Eating disorders are the deadliest of mental illnesses and not expressions of vanity or desire for thinness gone too far.
Eating disorders are the deadliest of mental illnesses and not expressions of vanity or desire for thinness gone too far. Unfortunately, this is what those with anorexia, anorexia bulimia and bulimia are vulnerable to being socially dismissed, summarised, generalised or judged as; victims of society and media obsessed with valuing, promoting and admiring thin bodies. Equally inappropriate assumptions such as lacking in willpower, self-control and discipline are commonly associated with those who compulsively binge eat. Such reductive and misleading misconceptions preserve ignorance, unease and estrangement to those with a profoundly nuanced, complex and potentially fatal illness also referred to as an addiction by sufferers and mental health professionals.
Addictions are born, consolidated and maintained by a core fear state that is unbearable in those who do not have the ability or awareness of how to return themselves to a homeostatic state of calmness in a healthy way. Consequently, such individuals maladaptively regulate feelings of unbearable anxiety via strategies such as substance abuse, compulsive cutting, unsafe sex, gambling, shopping… Each of these compulsive behaviours involves the individual being ruled by the need to act on these destructive impulses to achieve a temporarily calming euphoric or dissociative state which is what the individual is addicted to and perpetually chases.
Individuals with eating disorders are preoccupied with food, the body and harmful consumption and purging rituals that use these forms, image system and behaviour to speak a story of pain, insecurity and fear that can’t be consciously told or known. This is why treating the food and body with a nutritionally sufficient eating plan and being determined not to purge, or over-exercise doesn’t work without addressing the underlying story and deactivating the forms, image system and behaviour the individual will otherwise be compelled to return to as soon as possible.
Those with disordered eating manipulate and punish their body to an extreme.
Those with disordered eating manipulate and punish their body to an extreme. They use food consumption as secretive self-harming acts to punish and coerce the body and indirectly express an unbearable underlying problem/s beyond their capacity and inner resources to resolve, assert or expel. To put it simply their disordered eating is symptomatic of an intense emotional and psychological reality that they don’t know how to accept, overcome and grow beyond.
To constructively treat, address, care for, love, work and socialise with individuals suffering from an eating disorder is to approach them as the universally worthy, lovable and perfect human beings that they are. To listen respectfully and openly to the visual and behavioural story the eating disorder is symptomatically telling requires being attentive to the broader context of the person who, despite being consumed by their eating disorder, is not their eating disorder.
Without wishing to in any way detract from the specific details and unique experience each person with an eating disorder has, it must be acknowledged that each person, in essence, embodies a story being painfully lived out in reaction to a core state of fear and elusive sense of self.
For those who suffer from disordered eating, consumption becomes a ritual through which the individual self-soothes in a way that does not lovingly nourish the body. Also, an eating disorder serves more than just this role as fear (or anxiety) exists as one of many intertwined story threads. Like all tyrants and schoolyard bullies an eating disorder is not the disordered eater’s friend, sovereign protector or figure of benevolence the sufferer craves but the trickster, sadist and oppressor that is able to dominate via the sufferer’s pre-existing self-hatred or self-rejection. Without significant chinks, in the individual’s formative development an eating disorder simply can’t thrive. It needs an individual to have notions of either unworthiness, inadequacy, badness, wrongness, insecurity, instability, helplessness and/or belief that they are unlovable to take root.
The vulnerable psyche reacts to tyrants with disproportionate fear
The fragile mind responds to tyrants, perpetrators and bullies like all oppressive and abusive forces by superimposing the figure with the larger-than-life fear that is evoked. Consequently, the tormentor is inflated by the psyche (that has regressed to a childlike state) into that of an all-powerful monster.
In the case of those suffering from an eating disorder, they have internalised the negative figure which as already explained has expanded to monstrous proportion. An internal splitting or fragmentation has occurred where the monstrous part has turned against the vulnerable aspects of the self. Like tyrants, perpetrators and bullies, the internal oppression from an eating disorder is not the all-powerful abuser it is experienced as. Once deflated and all that hot and contemptuous air subsists, what remains is nothing more than a fragile and upset child desperate for love, reassurance, warmth and care. The perceived monster can only survive appearing as the all-powerful oppressor if the sufferer continues investing in and perpetuating the illusion responsible for the distorted experience of themselves, food, others and the world.
How then do those suffering from an eating disorder question the reality they experience as real and lose the tunnel vision required for the illness to thrive? Firstly, they need to learn to see differently like the fiction writer needs to consider the same event from each character’s perspective (see worksheet The Work) which asks one to vigorously interrogate whether what we assume to be true is in fact the case and what it would mean if our core convictions were indeed false.
Eating disorders have their sufferers hooked by promises that can’t be kept.
Eating disorders have their sufferers hooked by promises that can’t be kept. An eating disorder can’t make a sufferer feel grounded, happy, loved, fulfilled, at peace, free, safe, confident, valued, seen, highly regarded, admired or respected no matter how much they starve, exercise, purge, binge or restrict. An individual can only cultivate these feeling states deep within themselves, independent of external factors and then accept nothing less from those around them.
For example, They respond positively to and engage with, those that treat them the way they favourably regard themselves rather than behave towards and perceive themselves in the way others negatively react to them. To be clear these individuals practice confidence, self-protection and assertion by no longer giving their time, attention or thought to devalue reception and actively seek out environments and company that values them in the way they have come to value themselves.
The eating disorder is a false god who sufferers give all their power and potential too.
The eating disorder is a false god who sufferers give all their power and potential too. The eating disorder itself can only really ever induce a faux calm that requires an ever-increasing intensification of disordered eating behaviour to maintain these brief moments of mental stillness and physical serenity. Like an out of control ego, an eating disorder will convince its host that life without bulimia, anorexia, anorexia bulimia or binge eating isn’t an option, but it is always the contrary.
An eating disorder can’t exist without a host, but a host can always live without an eating disorder. Those with an eating disorder are never born with one and despite how it might feel they can live and die after having enjoyed a full life without one. To be clear, an individual can be born with a genetic predisposition to later developing an eating disorder, but this does not necessarily mean they will experience one in their lifetime as factors such as familial, social and cultural environment plus personality are also contributing factors. This is why four children with the same parents, gender, growing up in the same house, attending the same school may have one child who suffers from disordered eating despite all four having an equal genetic predisposition to it.
Although recovery is 100% possible, this is always so much easier to recognise from an objective perspective. The individual experiencing addiction can’t always see the forest for the trees and overcoming their eating disorder may not seem an option. While this feeling or conviction is more than understandable considering what it is hour by hour, day by day to struggle to overcome disordered eating, it must nonetheless always be reinforced that despite their belief and current despair recovery is possible.
Regardless of how badly an individual with an eating disorder might appear to be faring it is essential to understand, acknowledge and respect that they are always doing the best that they can to survive how afraid, disempowered, and/or wrong they feel. However, this coping strategy is killing them from the inside out and must be replaced with a practical and life-serving set of strategies to manage fear and reverse negative schema, core beliefs and self-regard.
Reasons why eating disorders are so hard to treat and overcome:
- Eating disorders are rarely immediately detected, acted upon or managed so once they are sufferers have typically lived with, adapted to and refined their hypervigilant adherence to the all-consuming rules and regulations either anorexia, bulimia, binge-eating, or EDNOS (eating disorders otherwise specified) come with. An eating disorder affects all aspects of life to the extent that it becomes a way of life, so treatment involves changing the way those with an eating disorder live, behave and perceive themselves, food, others and the world. It also means acknowledging the complex psychic and emotional damage that has been done and adapted to which in addition to re-feeding requires unpacking, undoing and restructuring emotional and cognitive processing from individuals that are depleted, exhausted and mentally consumed by their eating disorder.
- For those with anorexia, bulimia anorexia and sometimes bulimia, often initial weight loss is met with praise and admiration because sufferers are still within their healthy weight range and appear healthy. Detection is further prolonged in cases where weight loss is followed by weight gain as the disorder evolves into binging or bulimia and then lost again by restricting or restricting and purging only to start the cycle once more.
- Those with an eating disorder don’t necessarily admit it to themselves or anyone else, but on some level, recognition of their problem is taking place because they go to extreme lengths to hide its detection from others. Even once individuals become aware that they are in trouble they don’t necessarily want treatment despite desiring help. Especially those with anorexia or bulimia, because treatment involves weight gain (this is not always so for bulimia); the discomfort of digestion; being given ‘unsafe’ foods and being put in the care of others who are a threat to their disordered eating ways which can be the only thing these individuals believe they still have. Life without an eating disorder, when those suffering from one are in deep, seems terrifying because sufferers simply don’t know or can’t envision life without what is core to their daily life.
- Families and loved ones can be inclined to avoid addressing how serious the problem is because they don’t know how or what to do about it.
- Because it can take years before the body reflects how internally (emotionally, physically and psychologically) sick the individual is, twenty sessions of CBT (cognitive behaviour therapy) for disordered eating doesn’t always result in the long-term recovery it aspires to. It is understandable that a person with an eating disorder might need longer to sort through and unpack, understand and rewrite their story with food and the body. Formative experiences that have resulted in a negative schema; core beliefs; impaired interpersonal skills; negative self-regard, worldview; lack of purpose, motivation and confidence; a sense of self-value, capacity and a vision for a future that is desirable and feels attainable.
- To get the person with an eating disorder the kind of treatment they need for the length they need is not a financially viable an option for many. For example, the cost of In-Patient (IP) and Out Patient (OP) treatment programs for those who qualify but can’t afford it or aren’t covered by insurance eliminates it as a possibility. Or they may not be eligible according to the criteria.
- The Australian government offers subsidisation for up to ten individual sessions with a mental health professional per year which is not always enough. A ten week CBT treatment program for those with eating disorders has been devised to accommodate this government supported payment structure, but we are yet to know if its potential positive outcomes are lasting.
- There are affordable facilitated eating disorder groups, online forums, treatment programs and helpline services which require those suffering from disordered eating to make it their responsibility to reach out and connect at the pace and regularity they need at any given time.
- Recovery is hard, unpleasant and uncomfortable regardless of the type of eating disorder being overcome. Sufficient treatment is necessary, potentially very costly and not always easily and readily accessible. It’s also difficult to know precisely what set of variables and approaches will work for each individual. Nonetheless, an adequate support network, environment and sense of financial security and independence are as essential as establishing a sense of confidence and ability to assert oneself and know their own capacity to achieve their goals. Treatment has multiple factors that need to be brought into play for individuals to have a chance at long-term recovery but more than anything these individuals must take responsibility to their recovery, commit to it and do the work, that simply can’t be done for them.
Included among these options and in collaboration with them could be participating in an ongoing creative writing practice through a facilitated fiction writing group that is specifically intended for people with eating disorders or one on one mentoring. This is one way — as part of a holistic therapeutic approach — to help individuals with an eating disorder work safely, playfully and with authority on reconfiguring negative schema; core beliefs; interpersonal skills; self-regard; worldview; purpose; value and a vision for a future that is desirable and feels attainable.
- The story is about to change from processing emotional experience and obstacles that must be gone through to fully embody that transformation and growth.
- Writing story is a practice through which to cognitively, emotionally and physically experience and engage with a change towards the positive. It involves a physical means of processing thought and emotion via the physical act of writing as well as while walking, stretching, bathing and moving away from the computer screen, voice recorder or pen and paper to creatively and kinesthetically work through story problems.
- Individuals with an eating disorder who embark on writing fiction will have to consider events and scenes from multiple perspectives to understand how and why each character reacts and behaves the way that they do. This helps individuals with an eating disorder develop the capacity to see situations through the point of view of others and how toxic exchanges and dynamics play out.
- To write one must read, listen, take note, observe and research life and human nature which means this story writing strategy invites individuals with an eating disorder to get out of their own head and negative self-preoccupation to learn about their condition and other ways of living at their own pace. To address all aspects of the story, they are writing they can explore their particular interests. For example, a person with an eating disorder may have a passion for music and make their protagonist a musician.
- Learning to work with words in story develops individuals with eating disorders’ capacity to put words to their experience and potentially cultivate a capacity to verbally assert themselves with efficacy in future daily life.
- The protagonist of a story must be active, not passive otherwise there is no story because nothing happens. Eating disorders are a passive or submissive condition in that one either starve, purges, or compulsively eats to stuff down their unmet needs, wants, desires, feelings and thoughts. It’s also passive in the sense that you are internalising what is wrong with your circumstances instead of actively seeking to change things, speak up and acknowledge that what is wrong is external to you. And therefore, not in your control to stop. The act of writing a story with a protagonist who takes action gives them a mediated experience of practising assertive behaviour.
- Writing a way through disordered eating involves a process of understanding, observing, imagining and creating exactly how this could take place and perhaps be applied to their own recovery journey. In fiction, it’s possible to engage with what needs to happen, be understood and accepted for the desired change to occur.
- Writing a story is about making choices and therefore exercises conscious decision-making skills that can then be effectively employed in their own life.
For individuals to write about a protagonist overcoming eating disorders in a way that they want to recover from their own invites them to metaphorically, creatively and emotionally engage with and process their story to date. Where they want to take it in the future and what needs to happen to do so from the safe distance fiction provides. They also get to step out of their head and tunnel-visioned perspective while at the same time explore and engage with the essence of who they are.
Furthermore, the power and possibility afforded them in fiction writing is that it puts them in control of how the story they want to tell unfolds. This is of incredible transformative potential and self-empowerment because a person with an eating disorder has no control over their addiction. Which is so often the consequence of self-sabotaging ways to cope with all the intolerable variables in their life that are or feel out of their control. Because for whatever reasons they have been unable to be the one making important life choices according to what has meaning, value and feels true to them regardless of what society, family, friends, peers, and work culture encourages, needs, wants or expects. They need to stop using disordered eating as compensation and distraction from getting what they want and need and from being who they are.
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Dr Angelina Mirabito