3 Emotional states, eating disorders depression and This chapter outlines three general experiences around feeling and emotion from which you may discover more about your own reciprocalrole repertoire. First we look at'feeling bad'/ 'not having feelings' and 'unmanageable feeling'. Then we look attwo specific problem areas which are predominantin our Western culture: depression and eating disorders. As you read through, startto write a description of what you feel and what you relate to in the examples. 'Always feeling bad inside' Reciprocalrole procedures incorporate implicit values about oneself and others. When we getinto a critical/rejecting in relation to sad/bad reciprocalrole,the way out may be to reverse the roles so thatthe weight and hurt ofitlessens. Often we are not aware of how bad we feelinside until we startreflecting.It might be that we experience others and life as bad, as against us, and things go wrong for us. Feeling bad inside mightinfluence the relationships we make. We might feel we can only make relationships with people who might be worse than us. We don'tlike ourselves enough orfeelfree enough to know what we like, or to have relationships orfriendships with people who are attractive or success- ful. The result of allthis is that we feel depressed.It might be a generalthin veil of depression and worthlessness, or,in more severe cases, deeper depres- sion from which we feel we are never going to be freed. We somehow man- age to carry on, automatically doing things we feel we must do, but never really experiencing pleasure or happiness in any form. We may try to become 'bad' because, why not? People already think we are so why notlive up to it? You may wantto add to this list, naming for yourself what you recognise are your attempts to cope with feeling bad inside. Sometimes in our early lives we are actually told we are bad and that'nobody loves a bad girl or a bad boy'. We may pick up messages we interpretto be about our badness. Perhaps we don't come up to the standard required of us. Perhaps -----------------------------------------------------------38 our parents' view is that we don't give enough,therefore we're selfish. WC might enjoy doing things thatthe rest ofthe family doesn't, so we're labelled odd or difficult, and therefore 'bad'. WC may find ourselves in the grip of difficultfeel- ings in our early life -fury, a desire to hit out, a sense of entrapment and perse- cution. WC might be the subject of actual cruelty on a mental or a physicallevel. We are made to feel even worse if we do startto express ourfeelings offrustra- tion and hit out. W‡Uen there is nowhere for bad feelings to go, we bury them. These feelings tend to stay inside festering,like a boil,for years.Itisn't until something happens or we startthinking about ourselves that we realise we have believed inside that we are bad. Although logically we may know we are not bad, we may feelthat something in our core isn't quite right,there is something wrong with us, something unpleasant and difficult. But when we don't understand why we feel as we do,those bad feelings are often projected onto other people and situations. ‡eˆκˆκ If you recognise that you feellike this,just spend a few moments quietly reflecting. See if you can get some sort of graphic image forthe way you feel. Start with the phrase 'Itis tike ...' and let yourimagination offer you a picture, colour, shape orimage.It doesn't matter what comes to you/ just stay with whatever emerges. Examples could be 'heavy black mud'; squirmy tummy'; 'rotten apple'. When you feel you have got a sense ofit, make a graphic picture (drawing, note/ collage) of whatitfeels like to be you inside most ofthe time. Notice iffeeling OK is conditional only feel OK if...'. Can you recognise any ofthese other ways offeeling bad ƒƒRƒR Heavy weightin the body Feeling sick Depressed mood See how often you say to yourself'I will ƒƒƒƒƒƒƒ Always think the worst about myself Sometimes I believe I am evil Itend to move with a 'bad' crowd Ifeelthat people always end up hating me I always return to the feeling I was never wanted in this world If something good comes my way 1 can only spoilit Because I never do anything good,I must be bad When you recognise any ofthe above, note itin your own way in your monitoring notebook. Try to notice when and where these attitudes or thoughts come in your everyday life. Monitorthis process for a week to give you a pattern of what situations triggerfeeling bad. ----------------------------------------------------------------39 However many ways offeeling bad you identify in yourself, allow yourselfto feel sad atthis burden of badness. Forit's sad when an innocent child - usually where this mistaken idea began - believes they are bad. Next, start experimenting with a new idea,that actually,fundamentally you are not bad. Challenge the critical nagging voice from the past, whatever bad behav- iour you may have indulged in. Always thinking that you are bad might be spoil- ing your chances of proving to yourselfit's nottrue.It's a very old message and belongs to the past. Try to find someone to talk to aboutit. Sharing the 'I am bad' idea is helpful, because the hurt and pain ofthe old belief are maintained by the internalised reciprocalrole of critical harsh judge in relation to bad and guilty. Get some help to start a new reciprocalrole oflistening to one of being listened to and use itto startlistening to yourself differently. Look atthe things about yourself that are not'bad', however small. You have read this page. Thatindicates that part of you is searching -that's not bad but positive. Believe in that,that you have itin you to embrace something differentfrom the old message 'I am bad'. Not having feelings When I ask you 'How does itfeel?' what happens? Is it a struggle, or do you find yourself saying:'Ithink ...'? This may be because you have not been able to develop a language forfeeling. Sometimes we need to ask someone to write a list of'feeling' words for us to experiment with. Another way is to start noticing what happens in your body when you are asked how you feel.If your answeris 'Ifeel nothing', see if you can trace what happens in your body when you say those words. The use ofimages is also helpful, and descriptive words such as 'tight' or 'tingly' or'cramped' or'stuck' can be a good startto exploring more about what you are feeling. Some people presume thatthey do not have feelings, when in facttheirfeelings are bottled up and unseen. WHen feelings have been as firmly shut away as this, we can appear cold. WC appear unaffected by the most devastating news as if a reciprocalrole of cut off/controlling in relation to controlled/unfeeling is in operation. What happens when we shut down feelings? Can you recognise feeling dis- tancing in relation to distanced7 Feelings may be triggered off when something touches us deeply and gets under our skin and we cannot avoid orfreeze them out. Feelings may startto emerge when we are more confident about handling them and are less under pressure from our contemptuous or dismissing reciprocalrole to ourselves.I know a man whose bottled-up feelings came pouring out when he was forty- five and fellin love. He surprised everyone who thought he was a cold, unfeeling schemer untilthat point. Ourfear offeelings, defended by denial or avoidance, may waitfor a 'safe' environment such as a long-term relation- ship, or a satisfactory job of work. Iffeelings have been so damaged and battered, orif no satisfactory release forthem is found,they may get split offinto different parts and so our sense of ourselves is fragmented. --------------------------------------------------------------------------40 Some people referto theirinner'rageful bastard' who operates as angry/abusing in relation to terrified/hurt, ortheir'shapeless blob' who always cries, who expresses belittling in relation to put down/worthless, or a 'rescuing magician/angel' who is always idealising or being idealised \\\ relation to being special. We may have physical symptoms instead offeelings, as if our constrictions/ our inflammations, were expressing our unbearable pain. We may try to contain ourfeelings by choosing a profession that willforce us to operate only in our heads, using rationale and logic. We may act outinstead of expressing feeling, by driving fast, drinking too much,taking drugs,taking up dangerous sports and activities, gambling/ fight- ing, stealing. When feelings are unbearable and unmanageable we may go numb and our rage, anger,jealousy or happiness is experienced outside of us,in other people, objects or as fantasy. This means that we cannot own them as our own and we cannotintegrate them into ourselves as a whole. If you recognise this splitting off mechanism operating in yourlife, start by just noticing anything that could be a displacement activity away from expressing feelings you presumed you did not have. ‚Ήƒ‹’ƒmƒ“C»’ If you recognise that you are suffering from not having feelings, ask yourself when was the lasttime that you 'felt7 something inside? Where did you feel itin your body? What was thatfeeling? When did it occur? What was happening atthattime? If your answerto the last question was a long time ago (more than two years), what was the result of yourrecognition offeeling atthe time? Did you express it, and if so how? How did others respond? Did something happen to make you decide you would not express feeling again? If you have been unable to answerthe firsttwo questions because you cannotrecognise the expression 'felt'/ cast your mind's eye overthe last week. Whatis the most unpredictable thing that happened? Describe it, and what was happening. Talk to someone about not having feelings. Begin to explore whatfeelings are and how other people express them. Become a 'student' offeelings. Look through the section 'Gathering Information'in Part Four and see if you can identify how your current sense of not having feelings came about. Feeling WILL :arise in its own time. TAKE TIME. Choose music and poetry or descriptive writing to express feelings. Music and poetry bypass the left side ofthe brain, which is our more rational,thinking ‚ͺ‚Μ˜eΞ‘·Œχ ˆκ1@b@@Kb@@b ----------------------------------------------------------------------------------41 brain, and moves to touch directly into the right brain, which is the more feeling,intuitive,imaginative side. So allow yourselfto be touched; and to move with, dance to, hold tenderly a tiny bud offeeling;to fire up in a blaze of anger or passion;to hearthe sound of your own protesting voice arid your own lost poetic soul.In Finding What Wy Didn't Lose, \c^ (1995) writes:'when your poems become the"CQntainer" of yourtruest feelings, you wilLb^gin to .experience and'integrate^thpse;Jfeelings mp|re consciously'.;" @@ @@@@@n"."""'!:""'::'@:'|"-@i", "-" is :@:"'"..:,-.-@@|-r:;@@,:@@@@@@;@:@@ :,@:: @@@@@@@@@: The void Sometimes people say they feelthatthey have a 'black hole' or void inside them. They fearit, because they believe it will swallow them up and they will cease to exist. The reciprocalrole is emptying in relation to emptied. Perhaps we feel as if we are only defined oridentified by our work, or our looks. Because we fearthe nothingness ofthe void we may try to fillit with people,food, drugs, work or social activity - anything external. We do not trust ourselves inside, and so we avoid anything reflective, contemplative, or still. """" ALISTAIR, once he was brave enough to explore his experience ofthe 'void', had an image of a 'can of worms' containing everything he feared and loathed about his past and about some of his currentfeelings.(In Chapter 9 on writing ourlife story and working on our diagram, we will see how Alistair is currently working to cope with his particular void.)In exploring his 'can of worms' we met snakes who would come up and bite him in the form of an accusing/judging'v^relation to judged/worthless reciprocalrole and statements such as 'You'll never stay in the fastlane.' The feeling 'I'm unhappy' was strong and was suppressed as quickly as possible. Alistairfirstrealised his particular'void' when one day he caught himselfthinking, as he rushed from one appointmentto another,'I wonderiftaking drugs would help?' He believed thatif he allowed himselfto stop, he would fall victim to the vacuum and emptiness which he associated with the void. All his life he had coped with this feeling by being incredibly busy. We met when his body had begun throwing up symptoms - duodenal ulcer, analfistula, chest pain - and he had become phobic aboutillness and death. One of his firsttasks was to allow himself half an hour each day forreflection. He found this very hard indeed! Sometimes the void can be explored through visualisation,through draw- ing. Often life itself plunges us into the void, and we have to face itthe hard way -through a serious illness, accident, breakdown, or being left alone and isolated. --------------------------------------------------------------------------42 Questionnaire: H0‡Z do you recognise a void? Ifeel as if everything happens to me as ifit's behind glass I see other people doing things, butI don't belong It's like another planet ƒ ƒ ƒ ƒ I keep very busy with friends,relationships, work, eating, drinking, chaos,'things', duties, etc., because I know thatifI stopped,I would fallin the void. Inside Ifeel very lonely. Few people,if any, know this b@@l@@@@@@11@l@@@@1@@@@@@E@‹m A first step in recognition is to accept you feel a void somewhere inside. You could try to monitor when you sense you are either nearing orfearing the void. You could see what happened if you tried to find an image forit, draw- ing or painting it; using images -'itis like ...';telling someone you trust about it.Ifthe void has been created because when you were little you had to spend a lot oftime on your own without adult company,it may be thatitis very hard for you to get close to anyone,to trustthem nearto you. You may need help with this realisation and consider psychotherapy. This would give you a rela- tionship with another human being with whom you can take safe steps in get- ting close and in trusting others. Allow yourselfto considerthis possibility. Unmanageable feeling: Too sad, ortoo angry, or too frightened If you recognise that cutting offfeeling and 'not having feelings'is the way you coped with unmanageable feelings such as too sad,too angry ortoo frightened,respectthatthis was the best way you could manage atthe time. If your early life included experiences that were traumatic through which you were traumatised - not all experiences oftrauma lead to traumatisation - return to the diagram on page 17 and start monitoring your stress levels of hyper- and hypoarousalresponses when you are with other people. Find someone with whom you can start naming and exploring safely the feelings you carry in your body. If you have not already done so, create an image of a safe place (see page 25). This will offer containmentforthe previously unmanageable buried feelings, which mightfeel overwhelming atfirst,to be expressed. As you take steps to make these feelings conscious and you recognise signs of starting to become overwhelmed, or physically disregulated, allow the contained space to hold the feelings for you. RememberthatI am invisibly by your side. Sometimes these unmanageable innerfeelings can manifestthemselves in physicalform - nausea, heaviness in the legs, headaches,tension in the neck -----------------------------------------------------------------------43 and shoulders - and in symptoms, both physical and psychological.It's as iffeeling is trying to express itselfthrough the language ofthe body. Unmanageable anxiety, anger,fear and sadness may also be atthe root of many eating disorders,in bingeing and starving;in self-harm; and many pre- senting physical problems that are not organic in cause. Some provocative risk-taking behaviours, such as driving, drinking, smok- ing, dope-taking,flying,too fast,too much,too high, may also be a way of trying to manage unmanageable or unbearable feelings. There may be times when we spend too much money, or money we don't have, and buy things we don't need underthe illusion thatthis will make us feel better. All experiences of depression and suicidality share unbearable and unman- ageable feeling: hopelessness, helplessness and trapped and inexpressible rage. As we saw earlier,the creator of Cognitive Analytic Therapy, Dr Anthony Ryle,tells us that a very high percentage of depressed and somatic symptoms are connected to the inability to express angerin a useful way. Understanding this, and finding ways to make conscious, name, express, contain or simply be with, previously unmanageable anger makes a difference. Some shadow of these feelings may always be with us, but we can learn to know and under- stand the shadows better and be able to use feeling more usefully.In her poem 'Anger's Freeing Power' Stevie Smith (1983) writes thatitis the useful and enabling expression of angerratherthan love,thatfrees herraven from beat- ing himselfinside the walls of his self-built cage. Also on this theme,the orig- inal Brothers Grimm fairy story aboutthe Frog Princess had the princess throwing the frog she despised againstthe wallin a fit ofrage, upon which he was transformed into a prince.Itis only laterthat angeris replaced by the kiss, as if somehow the expression oflove needs to exclude anger. Many years ago I worked with heart patients as a counsellorin the cardiac department at Charing Cross Hospital with cardiologist Dr Peter Nixon, whose work was to understand the link between unmanageable feeling and its somatisation in coronary heart disease. He was challenging to the patients he was trying to help, as in 'Did you notlove your wife enough to be angry with her?' Giving permission for angerto be part oflove and the expression ofit as useful, was part ofrecovery from chest pain and its associated disease process. Unresolved and buried angeris very often under depression,itis the underlying cause of most panic attacks,itis now a recognised risk factor in the psychosocial causes of heart disease and can also initiate many physicalresponses represented in stress-related disorders. Depression Depression is an umbrella term for a whole range of difficult and unmanageable feelings which have been turned inwards.In Part One we saw the depressed feel- ing 'trap' created by depressed thinking and thatrecognition ofthe circular nature ofthe trap and the creation of exits brings about change. When depressed thinking and feeling startto merge into the more blanketterm 'depression'itis ------------------------------------------------------------------------------44 harderto getto the root ofthe internal patterns underneath. Butitis vitalto do so and notto waste time. Antidepressanttreatmentis needed for some cases of severe and disabling depression that has biological components, along- side learning aboutthe underlying psychological patterns.Itis very sad that depression and drug treatmentfor depression are so widespread in Western nations. In Mindfulness Based Cognitive Therapy for Depression, authors Zindal Segal, Mark Williams and John Teasdale (2002) write: Depression is rarely observed on its own,itincludes anxiety, and panic attacks are 19 times greaterthan someone without depression. Simple pho- bia and obsessive compulsive disorders have increased odds. Depressed patients spend statistically more time in bed than patients with lung disease. Work loss is five percent greaterthan non depressed patients. Suicide risk increases with each new episode. Major depression tends to be recurrent and the biological characteristics are: sleep disturbance often with early morning waking, gloomy desperate ruminate thinking in the mornings and a constant overactive neuroendocrine system creating the arousal associ- ated with cortisol. These experiences are not varied with life circumstances such as taking a holiday or getting married,(p.10) Let's start by trying to look at what our'depression'is about. Depression is not just about not coping.It helps to try to unravelthe knot of unmanageable feelings, assumptions and old beliefs that depression is made up of and find small manageable exits. Understanding the contextfor depressed feelings is importantfor we need to have some idea of what our depressed response is intended to resolve: 2 3 4 5 Depression may be a naturalresponse to a life event-the needed twilight of effortfollowing bereavement,illness orloss. The wasteland experience ofrites of passage during adolescence, mid-life,retirement where change in identity is taking place. Depression may be directly connected to a life situation - poor housing, chronic poor health,family disruption, no money/ racial discrimination/ violence. Depression may be a form of unconscious self-sabotage - a saferinternal choice to whateveris feared from success or happiness orfrom the conse- quences of expressing anger and rage. Depression may resultfrom a long period of exhaustion -too much, ortoo little work or contact with others and no way out orto say no. For many people depression is a form of breakdown -the breakdown ofthe way they have been before and seen as 'normal'. Maintaining our depressed response may be restricting, and self-limiting rec- iprocalroles such as punishing in relation to punished; criticaljudging in rela- tion to crushed restricted. There is often the dance ofthe bully and victim, both within and with others. The core feeling held in the internalised child reciprocalrole is often feeling a punished,flattened, crushed and restricted self, and repressed rage. This is maintained by the tight hold ofthe punishing, ---------------------------------------------------------------------------------45 belittling, orjudging internalised 'other'. Other people will also be invited to join this dance untilrevision and new reciprocalroles are learned. Questionnaire Answering 'yes'to more than three ofthe following may help you to recognise that you are depressed. I don't have a rightto exist My needs will never be met WhateverI do Ifeel bad There is something wrong with me Everything is all my own fault I'm worthless, useless I can't get overthis, ever in a cage? in a prison? stranded on a high cliff? stuck in the desert? doomed and drowning? When depressed, ourfeelings often include confusion, heavy-heartedness, sinking sick feeling,feelings of exclusion, a fear of our own and others' anger and rage,fear of going mad,the feeling of being trapped with something alien,inscrutable and intransigentthat does not wantto budge. And often deep, deep sadness and loneliness. @1 The following accountis from AMANDA, who has kindly written a piece 8 especially forthis book to illustrate her experience of depression. Amanda has S had a long history of depression, which has included hospitaltreatment as an Iin- and out-patient and also Cognitive Analytic Therapy and learning the j| practice of mindfulness. Her diagram is included in her account. 'Depression arrived suddenly and without warning.I was assured by the doctors that once the right dose ofthe right antidepressant was reached I would soon be fine again. Unfortunately it didn't work like that and I was referred for psychotherapy. --------------------------------------------------------------------------46 'AtfirstI was unable to focus on whatthe therapist was saying or asking.I had continued to work full-time and I was exhausted. Over many months we looked atthe snags, dilemmas and traps thatI was falling into.I wasn't quick to grasp the significance of what was developing. The diagrams and cycles of thinking centred largely on my anxiety about mostthings butin particular about my work and with my inability to deal appropriately with my own and anyone else's anger.It also took me a long time to realise thatin factthe diagrams were frighteningly similarin many ways and I needed to understand the processes involved.I could understand itin theory but much harderin practice,finding it difficultto "exit" at an early stage in the process. We also explored visualisation and for me,the concept of a lifebelt,thatI could recall to my mind in times of need, was enormously effective. 'Much later, after a third stay in hospital and a long course of ECT, which improved my energy levels but not enough else,Ireturned to therapy. The lifebelt was stillthere for me but alltoo often I stillfelt desperately low. Suicide was frequently considered and I had started to try to self-harm even though I knew thatthe exit points ofthe main diagram were to talk to someone,to be kinderto myself, being "good enough" and not constantly striving to do well and to "getit alright" but attimes they felt alltoo elusive. Now,in addition to this was the introduction to a more "mindful" way oflife. 'On the very first session with Liz, she pointed outthatI was holding my breath before I spoke.I had been going to yoga classes with differentinstructors and all would say, as we attempted a posture,to "keep breathing". Breathing appeared to be more difficultthan I had thought! 'Practice of mindful breathing became a daily part of my life.It was difficult at firstto let go ofthoughts that constantly entered my head, something thatin yoga I had yetto fathom. To my surprise,just by saying to myself "there's thinking" or acknowledging whatever was happening in the background, letting go ofit was much easier. Even if my mind wandered for a while it was okay and returning to the breath was even a matter of congratulations. 'Sobbing uncontrollably has been part ofthe practice too. Each experience of practice is different butthatis all part ofit. Sometimes the mind wanders a lot oritis particularly difficultto settle butitreally doesn't matter. Thatis where its beauty lies, especially for me, whose mind tends to be on full alertto what is going on all around.I can use the breathing to give me mental space and to break the negative process from the diagram thatI now know so well and recognise my difficulties for whatthey are. ?'Last week I walked into the town centre and started to feel very heavy in my ^body and mind.I decided to sitin the Abbey gardens and take in the calm of i|the beautiful park. There were only a few people about so it was easy to find @somewhere to sit and breathe. At some pointIrealised there was a broken beer illbottle lying on the ground. William Styron writes in Darkness Visible ?!oo\A being jjaccompanied by a "second self" who watches "with dispassionate curiosity" as Sone "struggles against oncoming disaster, or decides to embrace it". ---------------------------------------------------------------------47 |j'Sitting on the park bench I could look atthe broken bottle with this observer, jltaking in with curiosity whatIintended to do. Like taking pills, cutting my ill wrists was a considered idea. ButIfound myselfthinking about whatI had Ilearned in therapy,thatI had a choice.It was entirely up to me as to what |to do next. That choice in fact gave me strength to resist doing anything 111 except slowly force my legs to move out ofthe park and back to the |S hostel,[emphasis added] J'My depression hasn't gone yet.It comes and goes as it always did.I hope that one day it will go away completely as innocuously as it came, butfor now I can |j manage it much better.I can stillfeel desperate.I am lucky to have many 11loving friends and family. Talking to someone can do much to calm me, but 11then I have the thoughtthatis so welcome;thatI can give myself a few |;11 minutes ofthe space and peace that mindful breathing can invoke, howeverI iiifeel and whereverI am.' If you have had to bury feeling because it has felt unmanageable, once you begin to touch it again it hurts a lot, and we can feeljust as we did when we were two orthree years old,just as frightened and helpless. Take it slowly, knowing that now you are older you have help, you have breathing and other exercises to help you accept and process what you feel. You have notebooks in which we are going to find words for what you feel. Acceptthatthe pain you feelis the pain of a little one and feels huge. And during this process we are not so much concerned with the story, as with the pain you feel and the ways you have learned to manage it. See the pain as evidence that yourflesh and blood feeling nature is still alive and needs your help at containment and nourishment. Letitthaw out and flow and flourish. Trustitto show you what it most needs. Unexpressed anger and rage It can be hard to acknowledge that we have buried angry feelings. Fresh anger is usually a very physical experience, and like allfeeling and emotion,involves our bodies.If you recognise afterreading this section that you are carrying layers of unresolved anger and rage,just start noticing possible signs of anger, however small.It may be in clenching yourjaw or a tightening in the small of the back; your anger may be in forced laughter,in speeded up speech,in cold ruthless prose. You may hold your breath like Amanda orliterally swallow your anger with food or alcohol.In Part Three we will be looking atthe nature of traps, dilemmas and snags.In each ofthese you will also find out more about your own anger. When itfirst becomes conscious, previously unexpressed anger can feel out of proportion and we will have the same fears we had when we buried it-that Ofhpr.S doSP fn ITs Wl11 Tnatp nrrmt^ft nc-that TAW TAnll ho 1il'o tho @@nirrrxT TtQrc/->T-> in ---------------------------------------------------------------------48 Figure 3.1 Amanda's diagram ourlife we feared;that our anger mighttake us over. This is quite usual. After becoming conscious of anger and how it has been buried under symptoms we need to find a way of containing or expressing what we feel. One way is to write it outin ourjournal. Another way is to find a safe space to shout and jump up and down. The return from angeris to find ways to express itthat are useful,freeing and creative, not destructive or harmful. And, mostimpor- tantly, whatis our anger about? W?Uat are the reciprocalroles thatlead us to feel angry? WHat we really need -to feel protected, understood, accepted unconditionally -is often hidden under anger. Learning to -find a voice to ask forthese things is essential, once we have discovered what our angeris about. We need to know our own anger and be able to express it and to contain it appropriately. We will probably need to learn to become assertive,to 'sing on the boundary',to speak out, not necessarily our angry feelings, butjust what we feel and need, clearly and simply, notin aggression or acting out. We need to acknowledge and learn the language of our own feeling and emotional need and start expressing itin inner dialogue with ourselves, and then with others. Owning anger and learning to walk the talk of anger means that we have tempered the fiery dragons that once threatened to destroy us. Learning the limits of expressing anger and how to contain our anger and its more unreasonable or destructive side is essential. Lying beneath angeris often hurt. And grief. We may have made an uncon- cious decision to feel angry orresentfultoward those who have hurt us because *|---------------------------------------------------------------49 acknowledging hurt would have been impossible and also makes us feel so vulnerable. When we are able to reach beneath the smoldering or hardened anger we carry and touch the hurt, we have the chance to befriend and heal our hurt and vulnerability, using compassion and mindfulness. Pema Chodron, an American Buddhist nun, says, Tf someone shoots an arrow into your heartit's no good justrailing atthem. You need to attend to the factthat you have an arrow in your heart as well'(on retreat at Shambhala Mountain Centre, August 2002). Being able to grieve and mourn what has been lost or damaged, and forgive both others and oneself when appropriate is an essential part ofthe process of change. Eating disorders Eating disorders represent an abnormal preoccupation with food and weight, where food is no longer a simple substance for sustenance and pleasure. Underneath the symptoms of eating disorders are usually preoccupations with issues of control, submission, placation and perfectionism. This preoccu- pation becomes a means of communicating unmanageable feelings and emo- tions.It can be seen, as Tony Ryle and lan Kerrreportin Introducing Cognitive Analytic Therapy (2002), as a covert way of communicating or coping with feelings of not being heard or being pressurised to 'perform'. In eating disorders we splitfood into 'good' and 'bad'food, with which we have a love/hate relationship.'Bad'food we binge on may accentuate the badness and ugliness we feelinside and we have to getrid ofitin orderto feel clean;the control offood to the point of starvation gives the anorexic a 'high' and can become addictive. Too often groups or websites for eating disorders concentrate upon the management offood without attending to the underlying reciprocalroles such as controlling (neediness and mess as in unmanageable feeling)in rela- tion to controlled/withholding, and conditionally excessive and rigid controlling in relation to empty controlled/worthless and angry. 11FREDA (see life story on p.1 71) came into therapy because of her depression. g|Her eating problem only emerged later, as she had been ashamed ofit. Also 11she had failed to see it as a 'problem'/ even though she had never eaten with 11herfamily or herfriends. She was eating only a limited diet and taking laxatives j11that were seriously affecting her digestion. We made the following chart ofthe :i;:presenting problem,its underlying procedure and the aim forthe therapeutic 1111work. You will see thatthe aim is always directed atthe procedure, notthe gproblem. This approach gets us away from only recognising symptoms and 11being caught on the symptom hook. !BProblem 1: Depression. |SProcedure.IfeelI've never been me or been able to let myself go.I don't |;|ithink much of myself and getinto the 'I'll do this badly' and |jl'worthless'trap. There doesn't seem much in life for me so far, 'Sshprausp nthprs' npprk havp alwavc hppn mnrp nrp<;<;inn ----------------------------------------------------------------50 Aim. Problem 2. Procedure-. Aim. ‰~I‚ί•KΨƒ ‰~‚Μ‡t‡uMn–€ To monitor everyday negative and depressed thoughts such as those outlined above. To challenge this and to develop more time forthe things and occasions that put me in touch with the 'healthy island'- music, certain friends, being in the country. Placation trap,'doing what others want'. Needing to be needed. Recognition offeeding o/rin relation to fed off.I have always felt worthless and that others' ways are better, so I give in, and feel cross with myself and anxious. People can easily tyrannise me, and Ityrannise myself by judging myself harshly. To be aware ofthe times when I placate or create tyrants. To bring my awareness into the moment and risk saying 'no' or having a different view when thatis whatIfeel. To trust whatitis Ifeel I wantto do much more thoroughly, even if sometimes I am wrong about my decision. Aim. Eating compulsively,then starving and bingeing. Recognition oftyrannising in relation to tyrannised.Ilong to be 'full' butfeel bad ifI have anything, so I have to getrid ofit. To monitorfeelings priorto, during and after eating compulsions and binges. To recognise 'longing to be full'/ where Ifeelitin my body. To risk letting it be just so and letting it speak in words or images. Problem 4: Aim. Self-sabotage due to irrational guilt about dead brother and mother's depressed life. To be aware when I'sell myself short' or put myself down. To be aware when Ilet others 'win'/ ortake a back seat when I know inside I could take part equally. To take the risk of expressing myself more assertively, and let go ofthe family's disappointment and misery. To say,'I AM ALLOWED' withoutfeeling guilty. Freda took up herjournal-keeping enthusiastically. She said it was like having 'permission to live, even if only inside a notebook'. After a few weeks her depression began to lift. As she challenged her placating, her eating problems got worse. She noticed a craving forfood and an intensity offeelings of'high' followed quickly by heaviness and despair where she soughtfood for comfort. She found that she could express herselfin images. A colourfullanguage emerged,linking early life memories with her current need to starve herselfin orderto experience control. She found visualisation and drawing particularly helpful. During one particularly moving session she gotin touch with the hidden feelings around the time her mother came home afterthe death of Freda's brother atthe age of six days. There was an image of her mother's flat stomach, and a wave of profound despair,the intensity of her weeping (which she showed only to Freda, notto friends). Most of all was Freda's fear and over- responsibility forthe insatiability of her mother's need and hunger,forthe look in her eyes that Freda believed she had to make better. She saw that she had taken responsibility fortrying to fillthe space left by the dead baby. -------------------------------------------------------------------------------51 Freda described how she felt'eaten up' by her mother's needs and demands, which returned later when her sister developed anorexia and Freda was once again expected to fill an empty space. One of her drawings showed a huge open mouth into which tiny fish were being shovelled by a thin witch with a child's broken-handled spade.In one of her dreams herright hand was being bitten by a wolf. She drew a picture ofthe wolf, and came to associate this animal with her own emotional hunger and need, her'wolfishness'that tyrannised her. The wolf would nip her,reminding her of her own hunger(for something which she needed to name) and ofthe devouring and tyrannising quality of her mother's neediness,from which she was struggling to free herself. This needing to be needed, orfeedingoft'in relation to fed'off'was also recognised in several otherrelationships - husband, sister, children,family. Freda was encouraged by herfriends' new respectfor her holding on to her own ground. Two key phrases -'selling myself short' and 'I am allowed'- helped herto have the courage to express herselffully with other people, especially difficult people like her mother,to whom she felt duty-bound and very unfree. [Freda's dream is recounted in Part Six.] ------------------------------------------------------------------------------------52