GRIEF AND EATING DISORDER TREATMENT

“Only people who are capable of loving strongly can also suffer great sorrow, but this same necessity of loving serves to counteract their grief and heals them.”― Leo Tolstoy

Loss is a universal experience that impacts us all and an individual’s beliefs and feelings about grief are largely shaped by cultural, societal and religious influences. In Latino culture for example, the perception of death is significantly impacted by Catholic beliefs and women tend to demonstrate their mourning for the deceased through crying or wailing whereas men uphold the practice of “machismo” and avoid displays of emotion. The practice of paying professional wailers in death rituals is not uncommon in Chinese or Irish culture. Recent literature proposes that certain facets of Western culture including industrialization, the cultural exclusion of the elderly, advances in medicine, secularization from religion and mass death can promote an illusion of control over dying or reduce the spiritual significance and meaning attributed to each individual’s dying process.

In determining the direction of therapy with a client at Alsana, grief therapy can emerge out of attachment, trauma or anxiety focused treatment depending on which emotional factors primarily contribute to the development of or investment in the eating disorder. Understanding how an individual responds to a loss in their life, whether the response involves a restriction of food or affective expression, requires an examination of the cultural context and religious influences on the person’s grieving process. A client’s internalization of familial or cultural messages about grief and dying can strengthen and add meaning to the grieving process or can become the internal barriers to processing the emotional pain of the loss. In a family or cultural group that values a stoic disposition in the face of grief, an individual might perceive emotional expression of sadness or longing to be a weakness or violation of a cultural or gender norm. Therefore the therapy begins by gaining an understanding of the layers of protection around the grief and drawing upon internal or external resources to promote the resiliency and strength necessary to address and overcome the fears of moving towards emotional suffering.

I have found certain Eastern philosophies on grief and mindfulness principles to be incredibly beneficial in guiding clients to take those first steps towards their grief. Clients struggling with eating disorders are certainly not the only people who engage in coping methods that actually enhance suffering such as denying the reality of a loss or avoiding distressing emotions by utilizing maladaptive coping behaviors. In the immediate and raw aftermath of grief, we run the risk of persuading ourselves that we cannot tolerate the present moment and rather than accepting what is true we attach instead to the reality we long for which only prolongs and sharpens the grieving process. The eating disorder can assist an individual in detaching from the distressing present reality of the loss through numbing strategies such as restriction or binging. Eating disorder behaviors and the ensuing isolation can also serve as a protective boundary that disconnects a person from others and the outside world in an attempt to modulate the anticipatory anxiety of losing someone else again. The fundamental principles and practices of mindfulness can be drawn upon to help a client attend to the present moment, learn compassion, feel the emotions surrounding the loss and accept the ever-evolving nature of their grief. The primary objectives of grief therapy include helping a client evolve in their relationship to their grief, make meaning of their loss and continue to live and attach to others in a vulnerable and authentic way while coping adaptively with the fear we all face of losing the people we love.

I included an art piece created by a Alsana client on the anniversary of her family member’s death to provide a poignant example of the importance of establishing symbolic activities to process and honor loss. Developing grieving rituals can empower a person to progress from focusing on the death of their loved one to memorializing and commemorating the life that was lived.