Anorexia: A revealing history

Certosa di San Martino, Naples

Despite the widely-accepted notion that eating disorders are the result of a thin-idealizing media saturation, these diseases have actually existed for hundreds of years, long before being skinny was seen as anything other than a sign of poverty. The first cases of Anorexia were seen in people that were the least likely to pursue vanity or recognition for physical attributes. Anorexia emerged in nuns, saints, monks and other stations of life that promoted a sacrificing of self for the achievement of ‘higher good’ for others. What does this tell us about the nature of eating disorders? Perhaps it demonstrates that the thin ideal is more of a spurious variable rather than the actual cause of the pathology. Further, most patients with Anorexia before the 1960’s didn’t report a drive for thinness as being significantly related to their symptoms. Maybe exposure to skinny models is the most obvious variable that we latch onto when attempting to understand why people would emaciate themselves. Because it makes sense in the absence of a more enlightened perspective on the disease, we have run with this explanation and proceeded to ignore the more deep causes that we really need to examine. The more energy we invest in barking long and hard up the ‘thin is in’ tree, the less energy we devote to taking a more comprehensive look at the real dynamics involved. Is there a correlation between self-sacrifice as a personality feature/way of life, and the habits of self-deprivation that embody an eating disorder? I see that there is. We need to challenge ourselves to seek explanations that account for all of the facets of this disease and its history. When we find the true explanation for eating disorders, all of the unexplained pieces will fall into place and we won’t need to rely on tunnel vision to support our perspectives on this disease.

She’s leaving home


Having some trouble at school

There is a very interesting Beatles song called “She’s leaving home”, and I often ask my clients listen to it because it describes the way that some families react to a child going off to college. Many people with eating disorders hold unrealistic role obligations within their families, serving as the proverbial hub of the family wheel. They reassure mom, mediate fights in the family, hang out with dad when mom doesn’t share his interests, help younger brother with his school work, clean the house because no one else wants to, visit grandma when the rest of the family is busy, make the family look good by achieving more , they are mom’s ‘best friend’, they parent younger siblings, offer a therapeutic ear to adult problems, the list goes on and on. So when a child with these roles leaves home to go to college, the result is a very poignantly felt void in the family. Eating pathology and body image disturbance are worsened when one feels guilty, feels she/he has let others down, failed, harmed or deprived the family system in some way, and moving away from home can create these feelings. The eating disorder can really flare up when Atlas finally shrugs. Most often we think increased stress, independence and peer pressure at college make symptoms worse, but I always look to the ways that the family reacted to the client leaving. Most often we will discover the client’s underlying feeling of self-blame for no longer being there to hold the family together, coupled with a pushback (subtle or otherwise) from family members in response to their own sense of deprivation. To resolve the eating disorder, we must look at realistic v. unrealistic internalized roles and be more fair and accurate about what one person can shoulder in a family. I teach my clients internal boundaries so they can stop being responsible for everyone else’s issues and needs. When the burden of that heavy role is lifted, so often the burden of the eating disorder is lifted as well.

A symptom of choice

Worried young woman being accused

“I feel so guilty. I purged last night and I have been restricting all this week. I don’t want to tell my parents because I know they will be so disappointed in me.”

“Honey, if you are having moments of weakness, just tell us and we can help you be strong.”

“I just don’t want to let go of the eating disorder. I probably shouldn’t be in counseling at all because I am not ready to change.”

“You know, I had a friend who died of Anorexia. Do you want that to happen to you? Don’t you know what this is doing to your body?”

One of the most unfortunate things about eating disorders is that they are seen as a choice, a lifestyle, a diet, or a stubborn play for control. Eating disorders are real illnesses, and yet they so often evoke guilt and shaming. Would you feel guilty if you had cancer or the measels? Why do people with eating disorders blame themselves for having symptoms? Worse, why do people who don’t have eating disorders blame the affected individual for ‘choosing’ to be sick? Guilt implies choice, and the symptoms you experience while sick with an eating disorder are not a choice. The whole phenomenon of wanting to have the illness? Also not a choice–it’s a symptom of the illness itself.

You don’t have to be ‘ready to change’ to recover. Not being ready to change is a symptom of the illness itself, therefore waiting to be ready to recover requires that recovery has already started. So often, counselors set a prerequisite that their clients have to be ‘ready to change’ in order to benefit from treatment. This is wrong. When you are sick with an eating disorder, you will most likely “want” the eating disorder in a large part. Instead of using that as a criteria for determining potential responsiveness to therapy, we should look at it as a sign that the person needs treatment. My clients tell me they are ‘not ready to let go of the eating disorder’, as if I am going to be disappointed and wag my finger at them. I tell them the desire to let go of the eating disorder comes when the eating disorder lets go of you. This doesn’t make them resistant to therapy and it doesn’t mean they are not doing the work they need to do. It means they are sick. They are with me because they are sick, and as they get better the desire to be healthy will grow.

If you have an eating disorder, remember your symptoms are not choices. You are not a bad, irresponsible, stubborn, resistant person because you have symptoms. If you know someone with an eating disorder, don’t approach them with a lecture, don’t pretend to know better than they do what the experience is like. Don’t give them oversimplified advice like “you just need to come over and eat with us” or “you are so beautiful, you just need to gain some weight.” These illnesses are not forms of dieting, they are not a manifestation of lack of logic or common sense. Guilt and shaming make eating disorders worse. Almost everyone I come into contact with knows very little about eating disorders, and yet people hardly ever shy away from condescendingly presenting themselves as experts on the topic.