December 9, 2008

Necessary vs. sufficient: Looking for love in all the wrong places

One of the issues in Social Sciences that is often utilised is whether a problem is necessary and sufficient. While it is easy to confuse the two, one is a necessary condition and the other, given the necessary condition, is sufficient to make it happen. For example, it’s necessary to have food available if someone is going to survive. What’s sufficient, however is the conditions that connect the person and lead to the person over-eating. One stage is necessary; the other one makes the event happen.

Getting away from the intellectual to the practical – eating disorders are relevant to the world of eating disorders. While it is necessary in many situations, especially for women, that there be a culture of thinness, women should be thin, that’s not sufficient to cause the eating disorder. If it were sufficient, anorexia would not be a rare disease.

The number of women in New Zealand and America with anorexia is tiny. So what makes the difference? One concept we use with our clients is the idea that when the woman feels bad about herself, something is going on in her life that is making her feel bad. She says to herself, “I would feel better if I weighed less or dieted and got down to a size 6”. Of course, this becomes dangerous, as anorexia as well as other eating disorders, have their own tyranny – that is, if someone gets thin enough, they can’t force themselves to eat.

To coin a phrase – they are looking for love in all the wrong places. It’s not women’s eyes that are smaller than their waistline they are transformed what is making them unhappy. What’s really making the difference is their relationships and those paradigms and people that are making them unhappy.

In my experience, when I have asked people ‘what makes you unhappy?’ they reply ‘themselves’. But that won’t lead to change. We are all unhappy with ourselves at various points. What will lead to change is looking around and seeing what are the relationships that are making you unhappy.

For example, a young woman who I am working with had a very bad week. She doesn’t understand people who are making progress with her weight control (in terms of her compulsive over-eating), just couldn’t understand why suddenly she had the worst week in 3 months. In therapy, I asked her ‘what was happening in her relationships that were making her so happy?’ Suddenly it dawned on her that the child she was caring for was going to be leaving her. Her mother had lost her job and wanted to care for her baby full-time. This young lady and her mother was devastated. Again, the focus is on the stress and out-of-control behaviour. She was so miserable and felt that food addressed the sadness that now surrounded her.

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  • carole: this makes a lot of sense to me too.I instead of asking and asking for help with my partner and kids do the...
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Book: Enduring Change in Eating Disorders

Enduring Change in Eating Disorders - Book Cover

Dr Fishman is the author of 'Enduring Change in Eating Disorders – Interventions with long -term results' (Brunner-Routledge 2004).

This book presents the powerful and proven effective model of Intensive Structural Family Therapy and its application to the treatment of eating disorders.