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Companion Guide for A Season in Hell

QUESTION 5: WHAT ROLE, IF ANY, DID REGINA'S FAMILY PLAY IN THE DEVELOPMENT OF HER EATING DISORDER?

A Season in Hell is not only the story of Regina's eating disorder, it is also the story of a family. In the course of the film Regina's parents make many statements about their lives together, their attitudes toward raising children, and their anguished struggle to understand Regina's eating disorder and to get help for her. On the basis of these personal revelations, students will tend to form impressions of what it would be like to have Bob and Grace as parents. This speculation will in turn probably raise questions about the family's role in the development of her eating disorder.

Based on the information provided in this video, it is impossible to answer these questions directly. Because this film is about Regina, we simply do not get enough information about the nature of the family and its interactions with her prior to the onset of the eating problems. And, even if we had more facts, current research on the role of the family in eating disorders does not provide a clear sense of what we should be looking for in Regina's family. Nevertheless, since questions about the family are bound to arise, the following may be useful in guiding the discussion.

Points to Keep in Mind When Discussing Families and Eating Disorders

(1) Very few studies are designed well enough to permit valid conclusions about the role of the family in the development of eating disorders.

(2) Even the well-designed studies of patients and families are conducted after the patient has the developed the eating disorder. This makes it very difficult to determine whether the family characteristics reported by the patient and family members are a cause or an effect of the eating disorder. A hostile, frightened child who is out of control will create serious dysfunction in most families.

(3) A sizable minority of families with an eating disordered child cannot be distinguished from families with no problem children. Thus, the assumption that families must play a role in the cause of the disorder is untenable. Regina's parents may not have played a direct role in the evolution of her eating disorder.

(4) The problems noted in the families of eating disordered patients are usually indistinguishable from the problems observed in the families of patients with other psychiatric problems. In addition, as it is the case if Regina's family, it is often only one child within the family who develops the eating disorder. This reaffirms that eating disorders reflect the intersection of various factors, including the personality of the child.

(5) Whether one is a student trying to understand eating disorders, a friend of the family, or a therapist, it is useless and potentially harmful to blame the family for an eating disorder. Families are important resources for the child and for people trying to help. Consequently, people must try to understand the anger, pain, denial, and fatigue which A Season in Hell portrays so poignantly.

"As therapists, we are, first and foremost, concerned with building up a constructive and collaborative relationship with the family and especially the parents: we need their cooperation, and they need at least our support and understand." (Dr. Walter Vandereyecken, 1987)

A Capsule Description of Dsyfunction in Families with Bulimia Nervosa

Demographic and psychiatric characteristics. Statistically speaking, these families tend to be middle and upper-class, and thus they are achievement-oriented and appearance-conscious. Compared to the general population, the mothers are more likely to be very overweight, chronically ill, and clinically depressed. Fathers are at a greater risk for substance abuse. Not surprisingly, the risk of eating disorders is greater for the parents and other children.

Regina's family is working class. This illustrates the important point that all eating disordered people do no come from the upper socioeconomic classes. Like many mothers of girls with bulimia nervosa, Grace is overweight and has a chronic illness (diabetes). Bob does not have a substance abuse problem. Grace, at least, wants her children to leave behind "the rough ways" of farming, but we do not know if this translates into a status-conscious achievement orientation. Bob does not appear to be "status-conscious" in this sense, but he does focus critical attention on Regina's tendency to be overweight, thereby supporting many of her efforts, healthy otherwise, to reduce. Grace, cognizant of her family's genetic tendency to overweight, is certainly not driven to mold her daughters into the slender image of current feminine success. We believe her when she says that "It's the person and your feeling toward them" that determines attraction, not whether they are heavy or thin.

Family dynamics. Families with a bulimic daughter tend (keep in mid the qualifiers listed above) to be characterized by high levels of conflict and low levels of cohesion, independence, and emotional expression. Family members clash over many issues, but an unspoken family ethos prevents individuals from being assertive in establishing their own identities and in constructively expressing their true feelings. Moreover, family members are inconsistent in their support of each other and the family as a whole. All these negative influences combine to promote emotional instability, hostile dependencies, interpersonal mistrust, poor problem-solving skills, and the tendency to act out as a form of tension management and aggressive communication.

It seems plausible that the type of family described in the previous two paragraphs would increase the risk of an eating disorder. Growing up in such an unstable and emotionally distorted atmosphere would make it difficult to (a) recognize and express needs and feelings; (b) control them in accordance with (high) standards; (c) develop effective coping skills; and (d) establish both autonomy and the capacity for healthy relationships. Conversely, it would be easy to (a) become sensitive about weight and food; (b) develop inflexible standards of good ( = totally in control) vs. Bad ( = out of control); and (c) turn to the extremes of eating and weight management in an attempt to be in control or give in to hopelessness, indulgence, and anger.

As noted previously, we do not have enough information to determine whether Regina's family is the type of dsyfunctional family statistically associated with bulimia nervosa. In fact, the film reveals only five things about her family's "dynamics":

(1) When Regina was in high school, her father (who "likes things simple") and she clashed over shaving her legs, wearing tight jeans, earrings, and make-up. Bob had similar disputes with Robin. This raises the possibility that as a father Bob was intrusive and overcontrolling.

(2) When Regina was in high school, her father criticized her for being overweight as a result of poor eating habits.

(3) After Regina started dieting and going out with boys, she and her father had numerous angry confrontations, one of which resulted in her punching a hole in the wall by the telephone.

(4) When Grace wanted to lose weight, Regina cried and begged her not to do it, claiming that she would no longer be the mother Regina knew.

(5) Regina's eating disorder caused her parents to suffer terribly.

Points 1-4 suggest problems with conflict, emotional expression, and the "boundaries" between Regina and each of her parents. However, Point 5 reminds us that cause and effect statements are impossible to make with any real certainty.