The Tangled Web of Identity and Eating Disorders

In a recent meeting, a colleague, speaking about her work with children over many decades, recounted the story of a patient she has treated for thirty years, starting at age six, for "the most profound anxiety disorder I have ever seen." Just the other day, the patient, deliriously happy but exhausted, called to recount the story of the birth of her first child. "Imagine me," she said, "dealing with needles and so many doctors examining me! But I just explained to them my longstanding anxiety and fear of doctors, then they helped me through it." My colleague paused for emphasis, clearly proud, and then presented the moral of her story: if you know yourself and are clear with others about your limitations, anything is possible.

As she went on to expand her thesis into play therapy for children and even parenting advice, I found myself thinking about identity. This patient's sense of accomplishment was momentous and her ability to recognize her achievement moving, but I felt something nagging at me nonetheless. Although self-acceptance is no doubt a critical part of maturity, an identity--the reflection we see both in the mirror and through our family and friends--cloaked in symptoms and limitation seems like a misguided message for kids. Isn't childhood a time for hope and promise? Won't the humbling lessons of adulthood only limit a child in need of perseverance and confidence? All of this left me stuck on the larger question: what are the implications of an identity based largely on the extent of our deficiencies?
The individual accomplishments of my colleague's patient were something to celebrate, of that I was clear. The intended message, though, explored one way of addressing kids' struggle to find identity in today's world: find oneself through difference or limitation and fashion a life from the options remaining. But the implicit advice was cautious if not undermining: avoid challenge and even confrontation to do what you're capable of. Satisfaction comes not from hard work but from the most manageable path in front of you. This reeked of a self-help approach to the world, or the opening salvo of a daytime talk show special, not a potential solution to helping kids build a sense of who they are and certainly not a philosophy of expectation or hope for change. But when the pursuit of happiness becomes the prevailing life philosophy--an unfortunate consequence of the banal advice-giving media spawned from its roots in psychotherapy--progress, hard work and challenge all seem to go by the wayside.
The infiltration of psychiatric symptoms and diagnoses into our self-image is a given in many pockets of society. It used to be that only medical students during their psychiatry rotation nervously thumbed through the latest DSM--the bible of psychiatric diagnoses--terrified to find their deepest secret staring back at them from the criteria of a mental disorder. Now, the DSM is widely available through a mere search of the web, and identifying with mental illness a rite of passage for adults and youth alike. The trying, social process of overcoming shameful secrets has been supplanted by the now commonplace but brazen announcement "That's just my OCD." Your own personal psychiatric symptom is almost a part of the social resume: hometown, religion, race, socioeconomic background ... current mental illness. Or perhaps it's a permanent crutch, a built-in limitation for what one can achieve.
Of all the psychiatric symptoms, manipulation of food and weight create purpose, attainable goals and success out of thin air while simultaneously obliging those looking for children to just be happy. In the cloud of psychiatric symptoms, weight loss and the subsequent positive attention--including the hushed whispers of "is she anorexic?"--is almost a badge of honor, not a crutch in the least. It feels like the sky is the limit as the pounds come off. The demoralizing expectations of a life hampered by a series of psychiatric symptoms evaporates. The world figuratively and literally feels a little bit lighter. The growing epidemic of disordered eating and pursuit of thinness is a simple solution for the directionless child compelled to find meaning in the world. At least for a little while.
Caught between the adolescent drive for purpose and the lure of losing weight, many girls find solace in identifying as eating disordered. The formative years from middle school through college, if nothing stops the onslaught of the disease, can leave one's identity intertwined with the disorder itself. A bright, quick mind, when consumed with the fear and intensity of an eating disorder, will create a vast and complex array of rules to follow in this hidden world. While being controlled by the details of calorie-counting, avoidance of terrifying foods or the search for culinary perfection, the consummation of identity and the disorder is complete. In the end, "you ARE anorexic" is the accepted statement, not "you have anorexia." The grammatical difference may be subtle, but the meaning is crystal clear. Treating an illness is one thing; treating an identity is another.
This post brings up as many questions as it does answers. How do adults help children form identity? What avenues for self-exploration and achievement don't exist for kids? Without other available options, weight loss and food manipulation are powerful tools easily at a child's disposal. Whose responsibility is it to open new doors so at least there is competition for a child's attention and drive? I'll start with these ideas in the next post.

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