When the sun breaks down - Eating Disorders and the issue of control
On the face of it the two main eating disorders, anorexia nervosa and bulimia nervosa, are at the opposite ends of the spectrum. The person suffering from anorexia is in control of her eating and her life. The person suffering from bulimia is not.
The reality is that neither the anorexic nor the bulimic is in control. The difference between them is that the anorexic thinks she is in control while the bulimic knows she is not.
Over two thousand years ago Heraclitus pointed out that at their extremes, opposites turn into each other. If we look at these opposites more closely, we can see the truth of this observation.
The person suffering from anorexia exercises control by restricting her food intake. What happens at the extreme? The more she restricts, the more emaciated she becomes. Eventually her control breaks down. Either she gives way and starts bingeing or she dies.
So 50% of people suffering from anorexia turn into bulimics and many anorexics also binge and purge. The real difference between the anorexic and the bulimic is that the former needs to feel special and the way she tries to achieve that end is by being thin. The latter wants to be normal and feels guilty and ashamed because she is unable to control her eating.
How, as counsellors, can we help these clients? What are they really trying to achieve and how can we help them to achieve that? Why does the anorexic need to be in control? Why does the bulimic feel guilty and ashamed when she is not in control?
Opposites turn into each other because at bottom they are the same. Although anorexics and bulimics are superficially opposites in the sense that anorexics are rigidly in control while bulimics tend to be chaotic and impulsive, both share the same perfectionist personality trait.
Both restrict their eating on the basis of rigid, inflexible rules which are reflected in their dysfunctional thinking patterns. Typically the anorexic's belief is: 'If I'm thin, I'll be happy.' One of the bulimic's typical beliefs is: 'I must never eat chocolates or biscuits or some other "bad" food.'
Inevitably these rigid rules break down. When the bulimic eats one biscuit, she will be tempted to eat the whole packet. She thinks: 'I've blown it. I'm a failure.' She feels guilty because she hasn't been able to keep to her impossible rule, she binges, feels ashamed, tries once more to restrict her eating and so the cycle continues.
People suffering from anorexia do genuinely need to be in control of their lives; they need to feel special and they need a sense of mastery. It is important to recognise these needs as valid but also to question whether the needs are being met by restricting food. Is the client really in control?
Those who suffer from bulimia appear to be searching for freedom, the opposite of control. They need to feel OK about themselves and to be themselves. But by trying to live up to inflexible, perfectionist ideals they impose the very control that ultimately breaks down and creates their feeling of guilt.
The Romans knew that only the gods are perfect. When they made their mosaics, they always included one flawed piece. Our humanity is inherent in the principle that we are flawed. Our acceptance of this truth is the real measure of our humanity.
The paradox for the anorexic is that she will only really be in control when she stops trying to be in control. The more she tries to control herself artificially the more will her real identity elude her. Only by letting go, by accepting herself for who she is, can be be herself and really in control.
The bulimic too needs to let go and accept herself as a flawed human being instead of trying to be perfect. At bottom, both anorexic and bulimic are looking for the same thing.
And what about the counsellor? It is all too tempting, and common, for counsellors to find themselves in a parallel process and to try too hard with their clients. The result is that they end up trying to control them instead of genuinely allowing them to be in control of their own lives and their own process in counselling.
The ultimate paradox for the counsellor, then, is that they too need to let go. They need to have the courage to accept their clients for the people they are, to accept their need to be special, to have mastery, ultimately to find freedom through their own personal control.
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