“Lucia Giombini, psicologa che si è formata presso il Centro Palazzo Francisci di Todi, oggi lavora a Londra in un noto centro dedicato al trattamento dei Disturbi del comportamento alimentare. Questo l’articolo che racconta la sua esperienza a Todi”.
~Excerpt from Quest for identity: recovering from the eating disorders. The Psychologist.~
The soul needs a place.
That quote, by Greek philosopher Plotinus (204/5-270 BCE) hangs at the entrance to the inpatient eating disorder service in Todi, Italy, which I visited for the first time in 2006. The service admits both adults and young people for a few months at a time, and I recall my surprise at how little it resembled a hospital; its warm and nurturing – almost homely – atmosphere was designed to provide an appropriate environment to foster recuperation and recovery, to allow inpatients the space to be restored to physical and psychological health and to reconnect with themselves.
My experience came at the beginning of my clinical doctorate, when I went out into the field for the first time.
From the lectures I understood that eating disorders lead the sufferer to reject, or abuse, one of the most elemental ingredients of our lives – food.
I was also struck by how eating disorders affect the mind as well as the body, highlighting the importance of the circular connection between these two parts of our selves. A general lack of awareness of the illness, in conjunction with the degree of severity that this disorder can reach, was simultaneously both extremely upsetting and fascinating from a psychological perspective.
It is one of the few mental illnesses from which, initially, a patient has little motivation to recover. The link that a patient often establishes between the condition and his or her sense of identity is characteristic, as is the related feeling that it somehow makes them special, or unique. One of the first steps with a patient is consequently to help them to recognise that unhelpful thoughts, revolving around the body and food, belong to an illness.
Although there may be some variation in the detail of the clinical presentation related to age and gender, the core features are consistent across the age spectrum. What is being expressed through weight and shape concerns and unhelpful eating behaviour/patterns is essentially a quest for identity, starting with this question: “Am I good enough?” The immediate answer from loved ones is naturally “Yes, of course”. The way in which we can reinforce this message, and for those we love to actually believe it, is through a complex personal growth process in which every one of us – parents, relatives, teachers, coaches, professionals -is involved.
The message and the emotions that they want to express and communicate through their bodies are another essential focus of the psychological work. They display extreme behaviour such excessive dieting, intense physical activity, and self-harm. The attention that they pay to their own bodies can consequently easily metamorphose into an obsession.
How much time do you spend thinking about what you eat and how you look?
In a psychological session with a young girl suffering from anorexia it is crucial to ‘read between the lines’, as what is said is frequently contradicted by reality. An insistence that they are ‘perfectly well’ is common, as is an apparent unconcern with their deteriorating physical condition.
The main question I ask a patient to understand the severity of their condition is: How much time do you spend thinking about what you eat and how you look? Often the answer is all the time, apart from when I sleep.
Subsequently, the focus of the work is helping them to externalise the illness. Is it you or the anorexia’s voice speaking? This question is often met with hostility, even anger, as they are unable to distinguish between themselves and the disorder. Eventually, however, they will begin to adopt similar language to the practitioner when discussing their condition. The approach is always motivational: They need to feel that they are not being forced into changing, as this will usually trigger a powerful urge to resist.
When the youth cool off, the whole world will chatter their teeth
Despite working in this field for many years, it remains a challenge. The results of my work are often only seen years later, when I receive letters from patients thanking me and stating that – at the time of treatment – they did not allow themselves to openly acknowledge my words, but that they were nevertheless listening. Moments like this serve to reinforce my conviction that I am on the right path.
To quote Georges Bernanos, When the youth cool off, the whole world will chatter their teeth. We all need to try to respond to the ‘call’ of young people. Parents need to be informed of the defining characteristics of their children’s difficulties, and to remember that they are an essential ally in the prevention and treatment process.