There sure are a lot of different perspectives about eating disorders, some of which make partial sense (Hilda Bruch came the closest in my opinion–she had the “what” more or less right, the “why” half right, and the “how” half right). And some of the eating disorders perspectives I read are just plain creative.Here is a way I think we can discriminate between a good theory/therapy and one that is not useful. I suggest we make use of data that we hardly ever look at–the reaction that patients with eating disorders have to what we tell them and how we treat them. I believe a good theory will more or less immediately make sense to the patient. It will cause them to enthusiastically engage in therapy, they will build insight and a sense agency toward recovery. They will want to be treated, they will like being in treatment, they will lose the alexithymia. Their resistance will quickly turn into resolve, and they will quickly start to eat on their own without being forced to.One of the ways I can see that our theories are falling short is the way that clients tend to react to extant therapies. In many cases, we have to threaten and coerce (or arrest!) them to get them into treatment. They so often don’t comply, they don’t invest, they don’t engage and they don’t seem to feel positive about treatment. I think this is a huge, flashing neon sign that what we are telling patients about why they are sick and how they can recover is falling short or is downright false.
And it is a sign that we seem to not want to look at. I see that we generally discount these negative patient reactions as the result of advanced starvation creating an inability to engage, a resistance to giving up the eating disorder symptoms, a fear of gaining weight, a manifestation of ego-syntonia (yes that is for sure a word), or that the person is unwilling to give up the ‘control’ that comes from holding onto their illness. I believe these perspectives are both shielding and preventing us from having to actually look at the fact that PERHAPS these theories and therapies are unsophisticated and not well thought through.
I do have an alternative theory called Relational Exchange Therapy, you can read about it on my website, thedragonflyretreat.com under the ‘philosophy’ tab. I am not saying I have THE ANSWER, but I am saying we need to keep looking for better answers.
Like Bob Dylan says “You don’t need a weather man to know which way the wind blows.”