Updated: Mar 20
Mental health, medication, eating disorders, and body image
Please enjoy this month’s guest article by Stefanie Bonastia, below!
And CW: it discusses eating disorders and mental health issues!
As someone who has directly benefited from the support of medication to deal with anxiety and depression, I feel compelled to share my experience of how these tiny little pills went hand in hand with my recovery from binge eating and body image issues. I hope it can reduce some of the stigma and help inform someone struggling with the decision, or the shame.
Three months before I actively, consciously started repairing my relationship with food, I went on meds.
Not that meds were new – I’d been on and off of SSRI’s for almost two decades. The chronic push and pull of depression and anxiety has been a factor of my existence since adolescence, which is coincidentally the same time my food and body image issues surfaced. Meds had never, up until this point, “worked” for me.
Spoiler alert: this essay is not about healing my depression and anxiety. They are still factors of my existence, and I am still actively working on them.
But depression and anxiety are tricky, because they can be very much wrapped up in food and body image. From the point of view of a messy, muddled mind, they are without separation, and might as well be one and the same.
As far as I’d always been concerned, depression and anxiety were a result of my incompetence with food and body. If I could eat normally, if I could look in the mirror and be even mildly satisfied, then my mental health issues would have no reason to exist.
Laying in bed and wanting to hide from the world was body image induced depression, I believed.
Racing thoughts and indecision was a manifestation of my disorganization with food, I believed.
But meds never touched my food and body stuff. They didn’t make me stop binge eating, and they didn’t make me lose weight. They didn’t make me okay with the mirror. In fact, I was pretty sure they made me gain weight, and like the mirror less.
What was the point, then?
With these beliefs intact, I had taken medication in spurts, for months at a time, sometimes missing a day here or there. They dulled the ache, sometimes. They took the edge off. They did a little, but not enough.
I wanted a cure for my eating, dammit.
I wanted freedom from hating my body, and I wanted it to come with weight loss.
Without these things, I really didn’t think medication was very helpful.
But in 2014, I developed symptoms of what would later be diagnosed as chronic Lyme Disease, and experienced a side-effect suspension of food and body image issues, the likes of which I had never known before.
As my body became taken over with numbness, tingling, twitching, and joint pain, my mind became infused with heavy doses of depression and anxiety. I had no time to care about food or my body – I thought, at one point, that I was dying. Adrenaline and fear ruled every part of me, and the eating disorder that had dominated my life up until that point suddenly seemed small and insignificant.
This was the first time that I saw my mental health as distinct from my food and body. It was the first time I experienced the former without the latter, and this shifted my understanding of root cause and effect. I was paralyzed by my mind, by “what ifs” and “oh no’s” and “I can’ts” and “I don’t want to’s.” And yet, my food was regulated and my body was smaller than it had been since I was a teenager. I fit into the clothes I wanted to wear, and I had no desire to binge.
But still, the anxiety, the depression.
Years later, after the specialists and treatments and “symptom management” had all been played out (none of which actually did anything for me – my symptoms were only mitigated by a third pregnancy, for reasons still lacking explanation), my eating disorder returned. The old familiar song and dance awoke from its slumber, which I had mistaken for permanent good riddance.
Although it was not consciously processed, this next wave of my eating disorder was different than those that had preceded it. Underneath it was a separation of Church and State; I began to understand the way my mind felt as its own experience, an undercurrent propelling thoughts of food and body image, giving them a nest for a cozy home. My body and my food were not, as I’d always assumed, the main event.
I went on binge eating. I went on restricting. I flailed and floundered and cursed my inability to make peace with food and myself. I played the role, but the role started to bore me. When you can see the actors backstage, it takes something away from the show.
I went on like this for another year before I decided to try medication again.
When I talk about this decision, people ask me what it was that prompted it. I have always answered: I was too anxious, too low, it got too bad again and I needed to take the edge off. All of that is true.
But I think, also, that I was ready to heal my relationship with food and my body, and that I couldn’t do it with depression and anxiety pulling me down, drowning my resources and blaming me for the ineptitude. If I was going to swim upstream, I had to stay above water.
Three medication trials later, I landed on one that helped keep me above water the most.
It did not “cure” me, nor it did not magically turn me into a happy-go-lucky human who magically abandoned my eating disorder and magically accepted my body. I wish these little pills had that kind of effect, but to my knowledge so far, they do not.
But what they did help me do is take the edge off of an already very complicated process of eating food, reducing guilt and shame around food, and managing my emotional capacity to look in the mirror (at a body that increased in weight as a result) so that I could experience each moment with more clarity and presence of mind than I would have been able to with a brainload of fear and despair.
I had more freedom to choose more helpful thoughts and behaviors.
I had a buffer of space between my reactions and my responses.
I had more room. Just enough.
The difference showed up in the half-second spaces between looking in a mirror and heading into a self-loathing spiral. It turned down the volume of “I can’t stand myself!” enough to hear myself say, “You are not your body,” or “maybe everything is going to be ok.”
It showed up as an intervention between my tendency to catastrophize a binge urge and a newfound ability to see the gray area and extend myself some compassion.
The tiniest windows of mental space became everything.
I had never been able to access this space so reliably, not through any other natural method I had tried in my attempts to avoid medication.
It was a subtle, sweet relief.
And the relief allowed me to heal.
Without the medication, I don’t know what recovery would have looked like. I can’t say for sure if it was a necessary component of making it work for me, or just a really, really complementary support structure.
What I do know is that battling recovery would have been ten times as hard if I’d simultaneously been battling a frantic, impatient, defensive, rigid mind.
Meds helped me recover. Despite the stigma, they helped me recover. And like most people who struggle with mental health, I wish I didn’t need them – but I did. For me, the meds gave my brain space to heal in the same way that a cast would for a broken bone, and I respect it all the same.
For me, it changed enough to change everything.
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