Reflections on Media and Eating Disorders

Using therapy as a model for good parenting is a dangerous line of reasoning and altogether inaccurate. Although effective therapy can reveal what was missing in a parent-child relationship, inflicting therapy on your children never helps. The therapeutic relationship has many boundaries and rules that render it awkward and distant yet incredibly intimate--very unlike the parent-child bond. However, those limits also make therapy safe for the patient to explore experiences and feelings that otherwise feel taboo in the outside world. The therapist--in addition to fully engaging with the patient--uses these explorations first to understand how a patient lives, feels and relates in the rest of her life and then to reflect back what it might mean about the past, present and future. This process creates a mirror for the patient to look at herself and her life in a new way, and that perspective can lead to therapeutic change. I think that the collective therapies of women with eating disorders similarly generalizes to explain why disordered eating has become an accepted way of life. Perhaps the powerful ambivalence of these women in treatment reflects a society that has trapped them within an epidemic of eating disorders and disordered eating. And perhaps the aspects of therapy that help patients find the way to moments of arrival also explain what is missing in the media-centered environment women live in--and kids grow up in--today.
Attention, compassion, listening, limits and patience. These attributes of eating disorder therapy are sufficient for successful treatment. They are also essential for parenting but  on their own represent the ineffective therapy-influenced ideal: treating kids like mini-adults. What is missing is the eternal frustration and anger that bubbles over--from parents and kids alike--when children come up against rules and limits. Kids seem hardwired to creatively challenge any boundary set in their way until the child and/or responsible adult finally gets angry. In therapy for eating disorders, personal expression of anger is almost exclusively self-inflicted since any sense of individuality, identity and self worth emanates from the success of controlling food and weight. Even experiencing anger is taboo and a sign of weakness--how can you stand up to others when it is impossible to stand up to the thoughts in your head--and leads directly to an escalation in the harsh, punishment of the eating disorder. Thus, the therapist needs to focus on compassion and kindness to counter the horror of the disordered thoughts and behaviors. The moments of arrival expose how harmful and unnecessary this punishment is and open up a world of hope, promise and emotion. There is no need for the therapist to reinforce the rules and limits children might need because the eating disorder has turned them into a prison.
The contradictory expectations of young girls--boundless opportunity combined with extreme limitations--explain how the developmental anger of childhood transforms into the punishing disorder. Girls need to strive academically, socially and athletically to achieve as much as, or even more than, boys just to prove themselves. Yet the insidious, fully accepted message of thinness and control over food is the necessary foundation to any measure of success. Fat women who are financial scions, CEOs, lawyers or doctors are still fat first. This message is a societal leash that reins in any excess confidence women may feel by demanding they strive for an unattainable goal. In addition, girls are expected to be grateful for what they have since women have never been lucky enough to have so much opportunity. Last, girls see the lives their role models lead: a frantic rush to have it all while doing nothing very well. Despite the seeming excess of opportunity, girls are fully aware of life's limitations. The promise of a wide world of options does not match the lives of women around them. With the burden of generations past, the demand for thinness and no clear path ahead, there is no room to push up against the boundaries the way boys do. Instead, an inward focus on food and weight is encouraged at an early age to channel any frustration. If striving for thinness and disordered eating provides children a solution to an insoluble reality, then it is up to parents as a whole to devise a more effective alternative.
It is all too easy for me to write a series of prescriptions for parents: support girls' self-esteem, raise sensitive, self-aware boys, make sure girls know they are loved and be sure girls know their value in the world. I certainly believe that and more, just as I know those messages--when a patient really starts to believe them--contribute greatly to eating disorder recovery. But these truisms don't address the real goal: prevention.
Life often feels like an endless series of choices. Each fork in the road closes off certain opportunities forever while opening up otherwise hidden options for the future. But progress comes from making those decisions. Trapped by unreasonable expectations and inwardly-focused anger, girls are supposed to leave all of their options open yet not make any decisions, all of which guarantees that they have none. Towards the end of successful treatment, long after the moments of arrival, the sessions are tinged with a sense of peacefulness intertwined with loss. Patients often are waiting for the next storm of recovery to weather, but it never comes. Gradually, we start to talk about acceptance of themselves and their lives. Perhaps this is who they are and their life has taken a certain path through the eating disorder in a new direction. The calm doesn't mean life will lack ups and downs, successes and disappointments, new adventures and painful losses. But those changes are now external, not reflections of the internal chaos and punishment within the eating disorder. These patients are free to foist the anger elsewhere and not suffer for it. Parents may not be able to change the conflicting pressures girls face but can work together to find new rules to play by. Feminist thought has left girls holding the imperative not to accept the world as it is, a motto distorted by the media--and condoned by society in general--into a personal attack against girls' self-acceptance. But perhaps parents can reflect a new model of life to which girls can aspire: a balance between the continued need to buck the inherent paternalism (because girls can get angry too), with a renewed focus on self-acceptance--mind, spirit and especially body.
The next post will move away from the topic of media to explore the role of shame in eating disorders.


Children, Media and Eating Disorders, Part II

Most people can describe the gist of where their eating disorder came from, what they're missing in their life and what the eating disorder does for them, but it is an intellectual exercise and often only camouflage. Fundamentally, they don't really know what will help them get better. Focused and effective treatment of people with eating disorders needs to address the painful reality that their lives are run by the disorder without disrupting the core therapeutic relationship. This demands a few critical things: consistent but not judgmental attention to eating behaviors, unwavering compassion for the trials of enduring the illness, the capacity and desire to really listen, clear limits as to what therapy can do and what it can't and, most important, patience. When one of these ingredients is lacking, the patient will quickly recognize the deficiency and react, usually by getting angry or leaving the treatment. In a larger context, the therapist's job is to figure out which of these essential components means the most to the patient. In other words, what aspect of the relationship really helps slow down or even stop the symptoms.

For people whose symptoms do get better, there is a moment--or more likely a series of moments--when they finally see and feel what it is like to let someone, initially the therapist, into their lives. In that moment, a patient, who has only let herself exist in a small world hemmed in by a ruthless disorder, can finally see the freedom that exists for everyone else. What has felt like the calm sanctuary of the disorder transforms into the lonely prison she has occupied all these years. This is the opportunity for a patient to truly see what recovery looks and feels like, to finally arrive in treatment. It can be simultaneously terrifying to acknowledge how much time has been lost and miraculous to see the symptoms as relentless but for the first time not invulnerable. And this all happens with another person, the therapist. Allowing this real connection helps the patient realize what has happened to her, what is happening and how painful it all has been. The hidden suffering, even from the patient herself, becomes a moment of shared compassion for her struggle to try to survive the illness. At that point, when the intellectual exercise becomes grounded in the reality of living with an eating disorder and in the possibility of recovery, going back no longer feels like an option.

Patients often experience these moments as an immediate reliving of the entire course of the eating disorder but from a completely different point of view. This necessitates a rethinking of what the disorder has meant all these years. Most 
eating disorders begin between the ages of twelve and twenty, but the time of onset has more to do with luck and opportunity--such as enough privacy to use symptoms or exposure to really learn how to do them--than anything else. The vulnerability to the illness begins much earlier, as I explained in the last post. For many people, by the time they have ridden the course from initial exposure through the powerful, painful high of the first years of the illness, they are trapped. What felt like a choice, although it never was, starts to feel like a life sentence. The main delusion of an eating disorder, and what makes it so enticing, is that the person has mastered the world of food and weight and therefore is special, but the reality is quite the opposite: she is ill and unable to truly live. By allowing the therapist in and facing this reality, the patient irreversibly shatters that delusion. Re-evaluating every moment of the entire eating disorder opens up a host of emotions.  It is a rude awakening from the blinding calmness the eating disorder creates and a personal challenge to find the resiliency to face a wholesale shift in identity and self-worth.

These moments of arrival perplex me more and more. As I explained in a recent post, it has been eye-opening to realize that women with eating disorders often seem less stricken by an illness then chosen by a set of core personality traits--ones well-suited to success--combined with the conflicting expectations of society. The near universality of these powerful moments in successful therapy has the same jarring effect on my understanding of eating disorders. The moments feel remarkably similar no matter how different the person or relationship. I feel like I have witnessed the shattering of the shared delusion so many times, but how can they all feel the same? The essence of psychotherapy reinforces that all people and therapies are different, and so the sameness of these moments becomes all the more striking and has brought me to consider that the derailed development of identity and self-worth, especially in children, may be the missing link. The realizations occur when success within the eating disorder stops being synonymous with self-worth. But this means that the patient's identity must have been intertwined with food and weight long ago, well before the eating disorder started. Similarly, perhaps no true self-understanding ever started to develop, and these moments in therapy may be the first ones--no matter the age of the patient--of recognition of her own identity and value in the world.

With this foundation, these moments of arrival appear to be the formative experiences of learning to know oneself--something the influence of media has largely replaced in a child's process of growing up. If the messages and influence of the media are inescapable, then the goal is not to fight back as much as to offer viable alternatives: a way out for the young girls who see no other solution than to build an identity around food and weight. It also explains why these moments in therapy are so similar. Each moment represents a collective experience of helplessness and frustration: if living through an eating disorder--the preferred lifestyle of the times--does not work, what else is there? Living through food and weight seemed like the only way to make sense of it all.

These women have practically become the casualties of a lost art of parenting: creating hope and opportunity and individuality in kids in lieu of the current message of striving and conforming to a meaningless norm. What other value do women have in our society? Where can kids, especially girls, find role models who believe in a different kind of self-worth? What is there to strive for when the media influences our every thought and feeling? This brings the post full circle. When I wrote above about what a therapist needs to do to create an environment to promote successful therapy, I also described what children need to avoid this exact pitfall. When I suggested the therapist needs to search for what aspect of the relationship alleviates the eating disorder symptoms, I also described what children need from parents, friends and the world around them to find their own identity and their own voice and not succumb to the reductive appeal of the world of the media.

Next post, I will try to expand on how to apply the critical aspects of successful therapy to parenting about food, weight and the media.


Children, Media and Eating Disorders, Part I

The media's message has invaded the home and family as much as every other facet of our society, and there are many obvious reasons why. As a business opportunity, children represent a valuable advertising target if only because of their potential lifetime brand loyalty and penchant for browbeating parents into spending money. Millions of young souls are the tabula rasa of a media culture--a social movement masquerading as entertainment--primed to usurp parents' rightful authority and shape a directionless generation all too prepared to feel inadequate and fat, fat, fat. And why not? Kids have no idea where to look for guidance and identity, and the media can't do enough satisfy its own hunger for power and influence in the marketplace and for growth at any cost. And who's going to protect them anyway? Regulatory agencies or big business? Several previous posts make it clear that the answer is no. Parents? Themselves?
For parents raised on the splendor of icons like Tony the Tiger and "Trix are for Kids," media, advertising and TV used to mean something very different. It felt like sitting on the edge of your seat as a whole new world of promise came into view. As MTV and Star Wars dominated an ever-growing portion of the national psyche, kids placed their aspirations for a better world into media and entertainment. No one thought the media would renege on its unspoken promise and betray the national trust. Back then, the afternoon special starring a bulimic teenager seemed like a public service message about the rise of eating disorders, not the harbinger of a national identity crisis on the horizon. This was a time when the media knew its social responsibility to culture and society, when media celebrity meant being a role model to a new generation and MTV really did think it was changing the world. It's not that the media is less powerful--although that influence is no longer the purview of a handful of venerable institutions--but that the onus of building a better world has morphed into the need for immediate impact. When the goal is numbers and influence, nobody cares anymore what happens to the individuals who consume the media. Far from the heady but seemingly innocuous years of media forging a new frontier, now everyone is a consumer charged with protecting themselves. And with parents still awash in the old media ethic, that leaves children even more vulnerable to this brave, unforgiving, new world.
With no one protecting kids from media influence, it might be worth reviewing some child psychology to understand what the media uses to exploit children’s vulnerabilities.  The development of self-worth and identity goes through several stages, but one thing remains fairly constant: an absolute belief that they are the center of the world. Perhaps becoming an adult means fully realizing how false this is.  For children this is not a character flaw--as many overwrought parents are wont to believe--but an interesting psychological reality of modern life. It doesn't mean children think they are all powerful or that the narcissism makes them king of the world. Instead, it is a temporary solution to understand confusing events around them. Children understand the facts of the world long before they have emotional comprehension or a sense of personal identity. When kids don't have the tools to take something in, they almost magically believe they caused the events around them to happen and confuse their emotions with personal responsibility. Think of a child witnessing parents arguing. All kids think that they did something to cause the fight to happen: the emotions and context are too confusing. An adult would react emotionally but see that confusing feelings cannot cause something to happen. But that's much too sophisticated for a children, even for adolescents. And there is no amount of reasoning that would help a child to believe otherwise: call it the shared delusion of childhood. This means that, for a critical period of their lives, children determine their place in the world, i.e.  their identity and self-worth, exclusively from the world around them. If that world is predominantly peaceful and pleasant, the child has little to worry about. The more a child's life is complicated, confusing or worse, the development of that self-worth is marred by, for lack of a better term, "badness." Parenting manuals have distorted this fact of development into a backlash against discipline. Children still need rules and consequences and lots of them, but they also need consistency and praise. They need to hear through words and action regular reinforcement of their value and place in the world. By action, I mean the way parents, family and friends live their lives. Emotional maturity will follow.
With this background, it's easier to see why many children are at risk. Some kids will have the support system of family, friends and school that insulates them enough from the media to develop identity and self-worth influenced but not dominated by the culture of thinness. But what about the kids who have instability at home or live in a community consumed with thinness or take in too much "badness" in their lives or even just have parents who are unaware of the power of the media? For the vulnerable kids--not a small minority--this social movement becomes not just a culture but a cult that reels a large group of children into its fold. The appeal of a set of rules to define identity, a definitive moral code of food and weight to separate good from bad and an obsessive mantra that blocks out the confusing emotions of childhood and adolescence is just too satisfying to pass up. Add in parents themselves focused on media and thinness as a way of life and peers already drinking the Kool Aid and it's easy to see why the society as a whole has a tough time seeing the way to create a healthy, positive self-image in kids these days. An epidemic of eating disorders is hard enough to imagine, but what about the media culture as a rite of passage, or worse a method of raising the next generation? A discussion of some options to counter these real possibilities will be the topic of the next post.