Have you ever noticed yourself following an unusual routine around mealtimes, or, perhaps, repeating a behavioural quirk in the course of eating, or drinking? I must say that I have noticed a few things about myself in this regard.
I recall hurrying up Leith Walk after an appointment one winter's morning and, feeling a little peckish, popping into a dependable local bakers' for a hot steak pie. ”Mmmn, delicious!” I hear you gasp, or the more indiscriminate, sinew-mangling carnivores among you, anyway....More to the point, however, I then proceeded on my way, furtively taking a bite from my clandestine pie only when I was sure that there was nobody walking towards me, just in case they should notice this shameful public display of gluttony. Indeed, when a fellow pedestrian did approach- no doubt, taking no notice of my feeding behaviour whatsoever- I returned the offending savoury swiftly and discreetly to the brown paper bag in which it came; keeping thumb and three fingers on the pie and the little finger gripping the bag, so that I could perform the whole secretive exercise with one hand. Ingenious, but wholly unnecessary!
I mention this slightly silly anecdote to make an important point. We all have idiosyncratic practices around feeding and watering ourselves, but, often, more serious eating disorders, such as bulimia, anorexia or binge-eating, can have equally innocuous, or incidental origins, but can become magnified with the right combination of perceived external pressures, developmental deficits and personality styles. Dr.Laura Thomson, who skillfully delivered our CPD session back on 29th May, illustrated this possibility vividly with the almost archetypal example of the teenage girl who longs to lose a bit of weight in order to fit in with her “more popular” peers, who models her ideal figure on the 'Size Zero' fashionistas and, with her obsessive-compulsive character style (Johnson, 1994), sets a number of stringent targets which she observes scrupulously, noting every triumph and crushing failure. Suppose that she begins to receive an increasing quantity of positive strokes (Steiner, 1971) for her achievement from perceived elders and betters; that she “looks really good now” and has “done really well”, as compared with her previous stroke deficit and feelings of isolation, themselves underpinned by powerful Don't Belong and Don't Be You injunctions (Gouldings, 1979). As Dr.Thomson emphasised, it is not hard to see how that this sense of becoming more and more 'conditionally-OK' with each pound she lost might spiral into something potentially problematic in a matter of months, or even weeks.
In perhaps the most engaging element of the day's learning for participants, the assembled trainees from various stages in the CPTI programme debated the, often, pernicious influence of the mass media in this field, in terms of the distortion of body image and self-expectations, the stroking of starvation and, at other times, 'guilty pleasures' and, specifically, the plethora of magazines adorning the shelves that compete in hectoring people- women, more so, but increasingly men, too- around how they should look and who they should aspire to be. Though it proved tricky to avoid a game, or, at least, some heavy pastiming (Berne, 1964) on an 'Ain't It Awful' theme, everyone present was much exercised on the difficulty of tackling such a pervasive societal problem, particularly when you are the therapist presented with a vulnerable young person, highly distressed by their predicament, experiencing enormous pressure from their family, or social circle which is completely at odds with their personal quest for perfection and who is seeking your help in their battle to stay alive.
This gave me cause to reflect on a formative influence on my own teenage years- the words of the late Richey Edwards; shambolic guitarist and shamanic prince of despondent youth with the Manic Street Preachers. To my mind, the most powerful expositions of anorexic intrapsychic process is found in the lyric sheet for '4st 7lbs' from 1994's 'The Holy Bible'. The singular power of these few verses, written by Richey himself about his own worsening condition, need no further elaboration and I include them at the end of this article in full as a shocking hook on which to hang the reader's personal reflections on this complex and, often, puzzlingly contradictory illness.
I would not wish to give the impression that the prevailing mood during this CPD was one of sadness and hopelessness, however- far from it. Dr.Thomson and the group explored a number of treatment approaches, which, if pursued in a diligent and coordinated fashion can allow people suffering from the effects of eating disorders to make a steady recovery towards a healthy self-image and a health-promoting lifestyle. From the good doctor's point of view, the key to the success of this treatment is effective partnership-working between the counsellor, or psychotherapist and the client in question's GP, together with a range of complementary interventions including nutritional education, occupational therapy and, sometimes, psychiatric involvement with the prescription of mood-stabilising medication. After all, the transactional analyst needs some functioning Adult to work with- and, as Dr.Thomson usefully highlighted, we aren't going to get that with a client whose cognitive capacity is impoverished by malnutrition.
When all's said and done, then, 'Eating Disorders- An Overview' delivered on its promise to provide a solid grounding in the key diagnostic indicators, precipitating factors and key concepts of effective treatment planning with clients suffering from eating disorders. Better still, from my personal viewpoint, I left the session far more aware of the script decisions I harbour and rackety displays (Erskine and Zalcman, 1979) I engage in myself around eating, which is food for thought- if you forgive the dreadful pun- and something of profound interest to take to my personal therapist.
David Harford- June 2010
www.harfordtherapy.com
Days since I last pissed
cheeks sunken and despaired
so gorgeous sunk to six stone
lose my only remaining home
see my third rib appear
a week later all my flesh disappear
stretching taut, cling-film on bone
I'm getting better....
Karen says I've reached my target weight
Kate and Emma and Kristin know it's fake
problem is diet's not a big enough word
I wanna be so skinny that I rot from view
I want to walk in the snow
and not leave a footprint
I want to walk in the snow
and not soil its purity
Stomach collapsed at five
lift up my skirt my sex is gone
naked and lovely and 5st. 2
may I bud and never flower
my vision's getting blurred
but I can see my ribs and I feel fine
my hands are trembling stalks
and I can feel my breasts are sinking
Mother trys to choke me with roast beef
and sits savouring her sole ryvitta
that's the way you're built my father said
but I can change, my cocoon shedding
I want to walk in the snow
and not leave a footprint
I want to walk in the snow
and not soil its purity
Kate and Kristin and Kit Kat
all things I like looking at
too weak to fuss, too weak to die
choice is skeletal in everybody's life
I choose, my choice, I starve to frenzy
hunger soon passes and sickness soon tires
legs bend, stockinged I am Twiggy
and I don't mind the horror that surrounds me
Self-worth scatters, self-esteem's a bore
I long since moved to a higher plateau
this discipline's so rare so please applaud
just look at the fat scum who pamper me so
Yeah- 4st. 7, an epilogue of youth
such beautiful dignity in self-abuse
I've finally come to understand life
through staring blankly at my navel.
Richard James Edwards, 1994
References:
Stephen Johnson (1994), Character Styles (W.W.Norton & Co, New York)
Claude Steiner (1971), 'The Stroke Economy', TAJ 1:3
Bob Goulding & Mary Goulding (1979), Changing People's Lives Through Redecision Therapy
(Brunner/Mazel, New York)
Eric Berne (1964), Games People Play (Grove Press, New York)
Richard Erskine & Marilyn Zalcman (1979), 'The Racket System', TAJ 9:1
Manic Street Preachers (1994), '4st 7lbs', The Holy Bible (Sony Music Publishing UK)
