Why Therapy and Medication Don't Compromise Authenticity

People sometimes tell me that they have been feeling anxious, sad, or depressed for lengthy periods of time. Many of them wish things would change. But when I ask whether they would consider trying options that have helped others—psychotherapy and medication—my interlocutors sometimes reply negatively, arguing that psychotherapy and medication would compromise their authenticity.

I would like to explain why it seems to me that, in many cases, the authenticity argument against trying psychotherapy or medication is insufficiently strong. Of course, there may be other arguments against trying psychotherapy and medication. But here I will only discuss the authenticity argument. I know that some hesitate to see therapy as the same as medication, holding that therapy normally confronts one's beliefs and emotions rather than bypassing them chemically. I realize this, and accept that the difference matters. But I am focusing here on authenticity and suggest that the arguments ahead are relevant not only for psychotherapy but also for medication.

Being authentic is often understood as being sincere and true to oneself, being who one really is, or connecting to and acting from the deeper aspects of one's self. The authenticity argument usually proceeds more or less like this: "This is who I am. Even if painful, unpleasant, and sometimes disabling, these are my feelings, my real feelings, and being sincere and true to myself is continuing to have them and not others. These feelings, although unpleasant (and sometimes worse than unpleasant), also relate to deep parts of my psyche. Hence, I do not wish to try psychotherapy or medication that would alter these feelings. I do not want to become someone else."

Here are some reasons why I think that we usually shouldn't follow the authenticity argument.

Even if psychotherapy and medication were indeed to diminish authenticity (which I question below), it may still be worth it to opt for them. This is because authenticity is not the only or most important thing in life, a kind of a trump card that overrides all others. Authenticity is only one of many important values that we try to balance in a good and meaningful life—a life that often compromises all of them to an extent, so that none appear in their absolutely full degree, in order to be able to enjoy a fair degree of all of them.

There are many other cases in which we think that sacrificing some authenticity for the sake of other values is the right thing to do. For example, many are willing to compromise some authenticity in order to keep a needed job that supports their family. Many compromise some authenticity in order not to severely hurt someone else’s feelings. Many compromise some authenticity in order to prevent an unnecessary and destructive fight. Thus, from the normative point of view, lowering one's level of authenticity in order to diminish prolonged, harsh emotional pain may be a price worth paying.

But it is also unclear that opting for psychotherapy or medication compromises authenticity. The authenticity argument seems to presuppose that being sad, depressed, or in pain for prolonged periods of time is the real or true you. Although we can suffer from these dire conditions for a long time, it is unclear that they are authentic. It may well be that the true you is a much happier or serene person, and because of some difficult childhood experiences or chemical malfunctioning (analogous to a tumor that caused physical pain for a long time), we have been suffering. The true, real, deep "you" may be the person psychotherapy or medication will help you be, or bring you closer to be, rather than the way you live now.

Furthermore, an important and deep part of who we are has to do with our aspirations, hopes and wishes. For many people, attaining what they aspire to, or coming nearer to it, even if achieved with help (including technical help) is consistent with their authenticity. It can agree with and satisfy some of the most profound yearnings and needs people have.

True, psychotherapy and medication may well change people, thus making them somewhat different than they presently are. But that is true also of any other intended or unintended transformation in life. If psychotherapy and medication should be seen as making us inauthentic because they change us then so should, for example, growing up, learning anything important, recovering from a sickness, finding friends, falling in love, or going through a spiritual change. The authenticity argument, then, delegitimizes as inauthentic not only psychotherapy and medication but also any interesting and important thing we do or go through in life.

The transformation is also not total. We are not becoming a completely different person with a wholly new personal identity: Many memories, habits, views, norms, beliefs, likes, and dislikes remain the same. It is not as if one person suddenly disappeared and a new person popped up. It is the same person who managed to get rid of some things that annoyed her or him, or is happier and less anxious now.

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Further, as Neil Levy has already argued, there are various understandings of authenticity. According to some understandings, including those of the Romantics, authenticity mostly has to do with remaining or becoming oneself. This understanding of authenticity is the one just discussed. But in other usages, mostly influenced by Sartre’s employment of the term, authenticity has to do with creating oneself as one wills. Opting for change through psychotherapy or medication can be seen as aligned also with authenticity in this second sense. To be authentic in this sense is to be the true creator of oneself, to make oneself as one chooses to be.

Perhaps one can also employ an analogy with physical pain: if we have a toothache we do not refuse to have the pain relieved because this would make us inauthentic. We do not commonly think that it is more authentic to suffer from a toothache than treat it. We opt for means—including technological means—to ease the pain or get rid of it. Perhaps this should be accepted also with prolonged emotional or mental pain.

Perhaps there are other arguments against psychotherapy or medication that are stronger than the authenticity argument; I suggest, however, that the authenticity argument itself is too problematic to accept.