Reprinted from "Eating Disorders" issue of Visions Journal, 2002, No. 16, pp. 4-5
Every time I tell someone that I work for an organization doing work around disordered eating/eating disorders, they have a story to share — a story of shame, of frustration or anger, of bewilderment and loss; a rallying cry for action and changing the world; a quest for approval of actions taken; or an expression of belligerence for all who are weak.
Usually, the story will have an unrecognized thread of fat phobia and self-hatred weaving through it; and when I choose not to actively reinforce these beliefs — perhaps by asking an indirect question about the feelings that seem to accompany the story — people become uncomfortable.
They tend to expect the congenial commiseration that is the norm — praise for losing weight; anger at the villainous media that has us in its grip; support for how ‘bad’ they are for eating x, y or z; or scolding for how lazy they are for not looking after themselves.
Should I try to gently challenge this self-hatred and/or fat phobia, the reaction is almost always one of resistance. Only twice in the six years that I have been working for ANAD (Awareness and Networking Around Disordered Eating) has this not happened; and I hear these kinds of stories all the time. It doesn’t matter what the occasion — I even heard a story from my bank manager when I was negotiating a loan!
I am not complaining. I consider these exchanges as an opportunity to illuminate that which usually can’t be seen: can’t be seen because it — the self-hatred, the pain, and the disconnection from our bodies — is simply a normalized aspect of our society. Like a fish in a bowl we can or won’t see the water even though it’s everywhere.
My job at ANAD is to support environments that challenge this normalization; yet as part of this society it sometimes takes a sustained effort for even me to see what needs to be challenged and when. Thus, for me these shared stories are like a drop of violet dye in a glass of water: present, tangible and glaring, even though the dye inevitably becomes diluted again over time.
This edition of Visions is filled with a range of shared wisdom, experience and perspectives around disordered eating and eating disorders. Though there is disagreement about what causes disordered eating/eating disorders, how they should be treated or dealt with, or whether they are preventable or not, everyone in the field agrees on one thing — food is not the issue. So what is the issue? Well we haven’t yet made all of the connections needed to complete this particular puzzle, but as you read through this issue you will see we do have some significant pieces.
The causes of disordered eating/eating disorders are multifactorial, and the difficulty in teasing these factors out is compounded by the fact that many of them are currently considered normal practice in our society: dieting; body, food and weight obsession; gender roles; striving for perfection; and the relentless message driving our economy that we are not ‘good enough.’ As a society we haven’t taken collective responsibility for the impact of these beliefs, because as with most mental health issues, the problem manifests itself in individuals.
ANAD deals with this paradox by actively supporting environments that ensure that everyone gets an opportunity to truly be heard and/or to participate in creating solutions; also we strive to nurture environments that guarantee individuals the support to heal in the manner that is right for them; and finally, we support environments that challenge the normalization of fat phobia/discrimination that infects all aspects of our society. This is not an easy task, but given 20 years or so and lots of help, it’s definitely doable.
There are numerous issues currently challenging the community actively dealing with the issue of disordered eating/ eating disorders in BC. Let’s start with the conceptual framework associated with the term ‘disordered eating/eating disorders.’ We use this phrase to outline a continuum of concerns that need to be addressed, ranging from disordered eating behaviours — such as food and body preoccupation and yoyo dieting — to clinical eating disorders, which include the medical diagnosis of anorexia nervosa, bulimia nervosa and compulsive overeating. The use of the continuum concept emphasizes the socially-mediated underpinnings of the issue: but is it, in fact, a continuum? Some consider disordered eating behaviours to be preventable precursors to eating disorders, while others believe that eating disorders are genetic and therefore not preventable. A definitive answer does not exist.
Another hotly-debated issue is the consideration of whether or not any issues within the disordered eating/eating disorders spectrum should be considered mental illnesses. Some would argue no, that to label them as such medicalizes women’s lived experience (females experience 90% of disordered eating/eating disorders) and thereby undermines attempts to deal with the root cause of the issue — misogyny [societally-sanctioned hatred towards women].
Another perspective is that of families and friends who bear witness to their loved one’s inability to accept help while suffering with anorexia, bulimia or compulsive overeating, who see them going through endless cycles of recovery and relapse, who watch as they pull themselves out of their hell and start to live a productive life, only to then see them die young due to the damage that was inflicted on their bodies. To these individuals, yes, it is mental illness, a mental illness that kills.
These differing beliefs add to the complexity of our understanding of disordered eating/eating disorders. How we as a society then choose to act on these beliefs is what has a direct impact on our ability to effectively deal with prevention and treatment issues. So if we believe that eating disorders can be prevented, we must question why 95% of the available government funding goes into tertiary care. If we’re dealing with mental illness that can’t be treated through drug intervention, then we also need to question why such low priority is placed on making psychological interventions available for individuals along the continuum.
It is not pretty watching how these decisions play out for individuals trying to access appropriate health care. I can’t count the number of times individuals have called our office to say that the only help their primary health care practitioner could provide was to tell them to eat more, or conversely to eat less. These doctors aren’t uncaring, but even though there is currently systemic training to tell them that eating disorders are not about food, they just don ’t get it.
The consistent underfunding of both the tertiary and regional eating disorders programs also has a profound effect. The average regional eating disorder program is only funded for three full days a week, has a waitlist of two to three months, and usually has no ability to actively support individuals while they wait to get into the program. Our tertiary programs deal with their limited resources by admitting only the most medically compromised. In our ANAD support groups, there is always at least one individual who has been told that they are not considered sick enough to get into a tertiary program. As a consequence, these individuals make themselves sicker in order to get help. We need programs that provide support to individuals along the full continuum of care.
Currently our tertiary programs are not set up to deal with the individual who has a concurrent disorder — say alcoholism — so in order to get help with an eating disorder one cannot be drinking, or one’s eating disorder needs to be stabilized to get access to health care that deals with the alcohol problem.
Which beliefs get translated into funding allocations is a source of great concern and considerable tension for consumers, family members and health-care workers alike — though usually for different reasons! We hear a lot about using interventions that are grounded in ‘evidence-based practice.’ Yet in this field, while the medical aspect of dealing with anorexia and bulimia can be very successful, there doesn’t appear to be a unified psychosocial intervention available that ensures prevention or recovery in a significant number of individuals across populations.
BC’s tertiary eating disorders programs work for some individuals but not for others. This creates a lot of tension which has resulted in families going bankrupt to send their children out of country for treatment, and health care workers acting as gatekeepers, deciding who gets access to support and who doesn’t.
The solution? More funding? More programs? More research? That would be a good first step! Yet in order to create a lasting change we need ongoing dialogue and clarification around which beliefs fuel the funding allocations and around the philosophical underpinnings of programs relating to which areas need to be researched.
Of course, every field of inquiry needs to do this, but in the disordered eating/eating disorders field we have the added burden of being an active part of the problem, usually without knowing it. How do we systematically deconstruct the normalization of self-hatred, our disconnection from our bodies, and the fat phobia/discrimination that may inform our choices?
Systems of whatever kind — health care, social services or our current economic system — are simply a reflection of societies’ current choices. It is the societal beliefs fueling those choices that need to be changed. Where to start? Well, as you read through this issue the many contributors have offered several points of entry for you to consider and act on.
On a more subtle level, we can start by listening to the stories we share amongst our friends and family, or more importantly the ones we tell ourselves; and by learning to recognize, then question the ‘normalization’ of self-hatred, disconnection from our bodies and fat phobia/discrimination. When we all do this, I believe there will be enough drops of violet dye in the water of society to manifest a ribbon of understanding and compassion: one that doesn’t dissipate with time, and one we can all use as a catalyst for research, activism, healing, growing and living.