Episode 8: Beyond the Turkey - Eating Disorders From A Psychoanalytic Lens

Episode 8 – Eating Disorders

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Amynah Dharani: Hello, everyone. I'm your host, Amynah Dharani. This is the podcast for people who are passionate about the human condition by people who are equally passionate voices in their field. If you're a new listener to our podcast, welcome to the show. Friends, this is Thanksgiving week in the United States.

hed potatoes, and of course, [: 00:01:00

The meal represents togetherness and gratitude. Yet, for some, this gathering, and specifically the festive meal, represents a high source of stress. I'm referring to individuals who suffer from a range of eating disorders, disorders such as anorexia and bulimia, as well as conditions of being overweight or obese.

I'd like to share some facts with you to underscore the severity of these issues.

In: 2009

This report [00:02:00] identified that approximately 9 percent of the United States or 28. 8 million people in the United States will struggle with an eating disorder in their lifetime and approximately 10, 200 deaths occur in a year as a direct result of an eating disorder, which equates to one death every 52 minutes.

n were living with obesity in: 2022

In the United States, the CDC identified the prevalence of obesity in adults as 40. 3 percent during [00:03:00] the years 2021 to 2023. In a prior Small Bites episode, we had discussed eating disorders during which I had deliberated on what could be going on in the lives of the individuals suffering from these ailments from the perspective of a psychotherapist.

Beyond statistics, there are different ways to interpret or understand these ailments depending on the theoretical lens that we may use. Further to that August 30th episode, listeners requested a deeper dive into the topic. So we invited a very special guest to explain the understanding of adult eating disorders from the perspective of psychoanalysis and more specifically from the theory of object relations.

There's a lot to explore, so let's go meet her.

pist. She is the founder and [: 00:04:00

Amynah Dharani: published. Dr. Susan has received multiple awards for her writing contributions, including a Gradiva award, which she won in 2004 for her book. Mourning, spirituality, and psychic change, a new object relations view of psychoanalysis. Dr. Susan is on the editorial board of the International Journal of Controversial Discussion. And lastly, Dr. Susan runs online groups for therapy, clinical supervision, and creative [00:05:00] writing. And all this wealth of information is available on our website together with Dr. Susan's website and contact information. Welcome Dr. Susan.

Susan Kavaler-Adler: Good to be here.

Amynah Dharani: Your understanding of human beings and the human condition comes from a unique view, the psychoanalytical view. How is psychoanalytical psychotherapy different from the cognitive and behavioral therapies that is mostly offered by mainstream therapists?

lowing things to happen that [: 00:06:00

You see, this is very different than the cognitive behavior. I'm not directing anyone. I know, I know a little bit about cognitive behavior. I know they often gives. you know, prescriptions for making lists or doing direct behavioral things in between sessions. I don't do any of that. It's not about homework.

that they might be repeating [: 00:07:00

So it's very much about opening up love and creativity and my books. All speak about, you know, creative process, relationship process, loss, grief, and working through grief to open up loving creativity and renew it.

Amynah Dharani: Under the umbrella of psychoanalytic psychotherapies, what is unique about object relations specifically?

f as an individual being and [: 00:08:00

And how. There's also a process of what we call separation-individuation, that first there's the bonding, and if it's too disrupted or chronically disrupted, there are, there are problems throughout life. But there's also, Not only the bonding that needs to be sustained in a good enough way, but there's also a separation process to allow the child and later the adult to become an individual separate from the early mother self, uh, self merger together.

lects. This earliest time of [: 00:09:00

Amynah Dharani: , you use the word bonding. could we replace that with attachment? Would that be accurate? So we're talking about the attachment between, um, the mother and child. I say that because Attachment theory is such the buzzword, , on social media, but also popular psychology. And I just want the audience to be able to understand when you're saying the bonding of the child and the mother, are you also referring to, or perhaps interchangeably, would that be accurate to say that this is the attachment that we're referring to?

Susan Kavaler-Adler: I would say it overlaps with that, but it isn't limited to that.

Amynah Dharani: Okay.

of learning from that about [: 00:10:00

However, It's limited that it doesn't deal with meaning. It doesn't deal with how feeling and thought and integrating feeling and thought in the person as they develop allows. , them to find meaning in their lives, which, of course, relates back to what I said about loving creativity and moving forward in life as opposed to being disrupted or blocked.

, so it's it is that, but it's more than that.

Amynah Dharani: Thank you for explaining that. , I wanted to make sure that it's not misunderstood as necessarily just attachment. What about object relations? appeals to you as a therapist. And I'm thinking about it in terms of how does it help you as a therapist , in understanding the, client that is with you.

Susan Kavaler-Adler: Are you talking about? I think you had a, you were talking about observing what goes on. Okay. Okay, so.

Amynah Dharani: you [: 00:11:00

rnal world and how that gets [: 00:12:00

So in a session, you can see how someone's moving towards connection or disrupting it. Or if they have a certain kind of aggression that constantly interrupts their own unconscious, primal wishes for connection, how they disrupt themselves and self sabotage. So I would be observing that. Um, I enjoy it because it's right there.

It's such a meaningful way what's happening with them and me in the session, how this has played out in the relationship. But also how this relates back to them and their, in their cells, internal world, not only psychic conflicts, things that they're conflicted about, but, uh, but also things that are blocked because of parts of them actually being split off and dissociated, especially when we go back to that primal early time when the self develops in the first three years of life.

ic level, then we have whole [: 00:13:00

So you have to feel it to understand what they're trying to get rid of because they're totally unconscious of that. And the only way for them to find out what they're doing is through the therapist informing them and using their whole, whole mind body experience with the therapist. With the client, I call them patients, but, um, with the patient or client and, um, and informing them through not only what they hear both, you know, verbally and non verbally.

s connection or away from it [: 00:14:00

They're becoming more integrated in parts of themselves that they may have rejected. Yes.

Amynah Dharani: Dr. Susan, would it be accurate to say in that session with the patient or client, You are the object.

Susan Kavaler-Adler: Well, you inevitably become the object from what they have in their internal world of their primal. relationship in there from the earliest time in the first three years of life. And then, of course, later times when they develop relationships, they get internalized. Um, but since the topic today is going to be eating disorder, that really goes back to the first three years of life and what gets blocked and disrupted or dissociated from in terms of primal connection.

nd then you can feel how the [: 00:15:00

projected parts of them that they put into of their child self and the parental self and going back to the earliest mothering person.

Amynah Dharani: So to, , help the audience understand when you are speaking or considering a client in session, a patient in session, the history of the patient in terms of the early years, you speak of three years, that would be the history of that patient with its object.

And in that consideration, that object is mommy. that be accurate?

Susan Kavaler-Adler: Yes, but of course there are situations where it's not the biological mother and there's

Amynah Dharani: a caregiver. [: 00:16:00

Susan Kavaler-Adler: a lot of the primary mothering person. Usually it's the biological mother because that's where they're right away. Yeah.

Amynah Dharani: course. , and that's what I meant, right? So that primary caregiver figure is the object. And hence in the therapy room, you inevitably become that object for the, for the client. Again, I'm so I wanted to just make sure the audience

Susan Kavaler-Adler: Yes, well, I want to say that if someone is stuck in what we call developmentally arrested, if they're stuck in simple terms from, um, things that didn't go well in the first 3 years when the self was first forming, and then trying to separate and be it's self separate from mommy, um, if that's Disrupted, then that pattern will come in and inevitably be played out with the therapist, but it's played out with everyone in their lives.

layed out with the therapist [: 00:17:00

interpreting subjects and who are aware of interpreting, they might just be interpreting the other as this early depriving other or aggressive other or persecutory other, and not even know they're interpreting it that way. But it'll happen in their lives all over. It's just that when it happens with a therapist, that's the only place you can get a handle on it and make meaning out of it.

And psychoanalytics Psychotherapy and object relations therapy is all about making meaning and finding unconscious meaning as well as what's just consciously there. And this is another way we differ from cognitive and behavioral people.

um, this child, this patient [: 00:18:00

Susan Kavaler-Adler: Okay. Well, it's definitely understood in terms of taking in mother. Can you digest mother? Do you want to, you have to throw up mother? Cause she's, too much and you're not psychologically equipped yet to process what you're taking in from her. Do you want to take her in, but then you want to vomit her up like a bulimic?

food because you don't want [: 00:19:00

Mother is experienced as toxic. So you just want to want to be in control and not let her control you from within. So you don't want to even take in food, which symbolically represents mommy.

Amynah Dharani: Like us to walk through, uh, three of the identified eating areas for this discussion today. And, , the first one being anorexia. Dr. Susan, if you can Help the audience understand what is going on for the patient who is suffering from anorexia and then that link to early years. What might have happened.

middle of it, and others had [: 00:20:00

And so it becomes toxic or her abandonment of them emotionally as experiences too much. So it becomes toxic. So they just want to reject. Mother is the one who gives the breast or the bottle in the beginning. So when you reject food, you reject mommy. They're merged together in the infant's mind, which still lives in the adult of adult mind of the person.

norexics. It's definitely at [: 00:21:00

It's like they're rejecting the idea that they have emotional needs for mommy and for anyone else. And so it's a perverse view that they can be totally independent of human needs and emotional needs as well as physical needs. So they try to be above it all. And that's a lot of the Super athletics, they go into plus the starving or the, but I had worked with [00:22:00] one woman who, and she had psychotic fantasies.

We went into which she got over and working with me, but I mean, that's. Not just psychotic suicidal fantasy, but she, she had a blaring thing in her head. There's also phrases that these people hear that are rational phrases that they hear over and over again. They're tormented, tormented and tortured by them.

She used to hear in her mind, You are a fat fuck over and over and over. Her mother had left her for several years when she was five years old, she was left with her father, but she lost her mother at five years old for several years, severe trauma of the emotional loss that couldn't be processed. She was too young to deal with it psychologically.

So she had this. [: 00:23:00

And, you know, and these other rational phrases that come into people's mind. And I help people to understand what are the phrases, what are they saying? Try to hear them before you. You know, reject the food or go towards bad food or whatever, you know, what is your mind over and over saying to you from this early level that's being repeated now?

books and one of them on the [: 00:24:00

That she had a very, she had a very paranoid mother who was always sending out these, always intruding and always sending these messages to her that, you know, of, of wanting to be. involved with her, no, no space for herself.

Amynah Dharani: mother

Susan Kavaler-Adler: Yeah. And she, and then she became paranoid about the mother specifically. And then there, and she did have a father that she ran to fortunately, cause that helped because to make her not one of the most severe anorexia, she did get over it.

ned up the unconscious. This [: 00:25:00

So she realized she had this mother in her internal world and that it related to things with me and, and, You know what she might project onto me of was I being too intrusive or but the thing is that it came alive and we were able to understand the meaning of it, which, as I say, is what's different from attachment thinking or cognitive behavior.

ecause it was very connected [: 00:26:00

Amynah Dharani: that again for me is just poetic and just you're explaining that and being able to get to that really inner space with that person. And what about bulimia? What's going on for the bulimic individual?

Susan Kavaler-Adler: Yes. Well, in bulimia, the degree of rejection of the mother is much less. It's, there's a hunger for the mother that's very, it comes out as a hunger for food. There's a hunger for the mother. The mother's not experience is so totally persecutory and that you want to just not eat because you want to be in control of all your needs and not feel you need mommy in any way.

unger for mommy that's still [: 00:27:00

And you, and you don't feel you can psychologically process mother and keep her as good enough and she becomes toxic. So the food becomes like, Oh, you took this horrible, disgusting stuff in and you want to get rid of it. So you vomit it up in your body. Like just addictively gets into this pattern of.

e attached to this primitive [: 00:28:00

Amynah Dharani: You know, and I, the way you've explained it, there's such an aha moment to specifically considering anorexia and bulimia in terms of one is the control piece and the other kind of the, I'm thinking almost out of control piece, but perhaps both are out of control. Is there anything different that would have happened for the bulimic individual in the early years, in those critical years,

Susan Kavaler-Adler: Different than the anorexic you're saying?

h, each of these individuals [: 00:29:00

Susan Kavaler-Adler: Yeah, but, uh, well, The bulimic, as I said, it's somewhere in the middle between wanting to take in mother and like, you know, overeating, keep wanting to take in, and in between that and wanting to totally reject food because mother has experienced autopsy, it's in between, it's taking in and then you want to vomit her up because you can't digest her because Cause you've never been able to deal with your hate towards mommy.

Amynah Dharani: Wow.

Susan Kavaler-Adler: the hate towards mommy and the, and the unconscious rage turns the good food bad, and it physically feels bad. And you want to get rid of it. Plus there's the idea that you're going to get fat. You know, we all know about. Princess Diana and everything and her beautiful figure and her bulimia. Um, yeah, so there's the idea that you'll get fat and that's also part of it.

y image is being damaged, so [: 00:30:00

Early mommy.

pounds overweight, but [: 00:31:00

Susan Kavaler-Adler: Yeah. Yes. I have a patient currently that I've had for quite a while, and she is at the obese level. I have another patient with overeating. I might want to talk about both and distinguish.

Amynah Dharani: Absolutely.

Susan Kavaler-Adler: But the obese woman, is changing, but you know, it's been a long time coming. She's actually motivated now to eat in a healthy way and she's happy about it.

She was feeling like she just wanted to end her life. I mean, it was very severe because she really, she's in a wheelchair. She got so obese that she has to be wheeled around. Now she has to stay in the house at a time or be taken out by a caretaker who wheels her. So it's severe obesity, but her attitude has changed from wanting to die to wanting to live.

apy, you know, I can see it. [: 00:32:00

And so there are, there's an opening from that despair and to hope about that she could have a future, she could have a life, she could lose weight. And she is now, you know, sharing this joy that she is doing her own cooking. She's taking pride in getting healthy food. And she used to be, you know, she would order this stuff online and then have them deliver all this horrible fast food.

st going to die. Anyone now, [: 00:33:00

But let me mention the other woman with the overeating who's not obese. Um, she's gone up and down, up and down, and up and down with diets her whole life. And it's a constant thing. We've talked about how she has identified with her early mother and late, I mean, later lover through, uh, mother throughout childhood because her mother was, uh, an overeater who would sneak food and then have no good food in the house for the kids.[00:34:00]

And she would be in the car and get this stuff and she would eat it and gobble it up and kind of secret so her husband wouldn't see it. And then, and the daughter who was in some ways of the children. She was the closest with this mother. She took in and almost incorporated the mother. It's a kind of primitive identification, not just like identifying with some things about the mother, but like incorporated this mother who would eat in this way and hide food and eat bad food.

And she, She works with this now with very, and she, we talk about the kind of messages she gives herself when she'll go and suddenly think she's going to go into some, um, one of these places where you can order, you know, just get, I don't know. She gets things called sizzlers and things, but all these sugary products.

And we've [: 00:35:00

Amynah Dharani: uh, addictive. Yes.

Susan Kavaler-Adler: her, her ability to stop it before she takes a first, we have to talk about what's in her mind, where she says totally irrational thing.

Oh, well, you know, I blew it yesterday with my, what I wanted to eat in my diet. So I'm not, I'm gonna, of course, we've talked about not doing diets, but trying to just, modify food, but, um, and tune more into natural hunger. She says irrational things to herself. So she's beginning to become aware.

erself, I want it. You know, [: 00:36:00

I just the hell with it. I want it, you know? And then the other part of her that's saying, well, just because you didn't do so well yesterday doesn't mean you have to do it now and blow it all. So going back and forth, what are the internal messages and talking about them? With her and, and this can be played out in relationship to, you know, about, , feeling that she's never getting enough in therapy that she's insatiable.

ional needs or her, even her [: 00:37:00

And yet the mother would be eating all this bad stuff. So yeah, so she struggles and she goes up and down. But she's more and more seeing what's going on in her internal life so she can have more control and modify this and eat in a healthier way. Which of course is both gratifying when she loses weight because she hates herself when she gets a little heavy and she doesn't look so good in her clothes as she'd like, but she also gets scared of success.

She gets scared of being. and you know, and not, and I mean, some younger women, she's an older woman who's been married many, many years, but some younger women, when they have this and they lose weight and they start to look good, they get scared then of being wanted by men and wanted sexually, and they get scared of sexuality then, and then that has to be dealt with in therapy.

rani: That's so interesting. [: 00:38:00

I need to understand. about myself and then how am I going to help myself.

Susan Kavaler-Adler: Well, you know, it's the capacity to reflect on what you're doing on self reflection is a fairly high level what we call ego function and capacity and mental capacity. So the whole therapy has to work towards helping the person to be able to get to a level of self reflection so that when they see what they're saying to themselves.

ing for what they can modify [: 00:39:00

You felt the same thing, but you weren't in it. You were able to look at it and you had a degree of freedom, free will, a degree of free will to choose. And this time you chose still to do it, but this time you chose not to do it, but you have a choice now because you have ability to see it. Not just be in it, and that's also separation from mother.

o a separation individuation [: 00:40:00

Amynah Dharani: so interesting and I really like the way you've explained that in terms of the earlier stages of being kind of really in that emotion and at a very primitive place and then you really need to get to that higher level place the higher ego function to be able to step back and and observe and reflect on what's going on for you to be able to make those changes.

Susan Kavaler-Adler: right? Well,

Amynah Dharani: this explanation for me is very powerful. Certainly I'm a clinician, but it's powerful for me as an individual to be able to understand how we can make change, how that change happens in, in that psychoanalytic Versus the cognitive behavioral room, um, which is a, is a different layer that's being imposed.

ing issue. How can, , family [: 00:41:00

Susan Kavaler-Adler: I would suggest that. anyone with these kind of problems be in psychotherapy and psychotherapy. I think someone with an object relations understanding is the best for the early, you know, where there's these early imprints that get repeated inevitably and need to be understood as they're played out now.

emotional support, but don't [: 00:42:00

Amynah Dharani: That word you've used, right? The imprint. I think that that is so important in, in your explaining this, this process or this understanding

Susan Kavaler-Adler: there's when I talk about internalizing. And I'm talking about incorporation as even a more primitive form of taking something in whole as opposed to selectively internalizing. But we internalize the other from the earliest on, and not just the other, but us in relationship to the other from birth, we internalize them.

disconnected or disrupted or [: 00:43:00

We have an internal world where that is the person's blueprint, and they tend to interpret life through what their inner blueprint is and tend to project onto others what they already had, unless they become more aware of the unconscious meanings of this, which you can do in a psychoanalytic state.

psychotherapy situation?

or to. insight about each of [: 00:44:00

about what you eat or don't [: 00:45:00

I would suggest for the anorexic to have food that they can. Welcome and digest and be with the others without having to be too rejecting of their food, but bring what they can eat. Um, for, uh, an overeater, I would say you have to Separate enough to not eat everything that's put in front of you, but have some of that self reflection to say, is this, do I, am I really hungry anymore?

ood, but also that's related [: 00:46:00

So the more you work on this in therapy, where the person separates from the internal mother and is more of an individual autonomous self with their own, their own control and ideas about their own behavior, self reflection. The more they'll be able to deal with the external people and external food when they can deal with the internal situation, which is highlighted and brought to their awareness by the therapist in the therapy.

Amynah Dharani: Dr. Susan, thank you so much for being here today. This has been really invaluable. I hope you will visit our show again in the near future.

Susan Kavaler-Adler: I would be very glad to, and there are many topics we could discuss, of course. Thank you.

elopmental years has been re [: 00:47:00

And I encourage our listeners to explore this with a licensed mental health provider. If you are suffering from an eating disorder, please contact licensed healthcare professionals to address your concerns. Seek out care from a medical doctor, a registered nutritionist, and a licensed therapist specializing in food relationships so you can get holistic care.

If you'd like to learn about my private practice, you can go to thelifeinterrupted.com. In the meantime, please connect with The Love Vox on Facebook, Instagram, and X. And if you'd like to contribute to the show, please visit the show's website, thelovevox.com, where you can leave voicemails that can be featured on the show.

And you can also contribute to stories we're looking to feature. Until next time, stay passionate, stay curious.