Woes for My Unborn Child

Mariposai over at The Monster Beneath raises a point I haven't thought much about because I don't want to have children myself: What if you had a child who had an ED? Because I am not a parent and don't wish to become one, I have the luxury of looking at child-rearing what-ifs from a removed standpoint. It's a game, almost--theoretical, a reflection on myself, not the child-parent relationship, because I will likely only ever know one side of that pairing.

I remember a conversation with a friend of mine who's also a new parent. My friend doesn't have an eating disorder per se but has struggled with various forms of disordered eating, specifically orthorexia. She was petrified that her child wasn't getting enough to eat--she was constantly measuring and remeasuring her son's milk (she was unable to breastfeed), peppering the pediatrician with questions about her son's growth (which is normal), researching obscure pediatric swallowing disorders (which her son had zero signs of). This jibes perfectly with what a friend of mine who is a lactation consultant told me: Inevitably, when she has a client who is overly worried that her child is underfed, when my friend pressed the issue the client would reveal a history of disordered eating.

The uninformed snapshot of an ED patient's family history is that the parents encourage a disordered mindset: Praising her for losing weight, putting her on a diet at a young age, shaming her for a pubescent growth spurt that doesn't go from beanstalk to hourglass overnight. I've met a couple of patients with those kind of families, and I'm horrified at the thought of not having family be a refuge from the daily weight-loss assault the world throws at girls.

But most people I've met with EDs don't have such a seemingly logical family dynamic. The stories I heard that were more common were: the "perfect" family in which self-expression was silenced; families with too-permeable boundaries; distant, removed parents; the parents who told their daughter she was great as-is while the father openly ogled other women and the mother constantly dieted. And, of course, the families with abuse--sexual, physical, emotional--that is all too common when discussing women's mental health. It may be a biological crapshoot as to whether it's an ED or depression or OCD or a child who manages to somehow escape the darts of dysfunction (just as a highly functioning family is no guarantee of outrunning biological factors in mental health), but the point is: The things that actually trigger EDs at the base level are usually not what we, as ED patients and those who support them, think of as "triggers." My friend would never tell her son that he needed to change his body, but I can see how growing up with worry over food could confuse his own attitude toward nourishment when he's old enough to start making his own choices.

I was raised in a feminist household--I remember saving up my allowance to buy a Barbie (my parents wouldn't buy one) and my mother sitting down with me, undressing the doll, and pointing out how Barbie's body was different than real women's. They never did or said anything that a well-meaning but ignorant observer could point to as "why" I developed an ED. They never commented on my appearance (for good or bad), and the (very) few comments about my weight only took on a potency later on, after I began to examine why, in such a seemingly supportive environment, I was willing to do mean things to my body to make it "good enough." But children are intuitive: I saw my mother eating normal meals but saw her obesity, and somewhere in there knew that she must have been eating secretly. (Imagine my surprise when, decades later, we would start to discuss our own disorders and I found that we had the same binge foods, even though I'd never once seen her binge.) I knew that as the designated "good girl," I couldn't openly rebel; instead, I started restricting and desperately hoped they would notice that I needed help.

There are many reasons I don't want children, and fear of them developing an ED isn't at the top of the list. But, yes, it's on there. I've volleyed the questions to myself thousands of times: Is it in my brain / the magazines I work for / my home / what if I were born male / am I lucky it wasn't a "worse" affliction / what could I have done differently? I can't imagine asking the same questions for someone else's disease. When I told my mother that I was going into treatment and asked her why she wasn't as supportive as she could have been when I'd come to her for help years earlier, her response was one I couldn't have imagined: Because she'd been dealing with it all her life, she couldn't imagine that my problem warranted treatment. My mother loves me deeply, yet was blind to how that line of thinking jeopardized my own health--and her own, for that matter, as it kept her from having to confront her own ED. Perhaps my greatest fear is not that I'd have to deal with the pain of watching my child destroy herself, but that if my child developed an eating disorder, I'd have to confront my own recovery failures too.

(Laura Collins writes, excellently, about this in-depth at Are You Eating With Your Anorexic. She focuses on treatment methods, specifically Maudsley, and though I am not a parent I feel as though I've learned a good deal about family dynamics and EDs through her blog. As far as I can tell, Collins did not suffer from an ED herself, so her focus is different than what I'm addressing here.

Genes and Eating Disorders

Sunny at Healthy Girl brings up the role of genetics in eating disorders. I tend to have an irrational gut reaction against thinking that my issues could stem from a brain-wiring issue; I prefer to think that my problems stem from some sort of murky thing that happened circa 1979 or so and can be unearthed through therapy alone (which is why I was in therapy for 7 years before I quit). But it's obviously a worthy question.

One sort of offshoot question about genetics and eating disorders, though: What did people with ED genes do before eating disorders were, well, "invented"? I mean, I know that eating disorders go way back--Freud writes of patients with symptoms we now term anorexia, for example. But EDs have become a sort of handy place for people with generalized "issues" to turn. The "hysteria" epidemic of the 19th century wasn't actually an epidemic; rather, it was a way for culturally restricted women to act out in a way that, though it wasn't exactly understood by the establishment, was at least recognized. In the same way, EDs are far from understood in our culture, but we recognize them as requiring care.

It makes sense that there's a good amount of ED sufferers out there who turned to restricting or bingeing or purging not because some synapse organically told them to, but because in a culture that A) has an abundance of food and B) therefore treats food not as nutrition but as a thing of cultural and familial significance, and C) has a strict standard of beauty that requires thinness, food seemed like a pretty good way to deal with personal issues. In much the same way that hysteria became nearly a fad in the 19th century--not because it was to be aspired to, but because it was a recognizable funnel for one's social and personal issues--eating disorders can spread like wildfire in our environment.

What the studies linking genes with eating disorders are actually saying isn't exactly that there's a gene that makes you want to starve. ED sufferers are more prone to irregularities in mood-regulation hormones--the same hormones that play a role in depression and anxiety. And one way to spike a low serotonin level (linked to depression) is to eat lots of sugar (a common binge target); similarly, a way to calm a perpetually high serotonin level (linked to anxiety) is to starve it to death. But plenty of people have messed-up hormone levels--some just deal with it, others go on medication, others self-medicate through addictive substances or behaviors. Not all of those people go on to develop eating disorders.

And that's where images come into play for people who develop not just unhealthy body image, but eating disorders. When your mood regulators aren't regulating themselves and you find something that "works" for you (e.g. bingeing or restricting), you do that thing. And you have reinforcement on every billboard and magazine cover around you.

It's much more complicated than what I'm saying here, and it varies patient by patient. Few people in the ED community would argue that EDs are caused exclusively by genes, brain chemistry, family, or culture. The combustion point of all these factors (and more) is where EDs spring from. I'm just wary of jumping too heavily on the "it's genetic" bandwagon. If the "it's in the genes" theory comes to dominate ED research, it's not too far-fetched to think that ED treatment can be written from a general practitioner's prescription pad instead of from the comprehensive therapy that currently comprises ED treatment. (Which is the case with several other psychiatric and mood disorders.) And if an ED sufferer opts not to swallow a pill, then what are they complaining about? There's a "cure," after all. And then we're still left with the cultural images that tell overweight women that they're not really worthy; images that exclude an enormous proportion of beautiful people. We're left with associations with the words "thin" and "fat" that have nothing to do with being thin or being fat (like pretty, or slovenly, or loved). We're left where we are. A pill might be nice for ED patients, but it'll suck for everyone else.