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.