Since it would be difficult to cover the full impact of grief and loss associated with eating disorders in this article, I have chosen to look at loss in both the activities of the eating disorder and in the recovery process. Many of us have issues around food and body image which have arisen out of fashion articles and advertising in women’s magazines where women are portrayed as typically being a size eight, and having a perfect figure. This plays havoc with women who already have little sense of self, and suffer from low self-esteem.
When I use the term “eating disorder” I am covering anorexia, bulimia nervosa and compulsive over-eating. I will be using the female gender throughout the article, not ignoring the fact that there is a growing percentage of men who also suffer the pain and havoc of eating disorders.
When I was reflecting on what to write, I came across a painting by Edward Munch called “The Scream”. It aptly portrays the desolation, isolation and despair that a woman will experience in the height of an eating disorder. Food initially is a source of comfort and a release from painful feelings and situations. But as the eating disorder progresses, the destructive relationship with food becomes a living hell. There is a huge loss of comfort and solace from the pain and emptiness within resulting in an ongoing search for that initial relief.
The abuse of food often begins in early adolescence, continues into the thirties and forties, and sometimes right through a person’s life. It becomes a profane ritual and a means of coping with life. It results in a love/hate relationship. Women who abuse food have immense difficulty in expressing their feelings. Everything is put into the activities of starvation, bingeing, vomiting, abuse of exercise, laxatives and diuretics. As this obsession and compulsion continues there will be a strong feeling of disconnection from the physical body. Often a woman will speak of experiencing sensations only from her neck upwards. The body becomes a source of great emotional pain and there is a feeling of being trapped inside a body that is viewed with utter disgust, hatred and shame. It becomes unbearable to look in a mirror. The body becomes a “whipping post” through this destructive activity. Self-hatred and disgust seeps into the bone marrow.
I would like to use Marion Woodman’s description of this activity as the “Demon Lover”. Prior to choosing to go into the cycle of bingeing and vomiting, there is often a loneliness, a feeling of rejection, anger and emptiness. There is a calling from this “Demon Lover” within the person to enter into a destructive relationship with food. This relationship will compensate for the loss of intimacy in interpersonal relationships. It is a means of avoiding conflict and the expressing of emotion. The woman is driven by an overwhelming anticipation that drives her to steal food, to binge and then to purge. There are strong repetitive gestures such a s buying massive amounts of food and quite deliberately creating a space to binge and vomit. It is totally solitary and secretive. There is just the “Demon Lover” and the woman herself. She becomes an expert in ensuring that no one will interrupt this “Lovers’ Relationship”.
Within all of this, there is an incredible desire to escape the monotony of this earthly existence. The destructive ritual will bring the woman into a world of euphoria and forgetfulness. However, as this ritual progresses, the periods of forgetfulness and euphoria are short-lived. Like alcoholism and drug addiction the woman will need to partake in the binge/vomit cycle more and more often. Instead of once a day it will increase to three or four times a day and often much more.
No amount of devouring of food, vomiting or starvation will bring the woman into the spiritual and soulful search she so desires – rather it will bring her into what can only be described as a “Black Hole of Hell” where there is nothing but despair and desolation. The image of a young woman surrounded by empty cartons, gorging herself beyond the point of endurance, and then on her knees on the bathroom floor, forcing herself to vomit down the toilet is enough to repel the senses. It is soul destroying and there is a huge loss of dignity and self-respect. Often disgust and self-hatred will create strong suicidal tendencies and many will actually attempt to take their own lives. As the obsession and compulsion progresses, the more disembodied and disconnected from life the woman will become. However, this “split” of body and psyche is usually a result of early childhood trauma such as physical, emotional and/or sexual abuse and a sense of abandonment. When the abuse stops the woman herself takes over by continuing to abuse herself by this destructive behaviour. When a person becomes disembodied there is a strong tendency towards an intense longing for a place of rest that is not part of this earth. There is a hunger to belong and to be at peace. The woman will constantly blame her body for being unlovable and unacceptable. Everything becomes locked inside the body e.g. fear, anger, hatred, frustration, despair and desolation. Often the activity of bingeing and vomiting is a means of combating the above feelings.
Not everyone with an eating disorder will be thin; some women will become quite obese. This can be a way of becoming sexually unattractive and is used as a defence against life. It is not unusual for these women to walk alone and become detached from people. Femininity for many women with eating disorders is often regarded as unsafe, weak and makes them feel vulnerable. This is particularly evident among women who have been sexually abused or who may have been rejected at birth because they were female instead of the desired male. A majority of women who have been abused will go on to develop an eating disorder, especially bulimia and compulsive over-eating. Both anorexic and obese women will lose their feminine shape and stop menstruating due to abnormal body weight. There is an ongoing internal struggle to be out of the body as it has become defiled and unsafe. Some women will have learned that femininity is unacceptable.
Eventually the effects that were initially experienced in eating disorders will begin to fade. There will be a painful awareness that the obsession and compulsion around food no longer works. It is often experienced through dreams which, I feel, demonstrate the insidious nature of eating disorders. Women have shared some of their dreams with me and I have their permission to use the following examples:
“I went on a binge. I hid the food in my pockets and bags. I locked myself away in a public toilet which was filthy and overflowing. The food was becoming mixed up in the overflow. The panic inside me was enormous not because I would become ill but because I would lose the food. I began to force it down my throat. The food became the overflow and I continued to eat it. I woke up in sheer panic thinking it was real.”
“I was locked into an empty room with food in the shape of a mountain. I could not distinguish any food from another. It was just a mountain of food. I was very small in comparison to this mountain. I began to eat my way through it. The more I ate the bigger the mountain of food became because I kept getting smaller.”
For the woman, the threshold of knowing she has come to the end of the road with no apparent options open to her can be terrifying. She may experience feelings of disintegration, insanity and a loss of self.
Initial recovery and healing can often be described as a period of unremitting pain. Facing one’s self and breaking through illusion, denials and defences is no easy task. For a woman to do this, she has to stand “in the naked truth of who she is”. There is a risk of flipping over into another form of addiction such as alcohol or drugs. To really let go of the obsession and compulsion, there has to be an inner belief that this way of being is destructive and sterile. It also involves accepting the “shadow” side of herself that is potentially destructive. Recovery and healing becomes a movement towards self-nourishment and acceptance. It is taking that hurt and screaming child who is within, into your arms and loving her. It is a letting go of self-hatred and self-punishment.
Marion Woodman describes this process as the transformation of the caterpillar into the butterfly. It is an appropriate image for a woman coming out of the destructiveness of obsession and compulsion into a life of healing and creativity. There is both pain and joy in this transformation. Part of this is the marriage of soul and body and a growing belief that it is only through the body that one’s spirit/soul can be expressed. This process is slow and needs to be handled with immense patience, gentleness and compassion. There is a mixture of feelings of needing to be free and yet being terrified of letting go of the relationship with food. Some women will need to gain or lose weight which will mean becoming a sexual human being and having an acceptance of her femininity. The hours previously spent in bingeing, vomiting and starving have to be filled with creativity – a life- enhancing ritual where a woman does not become possessed, or obsessed, by spirit or matter. Marion Woodman refers to ritual as the “soul’s journey through images”.
In the initial phase of recovery, a woman can experience immense loss and sheer terror at what is going to be left when she lets go of the food and body obsession. Often she can experience a sense of being nothing else and may question “who am I without this way of being?” Letting go of this obsession means enduring the boredom of daily living without the escape of bingeing and vomiting. It means facing life’s hurts and betrayals, but also the joy of living. It is not unusual for women to become stuck in their pain which enables them to live out of old habits and ways of being.
In therapy the woman will need to come to believe that it is safe to live in the body and that it is not a prison or something to be hated and despised. It will take time for the body to return to its normal rhythm. This may be achieved through movement and dance where there is great potential for a woman to become ”embodied”. It will bring about an awareness of femininity and sexuality and helps to free the body from inhibition.
Voice work is also useful in helping expression of feeling. It is not unusual for women with this obsession and compulsion to have a strongly developed intuition but an immature ego. Therefore it is important to bring the body’s responses to consciousness in order to balance the intuition and the ego. This will enable them to respond differently to crisis and difficult situations rather than by abusing food. The aim of therapy is to bridge the distance between the body and soul and to empower the woman to make her own choices, decisions and to take responsibility for her own life. An important aspect of therapy is to look at ways of establishing a healthy relationship with food i.e. to establish a daily routine around meals and exercise.
Joy and Pain Recovery and healing is experiencing the joy and pain of life in the body. It is only when the woman herself can face and stay with her darkness and pain that the inner process of healing can begin. In early recovery it is important for both the woman and her therapist to recognise and acknowledge the grief and loss involved in letting go of the eating disorder. Food was a means of repressing painful feelings and a substance to fill the emptiness within. It was used as a means of escape from self. Both obesity and anorexia can be a cause of becoming asexual and, in fact, not having the body of a woman. The period of grief varies, and this should always be respected. When the loss of old patterns is grieved properly, then healing will be stronger and grief will not harden into bitterness and despair.
Woodman, Marion (1985) The Pregnant Virgin. Inner City Books
Woodman, Marion, The Owl was a Baker’s Daughter. Inner City Books
Meltsner, Susan (1993) Body Soul, Hazelden Press[Elizabeth Mernagh is a psychotherapist working in private practice. She is involved in running a group for people with eating disorders.]