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Resilience and Eating Disorders

Sometimes symptoms can be adaptive

Like many other psychoanalysts, I can sometimes get so caught up in looking at what went wrong in a client’s childhood that I miss evidence that many things went right. Yet what went right is very important. The good things in a client’s life are often the very things that help them get better in therapy. And oddly enough, they can also be the reason that some clients don’t want to get better! It therefore behooves us therapists to pay close attention to the positive, adaptive or resilient aspects of even the most painful symptoms.

Here’s how this can work:

Jocelyn* was nineteen when she came to see me. It was the beginning of her sophomore year of college. During her freshman year she had lost a significant amount of weight, and her parents were afraid that she was becoming anorexic. They had both been in therapy themselves and found it very helpful. They thought it would be a good idea for Jocelyn, too. Jocelyn was not so sure.

“I’m fine,” she said. “It’s just that my parents are worriers.”

“But you came to see me anyway,” I said.

She nodded. “Well, with my parents, it’s better to give into them than to fight them. And besides, they’re only doing it because they love me. I know that.”

Because many – I would even venture to say most – clients come into therapy with very mixed feelings about what they are doing there, and whether they even need a therapist’s help, I try to find out as much as possible about both their negative and their positive ideas about therapy. Jocelyn handed me that information on a silver platter. She came to therapy not because she needed or wanted it, but because she had learned that giving into her parents was a better and more productive technique than standing up to them.

“Doesn’t that make you angry sometimes?” I asked.

“Of course. But I also know that it is the best way to accomplish what I want to accomplish.”

Jocelyn’s rationality was amazing. She was extremely intelligent and very articulate. But she was also extremely thin. I had a sense that her rational response to her parents was only one side of a complicated coin; and perhaps her thinness was another. As I have written many times (see my blog posts on parent blaming), I think that therapists often jump too quickly to explanations that make parents into bad guys. Jocelyn had adapted to her parents’ somewhat rigid and overbearing natures by seeming to give into them, while still maintaining her own beliefs, and, as it turned out, by often doing exactly what they did not want her to do – but silently, without a fuss. While I know from long experience with people with these symptoms that eating disorders have many different meanings and causes, I thought one factor in Jocelyn’s eating behavior might in some way be one of those silent rebellions -- sort of a silent “you can’t make me do anything I don’t want to do” to her parents.

On the other hand, as I’ve described in another post (on separation and eating disorders) I knew that eating disorders in college are often signs of difficulties separating and/or managing the changes that occur with separation from families. I hoped to begin to explore some of the reasons she was so thin with her, but I could only do that if she became comfortable with me as a therapist. I asked Jocelyn if there was anything she would like to work on with me, since she had decided to come to therapy even though she did not want to. She looked at me for a long moment, then said, “Could you help me deal with my parents?”

I said, “I think I might be able to help you deal with your parents in a somewhat different way. But I’ll need to know more about you. Would you be okay talking to me about yourself, including about how you understand them?”

That was the beginning of some incredibly productive work. As Jocelyn and I looked at her life and her family, we did find some areas of difficulty, particularly around her parents’ tendency to be, as she saw it, rigid and stubborn about many things. But we also found many places where her parents had been loving, kind, caring and extremely helpful to her. We talked about how excited she had been about getting away and being on her own, and how hard it had turned out to be to be away from them.

“College was a lot harder than I thought,” Jocelyn said. “Not the schoolwork. That was easy. But being on my own. I was sad a lot. I started losing weight because I couldn’t eat. And then when I decided to become a vegetarian, my parents hit the roof.”

We talked about the probability that her parents had gotten angry because they were worried. And when they worried, they tried to control her. So for Jocelyn, not eating became a way of keeping her parents involved in her life, yet showing them that they could not control her at all. In some ways it was a highly adaptive symptom. Yet in others, of course, it was seriously problematic.

In therapy, Jocelyn and I worked on her ability to be more open and direct with her parents, even if it meant that they would become angry or difficult. We talked about how much they showed her that they loved her, and even the idea that she could tell them that she loved them, she just didn’t want to do things their way all the time. Gradually, she began to gain a little weight, although, as she made clear to her parents, she had no intention of going back to eating the ways that they did.

To her surprise, her parents were extremely responsive to these new interactions. As her father said to her, “I was just afraid that you couldn’t grow up and take care of yourself, honey. But it looks to me like you’re doing a fine job of it!”

Many eating disorder clients are, like Jocelyn, amazingly resilient. And I believe that this resilience comes from experiences – often unacknowledged and unrecognized – with their parents. It is important not only for therapists, but also other professionals, the media and the general public to begin to recognize that while we focus on the negative in a person’s past, the positive is often waiting silently in the wings to be recognized. But as soon as it is acknowledged, it can make the work of adapting and managing our lives much easier.

*names and identifying information changed to protect privacy and confidentiality

Teaser image source: http://www.sleepdisordersguide.com/blog/narcolepsy/high-occurrences-of-…

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