The expansion and monetization of eating disorder treatment has led to a primary focus on concrete steps and goals in recovery. Insurance companies demand practical goals for reimbursement, and the corporatization of treatment means less individualized care.
I believe strongly that behavioral therapy is a necessary component of early recovery and has a role in later stages as well. However, in the current jargon, full recovery indicates freedom from food and body thoughts without addressing the element of identity. If treatment doesn’t involve steps to separate oneself from the illness, it’s impossible to be free to live life fully.
Eating disorders encompass disordered eating, compensatory behaviors, body image thoughts and the all consuming experience of one’s mind being taken over by these demands. Recovery needs to help people find themselves beneath the all consuming nature of the illness.
Early recovery must normalize eating to insure one’s body gets the food it needs throughout the day while also minding the emotional and psychological turmoil that ensues. This part of getting well is always hard and is a necessary first step but is just that: a first step.
Treatment that began early in the eating disorder epidemic took the history of mental illness into account and recognized the existential component of treatment. Eating disorders grew out of the cultural imperative to be thin combined with the advent of mass media outlets spreading images of thinness throughout the country.
No one could predict the effect that sanctioned dieting combined with the idealization of thinness could have on a society. As social media made it easier to spread images and messages that propagate dieting and thinness, eating disorders have become endemic.
The nature of eating disorders and the media machine driving them necessitates a deeper dive into one’s identity for true healing. An eating disorder is now considered a widely accepted definition of identity in this culture. It’s easier than ever to eat well enough and be recovered while continuing to base one’s sense of self on the disorder itself.
An existential search for meaning can be painful at times. The work of therapy examines the core sense of oneself and reckons with the underlying thoughts of person, motivation and meaning. This exploration points the person in a direction of how to live life and what truly matters.
The process of pulling away from the safe identity of the illness and identifying the less sure but more genuine idea of being a full person allows someone to fully get well. Without the need for the eating disorder as a pillar of identity, there is much less reason for the eating disorder to linger.
If treatment ignores the key existential step in recovery, wellness simply means eating enough but still creating self around the empty meaning of food and weight. There has to be more to life than that.