the patient’s problem and helps him “reframe it”—or see the problem in a new light.

In the 1960s, psychiatrist Aaron Beck challenged Freud’s focus on discovering repressed past conflicts. Beck developed CBT to address patients’ immediate perceptions and feelings. Since then, it has been shown effective at treating depression, anxiety disorders, substance abuse problems, marital problems, eating disorders, and severe mental illness.

One of the main tools Porowski uses during CBT is the Bible. Part of reframing the problem, he says, is “bringing God into it and learning from Scripture how to handle different situations and experiences.” The soldiers and Marines he sees are haunted by war stories that in many cases involve them facing death or killing another person. Often they end their story with a question: “So what do I do?” Porowski starts by ­helping them simplify the problem.

“When I’m totally confused or deeply troubled,” Porowski tells his veteran patients, “I start by telling myself, ‘God knows what’s going on, I don’t. God loves me. There is a way through this and He wants to help.’” Porowski ties in relevant Scripture to demonstrate simple truths. For example, he often tells the story of King David and points out that although God knew David was a man of bloodshed, He still loved him and made him king.

THROUGH TRAUMA-FOCUSED COUNSELING, I discovered that the root issue behind my trauma was spiritual. I realized that when faced with the possibility of death during the delivery, I responded the same way I always have in stressful situations: “I’ll do better.” “I’ll try harder.” “I’ll pray more.” I’d been relying on my own abilities to overcome problems instead of trusting God. But in that hospital bed, I could not escape the truth that I was helpless to save myself.

Grant Castleberry, senior pastor of Capital Community Church in Raleigh, N.C., has seen cases like mine: spiritual problems manifesting in physical symptoms. He says that makes sense because God designed ­people with both a body and a soul—interwoven until physical death—and the two affect each other. While he understands that physical factors can play a role in mental health, he worries that treatment often relies on medication without addressing deeper spiritual needs.

That was the case for Heather Scott, a mother of two and business owner. When Heather was 12 years old, her father was murdered at a gas station near the family’s home. For 30 years doctors and therapists treated her for anxiety and depression with medications and talk therapy, but the root cause was never dealt with. She was prescribed an SSRI, but it only made matters worse because she gained weight, which added to her anxiety.

“I have been in survival mode my whole life,” she said. “When my dad passed away, my mom wasn’t working so we were in a financial crisis. … I remember thinking ‘I’ve got to get through school and graduate and get a career and make a lot of money.’ And that’s kind of what I did. I just sort of put my head down and I just started running.”

Heather continued running until she was forced to stop this past summer when California lawmakers sought to reduce the sentence of her father’s murderer. The old wound resurfaced as she began to fear her father’s killer being freed. Her anxiety spiked, and she had terrible physical symptoms including insomnia, full body rashes, and swelling. When Heather attended the resentencing, which took place in the same courthouse as the ­original sentencing, she felt 12 years old again, flooded with the same helplessness and grief.

Recently, Heather started visiting a Christian counselor to help her heal from the trauma of her father’s murder. While it has been difficult, Heather is glad the resentencing forced her to face the past. She believes God used those events as an opportunity to heal her.

Modern medicine is considered a secular profession based on observable phenomena. But the medical community acknowledges that spirituality—broadly defined as the human pursuit of meaning and connectedness to something—impacts both physical and ­mental health. Even evolutionary psychologists and materialists do not deny that religious and spiritual beliefs impact health in significant ways.

Castleberry, like Porowski, believes the best way to address depression and anxiety is to help people remember and understand the promises of God. “For example, maybe you committed a heinous sin, and it haunts you, and you’ve become a Christian. And the devil comes and he speaks condemnation to your soul. You need to remember Romans 8:1: ‘There is therefore now no condemnation for those who are in Christ Jesus. For the law of the Spirit of life has set you free in Christ Jesus from the law of sin and death.’”

Today, our society thinks of mental and emotional problems as primarily medical conditions, and sometimes they are. But Castleberry says people will never shake the grip of fear and pervasive sadness until they address the sickness in their souls.

My counseling sessions ultimately brought me to the foot of the cross, and I learned to trust God more fully for both protection and forgiveness. Today, I am completely healed from PTSD and no longer experience any symptoms or take medication. Not only am I healed, but I’m actually thankful for my experience: Even though it was incredibly difficult, it deepened my understanding of redemption as a gift from God. And it helped me take hold of the hope that I have in the face of death.

—Ashley Vaughan is a graduate of World Journalism Institute and holds a Ph.D. in nursing; she lives in Raleigh, N.C., with her husband and three children