Treatment of Anorexia - Honoring the Voice!

Having worked with eating disorders for nearly two decades, I never cease to be moved and touched by the magnitude of the human spirit and the incessant determination to be heard. While I often notice that the volume and tone of voice in an anorexic girl becomes softer and quieter as the illness progresses, I am nevertheless keenly aware that the anorexia itself is always a strong voice, roaring mightily beyond the rage of a thunder and over the bereft wailing of concerned family and friends. 

Poetry aside, I shall explain my thoughts, as they are indeed my understanding of both the cause and cure of the eating disorder.

An eating disorder serves a purpose.  It comes about for a reason.  It lingers for a reason.  And if and when it recedes, it does so due to a shift in that which has necessitated its presence.  In my experience, while the anorexia causes undoubted distress to all who are touched, it ironically also provides a voice for the sufferer.  To attempt to understand the voice and what she might be trying to communicate, one might look first at the feelings evoked by the patient - projected, shall we say (to use an important Freudian term of Defense Mechanisms) onto the loved ones.  Let us suppose that  a sibling is enraged that her sister refuses to eat; perhaps a mother is saddened and guilt-ridden; perhaps a father is in some way proud that his daughter has resisted temptation and shows self-restraint, control and determination, while also feeling irritated that she has "gone too far" and now has in some way "lost control."  All of these emotions are understandable in the face of the struggle of anorexia, from a personal standpoint and a cultural perspective.  Nevertheless, let us imagine that all of these emotions really belong to the anorexic herself.  If she were to embody these emotions with a personal voice and perhaps explore some metaphors hidden in the words, perhaps she would say:

I'm enraged
I'm sad
I feel guilty
I feel shame
I need to control my temptations
I need to restrain my self (I feel too much, I want too much, I need too much)
I have no limits (I go too far)

Using this process as a springboard for treatment, a place from which to practice curiosity and gentle  exploration, it would be useful to play with the words as keys to unlocking some secrets within the silence - secrets that may hold the rage, sadness, guilt, shame, and so forth.  And while this exploration is only a generalization in our beginning of understanding the voice of anorexia, it is essential to recognize that whatever the metaphors that are hidden within the restrictive eating patterns, they are ultimately not about food but about the deeper hungers for relationships, love, appreciation, connection, self-acceptance, and mastery over oneself - hungers which have somehow become shamed, silenced and starved. 

The healing process as I know it involves an awakening of the inner voice and creating a space and a platform to speak clearly, with volume, attention, and physical presence, on whichever stage is right for the individual whose voice we honor.