I teach this map to both clinicians and clients. The model you are about to see is, therefore, both a treatment philosophy and a treatment intervention. Giving a label to the feelings and behaviors can be a revelation for a client. As one woman said, “Ever since I was a kid, I have called myself FUD: Fat, Ugly and Dumb. Now I see that was just my superego talking.” For clinicians, while eating disorder behaviors don’t seem logical at first, they start to make sense once there is a map of the client’s inner world. This then makes it easier to choose and treatment interventions and time them appropriately.
There is an aspect of the ED sufferer’s experience that is the emotional “bottom line” of this cluster of diseases, and important to understand when treating someone: The person with an eating disorder has acute shame that is almost delusional. Depending on the severity of the person’s ED, the shame can be constant. Although we’ve all experienced shame, few people who have not had an eating disorder can imagine the intensity of the shame for someone who has. Recall your most excruciating, humiliating memory. Were you panicked? So desperate in that moment that you wanted to disappear? You have barely begun to experience what someone in the throes of an eating disorder deals with continuously.
This shame in turn pairs with her passionate nature to create a conviction, felt at a cellular level, that she is unlovable. This produces such a desperate feeling of isolation and failure that the person would do anything — ANYTHING — to improve the situation. The easiest thing to control is her body, so the dagger of shame turns inward. The depth of the conviction that she is unlovable, corroborated by emotions that feel true at a cellular level, combine to make her want to die rather than eat or gain weight. (Conversely, the person may be dying TO eat as an escape from the desperate feelings inside.) Hence the eating disorder behaviors, which make more sense in this context of shame and self-hatred – and make our job more important than ever, as clinicians who can help alleviate this extreme suffering. The map, below, explains what is out of balance in the psyche that creates this irrational shame.
When teaching this material to clients and clinicians alike, I first review Freud’s concept of the psyche: that it is a finite system of energy, and that the elements in it (ego, superego and id) are not fixed entities, but processes that channel and move the energy in that system. I then go over the basic terms ego, superego and id, stating that first we will define each, then go back and describe the special job each has in the psyche.
Ego means “I” in Latin, and is the central identity or sense of self. The ego is the seat of consciousness, and includes perceptual, intellectual, and executive functions.
Superego in Latin means “over-I.” It is an intellectual function that is most commonly defined as the conscience. It is in charge of information, sometimes about morals, that will help the person survive in that particular society and family.
Id has been translated from the German word “es” for “it.” The id is associated with the instincts, the animal and child parts of a human being. Although emotions can run through all parts of the psyche, they are primarily centered in the id.
Each of these parts has a special job, a job without which the psyche (and person) could not function, a job which the other parts cannot perform.
Ego – The ego acts as a container for the superego and id and as a loving parent who mediates between them if there is a conflict. (This function of the ego cannot be over-emphasized, as we will see.) Metaphorically speaking, the ego is a house for the psyche, showing up as such in dreams, myths and stories (like The Wizard of Oz.) The ego is also an executive, organizing the system to learn language, drive a car, and sort out sensory input.
Superego – The superego’s main job is to protect and guide the psyche to promote survival. It does this by providing information, regulations and boundaries. Primarily an intellectual function, when healthy it is a “good cop” whose tagline would be “protect and serve.” When out of balance, it functions as a bad cop whose tagline would be “search and destroy.”
Id – The id processes energy and information having to do with the body and instincts, relaying messages about physical and emotional needs. The id’s main job is to supply psychic energy to the rest of the system. While the id usually gets the blame for a person’s dysfunction (“I would be fine if I could just get myself to stop overeating,”) it does not usually also get credit for its vital role of bringing the life force in – along with optimism, joy and other qualities that make a person want to be alive.
In a healthy psyche, the ego contains the most psychic energy. The superego and id have equivalent but smaller amounts of psychic energy, cooperating in service of the psyche’s overall needs, with the ego having the final say about what action gets taken. Conflict is minimal. The balanced ego has wide and flexible — but reliable — boundaries, allowing a variety of emotions, beliefs, and experiences to be included in the person’s central identity and consciousness.
An eating decision in the healthy psyche proceeds as follows: There is a hunger pang in the stomach. The id receives this information and relays it to the superego and ego. The superego sees the need for food. Getting on board, it sends a message to the ego: “The id says the body is hungry. I recommend a meal.” The ego, taking in the information from id and superego, agrees and makes the final decision, using its executive powers to go the store, select groceries, and cook. The person then eats until the stomach sends a fullness signal. Again, the id receives this information and relays it to the rest of the system. In agreement that it is time to stop eating, the id, superego and ego decide to move on to the next activity. (Please see Diagram 1.)
An eating decision in the unhealthy psyche goes differently. In the unhealthy psyche, the ego does not have the most psychic energy. In the “normal neurotic” population, when the psyche is out of balance, the superego has the most psychic energy, with episodic takeovers by the id, a mixture of id and superego, or by the conflict between superego and id. As such the ego will not be strong enough to break up a conflict between id and superego. This is illustrated in Diagram 2 where the id is barely on the radar and the ego is narrow and disempowered, shuddering in the corner.
In an unhealthy psyche, the hunger pang is still received by the id. If there is enough id energy left in the psyche, the weakened id will still relay the message to the rest of the system. (If there is no id energy left in the psyche, then the superego is the only part that gets the message of hunger, and it will completely deny the need to eat, with no resulting conflict.) When the superego is overly large, it gets mean and will respond accordingly to the id, trying to push the id back into the unconscious. “YOU WANT TO EAT? YOU ARE WORTHLESS! NOT A BITE!” The id will respond in one of two ways. If it has a tiny amount of psychic energy left, it will agree with the superego. “You are right. I am worthless. Sorry I brought it up.” Then the id will get smaller, and the superego has succeeded in further repressing it. On the other hand, if the id has enough psychic energy left, it will get louder in order to be heard. “But you never let me eat, and I’m hungry!!!!” This escalates the fight.
Superego: “YOU ARE HUNGRY? WHO CARES, YOU DESPICABLE PIECE OF NOTHING. YOU DON’T DESERVE IT!!!!
Id: F--- YOU! I AM GOING TO EAT FOUR PANCAKES THEN!
Superego: PROVING THAT YOU ARE A PIG!
Id: TEN PANCAKES!!!
Superego: UGH, YOU DISGUST ME, YOU ARE AN ANIMAL!
Id: THEN I AM GOING TO EAT EVERYTHING IN SIGHT, AND F--- ALL!!!
At this point the id takes over, dominating the psyche while the superego goes temporarily unconscious, and the person may well eat everything in sight. Meanwhile the ego is powerless to break up the fight. In a healthy psyche, it would weigh factors such as hunger or fullness levels, fueling needs for the body, etc. and then not only make the final decision but execute on it (stopping the person from eating if she were full or permitting eating if the person were hungry.) In an unhealthy psyche, the ego does not have enough power to take action. (This is what is happening when a client reports that he knew what to do but could not do it. Still other clients report no presence of ego thoughts during a fight between id and superego over a compulsive behavior.) The overly large superego is the element in the psyche that gives rise to the overbearing shame mentioned earlier in the article.
The map in turn indicates two primary treatment approaches:
1) When the psyche is out of balance, the therapeutic goal is to re-balance the psyche by reducing the superego, re-integrating the id, and asserting the rightful power of the ego so that eating can be regulated again.
2) People with eating disorders have learned to reject and abuse themselves in a way that replicates how they were treated by caregivers growing up. Healing from an ED requires that people find out how they are replicating that abuse, and learn to treat themselves differently, ceasing to align with the aggressive superego against the id and basically, learning to be kind to themselves.
The first approach stays within the Freudian model and is attractive because of how clear and objective it is. The second approach is attachment-based and is useful because, when a client finally understands that she is hurting herself and doesn’t really deserve it, a sea change will take place, breaking the alignment with the superego and promoting an allegiance with the (compassionate) ego. When working with a client I blend the two approaches.
Showing the map to clients provides them relief as it explains and gives them a label for the forces that impact eating decisions. The map then begs the question of how the psyche got so out of balance. The best answers lie in the research on attachment (from Bowlby and Ainsworth to Meltzoff, Johnson and Wallin), which illustrates how the superego can grow too strong when there are chronic breaks in connection with the caregiver. While it is outside the scope of this paper to address these answers, I direct the interested reader to The Erasing ED Treatment Manual, which provides more detail, and to future articles.