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June 5, 2010 / missmarymax

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.”)

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11 Comments

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  1. Cherrie Herrin-Michehl, MA, LMHC / Jun 6 2010 3:06 am

    You offer a great deal of wisdom about the damage that could erupt if a reality show entered the doors of an eating disorder clinic. I can tell you have a wealth of information and a powerful story about living with an eating disorder. I am a licensed mental health counselor and am writing a book on the underlying issues of body image/food problems. As you are fully aware, these issues are much more about the pain in our hearts and our stories than they are about fat and calories. Until we deal with these underlying issues, we cannot fight the Body Image Bandit and win. (But as you said, it is certainly a voyage and not a destination.) Please check out my blog if you get a chance, which is based on the book. I would love to hear your thoughts. Take care, Cherrie Herrin-Michehl, MA, LMHC http://www.cherriemac.wordpress.com “Fannies: Reflections on Cookie Dough, Life, and Your Derriere”

    • missmarymax / Jun 7 2010 3:08 am

      Thank you so much for the kind words. I really appreciate them, and looking forward to reading more of your thoughts, in your blog and elsewhere.

  2. VoiceinRecovery / Jun 11 2010 3:28 pm

    Kudos. A VERY thoughtful and insightful post. I think the last paragraph was the most important. In our own recovery finding our “VOICE” is so important – hence why I started ViR(tm) – because I wanted to hear from the individuals. I think a production isnt a pure voice of the person struggling. I wonder too if it is possible to do a production/documentary on EDs in an honest way, bringing awareness, sharing the struggles, what recovery looks like to a person without exploiting the individual and twisting their words. But you are correct – reality to has proven it is NOT the way to do this.

    • missmarymax / Jun 11 2010 4:17 pm

      Thanks so much!

      There was a documentary that Stacy Pershall was working on, awhile back, which I REALLY wish had gotten the funding it needed. (It’s been put on hold, possibly indefinitely, due to lack of funds.) While there would still, certainly, have been a filter between the voices of those in recovery (still a production, still being edited, etc) Pershall and her partner Alice Brooks had a really phenomenal idea, in my opinion, that involved incorporating footage shot by the patients themselves, and refusing to show the triggering behavior these films generally exploit. They said this decision was not intended “to shy away from the reality of the conditions […] but to glorify recovery” — an idea I TOTALLY love. They also insisted that “Although relapse is certainly part of EDs and SI, it is not the story we want to tell. This is a story about finding a new, positive obsession to replace the old, negative one.” (http://tinyurl.com/26st5n7) While I’m sure it wouldn’t have been perfect, I thought their proposal was a groundbreaking challenge to the traditional narrative, and I wish it had found more support. If only OWN would forget this whole Inside Rehab debacle and fund Pershall instead! 🙂

  3. Casey / Jun 11 2010 4:42 pm

    Great points in this article!! Thank you for putting such a strong and dedicated voice to the recovery process!! I agree with you 100%. Looking back on my stay in residential and inpatient treatment – to be recorded alone, would have greatly hindered my progress.

    • missmarymax / Jun 14 2010 3:49 pm

      It would have hindered mine, too. Thanks so much for the support. We need as many strong voices as we can gather. 🙂

  4. Molly / Jun 15 2010 5:53 am

    This is incredibly written and I agree with you, 89045677%. I wish my voice was strong enough to put all of this to rest, but at least I know there are people like you who are thinking along the same lines I am! ED Recovery is so hard, and I am appalled that Oprah can’t see how much harm this kind of show could do. It’s such a fragile topic, and all I am saying is that I don’t think Oprah is educated on this enough to create a show out of it. I’m dreading the impact this show could bring on the already stereotypical society. If you need anyone to back you up, email me! mollylk393@gmail.com. You are so insightful and admire you for this! Keep up the great work!

    • missmarymax / Jun 16 2010 3:09 am

      Thank you so much, Molly. One of the things that keeps me voice strong is hearing from other people who so sincerely appreciate what I’m using it to say. I completely agree that Oprah is not yet educated on this topic enough to produce a show like this, and I sincerely hope that she and the other people with the power to take action will listen to those of us who are trying so hard to educate them. In the meantime, I do want to say that I hope you won’t downplay your own strength. I’m not sure what you feel your voice isn’t yet strong enough to put to rest, but — in my experience — that’s an ongoing process that you just keep working at. Speaking on your own behalf and on behalf of what you hold true can go a long way… and it seems to me you’re doing here. Keep at it, lady.

  5. Jennifer / Jul 7 2010 11:56 pm

    I can see how a view into treatment from a media sensationalized perspective would enhance stereotypes about what an ED pt looks like…if they did a real look into treatment, however, with portrayals of ALL the demographics ED’s effect then I think it would be beneficial for awareness measures.

    • missmarymax / Jul 8 2010 6:20 pm

      Interesting point, Jennifer. Can you clarify what you mean when you mention awareness? Although, as I’ve outlined here, I don’t think reality television is the right forum for this discussion, I definitely agree with you that it’s important to educate people about the experiences of people with EDs. There are certainly a lot of misconceptions that make living with and/ or recovering from an ED an even more difficult experience than it needs to be. However, I’m always a bit wary of the idea of “awareness” when it comes to EDs because — although it’s always well-intentioned — it’s often assumed that “awareness” = “prevention”… Basically, we tend to pretend that if people know eating disorders are dangerous, they won’t develop them, even though the research says otherwise. So I guess I think that it’s particularly important to weigh the risks of this material, given that its potential for triggering/ exploiting people often outweighs its ability to prevent.

      Have you read this post at EdBites? It’s a really good articulation of what I’m trying to say. (Better than I, in my current sleep-deprived state, am managing. ;)) http://ed-bites.blogspot.com/2010/02/on-nedaw.html

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