Normal brain activity of a Buddhist (r). In meditation, (l), activity in the parietal lobe on the right decreases.

Imagine a man in his late twenties who is brought by his father to a psychiatrist. The man seemingly has everything: great wealth, a happy marriage, and good health. Yet he is obsessed with death, sickness, and old age and derives no pleasure from life. The psychiatrist prescribes Prozac.

Six months later, the man reports being relieved of his obsessive morbid thoughts and able to find life pleasurable again. A number of years go by, and the man becomes an extremely successful leader in a large corporation.

Although I have taken a few liberties, this case is based on the life of Prince Siddhartha Gautama. Legend has it that when Prince Siddhartha was born, his father was told that he was destined to be either a great world leader or a great religious figure. Trying to insure that his son became the former, the father attempted, but ultimately failed, to shield him from the miseries of the world. Prince Siddhartha abandoned his secular life and eventually became the Buddha.

Would Prince Siddhartha on Prozac have fulfilled his other destiny?

Prozac is just one of a new generation of psychiatric medications known more generically as selective serotonin-reuptake inhibitors (SSRIs). These drugs have had a profound impact on how physicians treat such mental illnesses as depression and obsessive-compulsive disorder. Yet some critics, like the psychiatrist Peter Kramer, are disturbed by certain features of SSRIs. In his 1993 book, Listening to Prozac, Kramer thoughtfully explored the impact that these drugs may have on personal identity. For example, Kramer discussed the case of Tess, whose personality after taking Prozac for depression radically changed; she became more confident and socially at ease. When Kramer took her off Prozac, Tess asked him to prescribe the drug again, for, although she is no longer depressed, she said, "I am not myself."

Some claim that cases like Tess's demonstrate that Prozac is not so much curing mental disorders as it is changing the patient's sense of self. The philosopher Carl Elliott expressed concern in the March-April 2000 Hastings Center Report that SSRIs seem to be "curing" some patients of existential alienation. Alienation, as illustrated in the story of Prince Siddhartha, has been a common catalyst for religious quests. If Elliott is correct, should we be concerned that treating alienation as a disease may also relieve some of the craving for spiritual exploration?

In her memoir Prozac Diary, Lauren Slater provided an engaging glimpse into how SSRIs can affect one's religious life. Slater was one of the first to take Prozac, and a common theme of her memoir is religiosity. Soon after being relieved of her psychiatric symptoms, Slater recalled going to her bookshelf to select something to read. Most of her books were in "the disciplines of psychology, philosophy, and theology," such as Søren Kierkegaard's Fear and Trembling and Victor Frankl's Man's Search for Meaning. "But now, well, now I stood by my bookshelves a little lost. They were full of death and anxiety, the spines seeming to exude cold clouds. I had no desire to read Kierkegaard," Slater wrote. These books, which had at one time given Slater "clues about ways to live my life," now seemed antiquated to her new sense of self. She became concerned that this drug, which had relieved her of her "disabling obsessive symptoms" had also "tweaked the deeper proclivities of my personality. Who was I? Where was I? Everything seemed less relevant—my sacred menus, my gustatory habits, the narrative that had had so much meaning for me. Diminished."

This would seem to confirm Elliott's worst nightmare, that is, the creation of a happy-go-lucky King Siddhartha instead of the Buddha. But religiosity soon returns to Slater's life in a new cast. In the December entry of her diary, Slater wrote, "I am becoming a little bit spiritual, which I'm sure is not a side effect Eli Lilly reports in its literature on Prozac. After work today, I stopped by the bookstore and picked up Merton, a calm Catholic." In February, Slater discussed her new fascination with "contemplation," and she had a question for the late Trappist monk Merton: "What does it mean, for instance, that my burgeoning contemplative bent does not come directly from God but from Prozac?"

This change in her orientation reminds me of William James's grouping of religious temperaments: "healthy-mindedness" and the "sick soul." The religion of healthy-mindedness is the result of a personality in which "happiness is congenital and irreclaimable," he wrote in The Varieties of Religious Experience. The healthy-minded worldview is that existence is in its essence "good," and only our misunderstanding of it makes it appear otherwise. The way of the sick soul is the way of those "congenitally fated to suffer from" the presence of evil. From the perspective of these "morbid-minded types," evil and unhappiness are constitutive of the fabric of the world and not simply the result of our naivete. According to James the way of the sick soul can lead to happiness, but only through a dramatic and painful process of unification through "rebirth."

Although we most probably should be suspicious of James's relatively simple typology, these categories do provide a rudimentary vocabulary for understanding the potential alterations in religious orientation brought about by SSRIs. Prior to taking Prozac, Slater had the religious temperament of the sick soul. The happiness she gains, however, is not from rebirth but from the SSRI's alteration of her temperament. She has been reoriented toward the way of healthy-mindedness; she turns away from the melancholy world of Kierkegaard and toward the calm, contemplative world of Merton. Should we be disturbed by this new orientation?

For all his desire for neutrality, James clearly thought the way of the sick soul to be a more sophisticated path. His valorization of the sick soul, though, may be a sign of how American James was as a thinker. Elliott stated that "spiritual emptiness, the search for a sense of self, alienation in the midst of abundance" are particularly American traits; we seem to be a nation that venerates the way of the sick soul. Walker Percy—Elliott's muse for alienation—encapsulated this disdain for healthy-mindedness when he wryly commented in Lost in the Cosmos: "Consider the only adults who are never depressed; chuckle-heads, California surfers, and fundamentalist Christians who believe they have had a personal encounter with Jesus and are saved once and for all." Comparing Kierkegaard to surfer dudes clearly stacks the deck against healthy-mindedness; it is something akin to comparing Edward Hopper to Norman Rockwell.

A fairer match can be found in Abraham Heschel's A Passion for Truth. In this book, Heschel described his infatuation with two very different Hasidic leaders: the extreme healthy-mindedness of the Baal Shem Tov and the profoundly melancholy sick soul of Reb Menahem Mendle of Kotzk. The first valued love over truth and the second truth over love. Like Heschel, I wish to have both temperaments in the world, and so the dissolution of one seems a great loss to diversity (an aspect of life James himself greatly valued). As Heschel claimed: "Honesty, authenticity, integrity without love may lead to the ruin of others, of oneself, or both. On the other hand, love, fervor, or exaltation alone may seduce us into living in a fool's Paradise—a wise man's Hell."