Health

PREVENTION: A TEN-STEP PROGRAM

March 20, 2013

By Rabbi Dovid Goldwasser Author of “Starving to Live”

A major key in preventing the development of an eating disorder in a family member is to “know” them, to understand their individual natures and be attuned to the nuances in their behaviors. Very often, there are initial subtle hints that are actually a call for help. If the cry is not heard, or ignored, the individual may become frustrated, which may develop into an at-risk behavior.

To comprehend the meaning of eating disorders, we must understand their origins. Eating disorders are a complex negative interpretation of one’s role in life.

Reb Simcha Bunim of P’shischa questions the wordage in the pasuk, “Kamayim hapanim lapanim kein lev ha’adam la’adam – As water reflects a face back to a face, so one’s heart is reflected back to him by another.” Why, he asks, do we talk about seeing one’s reflection in water? If a person wishes to see his reflection he usually looks in the mirror.

His answer provides us with a unique insight into the human condition. A person can see his reflection in the mirror, even if the mirror is 100 feet away. For example, if one enters a great hall, where there is a mirror on the opposite wall he will be able to see his reflection. However, if one wants to see his reflection in a body of water, he must bend over and bring his face within inches of the water in order to see his reflection. Similarly, if one wants to understand the world of a person suffering from an eating disorder, he cannot observe it from the distance, in his wholesome state with a healthy attitude towards eating and body image. He must come very close to this individual, so that he can truly relate to this person and his situation.

Hundreds of people would flock to a renowned great rabbi for his counsel and blessing. Yet, the rabbi had a practice of taking a break between the meeting of each person. The shammash asked why it was necessary to prolong the wait of the petitioners with a break. The rabbi explained, “When the shoemaker comes in, I have to take off my rabbinic frock and put on the shoemaker’s apron. I place the hammer in my hand, the nails in my mouth, so that I can see the situation from his standpoint and give him the proper advice. When he leaves, and the baker is coming in, I have to first remove the shoemaker’s apron and don the baker’s hat and apron dusted with flour so that I can see his problems in life through his eyes.”

Know Your Child

• Be alert to your child’s inner needs • Be aware of anxiety and guilt feelings associated with separation • Be sensitive to any feelings of shame the child may have with regard to her looks • Take note of any indications of low self-esteem • Be attuned to signs of depression or disappointment • Notice expressions of resentment, anger, or a loss of control • Intuit any feelings of powerlessness that a child may be feeling

Early Detection of an Eating Disorder

In the last few years, researchers have developed a new test that is able to analyze a few strands of hair to determine whether someone is actually anorexic or bulimic. It has been found that as our hair grows, new proteins attach to the base of each strand. These proteins, which are produced and influenced by whatever we eat, push the strand up and out of the individual hair follicle. The hair, in effect, records a person’s nutritional health. Two of the proteins under analyzation — carbon and nitrogen – enable researchers to detect eating disorders.

This was in response to the realization that individuals with an eating disorder are extremely secretive and determined to conceal their disease. They remain on guard to keep their purging or fasting unknown to others. It therefore becomes very difficult, often, for the bystander to identify the presence of the eating disorder.

Pay close attention to the members of your family. Notice if someone begins to skip meals, if a child seems to be bringing home the same lunch that he took to school, or the teacher mentions that the child doesn’t seem to be eating his lunch or is playing with her food. Take note if your teenager pays unusual attention to the nutrition panel of foods, weighs themselves constantly, or engages in other activities that show undue concern with weight or body image. Be alert to any behaviors that may seem strange; tune in to conversations or offhand remarks made in the home.

Spouses have been known to be completely unaware of their partner’s anorexic behavior. A husband began to notice that his wife’s teeth were turning dark and suggested that she use the whitening toothpastes on the market. However, her teeth began to get darker and darker. He ultimately accompanied her to the dentist, who immediately recognized the drastic effects of an eating disorder. Her husband had no idea that his wife was severely anoretic.

Pressure

Daily life presents numerous challenges. Societal pressures of all sorts compound a difficult situation and may send a person over the edge. Adolescents are particularly vulnerable to peer pressure, competition and rivalry. There is pressure to succeed, pressure to outdo, pressure to be at the top. In addition, although much effort has been made on the part of educational institutions to alleviate academic demands, there is still a significant emphasis on an achievement of excellence. The high school experience, especially, is primarily focused on superior grades, exclusive cliques, and special recognition. These pressures can become overwhelming and anxiety-producing, sometimes precipitating an eating disorder.

There is the pressure. You feel, am I only worth something if I’m thin? There is this society thing, like, that to be thin you’re in control, or to be thin means that you’re accomplishing a lot more. And you start thinking to yourself, “Wait a minute. What about the other qualities that I have? Am I not worth it?” So then you automatically start to prove to them, “Oh, you think I can’t show you what I can do? Let me show you what I can do!”

Sometimes these pressures can get even more complex. Beginning from birth, there is a compulsion to get into the school of choice, then there is a need to get into the “right” high school, followed by the struggle to be accepted into the “best” institution of higher learning. That proceeds to the even more competitive scene that presents itself when young people begin the process of seeking a partner in marriage – where differences in the male/female ratio and multiple factors produce mega doses of anxiety and stress.

It is important to be able to recognize the various anxiety disorders, which can be classified in six categories: generalized anxiety disorder, panic disorders, agoraphobia, phobias, obsessive compulsive disorder, and post-traumatic stress disorder.

Rabbi Moshe Chaim Luzzatto illustrates the devastating effect of stress with an interesting insight in the Path of the Just. He notes that Pharaoh’s intent in subjecting the Jewish nation to torturous labor was twofold. Not only did he mean to deprive the people of their leisure so that they would not oppose him or rise up against him, but he wanted to strip their hearts and mind of any ability to think clearly.

The Family Unit A recent survey defined a wholesome family as one where the parents strive to instill values, trust, security, morals and open communication among its members, and include a spiritual component or affiliation. To be sure, a fair amount of attention needs to be focused on each child and his personal development. It has been found that when there is a lack of family unity, dysfunction, or the focus of attention shifts to a single member of the family or possibly even an outsider currently residing with the family, young people have been found to act out in a number of different ways. Disordered eating can be one of those ways.

Sibling rivalry is present in most families, to a greater or lesser degree. My own research has shown that primary candidates for the development of an eating disorder usually grow up in situations where an older/younger brother/sister outshines them or is given extra attention.

Siblings can never be compared to each other, nor can our expectations be the same for all. The Rambam states that just as our appearances are different, so too are our mindsets and thought processes different. Each child has a completely different set of strengths and positive attributes which must always be highlighted.

The catastrophic effects of favoring one child over another are narrated in the Talmud . “L’olam al yeshaneh adam bno bein habanim … — A person should never treat one child different than another, for because of two silver coins’ weight of fine wool that Yaakov gave Yosef more than he gave to his other sons, his brothers became jealous of him, and their jealousy intensified until Yosef was sold by his brothers into slavery and our forefathers ultimately descended into Egypt.”

Parental Persuasion

Parents’ behaviors and attitudes deeply affect their children, even in dysfunctional homes, or where parent are abusive. Children tend to emulate their parents’ actions and attitudes. Constantly talking about weight and diet, or commenting on how thin or overweight so-and-so is, sends a strong message to children that may have undesirable results. An extreme fixation on calorie counting, or an overzealous exercise program has similarly detrimental implications for children. It is very inadvisable to talk about food being good or bad or fattening.

You can say, “Oh, it’s so good that you want a rice cake … it’s so healthy.” You could encourage healthy foods. There’s nothing wrong with encouraging it. But there’s something wrong if a parent always says, “Don’t eat this,” or “Don’t buy that.” I see little kids, at snack-time, walking around with Weight Watcher’s snacks and I cry … Why should a nine-year-old have to be eating something with Nutrasweet in it? Her peer is eating a danish!”

A parent’s comment or remark – negative or positive – impacts profoundly on a child’s self-esteem. Children innately seek their parents’ approval. I have had people in their 60s and 70s come in for counseling because they are still dealing with parental disapproval or dissatisfaction.

Comments concerning body image and weight must be carefully monitored. An offhand remark like, “Are you sure you want another doughnut?” can be devastating to the vulnerable adolescent. A parent should not impose his/her personal prejudices or misconceptions about body image on their offspring by observing, “You could lose a few pounds.” Mealtime should not become a battleground at home.

Education

The Talmud discusses the parent’s obligations to his child, which includes teaching him how to swim. Our Sages have broadened this definition to encompass equipping the child with life-coping skills.

Talk to your children about:

• The importance of eating well-balanced meals three times a day • The danger of trying to change one’s body shape by drastic dieting • Being comfortable with their weight and/or shape • The importance of exercise in moderation for a healthy body • The injustice of prejudices based on weight or body image

We have allowed an unkind, sometimes inhumane, interpretation of eating disorders to prevail, and that interpretation has permitted numerous innocent fatalities.

Self-Expression

The Talmud cites Rav Ami and Rav Ashi who debate the meaning of “da’agah b’lev ish yashchenah.” Rav Ami says that one who is worried should remove the worry from his mind; Rav Ashi differs and says he should share his concerns with others.” It is explained that people have various ways of dealing with their fears and uncertainties. We are all different in nature and temperament, and the coping mechanisms for each individual must be respected and validated.

Therefore, if a child needs to talk about what is bothering him/her, he should feel free to be able to express himself. Children should not be told that they are foolish to worry, nor should their concerns be dismissed as nonsense.

If feelings are not allowed to be expressed in a family, the child’s true self – her emotional reality – is by definition rejected. This rejection of herself is experienced as a profound abandonment just as if she had been rejected by overly hostile, unstable parents.

In G-d’s Image

The Torah tells us that Hashem said to the malachim, “Naaseh adam b’tzalmeinu,” and our Sages explain that man was created in the image of G-d. In all our heterogeneity, we are all equally creations of G-d, and thus we are inherently beautiful. In fact, disparaging remarks concerning another’s appearance or looks is considered to be a transgression of a negative Torah commandment.

Although it is true that reference is made to beauty throughout the Talmud and rabbinic literature, in reality it is focused on the inner beauty of the individual. The Vilna Gaon notes that the Torah comments on the beauty of the Matriarchs – Sarah, Rivka and Rochel – and contrasts it with the statement of Shlomo HaMelech that beauty is vain. The Gaon explains that contrary to physical beauty which is only skin-deep, the Imahos possessed a spiritual beauty that radiated outward from within. Such beauty is noteworthy.

Communication

It is vital to develop good lines of communication within the family. The atmosphere in the home should be non-judgmental, allowing all members to express their true feelings. Thoughts and opinions should be validated; they should not be negated or dismissed.

The open exchange of ideas enables individuals to work through many of their difficulties and challenges. Once the channels of communication break down, however, people resort to more drastic means of getting their ideas and feelings across.

The Torah tells us, “Divrei chachamim b’nachas nishma’im – the gentle words of the wise are heard,” i.e., words spoken in a kind manner are listened to by others. Rabbi Meir Shapiro points out that this was stated with regard to the performance of mitzvos. Certainly one should be heedful to speak gently when addressing other critical matters. When someone speaks in a pleasant, caring and considerate voice, his message is much more likely to be heard. It will also help to eliminate any defensiveness on the part of the listener.

Our Sages tell us similarly, “Devarim hayotzim min halev nichnasim el halev – words that are spoken sincerely from the heart go into the heart.” Speak honestly, from the bottom of your heart. Show the individual that you care for his well-being. Do not convey reproach or fault-finding when you talk to him.

Communicate your points effectively, in a concise manner, as stated in Koheles , “Let your words be few.” Most people employ an automatic cut-off switch when they feel that the “lecture” has exceeded their capacity to listen. Edit your comments; consider which ideas are most important to convey and omit those that may be superfluous.

The Torah commands, “V’lo sonu ish es amiso – you shall not aggrieve your fellow man.” Our Sages tell us that verbal insults or abuse, as well as exhibiting a facial grimace, a motion or gesture that makes the other person feel uncomfortable, are all included in this prohibition.

Be careful not to be critical or say things that will hurt the other person’s feelings. Do not remind him of other occasions when he did not listen and the result was disastrous. Insults are usually counterproductive. Rather than being helpful in the person’s recovery, verbal abuse tends to cause an escalation in the at-risk behavior.

Be a good listener. Be attentive. Don’t interrupt. Allow the other person to finish conveying his thoughts. Make sure to address the points that have been raised in an orderly manner, as we learn , “Omer al rishon rishon v’al acharon acharon — [a learned person] discusses first things first and last things last.”

Prayer

We need spiritual guidance, like they have for the secular world. A twelve-step program – twelve steps to finding G-d in their way. They’re always coming up today with the answers: a spiritual leader, believe in doctors, prayer helps. We don’t have that in our circles.

The Talmud tells us that the world stands on three pillars, one of which is tefillah – prayer. In explaining the mitzvah of tefillah, the Rambam states: “A person should plead in prayer daily and say the praises of the Holy One … request his needs … and offer praise and thanks to Hashem for all the good that He has already given him…” Prayer is a service of the heart. It is the medium through which we praise Hashem and thank Him for His blessings. But it is also the vehicle for our requests and pleas for understanding, success and good health.

Prayers truly from the heart open all the doors in heaven – Rabbi Nachman of Breslov

Rabbi Dovid Goldwasser is the spiritual mentor of Khal Bais Yitzchok in Brooklyn, New York. He is a professor at Touro College and a renowned speaker who galvanizes audiences from every background with his eloquence and dynamism. He has authored over ten books, is a syndicated columnist in newspapers and periodicals throughout the world, as well as a radio commentator on WFMU and WSNR.

Rabbi Goldwasser’s widely sought-after counsel provides reassurance and inspiration to young people, couples and families globally. Additionally, for the past 15 years, Rabbi Goldwasser has been deeply involved in the field of eating disorders, working closely with medical personnel and mental health professionals, facilities, and their patients. He has counseled numerous individuals and their families who have been affected by an eating disorder.

Rabbi Goldwasser has also participated in the development of a suitable curriculum sensitive to Orthodox Jewish children, implemented by the Board of Jewish Education, to promote healthy body image, eating fitness and weight in children. Recently, Rabbi Goldwasser delivered a paper at the Nefesh International Conference for Mental Health in New York, entitled, “Bread of Affliction: The Spiritual Conflicts Experienced by Those With Eating Disorders.” He also made a presentation on the subject of eating disorders to a conference of mental health professionals in London, England.

Rabbi Goldwasser is the author of Starving to Live, a book which has become a classic that addresses the problem of eating disorders from a Torah perspective.

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