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Check out this short video:

Whether you read this video as funny or sexist – or both – there is more than a grain of truth in the message. Yes, men have a tendency to go directly for the tangible problem and women sometimes need to feel that they are understood more than merely “fixed.” But this video also points at a more profound underlying dilemma:  Are there times when talking is fruitless?

As a psychodynamic psychologist you might think that I would err on the side of feeling and conversation. But all too frequently, I watch clients – both mine and others – become stagnant because they are willing only to feel and not to take action. In truth, this is one of my pet peeves and greatest dilemmas within my field of work – at what point is talking not good enough?

It happens that I treat a large number of eating disordered patients – Anorexia, Bulimia and Binge Eating Disorder. These are patients who have very real physical issues that stem from profound and painful psychological issues. Many therapists want to believe that these issues can be fixed through talking about the feelings – that somehow the Anorexic will magically start eating or the Bulimic won’t need to vomit anymore because she knows how she feels. Unfortunately, that’s just not true.

The reality of the situation is that eating disorders – like many other disorders – need to be treated with a multi-pronged approach. Certainly the underlying feelings need to be addressed; however, at the same time the very real, very tangible fact that most patients with eating disorders are manipulating food and not nourishing themselves appropriately – often in ways that they don’t even realize – also needs to be addressed.

Being profoundly underweight is a self-reinforcing physiological state in which the brain stops functioning properly; so talking about what one feels from that vantage point may feel good for a little while but until weight is actually gained, until proper brain functioning is actually restored, there is little hope of actual change in neurochemistry, in neural pathways or in symptoms of depression or anxiety. Similarly, a woman may feel that it is the bingeing that is the problematic behavior – but if she takes a closer look, usually the bingeing is brought on by simply not eating enough during the day. Until real action is taken to shift the patterns of eating so that more is consumed throughout the day – a very tangible issue – the bingeing just won’t stop.

In other words, it is all well and good to talk about the symptoms of having a nail in your head, but until you get the thing removed, your symptoms just won’t stop. So why is it that some people don’t want the nail removed? This is where talking becomes relevant. Sometimes pathological behavior serves a purpose – even while causing pain. Until this purpose is understood and a very conscious choice can be made to find another way to get that need met, sickness will persist.