When someone gets sick, the initial human but often futile response is to find blame. Who caused this to happen and why? There are a few controversial exceptions: lung cancer, drug abuse, obesity-induced diabetes--illnesses seemingly caused by personal choice. And that includes eating disorders. A group of students in the lunch line or colleagues at the water cooler all too often gossip about the girl who's too thin. The implication is that she can choose to start eating and she would be fine. And if that girl dips her toe in the water of the illness and then proceeds to dive in head first, to everyone around her she chose to develop an eating disorder. Granted, she could have been a confused and scared 14 year old girl with no one to turn to, but, in the eyes of her family, friends, treatment team, in the eyes of the world, she is surely responsible. She wasn't stricken with an illness; she chose her own affliction.
What is similar about illnesses that blame the patient is that society has a role in the initial exposure. Although someone chooses to smoke and smoking causes cancer, that person--usually a young person with poor judgment--does not believe it will lead to a lifelong addiction. Moreover, how can it be legal for a lethal substance to be legally sold and marketed, especially to those most vulnerable? If our society promotes thinness and weight loss as a necessary part of being a successful woman, a percentage of girls who do go on a diet or throw up their food will end up with an eating disorder. The values of an era define the social illnesses of the time and are inherent in the disorder itself. So that even with these issues clearly laid out, even if the patient brings them up herself in treatment, escaping blame for the eating disorder remains a challenging leap in recovery. Indeed, the cause and effect appear to be one and the same.
The experience of having an eating disorder is centrally a mental exercise. Since emotion and personal connection is stripped from her life, the patient exists largely through her painful, harsh, punishing thoughts. In a world where every negative emotion or thought can be diagnosed and medicated away, the societal norm is that thoughts can and should be contained and eliminated. Any unwanted thought that lingers and, heaven forbid, leads to action, is a sign of weakness. Even the central mechanism of the disorder--not just the cause and effect--reinforces the idea that having an eating disorder is a personal choice.
Forgiveness starts with true recognition of how powerless the patient has been to the whims of the eating disorder. The driving force to remain stuck and spinning in the world of disordered thoughts and behaviors has been impossible to escape. I have discussed in previous posts why someone who experiments with disordered eating might become sick and why an acute eating disorder becomes chronic. These factors remain out of the patient's control. Our society has created a world to lure young people into an eating disorder and provided few means of escape. The seemingly controllable thoughts are actually the critical symptom of the disorder. The burden of personal responsibility for the eating disorder is the communal tactic to fob off our own responsibility of sacrificing so many young women. And the myth that all of these girls chose this disorder is debunked by the fact that society paints them into a corner. What other choice do they have?
When a patient begins to concede she is powerless and may not control the illness, she unleashes a torrent of regret. A glimpse of recovery makes the years trapped in the disorder even more painful to remember. To imagine there was a way out all that time makes the cycle of the illness even more pointless. How does one reconcile those lost years and begin the struggle to find a new path in life? Having been grounded in an excruciating present, the past looks like a tunnel of loss too deep to even contemplate, let alone mourn.
Unfortunately, although therapy can often make headway in reducing the sense of blame, I have found that directly facing a mountain of regret can backfire. For women who are smart and motivated and who have allowed themselves lofty but attainable goals, fully reconsidering the past is a sobering task. Instead of having years to reevaluate their future, the sudden revelation they are not to blame opens up the immediacy of the state of their lives today. There is no easy way to handle such a shift in self-perception and personal direction. I think people who do find full recovery tend to use a moderate amount of denial of the enormity of the change in order to function each day. They try to stick with the transition in the moment and work to lessen the punishing thoughts and incorporate a new self-identity. By staying present, they don't dwell on the past. The regret still lies under the surface and frequently is discussed in therapy but rarely takes over. In this way, the mourning is protracted but tolerable and doesn't impede movement forward.
The recognition of being powerless and of the sense of loss is a bitter pill to swallow after riding the high of food mastery for so long. These changes highlight the slow descent into mediocrity--a word frequently used by patients in recovery and uniformly despised. The eating disorder makes people feel special, even as its appeal diminishes over the years. The next post will address the importance of mediocrity and specialness in recovery.