It’s a fine line between blame and responsibility when it comes to eating disorder recovery. I wrote the last post with trepidation that it was too easy to interpret my words as blaming the patient for their illness, something I adamantly oppose.
And certainly the same logic wouldn’t apply to a purely physical illness such as cancer.
Part of the difference lies in the core medical knowledge and treatment options. The science of brain function remains in its infancy. Only a few decades ago, a common misconception was that people only use 10% of their brain, but that factoid reflected justification for our collective ignorance. Even as we learn more about how our mind works, the yawning scientific gaps preclude the large majority of any truly functional knowledge.
However, the medical information available about cancer is also very limited, as is treatment. Why is the discrepancy in attitude towards eating disorders as opposed to cancer so wide?
Cancer is an invasive “other” in one’s body. The psychological component of treatment is one of endurance and maintaining optimism in the face of so much fear and doubt. The goal of treatment is very clear. There is no way for the doctor-patient relationship to be adversarial.
Eating disorder treatment attempts to separate out the eating disorder thought process from one’s own independent thoughts. Although that construct is useful and effective, it is a construct nonetheless. Eating disorder thoughts may be the driver of the illness, but they still feel like one’s own thoughts. The cognitive exercise of learning to identify them as part of the illness, dismiss them and follow a different, often newly acquired set of thoughts is challenging at best.
When an educated, caring, well-meaning clinician urges week after week the patient to follow these new thoughts and ignore a well-worn pattern of daily life, inevitably there will be friction in the treatment. The process of learning new patterns with food and managing the concomitant thoughts is challenging and bumpy. Since no treatment can effectively ease this painful transition, that responsibility to work on new behaviors each day has to lie with the sufferer.
This is certainly a cruel joke. Not only is someone saddled with an eating disorder but the only effective treatment option is a slow and painful struggle against the powerful eating disorder forces. And it’s easy to see why not everyone can get well.
I am always searching for new ways to make this easier, to prevent the suffering and to sidestep the prolonged pain of the process. I remain hopeful because many, many people do get well. In the meanwhile, I also have to accept these realities and communicate them in treatment.
I still think you are missing the point. I am not sure how all of your statements fit in, so maybe I am mkssing something. But it seems like your perception is,
ReplyDelete"1.someone with an ED wants to get better.
2.it is very hard and painful to get better.
3.unfortunately, there is no way of lessening that pain and difficulty. Therefore the reality is that Noone but the patient themselves can do that."
If all those ststemrnts were true, that would be a valid point. But I feel like there is a crack between your recognition thwt eating disorder thoughts feel like one's own thoughts, and really understanding that to the endth degree.
If 'my' eating disorder thoughts feel like 'me' to the extent that I really believe that they are me, then there is absolutely no desire to 'get better' . There cannot possibly be any optimism about treatment because treatment feels like nothing but a violation of the self.
In this regard, someone with an Ed has it worse then cancer. The cancer patient sees the illness as other and wants to get rid of it. The Ed sufferer cannot even want to get rid of their illness.
How can you possibly give responsibility to someone who is Incapable of seeing any benefit in attempting the task you give them responsibility for?
That feels like putting a jar of cookies in front of a young child with diabetes and saying 'you are responsible to take care of your health".
If the young child cannot understand that cookies can make him die, and he knows that he wants them very badly, how can the term "responsibility" even apply?!?
Even if that person with an Ed is an adult who understands that the disease can cause them to die... For someone with an Ed, dying can be "the cookie"...
DeleteThe lack of understanding would be analogous to a lack of differentiation between self and disease, not a lack of understanding of the workings of an Ed per se.
Justme, I understand where you’re coming from and your frustration. My takeaway from the last two posts was that an eating disorder specialist, or a team of them, cannot on their own make a person get well. And yet people do recover from EDs, often with the help of professionals but sometimes all by themselves. So recovery is possible. If recovery takes a tremendous amount of dedication, patience and compassion on the part of medical professionals, it also requires persistence, resilience and creativity on the part of the patient. It’s a leap of faith and requires tremendous bravery to believe one can recover from a disease that feels like it’s part of oneself. I don’t think these posts meant to imply that it was easy to recover or even always possible. But there is no external cure or person that can make us well from the outside in. It has to be a partnership, and we are responsible for our side of the work. I’m not sure if I’m being very articulate or helpful, but those were my thoughts.
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