By Fr.
George Morelli
At first
glance, considering food in the context of Orthodox spirituality and practice
may seem inappropriate. But closer examination indicates, in fact, a rather
intimate, meaningful connection between the two. We can see this in the quote
from the Book of Proverbs that opens this essay. We should eat "the food
allotted to us," and which is necessary for our sustenance. To do
otherwise is to make ourselves vulnerable to two spiritual dangers.
Problems with Food as a Spiritual Disorder
The first
spiritual danger is that we may become so focused on food as an end in itself
that it distracts us from what should be our true end: God. In the most basic
and first of the commandments, God told us, "I am the LORD your God . . .
You shall have no other gods before Me" (Exodus 20:2, 3). This commandment
is echoed by Jesus: "'You shall love the LORD your God with all your
heart, with all your soul, and with all your mind.' This is the first and great
commandment." (Matthew 22:37, 38).
What is
our treasure: God or food? As Our Lord told us, "For where your treasure
is, there your heart will be also" (Luke 12:34). As our holy father Elder
Paisios of the Holy Mountain tells us, "If you want to take someone away
from God, give [them] plenty of material goods . . . [they] will instantly
forget Him forever" (Ageloglou, 1998).
The
second spiritual danger is sins against others and self. This may be a little
harder to grasp. Our holy father St. Dorotheos of Gaza understood this danger
so well. He asks: "If someone is offered a pleasant food [can he] not
partake of it? [Can one] be careful and not overreach . . . and take more than
[her] share? And what if the food is already divided into portions?" Is
there an eagerness "to get a large portion . . . and leave a smaller
portion?" (Wheeler, 1977).
The
spiritual root of this danger is easily seen in the context of the second of
the greatest commandments taught by our Lord: "You shall love your
neighbor as yourself" (Mark 12:31). Our holy father St. Theoliptos said to
monastics, "When you enter the refectory, do not look round to see how
much food your brethren are eating and so fragment your soul with ugly
suspicions. Look only at what lies before you. . . . Nourishing your body and
spirit in this way, with your whole being you may truly praise Him who
'satisfies your desire with blessings' (Ps 103:5)." The danger here is not
only a lack of charity, but also its offshoots of greed, envy, gluttony, and
anger.
St.
Gregory of Sinai has given us one of the most thorough discourses on how to
partake of food. He astutely notes, "As the fathers have pointed out,
bodies vary greatly in their need for food. One person needs little, another
much to sustain his physical strength, each according to his capacity and
habit." Speaking to those who are committed to a godly life, St. Gregory
goes on to say such Christ-centered individuals "should always eat too
little, never too much. For when the stomach is heavy the intellect is clouded
and you cannot pray resolutely with purity."
Interestingly,
the saint goes on to suggest an actual menu. The specific foods and quantities
are geared to the monastic life and not particularly relevant to committed
Christians living in the world. What is important and applicable, however, is
that he does suggest a schedule and a specific list of foods. With regard to
our commitment to Christ, St. Gregory points out, "Abstinence from
specific types of food is most beneficial."
Example: societal sanctioned gluttony
When I
consider the millions of people in the world literally starving to death, I
find a particular form of gluttony, that of wasting food under the guise of fun
and frolic, particularly abhorrent and sinful. Particularly egregious, for
example, on 14 July 2012 an online Miami, FL newspaper proudly posted this
invitation:
If you’ve
ever been to Spain, you might be familiar with La Tomatina, a tomato fight held
in Bunol on the last Wednesday of August where thousands of people go to throw
ripe tomatoes at strangers. This year, you won’t have to travel to this small
town in Spain to do it because Tobacco Road is bringing it to Brickell!
On
Saturday, February 11 10,000 pounds of tomatoes will be ready for Miami’s First
Tomato Battle and everyone is invited, even if you don’t want to participate
and just want to watch. The party starts at 2pm with food and drink specials
.... The fight begins at 4pm and it will last an hour. There will also be a
safety zone, ... for spectators who don’t want to get sauced...Don’t miss
Miami’s first Tomatina and get ready to get dirty!
A Google
Search 'tomato battles' indicate such society sanctioned wasteful, thus
gluttonous behaviors are rapidly spreading across United States communities.
Tomatoes are not the only instruments of such gluttony; watermelons and other
fruits and vegetables have become popular in fighting and throwing...
For an
Eastern Christian perspective on such conspicuous sinful wastefulness consider
the spiritual perception of St. John of Damaskos (Philokalia II, p. 338) who
would counteract such a vice with an opposite virtue. I consider only St.
John's words on the sinful passion of gluttony and its companion vice avarice
and their contrary healing virtues:
Gluttony
should be destroyed by self-control ... avarice by compassion for the poor ...
and offering thanks to God; ... and by considering oneself the least of all
men.
In the
Eastern tradition we pray:
O Christ
our God, bless the food and drink of thy servants, for Thou art Holy always now
and ever and unto ages of ages. Amen
We do not
destroy this gift of God and even indirectly deprive those in need of bodily
sustenance.
Problems with Food as a Medical/Psychological
Disorder
For those
who have a normal attitude toward food, the advice of Scripture and the fathers
as given above may suffice to enable them to eat in a way that is pleasing to
God. However, in our society, eating disorders are becoming increasingly
common. Those with eating disorders need a more in-depth approach to the
problem—one that combines spiritual, medical/psychological, and practical
intervention to help them learn to eat properly.
There are
two food-related problems classified as eating disorders according to the
Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric
Association [APA], 2000):
- Anorexia Nervosa is defined as the failure to
maintain a minimally normal body weight (85% of expected weight). It is often
accompanied by intense fear of gaining weight and the extreme misperception
(overestimation) of actual weight.
- Bulimia Nervosa is distinguished by recurring
episodes of binge eating. There are two types: the purging type exhibits
health-threatening compensatory behaviors such as self-induced purging
(vomiting), overuse of diuretics, enemas, and laxatives; the non-purging type
does not manifest these behaviors.
Both of
these disorders are sex-related, with females showing a higher prevalence.
There is evidence that both biological and social features may contribute to
the occurrence of these disorders.
Obesity
is defined as an excess proportion of total body fat wherein the person’s
actual weight is 20% or more above normal weight for their sex and height. It
may come as a surprise that obesity is not listed as an eating disorder. This
is because eating disorders are consistently associated with dysfunctional
psychological and behavioral syndromes, patterns, or characteristics (such as
those noted above). Obesity is considered rather a "general medical
condition" (APA, 2000). Clearly, however, psychological factors are often
related to the cause and course of obesity.
More
recently, in 2008, the National Institute of Mental Health (NIMH)iii announced
that psychological factors related to obesity are considered worthy of
scientific investigation. This new interest was also noted by an NIMH Report
reviewed by Allison, et al. 2009. It was noted that obesity is common among
individuals with Serious Mental Illness (SMI) and that this contributes to
higher risk for other medical conditions such as cardiovascular disease and
shorted life expectancy.
Medical-Psychological Considerations in
Eating Disorders
The medical
consequences of eating disorders are critical. Serious medical disturbances
accompany anorexia nervosa such as anemia, elevated blood urea, diminished
liver function, attenuated thyroid function, lowered neuroendocrine function,
heart and brain irregularity, and death. Associated psychological problems are
depression, social withdrawal, insomnia, lowered sex interest,
obsessive-compulsive features, social anxiety, poor impulse control, need for
control, and alcohol and/or drug abuse.
Accompanying
bulimia (purging type) can be: potassium loss leading to muscle weakness and
heart irregularities; and fluid retention leading to nausea, vomiting,
headache, hyponatremia and malaise. Eventually, confusion, slower reflexes,
convulsions, and/or coma may occur. Also associated with the purging type are
significant and permanent loss of dental enamel, chipped and ragged teeth,
increased dental cavities, enlarged glands, cardiac and skeletal myopathy, and
esophageal and gastric ruptures. Females (90% of those diagnosed with this
disorder) are subject to menstrual irregularity. Psychological problems
concomitant with bulimia of both types are mood disorders (depression) and substance
abuse and dependence.
Some Psychological Interventions
The
following techniques are not recommended for anorexic patients. Anorexia most
often requires an in-patient setting, with hospital release the reward for
weight gain (Craighead, Craighead, Kazdin & Mahoney, 1994). However, these
techniques may prove helpful to patients dealing with bulimia or obesity.
Metacognition.
This is thinking about our own thinking—knowledge and experiences we have about
our own thinking processes. Another way of putting it is controlling our
thinking about eating. A person with an eating problem could instruct herself,
"Before eating anything I have to consult my eating plan." A sequence
of control instructions might include: "Before eating, open my eating
control pad, check the time of day, look at the food and amount I am to have.
Just get out this portion on the list. Go to the kitchen table. Move away from
all food after eating, return to previous or scheduled activity." As
simple as this may sound, this metacognitive procedure of step-by-step
"talking to oneself" was found to help patients with previous
regulation and/or control problems (Meichenbaum, 1986).
Stimulus
Control. Any healing of eating disorders or obesity requires a program of
stimulus control. People respond to stimuli reflexively, without even thinking.
For example: Pass refrigerator-open door. Contemporary research psychologists
recommend changing the stimulus cues by using distinct signals such as
location, size, color, and sensory modality (Martin and Pear 1992). For
example, a sticky tape could be applied to a refrigerator or pantry door handle
to modify the stimulus cue. A colorful "Think First" sign or large
bold X could serve the same purpose. At home, one can restrict one’s eating to
a single room, preferably seated at the kitchen table, rather than carrying a
box of food from one room to another or sitting on a couch watching television.
The problem eater could put the foods to be consumed in portion-sized packages
in a special location, away from other family foods.
Response
Management. The more difficult it is to respond to a stimulus, or the more
complex the response, the easier it is to block it. A simple example: Reaching
for a peanut is more difficult if the bowl is across the room or at the other
end of the house than if it is within arm’s reach. Helpful response techniques
include putting food on a saucer instead of a plate, using very small utensils,
putting the utensil down after each bite, interrupting bites by sipping water,
or getting up from the table. A chart can also be filled out as a requirement to
eat: Before eating, the person has to write day, time, place, food, and
quantity on a chart. This could be initiated as a metacognitive strategy as
discussed above.
Reinforcement
(reward) techniques. Bulimics and patients who overeat could also make a list
of activities they like doing. These activities could serve both as a
substitute for the inappropriate eating behavior and as a reward for complying
with one’s healthy eating program. I have found a combination of daily and
weekly rewards to work well. One overweight patient found it rewarding at the
end of the day to take a bubble bath if she had complied with her eating
program. Going to a play or music program with her husband on the weekend was
her reward for following her program during the week before.
A Model Program
A model
medical-psychological obesity treatment program funded by NIMH was reported on
by Casagrande et al. (2010). The treatment protocol was entitled Achieving
Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). It was originally designed as an out-patient
program that required daily attendance. The intervention consisted of multiple
components applying a variety of methods to induce behavior change. The
components included repetitive and on-going activities, including group and
individual sessions that incorporate individually designed weight management
sessions, rewards, food models, daily record trackers.
The
ACHIEVE treatment model integrates the principles of social cognitive theory
relapse prevention procedures (Bandura, 1986), cognitive-behavioral management
(Morelli, 2009) and motivational interviewing. All of these procedures lead to
the building of intrinsic skills and environmental support. Preliminary
findings have shown the effectiveness of this model.
The Church’s Approach to Eating Disorders
Considering
the severity of the medical and psychological consequences of eating disorders,
the patient who suffers from one of them should not attempt self-treatment.
Family or clergy who know an individual with these disorders should make a
referral to an experienced, licensed health/mental health practitioner who
specializes in such disorders. (Please note that a general practice physician
or clinical psychologist is not necessarily an eating disorder specialist.) For
Orthodox clergy and laity to make such a referral is in the firm tradition of
our Church.
St.
Maximus the Confessor said that "grace builds upon nature" (Morelli,
2006). For the Orthodox Christian, this means that neither the spiritual nor
the natural dimensions of human existence are ignored. A parish priest
especially must be aware that many of the problems parishioners present to him
have psychological components and that the spiritual healing of a person often
involves psychological dynamics that require the aid of persons qualified to
address and treat them. It is foolhardy and dangerous to assume all behavioral
and cognitive problems have only a spiritual basis. As St. Basil said,
medicine, too, must be taken into account in the healing of persons. We should
take his words to heart.
In the
fourth century, various healing centers were opened and administrated by the
Orthodox Church, including hospitals and homes for the poor, orphans, and aged
(Demakis, 2004). Many of these centers were associated with monasteries. The
health care workers—the physicians, nurses, and psychologists of the day—were
often the monks themselves. St. Basil of Caesarea was trained in medicine and
was reported to have worked with the monks in ministering to the ill and
infirm.
St. John
Chrysostom as Patriarch of Constantinople used the wealth of the Church to open
hospitals and other philanthropic institutions, which earned him great love
from the people. Within two centuries, the rapid growth of these centers
necessitated state funding, although the Church retained the active
administration and care-giving in the arrangement. Emperor Justinian moved the
most important physicians into the hospitals, which enhanced the reputation of
these centers (Demakis 2004).
Treating the Whole Person
If one
has a food-related problem, there are two possibilities. If one does not have a
diagnosable eating disorder, then one could consider the problem to be a
spiritual one and it should be dealt with spiritually.
If the
problem with food is a diagnosable medical/psychological disorder, the person
with this disorder would be considered to have an illness or infirmity, one
that is most probably involuntary. This can only be determined, however, by a
thorough medical examination followed by medical/psychological treatment. Even
in eating problem cases that are medical/psychological, there is always a
spiritual component. In the tradition of the early Church, the focus was on the
healing of the whole person, body, mind, and spirit, accomplished by a synergy
between medical science and the Holy Mysteries of the Church.
St. John
Chrysostom presented us with the idea that the entire Church of Christ is a
hospital, thereby expressing in clearer theological terms the relationship
between the healing of body and soul practiced by the early healers. In the
Parable of the Good Samaritan (Luke 1:33ff), the Good Samaritan exemplifies
Christ, who, as the Great Physician, comes to broken mankind (the man beaten by
robbers) in order to bring healing. The inn to which the Good Samaritan
delivered the suffering man is the Church (Vlachos, 1994, 1998).
The
interrelationship between body and soul is noted in almost every liturgical
prayer. Most Eastern Orthodox corporate prayer begins with theTrisagion
(Thrice-Holy) prayer, which makes the relationship clear: "All-holy
Trinity, have mercy on us. Lord, cleanse us from our sins. Master, pardon our
iniquities. Holy God, visit and heal our infirmities for Thy name's sake"
(emphasis added).
This
interrelationship is also demonstrated in the spiritual practices and Mysteries
of the Church.
Disclosure
of Thoughts. An initial step in dealing with eating disorders is the disclosure
of the patient’s thoughts, behaviors, feelings, and symptoms. In a similar manner,
the church fathers emphasized the importance of practicing this disclosure in a
complete and systematic way. For the spiritual fathers, this is done with
vigilance (nepsis), watchfulness, and the guarding of the heart. Hausherr
(1990) quotes an anonymous old man as saying, "When evil thoughts harass
you, do not hide them, but tell them at once to your spiritual father. The more
one hides one's thoughts, the more they multiply and the stronger they
become."
The
Service of Holy Unction. Orthodox Christians perform the Mystery of Holy
Unction for the healing of soul and body and for forgiveness of sins. In his
epistle, the Holy Apostle James writes, "Is anyone among you suffering?
Let him pray. Is anyone cheerful? Let him sing psalms. Is anyone among you sick?
Let him call for the elders of the church, and let them pray over him,
anointing him with oil in the name of the Lord. And the prayer of faith will
save the sick, and the Lord will raise him up. And if he has committed sins, he
will be forgiven" (James 5:13–15). The anointing prayer reads, "The
blessing of Our Lord God and Savior Jesus Christ: for the healing of soul and
body . . ."
The
prayer of the blessing of the oil illustrates the goal of physical healing:
that those anointed may glorify God and thus be spiritually healed. The prayer
in part reads:
O Lord,
who through Thy mercies and bounties heal the disorders of our souls and
bodies: Do thou Thyself, O Master, also sanctify this oil, that it may be
effectual for those who are anointed therewith, unto healing and unto relief
from every passion, of every defilement of flesh and spirit, and every ill;
that thereby may be glorified Thine all holy Name, of the Father, and of the
Son, and of the Holy Spirit: now and ever, and unto ages of ages. Amen.
The Holy
Eucharist. The Holy Eucharist is the reception of the Body and Blood of Our
Lord, God and Savior, Jesus Christ. The Eucharist conjoins us to the Great
Physician, a point expressed in the liturgical prayer that is read immediately
before the elevation of the bread and wine: "We give thanks unto Thee, O
King invisible, who by Thy measureless power hast made all things . . . look
down from heaven upon those who have bowed their heads unto Thee . . .
distribute these Gifts here spread forth unto all of us for good . . . heal the
sick, Thou who art the physician of souls and bodies."
These
spiritual disciplines can combine with a traditional medical approach to
restore the whole person to a godly relationship with food.
The Food of Life versus the Food that
Perishes
St. John
of the Ladder counsels, "If you have promised Christ to travel the
straight and the narrow road, then keep your stomach in check." And he
also tells us, "Begrudge your stomach and your heart will be humbled:
please your stomach and your heart will be proud."
And
finally, let us heed the words of Our Lord Himself: "Do not labor for the
food which perishes, but for the food which endures to everlasting life, which
the Son of Man will give you, because God the Father has set His seal on
Him" (John 6:27). Furthermore may we meditate on St. Isaac of Syria's
(Holy Transfiguration Monastery, 2011) understanding: "This is THE RULE OF
LIFE that is chaste and pleasing to God ... use foods that sustain the body,
and not those that satisfy gluttony."
Source: http://www.orthodoxytoday.org/view/food-that-perishes-an-orthodox-approach-to-food-and-eating-disorders
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