Because this blog is relatively new - in that I’ve thrown out a few previous incarnations and keep wanting to start over (perfectionist? me? nah, I got over that - yeah, right) - despite my own struggles in the past and the ongoing eating disordered thoughts that creep in on me, I want to be sure that while I’m writing, I’m being unbiased. Of course, that’s not entirely true - any time someone writes about something that has meaning for them, there’s going to be a bias - but, because I am also a writer I know that research has its place.
So I’ve been looking at random sites around the web to see what other people have to say. Some of it makes sense, some of it I agree with. But there are also things here and there that just don’t quite do it for me. Take the following as an example:
(source)Eating disorders are clearly complex, affecting the individual on many levels—physical, emotional, interpersonal, and spiritual. Emotional, relational, biological, and societal factors all play a part in the etiology of an eating disorder. Though complicated, eating disorders are nevertheless treatable, requiring a comprehensive approach that takes the whole person into account.
The treatment of choice for eating disorders involves a team approach. The patient’s medical stability and safety are essential in order for outpatient therapy to proceed. Collaboration with the primary care physician is central given the medical complications that can accompany an eating disorder. Nutritional counseling, group treatment, medication evaluation and management can also be highly beneficial. At times, hospitalization or residential treatment is necessary. A thorough assessment at the outset will help tailor the therapy to the specific needs of the individual.
So far, I’m with the writer (a licensed clinical social worker). When I was struggling with anorexia and self-injury and purging and generally not taking care of myself at all, I wasn’t well on any level. I was a nihilist - I didn’t have the energy to believe in anything and other circumstances made me particularly uncomfortable with organized religion. My relationships all suffered: how can you be close to anyone when you don’t believe that you deserve to be cared about and when you’re lying to others because you’re so blind to your own situation that you don’t know what’s true anymore? Emotionally I was wreck and, after heart issues and frequent trips to the emergency room for dehydration and other problems, it’s fair to say that I wasn’t physically well either.
My situation when I was at my sickest is not going to be the same as that of anyone else so a lot of the specifics aren’t important. Do I agree that it’s important to have a team? Yes - I think that as long as communication is clear and everyone is on the same page a team approach is important, but when the ‘patient’ starts playing one party against another. . . well, I guess that’s where we start to have opinions that take different turns. Medication can help, but it’s not right for everyone. Hospitalization may be necessary, but it too can cause other situations to arise that may not be beneficial to the individual especially if the in patient care is provided in a generalized psychiatric unit rather than an eating disorder treatment facility.
You may be able to tell that I’ve got an opinion here and that it’s not quite the same as the other writer’s. She goes on (in the same article) to say:
Overall, individual psychotherapy for eating disorders uses a combination of cognitive-behavioral strategies and psychodynamic exploration to address behaviors and reduce symptoms and to examine underlying conflicts and issues, including the feelings that fuel the disorder. Concrete behavioral interventions may include keeping a log of eating and emotions, journaling, and identifying positive coping strategies to replace problematic behaviors. Therapy may also focus on modifying problematic patterns of thought that produce a distorted view of the self and the body and that lead to chaotic or restrictive eating behaviors. Psychodynamic exploration helps to address inner conflicts that fuel feelings of inadequacy and self-loathing, and attends to troubled interpersonal relationships that are often at the heart of the eating disorder. Psychoeducation and skill building are also important components of treatment. Throughout, it is important to keep in mind that eating disorders are not actually about food, but rather about the feelings that food is used to help regulate and manage, and they are not just about body image or external appearance, but rather about how the individual experiences and feels about him/her self on the inside. As self-esteem and self-efficacy improve, as relationships become more connected and satisfying, and as feelings become more manageable, food is more likely to find its place as a source of energy, sustenance, and pleasure, and the body is less likely to be used as the arena upon which internal and interpersonal conflicts are played out.
Keeping a log of my own emotions never really worked for me; neither did keeping a food journal - something that sometimes would lead me to further restricting and other times led to my making stuff up and entering meals that I hadn’t really consumed. At that time, my entire life was chaos; setting that aside would have been a lot like sending me to another planet - it wouldn’t have worked.
So here’s the thing - here’s my basic point: what I know about eating disorder treatment and recovery is that, while there may be a standard course of action, it’s not one sized fits all; I’m not even sure that it can be viewed as one size fits most.
Still, I do think that it’s important that counselors, social workers, therapists and doctors are able to look at the situation as something bigger than it may appear to be. And that’s why I value the writer’s opinion enough to include it, even if I don’t necessarily agree.
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