Volume 4, Issue 1: Winter 2005: Spiritual Dimension of Eating Disorders
Winter 2005, Volume 4, Issue 1
Bringing the Spiritual into Treatment
Spiritual Development: Growing in God’s Love
In the first issue of The Remuda Review, Fall 2002, we explained the basics of a scientifically-valid and Biblically-based bio-psycho-social-spiritual model of eating disorder conceptualization and treatment. Since that initial issue, we have journeyed, issue by issue, through this model, until the current publication, where we reach the final, spiritual aspect of eating disorders.
According to the Bible, human beings were created to exist in relation to God. The human spirit is the aspect of humanity that connects us to God. An active relationship with our Maker is the foundation of healthy spirituality, a cardinal aspect of the integral human person and optimal functioning. Therefore, discussion of the nature and difficulties of this relationship is essential for understanding human health and illness. The articles in this issue of The Remuda Review are intended to deepen readers’ understanding and appreciation of spirituality’s role in eating disorder treatment.
Among Christians, there are two schools of thought regarding the human spirit: the dichotomous, who believe that soul and spirit are Biblical concepts for the same thing; the trichotomous, who believe that soul and spirit refer to separable aspects of the human person. For a good introduction to the Biblical case for both perspectives, see Grudem (1994). Because of the importance of the human spirit in all Biblically-based understandings of human beings, the articles in this issue and later issues regarding the human spirit are being written carefully so that they are valid from both a dichotomous and trichotomous view of human nature.
Grudem, W. (1994). The essential nature of man. In W. Grudem (1994), Systematic Theology: An Introduction to Biblical Doctrine. Leicester, England: Intervarsity Press.
Editorial Staff
Bringing the Spiritual into Treatment
Marian C. Eberly, RN, MSW, LCSW, DAPA
Division of Patient Care Services
Remuda Ranch Programs for Anorexia and Bulimia
I am sometimes asked: “Why do you have to bring God in to everything? Can’t you just counsel your patients without all that God stuff?” The answer at Remuda is simple: “No”. Since some have difficulty accepting this answer, let me explain our understanding of why spirituality is indispensable in treatment.
Why Spirituality?
We practitioners want the same things for those entrusted to our care: to see our clients get well, to heal where they are broken, to learn to do things differently, to make better choices, for their suffering to be soothed, for wholeness mysteriously to happen.
In the Christian worldview, God permeates everything. “[I]n him all things hold together” (Colossians 1:17). He created the world, and its people were made in his image (Genesis 1:26) to fellowship with him (1 John 1:3). From this perspective, treatment without God would inevitably be incomplete, bordering on a crisis of meaning, with difficulty pointing clients toward wholeness.
The Bible is the Christian’s handbook for living (2 Timothy 3:16). It tells us that we are spiritual beings—in other words, that we have a spirit, and that our spiritual nature needs to be cared for in specific ways (Wall & Eberly, 2002). If we ignore spiritual care, we are only treating part of the patient. How then can we guide a patient toward the desired outcome of wholeness? Without spiritual direction and relatedness, it is a basic Christian belief that human beings will continue to strive to fill a place within them that yearns to know God (e.g., Psalm 42:1, 69:32, John 10:10, 1 Corinthians 1:9). As Augustine wrote early in the Christian era, reflecting on Scripture: “Thou hast made us for thyself, O Lord, and our hearts are restless until they rest in thee” (1960).
Philosophers have debated human spirituality for centuries, as have psychologists and psychiatrists in more recent times. Some have simply given up on the notion of spirit, and dismiss it as ridiculous. Others believe that human beings possess a body, soul, and spirit, intricately entwined, symbiotically collaborating with each other, each part needing the other for optimal functioning. Often when one part fails to thrive, the whole system breaks down and needs to be healed. There may be exceptions, such as when a terminally ill patient matures and flourishes spiritually in response to their illness. But more often than not, problems in one area will impact the whole person. More and more, this perspective is on the ascendant in modern medicine (e.g., Benson & Stark, 1997; Koenig & McConnell, 2001). Luminaries in medicine and psychotherapy are embracing and promulgating the role of spirituality in healthcare. In its emphasis on spirituality in treatment, Remuda is therefore not outside the mainstream thinking of our day.
In keeping with the emerging recognition that spirituality has a significant place in healthcare, studies bridging the worlds of psychotherapy and faith have seen burgeoning growth during recent decades in the US. Textbooks, books, and peer-reviewed articles and journals by mental health professionals on the subject of faith and counseling reflect a heightened awareness of the need to understand and deal with the client’s spiritual world (Scafranske, 1996). There is also an abundance of research on religion and coping (Koenig, George & Siegler, 1988; Mattlin, Wethington & Kessler, 1990; Wicks, 1990). Graduate programs in psychology have been formed that explicitly attempt to integrate spirituality with psychological theories and methods: e.g., Fuller Theological Seminary, Biola University, George Fox University, Wheaton College, John F. Kennedy University. Prestigious medical schools are offering courses on spiritual counseling (Gunderson, 2000). In this context, Remuda offers an opportunity whereby seasoned professionals schooled in spiritual counseling can utilize their knowledge and experience effectively to address the needs of the whole patient. In fact, healthcare professionals are in a strategic position to assist those searching and struggling with spiritual matters. In one study of terminally ill patients in a non-sectarian medical center, 76% indicated they would like to talk with their nurses about God, 55% wanted nurses to assist them with prayer, and 46% wanted nurses to acknowledge their religious beliefs (Soderstron & Martinson, 1987). Surveys by USA Today and Time Magazine indicate that 2/3 of Americans would like their healthcare providers to address religion with them, and 1/2 want their doctors to pray with them (Gunderson, 2000).
For those struggling with an eating disorder, the relationship with God has often suffered greatly. Why is that? Because God sees all, is in all, and we are aware of his presence even when we are otherwise alone. Hence, the desperate desire to hide our self-destructive actions from him becomes a priority. This is not new regarding human behavior, but indeed a primeval response to shame. Even at humanity’s beginning, Adam and Eve tried to hide their shame about their behavior from God: “They hid from the LORD God among the trees of the garden” (Genesis 3:8). We push God out of the picture because we want what we want through the methods we have chosen, and because we are not thinking about or focusing on whom we may hurt in the process, least of all ourselves. Slowly, God becomes silent to us, perhaps non-existent. This is followed or accompanied by a moving away from others, or at least attempts at isolation. We become more and more evasive, less available, and more detached from a range of feelings and emotions. The numbing process is well under way.
Caring for the spirit is indeed essential in such circumstances, because there has been a tearing away of the relationship with God, a separation. Human beings can live like this for a long time, usually in misery. But ultimately, when people desire complete healing, they want their spirit healed too. They want to be in communion with God again and to know and experience him as they once did or never have before. In Psalms 40 through 45, King David expresses this well, crying out to God while buried in his sins.
Do not withhold your mercy from me, O LORD;
may your love and your truth always protect me.
For troubles without number surround me;
my sins have overtaken me, and I cannot see.
They are more than the hairs of my head,
and my heart fails within me.
Be pleased, O LORD, to save me;
O LORD, come quickly to help me.
You are my help and my deliverer;
O my God, do not delay.
I waited patiently for the LORD;
he turned to me and heard my cry.
He lifted me out of the slimy pit,
out of the mud and mire;
he set my feet on a rock
and gave me a firm place to stand.
He put a new song in my mouth,
a hymn of praise to our God.
(Psalm 40:17, 1-3, 11-13)
Although there have been advancements recognizing the role of spirituality in healthcare and ample literature is accumulating on the prominent role of spirituality in eating disorders, some healthcare professionals still seem to tread very lightly regarding spiritual counseling with eating disorder clients. Occasionally there are explicit criticisms of non-clerical mental health professionals who have educated themselves to provide this service. Perhaps, then, some clinicians and researchers have yet to explore the evidence for the role and impact of spirituality in recovery and healthy living.
Why Christianity?
At Remuda, we address the needs of the body, soul, and spirit simultaneously for optimal healing, treating the whole person. Many practitioners, aware of the growing recognition of spirituality’s legitimate role in healthcare, come with us this far. But then they may ask: “Why does Remuda choose to address spirituality from the perspective of Biblical Christianity? Why not take a more generic approach to spirituality?” The answer is once again simple: “Christianity is our faith”.
By faith I do not merely mean the system of beliefs to which we adhere, although this certainly pertains. But more than this, faith in Christ, for us, is a living experience, a gift from God that enables us to believe in and follow his Son (Romans 10:17). Our spirits are alive because of this faith. We cannot authentically live spiritual lives, or communicate about spiritual matters, apart from this faith. It is the cornerstone of our spirituality (Ephesians 2:20).
We are certainly not alone in the United States. Up to 88% of Americans report Christianity as their faith system (Kosmin & Lachman, 1993). Interventions that approach spiritual care from a Christ-centered perspective are therefore able, without modification, to reach the large majority of patients seeking treatment in this nation. This is an important point not often recognized among healthcare professionals or scholars.
Furthermore, of the many spiritual traditions, by far the greatest quantity of research and theory on the integration of spirituality into mental health has occurred in the Christian tradition. The field of integration studies endeavors to integrate counseling and Christianity into a unified conceptual and treatment model. Accredited universities and seminaries support this work, as do scientific journals dedicated exclusively or predominantly to this work, such as The Journal of Psychology and Christianity and The Journal of Psychology and Theology. Thousands of books have been written on recovery and healing from a Christian perspective. Thus, the mental health professional wishing to follow current standards of the field and incorporate spirituality into his or her research or clinical work can draw on an extensive literature and evidenced-based content regarding the integration of patient care and Christianity. For other spiritual traditions, the resources are less extensive. As such, Christian-based mental health programs are not only following the standards of current practice by integrating spirituality into treatment, but they are also doing so in perhaps the most scientifically-defensible manner possible given the present state of knowledge.
At Remuda, we see God acting daily in multiple ways, continually confirming our faith. We have the blessing of seeing him move among us: families coming together, remembering and talking about their deep and abiding love for one another, their suffering in the grip of such love, the effects of their secret behaviors, their hunger to find a way out and restore their relationships. We see families rejoined after years of separation. We see crushed and devastated marriages take the first steps toward reconciliation. We see children and adolescents literally regain the joy and enthusiasm of youth. We believe that spiritual renewal of this magnitude is ever more possible when Jesus Christ is brought openly and fully into the equation, for he is the source of all reconciliation and redemption. “All things are possible with God” (Mark 10:27).
What About Non-Christians?
What about those who have never had a relationship with God? Are their spirits in need of succor, if they truly don’t care? Because of our Biblical understanding of human nature (Cumella, 2002; Wall & Eberly, 2002), we believe that all human spirits need care when they are suffering. If we provide treatment for the body and mind, and leave out the spirit, the result will be less than optimal. There is also ample scientific evidence of the need to attend to spirituality during treatment (e.g., Benson & Stark, 1997; Koenig & McConnell, 2001). All patients who come to Remuda are informed before admission of our emphasis on spirituality throughout treatment and they assent to our holistic model. In fact, they are carefully informed that they will be exposed to expressions of Biblical Christianity, and they explicitly consent to this prior to admission. If they strongly prefer another approach, they may not elect to seek treatment at Remuda.
At our facility, we ask many questions about clients’ spiritual condition. This assessment process is as critical as any of the seven clinical evaluations performed during the admission process. We want to know how the patient perceives God. Is there spiritual distress, a broken and hurtful relationship with a church or faith community, disappointment with God, or a crisis of faith? The Remuda Spiritual Assessment Questionnaire (Wall, Cumella, & Darden, 2003) was developed and validated psychometrically to assess objectively a broad range of spiritual issues with which patients may be dealing. We thus assess each client’s individual and personal needs for spiritual care. These issues are addressed during treatment with patient consent.
The Remuda Program includes classes to explore spiritual issues in greater depth. Patients attend chapel daily, including a devotional message and songs of spiritual praise and worship. Support group models are taught and opportunities given to experience these groups. For example, Celebrate Recovery and 12 Steps for Christians are offered on campus and made available for patients to participate in at their choosing.
Remuda’s patient care staff are compassionate people, highly skilled and fully credentialed in their professions, and also professing to know Christ. Through them, patients have the opportunity to be exposed to Christianity “with skin on”, and hopefully more is “caught” than taught at Remuda. We have often said that Christianity is more about relationship than religion. Someone once said, “no one cares how much you know until they know how much you care”. As Scripture says: “Your lives are echoing the Master’s Word… The news of your faith in God is out. We don’t even have to say anything anymore—you’re the message!” (1 Thessalonians 1:8; The Message). We desire that those who come to Remuda have an opportunity to meet Jesus through the love we demonstrate in the way we perform our duties.
Once they surmount initial obstacles, the women and girls who come to Remuda for treatment are often not afraid: they are some of the most courageous people one will ever be blessed to meet. They inspire us with their courage and strength. They are not afraid to ask hard questions about God, the purpose of life, and the mystery of death, and they want answers that make sense and that they can count on. Throughout their lives They want to know. They have already been hearing answers to these questions through our culture, answers that have left them empty, confused, and ill. Someone, somewhere, is going to offer them spiritual answers, so why not us? They need not accept our answers to these potent questions, but often they do, because the answers ring true for them and derive from a book which they have either long revered or recently come to appreciate as sacred, the Bible.
It goes without saying that, in all cases, Remuda respects the spiritual and religious backgrounds and choices of our clients. This is a standard of ethics in all healthcare professions. If a patient elects not to be exposed to Christian messages and ideas while at Remuda, we respect that boundary. In fact, many patients from other faith backgrounds have renewed their particular faith and spiritual joy through their experiences at Remuda. Our internal research shows that patients from non-Christian backgrounds experience short- and long-term outcomes equivalent to our Christian patients. Thus, the vital spirituality experienced at Remuda can be accessible to, and healing for, clients from many faith backgrounds.
Forgiveness: From Anger to Peace
Mainstream psychotherapy researchers and practitioners and other helping professionals have begun to apply spiritual methods of coping and counseling quite broadly. These methods include discussion of and training in the use of forgiveness to help people release old patterns of resentment and move forward toward new goals and relationships (e.g., McCullough, Sandage, & Worthington, 1997). Even before the popularity of forgiveness counseling in mainstream mental health, forgiveness counseling was one of the hallmark spiritual issues that patients and families were addressing at Remuda. It continues to be so.
In The Psychology of Religion and Coping, Dr. Kenneth Pargament (1997) writes:
There are many things forgiveness is, and many things it is not. Forgiveness is neither pardon, nor forgetting, nor denial, nor an act of moral superiority over a perpetrator. It is not a form of passive reconciliation, a way to quickly restore an unhealthy relationship, placing a person at continued risk. It is not simply a protective method of coping, one designed to limit the pain and hurt of injustice.
Instead, forgiveness is viewed by a growing body of healthcare professionals as an important and profound process. Giving up the right to bring retaliatory harm may seem counterintuitive to some who have witnessed the mistreatment of others or have been mistreated themselves. Yet those who practice forgiveness find themselves restored and radically changed.
David Augsburger, in his classic writing, Caring Enough to Forgive, Caring Enough Not to Forgive (1981), states that “forgiveness is one of the hardest things in the world to do, and one of the greatest of human achievements. It calls for change at many levels: relational, cognitive, behavioral, affective, volitional and spiritual.” It is one of the essential re-creating events that is performed every week by patients and families at Remuda, and it is the place where true healing begins on every level. Yet this transforming act arises from the human spirit. It is a spiritual decision that affects the rest of the person as well as those around them.
Unforgiveness reaps destruction. The powerlessness and anger one feels over injustice has the potential to leave one in the grips of paranoia, alienate one from sources of support, and intensify the physical signs of stress. The freedom gained by the act of forgiveness means that one is no longer held hostage by painful memories of mistreatment. Forgiveness offers one the possibility of emotional, mental, spiritual, and physical peace.
Forgiveness is rarely instantaneous. Although forgiveness involves a decision, that decision oftentimes must be made again and again—a process. Because forgiveness involves action, attempts are made to change one’s thinking, feeling, and relating to others. With changes in behavior, changes in thinking and feeling deepen.
Forgiveness is but one aspect of recovery, but one of the most essential in healing a person’s heart and spirit. It is for many the essence of spiritual care, whether from a Christian perspective or other faith. Christianity takes forgiveness to new heights by recognizing that it is the very source of spiritual salvation and central event in human history, epitomized in Christ’s crucifixion. As Christ said the night before He was crucified: “This is my blood of the new covenant, which is poured out for many for the forgiveness of sins” (Matthew 26:28). As Christians, we deeply recognize the value of forgiveness and we are awed to participate with our clients and their families in the unfolding of this mysterious spiritual process that renews lives and relationships.
References
Augsburger, D.W. (1981). Caring enough to forgive, caring enough not to forgive. Ventura, CA: Regal Books.
Augustine. (1960). The confessions of Saint Augustine. (Trans. John K. Ryan) New York: Doubleday.
Benson, H. & Stark, M. (1997). Timeless healing: The power and biology of belief. New York: Fireside.
Cumella, E.J. (2002). Bio-psycho-social-spiritual: Completing the model. The Remuda Review: The Christian Journal of Eating Disorders, 1, 1-5.
Gunderson, L. (2000). Faith and healing. Annals of Internal Medicine, 132, 169-172.
Koenig, H. & McConnell, M. (2001). The healing power of faith: How belief and prayer can help you triumph over disease. New York: Simon & Schuster.
Koenig, H.G., George, L.K., & Siegler, I.C. (1988). The use of religion and other emotion-regulating coping strategies among older adults. Gerontologist, 28, 303-310.
Kosmin, B.A. & Lachman, S.P. (1993). One nation under God: Religion in contemporary American society. New York: Harmony Books.
Mattlin, J.A., Wethington, E., & Kessler, R.C. (1990). Situational determinants of coping and coping effectiveness, Journal of Health and Social Behavior, 31,103-122.
McCullough, M.E., Sandage, S.J., Worthington, E.L. (1997). To forgive is human: How to put your past in the past. Downers Grove, IL: InterVarsity Press.
Pargament, K.I. (1997). The psychology of religion and coping: Theory, research, and practice. New York: Guilford Publications.
Peterson, E.H. (2002). The message: The Bible in contemporary language. Colorado Springs: NavPress.
Scafranske, E.P. (Ed.) (1996). Religion and the clinical practice of psychology. Washington, DC: APA Books.
Soderstron, K.E. & Martinson, I.M. (1987). Patients spiritual coping strategies: A study of nurse and patient perspectives. Oncology Nursing Forum,14,41-46
Wall, A.D., Cumella, E.J., & Darden, R.A. (2003). Remuda spiritual assessment questionnaire professional manual. Wickenburg, AZ: Remuda Ranch Center for Anorexia and Bulimia, Inc.
Wall, A.D. & Eberly, M. (2002). Five Biblical factors in eating disorder development. The Remuda Review: The Christian Journal of Eating Disorders, 1, 6-10.
Wicks, J.W. (1990). Greater Toledo area survey. Bowling Green, Ohio: Population and Society Research Center.
Spiritual Development: Growing in God’s Love
A. David Wall, PhD, Department of Psychological Services
Marian C. Eberly, RN, MSW, LCSW, DAPA, Division of Patient Care Services
Edward J. Cumella, PhD, Department of Research and Education
Remuda Ranch Programs for Anorexia and Bulimia
Remuda Ranch Programs for Anorexia and Bulimia, Inc.Note: This article presents a Christian view of spiritual development as it relates to eating disorder recovery. The article’s primary goal is to assist those who work with Christian patients to effectively and compassionately offer guidance that can promote spiritual growth in a manner consistent with the Christian faith.
I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God. (Romans 8:38-39)
Her name is Katie. For all the world, she looks like a healthy young American woman. Her sweet spirit is evident, especially when she smiles. Bright and personable, she should have the world by the tail. How did she end up needing intensive inpatient treatment for an eating disorder?
We discuss her family, school, friends, and her religious background.
“I’m a Christian,” she replies.
“Tell me who God is—not necessarily what you’ve been taught, but who you experience Him to be.”
“He’s awesome. He is someone I can turn to, someone who loves you. I know He died for me.”
“If He were to suddenly stand before you right now, what do you think He would say?”
At first she stumbles for words. Then she hesitantly replies, “He would tell me He loves me.”
“What do you think He would say about your eating disorder?”
“He wants me to stop. I’m destroying my body—that He gave me—and I’m wasting the gifts He gave me.” Tears flow, just slightly.
As she continues, her shame emerges. She is ashamed not just about her eating disorder. A trusted Christian boyfriend, Michael, slowly wore her down and pushed her into having sex.
“I said ‘no’, but he wouldn’t stop. He knew where I stood. It’s my fault. I never should have allowed that to happen.”
So much of what she values—her plans and dreams—disappeared in one night. Shame replaced her dreams.
Although devastated, and in spite of her boyfriend’s persistent physical advances, Katie continued her relationship with him. One day he didn’t call when he was supposed to. Days went by. Then Katie learned from a friend that he was dating another girl. Something inside her began to die: not simply because of the rejection, but because of what this relationship had cost her. For what? She was so ashamed of herself.
Within a matter of weeks, Katie’s preexisting focus on healthy foods erupted into an eating disorder. Her list of healthy foods shrank to precious few. Exercise became a compulsion. Her dietary rules and exercise regime demanded obedience. When she obeyed anything less than perfectly, she experienced unending waves of obsessive guilt. Her standards for herself were always just a bit higher than her achievements, so feelings of guilt became the norm.
Katie still garnered attention from young men, but pulled back in fear. She did not trust them, and more importantly, did not trust herself. She wanted to be physically attractive. Yet at the same time, she wanted men to see her as repulsive. This was just one of many areas in her life that seemed conflicted and confusing.
Katie gave of herself to everyone. She felt obligated to live out her faith by always being there for anyone who needed her and to “point them to the Lord”. After listening for some time, I interjected. “What is your vision for your life?”
“I just want to get better so I can help other people, to be an inspiration to them. This illness has me so focused on myself and so tired all the time, I can’t be the kind of friend I should be to other people.”
“Is God disappointed in you?”
“Yes. I know He is. I keep praying and praying for God to take my eating disorder away, but He doesn’t. I want to stop, I should be able to overcome this, but I can’t. I cry out to him; I beg him to help me. I would never kill myself, but I wish He would just take me home. Maybe He wants me to suffer to teach me and make me strong, so I can minister to others, but how can I, not like this? I say I love God, but I don’t show it. I am so wrapped up in myself. I guess being thin is more important to me than obeying God.”
“What do your parents say?”
“My mother is supportive, but dad just doesn’t get it. He tries, but he just thinks that all I need to do is start eating. But I can’t. I just can’t. Sometimes he gets so mad. He scared me with how angry he got a couple weeks ago. We used to be really close, but now...”
Soon our interview ended.
Works and Shame
A week later, Katie’s treatment team reported that she was having a significant impact on other patients in the milieu, reminding them of God’s love for them and helping them to trust in his grace for the difficult tasks of recovery. Yet she remained unable to apply this knowledge to herself.
Did Katie fail God? Is she simply reaping what she has sown? Did God fail Katie? She reads the Bible, attends fellowship, mourns the things she has done, pleads for God’s help, and cries quietly in the night. But she is not recovering from her eating disorder.
There are moments after meeting with young women like Katie when we wonder: “God, she is such a sweet young lady. She honestly loves you. Why haven’t you heard her cries?”
Katie appears to truly love and seek God. She has done the right things according to her faith system. So why haven’t her efforts sent her flying into recovery?
Katie is filled with shame. Dictionaries define shame by reference to other words, particularly disgrace and humiliation. Disgrace means a loss of honor, respect, favor, and trust. Humiliation means degradation, loss of respect for oneself, complete defeat. Regarding relationship with God, disgrace indicates the feeling that one has lost God’s favor and broken his trust. Humiliation indicates self-hatred and feeling powerless against a powerful, malignant force—complete defeat. Ultimately, the word disgrace seems to capture this human experience best: dis-grace, or the state of being removed from God’s grace, love, favor, and aid.
This is precisely the experience of many patients with eating disorders. They believe they have so disappointed God that He has withdrawn his grace, love, and help from them. Feeling as though one has been forsaken by one’s Maker is a crushing, even terrifying, experience. Many patients with this belief are desperately trying to get God’s love back; some, in anger and disappointment, have given up the quest. But all who struggle with this profound spiritual devastation ultimately believe that in order to receive God’s love again, they must earn it back. They believe that until and unless they change their behavior, God will not show his love to them. Enter the focus on performance. So often women and girls with eating disorders have come to believe, through a series of life events, that their performance determines how much love they receive, if any at all. They must outperform everyone to feel lovable and receive love.
According to the Christian Scriptures, this approach cannot succeed. It is, in fact, completely antithetical to Christianity. If there is one thing that distinguishes Christianity from other religious perspectives—one thing that so many Christians stumble over and struggle with—it is the belief that God’s love, forgiveness, and spiritual restoration come not by our own efforts but from God’s free, unmerited grace. Much of the Book of Romans is devoted to this topic. Here, describing the unmerited grace and forgiveness of God, the Apostle Paul writes: “And if by grace, then it is no longer by works; if it were, grace would no longer be grace” (Romans 11:6). The Living Bible translates this same verse even more illustratively: “And if it is by God's kindness, then it is not by their being good enough. For in that case the free gift would no longer be free—it isn't free when it is earned”.
The Truth About Love: The Christian View
How do we assist patients at Remuda to make this fundamental shift in thinking, to absorb this counter-intuitive understanding? We begin by sharing this most basic, yet essential truth: God is love (1 John 4:16). It is not necessary to do anything to earn his love, it is a free gift. There is nothing we can do to make God love us any more, or any less. He already loves us completely and this will not change based on our behavior. Hence, patients do not need to remain on the performance treadmill. It’s time to turn off the machine.
Explaining this to patients, showing them Scriptures that make this clear, and modeling this kind of love often have an impact. But it is not easy for the human mind to grasp the free nature of God’s love. Jesus irritated his contemporaries mostly because He spoke about love: love for God, love for one another… and God’s great love for us. How do you begin to tell someone of their incredible worth? Parents can tell their children that they love them, but that does not necessarily mean the children believe it. A therapist can tell a patient she is loved by God, but sometimes the words slide off like an egg on a Teflon pan. The knowledge doesn’t stick; she doesn’t believe she is loved by anyone.
One patient wrote the following poem, recording the struggle to understand the concept of grace.
Again I sinned, I turned away.
I broke your law, I defiled the Way.
Yet your response leaves me amazed--
Your love persists, you expand your grace.
You give me gifts when I least deserve.
You forgive me over and over.
You pick me up and clean me off
And clothe me again with your power.
You keep on giving—no matter what I do.
You boggle my tiny mind.
I haven't yet grasped that you are the Gift
Which has nothing to do with these deeds of mine.
Good or bad, you love me still,
For love is your unchanging will.
Can I ever take such grandeur in?
That you live your life inside my skin
Carrying my helplessness all the while
Like Mary with her newborn child.
Many Christians struggle to understand God’s love and grace. In fact, even when we professionals think we “get it”, we may find ourselves surprised all over again by the depth of his love. It is a lifelong journey to grow deeper in our understanding of and trust in God’s love and forgiveness. As we do, we grow closer to God and become more like him.
God, in his wisdom, knew that we doubt our own value and worth, and that we would doubt his love for us. So He did the greatest thing imaginable: He became a human being like us, leaving behind his abode of holiness, dwelling among us in a frail human body, and experiencing the injustice and suffering common to us all. And then He died for us. He allowed himself to be put to death to show us something about his unconditional love for us and our great worth to him. He knew we might be able to understand the depth of a sacrifice of life. “Greater love has no one than this, that he lay down his life for his friends” (John 15:13-14).
It has been said that the point Jesus was trying to communicate with his arms outstretched on the cross was this: “I love you.” For Christians, healing, growth, and wholeness begin with this realization: We are loved unconditionally and irrevocably by God. God loves us! This is the foundation of our self-worth. Not our actions, achievements, successes, appearance, talents, or intelligence—but the fact that the Creator of the universe made us in an act of love and loves us as we are. This is meant to be a eureka experience—“I am valuable because I am loved by God himself!” For someone like Katie, this realization is a dramatic and unexpected reversal. She no longer needs to strive and perform to earn God’s love. Her self-worth and dignity arise from the fact that He loves her already.
Spiritual Development
It can be difficult or time consuming to encourage patients to grow in their understanding of and trust in God’s love . We do so not by imparting to them from our great depth of wisdom, via lectures and sermons, but by asking them questions, and lots of them. It is not as though we are seeking information through these questions, but are instead encouraging patients to ask these questions of themselves. As they consider and reconsider these questions in light of what they know or are learning about God through Scripture and experience, they often begin to understand.
The kind of questions we encourage in our patients are:
From where do I obtain my self-worth?
Am I growing in love toward myself and others?
How do I really view myself and those around me?
How do I feel about the sins I commit?
Is something wrong with me because I am afraid to die?
Why do I find it so hard to forgive?
What do I really believe about God?
From a spiritual perspective, these questions and others like them hang on one nail: God’s love. God’s love is the foundation of human self-worth, healthy relationships, intimacy, forgiveness, and peace about death and afterlife. As Christians, we also believe that the Christian life centers on the love that flows through us from Jesus to others. Therefore, if patients grasp nothing else at Remuda, the message of love is the one that we hope is caught as well as taught. Learning what love is and how to experience and practice it is a lifetime journey that becomes the engine of continual spiritual development, also known as sanctification.
Most people think of love as a feeling or an emotion. Love is more than a feeling. In fact, it may not involve feelings at all. Love is about relationship. C.S. Lewis (2001) wrote, "Love is … a steady wish for the loved person's ultimate good as far as it can be obtained." But love goes beyond merely wishing for the ultimate good; it is an active commitment to the well-being of the one who is loved, regardless of internal emotions. Emotions can be volatile and fragile. Real love is anything but volatile and fragile. Affectionate expressions of love along with validating verbal and non-verbal messages are usually essential in love relationships, but love is not limited by the current emotional state of the one who loves.
Love is neither abusive nor indulgent, because neither abuse nor indulgence manifests a commitment to someone’s well being. Love isn’t guided by emotions such as guilt or anger. Guilty parents may be indulgent of a child. Their indulgence is not guided by a commitment to the child’s well-being, but rather by their desire not to feel guilty. Angry parents may punish to express and release their anger, but are not disciplining out of a commitment to the child’s well-being.
The focus on love as an emotion causes a plethora of problems: “I don’t love you anymore.” “I don’t feel God’s love for me.” We often base our perceptions of reality on how we feel. If I feel stupid, I am stupid. If I feel that no one loves me, no one loves me. If I feel fat, I am fat.
As Christians, we are often reminded to show our love for God and others, to be committed to their well-being. The Bible instructs us how to love others: “Love your neighbor as yourself” (Matthew 22:39). As means “to the same degree or amount.” So we are being told to love others to the same degree and amount that we love ourselves. Sometimes love for self is perceived as unchristian, hedonistic, or worldly. But Christ does not ask us to love ourselves, He commands us to do so.
And yet, we are also commanded by the Bible to be humble. Therefore, being humble is not mutually exclusive with loving oneself. "Perfect humility dispenses with modesty" (Lewis, 2001). Feeling worthless or superior are extreme conditions of self-concept that have nothing to do with humbleness. Jesus was humble, because humbleness indicates an absence of false pride—pride based on an unrealistic appraisal of oneself. Instead, humbleness indicates an honest and realistic appraisal of oneself—which includes an awareness of both one’s strengths and weaknesses. Love for oneself therefore has much to do with humbleness, since we can only authentically love when we honestly know who we are.
Yet loving oneself can sound discordant to the Christian’s ear—not because it isn’t Biblical, but because our culture links self-love to hedonistic egotism. When we love ourselves, we do not worship ourselves. Rather, we are committed to our well-being. We do not indulge ourselves. Rather, we follow God’s plan for healthy living. We do not put our needs above others’ and our comfort above all else. Rather, we are secure enough to be self-sacrificing for the sake of others. Our self sacrifice is not generated by an inner sense of worthlessness or need to compensate for shame—both of which are compulsive and self-centered expressions. Rather, we choose to sacrifice because we are loved and have been granted infinite worth by God, as with Jesus: “This is my Son, in whom I am well pleased.” God has made us his children.
Once, the Apostle Peter brashly declared that he would die for Jesus (Luke 22:33). But that statement arose from his egocentric need to be seen as great. Later Peter betrayed Jesus rather than dying for him. He failed in his own efforts at self-sacrifice. Then and only then, through Christ’s forgiveness and tenderness, Peter learned how much he was loved, valued, and considered worthy by God. Then, not because of his performance, but in spite of it; out of his knowledge of how much he was loved, Peter did die for Christ. History tells us that he was martyred in Rome in 63 AD (or thereabout). From his intimate knowledge of how much he was loved by God, this same Peter sought to build up the individual Christian’s sense of self-worth and value. He wrote: “…you are a chosen people, a royal priesthood, a holy nation…” (1 Peter 2:9).
Perhaps the number one problem for patients who come to Remuda is that they do not love themselves. Some pity themselves, some hate themselves, some indulge themselves, some promote themselves, and some hide themselves. But they seldom truly love themselves. Experiencing God’s love is the pivotal first step in change. What does experiencing God’s love do for us? Does it shame us or drive us to perform harder and harder? No. Christ said: "Come to me, all you who are weary and burdened, and I will give you rest… For my yoke is easy and my burden is light" (Matthew 11:28,30). Rather than demanding or depleting us with expectations, Jesus’ love empowers us.
Katie has already experienced that love. Why then is she having many problems? Eating disorders are complex, but one of Katie’s most enslaving issues is that, although she originally found freedom and love through Christ’s grace, she now seeks it by performance. Although grace saves us, often we unconsciously believe something like this: “Now that I am a Christian I have to work to be good.” With this mindset, we can become painfully aware of our failings. Katie needs to realize that she does not have to enter into recovery in order to be loved. Paradoxically, perhaps Katie’s best chance for recovery is when she realizes that she doesn’t have to recover in order to be loved. Rather, her recovery begins with the release from shame and guilt brought about by the experience of God’s love and her consequent ability to love herself.
Katie doesn’t know how to love herself. When she thinks about herself, she feels only shame and anger. When we tell Katie, “You need to love yourself in order to recover,” her immediate response is hopelessness. This is because people like Katie often view love as an emotion. Since she has no sense of emotional love for herself, just feelings of worthlessness and shame, self-love seems alien and far away. If she has to stir up love for herself, she knows she cannot do it. Because feelings are reality for her, and because she feels worthless, she fully believes that she is worthless.
“I can try to love myself, but it would be fake, it wouldn’t be real.”
“Why is it fake?”
“Because, I don’t feel it.”
“So if you don’t feel something it cannot be real?”
“Well, no.” She looks puzzled.
“If you had a daughter and she had done something very wrong, would you tell her she was worthless?”
“No, never. Of course not!”
“Why not?”
“Because it would hurt her and because it isn’t true.”
“You wouldn’t call her worthless because you would love her. And in your love for her, you would be able to see beyond her mistakes. You would know who she really is, her value to you.”
“Yes, I would. She’s my daughter.”
“Katie, you need to tell yourself what you would tell her. God loves you the same way—even more than—you would love your daughter, no matter what. Can you take that in, see yourself as loved, regardless of how you feel.”
She tears up.
“Katie, I’ve seen how you act toward other people. You know how to love and you really desire to love others. You’ve made a real impact on people here. Doesn’t the Bible say to love your neighbor as yourself?”
“Yes.”
“What is love, Katie? Feeling mushy all the time? What does God say love is?”
At this point, 1 Corinthians 13 may become the focus. In 1 Corinthians, the Apostle Paul offers a tutorial on love, telling us what love is and is not. The passage in 1 Corinthians 13 is among the Bible’s most well-known. It is often read at weddings and quoted by Christians. But the most amazing thing about Paul’s tutorial on love—something often missed—is that it is a tutorial about the nature of God himself. For God is love. And it is by experiencing the depth of his love for us that we learn to love ourselves and other people. “We love because He first loved us” (1 John 4:19). Our love for ourselves and others—our good works—are a fruit that develops from our experience of God’s love for us.
Paul begins his tutorial on love by informing us, foremost, that “Love is patient” (1 Corinthians 13:4). Patient means long tempered and long suffering. Do we recognize that God is patient with us, loving us all along, accepting us as we are, not expecting perfection, liberally forgiving us, and rejoicing in our little steps? As we absorb this and live in the reality of God’s unconditional love for us, we can begin to love ourselves and others as we are loved, unconditionally. Are we patient with ourselves, gently forgiving our errors, again and again, and allowing ourselves room to grow? Or do we expect perfection today? Patience does not retaliate when a wrong has been done—neither wrongs we do against ourselves or experience from others. Patience is truly love in action, and we learn it because of God’s gentle patience with us.
The Apostle Paul continues: “Love is kind…” (1 Corinthians 13:4). Kindness means proactively and enthusiastically doing good and showing compassion for the afflicted. This is how God treats us—with kindness, actively pursuing ways to bless us, showing compassion and mercy when we err, and joining us in our sufferings. As we believe in and receive this love from God, we can begin to love ourselves with the same kindness, and to offer it to others, allowing his love to flow through us toward the people around us.
The Apostle proceeds on love: “It does not envy…” (1 Corinthians 13:4). Envy is a discontented feeling that arises in the human heart. It occurs when one person is confronted with another person who possesses something of value to the first person. This can be a physical possession, special knowledge or skill, talent one has not mastered, and so on. Envy can recede, however, when we know how deeply we are loved by God: that we are made unique creations, each a child whom He is shaping and guiding to become in time the full person whom He has designed us to be. There is nothing more that we need to be or have today. Through this experience, we can enjoy ourselves in our uniqueness and others in theirs. We can celebrate others’ blessings and gently affirm them as they, too, grow toward wholeness. Remuda is often a classroom in which patients can learn these valuable lessons. Love, rather than envy, builds true Christian community. Knowing that we are all loved by God as his unique creations is a powerful unifying experience.
The Apostle continues on love: “It does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered…” (1 Corinthians 13:4-5). Outward actions demonstrate what is going on inside. How we treat ourselves and others reflects our inner attitude. Do we treat ourselves and others with respect and dignity, or with contempt and as objects intended only to meet needs and goals? The attitudes of love include humbleness, mutuality, and compassion rather than contempt, self-centeredness, and anger. By believing in and opening to God’s gracious love for us, we learn more about who we are, we become honest about our strengths and weaknesses and humble yet secure in our self-concept as unique beings created by God. When we discover that God loves us, seeks relationship with us, and above all wants to know us intimately, we recognize that we are not objects to him and we cease to objectify ourselves and other people.
Paul continues on love: “It keeps no record of wrongs” (1 Corinthians 13:5). Keeping a ledger, noting the debits and credits we have earned by our good and bad behaviors and those of other people—this leads to a hard heart. It places us in the role of judge, and judgment limits mercy. Learning to let go, to step back and think before impulsively acting out of offense or woundedness, and to overlook minor offenses against us and errors we may make—this ultimately leaves a soft heart. A soft heart is capable of mercy, forgiveness, and gratitude for the forgiveness that God continually offers us. Such a heart is humble, because it recognizes its dependency on God’s unending mercy and the extent to which He freely and continually offers mercy to us. Such a heart can receive forgiveness from God and from others, and can offer forgiveness to self and others. Such a heart is unburdened by the past and set free to live and love today.
Paul proceeds: “Love does not delight in evil but rejoices with the truth” (1 Corinthians 13:6). In Psalms 51 we read, “Surely you desire truth in the inner parts”. God is less concerned with our outer appearance, actions, successes, and failures, and more concerned with honesty and integrity. He delights in honesty. Learning about the tenderness of his love and forgiving nature enables us to become honest with ourselves in his presence, to experience being loved for who we are, exactly as we are, without expectations. This is a radical, transforming truth. It empowers us to be authentic with others and to invite them into authenticity as well. People who can be honest with one another become great supports to each other, rejoicing together in God’s love and acceptance for them. They can help each other with accountability regarding mistakes and sinful choices, and gently restore one another when problematic choices have been made.
Paul concludes his discourse on love: “It always protects, always trusts, always hopes, always perseveres. Love never fails” (1 Corinthians 13:7-8). These words are a description of God: God always protects us, trusts, hopes, and perseveres. God never fails us, and God never fails, period.
Protection means taking care of people, shielding from harm and loss, even absorbing harm and loss to guard others from it. It means holding up, supporting, and coming alongside another. These are the things that God has done and does for us. There are clearly many times in believers’ lives when they experience this protection. There are also times when difficult events may lead to questioning about God’s protection. But we hold in faith to this belief: “…in all things God works for the good of those who love him” (Romans 8:28). We recognize that, because God has the whole picture—past, present, future, all interactions and consequences of every event—his thoughts and his choices are higher than ours (Isaiah 55:8-9) and perhaps inscrutable to us. Yet his choices can be counted on to protect and promote his goal for us: our continued spiritual growth. Because we experience and believe in God’s protection for us no matter what, we can offer this same quality of love to others.
Trust means that, in his love, God believes the best of us. He lets go of our past mistakes and starts again with us every day on a clean slate. “The steadfast love of the LORD never ceases, his mercies never come to an end; they are new every morning” (Lamentations 3:22-23; Revised Standard Version). He sees who we will ultimately become, not just who we are today. Thus, He trusts the process of our spiritual growth, even when something seems amiss. He can do so because the outcome of the process depends on him: “…he who began a good work in you will carry it on to completion” (Philippians 1:6). We, too, can learn to trust God with the proper unfolding of our lives, in spite of our mistakes. And we can learn to trust his work in the lives of others, in spite of theirs.
Hope means that God believes in the best for us, and is optimistic about the choices we will make no matter how often we may have chosen poorly. He instills us with hope–the attitude of knowing that He is in control and has a future planned for each of us (Jeremiah 29:11). Scripture promises: “…in all things God works for the good of those who love him” (Romans 8:28). This becomes the source of our own optimism toward ourselves and other people. Because of God’s steadfast hope for us, we can learn to expect the best of others even when they have disappointed us many times, giving space to the possibility that they may come through this time. Of course, in doing so, we would not open ourselves to harm from others, because in addition to hoping, “love always protects”.
Perseverance means commitment and responsibility. God is committed, forever and unshakably, to our well-being. “For great is his love toward us, and the faithfulness of the LORD endures forever” (Psalm 117:2). God will never give up on us, never. “No one can snatch them out of my Father's hand” (John 10:29-30). As we learn about God’s persistent, unchanging love for us, we become more able to offer the same to ourselves and others.
Finally, love never fails. God never fails us and never falters. He is stable. We can count on his enduring love and power to bring about the things He has promised. God’s love will always, eventually, patiently and persistently, triumph over evil. “The one who is in you is greater than the one who is in the world” (1 John 4:4).
As we experience God’s immense love for us in these ways, we become able to treat ourselves with the same patience, kindness, mercy, and optimism with which our Maker treats us. We also strengthen our relationships and communities as we become able to offer this love to others. This, indeed, is the heart of the Christian life and the source of ongoing spiritual growth: The experience of God’s love for us becomes contagious.
Learning to love God, ourselves, and others perfectly fulfills Christ’s commandments to us: “Love … God with all your heart and with all your soul and with all your mind and with all your strength… Love your neighbor as yourself. There is no commandment greater than these" (Mark 12:30-31).We fulfill these commands not because we strive to, but because God’s love is experienced within us and overflows into the world. “…but whoever drinks the water I give him will never thirst. Indeed, the water I give him will become in him a spring of water welling up to eternal life" (John 4:14).
This is the good news that Jesus Christ came to preach. Sharing the reality of God’s love with eating disorder patients like Katie has the potential to help them break free from the performance trap that ensnares them. It takes a lifetime to absorb this message fully, but as we gradually do, we grow slowly, subtly, and continuously into wholeness and holiness as the children of God.
References
Lewis, C.S. (2001). The Weight of Glory. San Francisco: Harper San Francisco.
The Holy Bible (Revised Standard Version). (1962). Cleveland: World Publishing Co.
The Living Bible. (1971). Wheaton, IL: Tyndale House Publishers.
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