Anorexia – Susanne Gilmour – link to word document

Christmas holidays are a good time to catch up on reading. I picked up ‘How To Disappear Completely’ by Kelsey Osgood, a first person account of a young woman in the US, from a good family in a high socio-economic class who was diagnosed at 13 with this serious mental illness.
Osgood uses her experience to argue for an approach to treatment that she believes would have shortened the length of time she was ill, from 13 years until about 25 years old. She says she had a happy family life in a high socio-economic area of the US. However, she found that she and her fellow-sufferers, for a variety of reasons, but in particular, a need to feel special in an environment where achievement, appearance and self-discipline are admired. They thought, in the misguided way of puberty, they could be special by being the thinnest among their peers and respected for their self-discipline. Osgood’s brother was a high achiever, which she knew pleased her parents, while she felt she was not particularly outstanding at anything. In her book, Osgood emphasizes her parents were not to blame, although they struggled to work out how to help her. She debunks myths about parents being to blame, or the anorexic individual being badly misunderstood by those around them, a belief which, she writes, only perpetuates the illness.
Instead, Osgood argues for :
1. The necessity to understand that anorexia tends to develop in puberty partly as a way of finding an identity which a young adolescent feels will attract admiration for their self-discipline and extreme thinness. Fat, in our culture, is subtly and not-so- subtly equated with laziness, moral turpitude and undesirability. So a vulnerable young person who cannot find other ways to attract admiration and develop self-confidence for notable and rewarded achievements usually given to academic, sporting, social, musical or social talent, may bask in initial admiration for their figure and self- discipline. For reasons, perhaps to do with the interplay of genes, environment, the effects of starvation on the brain and lack of self-confidence, a minority of adolescent dieters may descend into obsessiveness with weight, lacerating self-criticism if they give into hunger and competitiveness with other sufferers
2. Therapy to be done on a one-to-one basis. Osgood and her fellow members in group therapy sessions, despite their desire to overcome their illness, found themselves consumed with envy and self-loathing when anyone else in the group had lost more weight than the others, thus proving herself more disciplined than the others which then only increased the rest of the group’s determination to starve themselves more rigorously.
Interestingly, a recent Stanford university study carried out in California, Texas and Beijing, found that dieters who attend weight loss groups become more competitive as they get closer to their weight loss goal which can lead to a secretive, competitive desire to lose the most weight in their group. (Reported in the Weekend Australian January 24-25).
3. Therapy that closely involves the family, assisting them in developing behavior interventions at home that will help change the young person’s mindset and eating habits. This involves rewarding even small improvements in weight and eating habits, and implementing appropriate consequences for anorexic behaviours, such as hiding uneaten food, taking food to her room saying she will eat it there, and so on) .
4. The sufferer’s treatment to involve medical personnel and to be treated as a medical problem as well as a psychological problem. Simply being treated as a misunderstood child, or blaming a dysfunctional family, may only succeed in reinforcing an anorexic client’s feeing of ‘specialness’, Osgood argues. Our culture conveys powerful messages to the easily influenced young about the importance of getting respect by being acknowledged as somehow special even if it means being a victim of what may seem to them the glamorous illness of self-starvation. Anorexia is anything but glamourous of course, even for those celebrities whose condition is reported on with fascination in the media. It results in very unpleasant side-effects such as excess body hair, bad breath, lank hair, poor complexion, fatigue, cognitive deterioration. It has long-term ill effects on bone density, heart and immune functioning. Emphasising these aspects of the illness, rather than focusing on anorexic specialness as a uniquely hurt, complex, intriguing personality (which, probably applies in some way to us all and therefore is not ‘special’) is a better route to healing, argues Osgood. The concept of anorexia as a condition associated with models, dancers, actresses tends to equate the illness, in the minds of impressionable, fragile young people, with glamour and possibly the price to pay if one wants success and admiration. This notion of the illness can be appealing to the young who may be struggling with finding a sure footing in this demanding society. Reframing this idea to a more mundane level as a medical illness can remove the appeal it can have in the minds of some who may find this path to identity and respect alluring.
5. Finally, Osgood writes, well-meaning prevention programs in schools and memoirs meant to help young people learn about the horrors of the illness, may instead actually inspire, in the vulnerable, ways to minimize food intake, suggest how to cover their self-imposed starvation behaviours and resist treatment. Osgood found that most of the videos shown in her groups and at school, and recommended readings of memoirs functioned more like how-to guides for her and her fellow self-starvers. Ms Osgood in this memoir is very careful not to provide details of how she went about starving herself. Instead, she focusses more on what treatments worked and didn’t work and the extreme emotional and physical suffering, the degrading aspects of the illness she endured in her battle with this grave mental illness.

Susanne Gilmour, Psychologist

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