The Helicopter Story
Lately several women have asked me to include information in my blog that could be helpful for someone who wants to recover from an eating disorder. I thought we could start at the beginning with the Helicopter Story. The Helicopter Story was written by the Reiffs -- brilliant dietitians in Washington State -- and I have used it with my clients for almost 18 years. It is by far the most accurate and provoking explanation I've ever read of the causes of an eating disorder. I invite all of you to read it and let me know what you found out about yourself!
The Helicopter Story
"Why don't you just stop?" This is the question with which people with eating disorders are confronted again and again by parents, spouses, friends, and themselves. Costly experiences with programs promising an end to the food behaviors once and for all frequently lead to brief abstinence followed by devastating resumption of old and familiar patterns. Regardless of whether the person starves, binges, binges and purges, abuses laxatives, compulsively overeats, gains weight, or loses weight the story of a roller coaster experience with behavior changes is all too common. Until the behaviors in an eating disorder are viewed as the symptoms rather than the problem, the focus of recovery remains in the wrong place, and the person is likely to experience limited success in attempts to recover.
Most people have great difficulty understanding the function of the behaviors in an eating disorder. Why would someone starve herself to the point of death, as often happens in anorexia nervosa? Why would someone binge and then induce vomiting or painful diarrhea, as happens in bulimia nervosa? Why would someone eat so much that her stomach hurts so badly that all she can do is lie down and fall asleep, as often happens for compulsive eaters? Why would someone maintain a body weight that is so high that she is physically uncomfortable and potentially endangering her health, as often happens in obesity?
The following story is one way to explain the role these behaviors play in a person's life. Its intention is to help both people who have never had an eating disorder and people who do to better understand what the person must recover from in order to maintain permanent behavior change. Because they did not develop an eating disorder by conscious choice but rather as an unconscious protection from emotional pain, most people with eating disorders who are just entering treatment do not know why they do what they do with food. All they know is that they have not been able to stop and they are scared that the food- and weight-related behaviors will never end.
Imagine that you are in an airplane and you do not know how to swim. Normally, when a person purchases a plane ticket, the agent does not say, "Excuse me, do you know how to swim?" It is not even as issue. However, imagine that the plane crashes into water, you are the only survivor, and the only way you have to stay afloat is by holding onto a life preserver. Due to the change in circumstances, not being able to swim suddenly becomes a very important issue. You realize that if someone does not come to rescue you fairly quickly, you will either drown or die of hypothermia. You scan the skies, hoping and praying someone will come by who can help you.
All of a sudden, you notice a helicopter flying overhead. You wave your hands, and the people from the helicopter indicate that they have seen you. You breathe a sigh of relief and eagerly await their arrival. The people come down from the helicopter and come to you and say, "We're here to rescue you!" You say, "I'm so happy you are here. I was afraid I was going to die." The people then say, "The way we are going to rescue you is by taking away your life preserver." You look at them with a puzzled expression and say, "No, wait a minute, you don't understand! I don't know how to swim!" The reply is, "Well, we're sorry but the only way we know how to rescue people is by taking away their life preservers," which means you have a very difficult decision to make. So you say, "Please wait a minute while I think about what I want to do." You are floating there in the freezing water, thinking, "This feels like a lose-lose situation to me. If I give up my life preserver, I don't know if these people will really help me or if they will leave me to drown. If I don't give up my life preserver, I don't know if someone else will come by before I die of the cold." The people from the helicopter become impatient and say, "Look, we're tired of waiting for you to make up your mind, so we're just going to take this life preserver away from you," and they grab onto it. You instinctively say, "No you're not!" and pull back, and a power struggle ensues. Surprised by your response, the people from the helicopter then say, "Okay, okay. There is one other possibility. If you look behind you, there is a lifeboat that you can take to safety." Given that most people are not trusting of strangers, even those who appear to be helpful strangers, to give up their life preserver right away, you think this through carefully, then reply, "That sounds like a good idea, but I'm going to take this life preserver with me. If the lifeboat sinks, I want to be sure I can still survive."
The Development of an Eating Disorder
Each part of that story represents something in the development and treatment of an eating disorder. The plane represents a person's life. This person is one who outwardly appears to managing life very well. She is also a person who feels she would look better if she lost some weight, which means she could be virtually anyone in our society. At some point in that person's life, there is a crash, which symbolizes one or more of the following seven scenarios:
- A single traumatic event: This is an occurrence that causes extreme emotional pain for the person in the story. Another person may have minimal difficulty facing the same situation, but for her the pain is too intense, and she does not know what to do with it. Examples of such an event include death of a close relative or friend, divorce of parent, leaving home for the first time, rape, abortion, rejection in a relationship, divorce, first sexual experience, or a degrading comment.
- A two- to three-year period of unusual stress or pain: This person would have been able to manage adequately had only one thing happened, but too much happened too fast, and the stress/pain level became too great. An example of this would be the person who leaves home for the first time, has her first sexual experience, is rejected in a relationship, and her mother dies, all within a two-to three year period.
- An extended period of emotional pain: The person has lived in a painful situation for a period of years and finally reaches the point where she can no longer tolerate the pain. Examples include growing up in an alcoholic family, growing up with physical, sexual, or emotional abuse, and living in an unhappy marriage.
- The onset of a mood disorder: All of a sudden, the person begins to experience depression or mood swings at a level of intensity she has never before experienced. She is not able to control the feelings because they are due to bio-chemical changes. Usually, the person does not understand what is happening, feels scared and out of control, and does not know how to or is afraid to ask for help.
- Having been a very sensitive child: In this case, the person in the story was a very sensitive child who grew up in a family in which there was emotional pain that was not acknowledged or discussed. Her family outwardly appeared to be "perfect" and problem-free. Frequently, the family is very religious and spends a significant amount of time attending church or synagogue activities. The source of the family's pain is often very subtle, thus difficult to identify. This child acted like a sponge for the pain and absorbed it, but did not know what to do with it after that.
- A controlling environment: The person either grows up in or marries into a situation in which she has a relationship with a parent or spouse who is a very controlling person. The only way she is able to survive is by giving up her own identity while trying to please the other person. Finally, she reaches a point where she finds this too painful and is not longer willing to do it any more, but does not know how to change.
- Lack of validation of feelings: The people with eating disorders who have the most difficulty identifying a "reason" why they developed an eating disorder are those who grew up in families and/or married into relationships in which there was no overt abuse or problem but rather a very subtle undermining of self-esteem. The person whom this describes is someone who repeatedly experienced lack of validation of her thoughts or feelings. She was given the message that she shouldn't feel that way or that it was wrong to feel that way, or that she was selfish to feel that way. Since she did feel that way, the only explanation she could find as a child was that she must be bad or crazy. Over time, she learned to direct her negative emotions inwardly or to take them out on herself, since direct expression was not allowed.
The common thread in all seven scenarios is that a person is experiencing emotional pain at a level of intensity that she does not know how to manage in a healthy way, mainly because she did not learn to express feelings directly while growing up. Although there is more heterogeneity than homogeneity among families of people with eating disorders, there does seem to be one common characteristic among all the families. Namely, these families do not model or teach how to express feelings in a way that promotes closeness, support, or resolution of conflict. People either express feelings passively (keep them inside, be silent, do nothing), passive-aggressively (agreeing to do something, then not doing it), or aggressively (violent outbursts of anger, physical abuse) with the net effect being emotional distance. Consequently, when the person who grew up in this type of family experiences intense emotional pain, she lacks the tools to talk about it or to ask for support.
It is at this point that something very significant happens. The person begins to focus upon her body or food, looking outside rather than inside for the source and solution to the emotional pain. Once this starts, the person travels one of two paths. Following the first path, she begins to eat and finds in food a source of comfort and nurturing. Food is consistent, reliable, and always there. It is something to look forward to coming home to at the end of the day as well as something to which to turn to when alone and scared. The person finds that when she eats, the pain does not hurt quite so much. This person is vulnerable to becoming overweight or obese due to compulsive eating.
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