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Weight problems: "no-fault" approach of biopsychiatry WEIGHT PROBLEMS: "NO-FAULT" APPROACH OF BIOPSYCHIATRY
As a physician who has treated hundreds of patients with eating disorders over the past fifteen years, I much prefer the "no-fault" approach to managing eating disorders. Simply put, if you have an eating disorder, or if you are the parent of an anorexic or bulimic child, don't condemn yourself: You are not to blame.
"Fault" and "blame" are unnecessary-even harmful-concepts. They result in mental roadblocks, such as: "I am sick [or my child is sick] because I am a bad person [or parent]. If I could just snap out of it [or fix the problem], I could make myself [or my child] well."
Thinking in terms of "fault" is counterproductive. You don't suffer from an eating disorder because you are "bad" or because you are "not trying hard enough." On the contrary, I believe you are actually trying very hard to deal with the stresses in your life. Unfortunately, the method you have chosen-starvation or rigid dieting or purging-is just making your problems worse.
People who skip meals to lose weight often succumb to the urge to binge. They wind up eating more than if they had just stuck to the old three-square-meals-a-day formula. Learning to then purge as a way to exert "damage control" over bingeing makes it that much easier to binge in the future, leading to a vicious cycle. Some girls starve themselves as a way of coping with their fears of growing up. The damage starvation does to their bodies may delay their physical and emotional development, but it can't stop the process of growing older. Rather than helping to overcome the challenges of maturation, an eating disorder can cause physiological havoc that leads to disease, more mental turmoil, and sometimes even death.
Someone on the outside might wonder why people try to cope with their pain through such misguided means as disturbed eating. The answer, I think, is that often they fear their lives will just get worse if they don't do something-anything. The problem thus arises not from lack of effort but from using the wrong tools. In a time of stress and change, they seek to control one basic element in their lives-food-somehow believing that if they can control their eating habits, they can keep all their other troubles at bay. Attempting to force the body to ignore its inherent biological rules of eating, however, is like believing you'll always win at gambling in Las Vegas-eventually the "house" always wins.
I conceive of eating disorders as arising, not from some inherent flaw within a person, but from the clash between social values and biological drives that exist within an emotionally vulnerable individual.
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