The grave misunderstanding in the treatment of Eating Disorders such as Anorexia, Obesity or Bulimia is that the struggle does not concern eating at all! To believe that an Anorexic only needs to be taught how to eat, spend hours convincing them to eat and practice “coaching by the spoonful”, shows lack of attention to the motivation behind the behavior. Built around these methods are hours wasted and money spent on research. It should be obvious by now that the problem is NOT with food at all but with something far less superficial than the eating or self-starving behavior we see on the outside! Common sense tells us we are born with a natural desire to nourish ourselves for survival. So why would a person eat so little that they could die, and not even care about what they are doing to themselves?
In Anorexia and other eating disorders the person feels badly NOT about eating, food, their body image, or their physical appearance. More profoundly, they feel badly about their own person – the person inside, whom they perceive as a failure and an object fit for criticism. Their behavior tells us the Anorexic is in a mental-Emotional mode of acting against their own best interests, and against their own inner SELF! They are fighting with their inner self-image and sense of inadequacy, as opposed to their outer body profile. Their behavior betrays this feeling of insufficiency, and tells us that this feeling grew so strong in childhood that by their youth it turned against their own SELF, and erupted into full blown SELF hatred. The facts indicate that they learned to HATE THEMSELVES so much that they became entirely SELF destructive!
On a psychological level, the inside, inner SELF is completely separate from the outer body profile we see from on outside. The outward visible body is rarely, if ever, the problem. Rather, the problem is with the owner despising the inadequate inner SELF. That this, this feeling of inadequate SELF or SELF hatred went so far as to cause them to stop eating to the point where they are unable to sustain their own bodies, or in obesity, let it grow to extreme proportions. Their behavior betrays their deepest inner secret: that they genuinely and profoundly hate and want to destroy their SELF – both inside and out! Herein lies the error made by current treatment. It is that the self-image, which relates to SELF-LOVE and how a person feels about her/himself on the inside is separate from the body profile that others perceive on the outside. The outside is only the physical exterior and what we can see. But it is the INNER FEELING of SELF that is negative and derogatory.
In normal life the SELF should be felt as LOVABLE, LOVED, cherished, respected and believed to be fully worthy of honor. Instead, in Anorexia the SELF is felt to be poor, inferior, undeserving of respect and blame-worthy. Therefore regardless of how they may look to us from the outside, the eating disordered person feels that their inner SELF is so bad, defective or unworthy compared with others, that it deserves to be destroyed!
In fact our proof that the INNER FEELING of SELF is negative is that no matter how many compliments come from outside, or to what degree an Anorexic achieves the ideals of beauty in reality, it does little to console them. Their emaciated appearance does nothing to change their behavior. Their disordered eating, as their symptom or expression of their distress about themselves remains stubbornly and unflinchingly constant, as in “It doesn’t matter if I look okay or not to you. I still HATE MYSELF and will continue trying to correct me!”. Consequently, despite our best efforts to convince them otherwise, they persist in punishing and harming their innermost SELF!
Now turning to our Emotional analysis, in human experience SELF-HATRED is the essence of DEPRESSION. And this Depression is always accompanied by its natural companion, Anxiety.
So we can conclude that anyone who develops a severe, diagnosable eating disorder such as Anorexia, is essentially DEPRESSED. Moreover, this DEPRESSION has reached a crisis point where they actively WOULD LIKE TO DIE, WANT TO DIE or ARE CHOOSING TO DIE rather than live. Their observable behavior reflects an unspoken inner DEATH WISH! They are merely communicating this intent through the medium of their feelings and attitude toward food, whether self-starving, overeating or otherwise. From this we can conclude that Anorexia, or any other serious eating disorder, as well as any other mental disorder that is fueled by Depression and Anxiety is an undeclared, disguised or VEILED ATTEMPT AT SUICIDE!
Treatment
How then should treatment proceed with eating and other disorders that are rooted in a similar Depression/Anxiety combination? Well, working within DOLIF and the realm of Emotions, we do NOT attack the behavior itself, try to knock sense into the person, aim to reverse their symptoms, nor recite “tips” on how they should correct their attitudes toward life. To start we know that, as with most mental disorders, the prominent Emotions are Depression and Anxiety, where Depression is primary and Anxiety is attached to it. In addition we learned in another blog that Depression and Anger are opposite ends of a seesaw, such that when Depression is high, Anger is too low, repressed and hidden outside the reach of the bearer. Conversely when Depression is low we can guess that Anger must be high, and we can expect this to be expressed through aggressive behavior such as rebellion or criminality. It means that Anger and Depression are natural camouflages for each other and when we see Depression, we should look to unearthing the Anger below it. Conversely when we see Anger, treatment should aim to uncover the Depression beneath it.
Because we know that Depression is high in eating disorders, Anorexia must be an expression of profoundly embedded ANGER that is directed against the INNER SELF, albeit misguided. Through their SELF-harming behavior then, the Anorexic is communicating to us that their Anger is not directed outward against others as it should be, but is being turned inward against the SELF, and aimed at compromising and upsetting not only their physical body, but also their own Emotional stability. So in line with this Anger-turned-inward psychological base, the Anorexic beats her/himself up mentally, and becomes DEPRESSED, as in “I am a terrible person and worthy of nothing but destruction. The Anger consists of hostile SELF-HATRED that is directed against their own physical person and personality, and is overwhelming them and driving them to hurt or destroy the SELF. In other mental disturbances this same dynamic unfolds through different behaviors, but the aim is always the same: to hurt the SELF in any possible way! And given human ingenuity, there is a multitude of ways to accomplish this, be it substance abuse, mental illness or otherwise.
The course of action then for the therapist is straight-forward. The treatment for Anorexia as with other Depressive disorders, is to MOBILIZE ANGER! That is, it consists of raising the level of Anger to balance the excess Depression and self-reproach within the eating disordered personality. To this end we need to encourage the person to recall, explore and discuss instances when they became Angry with others who aggressed against them, but felt impotent or helpless to defend themselves, and unable to react against their aggressor for any reason. We should infer that the hostility or Anger was conjured up by the aggressors in their immediate environment. While they desperately felt the urge to seek revenge at the time, this Anger could not be expressed for whatever reason, and remained stagnant.
The most frequent source of such intense Anger would be LOSS or failure to access the precious LOVE of their Prime Love Giving parent and negative comparisons with their next born sibling. The disordered person most likely would have felt that the aggressor was a Favored sibling who stole the LOVE they were entitled to as a child. In this case the Anger would erupt behaviorally as Sibling Rivalry or fighting. Alternately, they may be Angry with their PLG whom they blame for the pain and frustration they suffered because they did not measure up to the standards set by this parent the way their sibling did. They would be humiliated at the LOSS of the SIBLING RIVALRY or battle for the LOVE and attention they craved as a child, but were frustrated because it was denied to them and awarded to the other. In another scenario such as a case of abuse, they may feel they were treated unfairly or victimized and were not physically strong enough to confront their perpetrator, too young to understand their perpetrator’s actions, respected and complied with their authority figure, or felt crushed and forced to attend to the demands made upon them, and so on. The feeling (NOT the thinking) is: I LOST the battle with my sibling for LOVE –> I am not worthy -> MY PARENT(S) and others must HATE ME -> I HATE ME!
In therapy, once a sufficient amount of Anger is brought to the forefront, recognized, emphasized as important and encouraged, resolved or neutralized through empathic understanding in discussion with a DOLIF therapist, Depression abates. The Emotions that constitute the personality become increasingly balanced as Anger is progressively expressed, harnessed and integrated into the personality. Self-destructive behavior naturally melts away and is gone. Negative Emotions are reduced and room is made for more reasonable Intellectual forces to come forward and dominate behavior. Anxiety also diminishes automatically and simultaneously via the same treatment process. The overall effect is that the personality is strengthened through the balancing of Depression and Anxiety with Anger.
The blog titled Anorexia Part 3 – Case Study of an Anorexic presents an example of a situation where Anger accumulated as a result of abuse, but was unraveled in treatment.
***************************************************************
