"You just don't want to get better. Why don't you want to get better?"

My therapist (pretty much all of 'em before about 2006) was annoyed with me. I was going to therapy, talking, working on my "issues," and still I wasn't getting any better. I was still batty, still underweight or losing weight, still restricting or purging. I saw a therapist, psychiatrist, dietician, and internist as needed. I was doing everything I was "supposed" to.

And still I was sick. I had all of the proper treatments, with all of the experts, and I was still sick. I certainly blamed myself for my illness (and still sort of do). So why shouldn't my treatment team? It had to have been my fault...right?

Turns out many doctors and psychologists think that way. After all, they're human, too.

Writes Richard Friedman:

[A therapist] had been working with [a man with clinical depression] for nearly three years without significant progress, and she was now doing what many clinicians do when the chips are down: blame the patient for failing to improve.

“I think he has an unconscious desire to remain sick,” she told me.

About a month later, I saw this patient respond remarkably well to a novel treatment. Free of depression at last, he was joyful and relieved — an odd reaction, you must admit, from someone who secretly wished to be ill.

When Friedman questioned the man about the differences between his current state and his depressed state, the man responded "I guess I just think like that when I'm down."

The negative, pessimistic thinking was a result of the depression, not necessarily its cause (at least not totally). So the therapist was, essentially, colluding with this man's illness by saying he didn't want to get better.

And if you don't see the similarities with eating disorders by now, please go snort some espresso grounds and come back once the spots clear from your eyes.

Of course, EDs are a little different. Anorexia in particular is egosyntonic- that is, the sufferer doesn't mind the illness. Furthermore, anorexia tends to be anosognostic and the sufferer doesn't even think they're ill to begin with. Which makes blaming the patient all that much more ironic. How can someone "want" to stay ill if they don't think there's much of a problem in the first place? And what's more, even when illness is recognized, the very illness makes the symptoms more palatable and denies their seriousness.

So maybe lack of progress in treatment doesn't call for blame (of the sufferer, of their parents, of carbon emissions, of this barmy election season), but rather a different approach.

You'd think they would teach this in "therapist school," but the simple matter is that therapists are all too human.

Concludes Friedman:

Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it’s easier — and less painful — to view the patient as intentionally or unconsciously resistant...

But a vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let’s keep the blame on the disease, not the patient.

It's true- even the most anosognostic anorexic* is miserable, as much as he or she may deny it. An eating disorder is such a tremendous burden that the sufferer and his or her family don't need any more heaped on top of them in the form of blame.

*Say that three times fast. It's a good test to see if the snort of espresso grounds really worked.