| 23 April |
Which of these views is right? All of them-to an extent. But a complete picture only emerges when experts pool their information and examine the problem from all points of view.
Most anorexics are teenagers, and I believe that for them anorexia represents a way to avoid maturity. By maturity I mean not just physical or sexual development, but psychological and social development as well. A woman can translate her fear of growing up into a loss of body weight. If she can keep the same weight she had at age ten, maybe she can stay ten forever. Achieving thinness lets her turn back the clock and revert to a childlike physical appearance. Even more important, loss of body weight causes the menstrual cycle to shut down. The patient gains control over one of the most powerful-and perhaps frightening-signs of womanhood. (For males, of course, the issue is different, as I’ll explain later.) Thus anorexia can reflect problems in making the transition from childhood to adolescence.
In contrast, bulimia can reflect difficulty growing from adolescence into adulthood. Here the problem isn’t so much one of achieving maturity, but of handling its responsibilities: separating from the family; controlling oneself and others; assuming an identity through marriage or career; defining oneself through relationships with others.
A person with an eating disorder struggles with these deep and troubling issues. The pressures combine and drive her to create an identity based on her ability to control food and eating. Through such control she achieves something that everybody desires, something that society values: the ability to be seen as special.
Everyone wants to be special in some way. It’s a natural human trait. We seek distinction through our talents, achievements, or personalities. Some of us take jobs and provide things that people want. Others express themselves through the arts. Still others devote themselves to the care of their families. Rewards for our efforts come in many forms: a paycheck, applause, a child’s hug.
But victims of an eating disorder look for a different reward. They believe that the only way they can be special is to control their weight and eating habits-to starve themselves if they have to. An anorexic patient might say to me, “I want to be the thinnest person in my school,” or, “the thinnest in the world.”
Of course, many people realize that true self-esteem is based not just on physical appearance, but on other innate qualities. These are the people who answer the question, “Why must we be thin?” by saying, “I don’t have to be.”
As a specialist in eating disorders, I work to convince patients that defining self-worth through abnormal eating is a dangerously unhealthy business. To pursue the “ideal body shape” is to pursue a myth.
I see these myths every day in countless guises. I don’t know how many times I have heard my patients say, “I always felt that if I was thin I would be happy,” or, “If people really loved me then I wouldn’t binge out,” or, “Being fat lets people see me for the loser I am.”
Some people believe that someone with an eating disorder won’t get better unless she wants to. Wrong! For families to embrace this myth is to run the risk that their daughter will starve to death before she gets the help she needs. Many times, families refuse to get help for their daughter because they believe she can get better on her own. “Recovery is just a matter of willpower,” they claim. People who believe this graduated from the “Just snap out of it” school of thinking. An eating-disordered girl can’t “will” herself out of her condition any more than people can “will” themselves out of the flu.
Helping a patient to want to get better is actually part of the first stage of therapy. Once she has learned the importance of changing, she has reached a point where other types of therapy have a chance of succeeding. Patients need sensitive, thoughtful treatment to help them break the vicious cycle of disturbed eating, correct their faulty thinking, improve their eating behavior and resolve their difficulties in relationships with friends and family.
To me, the most frustrating thing about these myths is how deeply rooted they have become. Many people accept them as reality. Thus the first important step in treatment is to uproot these myths and correct them.
No patient is “typical.” Many share certain traits or experiences, but each patient has a different history-and a different future. Keeping that in mind, here are scenarios describing the course of these illnesses.
*19/35/5*
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