Narrating anorexia

A lot of discussion in the media and in therapy has to do with what "causes" eating disorders.

It's the obsession with thin.
No, with healthy eating.
Control! That's it! Control!
It's wanting to disappear.
Or could that be wanting to be seen?
Hell, it could be just about wanting to be thin.

Maybe maybe maybe. Could be all of the above. Could be none.

The cause of an eating disorder is important. Absolutely. Without understanding the root causes, it's hard to design effective treatments.

On the other hand...

A sufferer and his or her family could spend their time better fighting the illness.

A physician and anthropologist named Paul Farmer (who runs the non-profit organization Partners in Health and is one of my heroes) treats patients with TB at a clinic in Haiti. These people are the poorest of the poor, and if it weren't for his clinic, would have no other medical care. Period. The tragedies of this aside, he often has to confront people who genuinely believe they were cursed and went on to develop TB. They go to witch doctors. They do rituals.

And Farmer found that as long as people had access to antibiotics and got little rewards for taking their meds (food supplements for their families, etc), they took the pills and they got better. Some of them still believed in voodoo and curses and all of that. But Farmer's efforts to talk them out of it really weren't necessary. They took their pills, they got better, no matter how they thought they might have gotten sick.

Yet Farmer doesn't discount their experiences of being cursed. The Mycobacterium tuberculosis bacteria is a curse, in many ways. Perhaps not in the context that the patients in Haiti were thinking, but it is a curse. And you have to understand how a person experiences life. You have to narrate your own experience.

The experiences of the people in Haiti who thought they were victims of evil spirits are very real and very important. They help people make sense of an often senseless world. They provide a framework of reference. But trying to ferret a cause out of your experience may not produce anything.

I can't explain why I got sick, and I've really stopped trying to figure it out. But I'm still narrating anorexia. I'm still telling my story, hoping that someday people will better understand what this disease is like, how it feels, what treatment is like. I think an important part of therapy can be forming this narration, trying to make sense of what just happened and using it as a way to prepare for the future.

For more on Paul Farmer, check out the wonderful biography written about him by Pulitzer-Prize winner Tracy Kidder, "Mountains Beyond Mountains."

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Ai Lu said...

Wow -- I love the way you make reference to Paul Farmer and tie it in to eating disorders.

I think that the field is shifting from a psychoanalytically-oriented approach that emphasizes the "origin" of eating disorders, to one that is more behaviorally and cognitively oriented, focusing on what is happening in the here and now, and how to change things that aren't going well. While I love the practicality of the latter, on some level I know that my eating disorder was about other pain in my life, pain that had begun long before, and needed to be acknowledged before I could change my behavior. I had a poor opinion of therapists who tried to change my eating behaviors without acknowledging that there was anything behind them. For me, there WAS something there, and to say otherwise seemed to be denying the obvious (I didn't just wake up one day and decide to starve myself).

On the other hand, I know that insight was not as helpful as behavioral changes, such as replacing purging with healthier habits, in setting me on the path to recovery, and set in motion some "positive feedback loops" that made sustained recovery possible. So I'm not sure where I lie: I think that etiology can be important to some individuals when it comes to making meaning of their illness, but that isn't as universal, let's say, as the importance of behavioral change.
~Ai Lu

Lisa said...

I was lucky enough to get to hear Paul Farmer give a speech last year. I'm glad you posted about him - more people should know who he is and what he's doing.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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