Thursday, February 28, 2008

What, if anything, can you say?

That's the question raised by Kate in the previous thread:

If we think intervening is good, maybe even if the person we see struggling with eating is a stranger, how are we supposed to approach it?

She's wondering about what to say or do when you see someone who is obviously struggling with anorexia, whether it's a stranger, an acquaintance, or a friend.

I can't imagine anything anyone could have said to my daughter when she did have it that would have made a difference. But she was 14 when she was ill. Is it different if you're older?

I would really like to hear from those of you who have struggled with anorexia. Was there anything that anyone said that made a difference to you? What was it? What advice would you give someone like Kate?


Anonymous said...

You know, to be honest, when I was older and disordered, I would have interpreted any extension of help as someone who was jealous and out to sabotage me.

On the flip side, I have a sister who is TINY. We used to joke about her hollow leg. Even now, in order to keep from losing weight, she eats upwards of 4000 calories a day. She has a pretty physical job, but if I worked her job, I GUARANTEE that I would not need to eat as much as she does to maintain a "normal" weight (which according to the BMI - ahem - is still underweight).

The reason I mention her is that when she was a teenager, she looked horribly anorexic. People used to come up to her in stores and tell her to "eat a hamburger." Sometimes they were nicer, they really had her best interests at heart, but it still did damage, because she wasn't anorexic: she was just tiny. She was in her 20s before her upper arms were bigger than her elbows.

I guess . . . if it's a stranger, I don't know if there's anything you COULD say that would be interpreted as support. And when approaching a stranger, you also run the risk that said stranger might NOT be anorexic, and you might be making her self-conscious where she wasn't before. If that makes sense.

Anonymous said...

I'm 27 and I'm still struggling with anorexia. Honestly, I don't think there is anything a stranger could say to me that wouldn't come off the wrong way...and it would make me even more paranoid to think that other people are scrutinizing or at least paying attention to my body size. In my warped worldview, that would make me even more afraid to gain the weight I need to be healthy, because I would fear that others are watching that too. I've always had an irrational fear that when I gain weight, someone would tell me I was so "nice and thin" before, why on earth would I go and gain weight?

I just prefer if people wouldn't comment on my body size at all, whether it be to tell me that I'm too thin, or that I'm "so lucky to be so thin." Even if a person means well, often the things they say can be quite triggering.

Anonymous said...

I echo Marste's comment. My best friend is naturally very skinny. She has had 'friends' (classmates) TRY TO SNEAK MEAT into her food (!!!!) and tell her that she's so skinny because she's a vegetarian (orthodox Hindu). That is beyond disgusting.
Also, even young people can certainly have diseases/conditions that cause physical wasting. What if the person you spoke to was really battling cancer, or dealing with a thyroid issue, etc.?

Anonymous said...

A friend of mine had (has maybe) bulimia. I knew something was wrong a long time before she finally confessed to me, because she was extremely thin, had terrible self-esteem and body-esteem, and *never* ate in front of anyone. *Ever.* I tried to get her to open up by asking questions, trying to let her know that I would love her no matter what, that health is more important than body size, but no dice.

It wasn't until she hit her breaking point that she finally told me, and even then it wasn't allowed to be a part of the conversation most of the time.

I know that I can't extrapolate my one experience and say that it is the same for anyone suffering from anorexia or bulimia, or their friends and family, but I was left with the feeling that there was nothing I could do until she herself wanted the help. It didn't mean that I stayed silent - like I said, I let her know that I loved her all the time, and who knows but that maybe that helped her reach the point that she could ask for help.

Anonymous said...

FWIW, I've never been close to anorexic, but I can't imagine in a million years saying something about somebody's anorexia at all -- I mean, not a syllable -- if I didn't know them incredibly well.

Like others have said, unless you know someone intimately and know what their eating patterns really are and why, you don't know why they're the weight they are. There are many potential reasons for someone to be very thin. For that matter, anorexia without the "nervosa" exists too as a result of certain medical conditions and treatments.

I think if I knew someone a little bit and knew they were anorexic, I would want to compliment them on things that have nothing to do with their appearance, to reinforce the idea that they're not their bodies or their weight. I certainly wouldn't praise them for losing weight or not eating, but I'm also pretty sure that if I criticized them for it or expressed "concern" they'd probably find it triggering and resent me for it.

Unknown said...

You can't look at someone and automatically tell what their problems are, so you shouldn't say anything. I reckon approaching someone thin and telling them advice, no matter how good your intentions, is still just as bad as telling a fat person about this great new diet. Possibly worse.

Anonymous said...

I am 30 years old and have battled with anorexia on and off for 20 years and counting.

Even at the worst, when people tried to intervene, I took my behaviour and problems underground. I spoke to no one about food, I got an extra job, I took amphetamines, I moved- you get the picture.

When strangers made comments they went ignored, when friends made comments I withdrew. Frankly intervention can only go so far in my opinion. I think people intervene without really knowing that sometimes the way their concerns are expressed can be extremely triggering. Or can feed into the self loathing I know a lot of other people with ED's suffer.

Personally, even now that I'm older I cannot deal with comment on my eating. So I lie.

I think maybe the way in sometimes is simply saying, "I'm worried about you" and backing it up with actual compassion, empathy and acknowledging that you probably really don't get it goes a very long way. It might not be the road to recovery or helping someone through recovery but it's a start.

As to the last part of the post, honestly when you're older it's not better or easier. It's not easier to deal with intervention perhaps it's harder because as an adult it's not a natural feeling to have people come in and "take over". The only advice I have is listen if it's needed, don't push, don't assume and please when someone maybe has gained or seems healthier take care how and when you comment.

Truthfully I almost deleted this comment. I take part in the Fatosphere and read it and am still in the closet so to speak about all of this. Even now while I'm not actively sick, it's still that hard.

Anonymous said...

I was just wondering about this because I saw a personals ad where the woman mentioned "I'm working on myself, I'm on a strict 1200 calorie diet" and there is just so much wrong with this it made me want to cry and anonymously reply to her ad just to tell her she is beautiful (and she is, there are pictures.) But.... she put up a personals ad to get a date with a guy, not to have her choices criticized (even with the best intentions in the most positive way) by some random chick. I know my least favorite thing is when people try to tell me about how their religion that makes them happy could make me so happy too, and I feel like this would be the same unwelcome thing...(at least in this case, where there is evidence that she is disordered, but probably doesn't have a disorder.) It's really tricky.

Anonymous said...

I am... pretty much completely horrified at the entire idea of intervening with a stranger's anorexia. If somewhere were to do that to me, I think my reaction would be rage. You don't get to tell someone else what to do with her body, even if she is destroying it. I know what I'm doing to myself. I know why I'm doing it. (Even if you don't believe in my reasons, Harriet. That's ideology, not my personal experience.)

And, frankly, what always gets to me is this idea that anorexics don't know that they're killing themselves. We know. We get it. I don't think it was about the skinny jeans for most of us. I never had any aspiration to be a movie star.

So, seriously. What are you going to tell me by walking up to me in the grocery store? Fat is healthy! Don't listen to the patriarchy! You're beautiful! No, really, you are! Yeah, thanks.

Can you give me my family back and a life without chronic illness and take away what happened to me as a kid and give me enough money that I'm not forced to work this job I hate?

There's nothing a stranger can do. And nothing I want a stranger to do.

Harriet said...

Certain things I think we are in agreement on here:

1. It's not OK to comment about a stranger's body, size, or eating habits--especially since you don't know anything about them. This goes whether said stranger is thin, fat, or whatever.

2. Good intentions often wind up being triggering to someone actively struggling with an eating disorder.

3. For someone in the hell of an e.d., someone else's ideas (i.e., "You're too thin!") are about as convincing as a two-bit preacher.

I get all this. I really do. I respect everything that's been said here.

But I'm still left with the horrible dilemma that Kate articulated. If you stumbled across someone who was bleeding you'd apply a tourniquet. Is there nothing anyone can do to help someone with an e.d.?

When the person with the illness is a child or teenager or young adult, parents can help by taking charge of the eating, insisting on treatment, offering up love and compassion and recovery in equal measures.

I wish this could help for older sufferers too.

Anonymous said...

Again, I had people, who saw me eat unhealthily. who were convinced I was anorexic. They saw me eat plenty, yet I didn't gain weight. My BMI (for what its worth) was 17. I wasn't growing either. At 17 I was 5'0" and 88 lbs, and I ate intuitively. Every time people said something about how skinny I was I hated my body more. I didn't think I deserved healthy food until I could get myself up to a weight that wouldn't be critisized. I rarely ate by myself. I didn't eat much, but I doubt I ever went below 1700 calories a day. As small as I was, that could actually be enough. I never skipped meals, I never even drank anything that didn't have calories. No one could have helped me, but I looked, to many people, like prime intervention material. All anyone would have done, all most people ever did, was make the self hatred worse. Even with the envy, they made me hate myself more because all I could register was that I was what I shouldn't be.

In oder to intervene with someone you must first make a judgment and the consequences of making the wrong one are just as bad as the consequences you think you see. The first thing, the very first thing, you need to do before intervening is FIND OUT WHAT IS GOING ON.

criss said...

"The first thing, the very first thing, you need to do before intervening is FIND OUT WHAT IS GOING ON."

This seems very right.

And for what it's worth, all y'all pissed off people who think I'm talking about telling people they're too skinny...I wasn't. I was not talking about looking at someone and judging him or her to be anorexic due to thinness. I was talking about, when you see someone engaging in *behavior* that is clearly disordered. Now, you still shouldn't *judge*--maybe the person has a GI tract disorder and there are only two foods they can eat without getting sick--but you can see that the behavior is not likely to lead to good health.

In the instance of my classmate, for example, this is someone I knew to be an avid runner, because I saw her running every day. I knew she had been kicked off the team because she ran too much (because she told me). I knew she often (maybe always, every time I saw her) had this plate of mushrooms and green peppers for lunch, and then went running.

And yes, she was skeletally thin, like, to the point where you could practically see her internal organs. By itself, that wasn't something I would have presumed about, I hope (I surely wouldn't now, I hope I wouldn't have then). But her *behaviors* were disordered. I wasn't guessing.

So, to reframe my question, how do you--especially as a fat person--reassure someone that their disordered behaviors are not required of them?

It sounds like for most of you, the answer is "you don't"--but I'm not sure about that. I'm a very, very, very stubborn person, and at one time I had an essentially disordered behavior too, though nothing to do with eating. I was at the end of my rope, ready to give up an activity I loved, because of some problems I was having. I refused to take the one step that would have solved them, instead choosing to punish myself for needing to take that step.

If a complete stranger hadn't stepped in and browbeaten me until I gave up and did what I needed to do all along, I don't know where I'd be today. She later became a dear friend, but the point is, she observed my behavior, saw that I needed an intervention, and took it on herself to intervene. She was absolutely 100% right to do so. Was I offended as HELL at the time? Absolutely. But it worked.

Anonymous said...

I was talking about, when you see someone engaging in *behavior* that is clearly disordered.

But wouldn't that person have to have observed you over time to know that? I mean, if I see someone really skinny for the first time, just the fact that they aren't eating and it's lunchtime is not necessarily going to "tell" me they have full-blown anorexia nervosa. For all I know, they were anorexic but now they're eating, but at weird times, and they still have outward physical symptoms. For all I know they're having chemo and radiation and can't keep anything down.

Certainly if I saw them feeling faint and about to pass out I'd want to get them some help, but other than that, if they ONLY thing I know about someone is their weight and the fact that they're not eating RIGHT NOW, I'm operating with extremely limited information about them.

I believe you when you say a stranger's intervention "saved" you, but I'm curious to know: Is this someone who literally had NEVER seen you before? And what did she say that changed your entire way of thinking?

tori_927 said...

I am in recovery, but I know even now if someone said something about my weight it would really just make me nervous that people are analyzing what I eat, how much I eat, etc. I try to tell myself that other people don't pay attention, so if someone said something, it would either offend or upset me, probably both.

Back when I was at my worst, if someone said something like, "I'm worried about you, you look really thin," I would take it as a compliment and tell myself they were just jealous that I'm skinnier than they are. Not good.

I think if anyone, only friends should say something, privately, one-on-one with the person. Don't mention how they look or even that they may have an ED, just that they look like they're going through a hard time, and ask if there's any way they can help. That doesn't emphasize that they suspect an eating disorder because everyone goes through rough patches sometimes, but if they want to open up they can.

Anonymous said...

The troublesome part of all of this is that if you bring it up, it will probably just intensify the dangerous behavior. As a parent, you can take the child into the doctor and have them present the facts about what is going on with the body as a result of starvation, but when dealing with adults? It's just not an option.

You can express that you think your friend looks more attractive in good health, but beyond that, the process has to be internal for the other person to decide to get help.

Anonymous said...

If you know someone who seems to be suffering (ED or whatever), I suggest asking, "Are you doing OK?" and then saying something like, "Remember, I'm always available to help." This way, the person knows that you're thinking about him or her. I think that it's always appropriate to be compassionate, and total silence in the face of suffering is not, to me, compassion.

Carrie Arnold said...

For starters, what you say would depend on how well you know the person. I got stares at several points in my illness, and it wasn't pleasant. An immediate crisis would be different (ie, when I had a seizure).

Sometimes, what helped ME the most was when my friends would just treat me as if nothing was wrong. Watch a movie, go for coffee, go on a walk at night. I was much more likely to open up then than if I was specifically asked what was going on. Because the whole world was in a giant conspiracy to make me fat.

Which brings me to your question, Harriet. The reason, I think, it's so hard to intervene with people with EDs is that we so often don't realize we're sick, and if we do, we don't want help- at least on the outside.

I don't know what you do about it, ultimately.

Anonymous said...

For arguments sake, why would it be any more acceptable to comment on the habits/body of a extremely thin person than on the habits/body of a morbidly obese person? Both are well aware of the damage they are doing to themselves, no?

Harriet said...

"The reason, I think, it's so hard to intervene with people with EDs is that we so often don't realize we're sick, and if we do, we don't want help- at least on the outside."

That's it exactly, Carrie. People with anorexia are anosognosic--they cannot recognize they're ill, at least not for a long time. That is ultimately why I think intervention is not only appropriate but essential.

And ultimately it's families who are best placed to intervene. They know the person, their behavior, and the backstory. They have emotional and sometimes financial leverage. Most important they have the most emotional investment in the health of the person with anorexia.

So I think parents especially need a wakeup call here. And of course they need to not believe most of what they're being told by the medical profession about the causes and treatment of e.d.s.

Danijo, when you say "for argument's sake" do you mean you're playing devil's advocate? I hope so. Because if you've read this blog at all you know how I feel about the implication that obese people are doing harm to themselves: that it's bogus, bogus, bogus.

Anonymous said...

Given the comments by the people who know what anorexia is like from experience, whether personal or familial, I can't really see any other way to get a person help than to take them by the hand, literally, and lead them to it. Everything I know about anorexics is that they are fabulous at avoidance and misdirection. I can't imagine anything but sitting on them until they are in counselling actually working if they aren't ready on their own to admit their problem. But, I'll be the first to admit, I have no experience.

Anonymous said...

I was indeed playing devil's advocate. However, I more specifically said morbidly obese because i do feel there is a difference between living HAES and still being obese and living unhealthy and being obese. The difference is not in the right to live how you choose or in how one should be treated but the difference is in the effect on your overall health. But either way I'm still not sure I see a difference between commenting on someones habits/body at either end of the spectrum. I'm not trying to be argumentative or snarky. I would sincerely welcome another POV. I believe it is *beyond* rude to judge someones habits/body at the upper end of the weight scale, so why would it be anyless rude to do it at the lower?

Harriet said...

I don't see it as judgment; I think we're talking about intervening with someone who is very very ill, to save their lives. The parallel doesn't hold because obesity isn't an illness but a physical condition (although DSM-V would like to change all that). Some people who are obese are very healthy; others aren't, just like some thin people are healthy and others aren't.

But someone with anorexia is by definition not healthy and in physical danger.

Anonymous said...

"People with anorexia are anosognosic--they cannot recognize they're ill, at least not for a long time."

Not so in all cases. I was actually doing a research project on the incidence of eating disorders in various types of female athletes, when I first started getting sick. I knew almost right away that I was experiencing most if not all of the symptoms defined in my research. Though I have met some anorexics who deny they even have a problem, mostly it's been people who know they are ill, but aren't ready to recover, or flat-out do not want to recover.

On another note, I faced the dilemma of whether or not to intervene during the one period in my adult life when I was doing better, towards the end of my college years. There was a girl in my dorm who was painfully emaciated, and I saw her in the dining hall once, eating as I used to do: tiny plates of cottage cheese, fruit, a few lettuce leaves. I battled with what to say, if anything. Finally, I went up to her and simply said, "I've been there. It gets better." I walked away wondering if all I'd done was manage to terrify her with how "fat" I was, and only encouraged her to keep on the same path. I saw her again the next year and while she was still thin, she looked much, much healthier. Still, I'm not so sure I'd ever make a comment like that again.

Anonymous said...

The difference between anorexia and "morbid" obesity? Anorexia will KILL YOU a lot faster if not treated for properly.

Fat people aren't a disease, even though medical "professionals" and other assorted haters like to think of us that way.

Anorexia is a MENTAL disease with SERIOUS physical consequences.

criss said...

Meowser, sorry it took me a while to get back here. To answer your questions at least somewhat, yes, the person who helped me was a stranger who had never seen me until that day. I don't know why she decided to help, and I don't even really remember what it was that she said--other than just persistently telling me what I already knew, inside, to be the truth about what I needed to do. Basically, she wore me down until I agreed to *try* doing it her way, giving me the "out" that if I tried it and it didn't work I could go back to my non-working way (which of course I did not, because she was right and we both knew it).

All that said, the situation was not a life-threatening one in the same way as anorexia. I'm avoiding going into more detail because I'm pretty sure people would be offended that I'd compare the situations to each other, and also because the details are distractingly complicated.

As for my college classmate, I observed this person eating a lunch virtually without calories repeatedly (not every day, but every time I saw her). It was always the same thing. I also knew, from things she herself told me, that she had what seemed to me to be clearly compulsive exercise habits. I wasn't, as I've said now three times, just jumping to conclusions because she looked thin and sickly (though there was that too).

And as I've also said, I would not/have not made comments about a person's weight (unless the person brought it up, like my friend Allison who says she has trouble keeping weight on, so we talk about it). I was thinking more in terms of what would make it okay to eat, how one could talk about food that would be constructive. Women do so much destructive food-talk ("Oh, that's *bad*, I shouldn't eat any...well, maybe a tiny bite...I'm so *bad*...") that I thought maybe someone had suggestions as to how to do the reverse.

It kind of seems like the consensus is "don't mention food at all," which I guess is valuable information to have too.