There is so much confusion and controversy when it comes to the issue of choice and anorexia. Some believe that getting the illness is “a choice.” Some feel that you do not choose the illness but  you can choose to get better from it. I believe that this comes from a significant misunderstanding of what the disease is. I don’t think most of us would say becoming schizophrenic is a “choice.” However, many of us (or most of us if we are women) have tried to “look better,” or “lose weight,” or “be thin.” So unfortunately, we project this very common occurrence of trying to change our bodies onto those who have fallen down the rabbit hole of anorexia. For those of us who do not have the switch that flips in our brain to anorexia, it is indeed a choice. We can choose to lose more weight, stop losing weight, and change our eating to reflect more or less healthy choices during our day. However, those folks who are unfortunate enough to have their brain switch into this illness no longer have this luxury of control. What once started as something that was a choice – “I would like to become healthier and eat better,” has now moved into a very different realm of lack of choice. The disease now dictates, “you will not eat any fat and if you do, you will burn it off by running until you drop.”  The disease also makes choosing anything that has to do with food impossible – “you will not eat that, but, you are hungry so you will cook for others and watch them eat,” or “you are a big fat pig and you will stare in the refrigerator but not be able to decide to eat anything, as any calories are too much for you!” The disease takes away all clarity of choice. It imprisons the patients it affects, totally and completely.

Choices. “The patient can choose to get better, but needs more insight.”  “The patient can choose to get better but their dysfunctional family is holding them back.” “The patient can choose to get better but our sick culture is impacting them”. I disagree with all of the above. The patient can NOT choose, they are too sick. They need help! We must make the choice for them. We must relieve them of the torture of making food choices. We must relieve them of the burden of trying to fight this illness in one breath and then in the next succumb to its power. We must make the choices. We, the treatment team. We, the parents. We, the spouses. We are the ones who can lend the patients our strength and our voice while they have neither. We need to pull them from the depths of the rabbit hole. They CAN NOT do this on their own. I am completely stunned as to why the field hasn’t caught up to this thinking but instead feels it is “disrespectful” and “invalidating” to offer this type of help. I believe this utter lack of understanding of the illness is linked to the fact that this disease has the highest mortality rate. These patients can not turn this around themselves. This is NOT another diet. This is NOT a self-indulgent “vanity” that the child or adult needs to “just get over”. They can not. I will write more about the illness over time and everything I have learned about it. The darkness and the ugliness and the relentlessness that kills these patients.

It is the most confusing thing that the goal of most of our culture is to obtain what this disease wants as well  – thinness. How can we truly see the viciousness in the illness when most of us want what it proclaims as its ultimate goal – to be thin, to be powerful, to be confident, to be beautiful. I don’t think there is any other mental illness that promotes something that all of us envy like anorexia does. Most mental illnesses result in confusion, loss, isolation, and decreased functioning. There is nothing very attractive about that. So, we understand that these illnesses are something we need to help with. We have empathy, compassion and are willing to take a leadership role in helping these patients. But, what about those “pretty girls” who complain about “being too fat?” Sometimes it is hard to feel sorry for someone who is achieving what the whole world wants to achieve….

We need to gain a clearer perspective. The disease needs to be the focus, not the thinness that results from the disease.  We need to be educated. We need to take control and help eradicate this illness. Patients are dying and they need our help.

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