The emergence of eating disorders as a new group of psychiatric illnesses in only a generation opens the door to a host of inquiries. The changes in food supply, the homogeneity of modern life and the cultural focus on weight and thinness are the explicit pressures encouraging disordered eating and, for those susceptible, eating disorders. But the more profound questions remain unanswered as to why the public remains so uneducated about eating disorders and why those afflicted are never heard.
From a sociological perspective, the increased incidence of eating disorders coincided with the impact of the feminist movement. Protesting the oppression and limits of women's lives brought about substantive change and opportunity. Today's girls feel confident that their goals and dreams need not be different from the boys. Simultaneously, the pressure to look thin, to harshly critique their bodies and to become a sexual object encroach on younger and younger girls. Disturbingly, the current ideal woman's body is that of a fifteen year old, not a grown woman. The academic, intellectual and professional achievements possible because of Betty Friedan and many others seem to have come at a steep cost. Why has this external equality among the sexes forced women and girls collectively to feel enslaved to an internal source of inequality?
Much of what I have written explores the hidden side of these diseases as opposed to the DSM-IV-TR--the psychiatric Bible--which lists a series of relatively concrete symptoms that comprise an eating disorder. Although an accepted diagnosis is necessary to create consensus among clinicians, the absence of an emotional and psychological guideline only propagates the deeply rooted misunderstanding. It is too easy for the public to equate Anorexia Nervosa solely with starvation, for example, without any awareness of the psychological torment at the root of the illness.
Perhaps the most suffering is caused by the feeling that someone is at fault for their entire illness, that they are solely to blame. One goal of therapy is to see the self-blame as part of the illness--how can you blame yourself for something you never could control? Relinquishing the personal responsibility makes room for healing and subsequently the painful, personal growth necessary for recovery. However, misunderstood by family, the media and even ignorant clinicians, patients remain alone and often spend years sure that blaming themselves is completely accurate. It is curious to me that the general public response to these horrific diseases is to corner the patient into feeling fully responsible. Why is the needed compassion replaced by ridicule or contempt? How did eating disorders turn into a media spectacle? It is hard not to interpret these circumstances as a covert societal force intended to silence this subset of women.
Interestingly, this is one similarity between eating disorders and disordered eating. The self-reproach of disordered eating can be a modified version of the self-blame of eating disorders. Both serve to tamp down any burgeoning confidence fostered by the equality among the sexes today. Just as girls might be finding their rhythm in school, their attention shifts to body and self-image. Often, pressures to be attractive, including sexually appealing, entraps younger and younger girls. Considering the personality traits that increase the risk of eating disorders--motivation, perfectionism, drive and powerful empathy--it is hard not to connect the dots: many of the most successful girls are lost to the preoccupation with food and weight. The full implication of this statement is profound. Equality exists in this country no matter one's sex, but the covert societal forces now seem to generate enough internal turmoil in girls to severely limit their potential. By hiding the truth about eating disorders, society ignores and silences voices no one wants to hear. Now the inequality exists but can't be seen.
The next post will focus on the experience of empathy in people with eating disorders and the concomitant emotional pain of outpatient recovery, both on an individual basis and on the contribution to what remains concealed behind the public ignorance of eating disorders.