The Risk of OWN-ing Rehab.
Two weeks ago, I received a newsletter from Darryl Roberts, the filmmaker behind America the Beautiful, commenting on the brewing controversy around a new show from the Oprah Winfrey Network. The show — Inside Rehab — is a “reality show,” in the vein of Celebrity Rehab and Hoarders, which — (according to the network) — “gives viewers a rare look inside an eating disorder treatment facility where patients face their demons and struggle to come to terms with what’s behind the food.” The responding outcry — particularly among ED-recovery advocates, — is largely an argument that these “inside” looks are rare for a reason. The advocates, ED experts, and bloggers whom Roberts showcases argue that the show recklessly exposes already at-risk patients to further risk, as well as potentially triggering viewers into ED behavior, and contributing to stereotypes about what eating disorder patients (and eating disorders more generally) “look” like.
All of these concerns strike me as pretty well-justified. For starters, a growing body of research dissects the assumption that eating disorder education (e.g. offering information about symptoms and health risks) actually works to prevent eating disorders. Personally, I remember being stunned, during my own time in residential treatment, by how many of my fellow patients had watched (with the expected shock and disgust) the same after-school specials, read the same anti-ED memoirs, and viewed the same documentaries, only to eventually develop the disorder. While I don’t presume there’s a causal link between an exposure to information and an ED diagnosis, I do question the typical belief that the more information people have, the less likely they are to get sick. It strikes me as overly simplistic, and unrealistically reliant on an assumption that anorexic and bulimic individuals choose — out of naivete or deviance — to make themselves ill. Imagine a proposal for cancer prevention that relied solely on educating people about the terrible toll cancer would take on their health. The tactic seems ludicrous. But somehow, it’s less ridiculous when it’s applied to a mental illness, specifically one that we, as a culture, continue — on some level — to admire.
A focus on residential treatment is likely to reinforce stereotypes about who suffers from an eating disorder, as upper-class White girls are significantly more likely to be diagnosed and to receive treatment that remains impossibly expensive for those with lesser means. (More than eight years ago, when I was in residential, the cost was upwards of $400 per day, with an average stay between two and three months). Doctors, too, remain invested in the stereotype that constructs anorexia and bulimia as a disease limited to female teens, making it easier for them to miss (or dismiss) symptoms in other populations. And, given that the diagnostic criteria continue to rely on the long-term symptoms and physical consequences of ED behaviors, those in residential tend to be “at their worst.” The show’s focus, therefore, fundamentally limits its scope. It emphasizes once again the most common image of an anorexic person: the emaciated rich girl, whose life has been fully overtaken by her disease.
Part of the problem with this focus is its automatic dismissal of other, equally important, points. Where, for instance, is our “education” about disordered eating? Where is our discussion of media literacy, and our exposure to strategies for coping with messages — like the ones Oprah herself regularly communicates — about weight gain as a shameful failure and food as a villain to be battled? Where is the discussion of the post-crisis recovery experience, those impossibly isolated months that follow discharge from a hospital? Where is the representation for the experience, years into recovery, of having to deal with sudden weight gain? Or of being at a “healthy” weight and knowing that everyone in your immediate circle has taken that to mean you’re cured? A focus on residential treatment offers the full reality of the one image the media loves to exploit: bone-thin anorexic and bulimic teenagers destroying themselves, while altruistic treatment teams battle to save them. The narrative arc depends upon a question of whether they will be converted into hating their diseases as much as the medical professionals treating them, and neatly positions their commitment to recovery — (if/ when it comes) — as a sucessful resolution to the plot-problem of their disorder.
But eating disorders are not a linear story. Recovery is a cyclical experience of forward and backward movement, a spiraling relationship with food, psyche, and self. I resist the term “recoverED” for creating a dangerous expectation of the ED as ever fully “past tense.” I argue that this can — particularly for the perfectionist personalities who tend to develop eating disorders — create yet another standard we cannot fully live up to, and I firmly believe in a new model that works to understand recovery as an ongoing relationship, rather than a task we can “complete.”
That same argument applies against the kind of representation Inside Rehab proposes. The structure of a television drama, in collaboration with the structure of short-term residential treatment, creates an unrealistically simplistic representation of recovery. The result is edited, not only for time, but for content. As a genre, television dramas have an inherent bias toward specific constructions of exposition, climax, and resolution, which fail the very real story (or rather, stories) of lives lived with EDs.
And let’s not forget, when we talk about Inside Rehab as a television drama, that we are actually talking about a more specific subgenre: the “reality” show. Even understanding that MTV’s conception of the Real World differs significantly from our everyday experiences, we continue to place undue authority in networks like TLC and A&E , authority we might not grant to Vh1. Likewise, “documentary” reality shows, unlike the more overt competitions and catfights we tend to think of first when considering “reality TV,” still benefit from our sense that documentary-filmmaking, like journalism, is somehow “objective.” But how far-flung are documentary shows from any other reality-tv “guilty pleasure”? How much does the proposed “vote for your favorite patient” feature really differ from phoning in your support for an Idol contestant? And how does competition function in the recovery process?
Reality TV, specifically, thrives on the viewer’s desire to identify with and against the “characters” on screen. You are not just “Team Jacob,” you are also anti-Team-Edward. Like any stock production, a reality program needs its villains as well as its heroines. Our discussion boards and blogs are full of gossip about who we love and who we hate, even though — inevitably — the actual people are more complicated than their character types.
The “Reunion” special following the first season of Celebrity Rehab provides a perfect illustration of this genre in action. After 10, hour-long episodes consistently framed Vikki Lizzi as the show’s token villainness, host Dr. Drew Pinsky spoke a single sentence — during “Reunion” — in her defense. Pinsky attempted to call into question the way the show’s editing framed Lizzi personally, and the extent to which it undermined her support of partner Jeff Conaway. His paltry defense could hardly compete with the hours of footage offering Lizzi up as the token One to Hate. Pinsky’s revision, however well-intentioned, could not re-edit all that editing.
Knowing how common these stock characters are, it’s irresponsible not to ask who will get to be the villain of Inside Rehab. Who will be eviscerated via Twitter? …And who will be the darling with new, nationwide expectations to live up to? …How will the running commentary on who’s pretty, who’s not, who’s skinny, and who’s not aid in the recovery process?
(The “education” process, after all, is unlikely to address those issues.)
The advocates and activists uproar-ing over this show have raised important points. My own primary problem with the production is the lack of critical thought behind it. Instead of anything truly groundbreaking, truly empowering, it’s just another installment of an old-school narrative, already shown to do more harm than good. Perhaps the most powerful experience in my own recovery has been the restoration of my “voice” — the right that I’ve claimed, to actively tell my story my way. This production steals that right — integral, in my experience, to sustaining recovery — from the patients in this facility. It edits their experience to create a story that does not serve them, or — necessarily — its viewers. It serves, first and foremost, the pocketbooks of those producing it.
And its expense is greater than they realize.
(If you take issue with Inside Rehab, you might consider contacting the Oprah Winfrey Network, speaking with the residential facility that has agreed to allow filming, or joining the Facebook-based effort “Just Say No to Inside Rehab.”)