In one instance of severe Anorexia a young woman aged 19 was an in-patient on the psychiatric ward of a hospital. Despite undergoing treatment for nearly two years with two different therapists, there was little change in her status. There had been intensive attempts to help her by using the standard protocol of resources, but she was still pushing an IV that fed her passively, and was close to dying.
Concerned about her welfare, the chief psychologist at the hospital solicited help from an online psychologists’ listserv. I contacted him by phone, at which point he mentioned he was very grateful for my call since nobody else had reached out to him. I asked him to briefly describe this patient’s background, and he informed me that she had been sexually abused by her adoptive father.
In a brief conversation that lasted about ten minutes, I explained to this concerned professional that the main thrust of therapy should be to MOBILIZE ANGER!! For clarity, I explain the process here in four steps:
I said that the first duty of the therapist is to listen closely, empathically and sincerely and take in what the girl is saying, since the main aim of the therapist would NOT be to try to change her behavior. Rather, the purpose of therapy was to validate her feelings, especially in regard to her Anger with her adoptive father. The therapist should use statements such as “I agree with you. Of course. What a terrible thing to have happened to you. Things like that should never happen…..you were so young and helpless. I understand that things like that are so hard to take out of your thoughts.”
Secondly, the therapist should communicate sincere sympathy with the very real and horrific experiences this young woman had endured as a child. The therapist should not spare any expression of sympathetic understanding or minimize her general plight of having been a victim at the mercy of such a nasty, inconsiderate individual, who had unfortunately come to be her father and stolen her childhood. Note that the expressed Anger of the therapist about the circumstances is a significant factor in helping the girl generate, justify and express her own Anger at the injustice that was perpetrated against her. Note too that the social injustice of the situation and imbalance of power, in terms of one person in authority taking advantage of another vulnerable person, requires emphasis because it is a real factor in the Emotional dynamics of what the girl truly experienced and felt, and was the ultimate the cause of her illness. That is, it was wrong, he knew it was wrong, and so did she, but he was in charge and she was helpless. The overpowering sentiment here is that the agreement that in fact and in reality, it wasn’t fair.
Thirdly, discussion should center around her sadness. The DOLIF therapist should be aware that the goal of therapy is to slowly but surely move forward the sadness or Depressive sentiment so that it eventually morphs into Anger. To this end, the discussion should bring out her sense of LOSS of her innocence and loss of her childhood through statements such as: “I’m so sorry this happened to you. It shouldn’t happen to any innocent, unsuspecting young girl like you were. It isn’t fair and its so sad. Nobody should do that to anybody else.” Feelings of indignation at the unfortunate events of her life should be expressed. Feelings of sorrow should be elicited that draw tears of mourning for her childhood that was stolen, the time that was wasted and her future that had so far been ruined. Note that the main goal of this phase remains to allow feelings of Depression to come to the surface and be redirected and transformed into Anger and directed against the true target, her father.
The fourth goal of therapy should be to increase her feelings of self-worth. To this end, the therapist should encourage and support her sense of self esteem as a human being. Selected words should show her she is worthy of the moral support, praise and encouragement of others around her through statements such as “You’re such a beautiful girl and you have so much going for you. I know you’re so capable, and you’ve proven it just by going through so much already. You are a really strong person inside and you can go far.”
The final goal of therapy is to bring to awareness and provide full support for her seething, undeclared Anger toward her stepfather, which is the root cause of her illness. To this end I advised this psychologist that his staff should let their client know that she is realistically, truly, in fact and in real life, owed an apology. Moreover, those around her should verbally and non-verbally communicate to her that they love her and agree with her. They should show her that she is worthy of their moral support, and the praise and encouragement of all those around her. Those people would be the staff at the hospital, the friends and relatives in whom she could confide her Anger and Sadness, as well as the society around her. One could make statements such as: “That never should have happened. Somebody should have helped you” or “He never should have been allowed to do that to you. Nobody has the right to do that to anybody else”, and even “It’s our fault as much as anybody else’s that we, as a society, should allow this kind of thing to happen.”
Finally and most critically, they could pledge their help, as per: ” We will support you as much as we can. You can depend on us to do everything we can to help you”. To this end I advised that staff should even assure this young lady that if she chooses, she need never return to her abusive home environment, where her father could take advantage of her again and her mother had possibly overlooked, neglected or been unaware of the sexual abuse. Worse yet, her mother might even have been jealous of her. In fact, I recommended that hospital staff should offer to help this young lady move out of her home and find a new residence in the community through social services. I told the psychologist that staff could offer their support by helping her lay criminal charges against him, should she choose to do so.
Finally on a psychological level, in order to inform this chief psychologist of the essence of my advice, I explained that if this young girl were to come to terms with her Anger, SHE WOULD SPONTANEOUSLY BEGIN TO FEEL LIKE SHE WANTS TO EAT IN ORDER TO BE STRONG ENOUGH TO CONFRONT THAT HORRIBLE MAN WHO HAD PERPETRATED SUCH EGREGIOUS CRIMES ON HER. The part of DOLIF theory that supports this most is the seesaw action discussed so often in this context in which Anger and Depression are opposite poles so that if Depression is too high, then Anger must be too low and should be cultivated. In this case then, Depression was too high and Anger was suppressed and became a dying ember. Therefore, in this near-suicidal instance we would theorize that the young woman’s Anger and self-hatred was so great that she was almost crushed by the Depression it caused inside her. It illustrates the need to help such a victim by bolstering and encouraging their Anger, which we know is actually justifiable in reality, in order for the Emotional and indeed physical life of the subject, to catch up and be rescued from her dangerous, guilt-addled, self-destructive mindset.
Within a few months of our discussion, when I reached out to the psychologist again, I found out that this young woman had finally been discharged from the hospital. In support of DOLIF theory her case study demonstrates that, rather than a disorder of body image or eating, Anorexia is a problem of Anger that is turned inward and expressed against the SELF in the form of SELF punishment and SELF abuse. In this case the method of choice for self-destruction happens to be SELF-starvation. It clearly demonstrates that Anorexia is primarily a disease of Depression, SELF hatred and undeclared SUICIDAL intent. It also demonstrates that this serious Emotional/psychological trend can be halted and reversed. Successful treatment seems to depend merely on accurate diagnosis of the source of repressed Anger, and its mobilization.
Given the support and encouragement of others, this young woman was finally able to redirect her Anger toward the appropriate target outside herself – her stepfather who had perpetrated a heinous crime against her for so many years of her young life, and her mother, who was not Emotionally present and failed to protect or rescue her. Of great importance was the fact that the social injustice by a trusted person in her environment had finally first been psychologically validated, and then vindicated, which permitted her Depression to subside and her symptoms to dissipate. Her words to herself now would be “So yes. My feelings were right all along. He never should have done this to me. Thank you for confirming my feelings and the real facts. Thank you for agreeing with that gnawing, aching feeling I had that was eating me up from the inside”.
Note that in this case, as in any other, therapy involves no mention of the eating disorder nor its destructiveness. In DOLIF we never say “Look what you’re doing to yourself” or “Why don’t you eat just a little more, do a little less exercise and balance your diet?” The reason for this is that the motives and Emotional dynamics behind the behavior are understood beforehand, eliminating the need for tedious questioning of the afflicted individual. DOLIF is trusting and respectful. It does not question people’s motives or put them on the spot to answer questions from outsiders. It quietly empathizes with their deepest feelings about themselves, and leaves them in a strengthened Emotional condition to continue their lives as productive members of society.
It is not known in this case whether or not this father was the PLG, but that knowledge would not have been central to the young girl’s recovery. However if another therapy were to be undertaken with her at a later date, one might begin by attempting to diagnose the PLG/ALG situation, and look into the role that her mother played in her life. Note that it is not unusual for an abuser to be a child’s PLG, especially if the other parent, the ALG, is a denier, or detached, uninvolved or oblivious to the child’s Emotional issues.
When I contacted the Chief Psychologist to follow up on this case, he informed me that the girl had been discharged from the hospital a few weeks after we spoke. At the same time he noted that, although the staff had distinctly advised her NOT to return to her parents’ home, she had opted to do so anyways, and that they had not heard from her since. I
