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Who is Vulnerable, and When In a sense we are all vulnerable, at any time, to an eating disorder. Because rather than living in our Organismic Selves we function, to a lesser or greater degree, in our Self Concepts (these are theories formulated by Dr Carl Rogers. See How does an Eating Disorder come about? below, for an explanation of these terms). Although, therefore, we are all vulnerable, fortunately it takes the presence of a number of other elements to bring about the formation of a disorder. A disorder tends to set in earlier rather than later in life. I believe, and there is statistical evidence to support, the idea that it is in the late teens to early twenties that most people develop a disorder. A second vulnerable group is the older man and woman, at the time they start to put on the extra pounds that come with age. I believe there is a shared element to do with age: in the younger person it is at the point where they have to leave childhood and enter adulthood. For the older person it is when they have to acknowledge the reality of getting older. Therefore the acquisition of an eating disorder seems to be tied with a desire to avoid a fundamental change in the way someone perceive themselves, and the way they are perceived in the world. Rather than going forward willingly, or at least with acceptance, into the next stage of our lives, the person who develops a disorder seeks to freeze time, to return to childhood, to deny the reality of getting older and eventual death. Some causes behind a disorder are more dramatic and violent. Both Women and men who have been sexually abused or are the victims of incest may develop a disorder. It may be an extreme reaction to a traumatic loss. In the elderly, it may be a form of passive suicide. Part of my understanding of bringing about recovery from a disorder has to do with acceptance. This is generally one of the ways in which therapy helps the client – to accept reality, to accept themselves, to be okay with who they are – and where they are in life. This implies that if there is a specific traumatic, cause to which the disorder can be traced, it is necessary to heal that additional wound as well as bring about a recovery from the disorder.
How does an Eating Disorder come about? From my own experience, from working with clients, and from putting together appropriate segments of knowledge from a variety of sources, I have come to understand the following. Very rarely do people want to create a disorder, and it’s unlikely that they would be able to by aping the actions of others. Understanding how a disorder – anorexia, bulimia, a combination – comes about takes, first of all, looking at our psyche from a different point of view. Obviously we are familiar with the idea that we have ‘different facets’ of ourselves. But there is an Eastern school of thought that goes further: that we are made up of different sets of ‘I’s’. In order that we don’t fall into confusion we call every single thought we have, or word we utter, ‘I’. But these ‘I’s have different ideas from each other, different purposes. So firstly accept that inside us are a number of ‘I’s, some gathered into groups which gives them more power. Secondly – and this is easy to observe – we have different centres – intellectual, emotional, instinctive and moving (the physical internal and external movements we make). Each of these centres robs the others of energy and tries to do work they are not suitable for. For example, you have to take an exam in the morning. You need to engage your intellectual process. Instead you spend the night uselessly worrying – this is wrong work of the emotional centre. But we do it because we tell ourselves it’s easier than the mental slog. (In fact it’s the lazy, negative emotional ‘I’ that’s telling us). This wrong use of centres and energy stealing between centres is important with how we can find ourselves with an eating disorder. Additionally there will be peer and social pressures. For example, we have been teased about being overweight. So we decide to go on a diet, and increase our exercise. After a couple of weeks we’ve lost some weight, but not enough. So we stop eating whole meals, and at the same time we double our exercise regimen, starting the day and finishing with a set of exercises. People compliment us on our new look. And we’re aware of how proud we feel, now that we have control over our eating habits. Here we need to be clear that many people will never develop a disorder because they lack the discipline to put in the efforts needed to bring about and maintain a noticeable weight reduction. But for those who have the discipline, there’s the potential for developing a disorder. Because what we have not been aware of is while we have been feeling good about ourselves and loving our new look, subconsciously our various centres are being robbed by an artificial centre. In Rogerian :((or Client Centred) theory this is the work of the self concept. The self concept begins in infancy, when our own selfish needs come into contact with the rest of the world. We scream because we are fearful – our mother smacks or is angry with us. We learn that our natural response is unacceptable. We begin to shift our values from inside us, to trying to get it right for the rest of the world. So rather than be in what Roger’s termed our ‘organismic self’ we are all in some sort of ‘self concept’. The self concept is an artificial centre that tries to do the work of the organismic centre. However the self-concept has several disadvantages. Rather than being fluid and open to information and circumstances from the outside world, the self-concept has rigid boundaries. It likes black and white thinking. It is fearful of being challenged, shames easily, desperately seeks reassurance from the outside world. When clients enter Client-Centred therapy it is assumed they are in a self-concept rather than their organismic self. The process of therapy is for clients to rediscover their true self. The eating disorder is a particular sort of self-concept. To repeat, at the beginning the person felt in control of their bodies. But because they are in their self-concept rather than organismic self, the self-concept grows a new centre, the disorder. The disorder has the same characteristics as the main self-concept: it is rigid, black and white, fearful, and attempts to do work it is not suitable for. So, for example, the person with an eating disorder will start to have trouble breathing. In a normally functioning person the role of breathing is in the capable hands of the instinctive centre. But the self-concept/eating disorder doesn’t understand this. It believes that only it can manage the role of breathing. Then the person is stuck in the difficult situation of trying to breathe consciously rather than having this done by the instinctive centre. The self-concept has robbed the instinctive centre both of energy and it’s proper role – and now attempts to carry it out. At some point along the process the person wakes up to realising they have an eating disorder. This can take a long time. While all around people are giving negative feedback the person with the disorder hears only that they are thin. That they finally have control over their eating habits. For a long time they are unconsciously feeding the disorder – allowing it to take more and more power. Comes the day the person finally realises they have an eating disorder. By now the self-concept/eating disorder has taken over some of the functions of the normal functioning centres. The eating disorder is trying to run all the functions: intellectual, emotional, moving and instinctive. Using its inadequate resources. Also, the disorder, although it is not specifically trying to harm the person, does not have a proper plan for taking care of the person. Instead its only response to criticism, to trauma, to an event in the person’s outside life is to increase the manifestation of the disorder. So for example when a young woman’s boyfriend threatens to break up with her if she doesn’t start eating properly, the disorder manifests a response by increasing the woman’s exercise regime. It is essential to understand, though, that the disorder is not seeking the wilful destruction of the individual. It is only doing its job. It’s just that it’s not the right centre of control to do the job. By the time the person admits they have a disorder, internally things may be so askew that they cannot do what is now demanded of them: to ‘eat properly’. With the disorder in control, forcing a person with a disorder to eat properly is madness. The disorder may go with this sort of strategy for a while, but eventually it will kick back – and since the only thing the disorder can do – and since the healthy person has little energy, and the disorder has most of the energy – it will increase the cycle of denial, purging, discipline, exercise. So, from having started innocently, from having begun with a goal of taking off weight, or focussing more on ones self because the outside world or personal events were difficult, the person is now being controlled by the artificial self-concept/eating disorder. The most common reason behind the growth of the disorder is a desire to be slimmer, or more attractive, or just wanting to be in control of one’s food intake. But there are many, many specific causes to a disorder. I know of a young woman whose disorder began when her boyfriend wanted to break up with her. The ‘agreement’ she made with herself (which was heard by and acted out by the growing disorder) was that if she starved herself, time would stand still, nothing would change and her boyfriend would stay with her. In reality her boyfriend broke it off – but by then the woman was using her obsession about food and exercise to shut out the outside world. This woman’s disorder worked out a whole plan: the disorder would keep the woman safe. By starving and exercising the disorder could keep life at arm’s length and she wouldn’t have to feel the pain. In reality, the pain of the disorder was constant and her healthy self was constantly screaming. A young man enjoyed playing three girls off against each other. For some it would seem a dream but for him, the guilt involved and the constant lying became a fertile ground for his disorder to grow. In this case the disorder believed that by starving and purging (through vomiting) the young man was appropriately punishing himself for his fecklessness. For others, the disorder grows after a traumatic incident – rape, sexual assault, incest. The person/disorder – remembering that the person is in their self-concept, not organismic self – tells themselves that by starving they can be invisible to the outside world, and thereby keep themselves safe. Yet people can also ‘wake up’ to having a disorder without such a clearly defined explanation. Sometimes it’s not a single, recognisable reason but a number of small reasons. It can be because at the start of the disorder it gives the person some attention. They get into the habit of being helpless or ill. Health Food shops can inadvertently encourage the growth of a disorder by being ‘faddy’. I know of one couple who ate copious amounts of fruit and only particular sorts of solid foods. As their disorders grew they (or rather the disorder) would accept fewer and fewer specialist products. Whatever the history and growth of the disorder, it appears to take root through the simple diagram I have outlined:
And because the disorder has grown in this way, it is not terribly helpful to control it from outside. So establishments or individuals that demand an agreement that ‘normal eating patterns will be re-instated as part of the treatment’ are fundamentally mis-understanding the illness they are attempting to treat. So what can you, or someone you know, do?
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