Placing the fulcrum
"Prevention of eating disorders" and getting into arguments with people about it keeps me coming back to another visual: the fulcrum.
I think of the factors leading to a full-blown eating disorder as having a different placement on the lever above. I also think of each person has having a very differently loaded lever. For some people they are designed to fall into a break with reality around food and body as soon as given the simplest cue: a random comment leads to a delayed meal and they're gone. For some people they may need a massive set of outside influences at a particular time and... gone.
The big mistake I see out there is thinking that the illness itself is different once tipped. I see no evidence of that. The core illness doesn't seem to be different if the initial diet/restriction was due to a lifetime of pressure or a bad week. Now, the recovery, that IS influenced by environment. A family that can't respond properly, a lack of well-trained clinical assistance, slow diagnosis, mistaken diagnosis, no diagnosis - these all have an impact on recovery. But let's not mistake that for the illness or mistake the severity of the illness for the way the lever got tipped.
What is "prevention" then? Is it keeping all people from the tipping point? Is it identifying people with the fulcrum too far from the weight? Or can we separate primary prevention (community level) from secondary "prevention" and call the first a good social movement and the second "early intervention."
This matters because a lot of treatment is now focused on talking young people out of "wrong" ideas about food and their bodies and appearance. I have no doubt this will keep a small margin of people from being tipped, and will more importantly offer our whole society a great deal less grief and static. But I sincerely doubt if it has an impact on people who are designed to find that tipping point, or that already have.
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