There's a myth about eating disorders that people can't really fully recover. I have encountered many clinicians in the community who may not state this directly but organize treatment as if these were incurable, chronic illnesses. Even people who know little about eating disorders often ask me if any of my patients get better, fully expecting the answer to be no. This commonly held myth is widely believed and leads many people seeking treatment to give up hope.
To be honest, I've thought a lot about why eating disorders are viewed this way. The body of medical and psychological literature reports that people can get well. There are many books of recovered people describing their painful, but ultimately successful, path to full recovery. There are many clinicians who have fully recovered themselves. So if all the easily found information doesn't propagate a message of hopelessness, where does this myth come from?
I think the first culprit is the belief that having an eating disorder is a lifestyle choice, not a devastating illness. Although media outlets don't state this directly, there are very regular headlines that infer that restricting food intake and increasing exercise to maintain very thin weights are the ideal lifestyle choices one can make, not the signs of an illness.
Accordingly, it can be difficult for many people to differentiate between these supposedly "healthy" goals and an eating disorder. In fact, many magazine articles imply that choosing to eat less and overexercise is simultaneously healthy and synonymous with eating disorders, an extremely confusing and contradictory message.
The truth is that people with eating disorders struggle to eat every meal, not because of vanity, but because it's a symptom of an illness. To most people, it's almost unthinkable to have trouble eating, so it only makes sense to view eating disorders as a lifestyle choice. When people cannot comprehend something, they will concoct a theory that makes sense to them, so explaining to people that not being able to eat is a symptom, rather than a choice, is very challenging.
The second likely cause for the myth has to do with how long people stay sick. Many patients are sick for a long time before seeking help and, once they take the first step, experience treatment with a clinician who isn't knowledgeable about eating disorders. These initial forays into therapy imprint the idea that treatment won't ever really make a difference. It also means that many patients are sick for years before starting a true path to recovery. That extended time without much change in the illness makes it appear to others that eating disorders are lifelong. For friends and family, it's not surprising that they start to believe this will be a chronic curse, an inescapable maze the person is trapped in for life.
I have written much in this blog about family support. Bridging years of separation caused by the eating disorder is challenging but critical to recovery. I find that a significant part of recovery rests on being able to educate families and patients that eating disorders are curable. This step can invigorate all involved to muster enough energy and attention through the difficult process of getting better.
The raw, painful, emotional experience of nourishing oneself and re-entering life doesn't look like getting better, at first. The person usually seems to have things more together when she was even sicker because the eating disorder symptoms numb any emotions. Starting to eat again instead unleashes these feelings. If family and friends work hard to understand that the painful process is necessary to lead to full recovery, the chance of really getting better goes up significantly.
There's one other reason our society has trouble seeing people with eating disorders get well. It has to do with how we glorify these illnesses. Idealizing thinness, even being clearly underweight, reflects our collective understanding about eating disorders. The process of getting sick with an eating disorder is encouraged by the outside world. There are too many stories of adolescent girls enjoying praise as they lose weight only to find that they cannot stop the descent into an eating disorder.
As long as we make extreme thinness a goal, we will conflate desire with disease. In this case, how can anyone see an eating disorder as curable? Part of shattering the myth that eating disorders are lifelong is convincing people that there is nothing desirable about being too thin or about being sick. No one would choose a lifestyle that strips so much of life away.