No One Wants to Be Cured of Who They Are
Part two: on eating disorders, treatment, and why patience is part of the cure
Philip Bromberg has a sentence I keep coming back to: "No one will allow themselves to be cured of who they are."
In the last post I wrote about his idea that an eating disorder isn't a malfunction but a split-off part of the self, one that learned to control what it was never helped to regulate. This post is about what that means for getting better.
Treating what someone still does
Bromberg writes that we don't treat people "to cure them of something that was done to them in the past; rather, we hope to cure them of what they still do to themselves (and to others) in order to cope with what was done to them in the past."
We can't undo the past. What we can work with is the self-cure, the coping strategy that has taken over a life and foreclosed the present in service of an old danger.
A symptom can be pushed away quickly. If nothing underneath has changed, though, the part that needed it is still there, still on guard, and the symptom comes back.
Why getting better can feel like erasure
In adaptive leadership we say people don't resist change, they resist loss. Here the loss is literal.
If a symptom is a part of the self, removing it isn't experienced as healing. It's experienced as erasure, and a person will fight that. Not because they're stubborn, but because the thing being "cured" is them.
This changes what the work is. You can't take away something a person experiences as themselves. You can only help them build enough room to hold it alongside other parts, until it no longer has to run the show.
So Bromberg asks clinicians to treat symptoms "with patience." A symptom is a once-adaptive tool, and people only put tools down when it finally feels safe enough to.
Nobody does this alone
Most of us can sit with a painful thought until it wears itself out, letting it "gnaw at your heart till they are tired." Bromberg's point is that for someone who has been traumatized, that's often impossible. Dissociating is the only way through.
That's why a symptom can't be quit through private willpower. Letting go of it, he writes, "is not possible without an involved other who can hang in during the long process of collisions and negotiations." The collisions are the moments when the old part and the healthier part clash. The negotiations are the slow compromises between them. Someone has to stay through all of it without leaving.
He adds something that asks a lot of clinicians. The trust has to be built in a "transitional reality," and that can happen "only through the analyst's surrender to his own dissociated self experience." In other words, the therapist can't hide behind a polished professional version of themselves. A person learning to trust people again needs an actual person to meet, including the less tidy parts. You can't learn to trust a performance.
From raw experience to story
Bromberg names the goal of any treatment, regardless of method, as an "enriched self-narrative."
Trauma tends to stay stored as raw, present-tense experience: sensations and images that never got organized into this happened, and here's what it means about me. That's part of why it resurfaces as flashback or symptom instead of as a memory you can simply tell.
Being fully present lets new experience touch that stored material instead of routing around it, which is dissociation's whole job. When that contact happens in doses a person can tolerate, the old experience can slowly get woven into the story. It stops being something that happens to you and becomes something that happened.
The goal was never to get rid of the part. It was to give it a story it could live inside, and someone to tell it to.
What I keep turning over is the patience itself. With eating disorders the urgency is real, sometimes medically real, and I wonder how a clinician holds both at once: the pressure to move fast and the knowledge that moving fast is often what brings the symptom back.
