If you hear hooves, the saying goes,
think horses not zebras. The advice for doctors encourages them to think of simple pneumonia with an unrelenting, raspy cough in February rather than an exotic fungal infection from the Seychelles. For a therapist, it might mean that (as Freud put it) sometimes a cigar really is just a cigar. It's standard, fairly solid advice. Rule out the obvious before you start chasing something more obscure.
The problem is that hooves and horses don't always go together. Just because you see a horse doesn't mean you're going to hear hooves.
The Metaphor Queen will explain. An article on EmpowHer posited that the
number one reason for developing an eating disorder was a "relentless boundary invasion on every level." For this metaphor, let's call the eating disorder the horse (remember Mr. Ed the talking horse?) and any possible "boundary invasions" the hooves. Also for the sake of this metaphor, let's say that we know the horse is there, we know that the person has an eating disorder, but we're still listening for the hooves.
The problem with such arguments--beyond the fact that they have nothing to do with the latest science--is that they make the facts fit the theory. For the metaphor, you automatically hear hooves when you see a horse, even if the horse is standing still. Most people have had boundary invasions. The idea of a "boundary invasion" is fairly nebulous, and different people will have different standards as to what is a relentless boundary invasion. I'm quite a private person, despite my public blogging, so I have a fairly low tolerance for people poking around in my stuff. But if you look hard enough, most people will have had a boundary invasion, whether someone read their diary, they were touched inappropriately, or their mother insisted that her child let her know where they were at all hours.
Yet if most people have had boundary invasions, why don't more people have eating disorders? If there is a deafening cavalcade of hooves, why do we only see a few horses?
Having worked with an old-school psychotherapist for several years, a PhD psychologist who was quite probably the most well-known ED therapist in my area at the time, I know a bit about straining to hear hooves just because you see a horse. I must have sifted through every childhood memory, trying to figure out what might have caused my eating disorder. Mostly, we focused on my mom. The two of us were too enmeshed. I was afraid of growing up. She was afraid of letting go. I was symbolically rejecting her by literally rejecting food.
Maybe this was partially true- I don't know. But it ignored several pertinent facts: when your kid is sick with a deadly illness,
of course you're afraid of letting go. I wasn't afraid of doing my own thing until I got sick. I had no explanation for why I couldn't eat, I just didn't want to, and that had nothing to do with my mother.
We had the horse, obviously, and we kept thinking we were hearing hooves. We wasted years listening for hooves, while that damn horse stayed in the stable and I had to shovel out the shit. It wasn't until I started seeing my current therapist almost three years ago that I began to try and move the horse out of the stable. That even if there were hooves, I was still stuck mucking out the stable, which was the real problem. NOT the hooves.
An eating disorder diagnosis says nothing about the quality (or lack thereof) of parenting. Nothing. Period. Full stop.
My other real problem with this type of antiquated, outdated thinking is that it is not based on the latest scientific understanding of eating disorders. The article didn't mention the
strong genetic basis for all eating disorders. It didn't mention any of the
brain imaging studies or
rat models of excessive exercise. It didn't mention serotonin or dopamine or leptin or ghrelin.
The truth is, we don't know exactly what causes eating disorders, but we do know that bad parenting, skinny models, and "boundary invasions" isn't it. And it's time we moved on from these ideas onto something that actually helps sufferers and their families.
The problem is that hooves and horses don't always go together. Just because you see a horse doesn't mean you're going to hear hooves.
The Metaphor Queen will explain. An article on EmpowHer posited that the number one reason for developing an eating disorder was a "relentless boundary invasion on every level." For this metaphor, let's call the eating disorder the horse (remember Mr. Ed the talking horse?) and any possible "boundary invasions" the hooves. Also for the sake of this metaphor, let's say that we know the horse is there, we know that the person has an eating disorder, but we're still listening for the hooves.
The problem with such arguments--beyond the fact that they have nothing to do with the latest science--is that they make the facts fit the theory. For the metaphor, you automatically hear hooves when you see a horse, even if the horse is standing still. Most people have had boundary invasions. The idea of a "boundary invasion" is fairly nebulous, and different people will have different standards as to what is a relentless boundary invasion. I'm quite a private person, despite my public blogging, so I have a fairly low tolerance for people poking around in my stuff. But if you look hard enough, most people will have had a boundary invasion, whether someone read their diary, they were touched inappropriately, or their mother insisted that her child let her know where they were at all hours.
Yet if most people have had boundary invasions, why don't more people have eating disorders? If there is a deafening cavalcade of hooves, why do we only see a few horses?
Having worked with an old-school psychotherapist for several years, a PhD psychologist who was quite probably the most well-known ED therapist in my area at the time, I know a bit about straining to hear hooves just because you see a horse. I must have sifted through every childhood memory, trying to figure out what might have caused my eating disorder. Mostly, we focused on my mom. The two of us were too enmeshed. I was afraid of growing up. She was afraid of letting go. I was symbolically rejecting her by literally rejecting food.
Maybe this was partially true- I don't know. But it ignored several pertinent facts: when your kid is sick with a deadly illness, of course you're afraid of letting go. I wasn't afraid of doing my own thing until I got sick. I had no explanation for why I couldn't eat, I just didn't want to, and that had nothing to do with my mother.
We had the horse, obviously, and we kept thinking we were hearing hooves. We wasted years listening for hooves, while that damn horse stayed in the stable and I had to shovel out the shit. It wasn't until I started seeing my current therapist almost three years ago that I began to try and move the horse out of the stable. That even if there were hooves, I was still stuck mucking out the stable, which was the real problem. NOT the hooves.
An eating disorder diagnosis says nothing about the quality (or lack thereof) of parenting. Nothing. Period. Full stop.
My other real problem with this type of antiquated, outdated thinking is that it is not based on the latest scientific understanding of eating disorders. The article didn't mention the strong genetic basis for all eating disorders. It didn't mention any of the brain imaging studies or rat models of excessive exercise. It didn't mention serotonin or dopamine or leptin or ghrelin.
The truth is, we don't know exactly what causes eating disorders, but we do know that bad parenting, skinny models, and "boundary invasions" isn't it. And it's time we moved on from these ideas onto something that actually helps sufferers and their families.