Anorexia in one lesson

 

We looked beneath 16-year-old client’s anorectic feeling that “I don’t deserve to eat.” I suggested to her that “not deserv­ing to eat” is not a feeling. There is no emotion of “not deserving.” This remark led her to delve, possibly not directly into that cogni­tive elabo­ration of a feeling, but to other deeper feelings. She said that from childhood on, she has felt “unim­por­tant, not worth­while.” Her parents, she said, have been more “sup­portive” since previous session’s parents-only meeting, but their history has been not to show percep­tion, under­stand­ing and accep­tance of her feelings. That’s to say, they’ve lacked empathy. Evoca­tive descrip­­tions helped “Carol” under­stand that the feel­ing of being loved uncon­dition­ally would be enough to make a child feel secure and, in effect, “arrived”: able to accept her feel­ings and her own value. Such a child would not have bedrock-level pain to have to both rise above and express by means of dysfunc­tional behaviors such as cutting, reck­less behavior, self-starva­tion. I sug­gested that I may need to give her parents “more lessons” in the deep and “ulti­­mately patient” empathic inter­action. Carol was given to under­stand that all her feel­ings are accept­­able. She said that she does not know who she is, has no sense of identity. Feeling access – difficult and some­times scary – is what can give her back her sense of self-iden­tity. As we talked and as she looked inward, she came upon a buried memory: She has had an urge to “do some­thing wrong,” something defiant, against the grain of the expected decor­ous behav­ior that she has come to embody. This urge was vali­dated. We joked that if she felt an urge to “spit on the floor,” it would be applauded (from a psych perspective).

Parents are occasionally educable. At some point following that session, Carol and her mother talked for two hours. She realized that growing up, she had tried to make herself invisible and perfect as her parents were absorbed in her younger brother’s problems. She and her par­ents joined to make her unparented. She cried for hours. After that, she was able to eat. But – was her mother able to hold those tears by being a “cleared-out human heart”?* Not exactly. Instead, her response was the mildly plaintive: “I thought I had been a good mother.” That is a trick statement that is hard for the child to answer. I suggested a half-joke: “You were pretty good, mom. You got a B. Not an A.” I said that like so many children, her bedrock was a bad feeling. Simply put, cosmically meant. A bad feeling of wrongness, of alienation, of unlove, of fear that was intolerable without knowing it. One has to live above that feeling, so one grows all the defenses and self-medica­tions that plague human lives. For her, to eat something for pleasure, not in dry utilitar­ianism, is to feel that ground. So do it. Eat some Chunky Monkey ice cream and you will feel not happy but scared and depressed. Pour those feelings into your mother, and in therapy. Lean on her and be comforted. Collapse on her and be loved. That will be the security that doesn’t depend on food and starving.

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Jacquelyn Small, Becoming Naturally Therapeutic, p. 1.