Let’s Stop Shooting the Messenger

By Abigail H. Natenshon, MA, LCSW, GCFP

       Author of When Your Child Has an Eating Disorder

By assuming that aspects of Jewish observance may give rise to eating disorders, are we not shooting the messenger?  Though large numbers of Jews struggle with eating disorders, it may not be our practice of faith, but our turning away from Judaism that is the problem.

The magnitude of the epidemic of eating disorders and disordered eating today clearly qualifies these disorders as public health problems. Though there are 11 million reported cases, vast numbers of victims of anorexia and bulimia remain undiagnosed and do not receive mental health care. Eating disorders are primarily diseases of adolescence.  87 percent of victims are children under the age of 20. Girls as young as age five are succumbing to body image concerns, the compulsion to exercise and to be thin, and to pathological fears about gaining weight.  The most lethal of all the mental health disorders, eating disorders are a misuse of food to resolve emotional problems; they are disorders of self-esteem, self-regulation and life adjustment which occur in approximately 10 percent of women and girls past puberty in America. On college campuses, one out of five girls is a disordered eater, which can trigger the onset of a clinical disease in genetically predisposed individuals.  The incidence of males with eating disorders has doubled within the past decade. 

It is a commonly held belief that there is a disproportionate number of Jews with clinical eating disorders. The Renfrew Center of Philadelphia at one point reported that 12 percent of their inpatient eating disorder population was Jewish, despite the fact that Jews make up only two percent of the general population. Another study in New York showed that almost two-thirds of Orthodox girls are at risk of developing anorexia and bulimia. #1 In actual fact, the extent of the problem among Jews relative to the wider population remains uncertain.  What we do know for certain is that tens of thousands of Jews are struggling with anorexia, bulimia, compulsive overeating, activity disorders and derivatives thereof, a matter of deep concern to the Jewish community.  As a Jew and a psychotherapist who has specialized in the treatment of eating disorders in individuals and families for the past 41 years, I find the implications of the above statistics to be deeply troubling with respect to Judaism and Jewish observance. 

Is there something within the practice, values and culture of Judaism that has somehow led to this pernicious epidemic among Jewish youth?   Data interpretation might imply that this is the case, bringing various aspects of Jewish culture to bear and implicating traditional and Orthodox Jewish observance. In seeking to explain the incidence of clinical eating disorders amongst Jews, incriminating theories abound. Food and eating has traditionally been the centerpiece of Jewish communal celebration, holidays and traditional family lifestyle; “Ess, ess, mien kinde” conjures up images of the stereotypic Jewish mother who demonstrates her love by compulsively pushing food on her reluctant child. Demanding parents who hold their children to rigorous standards of performance have been said to foster perfectionism, or stimulate a “good girl” style of rebellion through self-destructive behaviors and dietary manipulation. Self-starvation has also been considered third generation identification with Holocaust martyrdom.

It is my belief that Judaism and Jewish parenting and family life have gotten an unfair shake. The location of the Renfrew Center close to one of the largest Jewish populations in the world could be a factor in skewing that study’s outcome, as might be the Jewish commitment to the support of family and prioritizing financial resources to maintain a sick child in such a healing facility. A greater prevalence of eating disorders in the Orthodox Jewish community may have less to do with religiosity and the culture of Judaism and Orthodoxy and more to do with the fact that the self-discipline and prescribed precision required for Orthodox observance, when applied to or turned against the self, can result in ritualized, obsessive and self-destructive consequences for individuals who may be genetically predisposed to compulsivity.  

The origins of eating disorders

Eating disorders cross all lines of socioeconomic class, gender, age, color, ethnicity and culture across the board; a multitude of diverse preconditions give rise to disease onset. Research now points conclusively to evidence that the roots and origins of these diseases reside significantly in genetics, in brain and body chemistries, and in personality structure and temperament.  Examples of environmental triggers setting off these genetic propensities would include the restructuring of the American family through divorce, remarriage and family blending, ever-greater numbers of mothers in the workforce, and children left to their own devices to fend for themselves at mealtimes. During the past four decades, increasing numbers of Jewish kitchens are becoming cooking-free, with only 50 percent of American families eat dinner together regularly.

The second most significant factor giving rise to eating disorders is upward mobility, a characteristic that Jews have enjoyed in our society for decades. The 1960’s and 1970’s were notable for the profound transformation in the role of women in society and for the changing structure and values of the American family, Jewish and otherwise. It may not be a mere coincidence that eating disorders, documented since the fifteenth century, only came to public awareness in the early 1970’s. The movement towards women’s liberation became a movement away from the practice of Judaism for a great many families; as women lost significant aspects of their connection with home and family, their children lost their connection with their parents, families and communities, as well as with the values that give life meaning and purpose. Living hectic and hurried lives devoted to the new god of productivity demanded time and energy, and resulted in a generation of Jewish parents who strayed from a commitment to a faith that had for millennia provided a context of learning, morality, education, esteem and identity… that fed and guided them even as they fed and guided their children and families.  Both parents and children have never been as overindulged, or as categorically deprived, of what they need the most.

Adults of all religions spend appreciably less time nourishing children, listening to their concerns, exchanging ideas and observing behaviors, guiding and providing limits and boundaries, structure and security…none of which is without consequence.  Research shows that American parents spend as little as 20 minutes a week engaged in significant substantive communication with their children; 65 percent of children grow up with televisions in their bedrooms, spending on average five and a half hours a day with some form of technology, under-supervised, apart from parental input and guidance, exposed to the tenets, traditions and lures of other faiths and popular culture.  Parents have lost emotional track of their children. Most significantly, parents and children alike have lost track of what healthy eating actually is; they have forgotten, or never knew, that a moderate, balanced and fearless relationship with food is as important a part of healthy living as is sleep, study, work, recreation, relaxation, exercise, or prayer.  By attempting to fill gaping emotional voids and internal emptiness, eating disorders are responses to a sense of alienation and disconnection from others, from the self, and from meaningful living. 

In addition, many parents have lost their sense of obligation and responsibility to sustain a presence in their children’s lives, their feelings of confidence and entitlement to share their wisdom and values with their children throughout the life stages. Some parents, who believe that children are born spontaneously competent, typically withdraw their influence prematurely, operating under the misconception that they have nothing much to teach and that children don’t have much need or use for their guidance anyway, particularly into their teenage and young adult years.  Many parents “walk on eggshells” with their children, particularly when it comes to food, eating and weight management, fearful that any form of confrontation might result in hostility and loss of love. It is not atypical for parents of children with eating disorders and health professionals alike to assume that parental involvement in their child’s healing process is inappropriate and intrusive, breaching confidentiality, crossing boundaries, invading privacy, and negating the child’s burgeoning independence. In actual fact, research has proven otherwise, demonstrating that appropriate and enlightened parental involvement is pivotal in achieving and sustaining a timely recovery for anorexic children who, as a result of their illness, have temporarily lost the capacity to exercise healthy self-regulation.  #2

Judaism as a healing force

The question we need to ask ourselves is “What do our children really hunger for?” And, “Mightn’t the wheel that we as Jewish parents seek to reinvent already exist?” Historically and traditionally, Judaism as a religion is based on human connectedness, responsibility for self and others, and the sanctity of the human body as the house of the soul.  The Torah values food as an object of holiness to be eaten with forethought and consciousness of purpose in prescribed ways, with appreciation, gratitude and structure.  It sanctions traditional roles of parents and children… “Honor Thy Father and Thy Mother”…prescribing a healthful attachment and appropriate bonding and communication between parent and child. 

In fact, evidence indicates that Judaism can be a protection against eating disorders. A study presented at the 2000 Academy of Eating Disorders annual professional meeting investigating the differences in body dissatisfaction and eating disorders between Orthodox and secular Jewish women showed that a higher level of religious observance may serve to protect individuals from the development of body dissatisfaction and overall eating pathology… that a diminished focus on the secular values of beauty and thinness, and a greater emphasis on morality and religious identification resulted in a lower incidence of mental health problems.  The study also showed that stronger social networks and religious affiliation resulted in higher self esteem. #3.  If secular Jews exhibit more symptoms than Orthodox Jews, mightn’t we extrapolate from this study that religious observance by itself is not the determining factor that predisposes Jews towards these diseases, and that it may be the wholesale turning away from the practice of religion that has in some respects contributed to the rampant spread of eating disorders amongst Jews?

Historically, culturally, traditionally, Talmudically, in courts of law and on psychiatric couches, Jews are problem solvers. As a people challenged throughout history, they have had little choice but to become so in order to survive.  Through a profound sense of the value of human existence, a communal and collective consciousness, and the age-old commitment to care for our own, every Jewish child who is ill belongs to every Jewish parent,  just as the story we tell at the Pesach table is each participant’s own personal tale. A tradition of profound self-searching and fearless self-awareness, together with a commitment to proactively-based responses to problems personal and communal set Jews apart from other peoples. Historically, Jews in their searching have looked to Torah and Judaism as an unparalleled source of answers and solutions to problems.  That has been the Jewish way and it has worked for 5000 years.  Why should it be any different now? 

By turning away from Judaism and its values, in essence turning their backs on the priority of family life connections, Jewish parents have minimized their capacity to mitigate the effects of society’s corrupting values on their children.  Lost is the child’s connection to many meaningful issues beyond himself or herself.  Lost is the opportunity to develop the sound judgment, internal controls and moral discipline that come with elements of observance….in all too many instances these voids are replaced by addictions or other extreme and excessive lifestyles. Lost is the potential for the child to become powerfully identified with a prideful history, to develop respect for body and self that comes with an association with a righteous culture and heritage. Lost is the likelihood of marrying within the faith and carrying on Jewish tradition.

Ultimately, Jewish parents and children who turn away from Jewish observance forfeit assets, values and a lifestyle which evoke self-esteem, self-regulation, along with a commitment to healthy living; they forfeit a meaningful, “mitzvahdik” existence which carries with it the potential to minimize behavioral and attitudinal triggers conducive to setting off an eating disorder. As Jews, in negating what is best about Judaism, haven’t we been guilty of shooting the messenger?

Taking action to prevent and heal eating disorders….

1.      Set standards for a balanced eating and exercise lifestyle at home. Everyone in your household should be eating three nutritious meals a day.

2.      Prepare meals and expect your family to enjoy them together as often as possible.

3.      Discuss your thoughts, feelings and values with your children. Speak until you are heard.

4.      Understand how your own attitudes about food influence your child, and try to keep them separate from your child's issues.

5.      Hear the feeling messages behind your child's statements; respond to your child, not to the food she consumes.

6.      Learn as much as you can before reaching out for help. Knowledge is power.

If your child has an eating disorder;

7.      Keep expectations realistic for yourself, your child, the treatment process, and the professionals. Remember that you are dealing with a highly imperfect science and that you need to be involved in the care of children, particularly those who reside in your home.

8.      Set goals for yourself and meet them. They will keep you focused and productive.

9.      Remember that there are many "right" ways to do things.

10.  Begin your foray into the community of health care providers knowing that your child deserves the very best and that your purpose is to make sure she or he gets it.

Excerpted from When Your Child Has an Eating Disorder; A Step-by-Step Workbook for Parents and Other Caregivers (by Abigail H. Natenshon, MA, LCSW, GCFP   Jossey Bass Publishers, page 57)

Jewish Resources for Eating Disorder Prevention

1. Union of American Hebrew Congregations: Litapeyach Tikvah-To Nourish Hope
2. Kolet: Reconstructionist Rabbinical College, Rosh Chodesh group curriculum for disease prevention in the Jewish schools.

Footnotes

1. The Jerusalem Report  July 5, 1999  When the Woman of Valor has Anorexia
2. Dare, Christopher. MD, Eilser, Ivan, PhD;  Family Therapy for Anorexia Nervosa;  The         Maudsley Psychiatric Institute, London, England.
3. Gluck Marci, PhD, Body Dissatisfaction and Eating Behaviors:Orthodox vs. Secular Jewish Women.  St. Luke’s’/Roosevelt Hospital, Obesity Research Center, Columbia University College of Physicians and Surgeons, New York, N.Y.