Living With Food: The Science Supporting Eating Disorder Treatment

By, Dr. Mark Warren

One of the most common reasons people stop medication or are hesitant to start them in the first place is a fear that they will not be themselves if they take medication. This question has implications that are biological, metaphysical, and spiritual. So therefore, any conversation about this topic will have multiple meanings for everyone. Nonetheless, let us dip our toe into the water of a question that rightfully is on many peoples’ minds. Part of the problem with this question is that it is assumed that there is something called “me” which, off all medications is a real me and somehow is different than any other version of who I am. My sense is that this is not an accurate way to look at who we really are. From a psychological perspective, the concept of the self is a constantly changing thing. I am different in the morning than I am at night. I am different alone than I am with others. I am different when I watch a sad or happy movie. The idea that there is some sort of universal me that is always there, I think, is a misconception.

A second fear is that if I take medications it will emphasize part of me and block out a second part of me. There are situations where this may seem accurate. For instance, if someone is paranoid or psychotic and they wish to not be, one could argue this part of the me is being blocked. At the same time, one can make an equally strong argument that the paranoid or psychotic part is not them in the first place and the medication allows the real me, whoever that is, to express itself beyond the illness of psychosis or paranoia. While people with eating disorders are not typically paranoid or psychotic, they often have thoughts and feelings that seem "not me". 

There are many other ways to look at this issue. In general, a medication that helps to suppress symptoms that make you ineffective in your life, or to promote states of being that will make you more effective in your life, are unlikely to be taking away the real you. Medication works at the biological level on neurotransmitters and the cellular receptors for these transmitters. They do not introduce new or unknown neurotransmitters to your brain and they do not take away functionality that you previously had. If these things do happen then the medication is likely not to be continued and should be reevaluated. The function of medication is to help make you as much "you" as you can possibly can be. It is similar in this way to medication for any other medical illness. Medication taken for heart failure allows that person to become who they were before their heart failed. One could argue that the real “them” has heart failure and the medication alters the real “them”, but I suspect someone in heart failure would prefer medication to treat it.

Because psychiatric medications involve the mind, these questions are not to be taken lightly. The implications of medication should be discussed with great seriousness and great attention to detail. If used correctly and with care, medication can help you become the "you" that you most want to be.

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Contributions by Sarah Emerman