The Certainty Trap

Caught in Red Tape A man caught in red tape. The man & tape and the background are on separate labeled layers.

I’ve heard it said by top leaders in the field that “there are no surprises in caring for patients with eating disorders”. I see how saying such would inspire confidence and be reassuring for patients and families seeking treatment, and to be honest, it’s a lovely thought. The statement implies certainty and comprehensive knowledge of this disease. However, I can’t help but wonder, if there are truly no more surprises, if we’ve thoroughly solved this puzzle, wouldn’t we be seeing a success rate above 50%? Wouldn’t our etiological theories and methodologies inspire so much hope and resolve in sufferers that more than 50% would reach out for treatment in the first place? Most of the journal articles I read indicate that eating disorders are continuing to elude us clinically, which is why we have so few evidence-based treatments at our disposal.
Schiller says “knowledge is death”, which to me means the stance of “knowing” causes us to lose the ability to discover, be curious and it overall precludes understanding. Of course, as professionals we want to rely upon empirical fact and utilize what we have learned through our experience, but it seems important to also approach our work from an open-minded platform, rather than one of certainty. The stance of “knowing” is like a closed hand, holding tight to what is assured. We should not confuse that which we are unaware of with that which does not exist. Like babies without object permanence, if we can’t see it, we assume it isn’t there, and this mindset can hamper the development of better approaches. Closed hands cannot grasp new information or reach for a new opportunity for growth.
In my practice, the most essential element of success comes not from the material in my manuals or the data in my books, it comes from my desire to understand each of my clients for the unique person he or she is. The more I am curious and intent on discovering them, the more they are able to discover and recognize their own true selves, and ultimately this is what paves the path to recovery. In short, each and every person we treat has surprises and we should strive each day to be worthy of hearing them. To do otherwise misses a golden opportunity to help clients cultivate self-curiosity that is the gateway for self-care. Certainty can be a trap and the biggest trap of all is the one we don’t know we are in.

3 thoughts on “The Certainty Trap”

  1. I love this. And I don’t think we can hear it often enough- a great reminder to have no memories and no agenda. I particularly like the idea of looking at a patient aloud, in a way that helps them to be open and curious about themselves. We are like snowflakes!

    1. Thank you Christine! You are actually the first person to positively respond to my blog! I enjoy the intellectuality of contention, but every so often it is very uplifting to hear an affirming voice! Ultimately, I think eating disorders happen because the individual loses himself or herself, and therapy’s job is to help clients root in themselves again. This requires us to literally see each person we serve as completely unique. Of course, we want to rely upon well-founded theories that can facilitate the recovery process, but ultimately it is the attuned discovery process that makes a world of difference. We can’t achieve this platform with those we serve if we approach our work with a stance of certainty. Thanks for reading and I look forward to further discussions with you!

      1. Anorexia Nervosa happens not because the person “loses herself” but because her eating patterns become too restrictive. The cure is not to “root” in the person but instead to help her restore normal patterns of eating. I don’t agree with the idea that we should have “no agenda.” As parents, we know that the agenda is to restore our kid to a healthy weight, and to help her resume normal, sustainable, patterns of eating behavior. If you don’t do that, you can be as “open and curious” as you want, but your kid will probably either die of starvation or be seriously impaired medically, and her brain permanently damaged, as a consequence of starvation. In other words, lets cut out the psychobabble crap and talk reality here folks.

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