"Getting It" Part 2

When people hear about children or young adults developing a serious, potentially chronic and even fatal medical condition, the responses are fairly predictable. Often an adult will feel sadness at the thought of someone early in life struggling, of a life derailed by illness, something most people are fortunate enough to associate with old age. Someone might focus on the unfairness of getting sick young or the loss accompanied with being unwell in the formative years. Many will feel powerful sympathy and even the deep desire to be able to heal a sick child. 

However, these are not the responses to a child or young adult diagnosed with an eating disorder. These reactions are also predictable but much less helpful. An adult often is perplexed at the idea that a child is not eating when food is plentiful. People often get frustrated and angry at the one who is ill. Someone who might sympathize with a sick child instead sees the eating disorder as a personal flaw and consequently only feels sympathy for the parents. 

Unlike other childhood illnesses which elicit support and love, eating disorders lead to confusion and frustration. A child or young adult in pain and suffering with an eating disorder needs care, love and kindness to find a path to recovery. Instead, the child is more often ostracized by the adults most likely to help.

The rise in the incidence of eating disorders was quickly followed by two phenomena that could bind together people with eating disorders against the universal lack of comprehension of these illnesses: the rise of eating disorder treatment programs and the birth and spread of the internet. These two events allowed isolated, scared children and young adults to find others who were sick and understood what they felt and experienced each day. As much as the growth of community has had negative consequences by allowing the birth of the pro-Ana and pro-Mia websites, the connection also created the opportunity to feel understood. 

The concept of "getting it" fundamentally reflects the powerful desire for people with eating disorders to feel understood. From the start, family, friends and clinicians treat them like pariahs, strange, confused and potentially threatening. The power of knowing that someone understands them, their behaviors, emotions and desires, is undeniable. In fact, just the experience of being understood often opens a door to imagining recovery more than any part of treatment. 

When I think back to my first experiences as a therapist in the outpatient program at UCLA, I realize that somehow I really did understand the internal struggle one has with an eating disorder very quickly. There was a level of communication around these illnesses that struck me personally and allowed me to deeply learn and understand. The group caught onto that piece of me and, desperate to feel understood and cared for, capitalized on it during my time in the program. 

In fact, they seemed to indirectly ask me not to abandon them by pursuing other avenues in my career. The message was clear: "Since you get it, we need you to help us. Please understand that not many people can make sense of the struggle and suffering of an eating disorder so use your knowledge to make this your career path. Please don't abandon us."

I got the message loud and clear  and have diligently followed that path. It isn't perhaps until now that I understood the message I received years ago, but I have felt the strong urge to make treating people with eating disorders my calling.

My very late reply to that entreaty from years ago is simple: I will do just that. Thank you.


"Getting It" Part 1

When I first started learning how to treat people with eating disorders, I was a psychiatry resident at UCLA. A colleague and I were the therapists in a weekly group therapy session as part of an intensive outpatient program. The age range of the women in the group was 18 to forties. Calling us the therapists was generous. We learned as much from the patients, if not more, as they did from us. 

I have been thinking about this group lately, more than for some time. In particular, when asked why I treat people with eating disorders, I speak about this group as the initial experience that began a quest to understand and help people with these illnesses. But recently, I have come to wonder whether I actually picked this specialty or, much as people find themselves trapped in an eating disorder, it picked me. 

As an impressionable and nervous resident, participating in this group therapy was a formative professional experience. After a few months, the patients who were more experienced in treatment settings had had sufficient time to vet the new trainees and determine that I, in eating disorder program lingo, "got it."

No stamp of approval was more potent. I had been accepted as a member of the club. I was now deemed worthy as a therapist. I had magically cracked some sort of code of empathy. I understood the complexity and confusion of having an eating disorder. The concept of not eating or of throwing up one's food, in the context of a complex life, made sense. Somehow, I had crossed over and now was one of them. 

I wasn't aware of any of this at the time but instead felt a heady, out-of-body sense that something significant has changed. It felt as if I had something special and had a responsibility to do something with it. 

Interestingly, my new status spread from patients to the clinicians who ran the program. I became one of their chosen residents and, over time, was invited into a small cohort of trainees considered capable of working with people with eating disorders.

The rest of the story is less interesting except that I have devoted my career to treating people with eating disorders. The effect of that initial group was to initiate me into the mindset and confusion of an eating disorder and to teach me how to use my own kindness, empathy and compassion to help a cohort of people left with limited treatment options, even in New York City, perhaps the most therapized city in the world. 

I have since learned hat the concept of "getting it" is central to most programs and patients alike. It has many uses like normalizing the confusion of the disorder, helping someone so alone feel a part of something and serving as shorthand for a therapist to trust. But the term can also signify the recalcitrant nature of the illness and the powerlessness the eating disorder thoughts brutally reinforce. 

In the next post, I will address the concept of "getting it" more carefully. Years after understanding its potent effect on me, I am curious to see more clearly the true meaning of this term.