The professional eating disorder community is reaching agreement about what causes eating disorders. The truth is that there is no one single cause for every individual and no constellation of causes that fits everyone. Despite some efforts to push toward the idea that a gene or combination of genes exist that are responsible, we are examining this as only one possibility, yet to be identified. If genes play a role, we will then also need to examine why they were now awakened. Best we know at this point are that biological predisposition to anxiety and depression, familial issues, stressors and conflicts, internal psychological forces that impacts how one perceives relationships, and one's sensitivity to their environment have an effect and can leave someone vulnerable to developing an eating disorder. For some, physical, sexual and/or verbal abuse can be a linchpin. Each individual, however, is different and so the combination or influence of forces vary; each eating disorder is as unique as is the individual. 

As we move away from a myopic and narrowly focused understanding about what causes eating disorders perhaps we can now take a look at the influence of the culture — media, fashion, idolizing and idealizing celebrities, quick fix solutions to all that ails us. Similarly to the acceptance that there is no gene or genes that is at 'the,' or even 'a' root cause at this time, the same is true about cultural influences. Culture does not cause eating disorders; it provides context for them to develop and through a media-frenzied and insidious manner has its hand in maintaining them. In this way, the culture is the vehicle for expression of what is already contained in the person, ripe for a way out. Culture seduces us to believe opposite to what we know to be best for us.

The fixation on achieving cultural ideals or even what we now consider its norms provide a way for vulnerable individuals to find a voice for their struggle (i.e. symptoms, body obsession, relentless and self destructive behaviors) and a way out, simultaneously (i.e. achieving the cultural ideal of body size and shape will fix all that internally ails.)

The bottom line is that we don't get away with not dealing with our stuff. Attempting or achieving the cultural ideal does not make the issues go away. In fact, for eating disorder sufferers trying to achieve the ideal indeed makes symptoms worse. Self-defeating and self-destructive behavior continues to increase in a culture that glorifies attention, quick fix and false roads to excellence; we convince ourselves that we need it or are entitled to it and think there is something wrong if we don’t get there quickly. The fast track to ‘Rome’ does not only apply to eating disorder sufferers. Substance abuse, shopping, gambling, depression and anxiety tied to relational or environmental stress are on the rise. The psyche needs a way out of its unrest.

I too have to talk myself down from the cultural ledge from time to time. TV, especially the reality shows that feature makeovers, fashion and body image, has made it increasingly more difficult for even the healthiest of individuals to maintain self-esteem and refrain from self-doubt or feelings of inadequacy. Much of what we view feeds negative self-reflections and perceptions about what is desirable. There are exceptions.

I have recently begun watching Sons of Anarchy, an AMC TV production beginning with the series opener from 2008. It appeals to my sensibility as a novice motorcycle rider. The writer, Kurt Sutter, is adroit at conveying the complexity of the psyche and the human condition. We are driven by competing motivations and often our feelings are fraught with ambivalence. We cannot avoid loss. Sutter gets this. What he also understands and viscerally portrays in his words is that sex and sexuality are complicated; aggression, along with fear, envy, competition, love and loyalty are unavoidable. We cannot control these forces in us, but rather be guided by them in how we respond. These are the choices that each of us makes every day. Clearly, the shows’ characters are not routinely guided to behave in ways that put them on the right side of the law or even morality. Sutter is not looking for judgment of his characters. They are overindulged and commit crimes against every aspect of human behavior. Their entitlement and need to conquer at all costs is clear. Sutter’s messages are powerful and emanate from the inside of his characters outward; their angst finds expression in the environment. He is not swayed, however, by a culture that promotes the body perfect and youth as solely desirable. I may be trading apples for oranges here, but on behalf of eating disorders, it is a step in a more right direction, perhaps? 

The lead female character, Gemma, played by Katey Sagal, is neither young nor has a perfect body. She is beautiful, sexy, intense, despite her Machiavellian nature — that is the fatal flaw, not her body or age. What’s the message in all of this? Culture can also support us to live from the inside out. Internal and relational forces guide us; we cannot escape this, especially when these forces are fraught with pain, sadness, suffering, anger, anxiety or unrest. Would those that are vulnerable to an eating disorder or other self-defeating behavior still need a vehicle for their pain and struggle, even if the culture were not punitive and rigid about what makes us beautiful and interesting? Yes. But if the culture could continue to create a context where achieving a narrowly defined standard does not attain cure from what ails us then we have a better shot. Then, ALL we have to deal with are the internal and environmental pressures and stressors that confront us everyday and learn to make choices about them that support our health and maintain the respect of others. Difficult road, but generally has a light at the end of it.

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