Like many fields, the “eating disorders field” is rife with polarization. It does not always hold tensions and contradictions in a way that yields comfort and safety for those in it. And yet, are dialectics not at the heart of so many of the modalities proposed to respond to eating distress?
My hand with a compass in it
Since I began researching eating disorders almost 10 years ago, I have felt uncomfortable with the certainty and finality that characterizes a) how we are supposed to “recover” from eating disorders; b) assertions about what kinds of treatment (and research) are “good” or worthwhile; c) expectations of moving beyond cognitive dissonance when it comes to encountering media imagery and general representations of bodies and feeling in our bodies. I’ve felt caught in between and uncertain about how to articulate myself, at times, because of the ways in which I inhabit shades of grey.
We are to love or hate types or treatment and places where treatment happens. We are to describe eating disorders as biological or social. We are to be recovered or not recovered. We are to research eating disorders in qualitative or quantitative ways. We are to be professional or coming from a place of lived experience. We are to be supporters or sufferers.
And yet, I would be willing to bet that many of us exist in the in between.
The other day I was watching a documentary film made by two former patients at the same hospital I received treatment. Though they were treated there a full ten years after I was, this experience brought up a lot of mixed emotions for me. These emotions were borne of the distance I have from treatment, the twists and turns my life has taken in the interim, the research I’ve done, and the advocacy work I’ve been a part of.
I want to firstly state that I think that in many ways this documentary is a triumph – I thought that the two young women who told their stories in this forum were courageous and thoughtful, and this is information that many need to hear. I was especially pleased to see attention paid to eating disorders in the context of religious fasting experiences, which complicated the stereotypical portrayal of eating disorders as issues of vanity. There was clearly a lot of heart, soul, and time poured into this film, and I applaud it.
My experience of watching the film brought me into confrontation with what I’ll refer to as two sides of my brain, but that feels like a reductive way to spin it. For the sake of linguistic brevity (ish), I’m going to rely on that somewhat tired narrative (for all that it somewhat plays into a dialectical, oppositional model of the sort I critique). The two sides I’m bringing into this piece are my grateful brain and my critical brain.
I cannot escape the fact that the treatment I received saved my life—perhaps not in a sensationalist way, but at least to some degree. Would I have died if I did not get treatment? I’m not completely sure. I do know that if I hadn’t had the chance to be in a place where engaging in my behaviours was not an option, I’d have kept on rolling down that hill, trying to walk back up but constantly returning to the behaviours that kept me in a kind of shadow state. I remember the feeling of walking through the doors of the hospital– I was terrified but comforted, cared for but uncomfortable, in pain and healing. In other words, I was (and perhaps am) a mess of contradictions.
In the years immediately following treatment, I was the poster child for the kind of recovery I came to understand as correct. I attended check-ups every six months at which I would be weighed and where I would discuss my life and how I was doing in terms of anxiety, eating, and exercise. After a while, I started to come back as a “recovered speaker,” and would share my story with current patients, promising some kind of hope for recovery.
I do not regret those experiences and I hold them as genuine at the moment they existed. And, in those moments, the recovery I enacted was buffered by a level of privilege around which I was completely unaware. It was not until I started to do research on eating disorders that I began to think more closely about how in many ways I reached a level of stability through this treatment experience because my privilege and personality allowed me to play by the rules.
And then I started to feel scratchy about the experience.
In the later years of check-ins, I began to have interesting conversations with my former psychiatrist where I challenged him about things like what body image really means. I thought a lot about how eating disorders are always represented in sensational ways, and how we rely on tropes to bolster assertions of seriousness. I also began to think a lot about eating disorder treatment systems, and how while I was free of some of the rigidities that brought me to the treatment centre, I had developed new rigidities and patterns—not through “contagion” of others’ “transgressions” or symptoms in treatment, but rather through the ways treatment itself operated. For instance, I noticed myself reticent to eat outside of “mealtimes,” still not able to fully trust my body, and completely unsure about exercise, which I had not been allowed to talk about.
I felt unmoored, like the very systems that saved my life had set me up to be a weird kind of human. I noticed these things most acutely once I started dating my now-husband and found myself confronted with new situations outside of my comfort zone around food timing. I realized my recovery had been so incredibly sheltered that I hadn’t bothered to question which norms it aligned with.
I was pretty angry about this at the time and felt deeply critical of the system. This rubbed up against my gratitude in ways that generated quite a bit of confusion and caused me to re-think how I articulated my recovery—which I now realized hinged on privilege, luck, and good old-fashioned rule-following.
I began to see the cracks in the system, and I couldn’t reconcile them easily with my own experiences. I critiqued (a lot).
I still critique (a lot). And, as I move through recovery so many years on, I situate these critiques within a constantly contradictory and always imperfect system. We do not have enough treatment, period. Residential treatment and increasing more of what we have is not a complete solution, but most people are not even getting those things. We are working within systems of capitalism and under neoliberalism, which call for financial accounting for all things and download all of the responsibility for health and happiness onto individual people. Racism, sexism, ableism, transphobia, and discrimination writ large are woven into the fabrics of society in ways that are slow to dislodge. Attempts at dislodging lead to painful, hurtful, explosive reactions, and most of the time the world feels like a bit of a dumpster-fire.
Healthcare providers in the eating disorder space are typically good-hearted people, trying their best to keep people alive.
And the systems are broken and causing harm.
What do we make of what is, frankly, a bit of a mess?
I certainly wish I could end this post with somewhat of an answer. If there’s one thing I have learned, living at the precipice of gratitude and critique, it is that I’m not the one to provide this answer—and, furthermore, there is unlikely to be one answer. “The” answer, I believe, lies in centering complexity and diversity, rather than seeing these as outliers, barriers, or deviant cases. It lies in digging into, rather than trying to excavate, that which isn’t working.
It lies in making explicit the ways in which we are not either one thing or the other.