In this section, I hope to offer an alternative to certain myths and set in their place what I have perceived is the true nature of eating disorders. -CNC and the Negative Mind.
"Anorexia is the by-product of
a culture that prizes thinness above everything."
"Anorexia is more prevalent in females
than in males because females are told that appearance is important
while males are praised for other qualities."
"Anorexia is caused by physical, emotional,
or sexual abuse."
"Anorexia is caused by distant, uncaring,
demanding, or otherwise dysfunctional
parents."
"Anorexia is the consequence of perfectionistic
people failing in their desire to be perfect."
"Anorexia is caused by low self-esteem."
"Anorexia is the result of trauma from
the pain of parents’ divorce, adolescence, or other life crises."
"Anorexia is a disease of the ‘economically
advantaged.’ "
"Anorexia is a psychosomatic disorder
caused by a child's refusal to grow up into an adult."
"Anorexia is an unconscious attention-getting
device, a cry for help."
"People with eating disorders are
selfish. They just need to get on with their lives and stop ruining
everyone else's!"
"Anorexia is a tool for control."
"Anorexics are to blame for their
situation. They’re doing it to get back at others."
"Sufferers need to hold on to their
condition as a crutch."
"The longer you have anorexia, the
harder it is to cure."
"Anorexia can't be cured; it can only
be managed. You’ll live with it and die from it."
"Anorexia is the byproduct of a culture that
prizes thinness above everything."
A widely held theory expounds that anorexia is in
part caused by a culture that values appearance over substance and prizes
women only when they are thin. Much has been said about the cult of
thinness, the rise of the supermodel as a public icon, and the belief
that victims of eating disorders lose weight to emulate a supposed physical
ideal.
Eating disorders are eight times more common in women
than in men. Surely one of the external values society offers as a venue
of perfection is the female body. Women grow up being complimented more
in their looks than on any other quality. We are told that most women
are perpetually dieting. Yet we must be careful about assessing blame
for eating disorders to this aspect of contemporary society without
considering the broader context.
The deification of thinness is dangerous, but where
eating disorders are concerned, it can be misleading. Indeed, this is
a much more complicated issue than appears at first glance, and if a
connection exists between the cult of thinness and anorexia, it is far
deeper than mere vanity.
There is a difference between becoming thin for the
sake of fitting into society's expectations and becoming thinner and
thinner and thinner for the sake of dying. Taken to their extreme, eating
disorders are, after all, a slow form of suicide.
If models in their beauteous, supposed perfection
are an example to the vulnerable, why do those suffering with eating
disorders progress so far beyond thinness to emaciation and, ultimately,
death? Why are boys and men affected? Why will one model become anorexic
and another not? Why do elderly women become anorexics crippled with
arthritis? Why do small children?
The distorted perception starts early-I have counseled
patients as young as three years old-and I now believe that the "failure
to thrive" cited in infants can be in some instances an early manifestation
of the Negative Mind. The seeds of anorexia may have been planted at
a much earlier age than the one at which individuals become body-conscious.
Society's emphasis on looks clouds the more important
issue that children are dying because they are trying to achieve impossible
standards of perfection. As we have seen in the previous chapter; this
focus on perfection is not so much for personal gratification as it
is a misguided attempt to improve the world.
Rather than thinking of the supermodel syndrome as
a cause of eating disorders, it is best to think of it as a possible
trigger. Modeling is an area in which perfection seems attainable, one
of the many venues for perfection (such as sports, academics, dance,
and so on) that eating disorder victims will fit themselves into. Most
teenage girls try to lose a few pounds for the sake of attracting boys
in high school. Many women are constantly on a diet, unhappy with their
bodies. But a girl with and eating disorder will use the ideal of the
model as a way to hone her sense of perfection; boys are not on her
mind. A woman with an eating disorder doesn't want to be a size 6; she
wants to be a size 0. The difference is knowing how much of what society
presents to take seriously.
I do believe that media and advertising images that
glorify perfection and beauty contribute to many women's sense of unhappiness
about their imperfectly human bodies. I would applaud a movement to
curtail the supermodel syndrome. But I am not convinced that at the
rate of eating disorders would fall as a result; I believe that people
with CNC would find another venue of perfection to emulate.
Moreover, anorexics frequently suffer from gross distortion
of their body image. They will often claim that they are overweight
in the face of all physical evidence to the contrary. One young woman
planning a third suicide attempt wrote to me that, at five foot four,
she weighed 93 pounds. "I feel fat all the time," she said, "but before
I kill myself, I must be thin. I cannot let some undertaker see my ugly
fat body."
The DSM-IV, the latest diagnostic manual of psychiatric
conditions, states, "Individuals with this disorder intensely fear gaining
weight or becoming fat. This intense fear of becoming fat is usually
alleviated by the weight loss. In fact, concern about weight gain often
increases even as actual weight continues to decrease."
I believe that the Negative Mind will not allow its
victims to see themselves as they are because weight is synonymous with
life. Given that victims are on an unconscious track to total self-negation
(death), if they perceive themselves as fat, this will allow the Negative
Mind to demand that they lose even more weight.
Anorexics will lie about whether they have eaten because
the Negative Mind, which insists without reason or logic on their demise,
instructs them to. They wear concealing clothes to protect the Negative
Mind, to forestall confrontation with the people around them. In the
few cases in which anorexics flaunt their gauntness, they are pointing
out that they are more unworthy than others. They vie to be the best
at dying.
Anorexia is about self-loathing and self-hatred for
falling short of perfection. Nora wrote several years after her recovery,
"I didn't look at models and dream of looking like them. I didn't think
that I was becoming beautiful. I thought I was the ugliest, most selfish,
and horrible person.
TOP
"Anorexia is more prevalent in females than in
males because females are told that appearance is important
while males are praised for other qualities."
I do agree that women are bombarded with images of
unattainable female beauty. Women's magazines are filled with articles
and advertisements touting diets, weight loss, exercise machines, and
so on. Beautiful women are featured in television ads that sell everything
from beer to automobiles to detergent.
Though the images of "perfect" women still vastly
outnumber those extolling male perfection, I do in fact see a rise in
the number of images of men, although they are perhaps more obscured.
Men's Health and GQ as opposed to Glamour and Vogue-the
magazine titles may not always be direct.
Once again, however, I think we are looking at a trigger,
not a direct cause. Eating disorders are not gender-based any more than
CNC is gender-based.
Historically, women have been honed to the caregivers
of home and therefore of society's needs. For years, they have been
the quiet support person, the one to whom the expressions "The power
behind the throne" and "Behind every great man is a great woman" applied.
So naturally, it would follow that there would be a higher incidence
of eating disorder manifestation among females.
Today, society is evolving. Men can act more sensitively.
We are finally a more humanistic culture rather than a culture of warriors.
And eating disorders among men are on the rise-at
least one million men number among the eight million people afflicted
with them in the United States. I attribute this to the ever-increasing
anxiety and attitudes toward perceived stress in society (the macrocosm)
and the changing rules within the nuclear family (the microcosm), coupled
with the victim's sensitive, caring nature.
Perhaps more men are not faced with the anxiety of
society's contradictions as often because their stereotypical role is
to do rather than to mediate and placate. But given the changing roles
in society, men see themselves more often in the position of giving
care. One young man who came into my care after years of hospitalization
that culminated in institutionalization in a mental facility because
of the severity of his suicidality had begun his slide toward CNC and
anorexia as a young boy. His mother had suffered stomach problems so
intense that she had run to the hospital for treatment. Jonathon took
it upon himself to keep his two younger siblings quiet while his mother
recovered from her frequent ailments. She had not asked him to do this,
but in his own mind, he saw it as his role.
Each cause of anorexia is different. But anorexics
all hear the same language and display the same inherent kindness. After
their recovery, their Actual Minds regain control, and these former
victims will be objectively, not subjectively, kind.
TOP
"Anorexia is caused by physical, emotional, or
sexual abuse."
Abuse falls into the category of "Underlying Issues."
These issues are real, and they need to be addressed. In this discussion,
I applause the work being done with people who have such issues. At
the same time, however, I question whether these issues are directly
related to anorexia. As one victim wrote me, "I don’t know how to change.
Any program I've been in was a stop-gap measure-a one- or three-month
hospital stay where I’d put on weight that I’d immediately drop as soon
as I was released. (Sure, I worked through many important issues-but
never unraveled the behavior.)"
I keep reading that eating disorders are skyrocketing
because sexual abuse is coming out of the closet. I have had patients
come to me and say, "I don’t remember being sexually abused, but since
I have anorexia, I guess I must have been."
I know of one father who was accused of sexually abusing
his daughter because she was anorexic. There was no evidence for believing
that he molested his little girl. Even though no one in the family could
see how this abuse was possible, the mother divorced him because of
the groundless charge. Both child and father denied any abuse took place,
and I believe them-it took me two years to put the family back together.
I do not deny that sexual abuse occurs in situations
which child and parent vigorously deny it, nor do I want to minimize
the devastating trauma that can occur after sexual abuse. However, most
of my patients have not been abused, and I want to set aside the common
misconception that every eating disorder is the product of abuse-physical,
sexual, or otherwise.
On the other hand, I have worked with several anorexics
who have been sexually abused. They felt that they deserved what happened
to them, they did not feel traumatized by it, and were primarily relieved
that it had not occurred to someone else. Typically, they welcomed what
must seem to the rest of us like cruel punishment (the work of the ever-perverse
Negative Mind), and still they cared for others first-even their abusers.
In truth, they lacked an accurate perception of their reality and responsibility.
Consequently, I believe it may not be the trauma of
the abuse per se, but the individual's perception of reality that will
cause anorexia. We can change reality only to a certain point (by addressing
the trauma and distress that act as triggers), but we can try to change
people's attitudes toward and perception of reality. In other words,
we can objectify abuse, that is, try to help the abused victim understand
that she did not deserve or cause the abuse, in order to preserve the
sanity of the victim. Perhaps anger toward ignorance only compounds
the problem and prolongs the suffering of the victim. Compassion and
understanding for the limitations of human awareness would seem more
likely to heal the victim than criticizing her for not condemning her
abuse or her abuser.
TOP
"Anorexia is caused by distant, uncaring, demanding,
or otherwise dysfunctional parents."
There is a widespread perception that anorexia is more
common in families in which rigid, exacting, uncompromising parents
impose their own personalities on compliant little children. The "best
little girl in the world" stereotype conveys that nothing the child
does is good enough for insatiable, demanding parents, so the child
keeps trying harder and harder to please them.
This is blatantly untrue for the vast majority of
my cases. In fact, I was alarmed to discover how wrong the stereotype
is. It would have made it easier to find that parents were uncaring
or demanding or dysfunctional, because then the answer to the eating
disorder conundrum would have been much simpler.
Parents are primarily responsible for defining the
world in which their children find themselves, but the emergence of
an eating disorder is not in itself a response to a specific social
structure within the family. Rather, I find that motivation for achievement
is far more self-imposed.
I have observed that these children are determined
to create the best possible scenario for the ones they love, without
having been asked or pushed. Generally, the intense striving to achieve
and the insatiable need for validation come from within them, not from
external sources such as parents.
One girl wrote in her journal, "I was running track
before school, doing homework instead of eating lunch, doing more running
after school, studying until one o’clock or two o’clock in the morning
and sleeping for four or five hours a night, maximum....I contemplated
driving my car around a corner and not turning because I had gotten
a 97 percent on a project that was worth only a fraction of my final
grade. I made one stupid mistake on a departmental exam and it
haunted me for months! Nothing was ever good enough. And when I did
achieve ‘perfection,’ it meant nothing to me."
Another wrote, "I cannot recognize or appreciate any
of my own accomplishments. Others are always better. Even when I achieve
excellence it isn't good enough. I recently got 98 percent on my calculus
final and was upset with myself for not doing better. My goals are far
too high. I lose sight of what is realistic or even excellent, and strive
for what is impossible. I never reach it, so I am always a failure in
my estimation and that makes me unhappy."
Moreover, young people with eating disorders work
at parenting their parents; they insist on caring for the adults. As
I explained in Chapter 2, parents are generally struck by the maturity
of these children from a very early age and tend to lean on them because
they can.
Most of the parents whom I see are incredible-extremely
loving and caring. They are also incredibly human-they have flaws and
faults like the rest of us. Parents are people-they are human and imperfect.
Every family in the world has circumstances that play the scale of that
humanness. Motivation and the effort to make things work are all that
are available to any of us. Failure requires tolerance and understanding
without one being labeled a misfit.
The stress of parents’ divorce in particular is blamed
for children's eating disorders. However, most of my patients’ parents
are not divorced, and most of the families I see are not dysfunctional.
However, if parents have the slightest squabble, the child with CNC
regards it as a crisis of the most major proportions and will try to
intervene. This later gets misconstrued by many therapists as evidence
of a "dysfunctional family," when in fact it is a reflection of the
hypersensitive perspective of the child with CNC.
As I've mentioned, if anything, family traumas such
as illness, divorce, or other life crisis may act as triggers that
help shift someone with preexisting CNC into a full-blown eating disorder.
If a child is already feeling more negative and subjective about what
is going on in her life, she is more vulnerable and susceptible to taking
these emergencies personally and feeling helpless about them. The more
pervasive the pessimistic thought patterns-that is, if they dominate
60 percent of her thoughts rather than 20 percent-the more effective
the trigger will be in setting off the eating disorder.
Certainly there are extremes-true dysfunctional families,
and that dysfunction can act as a trigger for eating disorders. It is
essential that such families come to terms with the dysfunction and
seek appropriate therapy to address it. Although I believe that an individual
whose CNC has been reversed will not respond to the same trigger-divorce,
depression, or other trauma-by relapsing into an eating disorder, the
trigger is nonetheless a potent source of stress. For the health of
the whole family, it must be dealt with. I’ll discuss this further in
Chapter 7.
However, not every family that raises its voice one
in a while is dysfunctional. Conversely, an eating disorder will be
highly distressing to any family system. A cohesive and healthy family
unit can be pushed to self-destruction by the very threats and misguided
suspicions we have talked about.
I have found that many parents of eating disorder
victims, like most parents, are possibly overanxious, but that anxiety
is shaped and even inadvertently encouraged by society. Parents may
rush to the doctor for every little thing; they may use a pill for every
perceived problem. Is this about the child or about the "anxiety of
prevention"? Certainly, parents generally come from a place of good
intentions.
Because of this, I feel it is imperative to let go
of blame. Often parents live with guilt for feeling that they have somehow
contributed to and are responsible for the way their children behave.
Parents are moved to shame because they have been labeled-rightly or
wrongly-dysfunctional and feel they are the objects of a witch-hunt.
This serves to create more agitation, stress, and negativity within
an already tormented family.
These parents spend untold hours denouncing themselves
for their human inadequacies while simultaneously living in the war
zone of their sick children's lives. They try to carry on their jobs
and lives while entertaining a nightmare within the walls of their homes,
a nightmare that they are too often told is their faults and inadvertently
their doing. Their most important focus, their child, is at risk of
dying. Parents stand helpless in the apparent hopelessness of their
situation.
In the long run, placing the blame on parents-even
if they are "guilty" of creating triggers for eating disorders-can be
detrimental and dangerous to their child. It may prevent them from being
available to her when they are most essential as her basic support system.
Their energies will be diverted to searching for their error in "causing"
their child's condition and possible death. Their guilt will rob them
of the strength to stand firm to reverse the Negative Mind, and so they
may give in to what they assume are their child's needs when they are
actually giving in to the condition's demands.
TOP
"Anorexia is the consequence of perfectionistic
people failing in their desire to be perfect."
Perfectionism for an individual with an eating disorder
is about appeasing society and placating its expectations. One child
wrote in her journal, "I don’t feel confident with myself as a person,
so I feel I have to try to conform to society's pressure to meet the
expectations it places on people's acceptance based on their appearance.
Why does a child need to be perfect? Perhaps she does
because we, as a society, have told her that she can be, and
because she feels she therefore must be. But there is a great
difference between seeking to perfect oneself for self-satisfaction
or the accolades of family or society-behavior that we would probably
label as "normal"-and the victim's attempt at perfection in order to
make society, as a whole, a better place for all. A tall order, indeed!
TOP
"Anorexia is caused by low self-esteem."
When Nicole was still ill, an old friend told her
that she was conceited because she was always looking in the mirror.
"doesn't she understand? It isn't about that, Mom," she said tearfully.
"I was looking to find myself. I was hunting for me."
It makes little sense to talk of self-esteem in the
same breath as anorexia. As I have explained in the previous chapter,
anorexia is a condition based on the lack of a fully defined self. To
recover from anorexia, the victim must first develop a self before she
can address her self-esteem.
I become concerned when I hear about people struggling
to build an acutely ill patient's self-esteem, because that person has
no clear sense of self to which to attribute the esteem. This makes
the victim feel more worthless, and the parent and loved one more guilty.
Esteem will naturally begin to develop after the self
has begun to emerge.
TOP
"Anorexia is the result of trauma from the pain
of parents’ divorce, adolescence, or other life crises."
In the case of my own divorce, it is natural to wonder
whether tensions in the household before the breakup or the stress of
the breakup itself were what tipped my daughters toward anorexia. Kirsten,
Nicole, and I have discussed this at great length and do not believe
these issues were the trigger for their eating disorders. My former
husband and I did not have a turbulent relationship; it just gradually
became apparent to us that we wanted different things out of the marriage.
We did not have an acrimonious split-up; it was a long time coming and
the girls knew and were in agreement with it. (It was our friends and
neighbors who were surprised.) I've been asked if undercurrents of tension
rather than overt drama might have pushed my daughters over the edge.
If so, why were they well all during the years when my husband and I
were living on parallel tracks yet under the same roof, and only became
ill when I moved out on my own? Surely one's parents splitting up-even
if my daughters acknowledged that it made everyone happier-must be traumatic;
how could a family's dissolution not be negative? Yet Kirsten and Nikki
tell me they didn't see it that way. In retrospect, it is clear to us
that the trigger for their illness was not my divorce but their anxiety
and hypersensitive reaction to my struggles as a single parent trying
to earn a degree and raise two children on her own. In typical CNC fashion,
they were worrying not about themselves, but about my well-being. My
struggles became their burden, Although I wasn’t aware of it at the
time.
Of course, every divorce is unique because every marriage
and family is unique, and I do believe there are children who feel traumatized
by their parents’ breakup. However, it has been my experience that in
these cases, it is not the particulars of the divorce itself, but the
manner in which the CNC-disposed child takes the blame and burdens upon
herself that triggers the eating disorder. This can happen even in the
most civil divorces. A divorce represents a failed marriage, and the
person with CNC will inevitably see herself as responsible for the failure-or
as a failure for not being able to prevent it.
It is true that the majority of eating disorders begin
during adolescence. What is unique about adolescence today? Teenagers
live in a more anxious society. The person with an eating disorder takes
on the role of the caregiver and nurturer. She has to decide many things
about her future at a much earlier age. Society's message is anxiety
and fear and despair.
Parents are busy trying to accommodate their child's
individuality. Given the psychological onus that society places on evaluating
the self, parents are perhaps less inclined to make a defined stance
on what direction to push their child. Thus the child feels she is sinking
in quicksand at the very time she needs direction. She cannot find a
platform from which to spring.
I believe that generally today's parents turn the
responsibility for decisions-"What would you like, dear?"-over to children
too early. Fewer rules, less structure, less black and white. Perhaps
parents are loath to appear directive of their child's potential because
in contemporary society people are generally less sure of their environment
and therefore their role in it. Maybe it is out of a misled "respect"
for the child with CNC, given that we are so afraid of harming her integrity
as an individual, that we do not create enough structure for her when
she needs it early in life.
TOP
"Anorexia is a disease of the ‘economically advantaged.’
"
Eating disorders have often been said to be the province
of middle or upper socioeconomic classes. That may generally be true,
but it is also understandable. Today there is less physical stress in
living in middle- and upper-class households, but in my observation
more emotional stress and more anxiety that sensitive children are bound
to absorb. Perhaps parents in these circumstances are more rushed and
anxious in maintaining their lifestyles. This may result in more perceived
stress, which children turn translate as anxiety.
Perhaps a child's internal interpretation of her parents’
achievements creates in her the expectation that she must live up to
their "standards," even though this does not come from parental edicts.
She has constructed these "standards" herself. The middle- and upper-income
child may shoulder more responsibility; not because her parents ask
her to, but because she takes it upon herself to fulfill what she perceives
as their high aspirations.
I believe that middle- or upper-income children have
more choices than their lower-income counterparts. Their parents' lives
are not clearly cut-and-dried as other people's may be, and for sensitive
children, the proliferation of choices and expectations, real or perceived,
may be overwhelming. Lower-income children seem intuit their limitations-or
have them forced upon them-and harbor fewer illusions about their reality.
For such a child, the platform to build her identity may not be complicated
with the confusion of the parents’ search for meaning and society's
pressure of expectation. The existence of boundaries, whether desirable
or not, at least provides a form of stability. Perhaps, too, children
in lower socioeconomic circumstances enjoy the benefits of a larger
extended family. Grandparents, uncles, and aunts may share the chore
of nurturing, and as I mentioned earlier, the more adults participate
in a child's growth, the more likely the child will grasp objective
reality.
Nevertheless, in my practice, I see eating disorders
in all socioeconomic groups. I think it continues to be more prevalent
in the upper and middle classes, but I know there is no clear "class"
line anymore.
TOP
"Anorexia is a psychosomatic disorder caused
by a child's refusal to grow up into an adult."
A common misinterpretation is that anorexics are struggling
to remain childlike. As purported victims of the Peter Pan syndrome,
they are thought to fear and loathe adulthood. But our case histories
show again and again that the fear of growing up may be a consequence
of the eating disorder, but it is not a cause.
Before manifesting the condition, these young people
had extraordinary capability for self-direction and social responsibility.
Depending on their age, they excelled in every area. Far from reneging
on adult responsibility, they shouldered too much of it to adhere to
society's extended values. They appeared compliant for fear of offending
others. Their primary focus was always for the well-being of others
rather than themselves.
But by being the "caregiver" and "parent" in their
own minds, CNC victims have already tried to grow up before their time.
They have taken on mature responsibilities long before they acquired
the adult objectivity or reasoning to recognize their own limitations,
and naturally they were not up on the task.
The world is large and daunting. CNC-predisposed children
have tried to make it all right for everyone and they have failed miserably
in their own eyes. It is not that they do not want to grow up, it is
that they do not know how. They have had responsibility and failed at
it. One young girl wrote to me, as so many others do, "I don’t want
to die, but I don’t know how to want to live."
Saying that a child "refuses to grow up" implies that
she is reneging on her obligation. The fact is, she is an altruistic
soul, the true caregiver who believes she has already tried to grow
up and failed. Her perceived monumental failure overwhelms her with
the realization that she has been unable to make the world a better
place for everyone else.
In Gunter Grass's classic novel The Tin Drum,
the protagonist, Oskar, gets smaller and smaller and smaller inside
himself because he has no sense of self. Just like the anorexic, he
gains his sense of self vicariously by being a guardian angel to an
adult. When the angel fails, he does not blame the adult for ignoring
his instruction; he blames himself as the poor guidance counselor.
Children are also said to become anorexic because
they do not want to become sexual beings. Sexuality implies not just
maturity but pleasure. Just as the punishing Negative Mind will not
allow its victims food, so will it deny them any other form of pleasure
as well.
Sexual maturity is also synonymous with graduating
to being normal. In their minds, anorexics believe they do not deserve
that privilege because they have already "tried" adulthood and failed.
Avoiding sexual maturity (or any act of normalcy) is a way of relieving
themselves of the guilt they experience for failing to help the world.
It is not fear of sex per se, but rather fear of further failure at
responsibility and the guilt that new failures would engender. Menstruation,
and indication of physiological normalcy, is not a welcome rite of passage
for these victims.
The individual in the acute grip of an eating disorder
is therefore asexual. I have received many letters from women who have
managed to marry and even have children while wrestling with an eating
disorder. They are maintaining their condition and their relapses suggest
that while they have subdued the inner turmoil temporarily, they are
not truly inhabiting their sexual selves.
TOP
"Anorexia is an unconscious attention-getting
device, a cry for help."
Anorexics are highly embarrassed at being noticed.
They typically wear baggy clothing to disguise their weight loss.
There is, however, a contradiction here. Victims of
CNC yearn for someone to understand them, but their Negative Mind will
not allow them to ask for help, and they do not feel they deserve it
anyway. If weight loss is the unconscious cry for attention, why don’t
victims stop losing weight once parents and other loved ones try to
intervene, often with valiant efforts? It is because their unconscious
motive is to die, not to get attention. If there were a way to die of
anorexia without losing weight-a visible sign-they would do it.
My patients tell me, "I have to die in a way that
won’t hurt people." It's not that they want to die; it's that they feel
they can no longer exist because they are failures in their own minds.
TOP
"People with eating disorders are selfish. They
just need to get on with their lives and stop ruining everyone else's!"
As I hope I've made abundantly clear, eating disorder
victims are the antithesis of selfish. Indeed, they are selfless
to the highest degree. Unfortunately, the Negative Mind constantly accuses
them of self-indulgence when they want merely to exist in the world,
so any allegation of selfishness from external sources such as family
or medical professionals simply reinforces and strengthens the Negative
Mind's hand.
The mother of three children in England contacted
me about her fifteen-year old daughter who was dying of anorexia. Gabrielle
had had the illness for a year and a half, and during that time had
been hospitalized eight times. "The doctors told her she was a spoiled
brat," this distraught mother complained to me. "They said , ‘All Gabby
needs is a good kick in the bottom.’ "
This response to an eating disorder reminds me of
how people used to regard depression. We once believed that depressed
people could just "snap out of it" if they tried hard enough. And somehow
we are still of the opinion that if victims of eating disorders cared
enough (about their parents’ or other loved ones’ anguish?), they could
will themselves to get better. Nothing could be further from the truth.
Indeed, the problems began because these "old souls" cared too much
and they need help to find a way out of the miasma that traps them.
TOP
"Anorexia is a tool for control."
The misconception is that by denying themselves food
in the face of the vigorous encouragement to eat, anorexics are trying
to control their world against others. Rather than control others, I
believe victims are trying to control the remaining bit of their Actual
Mind against the Negative Mind. They are losing power because the Negative
Mind bullies the Actual Mind into submission.
If we ignore the existence or misunderstand the role
of the Negative Mind, it can only follow that we will misconstrue whom
the child is trying to control. The Actual Mind always takes the rap
for the Negative Mind, since the latter is so carefully hidden from
our view. Consequently, the child will understandably be mislabeled
as controlling.
As the Negative Mind gains in strength, it creates
internal chaos.
"On the outside, I still look like I am in control
and so together, but on the inside I have nothing."
"I have been in turmoil. I’m so completely without
direction."
"I feel myself completely shattered and I'm so afraid."
"Emotions control my food. The life that I can’t control,
controls my food."
"There is always that fear of criticism, ridicule,
being scolded, losing a job, losing a friend, or failing. I’m always
afraid when asked to do a job, or left with the decision of what to
make for dinner that I’ll do it wrong and thus be rejected."
Controlling behaviors can be seen as a child's attempt
to create a structure for herself. Indeed, at the clinic I give a mug
and a plate with an individual design to each patient who comes to us.
This seems like a small gesture, but it's an important one. The unique
mug and plate are hers alone-part of the interim structure she so desperately
needs. Until that point, she is searching for any level of structure
in her habits, food, and being.
The anorexic's habit of preparing food for others
while refusing to eat it herself is commonly misinterpreted as a need
to control her environment. Again, understanding the motivation behind
the actions is useful.
This behavior demonstrates the Negative Mind's domination
of the Actual Mind. Victims stand near food; they spend time focusing
on it because they are desperate to be allowed it. They consciously
deny themselves but subconsciously desire food because they are physiologically
starving. So they eat vicariously by preparing food for others, they
also demonstrate their own unworthiness to be normal human being. In
fact, many children will adulterate their food with hot sauce, vinegar,
or even chlorine cleanser to make it unfit for human consumption and
only worthy of them, the unworthy.
According to DSM-IV, in the anorexic, "weight loss
is viewed as an impressive achievement and a sign of extraordinary self-discipline,
whereas weight gain is perceived as an unacceptable failure of self
control."
For normal dieters, weight loss may be considered
a bona fide achievement, for those with eating disorders, weight loss
is the antithesis of achievement, despite what the victims consciously
believe. Weight loss is the unconscious acceptance of failure, and acknowledgment
or resignation that the anorexic is giving up the right to live. The
only "impressive achievement" is that she has proven to herself that
she is indeed unworthy of life. She is controlling herself to death.
The stereotype is that these children want to control
everything, but in fact they want to serve everyone and ensure the well-being
of the planet. They see themselves as "trouble-shooters" and are ever
on the alert for problems to solve.
It is contradictory to be both pliable, as a common
stereotype foes, and also controlling, as another common stereotype
goes. It is contradictory to be both a good caregiver and listener-which
implies an adult sensibility-AND someone who does not want to take responsibility
for her controlling actions.
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"Anorexics are to blame for their situation.
They’re doing it to get back at others."
Given that the dynamics of an eating disorder occur
at an unconscious level and are as perplexing and complicating for its
victims as they are for their families, the view that anorexics are
intentionally guilty of hurting their beloved parents just adds to the
nightmare of their existence.
When unwitting practitioners blame parents for their
children's anorexia by insisting that anorexia results from favoritism,
abuse, or some other symptom of family dysfunction, they often create
animosity among parents toward their children, and the victims end up
as losers. After such finger-pointing, parents often ask victims, "Why
have you done this to us? How could you continue to be so cruel?"
The victim will cope more easily if a therapist tries
to teach her with compassion and intelligence that everyone is imperfect.
And so it is healthier for all involved to translate "blame" into "limitations."
The individual stops hunting for wrongdoers.
The very word "victim" implies helplessness at the
hands of another. In this case, the victimization is neither by the
inadvertent ignorance and unawareness of society nor of any given individual.
Eating disorders are an exceedingly negative response to a misinterpretation
of one's role in the world. The victimization occurs in the negative
construct the patient has unwittingly built against herself. She becomes
helpless against the onslaught of the Negative Mind within her.
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"Sufferers need to hold on to their condition
as a crutch."
I have often heard it described that victims of eating
disorders are in some perverse way clinging to the crutch of their illness.
It is more accurate to say that they are dominated and enslaved by it.
They want to let go of it, but they have nothing to replace it with.
As Carrie wrote in her journal, "One reason I've held on to anorexia
for so long is probably because every time I feel a bit stronger or
happier, I worry and immediately retreat. It's because I feel guilty
for feeling good..."
Ultimately, victims are terrified to relinquish the
condition because they know no other way of being. For example, Sharon
wrote to me, "I basically have resolved to accept my life as an eating
disorder. It's the only thing no one has ever been able to take away
from me."
Therefore to give up the condition is to cease to
exist-even worse than death. Anorexia becomes a negative structure-
"Who am I if not my illness?"-and an all-pervasive way of being.
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"The longer you have anorexia, the
harder it is to cure."
On occasion, this may be true because the condition
has been confirmed repeatedly, possibly due to so many futile hospitalizations.
With each failed program, the Negative Mind reconfirms itself and becomes
more pernicious. Similarly, the longer the Actual Mind has learned to
exist marginally and the longer it feels the negative comfort of that
existence, the more difficult an eating disorder is to cure.
However, I have found that it is just as difficult
to cure anorexia in people who have had it for a short time as it is
to cure those who have been ill for years. Once the Negative Mind has
enough control to manifest an eating disorder, healing appears to depend
more on the basic personality of the individual than on the duration
of the eating disorder manifestation.
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"Anorexia can't be cured; it can only be managed.
You’ll live with it and die from it."
Eating disorders are a silent epidemic. Anorexics have
no constituency. They cannot rise up en masse to say, "We need help."
You do not see them banding together to form research societies and
associations, although others have formed these organizations on their
behalf. Nevertheless, these conditions are completely reversible, though
the cure requires a total renurturing of the afflicted individual.
However, to "manage anorexia" is merely to maintain
the condition's status. To maintain it is to invite recidivism. In order
to correct the eating disorder symptom, the CNC must be addressed and
reversed. This reversal requires patience, complete understanding and
as much time as each individual needs.
How can we integrate this concept into society as
it exists today? How, given the vast tragedy we see before us, can we
not.
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