What does Anorexia and the spawning rituals of the North Atlantic sea bass have in common? Well, most people have about as much understanding of one as they do the other. Even people who claim to understand eating disorders, specialize in their treatment, even leaders of the field, fall frighteningly short in their ability to explain why eating disorders happen and what to do about them. I say this not to be condescending, and perhaps I don’t really understand these illnesses myself. In fact, up until about 3 years ago I was as confused as anyone about this topic, which is embarrassing considering I had an eating disorder for 20 years, I have an M.S. in counseling psychology, I did my master’s thesis on eating disorders, and I was endeavoring to specialize in eating disorders for a private practice. Despite all that, I didn’t start to gain any footing with eating disorders until I became discouraged enough with the traditional treatment approaches to seek out a more enlightened perspective on the illnesses. After going through a period of frustration and despair, I started looking at things that we don’t usually look at when treating someone with an eating disorder; which is pretty much anything not directly related to weight, shape, eating, eating, or weight or body image, or shape, or…you get the picture. I started listening to the person underneath all that, only to discover that this was a voice heard seldom and with little volume–heard least of all by the client herself. Turn up the volume on that voice, and you will turn down the volume on the eating disorder.
Case example #1: The first client I saw with an eating disorder was dying. She came to me to show a gesture of effort to her parents–they sought me out because doing nothing was unimaginable, as unimaginable at that point as the idea of her actually getting better. Nevertheless, I gave it my best shot. During the first session, I did therapy ‘business as usual style’. I got out my manual and talked to her about food and weight and eating habits, gave her some homework to chart food and thoughts and blah blah blah. The second session, I left the manual untouched as I realized the more I followed it, the more I felt like I wasn’t talking to Sierra so much as I was talking to her eating disorder. I imagined the eating disorder embodied, taking over her like a ventriloquist. It was creepy. It was unproductive. The homework assignment for the second session was for her to buy a plant and start taking care of it, because she mentioned she liked plants. Then I asked her to buy some Barbie dolls and play in her Barbie beach house from when she was a kid–something she could say would be fun to her. Then she cut her hair in spite of being terrified of disappointing the people who adored her waist-length locks. She died it purple.
At the core of her eating disorder though, was exhaustion, as it is with every eating disorder I encounter. The real cure came when we discovered the source of her exhaustion (no, not the eating disorder itself, as that is an OUTCOME of the exhaustion, not the cause). Her relational exchange with her father was causing her to hemorrhage energy. We worked on challenging the beliefs she had about her role as a ‘good daughter’, restructuring what she took on as her responsibility with him. This restructuring caused her to no longer take inappropriate duty to protect him from himself, (a never ending source of entropy). Restoring her relational energy allowed her to meet her own unmet needs, eliminate the constant state of ‘failure’ that comes from trying to do impossible things for other people, (which by the way makes you feel fat). Sierra gained 40lb in 5 months, and she was discharged from therapy in another 4 months. She had a baby the next year, something her physicians said she would never do. Of course no one expected her to live, let alone recover either, but she did that too. And we both celebrated by eating a delicious North Atlantic sea bass.