The notion of self-help is an ancient one. Some American Indian tribes had healing cults in which people who survived a disease became tribal healers. They acquired their knowledge through suffering as they struggled to overcome a particular illness.

Modern self-help groups follow this ancient principle, that people who have emerged from a “trial by fire” can offer guidance to those struggling with similar problems. Self-help groups reflect traditions of self-reliance and voluntarism.

A thread that ties most self-help groups together is support through empathy and mutual affirmation. The groups reinforce change by offering role models for behavior and a forum for sharing successful strategies and attitudes. Self-help groups emphasize personal responsibility and effectiveness-valuable lessons for anyone with an eating disorder. They communicate the message that members are not helpless or hopeless, even though they may feel that way at times.

For some, a self-help group is the first step toward recovery; for others, it may be the only step they take. Ideally, such groups reinforce other kinds of treatment and offer ongoing support through a network of concerned, like-minded people.

Some self-help groups arise because patients feel that professionals have failed to understand their condition or treat it properly. Sometimes groups form because facilities don’t exist in their areas of the country. People may turn to such groups when they can’t afford other treatment.

Let me state my bias clearly: I strongly believe that self-help groups can do tremendous good. Ideally, self-help is a complement to professional treatment, not an alternative. Patients usually do better when they combine self-help with other forms of treatment. Using self-help exclusively can lead to problems if the patient is actively suicidal or psychotic. In these cases, a sensitive self-help group leader can steer the patient to find the professional help she needs.

The chief advantages of self-help treatment include its low cost, its availability (in areas where programs exist), and the limited degree of commitment required. Other benefits include anonymity, confidentiality, education about the illness, positive feelings of effectiveness and self-esteem, an increased sense of control, and the feeling that one is valuable to oneself and others.

How they work: The concept of self-help for eating disorders is about thirty years old. Goals, formats, and principles are still evolving.

Most eating disorder self-help groups welcome both anorexics and bulimics. Some groups start off with a lecture, and then open the floor for discussion. Other groups prefer to let members bring up the subjects they want to discuss. The most helpful part of the meeting may come during the informal interaction afterward, as members chat freely, exchange phone numbers, and share advice.

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The first time she topped 200 pounds was in high school. “At the time, I had a jealous boyfriend,” Susan says. “We didn’t socialize much. In fact, about all we did was eat out. I think my overeating was a means of compensating for a lack of interaction with other people.”

When she was 19 years old, she stopped getting her periods. Her doctor told her that it was because she was so overweight. This ST was the wake-up call that Susan needed. Once she made up her | ^ mind to slim down, she cut her weight by almost half in 1 year. “I | § did it mostly by changing my eating habits and giving up certain fattening foods,” she says. “The trouble was, I never changed my attitude toward food. So once the weight was gone, my old eating habits returned.”

A decade later, with two kids and bills to pay, Susan went over 200 pounds again. “I wasn’t making the right choices food-wise, and I wasn’t exercising like I should have been,” she says. “I can put on weight very quickly, and it came back fast.”

By 1994, Susan weighed 260 pounds. Her back hurt so badly that she had trouble walking, let alone playing with her kids out in the yard. It was time to lose weight again.

While her overall goal was to shed 100 pounds, from day to day she focused only on losing the next 5. Each time she met one of her mini-goals, she rewarded herself with a small treat, like a bubble bath or an exercise tape.

“To wait until you get to your goal to say ‘I’m going to treat myself is too long a time,” says the Warren, Rhode Island, resident. “You need to look at each 5 pounds as something worth celebrating because it’s closer and closer to where you want to be.”

After a year and a few months of sensible eating, exercising, and participating in the support group TOPS (Take Off Pounds Sensibly), Susan had met all of her little goals. They added up to 100 pounds—gone for good.

Inspired by her weight loss and religious about her exercise, Susan became a fitness instructor. And she lost another 25 pounds.

Now in her late thirties, Susan passes along her success story to her support group and at the fitness center where she works. “It

gives people hope,” she says. “They realize that if I did it, they can do it.”

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