Using the narrative to resist and break the chains of Anorexia Nervosa

H: How do I put on weight?

DE: How do you put on your PERSON?

H: As I am putting on weight, I am putting on my person.

DE: Maybe you put on your person and the weight follows…

June Alexander

Narrative therapy works by separating people from their problems. Developed by David Epston and Michael White in the 1970s and 1980s, narrative therapy is non-pathologizing, empowering, and collaborative. It recognizes people have skills and expertise that can help guide change in their lives.

Today’s post — a conversation between David Epston and his client, Helen — follows on from our post last week and presents insight into the unmasking of Anorexia Nervosa. The narrative provides insights into the mind of Helen, as she starts to see the illness for what it is – a sneak, and false friend.

To set the scene: therapist David Epston is writing to his client, Helen, following another session. She is making good progress. In the conversation, DE is the voice of David Epston, and H is Helen.

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DE: What thoughts come to mind now, on listening to me read the letter I wrote to you after our last meeting?

H: It was quite good telling me that you are going to keep on telling me the tricks IT will play.

DE: Why do you think it is important for me to keep that up?

H: Because I will forget everything. She doesn’t allow me to acknowledge things. Do you know what I mean?

DE: Can you say a bit more about that?

H: I guess I will need some power; you know, from others so that she can be less powerful.

DE: Just talking to you today, there seems to be more power in your voice. Do you think there is anything in what I appear to be observing?

H: I am impatient.

DE: What are you getting impatient about?

H: I am finding it so incredibly hard.

DE: Are you getting sick of IT?

H: Yeah…yeah, I (very thoughtfully) I just can’t break free.

DE: Is Anorexia trying to convince you that the only way to be free is to break free?

H: Yeah (coming to life again).

DE: To be totally free?

H: Yeah (authoritatively).

DE: Okay, don’t believe a word of IT!

H: It’s like I can’t do it all at once.

DE: Is that the trick we are talking about?

H: Yeah. IT is putting a lot of pressure on me.

DE: That you are not good enough…that you are not doing good enough Anti-anorexia?

H: Yeah…yeah!

DE: Can we talk about how imperfectly you are doing it? Tell me some of the mistakes you have made in terms of your opposition to Anorexia? How have you made a few mistakes?

Did you give into Anorexia since we last met?

H: Yah, a couple of times.

DE: GOOD…GOOD…GOOD! Can you be pleased about that?

H: No (laughing)I feel guilty. I am under so much pressure at the moment.

DE: Pressure from whom? From Anorexia or Anti-Anorexia? Where is the pressure coming from?

H: I am just getting really frustrated for myself, you know.

DE: Hold on….hold on. Can we talk about something differently so we can have an anti-anorexic conversation? If you come here and tell me how badly you are doing, are we falling in to Anorexia’s hands? So I won’t do that. Is that okay?

H: Yah, that’s good!

De: I am more interested in talking to you about the ways you are resisting Anorexia. I think resistance comes before break out…before freedom. Don’t you think we should get ready for freedom? Can we talk about resistance?

H: I just need to know about commitment…the change and that. What sort of things you know…I want to be more Anti-anorexic. I was talking to Tracy. She said she just decided to change….

DE: What about you? Do you think you have changed? Do you think it’s important for us to talk about if you are ready to come to the conclusion that it’s not right and proper for you to be murdered?

H: Yeah! (enthusiastically)

DE: What do you think about that? Why shouldn’t Anorexia murder you?

H: I don’t know. It just shouldn’t!

DE: Why you do you think it has put you in the concentration camp so far?

H: Because I deserved to be punished.

DE: Tell me where you get that idea from? And how did Anorexia exploit that idea?

H: Because I always feel guilty about what I say and do to people. You know – I’m a bad person.

DE: Do you think Guilt is the thing that has sentenced you to torture?

H: Yah…yah…yah! I feel guilty that it was my fault for the abuse.

DE: Do you think that when you come to a different conclusion about that, that that will free you up a bit?

H: Yah (breathing a long and deep sigh of relief).

DE: Good!

H: Yah. Then I wouldn’t feel guilty, would I? I won’t have to be punished for the guilt because it won’t be there.

DE: Is that an attractive idea to you?

H: How come some people have had sexual abuse and they don’t get Anorexia?

DE: There are plenty of other ways to be tortured and punished.

H: I still find it hard to connect eating and Anorexia.

DE: How do they torture people in concentration camps?

H: Starve them.

DE: Now you know. What else do they do? Do they humiliate them and call them names? What else do they do in a concentration camp? Do they say you are vermin and not worthy of life itself?

H: Keep stamping them down. Overworking them.

DE: Does that sound a bit close to home?

H: Really close to home. Put them in a structure and brainwash them.

DE: Not let them sleep. Tell them they don’t know their own minds.

H: Yah….yah (in a hushed tone).

DE: Reduce them to the level of animals. Don’t allow them to ever clean themselves so that they believe they are responsible for being dirty. Can you see the parallels now? (she nods)Is that helpful to see the parallels?

H: Yah.

DE: Up until now, were you unable to see the connection?

H: All this punishment and the Anorexia is my way of punishing myself for the guilt I am feeling over the abuse.

DE: Sounds like it to me. What do you think? Does this all fit together?

H: I am wondering how did it get in to my mind in the first place

(we take a break).

DE: What does Anorexia do when you eat a little bit? Does it scream at you?

H: Yah.

DE: Say you were to go home right now and I were to give you some food which I would never do but in our imagination you ate it. Just imagine yourself doing that and say you even got a little bit of pleasure out of it. It tasted good. You felt you were putting life in to yourself. Nourishment and life and strength and power. Tell me exactly what Anorexia would do?

H: It would get really angry. It would make me feel dirty and disgusting. I would want to rip all the food out of me. It would make me feel really guilty and quickly take it all off…either exercise it off or just get rid of it. When food is inside me, it is like I have eaten shit or something. It makes me feel I can’t cope. I just want to run away.

DE: That’s what Tracy said.

H: It’s like poisonous and evil.

DE: Do you think there is any connection between those feelings and how you felt when those people perpetrated abuse on your body, mind and spirit?

H: That’s how I felt when it was happening.

DE: I am sorry to hear about this but does it make any sense to you?

H: Yah (very softly). Like when they were inside me, the food feels the same way.

DE: Do you think what was un-good for you has contaminated what is good for you?

H: Yah (meditatively).

DE: I know this is upsetting but is it helping in any way?

H: So does the food represent abuse?

DE: What do you think?

H: Yah, it must do. When I am eating, I must be thinking I am being abused again.

DE: If you were able to separate food as nourishment and being good for you from the abusive experiences….

H: (interrupts) the food won’t become threatening because it won’t have the meaning because I will have separated the two.

DE: I am wondering if you aren’t separating the two a little right now?

H: It’s just knowing. I have never known. All I have ever known is the Anorexia. And how can I solve it if that is all I know it is. Because you don’t know the reason. I have felt so unconnected. It is just like a dark tunnel and there is no way out because all there is, is this food stuff. But people keep telling me it’s not food. That’s just the symptom or whatever. It’s not the Problem.

DE: Now Anorexia is very likely going to try to muddle your mind pretty soon, isn’t it?

H: Yah…yah.

DE: That’s why I’m pretty happy we have got this on tape so you can take it home with you.

H: That would be good. I just feel like crying all the time. And I don’t know why but I think it is getting clearer because I don’t think I have ever faced the abuse before. I didn’t even know I had been(abused).

DE: Is that how the concentration camp of Anorexia became invisible?

H: Yah…it’s frightening. Because I have never faced it before. All I have faced is the food and that was frightening. I was facing the punishment rather than the real thing. Maybe that was why I could never let it go. I still find it really hard to let it go and I know it will take time but in the meantime you need it.

DE: By the way, have you ever deceived Anorexia? Have you ever gone to a place where Anorexia doesn’t know where you are or can’t follow you?

H: OH, IT DOESN’T COME HERE! Generally, it doesn’t allow me to do things I want to do; rather it makes me do her stuff first and then I don’t have time for your stuff or if I want to write to my mum or if I just want to cry. Or if I want to read the Bible.

DE: Would it be an act of resistance against Anorexia to write to your mum, to cry.

H: Write my Anti-anorexic diary for you….

DE: You don’t have to; just if you want to..

H: Dad wants to go through the photos of my childhood and we are going to do that.

DE: If you came here and ate…and I am not saying you should or you shouldn’t, but just because Anorexia is not here…

H: She still might be here but she holds back.

DE: Is she scared of Anti-anorexia?

H: Yah…she wouldn’t say anything here but she is here.

DE: She wouldn’t dare open her mouth?

H: She is scared of you.

DE: Why is she scared of me?

H: Because you are a man and because of what you stand for.

DE: What do I stand for that it can’t stand up to me?

H: BECAUSE YOU HATE HER!

DE: I see…I see.

H: AND THAT IS THE KEY!

DE: (excitedly)Is that the key? Oh great!

H: Yah.

DE: I am wondering if we are stumbling on to something?

H: And that is what I’ve got to do but you see I was taught never to hate. That was really strong in my upbringing. Like, hatred was kind of evil but the people who taught me that, hate Anorexia.

DE: Could you make a special case for Anorexia? Do your mum and dad hate Anorexia? Do you think if you sought their permission to make a special case for Anorexia that Anorexia should be hated because what it has done to you? What would they say, do you think? For example, if you asked your mum for a special concession in the case of Anorexia instead of being loving to everyone?

H: After all, I hate myself!

DE: Does that mean you know how to hate?

H: Yah, but I don’t feel bad hating myself but I feel bad hating other things…guilty and that.

DE: There are two things you have told me, Helen, that interest me. One is that you can hate but the trouble is you hate the wrong person, and two is that your mum and dad might give you permission to hate Anorexia and in fact, they already do.

H: Because they hate it!

DE: Do you think if they loved Anorexia, they would love their daughter’s murderer?

H: Yah.

DE: That would be pretty strange, wouldn’t it? You would have to think of them as the most horrible people in the world, if they did that. Don’t you think? Say they invited Anorexia around and said: “There is our daughter. Why don’t you kill her. We don’t want her around much anymore. We’ll hire you. We’ll pay you.”

H: “Or she’s been bad so why don’t you bump her off?”

DE: If I said to your mum, “Helen thinks you have hired Anorexia to rub her out”, what do you think she would say? Would she be shocked by that?

H: Yah. She would say that Helen is nuts in the head(laughing out loud).

DE: I would reply, “Helen isn’t nuts in the head; she has Anorexia in her head driving her nuts”.

H: Yah(enthusiastically). But how did IT get there in the first place?

DE: Do you think the abuse opened the door for Anorexia to walk in to your life and occupy it? Were you a very sensitive and loving person?

H: Yah…yah.

DE: And were you taught that there was goodness in the world?

H: Yah. And I had to be Perfect and when I didn’t measure up, I felt inadequate.

DE: Did you get the idea that being abused was your fault rather than the criminal’s fault and this meant you were bad?

H: Yah…yah…yah.

DE: Did it ever try to convince you were bad forever?

H: Yah…and SINFUL. VERY SINFUL! And God hated me because of what I’ve done.

DE: I believe that God with his all-seeing eye and compassionate love knows what is going on here. Do you think so?

H: Yah, He is the only one who does.

DE: Do you think God, with His all-seeing eyes and loving wisdom, when He looks down, do you think He takes the abuser’s side or your side? Who do you think HE thinks is evil?

H: (Puzzling and sounding quizzical in reply)I don’t know…the right side. I haven’t found out yet who is on that side?

DE: When you and your sexual abuse counsellor work that one out, do you think you will no longer be required to be in the Concentration Camp of Anorexia?

H: Then I will be free(reconsiders)BE FREER.

DE: How long have you been in the concentration camp of Anorexia?

H: Eight years.

DE: Do you think you have forgotten how to be Helen? Remember your dad talked about how he started losing you around that age? That’s 13 or more years, altogether. Do you think you have lots to learn?

H: Yah.

DE: New ideas to have about yourself…new pleasures to figure out…new thoughts.

H: I don’t think it is going to happen overnight.

DE: That is something you might like to talk to Tracy about.

H: Did she put on weight right away?

DE: I don’t know about that. What I do know is that she put on substance as a person. I choose to see you as a strong and powerful person because Anorexia tells you that you are weak and worthless.

H: How do I put on weight?

DE: How do you put on your PERSON?

H: As I am putting on weight, I am putting on my person.

DE: Maybe you put on your person and the weight follows. I remember Tracy’s concerned parents ringing me and saying, “She hasn’t put on any weight!”. I would reply: “I don’t know anything about weight but have you found her more intelligent than she used to be”. They would reply: “Of course she is…before she didn’t even say anything. And now she is doing this and that and got a job and people admire her and she’s got all these friends and is going out”. So “what does that tell you?” I would inquire.

H: SHE IS GETTING HER LIFE BACK!

DE: She is getting her life back. I said to your parents, “Do we need to be concerned about weight right now?” They said: “Oh right, David. Right, David. Yah, we forgot. WE forgot”. I said, “If your concerns return, just ask yourself: “How much of her mind has she got back?” Can I ask you this question, Helen: When you consider or listen to what we have been talking about today, would you consider that you have been more thoughtful – like, putting ideas together that you would never have been able to do when Anorexia totally dominated your mind?

H: My mind is working slowly, eh! But you help me. I wouldn’t think these thoughts otherwise…I guess the more and more you go along, you want freedom more because before you are not seeking it because you don’t know it is possible.

DE: Do you think Anorexia putting ‘punishment and torture’ into your mind might sadden Anti-anorexic people?

H: People tell me that’s how they feel about it.

DE: Can you appreciate that they might feel that way?

H: I find it difficult.

DE: Is it getting easier to believe them? Do you remember Tracy saying that Anorexia told her that everyone else was lying to her and IT was telling the truth?

H: She also told me that you really cared for her and thought she was a worthwhile person and that helped her to see that she was.

DE: Is there any way you can see that in me?

H: I can’t feel that in anyone. SHE HAS MADE ME LOSE THE SENSE OF LOVE..OF PEOPLE

LOVING ME. I feel unloved and I don’t know how to feel love. I’ve lost it. All the people keep telling me and that.

DE: Does that have anything to do with what Tracy said that “Anorexia cuts you off from the outside world”? Is there any way I have been able to sneak under Anorexia’s barb wire fences around your heart to give you the idea that I do understand a bit the tortures you are enduring and that I will always oppose that? There will not be one day in my life from hereon in that I will not oppose that. Do you have any sense that Anti-anorexia support is there now, calling out to you? We are small but we are zealous and vigorous in our opposition. I wonder if you got any idea of that when you were talking to Tracy?

H: Yah, I totally got that impression from her. She still has problems, but she is definitely Anti-anorexic.

DE: How can you tell she is Anti-anorexic?

H: (laughing)Because she told me.

DE: And when she said it, did she say it in a proud way?

H: YAH! YAH! She is really proud of it. And it’s like she has found her sense of herself. She respects herself and loves herself.

DE: Do you think if you come to love yourself that Anorexia won’t be able to convince you to hate yourself?

H: Mmmh.

DE: What offends me the most and I don’t know if you can appreciate this is how Anorexia is humiliating you?

H: What do you mean by humiliating?

DE: Betraying…deceiving…

H: And abusing.

DE: Are you getting tired of all this thinking? You will have to let me know because it actually makes me stronger when we talk together. I don’t know if it does the same for you.

H: I am worried I won’t be able to think about it after I leave here.

DE: Do you like the idea that we have tape-recorded this conversation and you can take it home with you?

H: Yah, it’s the best thing because I can then go over it. AND IT’S WITH ME. AND I KIND OF FEEL SECURE, AS WELL, THAT YOU’VE GOT IT.

DE: Do you think Anorexia will try to forbid you to listen to the tape?

H: OH YEAH!

DE: What would happen if you went to your dad and asked him to stand guard for you? Do you think he might provide you with protection? I don’t know If you want him to listen to it as well…that’s up to you.

H: Yah.

DE: I only met your mum and dad once but they became your allies quickly. I know they were shocked as they were making some connections, too, that they had never connected up(Helen disclosed sexual abuse to her parents). And they are shocking connections, aren’t they? And they seemed a bit numb, didn’t they?

H: Yah.

DE: But I think they were in a state of emotional shock…psychological shock. But when I talked to your mum the next day on the phone, I got the strong impression that she was feeling pretty strong and Anti-anorexic. And then I met your dad the other day and he was seeing you differently. He was seeing you more as a torture victim than a naughty girl…a bad girl. And I think he cherished you and valued the fact that you were getting closer again. You were starting to have a bit of a reunion because I think he feels Anorexia has robbed you from him.

H: Yah…people also feel I am punishing them. My doctor told me that I am angry at my parents for my abuse happening and that I am starving myself to punish them.

DE: Does that make any sense to you?

H: I don’t think I am.

DE: If you were to trust your own mind, what would you think?

H: He said I was really, really angry at them for not looking after me and protecting and nurturing me and providing me with safety. They didn’t know. How could they protect me from something they didn’t know about? It was something that had happened. AND WHAT THE DOCTOR SAID MADE ME FEEL EVEN WORSE. What he said, makes me feel worse because that is the last thing I want to do.

DE: If your brother or your father’s best friend said this, “I’ll just ask my/your parents if I can abuse you”, what do you think your mother or father would have said?

H: (laughing aghast with the thought of my question)THEY WOULD HAVE CHUCKED THEM OUT.

DE: I am totally convinced of that myself.

H: Yah, I don’t reckon I’m doing it to punish them. I am doing it to punish myself. I AM THE ONLY WHO IS FEELING GUILTY FOR WHAT HAPPENED.

DE: H, whose life has Anorexia invaded…your father, your mother or your life?

H: MINE!

DE: Who is in the concentration camp of Anorexia — your father, your mother or you?

H: ME (the most forceful comment Helen made in this session).

DE: Who is being punished?

H: ME!

DE: I am glad we talked about this. Are you feeling tired? No matter, we can talk about this some more next time we meet.

H: Yah.

DE: Is it time for us to wind up?

H: Yah.

The Diary Healer will share more transcripts of therapist-client sessions in weeks to come.

Here are three more of David’s favorites:

  • A Polemics Of Life And Death by David Epston & Rick Maisel published in (2009), Malson, H. and Burns, M., Critical Feminist Approaches to Eating Dis/orders, London, Routledge.
  • Bearing Witness is based on the Plenary Address to the Australian & New Zealand Academy of Eating Disorders, Adelaide, October 20, 2006). This piece was published in Epston, D. (2008), Down Under and Up Over: Travels with Narrative Therapy, Warrington, United Kingdom; Association of Family Therapy (UK).
  • Unsuffering“Are you ‘unsuffering’ your life through your thoughts and deeds? Should we introduce ‘unsuffer’ into the discourse of anti-anorexia/anti-bulimia (anti-a/b)? And the world at large? I am very intrigued by such a prospect…are you?” This conversation mostly occurred in 2007, between Julie King and David Epston.

The narrative therapy approach was an offshoot of Narrative Therapy (see White and Epston (1990), Narrative Means to Therapeutic Ends, Marsden, Epston and Markham (2016), and Narrative Therapy in Wonderland: Connecting with Children’s Imaginative Know-how). The best sources of information regarding anti-anorexia/anti-bulimia are the above-mentioned book, Biting the Hand that Starves You, and ‘Archives of Resistance: Anti-Anorexia/Anti-Bulimia’ at www.narrativeapproaches.com.

Further reading

  • Epston, D et al, A Narrative Approach to so-called Anorexia/Bulimia in Weingarten, K(ed), Cultural Resistance(1995)
  • Lock, A., Epston, D., and Maisel, R(2004), Countering that Which is Called Anorexia, Narrative Inquiry.
  • Lock, A., Epston, D., and Maisel, R.(2005), Foucauldian Perspectives in Narrative Therapy, British Journal of Guidance and Counselling.
  • Epston, D. and Maisel, R.(2009), Anti-Anorexia/Anti-Bulimia: A Polemics of Life and Death in Malson, H. and Burns, M. Critical Feminist Approaches to Disordered Eating.
  • Epston, D.(2008), Anti-Anorexia/Anti-Bulimia: Bearing Witness (Plenary Address to the Academy of Eating Disorders Conference, 2006 in Adelaide).