by Edith Eger
When I had worked through a day in her life, I asked her a question that she didn’t know how to answer. “What do you like to do?” I asked.
“I don’t know,” she said.
“What are your hobbies? What do you like to do in your free time?”
“I don’t know.”
I walked over to the whiteboard that I keep in my office. I wrote, I don’t know. As I asked her more questions about her interests, her passions, her desires, I put a check mark for every time she said, “I don’t know.”
“What are your dreams for your life?”
“I don’t know.”
“If you don’t know, then guess.”
“I don’t know. I’ll think about it.”
“A lot of girls your age write poems. Do you write poems?”
Emma shrugged. “Sometimes.”
“Where would you like to be in five years? What kind of a life and career appeal to you?”
“I don’t know.”
“I’m noticing that you say these words a lot: I don’t know. But when the only thing you can think is I don’t know, that saddens me. It means you’re not aware of your options. And without options or choices, you aren’t really living. Can you do something for me? Can you take this pen and draw me a picture?”
“I guess.” She walked to the board and pushed her thin hand out from her sleeve to take the pen.
“Draw me a picture of yourself, right now. How do you see yourself?”
She uncapped the pen and drew quickly, her lips pursed. She turned so I could see her drawing: a short, fat girl with a void, blank face. It was a devastating contrast—skeletal Emma beside a blank, fat cartoon.
“Can you remember a time when you felt different? When you felt happy and pretty and fun loving?”
She thought and thought. But she didn’t say, “I don’t know.” Finally she nodded her head. “When I was five.”
“Could you draw me a picture of that happy girl?”
When she stepped away from the board, I saw a picture of a dancing, twirling girl in a tutu. I felt my throat catch, a spasm of recognition.
“Did you take ballet?”
“Yes.”
“I’d love to hear more about that. How did you feel when you were dancing?”
She closed her eyes. I saw her heels pull together in first position. It was an unconscious motion, her body remembering.
“What are you feeling right now as you remember? Can you give that feeling a word?”
She nodded, her eyes still closed. “Free.”
“Would you like to feel that way again? Free? Full of life?”
She nodded. She put the pen on the tray and tugged her sleeves down over her hands again.
“And how does starving yourself get you closer to this goal of freedom?” I said it as warmly, as kindly as I could. It wasn’t a recrimination. It was an effort to bring her into an unflinching awareness of her self-sabotage and of how far she had taken it. And it was an effort to help her answer the most important questions at the outset of any journey toward freedom: What am I doing now? Is it working? Is it bringing me closer to my goals, or farther away? Emma didn’t answer my question in words. But in her teary silence I could sense her recognizing that she needed and wanted to change.
When I met with Emma and her parents all together for the first time, I greeted them with enthusiasm. “I have very good news!” I said. I shared with them my hope, my confidence in their ability to work as a team. And I made my own participation in the teamwork conditional upon their agreeing that Emma would also be in the care of the medical staff at an eating disorder clinic, because anorexia is a serious, potentially fatal condition. If Emma ever got below a certain weight, which would be determined in consultation with the staff at the clinic, she would have to be hospitalized. “I can’t risk you losing your life over something that can be prevented,” I told Emma.
A month or two after I started working with Emma, her parents invited me to their home for a family meal. I met all of Emma’s siblings. I noticed that Emma’s mother introduced each of her children with qualifiers: this is Gretchen, the shy one, and Peter, the funny one, and Derek, the responsible one. (Emma had already been introduced to me: the sick one.) You give children a name, and they play the game. This is why I find it useful to ask my patients, “What was your ticket of admission in your family?” (In my childhood, Klara was the prodigy, Magda was the rebel, and I was the confidante. I was most valuable to my parents when I was a listener, a container for their feelings, when I was invisible.) Sure enough, at the table Gretchen was shy, Peter was funny, Derek was responsible.
I wanted to see what would happen if I broke the code, if I invited one of the children into a different role. “You know,” I said to Gretchen, “you have such a beautiful profile.”
Their mother kicked me under the table. “Don’t say that,” she admonished me under her breath. “She’ll end up conceited.”
After dinner, while Emma’s mother cleaned up in the kitchen, Peter, who was still a toddler, was pulling on her skirt, asking for her attention. She kept putting him off, and his attempts to get her to stop what she was doing and pick him up became more and more frantic. Finally he toddled out of the kitchen and went straight for the coffee table, where there were some porcelain knickknacks. His mom ran after him, swooped him up, spanked him, and said, “Didn’t I tell you not to touch those?”
The spare-the-rod-spoil-the-child approach to discipline had created a climate in which the children seemed to get only negative attention (bad attention, after all, is better than no attention). The strict environment, the black-and-white nature of the rules and roles imposed on the children, the palpable tension between the parents—all made for an emotional famine in the home.
I also witnessed the highly inappropriate attention that Emma’s father paid her. “Hey there, Hottie,” he said to her when she joined us in the living room after dinner. I saw her shrink into the couch, trying to cover herself. Control, punitive discipline, emotional incest—no wonder Emma was dying in the midst of plenty.
Like all families, Emma and her family needed rules, but very different ones from those they were operating under. So I helped Emma and her parents to make a family constitution that they would help one another to enforce, a list of family rules that would improve the climate in their home. First, they talked about the behaviors that weren’t working. Emma told her parents how much hearing them yell and blame frightened her, and how resentful she felt when they changed the rules or expectations at the last minute—what time she had to be home, what chores she had to finish before she could watch TV. Her father talked about how isolated he felt in the family—he felt like the only one disciplining the kids. Interestingly, Emma’s mother said something similar, that she felt like she was parenting all alone. From the list of hurtful habits and behaviors—the things they wanted to stop doing—we built a short list of things they agreed to start doing:
Instead of blaming others, take responsibility for your own actions and speech. Before you say or do something, ask, Is it kind? Is it important? Does it help?
Use teamwork to reach common goals. If the house needs cleaning, each member of the family has an age-appropriate job. If the family is going out to a movie, choose together which movie to see, or take turns getting to choose. Think of the family as a car where all the wheels are integrated and work together to move where it needs to go—no one wheel takes control, no one wheel bears all the weight.
Be consistent. If curfew has already been established, the rule can’t change at the last minute.
In general, Emma’s family’s constitution was about giving up the need to control someone else.
I treated Emma for two years. In that time she completed the outpatient program at the eating disorder clinic. She stopped playing soccer—something her father had forced her into when she started middle school—and went back to ballet class (and then on to more dance classes: belly dancing, salsa). T
he creative expression, the pleasure she took in moving to the music and rhythm, led to an enjoyment of her body, which gave her a healthier self-image. Near the end of our time together, when she was sixteen, she met a boy in school and fell in love, and this relationship gave her another motivation to live and to be healthy. By the time she stopped working with me, her body had filled out and her hair was thick and shining. She had become the present-day version of her picture of the twirling, dancing girl.
The summer after Emma’s junior year of high school, her family invited me to a barbeque at their house. They put out a wonderful spread—ribs, beans, German potato salad, homemade rolls. Emma stood with her boyfriend, filling a plate with food, laughing, flirting. Her parents, siblings, and friends sprawled on the lawn and in folding chairs, feasting. Food was no longer the negative language of the family. Emma’s parents, though they hadn’t completely transformed the tone of their parenting or their marriage, had learned to give Emma what she had learned to give herself—the space and trust to find her way toward the good in life. And without having to live consumed by their fear of what might happen to Emma, they had grown free to live their own lives. They had a weekly bridge night with a group of friends and had let go of much of the worry and anger and need to control that had poisoned their family life for so long.
I was relieved and moved to see Emma restored to Emma. And her journey also prompted me to reflect on me. Edie. Was I at one with my own inner dancing girl? Was I living with her curiosity and ecstasy? Around the same time that Emma left my practice, my first grandchild, Marianne’s daughter, Lindsey, began a toddler ballet class. Marianne sent me a picture of Lindsey in a little pink tutu, her sweet chubby feet tucked into a pair of tiny pink slippers. I wept when I saw the picture. Joyful tears, yes. But there was also an ache in my chest that had more to do with loss. I could picture Lindsey’s life spreading out from this moment—her performances and recitals (sure enough, she would continue to study ballet and perform in The Nutcracker every winter of her childhood and adolescence)—and the happiness I felt for her in anticipation of all she had to look forward to could not be uncoupled from the sorrow I felt at my own interrupted life. When we grieve, it’s not just over what happened—we grieve for what didn’t happen. I housed a year of horror within me. And I housed a vacant, empty place, the vast dark of the life that would never be. I held the trauma and the absence, I couldn’t let go of either piece of my truth, nor could I hold either easily.
I found another mirror and teacher in Agnes, a woman I met at a spa in Utah where I was speaking to breast cancer survivors about the importance of self-care to promote healing. She was young, in her early forties, her black hair pulled back in a low bun. She had on a neutral-colored smock dress buttoned up to her neck. If she hadn’t been the first in line for a private appointment in my hotel room after my talk, I might not have noticed her at all. She kept herself in the background. Even when she stood in front of me, her body was barely visible beneath her clothes.
“I’m sorry,” she said, when I opened my door to invite her in. “I’m sure there are other people who deserve more of your time.”
I showed her to the chair by the window and poured her a glass of water. She seemed embarrassed by my small caretaking gestures. She sat on the very edge of her chair and held the water glass stiffly in front of her, as though to take a sip would be an imposition on my hospitality. “I don’t really need a whole hour. I just have a quick question.”
“Yes, honey. Tell me how I can be useful.”
She said she had been interested in something I’d said in my talk. I’d shared an old Hungarian saying I learned as a girl: Don’t inhale your anger to your chest. I had given an example of the self-imprisoning beliefs and feelings I had held on to in my life: my anger and my belief that I had to earn others’ approval, that nothing I did would be good enough to make me worthy of love. I’d invited the women in the audience to ask themselves, What feeling or belief am I holding on to? Am I willing to let it go? Agnes asked me now, “How do you know if there’s something you’re holding on to?”
“It’s a beautiful question. When we’re talking about freedom, there’s no one-size-fits-all. Do you have a guess? Does your gut tell you that there’s something inside that’s trying to get your attention?”
“It’s a dream.” She said that ever since her cancer diagnosis a few years ago, and even now that her disease was in remission, she’d been having a recurring dream. In it she is preparing to perform surgery. She puts on blue scrubs and a face mask. She tucks her long hair inside a disposable cap. She stands at a sink, scrubbing and scrubbing her hands.
“Who’s the patient?”
“I’m not sure. It’s different people. Sometimes it’s my son. Sometimes it’s my husband or my daughter, or someone from the past.”
“Why are you performing the surgery? What’s the patient’s diagnosis?”
“I don’t know. I think it changes.”
“How do you feel when you’re performing the operation?”
“Like my hands are on fire.”
“And how do you feel when you wake up? Do you feel energized, or tired?”
“It depends. Sometimes I want to go back to sleep so I can keep working, the surgery isn’t finished yet. Sometimes I feel sad and tired, like it’s a futile procedure.”
“What do you think this dream is about?”
“I used to want to go to medical school. I thought about applying after college. But we had to pay for my husband’s business degree, and then we had kids, and then the cancer. It was never the right time. That’s why I wanted to talk to you. Do you think I’m having this dream because I should pursue medical school now, this late in my life? Or do you think I’m having this dream because it’s time to finally put the fantasy of becoming a doctor to rest?”
“What appeals to you about medicine?”
She thought before she answered. “Helping people. But also finding out what’s really going on. Finding out the truth. Finding what’s under the surface and fixing the problem.”
“There aren’t absolutes in life—or in medicine. As you know, diseases can be difficult to treat. Pain, surgery, treatments, physical changes, mood swings. And there’s no guarantee of recovery. What has helped you live with cancer? What truths or beliefs are you using to guide you through your illness?”
“Not to be a burden. I don’t want my pain to hurt anyone else.”
“How would you like to be remembered?”
Tears sprang into her light gray eyes. “As a good person.”
“What does ‘good’ mean to you?”
“Giving. Generous. Kind. Selfless. Doing what’s right.”
“Does a ‘good’ person ever get to complain? Or be angry?”
“Those aren’t my values.”
She reminded me of myself, before the paraplegic veteran had brought me to an encounter with my own rage. “Anger isn’t a value,” I told Agnes. “It’s a feeling. It doesn’t mean you’re bad. It just means you’re alive.”
She looked skeptical.
“I’d like you to try something. An exercise. You’re going to turn yourself inside out. Whatever you usually hold in, you’re going to get out, and whatever you usually get rid of, you’re going to put back in.” I took the pad of hotel stationery off the desk and handed it to her with a pen. “Each person in your immediate family gets one sentence. I want you to write down something you haven’t told that person. It might be a desire or a secret or a regret—it might be something small, like, ‘I wish you’d put your dirty socks in the laundry.’ The only rule is it has to be something you’ve never said out loud.”
She smiled faintly, nervously. “Are you going to make me actually say these?”
“What you do with them is entirely up to you. You can tear them up like confetti and flush them down the toilet, or set them on fire. I just want you to get them out of your body by writing them down.”
She sat in silence for a few
minutes and then began to write. Several times she crossed something out. Finally she looked up.
“How do you feel?”
“A little dizzy.”
“Topsy-turvy?”
“Yes.”
“Then it’s time to fill yourself back up again. But with the things you usually give to other people. You’re going to put all that love and protection and nurturing back inside.” I asked her to picture herself getting very small, so tiny that she could climb inside her own ear. I told her to crawl down the canal, and down her throat and esophagus, all the way to her stomach. As she journeyed within, I asked her to put her tiny loving hands on each part of her body that she passed. On her lungs, her heart. On her spine, along the inside of each leg and arm. I coached her to lay her compassionate hands on each organ, muscle, bone, vein. “Bring love everywhere. Be your own unique, one-of-a-kind nurturer,” I said.
It took awhile for her to settle in, to let her attention move away from the surface experience. She kept shifting in her chair, brushing a stray hair away from her forehead, clearing her throat. But then her breathing deepened and slowed, her body became still. She grew deeply relaxed as she ventured within, her face looked untroubled. Before I guided her back out through her ear canal, I asked if there was anything she wanted to tell me about what she had felt or discovered inside.
“I thought it would be so dark in here,” she said. “But there’s so much light.”
A few months later she called with devastating news: Her breast cancer was no longer in remission. It had returned and was spreading rapidly. She said, “I don’t know how long I have.” She told me she planned to do the inside-out exercise every day so that she could empty herself of the inevitable anger and fear she felt, and fill herself back up with love and light. She said that, paradoxically, the more honest she was with her family about her more negative feelings, the more grateful she became. She told her husband how resentful she had been that his career had taken priority. Telling him openly made it easy to see that holding on to the resentment served nobody, and she found she could see more vividly all the ways he had supported her throughout their marriage. She found she could forgive him. With her teenage son, she didn’t mask her fears about death, she didn’t give him the reassurances that left no room for doubt. She talked openly about her uncertainties. She told him that sometimes we just don’t know. To her daughter, who was younger, in middle school, she expressed how angry she was about the moments she would miss—hearing about her first dates, seeing her open her college acceptance letters, helping her put on her wedding dress. She didn’t repress her rage as an unacceptable emotion. She found her way to what was beneath it—the depth and urgency of her love.