Are those my legs? Extreme states of being in working with patients experiencing eating disorders

Reflecting phenomenologically upon what it means to lose oneself in an experience helps me to understand the nature of an extreme state of being and is a recurrent theme in my work as a psychologist. Eating disorders are predominantly conceptualized as individual, brain-bound neural events that occur within behaviorist conceptualizations of our reward-related neurocircuitry. I think extreme states within eating disorders are relational problems with living and illustrate our organismic imperative towards transformation as a constant seeking and an often prereflective striving for difference and change. This organismic imperative is pure process ontology that lies at the heart of the classical problem of being and becoming and illustrates the radical interpenetration between self and world, what Evan Thomson and Francisco Varela called radical embodiment , borrowing from Andy Clark's original use of the term. In the radical embodiment proposition, the organism enacts, or brings forth, their world as an active-seeker, rather than a passive-recipient of stimuli.

I am keenly interested, both clinically and personally, in those types of radical self-making or self-breaking interactions that take on a life of their own. I am referring to how an experience can feel larger than life such that one feels carried along, swept along in a flow that appears to have a life of its own. In some sense, we are always already in an experience in that an experience always has us in some way. It is who we fundamentally are. We have to be. But I am interested in those particular states of being where we feel, either in the moment or at some later point in time, that an experience is having us to the point of possession — we belong to an experience, but the experience does not necessarily belong to us. We do not feel we are driving. At the perceptual level, there may be a strange absence of the felt sense of mineness or aboutness of the happening. These moments where we feel swept along, or lost in an experience, disclose our subjectivity to us in surprising, unusual and sometimes dehumanizing ways. These states are usually accompanied by a loss of the usual sense of self, or some change in self-perception. Some kind of lostness almost always pervades the scene.

Coming from a background in theatre and dance, I explicitly draw on experiences where I have felt myself contained in and even controlled by interactions that take on a life of their own. These experiences paradoxically are accompanied by a loss of my usual sense of self, or a sort of lostness, and a simultaneous sense of union with the larger totality of what could be described as the arc of the play, or the performance. By losing myself in the performance, I find myself in surprising and unusual ways. I am not myself, and yet somehow, I am most profoundly myself. In these moments described above, to lose myself in an experience is to belong to an experience. You as a subject, lose yourself at the exact moment that you do not stand over and against the object. It is precisely in this moment that you find yourself. Being both lost in the experience and the agent of it is also the moment that I think defines good therapy: the moment of being carried along in something new but somehow feeling more like oneself, perhaps than ever before.

This critical therapeutic moment makes me associate to Gadamer's explication of his complex notion of play as a generalizable symbol for art. He presents an ontology of the work of art through various elaborations of his play notion that illustrate how the true conception of a work of art, or play, is not in possession of anyone. It does not belong to anyone, but rather, for Gadamer, the artist, the spectator, the player, the audience, belong to the full meaning of play. They are enfolded in an interaction, a rich relational structure that produces both subjective and objective experiences. They belong to it, not it to them. Another way to say this is that the full meaning of a work of art cannot be located anywhere. It is like an autonomous dynamic event.

This is how I understand the nature of an extreme state of being, psychosis-as-such, a dissociative state, or a state of starvation; as a self-organizing dynamical system. Its “center”, or its cause, cannot be located anywhere, not in the brain, and not in the individual, and not in the genes. There is no central directing agent. For an extreme state of being, like a work of art, its way of being is its pattern of organization, its relationships. Its way of being is not solely as a subject. Our patterns of organization are, as Gregory Bateson famously said, the pattern which connects. To get at the way of being of an extreme state clinically, we have focus on the radical nature of the interaction itself.

This generalizable ontology depicts how, like a work of art, an extreme state of being is always pointing beyond itself while simultaneously directing us into itself. The way of being of a work of art is that way that it points to itself by pointing beyond itself. As the viewer of this work of art, it comes upon me, and I upon it, and I am swept along, carried and contained in play as a rich relational structure.

The extreme states occurring within the phenomenon of eating disorders are foundational, relational or ontological issues. They have to do with this way that we are fundamentally dependent, or as I prefer to say, interdependent, upon others to know ourselves, to be ourselves and to find our way through the world. Eating disorders go against one's ontological nature, while paradoxically asserting it at the same time. They have a way of insisting that patients must be found differently than they were before. Eating disorders, like all extreme states of being, signal the way that we no longer feel we belong in the world. An extreme state is how we embody the ways we no longer want to belong in the world, the ways we no longer want to be in the world.

Treating the thoughts or the behaviors is offering Cartesian solutions to a holistic problem. To treat an eating disorder ecologically, we have to understand the radically relational nature of the brain and the nervous system. And we have to take experience more seriously and cut across brain-body-self-world ontological divides. To do this, I work with patients from a self-organizing relational process model.

Self-organization, or systems thinking, provides a way of expanding the notion of eating disorders to include the co-determining relationship between personhood and world without neglecting our deeply affective neurobiological dimensions. We are always, at the level of our open nervous system, coupled with the environment, and this means that a mood or a state of being or the activity of thinking occurs in a brain-body-environment system, not IN the brain of the isolated individual. This approach is vital to psychology in our current age of brainiacs because we cannot simply focus on the neurotransmitter sites, but neurotransmitters nested within brains, in bodies, in the world.

Self-organization encompasses this way interactions can take on a life of their own because of how a system has to continually reach outside of itself to create itself, to make itself as a whole. Self-organization can be understood broadly as a process by which an organism makes itself, or creates itself, through its dynamical interaction with the environment. A self-organizational or ecological approach gives us another robust way to frame clinical phenomena that does not privilege one side or another by relying on 17th-century dualisms of perception, appearance and reality. How we broadly conceptualize development — or change — lies at the very heart of this problem and requires us to more fully articulate the ontological framework of a self-organizing perspective.

To build more inclusive revisions of humanism and conceptions of personhood that carry psycho-physicalist unity, we need to recognize that what happens in therapy is built on not just causal but constitutive interdependence. Dependence of this radical constitutive sort is demanding, and I think psychology in general and humanistic psychology in particular needs to reach outside of itself, reach beyond its own borders and intellectual traditions to continue to maintain itself as a thriving discipline. I do not think we can get out the heart of matters like selfhood, identity, perception and global mood states that have a totalizing imperative, without a relational metatheoretical model of constitutive interdependence, or reciprocal causality.

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