Anorexia and Photo Therapy

Veteran actors are familiar with the old adage “the camera never lies.” That’s one reason they always strive to look their best. But the lens has also been used for a very different purpose: to stimulate recovery in anorexics.

According to a June 7, 2000 article in The New York Post [“Photo-therapy helps anorexics overcome obsession with weight”, pp.8-9], anorexics who viewed nude pictures or videotapes of themselves showed improved body image and eating habits. Although skeletal, most anorexics see themselves as fat. However, an anorexic patient quoted in the article said that after viewing her pictures, she thought she looked like she “just got out of a concentration camp.”

The Post reports that Dr. Ira M. Sacker has been using the treatment since 1997. Dr. Sacker is director of the Eating Disorders Program at Brookdale Hospital in Brooklyn, New York and author of Dying To Be Thin, Understanding and Defeating Anorexia Nervosa and Bulimia – A Practical, Lifesaving Guide (Econo-Clad Books 1999).

According to The Post, he was introduced to the technique by New York City photographer Helen Fisher Turk, who has used it to help hundreds of rape and incest victims deal with their trauma. Shortly after learning of her work, Dr. Sacker began sending his eating disordered patients to her. The article observes that Turk photographs or videotapes sufferers nude or semi-nude, and then has them write about the experience. The Post reports that “all of Sacker’s patients have shown marked improvement.”

In an attempt to discern the prevailing attitude among professionals toward this technique, I emailed several eating disorders specialists. Opinions were mixed.

Christine Hartline, M.A., Executive Director of Edreferral.com , an eating disorder referral and information service, believes that the approach shows great promise. “Photo-therapy is a very interesting and compelling topic right now,” she notes in an email. “It has been used in research for years but it seems like it is finally filtering into being used in the private practice sector. I did a research project years ago on body image and that is when I first came across this subject.”

Others are more skeptical. Monika M. Woolsey is a registered dietician, nutrition consultant and author of the American Dietetic Association’s first book on eating disorders, Eating Disorders: Putting It All Together. She emphasizes photo-therapy’s potential for sexual abuse. “I won’t say it is ineffective, but it’s pretty radical, and further research to be sure it’s helpful and not harmful would be a good idea,” wrote Ms. Woolsey in an email. Her 16 years of experience includes work in three different eating disorder treatment centers. “My main concern is that since there is a significant percentage of people with eating disorders who have issues of sexual abuse, this type of therapy could easily attract sexual predators passing themselves off as therapists. Anyone considering this treatment would need to do it in conjunction with traditional psychotherapy and do a thorough background check of the person in charge.”

Joanna Poppink, a licensed psychotherapist in Los Angeles, California, concurred:

I am concerned that talking about so-called photo-therapy can discount the complexity of eating disorders and be disrespectful of the individuals courageous enough to undertake a path to recovery. I’m also concerned about the very real possibility of exploiting the eating disordered person by publishing these photos.
I can see that looking at pictures of themselves provides eating disordered persons more distance and safety than the immediate experience of looking into a mirror. Viewing the picture might help a person wake up to her actual appearance. This could be helpful.

However, I hesitate to support this approach because I think it is fraught with possible negative consequences. People pleasing is a strong aspect of eating disordered behavior. I wonder if the patient is psychologically free to say “no” to a request/suggestion from her therapist that she disrobe before a stranger.

I also wonder about the actual experience the patient has in being photographed nude. Who else is present? Is there someone other than the photographer working the lights? What is the setting? How many photos are taken? How are poses established? What kind of conversation occurs during the photographing session? How respectful is the entire procedure?

Many people with eating disorders have histories of sexual exploitation. Being photographed in the nude could be retraumatizing.

In this light, I wonder why nudity is required. Even a photograph of a hand, arm or leg would show an extreme thinness. Why couldn’t the patient bring in her own photos taken in the context of her life? She may have revealing photos of herself in shorts or a bathing suit that would serve the therapeutic purpose without sensationalism.

I’m also concerned about the patient feeling psychologically invaded because other people are seeing her naked photos. Who sees these pictures? Who develops them? Who owns the negatives?

Furthermore, people suffering from eating disorders have a poor sense of boundaries and limits. I’m concerned that putting them through the experience of being photographed in the nude is taking advantage of their vulnerability. An important part of their therapy is the development of an appreciation and respect for personal boundaries.

People with eating disorders obsess about their bodies. However, the core of the eating disorder is not physical but psychological. Healing has to do with the person developing a genuine respect and appreciation for her true self. When that is accomplished, she understands her genuine needs and lives in a way that adequately nourishes her mind, spirit and body.

Photography may have a place in treatment under specifically defined situations. I think it must be used with great caution, with great sensitivity, and with the patient owning the photos and negatives.