It was the summer of 2011. I had been treating Eating Disorders for many years. The same focus on feeding to heal the body and on psychotherapy to heal the past. Sadly, the treatment held no answer for a change for the future and promised little more than a life on the verge of relapse.
For several weeks, I had been seeing a patient – a young anorexic girl who had personified her eating disorder as “Ralph”. She spent many sessions talking about their abusive relationship.
“Why don’t you let go of him?” I asked one day. “What do you really have to lose?” as I tried to help her visualize a future without an eating disorder.
She thought for a long time. And then finally: “I have nothing to go back to” as tears flowed down her sunken cheeks. It was the first sign of emotion I had seen from an otherwise highly “disciplined” girl who lived to tally calories and divide her food up into midget sized portions.
Her words stayed with me. There was something beyond a perfect body that she sought – and we all knew that. But what was it? And where did it come from? My search for an answer took me through various disciplines from neuroscience to evolution and spirituality. I wanted to understand what it was that drove patients to override the primary instinct to survive and starve themselves purposefully, sometimes to death.
The Motivational Drives of the Human Brain
The human brain evolved over millennia into a triune brain that is primed to meet three essential needs. First and foremost arose the need for survival, the primary instinct that is common across all animal species and at the root of most of our instinctive reactions. Then came the need for novelty that emerged in early primates and that is intricately bound to the dopamine system. And finally emerged the need for love, as is evident in apes and chimpanzees, and that became highly elaborate in human beings. We are capable of profound love and heroic acts of altruism that point to something deeper within us. Would it be the inklings of a soul?
This is not just an abstract concept. In fact, it is a very embodied one. All expressions of awe and gratitude are expressed through the body, as are the sensory capacities we feel as part of an uplifting experience. And nowhere is this more evident than in the expression of an eating disorder.
The physical starvation of the body is simply the outward manifestation of the emotional starvation of the soul. It is a soul that is keenly aware of the uncertain nature of life, of the search for connection and of the suffering and pain of life’s journey. And it is housed in a body in turn embedded in a biological, psychological and cultural milieu that does not allow it to engage with its inner turmoil. And so the pain is avoided, by clinging to certainty, by numbing the need for connection and by escaping it all through controlling the body.
The Ability to Deal with Uncertainty and Pain
For patients suffering from eating disorders – and many other psychological illnesses such as addictions, self-harm and even depression – this is the very ground on which their life story unfolds. A biological nature of sensitivity, a genetic predisposition for eating disorders, a home where unconditional love flows sparsely and a society that worships thinness and perfection provide the tragic backdrop that turns on the detrimental gene when faced with life’s inevitable uncertainty and challenges.
To unsuspecting parents, this can seem like the innocent dieting of teenage years. However, it masks a very real fear of coping with the situation, and an actual inability to adapt to uncertainty. Surprisingly, it all comes down to the strength of primary relationships.
Neuroscience shows that neural connectivity depends on unconditional love. fMRI images show that the brain of a child who receives inadequate love is smaller and way less connected than that of a child who receives a healthy dose of it. And a well-connected brain is one that is flexible and emotionally resilient. It can handle pain and uncertainty without succumbing to the pain avoidance system that seeks to escape through external means.
This is not meant to point the finger of blame at parents. After all, parents themselves are children who grew up with their parents – and this ladder can stretch back through generations. A parent who withholds love does so for no reason other than not knowing any better.
Sadly, the mismatch between the love given to a sufferer and the love they yearn for creates a gulf where low self-worth takes birth – and no amount of achievements and successes – or dieting – can negate the conviction that they are not “enough” – enough loved, enough worthy, enough perfect and yes enough thin.
Treat the Soul as well as the Body
It is often said that we see the soul in somebody’s eyes. The listless eyes of an anorexic make me believe that an eating disorder is really a soul sickness. Relentless dieting beyond thinness, in the pursuit of unattainable perfection in order to prove their self-worth, points to something far deeper than the body. And when we focus solely on feeding their emaciated bodies, we do more harm than good.
Firstly, we deny, yet again, the emotional starvation that gnaws at them and haunts them constantly. Secondly, we deprive them of the very mechanism that they have to handle their pain – that of food denial – that is also sadly a potential pathway to perfection and self-worth. And lastly, we overlook the fact that pain avoidance makes us naturally dependent on dopamine. Avoiding food makes an anorexic happy, even if temporarily.
My young patient’s soul had spoken when she said she had nothing to go back to. Ralph provided her with something, even though it was the worst form of meaning. Love, on the other hand, fulfills a very real human need and satisfies the soul’s desire for connection and belonging. And in the process, it builds the inner resources that allow the body to deal with life’s yo-yoing journey.
She needed feeding, yes – for no amount of love will register in the mind of a starved child. But that was no longer the purpose of her treatment. Feeding was purely a way of getting to the core of the matter, which lay in the center of her being. What she really thrived on was the unconditional love of her parents that made her whole again.
I met her again a month ago. She has been relapse free for over two years. Her eyes sparkle, her body oozes energy. We do not talk about her past. But something in her demeanor tells me that she has found contentment. Deep in her soul, and expressed through her body, she has found the ‘enoughness’ in herself.
Homaira Kabir is a Women’s Leadership Coach, a Cognitive Behavioral Therapist and a Positive Psychology Practitioner, whose work expands the breath of the human experience. She empowers women to become leaders of their own selves in order to become leaders in relationships, at work and in life.