Anorexia is the most serious of the eating disorders because it deprives the body of essential nourishment, and can bring its owner close to death. When the brain has limited nutrients, thinking and judgement become impaired, and the self image warped. The opposite behavior, overeating, can also become life threatening.
As mentioned in the blog about the 3 negative feelings, Anger, Depression and Anxiety, it has long been known that Anger and Depression are opposite poles of emotion that vary inversely. That is, they act like a seesaw, so that when Anger goes up, Depression goes down. Conversely, if Depression is high, it means that Anger is too low, angry feelings are weak, and the client’s aggressive thoughts and feelings need to be brought to the forefront. For example, we know that Anger is the most prominent feeling in a person who seems constantly irritable and acts out of Anger, such as one who commits criminal acts, has temper tantrums, hurts others physically or verbally, or is otherwise socially defiant and oppositional. We know that Anger is the most prominent motivator or impetus behind this person’s behavior. Therefore in therapy the resolution to an Anger problem centers around bringing the person into greater touch with their Depressive feelings, making them more aware of the emotional pain they may have suffered, in their past, for whatever reasons. For example in working with a person who commits criminal acts we need to work on softening and mellowing her/his Angry feelings by increasing this person’s conscious awareness of her/his Depressive feelings, deep rooted sadness, sense of failure, abandonment, loss, etc. We do this by acknowledging this person’s defeats and losses in life, their attachments to others who have failed or hurt her/him, the unfair circumstances they may have had to bear and in effect, the entitlements they missed out on that happened either randomly or were deliberately brought on by others. These actions and in particular, our understanding and empathy with their losses, humiliations and insults, serve to mellow angry feeling and increase this person’s empathy with the sadness and suffering of others.
On the other hand, when faced with an individual who is displaying signs of Depression as demonstrated through pervasive feelings of deep sadness, low mood, discouragement, poor self-image, inertia and such, the task of the therapist is to try to bring more Anger into this person’s consciousness by gently but cautiously accelerating their sensitivity to and expression of Angry feelings toward those who may have hurt them. Thus we investigate the instances when this person felt disgraced, put down, or less worthwhile than others, such as during instances of bullying in school or at work, or discrimination by parents as compared with a sibling. Then, either by means of direct instruction or by using indirect means such as validation of injured feelings or gentle suggestion, we help the person come in touch with the feelings of Anger they must have experienced when they felt wronged, humiliated, and needed to find revenge; or situations where they must have felt Angry, but did not respond with sufficient aggression toward their opponent when they were unjustly treated, such as in a case when they were outnumbered, or overpowered by older or more aggressive opponents. There is a need to increase the sense of self-esteem, enhance the appreciation of the self and the self-image, and advance the feeling of entitlement as compared with others.
Most often, the therapist’s recognition and validation of the client’s feelings of unfair treatment by others, belittling, bullying, neglect or physical or verbal abuse, that have resulted in their sense of inferiority is sufficient. Depressed people typically show a lack of will to assert themselves or affirm their needs, and are characterized by meekness and self-deprecation, making the job of the therapist that of bringing about the appropriate reaction of Anger and self-righteous entitlement either for the hurt feelings, or for the actual reality of having been treated unjustly.
When we can combine these strategies with our empathy about their plight, strangely in the mystery that is life, and that is the process of healing, an essential component of recovery from Angry or Depressive feelings seems to be that they must become intertwined with the love and understanding of an outan outside human sympathizer. External validation of the suffering that an emotionally ailing or needy person endured, coming from us, like the caring they must have missed from a loving parent in their past, expands their capability for empathy with the plight of others. Most difficult of all, we must put aside our anger with them and their actions, restrain our accusations and punishments for their deeds, and allow them to cry for themselves and their losses. Through our empathy, they will develop the capacity to feel for others, feel remorse and take responsibility for their actions, and even come through by feeling apologetic. The process culminates in making them better, more charitable human beings, better members of society and better parents themselves for future generations.
The essential concept that is missed in the understanding of eating disorders such as anorexia and obesity, is that the struggle is not a matter of eating at all. To believe that the anorexic has an eating problem and that it is best treated by teaching the subject how to eat and spend countless hours, amounts of time interacting, and research monies on devising various methods of feeding and “coaching by the spoonful” is nothing less than nonsense. In essence and in regard to their motivational sources, we must first acknowledge that ANOREXIA AND OBESITY ARE FIRST AND FOREMOST A WISH FOR DEATH – A DISGUISED ATTEMPT AT SUICIDE. The depression is genuine and profound, and the self-image is so negative that no matter how many compliments come from others, or to what degree the ideals of beauty are achieved, the self-hatred and sheer amount of Anger turned against the self remains unflinchingly primary.
In one case of severe anorexia a 19-year-old young woman had been a psychiatric in-patient and under treatment with two different therapists for over 2 years and was close to dying, with little change in her status. Concerned about her welfare, the chief psychologist solicited help from an online psychologists’ listserv. I contacted him by phone, at which time he mentioned he was very grateful since nobody else had contacted him, not even by email. I asked him about his patient’s background, and he informed me that she had been sexually abused by her stepfather.
In a brief conversation that lasted about 10 minutes, I explained to this concerned professional that the thrust of therapy should be first to validate her Anger with her stepfather, providing empathy with her genuinely serious and the admittedly horrendous plight she had faced at home. Secondly in order to bolster her Anger, I advised him to let her know she is, in reality and in fact, entitled to the moral support of those around her, the staff and society in general, for the heinous situation she had endured. I advised him that staff should even assure her that if she chooses, she need never return to her abusive home environment, where her mother had neglected her abuse, or worse yet, been jealous of her. Moreover I recommended that hospital staff should support her in finding a new residence. I told him he could even suggest to her that staff would support and assist her in laying criminal charges against her stepfather, if she chose to do so.
FINALLY ON A PSYCHOLOGICAL LEVEL, I explained that if she were to come to terms with her Anger, SHE WOULD WANT TO EAT IN ORDER TO BE ABLE TO CONFRONT THAT HORRIBLE MAN WHO HAD PERPETRATED THESE EGREGIOUS ACTS ON HER! This young woman was discharged from the hospital in a few weeks.
Rather than a disorder of consumption or eating then, anorexia is a problem of Anger turned inward, of self-punishment and self abuse. Once Anger is redirected toward the appropriate target on the outside, symptoms miraculously disappear. Anorexia, not unlike many other mental and emotional disorders, is a disease of self-hatred, sometimes more extreme and sometimes less so.