anorxia

January 27, 2002

'The Truth Will Set You Free'

By ALICE MILLER

often see elderly persons in the pharmacy collecting the pills and potions prescribed to them by their family doctors. Sometimes I ask them whether their doctors ever talk to them about their lives or only about their illnesses. "What do you think?" they usually reply. "There's no time for that kind of thing—there are dozens of people in the waiting room. And what good would it do, anyway? The main thing is he knows what's wrong with me and what to do about it." Sometimes I persist and ask whether there is anyone at all they can talk to about their lives. "What are you driving at?" they ask. "When I was younger I went out to work and had no time for talking. Now that I do have the time, who'd be interested in hearing the story of my life? When it comes down to it, you're on your own."

True, most of us are indeed on our own in that respect. But we would benefit tremendously from having someone to talk to about our childhoods, particularly when we get older. As our physical strength fades and we lose our youthful vigor, we are particularly susceptible to flashbacks to a time when we were helpless children. And that may be what makes us cling to a bagful of tablets in much the same way as we clung to our mothers for the help we urgently needed. Perhaps this symbolic substitute really does help in some cases. But it can never be a replacement for the presence of someone truly interested in our personal history. That kind of interest does not take up anywhere near as much time as we might think. We need an open door to our own past, an opportunity to take its very beginning seriously.

It is common knowledge that eating disorders are typically psychic in origin. But many doctors, not having learned to face up to their own emotions or gain access to their own childhoods, do not genuinely understand the language of the symptoms displayed by their patients suffering from such disorders. Failure to understand generates a feeling of powerlessness that has to be fended off quickly. How do we fend off feelings? Frequently by resorting to measures that will silence the language we cannot comprehend, thus making ourselves feel powerful again instead of ineffectual. And how do we reduce symptoms to silence?

The possibilities are legion. Most of them take the form of medication. In the case of eating disorders, elaborate diets can give patients the illusion that the doctor is immersed down to the smallest detail in their lives, their eating habits, their well-being. Minute supervision of eating regimens in hospitals does in some cases bring about a slight increase in body weight for anorexics. The psychological side effect of realizing that one is not some kind of freak, that there are other people with the same problem, can help these patients regain a bit of zest for life, perhaps even some enjoyment in eating.

But this approach does not even address, let alone solve, the main problems of anorexics: Why do they shy away from life? Why can't they trust their families? Why must they obsessively monitor their eating habits? Few hospitals encourage or even allow an anorexic patient to ask: How did I get this way? What's at the root of my illness? What am I feeling? What am I trying to avoid? What kind of nourishment do I really require? Yet in most cases the source of these people's illnesses is a major breakdown in communication, a profound and tragic form of distress often dating back to early childhood.

I once saw a television program on eating disorders that portrayed four adolescent girls and wound up with a discussion by a panel of experts. All the physicians on the panel agreed that anorexia was a medical mystery, that there was no way of determining where it came from. Nevertheless, they stressed, the situation was improving and it was important not to lose faith in the prospects for finding a cure.

The genuine improvements achieved in therapies that empower patients to experience and express their true emotions are never touted by either journalists or medical experts, no doubt because the people who have undergone such experiences are not invited to participate in televised discussions. Such lone voices are silenced by the fear of placing blame on parents. But only by overcoming that fear will we be able to understand a patient's emotions and history. And parents themselves will never learn to understand if they keep knowledge at arm's length for fear of the guilt it might arouse in them. Parents agonize over their children's symptoms and want to help them, but they do not know how. And doctors cannot afford the time to understand the motives of their patients—unless, that is, they themselves know by experience that facing up to accusations from their children will not have a lethal effect on parents. The worst thing such criticisms can do is to confront them with their own histories. And that kind of confrontation can sometimes motivate parents to start communicating with their children far more deeply than was possible before.

In the televised debate, the experts spoke of anorexia as if it were a purely physical phenomenon necessarily devoid of any other meaning. What they had to say no doubt appeared plausible enough to most viewers: a feeling of hunger can indeed disappear once a person has lost a certain amount of weight and sticks to a reduced diet low in minerals. The physiological and anatomical mechanisms behind a total loss of appetite are easy to understand. But they say nothing about its causes; they merely describe its mechanics.

What triggers anorexia in the first place is the tragedy of a young person unable to confide in anyone about her own feelings, to talk with anyone about how she needed to be nurtured as a child. Now she is unable, without help, to grasp the conflicts raging within her. In medical or psychiatric therapy she then encounters specialists equally concerned to evade such conflicts in themselves for fear that they might end up blaming their own parents. How can they hope to offer support to these young people? The patients can only summon the courage to put their discontent, their pain, their disappointment, their rage, and above all their needs into words if they are encouraged to do so by someone who does not share those fears or who has already experienced them and recognized them for what they are. There can be no doubt that successful therapeutic activity hinges on the therapist's own emotional development. The help provided by therapists, doctors, and social workers would take on a new dimension if knowledge of this childhood factor were widespread. So far, however, it appears to be taboo for the medical world.

Many people seeking help have realized the problem this issue represents for conventional medicine. But this awareness will not prevent them from falling prey to charlatans proposing all kinds of alternative methods, arousing hopes of a cure and sometimes even effecting a degree of relief where faith and hope turn out to be stronger than their patients' powers of judgment and knowledge of human nature. But what of those without this kind of faith who are tormented by physical symptoms? In many cases, working to recover one's own repressed and denied childhood brings genuine relief, especially to those with the good fortune to encounter enlightened witnesses who have gained emotional access to their own history.

For a long time I believed that learning to read the story of one's own childhood was something that could be achieved without the help of such witnesses, largely because I myself had no choice but to go my way, supported only by my writing and painting. But ultimately I was lucky enough to find an enlightened witness, and it was not until then that I was able to admit truths that I could never have borne on my own. Only then did I achieve the freedom I needed to take the messages from my body and my emotions completely seriously instead of questioning their validity.

But even for those who have not yet found an empathic therapist who has come to terms with his or her own childhood instead of projecting it onto clients, it can be helpful to tell someone about traumatic childhood experiences, as long as that person understands how those experiences can leave their mark on a child for life. Psychologist James W. Pennebaker, who describes the results of his studies in his book Opening Up, would appear to be an empathic listener. One of the many experiments he conducted took the form of asking students sitting in separate booths to report on painful experiences and to give free rein to the emotions that went with them. Another group was asked to describe events that hardly engaged their emotions, such as buying a pair of socks. The participants were students of psychology who were also undergoing outpatient treatment through the university health service. After the experiment Pennebaker established that those who had reported on emotionally charged events consulted their doctors at the health service less frequently than those who had recounted mundane occurrences.

From this study Pennebaker concluded—quite rightly, in my view—that a person's state of health will improve if he or she is given the opportunity to tell someone about distressing events, provided the listener shows interest and understanding. While this will hardly be sufficient to cure a severe illness like anorexia, it might have a salutary effect. But in encounters between doctors and their patients this opportunity is rarely taken. Doctors have little time to listen to their patients, and those who do take the time lack the necessary knowledge to understand the language of emotion. Probably the single most important factor militating against success is doctors' fear of reviving their own childhood traumas. Unfortunately, doctors frequently ward off such fears by diverting them onto their patients and instilling fear in them.

Isabelle, a fifty-year-old actress from Chicago, told me of her consultation with a specialist in internal disorders. She had been suffering from a chronic inflammation of the intestines that had set in immediately after a psychic shock she had endured. Isabelle was firmly convinced that she needed the help of another person to get to the bottom of her emotions and to understand why the illness had broken out suddenly and would not subside. Her temperature was normal, but she suffered from severe cramps, which she felt sure were the expression of her repressed emotional distress. Accordingly, she refused to take antibiotics. She had been to several other doctors, including homeopaths, all of whom had listened benevolently to the history of her problem and then prescribed medication.

Her new physician, Dr. Walker, appeared to justify her hopes of greater sympathy and understanding because he began by asking her about the most significant illnesses she had had in her life and listened with apparent interest to what she had to say She succeeded in describing her central concerns within the space of ten minutes, and was pleased with herself. One of the threads running through the fabric of her whole life was the neglect of her psychic distress. Medication was considered the only remedy that could relieve the pain, yet she frequently suffered from the side effects without any easing of the symptoms themselves. Naturally, this merely served to increase the distress she felt.

Though she was in considerable pain, she refused medication because she was convinced that the pain would go away once she had understood the reasons for her illness. A number of her organs had already been removed; after each operation some other organ would immediately start causing her trouble and would persist until it, too, was removed. She was determined not to repeat that experience yet again.

The doctor listened to what she had to say and made notes. When she had finished, he reached for his pad and prescribed a three-week course of antibiotics. He said that she must embark on this treatment without delay if she did not want to risk cancer or another operation, which would probably involve the insertion of an artificial anus. Much alarmed by this verdict, Isabelle started to speak, but the doctor pointed to the clock and said there were lots of other patients waiting. He added that she was now fully informed about her condition and would only have herself to blame if she did not follow his instructions to the letter.

It is hardly surprising that in the days to come Isabelle's despair and physical pain became even worse. A series of blood tests she underwent at the recommendation of another doctor revealed nothing abnormal, nor did a sonogram of her intestines. Still refusing antibiotics, she found a psychotherapist with whom she could work on the emotional shock that had triggered her illness. There she was able to give free expression to her emotions and the strong feelings stemming, as she then recalled, from experiences in her childhood. After only a few weeks the intestinal symptoms began to fade as she gained an increasingly acute understanding of the way in which her illnesses were reflections of the plight she had gone through as a child.

It is not always possible to identify the complex causes of such an illness in the space of a few weeks or months. But when that does happen, the consequences are astounding. The indispensable requirement in all cases is the patient's willingness to embark on a journey of self-discovery. Of almost equal importance is the appreciation of the therapeutic prospects held out by such a method, the beneficial effects, so often ignored, of simply talking and listening.

I have singled out Isabelle's experience from among countless similar reports because it clearly delineates the dynamic that results when doctors mask their own fears and feelings of powerlessness to salvage their prestige. My impression is that the cogent description of the destructive role conventional medicine had played in Isabelle's life confronted Dr. Walker with a problem that he had perhaps never given any thought to and felt unable to address. At first he was prepared to listen to the patient's history of her illnesses because he expected her, like the majority of patients, to describe symptoms he had learned to treat in medical school. But Isabelle spoke of entirely different things: she described how medical treatment had occasioned the progressive destruction of her organs by subjecting her to operations that led only to more operations. No mention had been made in the doctor's medical education of how such destruction reflects the tragic history of a patient's childhood.

Do patients have any real defense against operations not only recommended but more or less forced on them as their only chance of survival? Where else are they to seek counsel? A person who has grown up in the company of parents able to come to grips with their fears and other emotions without passing them on to their children would immediately realize that the doctor was inadvertently foisting his own fears onto the patient. Such persons would have developed the capacity to see through unconscious manipulations. But such a person, having been allowed in childhood to articulate freely whatever caused her distress, would not be likely as an adult to suffer from chronic inflammation of the intestines. Typically, patients suffering from psychosomatic disorders were forced to develop a very different attitude in their early years Ask no questions, shoulder other people's anxieties, tolerate contradictions, roll with the punches. And if they can find no one to guide them out of that rut, they may continue doing precisely that all their lives.

For Isabelle, the encounter with Dr. Walker was a turning point. What escaped him in her description was something that she herself realized. From then on, she knew with blinding clarity that it was up to her to take the necessary action. One could not expect a complete stranger, even a respected physician, to gain insight into her personal tragedy in the space of ten minutes. Neither his training nor his own motivation had equipped him to do so. Isabelle was the only one equal to deciphering the messages coming from her body. Recognizing that her symptoms were telling a story that reached back to her infancy, she knew that if she wanted to get to the heart of that story she needed someone to accompany her on her quest. On her own she would never be able to discover, let alone bear, the pain that small child had suffered. She would have to find a witness to whom she could say, "Look, this is what happened to me," and who would be prepared to take her seriously, having been through similar experiences in childhood. When Isabelle finally succeeded in finding such a person and spent several months engaging her total emotional energy in working through the shock she had suffered, she was able to identify the complete emotional loneliness in which she had spent her early childhood.

She had idealized her father for fifty years, but now, with the help of her therapist, she managed to accept the truth. In the first years of her life she had been sexually abused by her father, a successful dermatologist. Her mother did nothing to protect her. As she had been unable to confide her feelings to anyone, she frequently suffered from stomach aches and constipation. Her father's response was to give her frequent enemas, which she found very painful. He also ordered her to hold back the content of the enema for as long as possible. At a symbolic level the child took this to mean she must keep silent, remain alone with her pain, and yield to the violence done to her by her father. But the real injury, far from manifesting itself in frank brutality, was that her father ignored her personality. He degraded her, turning her into an object for gratifying his needs without caring in the slightest about the consequences his actions might have on her future life. One of those consequences was that Isabelle spent decades obeying her doctors in the same way she had obeyed her father.

As an educated woman, surely Isabelle could have found a doctor or therapist willing to listen to her, couldn't she? Today, she feels that she was unable to do so as long as she remained incapable of seeing what her father had done to her. She came to me after reading Marie-France Hirigoyen's Stalking the Soul: Emotional Abuse and the Erosion of Identity, in which she was convinced she had finally found the key to her life history Isabelle had already been through a course of "classical" psychoanalysis which, though teaching her to call the "errors" of her parents by name, left her still unable to understand the bearing they had on her adult life.

Her intestinal problems, the many operations, and the eye-opening encounter with Hirigoyen's book made Isabelle realize that she would be destroying her own life if she went on trying to uphold her idealized image of her father and ignoring the signals emitted by her own body. In Stalking the Soul she found a description of a form of perversity her body was only too familiar with. But her mind refused to accept her father's true character. It was this refusal that made it necessary for her physical pain to persist until such time as Isabelle could summon the strength to face the truth.

Only after this discovery was she able to understand why she had found no one ready to sympathize with or even comprehend what she called her "shock experience." For behind the events she was trying to recount was the suffering of an infant, of the little girl before she was able to speak, entirely dependent on the understanding of adults and otherwise completely alone. Thus, although Isabelle felt the fierce pain of that shock, the full dimensions of the experience remained closed to her as long as she clung at all costs to her love for her father.

Outwardly, nothing spectacular had occurred—no heart attack, no accident, no event enlisting the immediate compassion of the people around her. What struck Isabelle full

Excerpted from THE TRUTH WILL SET YOU FREE by Alice Miller. Copyright © 1998 by Alice Miller.
Translation copyright © 2001 Alice Miller. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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