It's not enough to create the life you want unless you have the body to match. That's the adage most people live by in our society. Starvation, dieting and weight loss dominate a large swath of the mental time and energy of our daily lives. Even the most productive and successful people usually have a running food loop in their mind. To explore why maladaptive eating is so highly valued, it makes the most sense to understand what other values have slowly become worthless in recent decades. The daily pleasure of eating and the community of food has declined in importance, unless the food industry is your career. Youth and perceived immortality routinely trump the value of experience and knowledge. Any worthwhile political or social movement buckles under the weight of the media's choice of the news du jour. The substance and dialogue of our collective narrative are largely devoid of meaningful content in favor of celebrity gossip or diet tips. Even the more serious news reporting often emphasizes the need for lighter matters to shield us from the real concerns in the world. There is little focus on the meaning of our lives as an individual or as a whole. It is unclear whether there is inherent value in having an opinion, a voice or a community anymore or if they are just a means to an end. So the mastery of food and weight represents the apogee of personal identity almost by default. It's either a place holder while we wait for something of true significance to shape our self-image or a prolonged drug of the masses that lulls us into perpetual slumber.
If this were only the newest communal vice, maybe we could all just chuckle and move on, but there seems to be something insidious and more deeply disturbing underneath. The history of psychiatry reveals a series of psychosomatic illnesses which have primarily affected women--fainting spells and hysteria as the two most notable examples. These diagnoses were social constructs to pathologize, contain and, presumably, treat overwrought women who had no alternate emotional outlet in that era. How is it now that eating disorders often pick out extremely bright, driven and talented women and render them impotent? The media suggests that these illnesses are just a luxury of the well-off--just watch an episode of "Gossip Girl"--with nothing better to do than obsess about their weight and manipulate their food. Yet, across socioeconomic and ethnic groups, the personality traits that self-select for eating disorders suggest otherwise. Perfectionistic, diligent, hard-working. Self-sacrificing, empathic, engaging. Funny, self-deprecating, quick-witted. And always remarkably unaware of their strengths and talents. Working with these women often feels like going to the hall of mirrors at an amusement park. No matter how much I reflect back the person that I see and know, all they can see is a distorted self-image. In the post-feminist world of supposed opportunity, these women seem primed to thrive and take advantage of what life has to offer. Yet, in the forty years since the feminist movement opened those doors, the incidence of eating disorders has skyrocketed. It feels too pat to imagine this is a coincidence. Has the influence of the media helped an entire society find a new way to contain and manage capable women in the useless pursuit of dieting and thinness? Eating disorders do seem like the current iteration of silencing women with psychopathology.
This is another instance where social phenomena and clinical acumen overlap. Effective treatment needs to undo the pervasive influence of media as much as the emotional and psychological cause of the disorder. That doesn't mean discussing the pros and cons of Us magazine. It does mean reassessing what gives value to a smart, capable woman in our society. Or what are the realistic goals a driven woman can aspire to. Or what it means to engage in the world without the constant fear and anticipation of personal judgment or sexual leering. Addressing these issues means directly questioning the world the media has shaped. Although that's a start, it's naive to think it's enough since we don't live in a bubble. Coming to terms with one's own place and value in the world will also mean questioning family, colleagues and peers: the immediate world around each of us. Patients who fully recover don't just stop their behaviors. Many people may eat relatively normally but still view food and weight as the most important part of their identity. Treatment that works has to help the patient recover her identity both personally and within her community. She needs to see herself outside of the hall of mirrors but also know that her value may still be seen through the prism of the media by many around her. It takes motivation and strength to persist in real recovery while the world still swirls around thinness. Recovery demands that one always pushes back against the tide of the media and strives to show one's true value. While everyone else just wants to lose weight.
If recovery involves taking a moral and philosophical stand against the perceived norm, it follows that the media, pursuit of thinness and eating disorders may be the closest thing we have to a social movement right now. With all of the current press about an anti-obesity campaign that largely ignores the complicity of big business and lax regulatory agencies, how can our national starvation escape without a mention? Michelle Obama placed her spotlight on childhood obesity but put her pre-teen daughter on a diet? The message cannot be more clear. The inherent danger of a widespread social belief that thinness is best leaves children with no other way to see themselves. The media has invaded the home and parents have made it acceptable to inculcuate children in this world view. And everyone just looks the other way. This will be the topic of the next post.