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Listed below are articles written by Doctors, Therapists, Nutritionists, and others who have worked in the field related to Eating Disorders Awareness and Treatment. If you have an article you'd like to submit, please contact us to make arrangements to place it on the site with proper credit and referring information.

Speaking Out for Self Discovery:
A Psychotherapist's Approach to Helping People with Eating Disorders

by: Joanna Poppink, M.F.C.C.

"I am a person; I have an identity of my own outside of the disguising disorder. The disease just appears on the outside to be ME. The search is truly to discover who I really am. And I believe that can only be done by considering each and every victim's own unique qualities. I am normally a quiet person so I thank you for provoking me into speaking out."

-- Debbie, anorexic for 20 years.

Importance of Identity

When Debbie made this self-affirming statement she inspired me to write about the importance of self discovery and speaking out in healing.

Her words, which I've heard so many times in so many different ways, cuts to the chase in healing eating disorders. I've been listening to women with eating disorders since 1980. I've grown to firmly believe that regardless of the eating disorder diagnosis, a person with an eating disorder is courageously struggling to keep her core self, her most basic true identity, even the integrity of her soul, alive, secure and strong.

My approach to my clients, particularly those with any kind of eating disorder, is to use all my training, experience, perceptual skills and emotional knowledge to help them discover, respect and trust who they really are.

Behavior is Honest Language

To me, the behaviors that accompany various eating disorders are metaphoric communications from the real self trying to live, survive, communicate, protect itself and emerge into life. In my opinion the meaning behind the eating disorder behavior is far more important than any category or diagnosis. Also, in my opinion, the meaning is usually unconscious.

Because the meaning is unconscious we often have a situation where a person wants to live and live well yet continues to starve or binge or vomit or do any of the other activities that seem so destructive in eating disorders. I say "seem" because to the outsider and often the person her/himself, real damage to the body is happening. Yet, somewhere inside there is another aspect, the real self, who is trying to express something vital to life which is very powerful but has no words or conscious awareness.

The result that we clinicians often see in our practices, our friends, our daughters, sisters and in the mirror is a person either totally numb or oblivious or, even more often, spiritually and emotionally shredded into conflicts that seem unresolvable.

When such a person stops the physical acting out of the eating disorder, in my opinion, it is just the first step to healing. When the acting out stops the real self may have an opportunity to begin communicating in a less disguised way. The troubling unknown issues are still present, but they may be more accessible to understanding.

Secrets and the Law of Eating Disorders

As I believe many of us appreciate, underlying eating disorders are various kinds of traumas including physical and emotional abuse and sexual exploitation. The common theme among eating disorders is that the abuse is supposed to be secret. No one is supposed to know, often not even the victim.

Hence the great law of eating disorders is born: Thou shalt look good and keep the secret. Not to follow this law is to break a powerful commandment.

Looking good is essential to keeping the secret. Supposedly, if you look good it is a statement that everything is fine. There is no problem anywhere. Many women try to get around the severity of this law by substituting, "be invisible" for "thou shalt look good" or alternate between. Often being very thin or very fat are both attempts to painfully be invisible. Dressing in body concealing clothes is another. Going drab is another.

Along with this law come backup laws and supports for the law. For example, if you don't know what the trauma is you can't tell anyone. It's much easier to keep a secret if it's a secret from your own conscious mind.

The Appeal of Destructive Relationships and Isolation

So we see people with a history of eating disorders enter into destructive relationships, not recognizing whom they can or cannot trust. In fact we often see people reject signs of trustworthiness and find such trustworthy people uninteresting. A person in the invisible mode will spend much of her life in painful and lonely isolation rather than risk the inevitable pain of yet another exploitative relationship.

People following the look good and keep the secret commandment will often, with dangerous naivete, fling themselves passionately and loyally into relationships with untrustworthy people. In my opinion, this is part of the defense. A person goes to what is familiar, what is similar to the original abuse. She doesn't recognize it as dangerous so the abuse gets played out again. She will experience tremendous pain and bewilderment because she doesn't know she is defending herself from self knowledge.

Looking For Meaning

The pain, and the pain can permeate a life, is coming from the whole self. That self is in a terrible dilemma as it tries to survive by honoring the psychologically entrenched law. All options seem desperate and hopeless. And, of course, guilt and shame come because people in this situation think they should be able to live their lives much better than they do.

So, if someone forces himself or herself to eat more than they can bear and then forces themselves to throw up, that's one level, a physical level, of experience. Yes, a person will throw up to relieve physical pain from gorging on too much food. But there's more to it. People want to throw up till their insides are "clean". They want to get it all out. They can go into a panic if they can't purge themselves.

If someone is starving themselves to skeleton proportions they are not trying to die. They speak of being light and pure. They will go into a panic if they eat enough food to interfere with that light and pure feeling. As we know, even eating one cracker can be enough to cause that panic.

And if someone is eating so much that their weight is creating a limit on their participation in life or an actual health danger they too, are not trying to die. They want to stop overeating and lose weight. Yet the weight also means a kind of emotional numbness. To give up the weight means to feel and the first feelings that arise stimulate panic.

My question is, "why?". What do these experiences represent? Together with my clients we look to answer that question in the context of their lives and the inclination of their minds and hearts.

If a person is forced to live a life that she cannot bear, that is killing her soul, and on top of that, she is supposed to act as if she likes that life and look good at the same time - that can be a formula for an eating disorder.

If she erupts, starts telling secrets, starts letting the source of her pain be visible, she is breaking the eating disorder commandment. She feels and thinks she is doing a very bad thing if she vomits. She feels and thinks she is doing a very bad thing if she feels the weight of her body being present in this world. She feels and thinks she doing a very bad thing if she speaks out.

Yet, I believe, being present for the secret, and speaking out with your own truth, whatever it is, is the way to self-discovery and true healing.

Why Healing Takes Courage and Support

If it were only a matter of personal self-healing it would be a difficult journey. But it is more than an individual matter. Often the truth telling exposes abuse and exposes other people's secrets. Those people don't don't like that. In reality they will often use all the powers of manipulation and control within their power to negate the voice of truth or even destroy it.

So, living with abuse is dangerous. Living with an eating disorder is dangerous. And going through recovery has its own dangers.

Taking care of oneself in the process of healing is an incredible challenge. I don't think it can be done without conscious and aware support. Too many people in the eating disordered person's life do not want their part in wrongdoing to be known.

So, a recovering person who, as part of her old defenses, cannot well distinguish between the untrustworthy and the trustworthy is vulnerable to forces around her which she cannot yet recognize as adversarial.

Psychotherapist's Task

I believe our task as individuals and as psychotherapists is to respect and trust that the true self of our clients is valiantly working to come forth and is communicating as best it can. As we earn the trust of our courageous clients I believe that our task is to help them become conscious of what has been unconscious. At the same time we must provide support as our healing clients begin to learn about themselves and lose their dangerous naivete about others.

I believe we must continually learn and be as present as we can for the world and the people in it as they are, not as we wish them to be. The more we can get through our own denial systems the more we can be trustworthy companions for our clients in their search to "discover who they really are."

We need to learn to recognize and honor the meaning behind all the eating disorder behaviors. That meaning comes from the true self. When the true self is discovered and free to speak the whole person becomes free to heal and live an authentic life.

Thank you, Debbie. Your speaking out inspired me to speak out too.

Joanna Poppink, M.F.C.C.
Psychotherapist in private practice
10573 West Pico Blvd. Suite 20
Los Angeles, CA 90064 U.S.A.
(310) 474-4165

©1998 Joanna Poppink, M.F.C.C. Reprinted with Permission.

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