The Isolation of an Eating Disorder

Much has been written about the isolation created by chronic illness. Healthy people have the luxury to live as they please, or believe they will one day, and to dream about the future. Being sick takes away those gifts in a moment, destroying the pleasure of each day and allowing only the hope for survival. Although sickness highlights how precious each day is, that's no solace for the loss of personal freedom.

This pain is magnified when the sick person is young, and eating disorders are afflictions of youth. Adolescence and early adulthood, the typical time of onset of eating disorders, are typified by idealism, hope and brazenness. Even if the reality of these stages feels much harder to the individual, society idealizes the freedom of this age and cherishes the passage from childhood to responsibility and seeks to delay the transition as long as possible.

It's a bit easier when the young have diseases that instantly trigger sympathy and understanding, but for people with eating disorders, the loss is magnified further by the confusion surrounding these illnesses. Not sympathized with like cancer or dramatized like addiction, painful and destructive though they both are, eating disorders are the strange diseases when someone cannot eat. The general misunderstanding of eating disorders makes it easy for family and friends to ascribe blame to the sick person. The psychological and emotional torment makes little sense to the uneducated, and the refrain "just have a milkshake!" seems as likely a fix as intensive, and usually expensive, treatment.

Crossing the line from well to ill, early age of onset and limited public knowledge quickly isolate someone with an eating disorder. For a time, many people can hide their symptoms and suffering while acting as if they are fine, just like everyone else. There's a time, around the mid-twenties, when it becomes much more difficult to stay connected with the truly well. As social events typically revolve around food and as other people's lives progress in the way a sick person's can't, it becomes too hard to continue unfazed by daily life. The isolation, once internal, largely about feeling different, becomes external and much more real. The time spent alone burdened by the years of sickness, the years gone by and the hours still lost to the eating disorder symptoms become even more painful and isolating. The years of feeling so different from everyone else truly takes its toll.

Much is made of the medical and psychological treatment of eating disorders, but the isolation created by these illnesses brings an even greater need for people to get well: community. Fostering the growth of connectedness, of not feeling alone and of others who have tread the same path opens up a long sick mind to the hope of getting well. The shame that is a bedrock of eating disorders furthers the notion that these people cannot connect. The misguided fears of clinicians that patients will only egg each other on and worsen their symptoms limits potential friendships and bonds. The rules of some programs to curtail personal connections among clients serves to heighten the isolation. But connection and dependence on others strengthens each individual's belief that full recovery is possible. It's crucial the clinical field and national organizations not only support awareness but support building community.

There are several ways to build community and give hope to

the chronically ill with eating disorders. Probably the most common option is group therapy. The opportunity to engage with other ill people and therapists is often eye opening for people who've been so isolated by their illness. Seeing the similarities between themselves and others also afflicted makes it clear that an eating disorder is not a personal failure but an illness. 

Many programs hire therapists who have recovered from eating disorders themselves. Becoming close to someone who found a way to health is a powerful experience and makes true recovery tangible. It also helps people so alone in the disease see the larger picture of relapse, recovery and wellness right in front of their eyes. Encouraging people to stay in touch with therapists and clients after discharge solidifies the reality that a bonded community fosters healing and isolation encourages sickness.

The organizations and opportunities already exist to encourage togetherness to help people get well. The more clinicians help patients and families connect to community from the start, the more the message of true recovery will spread. A therapy team is a critical first step in treatment, but community is a lifeline that ought to be part of that first line of help. Knowing full recovery is an option within your grasp, and that there is a group of people behind that imperative, must be part of any initial steps to get help.

Killing an Eating Disorder with Kindness

The behaviors of an eating disorder are obvious, if confusing, to people with limited understanding of these illnesses. People either stop eating and lose weight or binge/overeat regularly and then try to compensate by purging or exercising or a variety of other measures. What drives these behaviors is much more murky.

But there is a reason eating disorders are classified as psychological. The maladaptive thoughts and emotions form the engine that drives the illness. The cure seems straightforward--to just eat--yet clearly that seemingly sage advice is ineffective in eating disorder recovery. The underlying psychological process makes the mundane chore of eating impossible. 

Describing the thoughts and feelings of an eating disorder is difficult. The specifics are confusing even to the most open-minded. We are programmed to view food and meals as necessities, like sleeping and breathing. Even for those trapped in the cycle of disordered eating, food isn't the enemy, only for those with eating disorders.

The level of fear, if not terror, associated with food for someone with an eating disorder is very heightened. The actual thoughts about food reflect as much: you don't deserve to eat; you aren't worthy of food; everyone else gets to eat, just not you. Facing food several times per day feels like going into battle. Since food and terror aren't linked for most people, these thoughts just don't make sense.

It takes a leap in imagination to understand the psychological prison of an eating disorder. We all go through our days with an internal thought structure about ourselves and our lives. These thoughts can range from positive to critical, arrogant to self-deprecating, conscious to mostly out of awareness. Our internal world affects how we live and decisions we make.

Now try to imagine one's mind hijacked by a powerful, harsh dictator. The resulting thoughts aim constant barbs criticizing everything about you, putting down every aspect of your life and insisting you're worthless and your life is pointless. These are the thoughts of an eating disorder. After reaching a crescendo of punishment, this internal monologue insists on retribution to confirm how awful the person is, namely either by restricting or binging. The harsh thoughts are the driving force of the illness and make the suggestion to just eat, as if it were that simple, absurd.

Once the psychological suffering of an eating disorder is clear, the actual help and care the person with the illness needs shifts markedly. These punishing thoughts are not the thoughts of the person who is ill but the symptoms of a disease. And when a person is bludgeoned by constant punishment, the instinctive reaction at first is to fight but, without any success time and again, it is to cede power and just to try to survive.

The most effective tool to counter the punishing thoughts is kindness. A period of being punished and being alone leads the person to crave kindness and compassion. Often uncomfortable at first, regularly receiving kindness offers an alternative to the punishment of the eating disorder. It reminds the sufferer of a forgotten way of living in the world and of how to reflect on oneself. It opens a door to a life no longer dominated by punishment and starvation or binging.

The protracted course of an eating disorder actually leads family and friends to frustration and, if anything, harsh responses. Years of watching the person stay sick with multiple aborted attempts at recovery prompt anger and resentment. It's hard not to believe the disease is self-inflicted, the grief of lost time self-pity. It's a logical step to interpret the internal punishing thoughts as a sign of not wanting to get well, not as the symptom of a relentless illness.

These false assumptions only isolate the person more, thereby strengthening the illness. Alone with the internal dictator, the ill have no chance at recovery. The education of loved ones must include two steps to help them provide needed support.

First, the psychological component of eating disorders needs to be reinforced repeatedly. The behaviors may be clear, but the punishing thoughts are too hidden and too powerful to be ignored. It's essential to understand how the thoughts function and to see them as symptoms, not self-sabotage.

Second, families and friends must understand that the only successful counterpoint to criticism is kindness. Regularly asking how she is doing and how you can help goes a very long way. Offering regular support without judgment means more than words can say. Sticking it out with her even during hard days and weeks can weakens the internal dialogue. The outside pressure of kindness can speed up a recovery more than almost any other personal support.