Expectations

At the end of the last post, the ideas of specialness, hope, living through the future and secretiveness--all discussed here previously--began to seem as relevant to adolescence as they do to eating disorder recovery. The question that came to mind is that perhaps the narrative of an eating disorder tends to remain stuck in the limited scope of adolescent expectations. That doesn't mean that someone with an eating disorder IS an adolescent at all but that having an eating disorder stops the personal development of how one views life's course. And then understanding the difference between the expectations of an adolescent and those of someone with an eating disorder might be a clue to help protect children from getting sick.

The state of becoming--the central theme of adolescence described in the last post--is a precious moment in life when everything seems possible for an instant.  But this developmental stage has instead become the Holy Grail, so revered that people try to extend it well past its expiration date. The sense of becoming is valuable for society at large because, by definition, it remains a brief moment in life. Teenagers embody the hope of a community for a new and improved future, but there is nothing pretty about someone in middle age working too hard to look or seem ten or twenty years younger. At some point, to have value for oneself and one's community, we all have to become something, namely ourselves.

In the world of an eating disorder, one is always becoming: becoming thinner, becoming sicker or imagining a future life when one has become well. In the end, the therapy for an eating disorder must lead to one significant transformation: from becoming to having become. A patient is so used to focusing on a future of being well and the fantasies of what life will be like that she has generally lost the ability to think and feel today, now. The end result is to completely eliminate any expectations for today and to ignore the real process of how life changes. The goal, dictated by the rules of an eating disorder, is predetermined. Each day is the same. Someone with an eating disorder continues to mature but her sense of how to become doesn't. And so expectations become almost contradictory: the aimless musings of a teenager explained by an intelligent, sophisticated adult.

But these free-floating expectations are the essence of adolescence. Suspended between an unrealistic yet somehow universal sense of promise and a tumultuous, emotional present, teenagers seem incomprehensible to any adult. They resemble wild, irrational beasts with the potential brainpower of a Nobel Laureate, the libido of a dog in heat and the emotional intelligence of an infant. The challenge of having a rational conversation can feel like learning Mandarin in one sitting. And even any linear sense of narrative is constantly being interrupted by fantasy and wild expectations. The precarious mental state and instability of a self that dominates adolescence seem to act like bait for disordered eating. As I have written in several posts, focusing on food and weight can provide order and identity to the utter confusion facing these kids. How then does a well-meaning parent talk to them in a language that will make sense? How does a parent be sure that the process of becoming lands a child squarely in the world of having become?

This is where the difference between eating disorder recovery and adolescent angst is useful. In treatment, the relationship in therapy acts like a mirror, and the patient consistently learns about herself by looking at her reflection each session. The disorder makes that image look like a monster: fat, slothful, disgusting and unlovable. Session after session, it becomes harder to believe the disorder when therapy reveals a very different self-image. The role of the therapist is to remember to state the obvious. Consistent positive feedback is  something a patient has never received and needs to hear over and over again. Patients with eating disorders have pretended to be okay while hiding the constant internal suffering. By letting their guard down and still getting regular praise--something most people take for granted--an entirely new reflection comes into focus. The subsequent confusion, emotions and dependence, previously inundated by eating disorder thoughts, represents the patient's introduction to life without the disorder. Living no longer needs to be synonymous with isolation. Being real no longer needs to mean being a burden on others but getting help and support.

The opportunity of involving all of oneself--thoughts, feelings and apprehensions--in the moment is an enormous relief for a patient unable to allow her expectations of life to mature since first becoming ill. For an adolescent, especially one at risk of perpetually becoming, the role of adults in her life is to act like that mirror. The adult doesn't need to tell or retell the child's story. The kid needs to figure that out on her own. But an adult needs to try to translate the Adolescent language (Mandarin perhaps) into something the world can understand. Although it certainly will take a few tries--and likely be very trying--a caring adult needs to show the child her reflection--with a combination of practical advice and regular positive feedback--and attempt to really understand the confusion of identity, emotion and expectations. Just as in therapy, this can create a stabilizing force. Think of it as harnessing all of this energy so it really can become ... something.

The risk of an adolescent slipping into an eating disorder, according to the above argument, hinges not just on self-esteem but on the reflection adolescents get from adults in their lives. I want to speak more about reflections and relationships in the next post.