The Conundrum of “Body image”
I suspect that all therapists working in the field of eating disorders know that the concept of “body image” is an elusive one. I have found it helpful to question the term we are trying to deconstruct - Body Image. The term , as is, suggests that body image issues have to do with the “image” of the body. In working with my clients, I have realized that this will lead us into a cul-de-sac with a roundabout that takes us nowhere. In my years of working in this field, I have learned that it works better to address it from a deeper place.
A baby has little awareness of herself as being separate from her mother. Small children live in their bodies without criticism, collecting somatic experiences from their environment. In the absence of abnormal or unusual experiences that bring undue attention to the body, the child lives in her body unconsciously, without any sense that anything is wrong with it or that anything should or can be changed. So when does a person develop this hyper-focus on changing parts of the body as a pathway to finding “happiness”.
An eating disorder, the obsession with food and numbers, starts well before it makes its appearance in a noticeable way and usually coincides with the early teenage years. The circular rumination with food and numbers is the obvious symptom, the tip of the iceberg and mostly, the place where we get no movement. Families often don’t understand why the person simply does not eat and return to “normal”. The person themselves, while having an eating disorder , cannot really explain why they are struggling so much. I find that clients often get stuck in statements like “I hate my body” or “I hate myself”. It is important that the therapist does not also get stuck in this concrete statement and try to alleviate it with ‘positive affirmations’ . It helps to go back, to the time before it started, to catch a glimpse of the person before the fog set in.
This would all make much more sense if the person were to say “ I hate how my emotions feel in my body when I feel anxious” or “It is very scary to me when I feel difficult emotions moving around in my body because I have not learned that I can ride the wave of an emotion and regulate it”. Unbeknownst to us, children feel anxiety very often in their little bodies. It is a given that we are not the decision-makers in our lives as children. We float around in the universe created by our parents, marinated in the saturated emotions around us. Gordon Neufeld talks in detail about the significance of separations in a child’s life. From the time we leave our mother’s womb , we go through incremental and progressive separations from her - leaving the uterus, then sleeping in a separate bed, sometimes in a separate room, going to day care, then going to school. Sometimes a child has to share her mother very quickly with a following pregnancy. Every degree of separation requires adequate, attuned and timely soothing. We can see already that this is a situation that leaves the body with much uneasiness. Restlessness, the opposite of restfulness. The beginning of that ubiquitous symptom - anxiety.
Anxiety is not always a pathology. It is something we all experience at various levels at various times in our lives. When we feel alone and unprotected, when we do not have the information, when we cannot predict what is going to happen, when we feel we do not know the answer. Anxiety runs around in our bodies and further, often in our family systems. Anxiety is often recognized only when it boils over, when we can see it, when it interrupts a person’s functioning. The trouble with emotions is that they are ‘felt’ as physical sensations in the body. The physical sensations invite us to respond with actions. And we do. The ensuing action is outwardly directed (like punching a wall or yelling at somebody) or inwardly directed to self ( like cutting oneself or not feeding oneslf). Anger that cannot be directed outwards towards the target can be directed towards self and feel like punishment. Anxiety is often experienced with a secondary feeling of shame because “I should not be feeling this way”. Emotions are pervasive, inconvenient and have a very long shelf-life. They can be stored in our bodies for years and pop out at the most inopportune moments in the most inopportune places. And often there is no room for them in our busy families. hence “ I should not be feeling this way” or “She is just too sensitive”.
As you can see from this, working with ‘body image’ is best served if we understand that we are working with the physical sensations of emotions that move around in the body. It is common for my ED clients to say they are “bloated” after a meal because they have become addicted to the safety and lightness of the “empty” stomach. The safety and lightness of the absence of feelings when one is consumed by the ED. The “bloated” sensation is not really about food, rather that of emotional feelings in the body. When an ED is successful, the person needs to think about nothing beyond the number of calories in the next meal and the number of carrots on the plate. Everything else , the world with all its worries, fades away.
“Controlling my body yielded an illusion of control over my life………….I had reduced my world to a plate of steamed carrots and over this tiny kingdom I proudly crowned myself queen.” - Quote from The Religion of Thinness
