The clinicians who treat people with eating disorders have often themselves suffered from anorexia or bulimia. Little has been written about having the recovered treat the ill, but informal conversations quickly reveal strong reactions from patients and clinicians alike. In fact, many programs and individuals fall in one of two camps: those who think only someone who had an eating disorder can be an effective therapist and those who think that this creates a community of people who never get well.
Although everyone's goal is successful treatment, there is something about eating disorders that generates emotional and even political factions. The confusion only grows deeper as these illnesses burrow further into the modern ethos. The multiple possible causes, limited therapeutic options and endless debate of disease vs. lifestyle choice opens the door for multiple, unsubstantiated and fractious theories.
The movement for the recovered to treat the ill has a clear precedent. Addiction treatment has been notoriously challenging and largely unsuccessful. Alcoholics Anonymous, a peer sponsored, ongoing support network with a clear program and 24 hour system provides what no treatment option can. The components include a group of people like-minded in the desire for recovery with similar experiences and a formula for success. Most important, when an addict feels the craving, there are many people only a phone call away.
Similar to addiction, it remains very difficult for people without eating disorders to understand and have compassion for the incessant mental torture of these diseases. Trying to live in the world while struggling to eat at every meal creates a very isolating existence. The deep sense of loneliness and separateness of the recovery process experience remains a barrier to getting well. The psychological and emotional pain often makes the potential relief of the eating disorder symptoms irresistible.
Understanding why eating disorder recovery is such a lonely experience is very hard. However, everyone can identify with the actual feeling of being alone. One irony of the human condition is that the feeling of being alone in the world is universal. How can we all share together the reality of being so alone? Although feeling part of a group always alleviates this ill, the relief is always fleeting.
In the eating disorder community, the banding together of the recovered and the ill creates just such solidarity. A group of people whose experience runs the gamut from very sick to fully healed can embody the entire scope of the process in one room and generate hope in a way that is at the core of any successful treatment. Seeing a therapist who communicates hope just by being there and saying "I am well" can change the tenor of recovery. In the throes of the daily struggle to eat and get well, a daily reminder of hope is invaluable.
There is one critical, potential pitfall. In any group with people still quite sick with an eating disorder, the internal drive back to starving or binging remains strong. In the face of powerful forces that everyone in this group has experienced, there has to be a constant, overt undercurrent that recovery is the goal. This may seem obvious but many well-intentioned groups have succumbed to the power of relapse. The fundamental notion, borne out of AA, is to respect the disease. As long as even the members with the longest recovery acknowledge the risk of relapse, the group as a whole will remain on track.
What clinicians without an eating disorder provide is perspective. Treatment acts as a bridge from sick to well and from isolation to connectivity. To exist in a therapeutic environment simultaneously without judgment and with the luxury to be fully honest liberates a patient from the prison of an eating disorder. Nestled solely in the arms of the recovered, a patient will remain scared to be in the world. A clinician from the outside can help that person learn how, even with the history of an eating disorder, to be in the wider world.
The community of practitioners--the recovered and the outsiders--need to stay together. The treatment of eating disorders need not be a political battleground between the afflicted and the perpetrators. It need not foster the endless debates of illness or imposed prison. Yes, the social forces behind the steep rise in eating disorders in recent decades are polarizing, but it is the clinician's job to heal. Let's put aside the disparate motives and agree that there are many, many sick people in need of help to get well.