The Body and Its Image

I have wondered how someone comes to feel so terribly wrong in a body they have never lived without. There are people who have spent much of their lives attempting to change their appearance, only to discover that the person they encounter in the mirror remains strangely familiar. Others may have achieved the very body they once desired and still experience themselves as unacceptable. I am interested in how the body becomes involved in our most enduring experiences of shame, desirability, and recognition, particularly when the image through which we have learned to know ourselves seems incapable of changing even as the body itself changes.

In my work with eating disorders, I have come to appreciate the distinction between treating a behavior and understanding the experience of someone who has become identified with it. This does not diminish the importance of nutritional rehabilitation, behavioral interventions, or the medical care required when someone's health has become endangered. Yet the longer labor of psychotherapy often concerns something that cannot be adequately measured through weight management, social functioning, or the return to meaningful productivity. Someone may begin eating more regularly while continuing to feel profoundly ashamed of being seen. Another may learn to tolerate the distress of a meal while remaining convinced that they are fundamentally unacceptable. I wonder what happens when the symptoms through which someone has come to recognize their illness begin to change, but their experience of being ill remains remarkably intact.

In the previous essay, The Five Faces of ED, I considered the curious way we add the suffix -ness to experiences such as happiness, kindness, and funniness. I wondered what happens when the 'ness' in illness is now an enduring state of being ill. There may be something especially difficult about suffering that has become familiar enough to provide an identity. A person may have spent years trying to escape an experience of shame while becoming unable to imagine themselves without it. They may seek a diagnosis hoping to understand what has happened to them, only to discover that the diagnosis has become another way of knowing who they are. I am interested in how these chronic feeling states become so intimately connected with our images of ourselves that the prospect of feeling differently can become almost as disturbing as the suffering we wish to escape.

Marya Hornbacher's Wasted: A Memoir of Anorexia and Bulimia offers a particularly unsettling encounter with these questions. There is a disturbing bravery in her willingness to write about an illness that so profoundly endangered her life. Hunger, shame, desire, and the struggle to be recognized become entangled in ways that resist any simple explanation of why someone might continue doing what they know is destroying them. Yet I find the memoir itself especially interesting. In giving an account of her illness, Hornbacher makes something of its organization available to another person. The writing does not simply describe what happened. It becomes a way of encountering experiences that may have been difficult to recognize while she was living through them. I would not presume that the memoir reveals the psychological structure of everyone who suffers from anorexia or bulimia. Its value lies precisely in the particularity of the life through which the illness becomes known.

Donnell Stern's account of unformulated experience has helped me think about what becomes possible when someone finds a way to express an experience that had not previously become available for reflection. I do not understand the unconscious simply as a collection of fully formed memories and desires waiting beneath awareness to be uncovered. Sometimes what remains unconscious has not yet become something that can be thought. We may feel the persistence of an experience without possessing the language through which it could become recognizable. A person may describe feeling disgusting, frightened, or ashamed without knowing what these feelings have come to mean, or why they remain so familiar even when circumstances have changed.

Stern's attention to witnessing becomes important here because experience does not necessarily become more thinkable through explanation alone. Someone may have spent years attempting to understand why they feel the way they do, collecting interpretations that are reasonable and perhaps even convincing, while continuing to experience the same familiar distress. I have become interested in what happens when another person can bear witness to something that has not yet found its form. The analytic listener does not simply supply the missing explanation. Something of the experience may begin to emerge through a relationship in which neither person knows in advance what will become possible to say.

I think of Harriet Brown's Brave Girl Eating, in which a mother writes about the frightening experience of helping her daughter recover from anorexia. Brown's account is not the same as her daughter's experience of illness, nor should one be mistaken for the other. Yet there is something consequential about the mother's attempt to give an account of what happened to the family as they struggled to provide care. Her writing bears witness to the fear, anger, dependence, and extraordinary demands of loving someone whose life has become endangered. I am interested in how the memoir preserves something of the difficulty without requiring the family to have understood everything that was happening while they were living through it. The work of witnessing does not mean that another person can finally speak for us, but that an experience may become possible to approach when someone is willing to remain with what has been difficult to bear.

Philip Bromberg's writing on dissociation and self-states introduces another difficulty. We often imagine that a person possesses a relatively unified self whose feelings and desires occasionally become contradictory. Bromberg approaches the mind through different self-states that become available under particular circumstances, including experiences that may remain dissociated from one another. Someone may feel confident and desirable in one relationship while becoming profoundly ashamed in another. The same person may experience themselves as independent and capable while finding their need for comfort almost impossible to acknowledge. These experiences do not necessarily indicate that one is genuine and the other false. I am interested in what becomes possible when someone can begin re-associating experiences that have remained dissociated, especially when recognizing one part of themselves has seemed to threaten the existence of another.

I have come to think that vulnerability is especially important to this work. It is one thing to understand intellectually that we have conflicting desires, and quite another to allow ourselves to experience a desire that has remained unacceptable to the image through which we recognize ourselves. Someone who has always been independent may discover how difficult it is to be cared for. Another who has been recognized for their kindness may find their aggression almost unbearable. We may speak convincingly about these contradictions while remaining unable to experience them in the presence of another person. The long labor of psychotherapy involves something more than recognizing what has been kept apart. We may gradually become capable of bearing the vulnerability of allowing these experiences to become associated with one another, without having to decide which one represents who we really are.

The body becomes especially consequential when these different experiences cannot be held together. Someone may recognize themselves as disciplined and controlled while experiencing moments of appetite that feel entirely incompatible with the person they believe themselves to be. Another may become frightened by tenderness because the experience of being cared for awakens a dependence they have spent years attempting to overcome. I do not assume that eating disorders are caused by dissociation or that these conflicts explain every difficulty involving food. What interests me is how the body may become the place where experiences that cannot yet be held together are repeatedly encountered. The image promises something stable about who we are, even when maintaining it requires considerable suffering.

Jenni Schaefer's Life Without Ed approaches this difficulty differently. She describes learning to distinguish herself from the eating disorder by imagining it as a relationship with someone she came to call Ed. There is something useful about this intervention because it creates room for the possibility that the demands of an illness need not be identical with the desires of the person experiencing them. Yet I wonder what further questions emerge when someone begins separating themselves from a familiar pattern of suffering. If Ed is no longer the person determining what she eats, how does she begin to recognize the person who remains? What becomes possible when the familiar demands lose some of their authority, and what remains difficult to experience even after a person has learned to resist them? These questions do not diminish the value of Schaefer's recovery work. They invite us to consider what may become possible beyond the immediate relief of no longer having to obey the illness.

In my developing account of Imago Psychotherapy, I am particularly interested in the body and its image as foundational to the ways we have learned to recognize ourselves. The image is not simply what appears in the mirror, although the mirror can become a particularly troubling place of encounter. It involves the person we have come to imagine ourselves to be through the recognition, disappointment, desire, and expectations of others. Someone may become the attractive one, the responsible one, the one who never needs anything, or the person whose suffering has become the most recognizable part of their life. These images are not merely mistaken beliefs that can be corrected through reassurance. They may have developed through relationships in which becoming recognizable was intimately connected with being wanted.

What I have begun calling imago dissolution concerns the possibility that these images may lose some of their necessity without requiring the person to abandon what remains meaningful about them. I do not imagine that the work involves uncovering a more authentic self hidden beneath the illness, nor do I believe the therapist should determine which image the person ought to occupy instead. I am interested in how the person may become vulnerable enough to recognize experiences that have remained dissociated from the image they have learned to maintain. A person who has always understood themselves through shame may begin to encounter desire without requiring that desire to become another occasion for shame. Someone whose illness has become central to their identity may find that other experiences of themselves have been present, although difficult to acknowledge. The work is not to replace one image with another, but to make room for a new form of recognition through which more of one's experience can become possible to bear.

I have come to value the low and slow labor of psychotherapy, particularly when someone has already endured years of interventions intended to change how they behave. There are moments when the therapeutic frame must become more supportive, when immediate needs require practical attention, and when coordination with medical and nutritional professionals becomes essential. A person whose physical health has become endangered cannot be asked to wait for an analytic discovery before receiving appropriate care. Yet I also believe that the therapist must remain capable of listening when treatment itself has become another experience of being measured, corrected, or expected to improve. The flexibility of the frame matters because the person does not always arrive with the capacity to undertake the same kind of work at every moment.

This is not an argument for preserving suffering or regarding recovery as a threat to the analytic process. I am interested in how easily we can confuse improvement with conformity to the images through which a person has already been judged. Weight, relationships, work, and ordinary responsibilities may all be important parts of treatment, but I do not want these measures to become the final account of someone's capacity to experience themselves differently. Someone may return to work and remain profoundly alienated from their own desires. Another may become socially active while continuing to feel that every relationship requires the same familiar sacrifice. The analytic work may become possible precisely where the usual measures of improvement have ceased to tell us very much about what the person is experiencing.

Stern and Bromberg help me consider why this labor cannot always be hurried. What remains unformulated may require a relationship in which something new can be experienced before it becomes possible to understand. Dissociated self-states may begin to encounter one another without requiring that their contradictions be settled through a more acceptable image of the person. The analytic listener participates in this work without possessing its outcome. There may be long periods in which little seems to change, followed by an encounter that makes something previously familiar appear strangely different. Even then, what has become possible to recognize may need to be encountered again, perhaps many times, before it becomes something the person can bear.

I return to these three memoirs because their authors do something that no diagnostic description can accomplish. Hornbacher gives form to an illness that had become entangled with her experience of herself. Brown bears witness to the struggle of a family attempting to care for someone whose suffering could not be resolved through love alone. Schaefer writes toward the possibility of a life no longer organized around the demands of an eating disorder. Their experiences are not interchangeable, nor do they establish a single theory of recovery. Yet each allows something previously lived to become available to another person through language, and perhaps to be encountered differently by the writer as well.

I wonder whether this is something of what makes the long labor of analysis possible. We may begin with the body as the place where suffering has become most recognizable, yet discover that its image carries experiences we have never entirely been able to formulate. The work of becoming someone “I” recognize may require allowing ourselves to be vulnerable to the very experiences we have spent years keeping apart. I do not imagine that this produces a final or complete image of ourselves. Rather, something of what has remained dissociated may become possible to associate again, through a relationship in which we can bear being known without requiring that every experience confirm who we have always been. Perhaps the body can become something more than the image through which we have learned to judge ourselves, and recognition something more than the familiar certainty of being the person we already know.