Food and Desire with Dr. Judith Brisman
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Dr. Judith Brisman opened the first center in the country for bulimia. She is known for taking a psychoanalytic approach with eating disorders, and for writing a book for the family and friends of those struggling with eating disorders entitled Surviving an Eating Disorder: Strategies for Families and Friends. In addition to discussing how eating disorders relate to desire, she also gives us some insight into Family-Based Treatment and how families can seek help to support their child suffering from an eating disorder.
*Keep in mind that while the examples included in this post are helpful, the revelations necessary for healing need to come from an internal place for each person. The whole point is that we aren’t aware of what’s going on and the process of healing entails uncovering what that is for each person individually.*
Managing Food as a Way of Managing Desire
We all have ways of trying to cope with emotions… it’s just part of being human.
Sometimes we’re trying to distract ourselves (i.e., binge watching Netflix shows, mindlessly scrolling social media), but sometimes, the feelings get so overwhelming that people don’t have a way to deal with them. They might turn to other coping mechanisms, like alcohol or disordered eating.
If an emotion feels too overwhelming, it’s possible to turn to food to distract or numb yourself. But it could also be about wanting something. Someone might want something so desperately that a way to deal with it is to not want at all. This may be to avoid the disappointment coming from wanting something so badly and not being able to get it. It all could be played out with food and desire.
Example: an older woman in her 60s fell in love for the first time. After falling in love, her disordered eating intensified and affected her physical health. She wanted to be with the person she loved so much that she felt out of control, and to calm herself down, she stopped eating. Food and desire were connected. She was able to recognize on her own that she needed help and came in for treatment.
It’s so common to think about someone using substances, like drugs or alcohol, to numb emotions. But when we think about physical hunger and fullness as a metaphor for desire – for our needs and wants – it makes sense that we can use food to try and control our emotions.
Your Relationship with Food and Desire
As you begin to consider how you may use food to manage your emotions, think about what your relationship with food is like.
Meaning, if food were a person, what would your relationship with that person be like? Do you have a relationship where you push them away because you’re scared of them? Or do you take them in, but you’re afraid of losing yourself, so you push them away? There’s so many emotions that get played out through food.
Example: a woman was restrictive in her eating in order to keep her weight the same. Every once in a while she would binge and purge, and after working in therapy, she realized she would feel angry at her mother right before a binge. The restricting food became a learned way of blocking out her anger, because it felt overwhelming. Recognizing that helped her to be aware in the moment when it was happening, so she could stop it BEFORE it happened.
Of course, this is so unique to every individual. If you feel like bingeing or restricting “just happens,” then it’s possible you’re feeling something under the surface that you might not be aware of.
A common occurrence is bingeing due to pent up feelings of anger. Bingeing might represent letting out an aspect of someone that is contained, pent up, and put to the side. It might be a form of dissociation or letting out a desire that the person can’t otherwise let out.
Getting to Know Yourself
Starting to recognize your behaviors and how they’re connected to your emotions is actually an opportunity to get to know yourself better.
We all have different parts of ourselves. We might have a professional self, a parent self, a self we are with our friends, and so on. Sometimes we exhibit behaviors that represent parts of ourselves that we don’t even know about. Sometimes we want things that come from a place that we don’t even know exists.
Example: a woman has been bulimic every day from ages 13 to 26. She expressed having a good life, but just wanting to get rid of her bulimia. She worked with a nutritionist and was able to address her bulimia slowly. Over time, she realized she came from a family who was well-intentioned, but did not allow any space for complicated feelings, especially anger. As she stopped the bulimia, she had to work through how she differed from her parents. She realized she was trying to get rid of her anger her whole life, and hadn’t realized the anger existed.
*Keep in mind that while these examples are helpful, the revelations necessary for healing need to come from an internal place for each person. The whole point is that we aren’t aware of what’s going on and the process of healing entails uncovering what that is for each person individually.*
The key is getting to know the part of yourself who is about to binge or restrict. What are you thinking or feeling when you’re bingeing or restricting? If you’re not sure, come up with 5 things you could do instead of binge or restrict. If that sounds like a ridiculous idea to you… why? Why won’t that work? That’s the information we’re looking for.
If describing how you’re feeling when you’re bingeing or restricting (or anytime) is difficult, then know you’re not alone.
Someone might enjoy clothes and fashion, but have no knowledge of fabrics. If you ask them what fabric they are wearing, they would have no words for it. In the same way, it’s okay if you don’t have the words to describe your emotions or needs just yet. The goal is to get there, slowly.
The Maudsley Method
It’s really unclear how eating disorders develop. There is evidence to support that there is a genetic link to anorexia and certain cravings, and of course, we know our culture focuses on the body. We also know that families can play a role, no matter how well intentioned they may be.
A famous example comes from Sal Minuchin, one of the first family therapists to do work with eating disorders. He was one of the first researchers to suggest eating disorders developed due to problems in the family. His research suggested that if you disentangled parents from the child and allowed the child more autonomy, the child’s eating disorder would be resolved.
His research was validated and then questioned over time, and eventually gave way to the realization that even if parents were removed from the situation, their child wouldn’t necessarily eat or stop bingeing. The field took a turn and began to focus on parents setting limits and re-feeding their kids in what is called the Maudsley Approach, or Family-Based Treatment. This method got the parents back in the picture for treatment.
The problem with family-based treatment is that many families don’t have the time, logistically, to make it work. And although the family-based researchers make a point to say families are not to blame for the eating disorder, many family members do feel blamed in this approach.
Eating Disorders in Families
Family-Based Treatment uses consequences if the child is not able to eat their meals/stop bingeing, such as stopping team sports or canceling trips. But the consequences and the food aren’t the heart of the issue. The most important piece of the puzzle is looking at who the parents become when they deal with the eating disorder, and who they see their child as.
Example: A teenage daughter with anorexia had two good natured parents. The family had a good relationship, until they were faced with the eating disorder. The father grew up with a brutal, critical mother, and he would become similarly angry with his daughter when dealing with her disorder. The mother grew up with an alcoholic father, and she was afraid of him. When she was dealing with the eating disorder, she would feel the helplessness she used to feel with her father, and she would back down.
The point? It’s important to look at what parts of the family react to their struggling child. It’s helpful to see what patterns the family is stuck in.
This is something that is potentially hiding in LOTS of families, by the way. There are often very complex interpersonal dynamics and communication patterns in many families.
That being said, it’s important to remember to keep the focus on the child suffering; I’ve heard from adults who experienced Family-Based Treatment as kids who say they experienced “re-traumatized” them, because it wasn’t really about them – it was about their family members.
Personality Disorders and Other Complications
There are other family dynamics in which the response to an eating disorder is flippancy or anger. This might be because of personality disorders coming from a parent or a child, and it makes treatment feel almost impossible.
Sometimes the family members can be separated and worked with individually. It’s important to try to understand the helplessness and powerlessness behind the big feelings of anger and frustration, and deal with those separately from the eating disorder.
Example: A mom had been beaten as a child. When she found out her teenage daughter was purging, she would verbally assault her and almost repeat the violence from her childhood. Her feelings were too big for her. She worked with a therapist separately from the daughter to ensure her feelings were being heard.
Deciding What You Want
When kids are in situations where they have parents with big feelings, they develop radars for what their parents need. Every decision, every choice becomes about navigating others’ emotions and avoiding blow ups instead of what the kid actually wants or needs. They tend to struggle to make decisions as adults, from what to eat to who to date.
The solution is building a toolbox for what they feel and what they want. This is where working with a nutritionist is so helpful, because knowing what you want to eat is a very primitive beginning sense of what you want and who you are – rather than looking to someone else for who you should be. Sometimes, starting with knowing what you want to eat is a way of getting to know who you are.
If you’re so removed from what you want that even trying to decide what to eat is completely foreign, definitely work with a nutritionist or dietitian. Some questions you might start to answer with them could be:
What kind of sensation do you want – salty or sweet?
What kind of texture do you want – crunchy or soft?
Do you know when you have to pee? (yes, really. This is a primitive feeling, too)
Breaking Family Patterns
If someone is struggling with anorexia, FBT says the goal is to get the parents back into an authoritative role where they offer consequences (i.e., the child cannot go on a trip if she is not in good health) and ultimately, where they have concrete strategies so they can pay attention to the part of their child that is hurting.
With bulimia and binge eating, it’s a different process. The more parents try to control weight, the more problematic it becomes. The goal is to get a treatment team in place, and get the parents to shift the focus away from the food and onto why their child is hurting.
As with all cases, we want to bring the conversation onto what’s going on underneath. What’s the hurt behind everything, identifying the emotions, and the patterns in the family. Once we can identify those emotions and patterns, that allows for choice. If parents know their child is hurting, they can react differently than if they believed their child was trying to be defiant.
It’s not so important to identify the cause of the eating disorder. Maybe it’s interesting and for some, really important, but that’s not always going to be the key to healing. It’s more about what’s happening today, how you can identify why it’s happening, and the choices you make afterward.
Tweetable Quotes
“Families all get into patterns, some of which work, some of which don’t work. An eating disorder in the family is an opportunity to say, okay, what might need to be changed right now? What might need to be inspected?” – Dr. Judith Brisman
“We don’t just see a parent in their role, and a child in their role; we see everybody in their roles, and how the dynamics come together.” – Rachelle Heinemann
“Knowing [your emotions and patterns] allows for choice.” – Dr. Judith Brisman
“It’s not so important to identify the cause of the eating disorder… maybe it’s interesting, but that's not going to end all or be the key… it’s more about what’s happening today, the identification, and what choice that provides.” – Rachelle Heinemann
Resources
Surviving an Eating Disorders: Strategies for Families and Friends
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