Jean Petrucelli, Ph.D.
In my 29 years as a clinical psychologist and psychoanalyst working with eating disorder patients, I have learned that, paradoxically, the easier part of treatment is symptom alleviation; the more challenging aspect is helping the individual to understand her relationship to her body. Many people believe that when their symptoms are gone so are their problems in living. In fact, the hardest work has just begun.
A morbidly obese patient had gastric bypass surgery and lost 220 pounds—celebration! How come, she wondered, the rest of her life did not improve in the way she had imagined? “Why can’t I love my body like I love chocolate?” she lamented. Her difficulties with regulation of self-care, body-mind issues and work/life balance were pervasive. She had trouble knowing if she was saying too much or too little to friends; sometimes she spent vast amounts of money, other times she was unable to part with any at all; she overworked, under slept and took on more than she could chew. She went from over eating to starving without wanting to do the work required to be conscious, mindful and consider the consequences of her impulsive actions. “I don’t ever want to want…” was her motto, and so she kept herself from longing, or knowing things she did not want to know. She was terrified to give herself permission to develop an appetite for living.
So we had to explore her underlying fears and worries in order to understand what was really going on. For example, we came to know that her feelings of insecurity about not being “good enough” led to compensatory behaviors of “too muchness”: she would make herself available when she was not needed, she would write reports as if they were to be graded by the pound, she would sabotage herself so as to avoid attempting an endeavor outside her comfort range.
Although being morbidly obese caused her pain and humiliation on a daily basis, it paradoxically protected her from other feelings of shame—the shame associated with the constant comparison with other bodies—with which she struggled. When she achieved a healthy body weight, her mind and body remained extremely vigilant, scanning for confirmation of her misguided belief that she was still, in her words, “defective and disgusting.”
Optimally, the mind and body are in friendly communication with one another. But sadly, when people are struggling with eating disorders, they have often lost hope and live with internal despair; pain has taken root in their body and body-based behaviors. The mind and body are not in sync. So when someone is in the throes of an eating disorder, striving to achieve a sense of “body perfection,” or the illusion of control over their body, they may be attempting to manage feelings of helplessness. It is a misguided belief, a maladaptive solution, that for many leads to placing inordinate importance on the way their bodies look. Cultural messages about “beauty,” and the frequent intergenerational transmission of standards for beauty within families, can conspire to daunt living in one’s body as is. For most people, to do so requires relinquishing the tyrannizing ideal of the “perfect” body.
When another patient said to me, with a Cheshire cat smile, “I just realized I don’t have to be exceptional! What a relief!” we both delighted in this shared moment of joy. The achievement and perfection pressure she felt in adolescence—she was top of her high school class, varsity athlete in three sports, class leader, one of the “popular girls”—came crashing down when, right before graduation, she got arrested for drunk driving. The stress of being picture perfect in a small town had taken its toll and years of binge eating followed—it was a way to numb and ease the pain of humiliation. Tragically, her body became the public theater of her humanness.
Our work has centered on finding acceptance and beauty in her imperfections—coming to terms with her “true self,” rather than hiding behind the illusion of a “false self” persona not allowed to make any mistakes. Finding beauty in her imperfections has meant cultivating self-esteem by helping her re-engage with “damaged” parts of herself. To do this she needed to relinquish fear of failure, to embrace her vulnerabilities by tolerating the discomfort of intense feelings, and no longer binge on food to numb psychic pain. To consider herself of value….just as she is. Not having to be “exceptional” has opened a window to exploration of her relationship with her body as well as recognition of ways she can truly feel “good enough” inside and out.
So what does it mean to have a healthy relationship with one’s body? It requires being able to live in a stable body rather than a culturally created body; a body that works effectively with all its imperfections in whatever size or shape. It may not be exactly how you imagine it should be, but it is the body you were born with which constantly evolves with mindfulness. It requires developing compassion, a presence of being, a belief in the possibility of possibilities, and tolerating the risks of uncertainty and the uncomfortable emotions that follow. The message I hope to impart to my eating disorder patients is that I offer not simply understanding of their pain and suffering, but my full presence. We are in this process of discovery together.
Jean Petrucelli, Ph.D., is Director and Co-Founder of the Eating Disorders, Compulsions & Addictions Service; Faculty, Supervisory Analyst at the William Alanson White Institute, NYC ; Adjunct Clinical Professor at NYU Postdoctoral Program; author and editor of several books. Her latest is to be released in July 2014, Body-States: Interpersonal and Relational Perspectives on the Treatment of Eating Disorders (Routledge). For further information on the White Institute’s 2014-2015 one year training program, click here Appetites and Urges.