Author: Randy K. Hardman, PhD
I would like to share a few observations from my ten years of experience at Center for Change. These observations will be about treatment and recovery from eating disorders and are related to the many wonderful women who have been in the clinical programs here at the Center. I have noticed many important keys to recovery, but from my perspective the most important key to recovery always seems to be centered in the heart, and to be a matter of the heart. I will be drawing from my own clinical experiences as well as my observations as a clinical director overseeing treatment programs. I will also include information from a recently published book entitled Spiritual Approaches in the Treatment of Women with Eating Disorders by P. Scott Richards, Ph.D., Michael E. Berrett, Ph.D., and myself. I also want to draw from some of the principles and ideas that are included in the Life Quest and Life Strategies workshops that are facilitated at Center for Change and were published by Roger K. Allen, Ph.D., in 2003 and are a part of his Human Development Institute in Littleton, Colorado.
One thing I’ve discovered in these many years of eating disorder treatment is that these amazing women have often lost their sense of self or identity to the eating disorder. Therefore, a most important component in recovery entails the process of regaining their sense of self by getting their hearts back and getting to the point where they can trust themselves and their hearts again. They can learn the power of their own good hearts in giving them direction and helping them to know what is best or true in their lives. They have often lost clarity about what they truly want, other than a thin body and the supposed acceptance that will come with that body ideal. Most often, they have lost their sense of a true self, including their spiritual identity. It is common in therapy to hear that patients can be very afraid of recovery itself because they do not know who they will be after recovery, or they do not know who they are if they give up their eating disorder. It can be a rewarding process to help them reacquaint themselves with their good hearts, with qualities, strengths, and attributes that they have possessed all along, but have lost in the obsessions and compulsions of the eating disorder.
EATING DISORDER PURSUITS THAT TAKE WOMEN FROM THEIR HEARTS
One of the things that I have seen as a recurring theme is this intense pursuit of approval
This false belief that approval will make up for any self-proclaimed deficits and deficiencies can be well hidden in the pursuit of perfection in the eating disorder. The hope is that the eating disorder will give them the approval and acceptance they are not willing to give themselves. Unfortunately, for most of patients, the result of this intense pursuit of approval is mostly a sad sense of disapproval or rejection because no matter how positive the outcomes, or pleasing the responses from others, there is always this sense of emptiness and “not enoughness” that lingers with them. My observation is that this intense pursuit of approval will end up in painful self-judgments, self-criticisms, and overall self-contempt that indirectly feeds the eating disorder.
Another recurring theme is in the intense pattern of avoidance
Eating disorders are the addiction of avoidance. Patients can maneuver to avoid many things, but in particular, to avoid emotional pain, feelings, conflict, losses of control, and failure. In this pursuit of avoidance, they oftentimes feel a great deal of personal shame or a sense of unworthiness. They feel this unworthiness because they have given up so much of their lives and relationships for this all-consuming need to avoid everything that interferes with the eating disorder. To avoid pain at all costs also means to avoid anything that is good and positive about them, or to avoid facing the problems that can be solved and the relationships that can be healed along with the forgiveness and the love that can change everything. Because the fear that it will all go badly is so intense, they simply avoid it all. By limiting their lives to one thing – the eating disorder – they feel a lot of shame which leads to more self-contempt, which indirectly feeds the eating disorder.
Another common false pursuit is comparison
There is a constant preoccupation and oftentimes an obsession with how well a patient is doing compared to someone else, particularly in terms of appearance, performance, image, or body qualities. This constant preoccupation of comparing how they are doing to someone else usually leads to a greater sense of inadequacy. Unfortunately, all of this comparing leads to more self-contempt, which indirectly feeds the eating disorder. Jenni Schaefer, the author of Life Without Ed, makes a good point about what comparison truly is. She stated, “On days like this, I think of a phrase that I learned in therapy, compare and despair. The fact is that when it comes to body image, I know that I cannot see straight. My vision is literally distorted, so comparing myself to anyone else is just setting myself up for disappointment.”
There is always an over-pursuit of control
This is an illusion that somehow permeates all the mechanisms of the eating disorder. Patients will either have a complete sense of control or be in complete control of all outside variables. It is an attempt to control against those things that will make them look bad, prevent those things that will make them feel bad, or find control over the sense of gnawing emptiness and self-contempt that is ever-present. Unfortunately, in all of the hard work and effort to be in control, they are always on the verge of feeling out of 4 control. The “out of control” monster is always breathing down their necks and will, without the protection of the eating disorder, get them. Patients believe they have to constantly exert more effort to be in control, follow more rigid rules to keep the control, and put up more rigid walls and defenses to protect them from potential experiences that will make them feel vulnerable, stupid, or powerless. Unfortunately, the consequence of this kind of pursuit is a deep sense of loneliness or aloneness which leads to more self-contempt which indirectly feeds the eating disorder.
Finally, a common theme of eating disorders is overwhelming fear
Fear seems to be the only feeling anyone suffering with an eating disorder is allowed to feel without chasing it away. All of the other feelings seem swallowed up in the phrase, “I’m fat.” Fear seems to be the main reason for all of those other things they pursue through the illness. There seem to be a lot of fears about who they are, what will happen next, how other people will react or think, whether they will be accepted, whether they will fail, or how they will come up short, etc. Fear is an awful reminder that they too are human in a life full of anguish. It is in the depth of this anguish that they often feel hopeless. I would say, for many of these wonderful women who have suffered from an eating disorder, the fruits of fear are hopelessness and despair. They have lost a sense of hope. They gave up a sense of self-dignity and self-respect long before the sense of hopelessness, but now it does not feel like there is anything good to hold on to in life. Things somehow feel too slippery and too far removed from them. This hopelessness leads to self-contempt, and the self-contempt indirectly feeds the eating disorder.
THE HEART IS NEEDED IN RECOVERY
There is a remedy for all of this self-imposed suffering and it is at the core of recovery. It is the matter of the heart. All of these false pursuits and the subsequent negative complications that come with these eating disorder pursuits are matters of the mind. They are preoccupations, ruminations, obsessions, doubts, analyses, questions, predictions, beliefs, judgments, negativity, perceptions, criticisms, and a host of other thoughts that all are in the mind. From my perspective, women in treatment need more help becoming better acquainted with their hearts, starting to listen and learn more from their hearts, and relying a whole lot less on their minds. It is my belief and also my observation that hope, love, healing, faith, peace, honesty, courage, conviction, congruence, and dignity are all matters of the heart. If we are going to help women who suffer with this terrible illness find themselves again and fully recover, they will need to use their powerful and good hearts.
I want to emphasize the importance of the heart in this article because I believe the heart helps women remember intuitively and deeply the important truths about who they really are. It helps them remember what matters most in their lives. The heart helps them remember who truly loves them. It also helps them remember what they really want and where they want to be. I believe that by listening to their hearts again they will remember that they are not alone in this world, and that they are surrounded by seen and unseen influences of good. The heart can help them remember all the good things that once spoke to their hearts.
I believe the heart promotes self-forgiveness and forgiveness of others. It promotes self acceptance, healing, and love. The heart promotes hopefulness, whereas the eating disorder says none of these things matter. The only thing that matters in life to an eating disorder is pleasing the eating disorder. The only thing that matters to the eating disorder is whatever is needed or is necessary to win its approbation. The eating disorder tells these women that approval from others, being in control, avoiding anything they do not want to experience, coming up on top of the comparison is all that has meaning. Listening to the heart can help them feel the better days and to sense the brighter tomorrows. Listening to the heart can nurture hope for their lives, and give a sense of contentment or calmness about the good choices of today. Listening to the heart and beginning to act upon these inclinations will help women move towards recovery in a way that will enlarge the healing process and will replace the eating disorder with matters of much more depth, value, meaning, and importance. That is what makes recovery a matter of the heart.
HEALING THE BROKEN HEART
Unfortunately, women who have lost their hearts through the course and development of the eating disorder, may believe that self contempt is a natural consequence and an obvious evidence that their hearts are bad, or that they are personally broken in ways that are irreparable. It becomes apparent in therapy that patients often associate anything to do with their hearts, as too emotionally painful. When most people think about the heart, they think of it in positive terms and positive ways, but for those who suffer with eating disorders, the heart seems filled with too much pain, failure, loneliness, despair, shame, and hopelessness. Any emotional pain has been interpreted to mean that the very core of who they are – their hearts – are damaged, bad, and unacceptable. This negative and symbolic connection between emotional pain and their hearts is one of the reasons they have come to believe they are damaged and broken. In the depths of their eating disorder, they do not understand that the reason they feel so damaged and unacceptable is not because of their hearts, but because of the self contempt that is the product of all the false pursuits.
We want to invite patients to listen to their hearts again and to come back to their hearts because it is crucial for their recovery. The heart is often described as the center of both physical and spiritual well-being, the inner core of being, the deepest seed of desires and emotions. It is important to help those we work with to know that their heart is much more than feelings and has very little to do with thoughts. Their heart goes to the very core of who they are and it is part of their identity. It is the source of impressions, intuitions, and a deep sense of knowing or understanding things about themselves and the world around them. It includes inner desires, inner motives, heart-felt knowledge, and the intents of their heart. What I have learned about listening to the heart is that it conveys to each person a sense of knowing, understanding, or personal truth that is often very hard to explain in words. We can try to help patients learn that knowing and sensing something deep inside themselves is worth listening to and remembering. We can teach them that these heart-based impressions, desires, and motives can be a powerful resource in redirecting their lives and moving them forward in recovery from an eating disorder. If they understand what their internal motives are and understand with clarity what they know in their hearts, they can know how they want to be in this moment of time and how they want to live their lives into the future.
THE HEART SPEAKS OF LOVE
One of the most important things about listening to the heart is to remember that the heart connects to love. One of the most significant consequences for those who have forgotten or who have lost their ability to listen to their hearts is they have lost the connection to love. To lose their connection to love is to lose the experiences of love, intimacy, vulnerability, and emotional closeness, where they can feel connected to other people in their lives. For many of these women, to lose that connection to love is to also lose a spiritual relationship with God. They can feel distant and far removed from God’s influence and love. They often feel alone, lonely, and empty, even in the presence of people in their lives who genuinely love and care for them. The message for patients with anorexia and bulimia needs to be that in order to get your hearts back, you need to let love in and let love out. We need 6 to talk more to patients about how they refuse love, how they resist love, and what they can do to open up their hearts to receive love again, and to give love again. We can talk with them about ways to show love for other people and to recognize when love has been given to them. We can talk about ways to increase the expressions of their loving hearts, either through word or action. The key to this process is to label love as an expression of the heart and to see experiencing love from others as a gift from their hearts. They can begin to increase their awareness of how much love there really is around them and how much love there really is inside of them. What a powerful remembrance it is to know how much love is really available inside their own hearts and to also trust the love given to them by other people. To know that their love is a gift worth giving and that it truly matters is a powerful component in recovery. Love is much more than approval. Some approval may be expressed in love, but love is much broader and much grander than approval. Too often with eating disorders, patients equate approval to love, making approval and love the same thing. They can not find their hearts without separating approval from love. Love connects to the heart. Love is a change agent, approval is not. Love has greater influence in changing lives than approval ever will.
I remember facilitating a group many years ago with a college-aged woman who felt and believed with all her mind that she was the exception to love. She believed that somehow love was okay for others but was not okay for her because she was too broken, too undeserving, and too unacceptable. She felt she had not merited love and therefore she resisted and refused love, even though there were many women in the group as well as staff members who loved and cared for her. On this occasion, we had her sit in a chair in the middle of the group and we had the other participants in the group come up to her, one at a time, and with white tissues in hand kneel down before her and hand her a tissue with each expression of love that they felt for her. With each loving appreciation, acknowledgment, perception, or remembrance they had of her, they would hand her another tissue. One thing I noticed in this activity is that the other women in the group could hardly wait to come with their tissues of love. In fact, sometimes they literally came running with their tissues of love in hand, giving freely and symbolically with those tissues the gifts of love from their own hearts to this woman who believed that somehow love could not reach her and that love was not hers to have in this life. When this activity was over, this patient sat with her arms full of white tissues. Her lap was piled high with tissues clear to her chin, and there were many tears running down her face. She could see the love and she could not deny it. It was plainly evident, tangible, and real. She started talking about letting love in again. She knew in her heart she needed to if she was going to get better. For those few minutes, her heart rejoiced in the love that was available in the room even for her. I believe it was a turning point in her recovery. In that group activity and many others like it since that time, tender-hearted women have spoken to each other about the love in their hearts and for each other.
One of the truths we try to teach patients is that when they give love and someone receives their gift of love, the receiving of their love gives them a gift back. All patients know what it is like to give a gift to someone and to have that person reject, resist, or refuse the gift of love. All of them have also been on the receiving end and have made the same refusal. Reconnecting to love is an important part of having their hearts back.
The Heart Is Present in Every Moment
One of the important concepts Dr. Roger Allen teaches in his Life Strategies workshop is the importance of being present and living in the moment. Living in the moment and being present is a key to reconnecting with love. He states:
Being present is showing up and living fully in any given moment of time. It requires a willingness to “wake-up,” to notice what is going on, to see, think and participate in this moment in life. Being present is living with awareness and willingness to make choices appropriate to the task or moment at hand. It could be considered the state of being mentally alert, conscious, and focused. Being present is the gateway to change. Only by being conscious and aware can we make changes in our lives. We can not change what we are unaware of or refuse to admit.
Too often patients with eating disorders retreat into their minds instead of being present in the moment where love may be available. They are living life only in their minds. They may be living in the past or the future. When they are living in their minds, they are not living in the present moment — the here and now. I think this is how patients become so consumed by the mental preoccupations of the eating disorder that they miss the love available to them. In the Life Strategies workshop we teach patients that this is the only moment where they can make choices. It is the only moment where they can be happy or be empowered to choose something different than they have chosen in the past. It is the moment when they can choose to listen to their hearts. If they spend their time in fear, they are in the future. If they spend their time in despair they are in the past. Helping patients to be more focused on the present is a part of helping them to connect again to love, not only from others, but in themselves as well.
RESPONSIBILITY IN HARMONY WITH THE HEART
As we help patients reconnect to their hearts it is important to help them develop a better definition of personal responsibility. Most eating disorder patients have a distorted view of personal responsibility that consists mostly of fault, blame, self-judgment, and self-contempt. What we are trying to help them understand, and what can speak to their hearts, is that personal responsibility has nothing to do with self judgment, blame, or fault. From the definition in the Life Strategies workshop, Dr. Allen states:
Personal responsibility is acknowledging that I create my life through the choices I make. It is living from the empowering mind-set that we are free agents who make choices every day of our lives. The quality of our lives is a result of those choices. This does not mean, of course, that we cause or control everything that happens to us, but we do have choices about how to respond to everything that happens to us and through our ability to choose, we even create the events and circumstances to which we respond.
In the negative sense of responsibility, when patients are lost in eating disorders, they want to avoid responsibility at all costs because it means more chances for failure, more expectations they cannot live up to, and more letting other people and themselves down. And so, instead of personal responsibility they may use a pursuit of control, avoidance, or perfection in an attempt to not be blamed for their choices made in life. If they feel blamed or if it is their fault, they will automatically move to self-contempt and the self-contempt always feeds the eating disorder. Self-blame is a comfortable but punishing aspect of self-contempt. The true sense of heart is to be for, and not against themselves. To be in harmony with their hearts is to make self corrections that do not damage their sense of identity.
Taking responsibility requires honesty. It does not require judgment. An important part of listening to the heart is to seek for an honest heart and be true to their hearts. Honesty is telling the truth and being accountable for their choices. It is not about finding someone to blame nor is it about finding fault with themselves. It is not about finding someone to judge. We encourage those we work with to choose to be kind and patient with themselves as they assume personal responsibility and learn from choices that lead to their recovery. Self-contempt is never a part of the heart. If a patient’s notion of responsibility leads them to self-contempt, then they know it is one of those negative matters of the mind. We can invite patients to face their lives directly and to make changes and corrections without self-blame so they can keep making better choices and see the options beyond their eating disorder. Kindness and compassion are a more effective context of honest self-correction. Kindness and compassion speak to the heart. Truth is never easy, but truth is simple, powerful, and changes lives. A big part of telling the truth is to begin to listen to their hearts again.
I am grateful for the many honest women who have recovered from their eating disorders because I know that it required their willingness to have an honest and true heart and to be kind to themselves in the process. In their book entitled How We Choose to Be Happy, by Rick Foster and Greg Hicks, they said something very important about not telling the truth:
Not telling the truth to ourselves and others is the source of many of our greatest problems. Without truth there can be no real intimacy in our most important relationships. Most important we lose contact with our true selves. Can we in fact know ourselves if we do not tell the truth to ourselves. It is not always easy to tell the truth to ourselves, but when we do, we have achieved a feeling of personal integrity. The world seems right and we feel happy. When we make a commitment to tell ourselves the truth, we have forged an internal contract, having the idea that truth is a personal contract is where extremely happy people seem to have a special corner. On the word truthfulness, they are adamant about understanding their own truths in any situations. They test the reactions to people and problems. They are searching for what is real in their response to life. In short, they strive for authenticity and accurate and personal evaluation to exist in a state of integrity with themselves.
CLARIFYING THE DESIRES OF THE HEART
It’s important that we spend time helping patients clarify what they know in their hearts so they can begin to have the courage to act upon it. It is interesting to note that when patients begin to ask themselves what they truly want and they are getting answers from their hearts instead of their minds and the redundant answers of the eating disorder, they begin to open their hearts to the possibilities of what is available in life instead of what is missing for them. They begin to lose their hopelessness and begin to be more hopeful about life. They know that what they truly want or what matters most to them can become available through their personal choices at any moment of time, and that over time, heartfelt desires can become realities. One of the things that Dr. Allen talks about is the notion of Vision. He said:
Vision is knowing what we want. Vision is a powerful positive motivator for action. In fact, we change more by clarifying and deepening the importance of what we do want than by overcoming what we do not want. It is when our vision burns within us that it will become a reality. Vision is knowing what we want. It consists of four aspects:
Clarity – if we are to have what we want, than it must be clear in our minds.
Value – what we want must have value to us or there will not be the motivation to achieve it.
Faith – we must have the positive expectation or belief that what we want is in fact possible.
Alignment – what we want must be aligned with our true selves and what is most important to us.
Vision is power. It is the power to bring to life something that does not now exist, because it already exists within their hearts. Women suffering with eating disorders can know what matters most to them in their hearts and by acting upon 9 those desires with faith and courage, they begin to make the choices that will help bring these desires into their lives. One thing I have observed from women in recovery who have a powerful vision is that they want to live for a purpose larger than themselves. By listening and being in harmony with their hearts, they are giving up much of their self-focus or self-centeredness. Their hearts are leading them to something much bigger than just themselves. It is leading them in a direction to believe they have much to give others and the world, and there is much good available inside of themselves.
THE NEED FOR A COURAGEOUS HEART
Finally, we need to help patients understand in listening to their hearts that they also need to have a courageous heart. I will often tell my patients that if they are going to listen to their hearts, follow their hearts, and be true to what they know is there, then they will need to be brave and courageous in new ways. It is important they discuss bravery and courage so they can be in alignment with their deepest desires and in harmony with their hearts. Even if everything does not work out exactly the way they had planned, they still can feel good inside because they have been true to their hearts, and have acted with faith and courage. They can simply make corrections and keep moving forward. There is no “all or nothing” thinking in the heart. “All or nothing” thinking is a matter of the mind. It is a process of moving forward with faith and courage, believing they will get to where their hearts want to take them. It is impossible to make a stand for something very important to them if their hearts are not in it, for it will not last. Being courageous is having their words and actions become more and more congruent with the desires of their hearts. These courageous actions feel good to them and they learn this important lesson: whether they have failed a hundred times or they have succeeded a hundred times in their progress towards recovery, their heart never changes, and who they are remains the same.
THE CHANGES OF HEART
One of the things that I have witnessed often over these ten years at Center for Change is many evidences of changed hearts in the women who have worked toward recovery. It has become a powerful reminder to me, over and over again, of the importance of the heart in recovery. I have observed as these patients continue to recover from their eating disorders and progress through treatment, their artistic impressions and expressions about themselves show a significant change of heart. Earlier pictures of their hearts which were broken show a different heart at the end of their treatment. These images will show a complete and growing heart, often times, the heart is bigger and has a more profound presence in the drawings. The heart is often radiating, growing, or glowing with vibrant colors. The heart can be of many colors and there are many powerful words which are often written on their hearts. I have seen artwork where the heart was the center of the body and from that center it radiated beams of different colors of light which fl owed through the rest of the body and mind. These new hearts show love, courage, faith, strength, hope, and peace. I have seen these changed hearts in the words, actions, and lives of many wonderful women of all ages, and it all tells me that recovery is truly a matter of the heart.