For the majority of the first seven years I spent in therapy for anorexia, I was told to look at "why."
- Why had I gotten sick?
- Why was I still restricting?
- Why did I have "enmeshment" issues?
- Why couldn't I move on?
- Why was I obsessed with my body?
- Why was I obsessed with obsessing?
- Why wasn't I choosing to get better?
Ed loved this. The questions, the analysis. He totally ate it up (pun intended). It was a perfect way to keep him near me. I would ponder the questions and talk and try to feel...and still I would restrict what I ate, purge, overexercise.
I wasn't choosing recovery. I wasn't trying hard enough. It was my fault. No, it was my parents' fault. If they hadn't loved me so much. If they had emoted more freely. If they hadn't been so controlling.
Now, I've come to stop asking why.
IrishUp, a mom using the Maudsley Approach, posted this on Laura Collins' blog:
Let's change the paradigm and look at it: You have a 60yo white male, who wakes up one snowy morning, digs out his car, and in that process BANG - heart attack.
Now, when he gets to the EW, and starts being evaluated, is anyone saying or even thinking that it was the snow shovelling that CAUSED the heart attack? NO, they're thinking that coronary-artery disease (CAD) CAUSED the heart attack. They know perfectly well that that snow-shovelling was the activity that started a cascade of physiological changes, which a healthy person would have easily accomodated, but in this case resulted in a disease event.
Now it's true that a variety of things contributed to developing the CAD in the first place: Genetics, age, metabolic function, lifestyle choices, life stressors, etc. But nobody waits to tease out the relative contributions of each BEFORE treating the guy. The medical team is acting immediately to restore as normal function as possible using every best medicine available. They know the longer the right therapy is delayed, the worse the long-term outcome is. Now, sorting out better lifestyle choices, etc, might be incredibly useful at some point, but medical intervention doesn't hinge on it. Effective treatment isn't withheld until the patient or family has insight as what they may done to contribute to that heart attack. Or until the patient declares "I'm going to choose to minimize my CAD".
And on the flip side - how effective can you imagine medical treatment would be if the snow-shovelling WERE taken as the problem? He'd get worked up for all the wrong things, and advice like "don't shovel, don't be active" might actually make the underlying disease worse. The poor guy would almost certainly be doomed to have another heart attack, because while his symptoms were being addressed, the CAD would be going untreated.
The trigger of a disease event is a different thing altogether from the disease process. It's a "necessary" for disease to manifest or develop, but it's not sufficient to cause disease. The meaning we find in our lives for who we are and what happens to us is surely related to those experiences, but they are not the same thing as each other. How we understand the world is subjective, and shouldn't be confused with the information we use to come to that understanding.