ISRAEL has one of the highest eating disorder rates in the world, according to Dr. Catherine Steiner-Adair, a clinical instructor in Harvard Medical School’s department of psychiatry.
While there is sparse statistical data on American Jewish teens suffering from the potentially fatal affliction, Steiner-Adair suggests that Jewish cultural mores can reinforce the disorder.
“There is no other religion that I’m aware of where food is so deeply tied to religion, family ritual and culture than Judaism,” she says.
Steiner-Adair, director of the eating disorders education and prevention program at McClean Hospital, received funding from the Hadassah Foundation to research ethnic specific pitfalls that may contribute to the disorder in Jewish girls.
The result is “Bishvili: For Me,” a Jewish companion online guide to her book, Full of Ourselves: A Wellness Program for Advancing Girl Power, Health and Leadership.
“The whole process of cooking and preparing and eating food, and why we eat it, can be wonderfully nourishing for Jews — but it can also be an area of family enmeshment and power struggles,” Steiner-Adair says.
“For some Jewish women, cooking is one of their most creative outlets, and their domain. How well their food is received is integral to their self-worth. Reject the food, and you reject the woman.”
A daughter who turns down Mandelbrot or extra matzah balls may initially want to express a little autonomy at the all-important dinner table, but if her efforts are met with too much opposition, obsession sets in.
“When a girl feels wobbly about her self-esteem and there’s very little to make her feel more in control, you can see how easy it is to literally weigh your self-esteem,” Steiner-Adair says.
In Jewish homes, it’s not unusual for daughters to hear their mothers talk about food in terms of good and bad behavior.
“A mother might say, ‘I’ve been bad today,’ meaning she cheated on her diet. ‘So tonight I’m going to be good.’
“Some girls sit down to Shabbat dinner and say to each other, ‘Let’s be really bad.’ They’re not talking about gossiping or refusing to help someone in need. They’re talking about how much food they’re going to eat.”
Shrinking one’s waistline to gain a sense of control — over parents or internal chaos — is a significant factor in the development of eating disorders.
Add the demands of the dominant culture, and complications explode.
WITH Twiggy’s appearance in the 1960s, nearly every young American woman began idolizing the super model whose gaunt frame and skinny legs revolutionized the feminine figure.
“We were told that to be truly successful, you needed to be as thin as possible –– and then make yourself even thinner,” says Steiner-Adair.
“Succeeding through education and achievement is a Jewish value. There’s pressure not only to change the world, but also to be the most successful person you can be.
“When the dominant culture says the best thing you can do to ensure success is work on your appearance, and if you don’t feel confident academically or in other areas, you focus on body image.”
Steiner-Adair’s book is designed for young women 8-21. Her lectures target the parents of children as young as three.
She has identified a cluster of personality traits associated with eating disorders: sensitive, intelligent, eager to please, low risk taker, anxious, high drive for achievement.
“How many Jewish people do you know who fit that bill?” she asks rhetorically. “A lot. Whether that’s nature or nurture, we don’t know.
“But the more you start to restrict food and buy into cultural messages and the gender socialization of girls, this becomes a real thought disorder.
“What people don’t realize is that eating disorders are serious thought disorders, and they need to be treated.”
The treatment of anorexia, bulimia and related behaviors often involves years of therapy. In life-threatening situations, patients could be hospitalized.
But eating disorders are never the real problem, Steiner-Adair emphasizes.
“They are symptomatic of a deeper problem — a sign that something else is eating away at the individual.
“And this is really important to understand.
“This is not just about a bunch of spoiled girls skipping lunch or throwing up in the bathroom. Eating disorders are a coping mechanism.”
Depression, anxiety and other psychological complications can trigger a host of dysfunctional behaviors —including eating disorders.
“However, an eating disorder is a culturally mediated illness,” stresses Steiner-Adair. “They do not need to exist.
“In other words, people have always had depression, anxiety, obsessive compulsive disorders. But there were no records of eating disorders prior to the 1960s.”
Steiner-Adair says that eating disorders have the highest mortality rate of any psychiatric illness — even severe depression with suicidal ideation.
Eighty-five percent of people with eating disorders are women.
“There is no other psychiatric illness that is so stunningly gendered.”
ONCE a person develops an eating disorder, the anticipated cure rate is what Steiner-Adair calls “one third, one third and one third.”
About one third make a complete and lasting recovery.
An estimated 30-35% recover until something upsetting occurs. Then they revert to the old coping mechansims — but ultimately get better.
The remaining 30% “live with it their whole life — and 10% of these people will die from it.”
“The most important thing in terms of improving the chances for recovery is early intervention and treatment,” Steiner-Adair says.
“That’s why it’s so critically imperative that we do a lot of prevention in the Jewish community.”
She adds that it is “perfectly fine, and safe, for families to seek help for a loved one. We don’t criticize the family. We don’t judge parents. We help them.”
Steiner-Adair hopes that “Bishvili: For Me” increases Jewish teens’ resistance to the glamorization of anorexia in America and also strengthens their connection to Judaism’s core values.
Her pioneering work in America and Israel has taught her that one case is one too many.
“It doesn’t matter whether there are more cases or fewer cases in the Jewish population.
“What matters is that there are any –– and what we can do about it. We need to pay attention to this, period.”
Information: www.bishviliforme.com.