Anorexia and the Brain: An Interview with Bette Lamont

Anorexia Brain interview (photo of Bette Lamont)
Bette Lamont

“Anorexics often don’t have good pons level functioning. Most notably,
people with pons level challenges may not be aware of when they are hungry.
Lacking an accurate perception of hunger, anorexics cannot then respond
appropriately to their need for food.”  —Bette Lamont

By Cat Saunders

Seven out of ten people—around the world in every culture—suffer some amount of brain trauma just being born. After that, people may get hit on the head, fall off a bicycle, or have a car accident. Or perhaps they just collide with a cupboard door so that they “see stars.”

In addition to these mishaps, people may grow up in families where there is abuse, physical or emotional neglect, or severe repression. Or there may simply be a lack of knowledge about what children need to grow and be healthy.

All of these factors can affect the development and functioning of the brain. In innovative research, scientists have been discovering more about how traumatic childhood experiences can actually alter the chemical makeup and synaptic functioning of brain cells. In addition, this research is revealing how these alterations in brain function can result in a wide variety of physical, mental, and psychological difficulties later in life.

Thus, many issues that people suppose to be purely psychological, can also have an important neurological component. Since the late 1970s, a form of therapy called Developmental Movement Therapy has begun to address this overlap between brain function and psychological health.

Developmental Movement Therapy began in the late 1940s as a way to help people with significant brain injury. A neurosurgeon named Temple Fay and a nurse named Florence Scott pioneered this work.

Several people in the United States, including Florence Scott, have continued to develop this work. One such practitioner is Bette Lamont, who apprenticed with Scott for many years. Bette later founded the Developmental Movement Center and Developmental Movement Consultants in Seattle.

In the following interview, I asked Bette about her work with Developmental Movement Therapy, also called neurological repatterning work.

First, Bette answers questions about the basic functions of the lower brain (pons level) and the midbrain. This includes a discussion of the physical, mental, emotional, and spiritual issues associated with different parts of the brain. After laying this groundwork, Bette then addressed some of the neurological issues specifically related to anorexia and the brain.

Cat: In very simple terms, the work you do involves the brain stem or pons level, the midbrain, and the cortex. Would you talk first about how pons level problems can show up at the psychological level?

Bette: People who have brain stem—or pons level—dysfunction often don’t have good self-caretaking skills. If you have pons level damage in the extreme, you will stop breathing and die. But pons level issues run on a continuum.

Frequently, people who have these issues may report that they don’t know why they’re alive. Or they may not feel very interested in being alive. They may feel isolated or alienated from other people, or they may have suicidal tendencies. They often don’t have good life-preserving skills because they literally can’t perceive what is a threat to them.

People without a good sense of physical pain often don’t have a good sense of emotional pain, either. They may be in a horrible relationship, but not realize they’re in pain until they do neurological repatterning work. One of our basic functions neurologically is to be able to feel pain. The healthy ability to feel pain is accompanied by the ability to take ourselves out of painful situations.

Healthy babies have a powerful knowing of their right to be here. They may not look very powerful because they are so tiny. But when you look at what they’re doing, their actions are all life-preserving. Their brains tell them to cry when they’re hungry, demand help if they are in some discomfort, or crawl to get away from danger. Everything about these babies says, “I have the right to be here. I deserve to live.”

Cat: After I completed my brain work, I noticed I didn’t have that persistent “I’m not good enough” thought anymore. By the time I found out about your work, I’d already done more than 20 years of work on myself. I’d worked with all kinds of therapeutic disciplines, bodywork techniques, and spiritual practices. But I still did not feel “good enough” until I got my pons level “hooked up.”

Bette: Feeling “good enough” is about the fundamental right to be here. Pons level function can be disrupted—for all kinds of reasons—early in life. So people don’t realize this foundation piece is missing, because it has been missing since the very beginning of their lives. But we all deserve this fundamental knowing of our right to be.

If our brains are fully functioning, the feeling of being “good enough” should be present without effort. We shouldn’t have to work at it.

Cat: Another thing that fascinates me about the brain is its relationship to bonding. You described the bonding process to me in terms of three stages. When you’re first born, you don’t know the difference between yourself and your mother (or other primary caregiver). At first, there is no sense of separateness.

Then, sometime during the first year, you go through a separation stage—which causes a lot of anxiety—when you realize that you and your mother are separate. If you continue to get everything you need to develop in a healthy way, you will progress to the third stage of bonding. This third stage involves the development of your capacity to perceive your separateness and still feel safe.

At that point, you can love and be loved, without having to “merge” with the other person. You also mentioned that a disruption in these developmental stages of bonding could contribute to codependent behavior later in life. Would you say more about that?

Bette: There is no absolute distinction between neurologically based responses and psychologically based responses. It is a continuum. We therefore advise clients to do therapy for a year or two. That’s how long it usually takes to do their neurological repatterning work. Lots of feelings can come up when you do this kind of work. People often need help to consciously sort through and express all these feelings in a safe way.

We generally only reevaluate clients every two months, aside from brief appointments to check their repatterining movements. Since their movement work is done daily on their own, it’s helpful to have the support of a good therapist. It’s especially helpful if the therapist is knowledgeable about developmental stages.

It is typical for dysfunctional families to have many levels of dysfunction happening simultaneously. A child who grows up unable to bond will typically have parents who don’t know how to appropriately nurture a child. Such parents probably never finished their own developmental integration. These parents may be remote and unresponsive or have a “flat affect.” Or they may be disinclined to reach out to meet the baby’s needs.

A neurologically compromised baby may not demand that her needs be met in the insistent way healthy babies do. When both parent and child are unable to go through the steps of bonding, some pretty profound disconnections can develop over time.

The capacity to bond is first of all a neurological process. You can have a wonderful family and still not be able to bond, if your neurological development has been impaired in some way. This can happen because of a difficult birth, a head injury, emotional trauma, or a lack of developmental opportunity.

Babies who have gone through all of their developmental stages have a better chance to integrate healthy emotional responses. It is these movements that support healthy brain development. Developmental Movement Therapy uses these same movements to help clients restore full functioning of their brains.

If pons level development is impaired, we may not move out of the separation anxiety stage. If we don’t feel separate and safe, we may always try to return to the only kind of bonding we remember. That would be the “merged” kind of bond we experienced at the beginning of our lives.

If we didn’t bond effectively early in life, we tend to repeat the pattern of wanting to “merge” to feel loved. This may show up later in life as the tendency to become enmeshed or codependent with partners.

There is good news, though. If the brain remains physically undamaged, it retains the information necessary to learn how to bond. Our developmental stages can be completed anytime in our lives. The same movements that infants use to “hook up” their brains can be used to heal the brain later in life. The result will be that we can then bond with partners in a healthy way.

Cat: Would you talk about how midbrain issues can show up psychologically?

Bette: The midbrain is responsible for how we make bridges to the world and how we make buffers from the world. When I work with adults with midbrain dysfunction, there can be lots of problems with processing stimuli. At the extreme, people may be agoraphobic-unable to leave the house because the world feels too overwhelming for them.

Stimuli issues arise from not being able to sort things out, or not being able to prioritize what’s important and what isn’t. This can manifest psychologically with confusion about questions such as, “What is important? What should I do now? Where do I begin?”

Midbrain issues therefore involve organizational and focusing skills. If the midbrain is working, we can see what we want, and we can go after it in an organic way, without having to think it out with our high brain, or cortex.

People with midbrain issues might complain about procrastination or staying stuck in ruts. Or they may say they can’t seem to get on with their lives. This can show up in terms of not being able to set goals and follow through with actions to reach them.

The midbrain also affects a lot of body “housekeeping” issues. These issues include body temperature and sleep regulation, weight set point, metabolic function, and the ability to respond appropriately to “enough” in terms of eating.

For example, people with only midbrain dysfunction may have the tendency to gain weight. But people with pons level dysfunction might experience weight loss, and even anorexia, if their ability to feel hunger—and respond appropriately to it—is neurologically impaired.

In terms of the midbrain housekeeping functions, people with impairment at this level might experience a whole range of physical and psychological problems. It’s difficult to be in the world comfortably if you’re constantly fighting to regulate physical processes that should take care of themselves naturally.

Cat: What about the relationship between the midbrain and so-called “boundary” issues that people so often struggle with in relationships?

Bette: Yes, boundary issues! The midbrain tells us, through very specific visual and sensory cues, where our bodies are in space and where the world is in relation to us. I have never worked with anyone who has boundary issues who accurately knows where their body is in space. In simple terms, they don’t know where they end and the other person begins. It’s no wonder they have boundary problems!

When people do their developmental work, their midbrains begin to function normally. They come back and say things like, “I’m saying ‘no’ more often.” Or they say, “I’m setting better boundaries for myself.”

Cat: Something I’ve been noticing recently is the relationship between spiritual work and the brain. I tell my clients that when they start working with powerful energy at spiritual levels, they better get a neurological evaluation. 

Consider the wiring of a house. With bad wiring, you can’t turn on a switch without worrying about blowing a fuse or starting a fire. But with a correctly wired house, you can run more energy through it without fear.

Bette: That’s true! I hardly need to elaborate on that, but I can share a story from my own experience. Before I did this work, my life focused on looking for something outside of me—a spiritual practice or a therapy. When I leafed through the local resource publication, I thought, “Oh, that’s what I need—or that.” I always looked for something out there. I didn’t trust what I had inside myself.

Neurological repatterining changed that. The transition wasn’t immediate because the work took some time. But at some point I realized I wasn’t looking through the resource guide anymore. I had a sense of my own self-worth, and I didn’t need anything “out there” anymore. I felt strongly grounded and in touch with my own wholeness—or holiness. Best of all, I felt connected to my own god within.

We are always in the process of trying to make ourselves whole. The more you feel whole on the inside, the less you need from the outside to feel whole.

Cat: Well said. Thank you. Let’s talk more specifically now about anorexia and the brain. What are the main signs of neurological dysfunction that generally characterize anorexia?

Bette: In the areas that I test, anorexics often don’t have good pons level functioning. As a result, they usually don’t have good pain perception. In addition, they often don’t respond appropriately to heat or cold, because they cannot accurately perceive heat or cold. Some anorexics may also still have a grasp reflex, which is an infant-level reflex that I can talk more about later.

In addition, anorexics may have an eye that overconverges or rotates in. An untrained observer may not perceive this problem with the eyes, however. It occurs because the pons level also controls the muscles that pull the eyes out.

Because of this, the anorexic may have poor visual convergence and some depth perception issues that can be mild. Or this may be severe enough to make the client feel anxious going out into the world.

Most notably, people with pons level challenges may not be aware of when they are hungry. For example, I have clients who say they must force themselves to eat. Or perhaps they go all day without eating because they don’t feel hunger, so they forget to eat. Lacking an accurate perception of hunger, anorexics cannot respond appropriately to their need for food.

Clinically, those are the main factors I check, but I also listen to the stories anorexics tell. Often, their stories have a lot to do with neglecting their own needs or feeling like they don’t belong. They may be unable to effectively attend to their own survival needs—physically or emotionally. These may be people who have a long history of accidents or other forms of harm. Sometimes it almost seems as if they draw a lot of hurts to themselves.

Maybe they’ve had five or six head injuries and a car accident. Perhaps they were hit over the head, or they fell down the stairs. Perhaps they sustained so many traumas that you wonder how one person could have survived it all. This isn’t typical of all anorexics, but it is one kind of story an anorexic might present.

My sense about this is that these people’s life-preserving instincts are not very acute. Otherwise, danger signals or negative cues from their environment would impact them more strongly. Then they would either avoid such situations, or they would get away from them sooner.

The pons level is the part of the brain that notices what’s happening in the environment—both internal and external. The pons says, “I need to be alive. I need to pay attention to those things that are a threat to me, so I can continue to stay alive.”

As I mentioned, anorexics are almost certain to have serious dysfunction at this pons level. In fact, I’m not sure it’s possible to actually be anorexic without pons level impairment.

In my practice, only one woman discussed anorexia, but she didn’t have any pons level hurt. She tried to be anorexic once for three weeks, trying to starve herself in order to be thin. But she said her body wouldn’t let her do it. I thought that was fascinating!

She was the only client I’ve ever had who talked about anorexia without having any  issues at the pons level. I often work with clients with no pons level symptoms, but anorexics always exhibit pons level trauma to some degree.

This client couldn’t be anorexic even when she tried, because her body wouldn’t allow it. Her healthy brain would not allow her starve herself.

The more I work with anorexics, the more I discover psychic and emotional factors that may seem subjective. But you must consider these factors in order to give a true representation of the whole picture. If I am only working clinically, I would check for the following issues. What are their eyes doing? How appropriate are their responses to heat, cold, pain, and hunger? Do they have a grasp reflex, and how do they crawl on their bellies?

For example, some anorexics get down on the floor to crawl on their bellies and immediately I’m concerned. At worst, I see someone who looks like a little fish. They flop along with their hands down below their hips like little flippers. Their bodies flop back and forth. Their legs move as if they are hooked together, like a tail.

It almost looks like there is a phylogenetic regression. This does make sense, since the lower brain is sometimes called the “reptilian brain.” The lower brain links us to our evolutionary ancestors.

Clinically with anorexics, I look for several things. I check eyes, sensory skills, mobility of belly crawling, and hand function. In addition, I also listen carefully to the anorexic’s story.

Cat: Would you say more about the grasp reflex?

Bette: Anytime you touch the palm of newborn babies, their hands will automatically grasp around whatever is touching them. This is a skill—a medulla and spinal cord skill. The next skill is that the baby can open her hand out, which is a pons level skill.

When under stress, some people with pons level dysfunction may have their hands revert to that infant hand. Their hands may revert to grasping hands curled into little fists. The stress may be as simple as skipping, or being asked questions in a casual conversation.

This grasp reflex is typical for people who have pons level brain injuries. They are physically unable to release that grasp reflex. You’ve probably seen this in the tightly clasped hands of some stroke victims whose pons level has been affected.

Sometimes I see anorexics who have the tendency to close their hands into little fists. They may do this even when they are just talking with me in ways that would seem casual for other people.

Cat: Hmmm. I have noticed that in a couple of anorexic clients.

Bette: Yes. Neurologically, a doctor might notice it and say, “Yes, grasp reflex is present.”

I think the grasp reflex has many emotional ramifications in terms of the ability to open up. For example, consider the stage where babies are starting to open up their hands. This is when they are also starting to make stronger connections to opening up to people and bonding.

I think the reflex ability to open the hand reflects that stage emotionally, too. When I work with kids who are unbonded, it’s striking. They do their belly crawling with their hands tightly closed into fists.

Cat: On a hypothetical scale of brain hurt from one to ten, where would you place anorexics?

Bette: I don’t know if I can do a “one to ten” scale. But I can speak to the issue of severity of brain disorganization. The pons level is a place in the brain that cannot sustain much injury without incurring death.

But the brain is very complex. I think of the brain like a fan. The small part of the fan represents the brain stem and pons level. The upper, wide part of the fan represents the high brain, or cortex.

If a part of the wide, upper area of the “fan” is hurt, it will only affect a small part of your experience. But if part of the base of the “fan” is hurt, it can affect your experience significantly. This is because the base radiates up and out, and therefore affects a much greater area. Even small injuries at the pons level can have great consequences. These consequences may be both physical and psychological.

I would say that anorexics have a significant level of brain dysfunction, compared to other clients.

For example, one of my anorexic clients has more pons level dysfunction than anyone I know who is not considered disabled. She walks and talks and works a full-time job. Now let’s consider only people who have pons level injuries who are still largely functional. In comparison to others in this category, she’s really hurting. She’s struggling at about an eight or a nine on a ten-point scale of brain disorganization.

Cat: That helps put it in perspective. My sense is that anorexics’ level of brain dysfunction is indeed quite severe. It’s a tribute to the human spirit that these people can live active lives despite their lack of brain support. I did it myself for fifteen years of anorexia!

On the flip side, it’s incredible to see how neurological repatterning can truly help heal anorexia.

Bette: I want to say in all honesty that Developmental Movement work can be very difficult for anorexics. It plays a significant role in healing anorexia. However, neurological repatterning can stimulate deep emotion that can be scary for anorexics.

Developmental Movement Therapy takes longer to complete for neurologically injured people. This is not only because there is more extensive brain dysfunction to heal. It’s also because anorexics generally need to proceed more slowly due to the emotional repercussions I mentioned.

Even though it can be hard work, neurological repatterning is an extremely valid way to help heal anorexia. This is because it stimulates and heals the area of the brain that governs self-care and right-to-be issues.

Cat: I agree. I’d succeeded in healing all the outward symptoms of anorexia before I completed my developmental movement work. The deep, underlying “crazy thinking” and emotional patterns did not dissipate until I did my brain work.

You mentioned earlier that you don’t think it’s possible for someone to be anorexic unless they have pons level hurt. Would you say more about that?

Bette: I should instead have said that it may be possible for someone to be anorexic without pons level involvement. However, I’ve never seen that in my practice. There is definitely a psychological profile for anorexics, and I see that psychological profile when I work with them. However, it always appears to correspond to their neurological situation as well.

I think that if the psychological component is present without the neurological piece, the person would make different choices. A person with pons level dysfunction without the anorexic psychological profile might have other kinds of self-care issues going on, but they wouldn’t be anorexic. That’s my best guess.

Cat: How do you tell the difference between stoicism and the inability to feel pain? For instance, when I first came to you, you did the “pinch test” to see how good my pain perception was. I couldn’t feel anything until you were pinching hard enough to bruise me.

In my family, emotions such as fear, anger, or sadness were considered signs of weakness. So I figured I learned to be stoic so I wouldn’t show pain.

You told me this wasn’t true. If it was just stoicism, you would see at least some change in my face. You would have seen some indication that my body was feeling pain, even if I was refusing to show it. But you saw no change in my face. In fact, the pinch test showed that I was literally unable to feel pain unless it was extremely intense.

After that initial pinch test, I finally understood something my friends used to ask me before I did brain work. They’d say, “Why do you always wait until you’re practically dead before you get help?”

Because of this work, I realized I did that because I was neurologically unable to do anything different!

Bette: Fundamentally, I think the brain is a mechanism that wants us to survive. I honestly don’t think our will alone is strong enough to suppress things that hurt us.

Some people have a neurological tendency toward suppression, and that might be supported psychologically. We could do studies about these people and say they don’t feel pain because their family messages were all about not showing pain.

But I have met siblings from those same families who are very responsive to pain. They are appropriately responsive to pain because of what’s happening in their neurological profiles. In other words, I think the neurological piece accounts for the difference between stoicism and physiological insensitivity to pain.

If somebody has a history of not being able to feel and respond appropriately to pain, that person should not only do brain work. They should also do their emotional work. Even if the original trauma was primarily neurological, there may be a lifetime of inappropriate responses to pain. This lifetime of emotional patterns will also require attention as the brain work unfolds.

Cat: That makes a lot of sense. Some families give children overt or covert messages that say, “don’t show emotions.” That same family may have given them more than just messages. The children may also have sustained actual physical, psychological, or sexual abuse.

Perhaps the children’s basic needs were neglected. Or maybe the parents did not respond appropriately when their children were in physical or emotional pain. The neurological and psychological pieces weave together along the way.

Bette: The worst case I’ve seen in that regard was a father who said to his children, “Don’t show feelings.” If they did, he put them underwater and threatened to drown them! Meanwhile, he demanded that they not say anything or show any feelings about him threatening to drown them. Talk about twisted!

Cat: That kind of crazy making, double-bind behavior on the part of parents can really hurt children at deep levels. I’ve heard similar stories from women who have grown up in anorexic family systems. What changes do you see in anorexics when they start to do neurological repatterning work?

Bette: Often fear comes up—the fear of feeling. For some anorexics, it’s simply the fear that they will gain weight and get out of control. For other people, it’s fear about feeling pain, or feeling life and all its sensations in their bodies. Still others fear the terror of feeling anything at all, even ecstasy. The fears are different for different people, but fear is usually the main issue for anorexics.

Cat: That matches my personal experience as well as my experience in working with anorexic clients. As with any serious addiction, anorexic behaviors may serve to keep intense underlying fears at bay. The anorexic behaviors help the anorexic feel more in control.

It’s actually good when anorexics begin to connect with their fear. That means at least they’re feeling it instead of avoiding it. I think that old adage is true: “You can’t heal what you don’t feel.”

Bette: It’s definitely a positive sign when anorexics begin to contact the underlying fear. That allows it to be addressed. Also, it’s important to understand that the repatterning work—which allows these intense feelings to come up—is the same work that stimulates a growing sense of core strength.

This can be particularly helpful for anorexics. Their badly hurt pons causes them to struggle with things most people take for granted. They may struggle with eating a casual meal with friends or lying down to rest when they’re tired.

When anorexics do brain work, they often begin to feel a growing sense of personal power.  They begin to develop a sense that they can take care of themselves. They may begin to feel closer to people and more able to share their feelings with others.

With Developmental Movement Therapy, anorexics generally develop a stronger sense that they can survive. They also begin to feel like they have a place in the universe. I think that’s the bottom line. They begin to realize not only that they can survive, but also that they have a right to survive.

Cat: In the context of being able to survive, you’re saying it’s essential to be able to feel fear. This is because fear is a basic component of our survival mechanism. Would you talk more about the relationship between fear and the brain?

Bette: The pons level is the part of the brain that says, “PAY ATTENTION! RED ALERT! DANGER! GET OUT OF HERE!”

It also says things like, “You’re hungry—eat something!” If you get really hungry without eating anything, the pons level will get louder. It will say, “Get something to eat NOW! Take care of it or you’re going to DIE!”

It’s definitely essential to be able to feel fear or hunger or pain, so you know where that boundary is. That’s the only way you’ll do something about it.

That’s another thing I often see with anorexics. They can’t perceive their pain boundary effectively, so their pain boundary gets trampled a lot. You need to know where your pain boundary is—the line where you start hurting. That way, you’re less likely to do things that might hurt you.

If you don’t know where your pain boundary is, you won’t feel fear appropriately when you approach your limits. You won’t have a warning to stop before you get hurt. This is true both physically and emotionally. If there is pons level impairment, you won’t be able to say “no” to physical or emotional pain very well.

Cat: I remember something you once said about crawling on our bellies. Belly crawling is the first kind of forward movement we do as babies. Is its purpose to help us get away from something we don’t like?

Bette: Yes. Babies initially begin crawling to “get away from” something. You know, that little pons level baby is very powerful! If they sense that something is a threat, they crawl to get away from it. Eventually, they use crawling to go toward something. But initially, the purpose of belly crawling is to get away from danger.

We don’t lose this piece of brain function, either. It’s not like a baby tooth that falls out. Hopefully, upper brain function becomes increasingly sophisticated. But that lower brain is still there, shouting out. It needs to always be alert and paying attention.

We must remain capable of getting away from pain or danger. This is a basic pons level function.

Cat: Anorexics often don’t have the instincts or the reflexes to get away from situations that might harm her. These situations could be related to her physical or emotional well being.

Bette: For the most part, that’s true. She could get away, but often doesn’t.

Cat: Some anorexics who were healthy in childhood become anorexic after a significant stressor in their lives. Can you explain how that might happen?

Bette: It’s possible for stress to bring up neurological injuries or the underlying neurological dysfunction. Sometimes the high brain—the cortex level—has been compensating for the lower brain functions for a long time.

When a major physical or emotional stressor arises, the underlying dysfunction may then make itself apparent. This may happen if the high brain can no longer compensate for the lower brain plus do its own job.

Another possible explanation is that the person may have had some kind of neurological injury after childhood. This could be as seemingly simple as whiplash from a car accident.

Cat: There is often some degree of sexual abuse in the background of many anorexics. Would you talk about how sexual abuse can impact the brain?

Bette: I can’t give you a linear, cause-and-effect answer. But I do have a lot of thoughts about it. I’m reading a book that explores the common characteristics of children who have been sexually abused.

I believe there is likely something going on for these children neurologically. Some children who suffer abuse already have more neurological dysfunction. This neurological dysfunction makes them more vulnerable.

For example, such a child might not put up good boundaries if they can’t recognize and appropriately respond to hurt. Maybe they don’t know how to stand up for themselves and say, “Don’t touch me or I’m going to kick and scream.”

If they don’t know their boundaries, another person could more easily abuse them. This is not to say that these children are inviting the abuse, or that they are somehow responsible for it. I hate that kind of thinking! However, it makes sense that a child who doesn’t have a good sense of boundaries might be more vulnerable to abuse.

Another answer to the question of how sexual abuse might affect the brain revolves around the issue of early development. We have this great mechanism within us that makes sure we do whatever we need to help our brains develop. This allows us to become healthy, whole human beings. But sometimes there is violence in the household. Sometimes there is physical or emotional or sexual abuse that threatens the baby.

Infancy and childhood must be safe and joyous in order for this internal mechanism to develop fully. However, if the environment is threatening in some way, a child may withdraw. If this continues, the baby may not play, crawl, or roll around. She may not do the kinds of movements she needs to do to develop neurologically.

In this way, the abuse could impact her neurologically and keep her from growing. It could even keep her from growing physically. A baby who is deeply withdrawn might shut down and not want to eat.

This question of the relationship between sexual abuse and brain dysfunction is very complicated. We could talk for days about it and uncover all kinds of related issues. But those are two of the main ways I think abuse is related to brain dysfunction.

In the first scenario, a neurologically impaired child may not have strong enough instincts to ward off inappropriate behavior by others. Again, this in no way means that the child is responsible for the abuse.

The other way abuse can negatively impact the brain is when a child is denied a safe environment. Children need to be free to move and explore. This in turn allows them to do the physical movements necessary to complete the brain’s developmental stages.

Cat: I appreciate your insistence that a child’s increased vulnerability does not make her responsible for abuse. The danger of “blaming the victim” can be particularly acute in the case of anorexics. 

Anorexics tend to be overly responsible—sometimes to the point of thinking everything is their fault. They might think they are somehow to blame for the abuse. They may think it’s their fault because they didn’t know how to communicate their boundaries better. Or they think they should have fought off the abuse more effectively once it began.

Whatever shape a person’s brain is in, the responsibility for abuse rests squarely on the shoulders of the abuser. Period.

Bette: Yes. There are definitely people who will hurt others, no matter how good the other person’s boundaries are.

Cat: And abuse can and does affect and hurt a healthy brain.

Bette: That’s right. In addition, the younger a person is, the more any abuse will impact the health of her brain.

The biggest cycle of growth happens when the brain is first developing. If you think of development like a spiral, then birth to six or eight years is the first big cycle. Then we work through these stages again and again.

The first main cycle is the one I work with, from birth to six or eight years. But abuse can retard your growth at any stage of development throughout life.

Say you’re 14 years old. You begin to experience yourself as a sexual being, but what if someone abuses you? That abuse can impact your growth neurologically. This is because many functions that relate to social skills and judgment are maturing at this age.

If there’s a healthy brain underneath the stress of infrequent abuse, it’s more likely the 14-year-0ld will recover okay. However, we spoke earlier about what might happen if there isn’t a healthy brain underneath.

A significant stressor later in life results in a different scenario if the brain is already hurt. Then the stressor may cause the underlying dysfunction to become more pronounced.

Cat: Can you estimate how long it might take an anorexic to heal her brain doing Developmental Movement Therapy?

Bette: If the person were willing to work solidly for three years, she could finish most of it. But truthfully speaking, a person would simply have to keep working until she has “paid her brain debt.”

I know that may not be a very satisfying answer. For most functional adults who are doing developmental work, it generally takes two to three years  to complete the work. But for people who are anorexic, it may take longer because so much comes up for them emotionally.

It’s important to note that I do work with people who have pons level dysfunction but aren’t anorexic. They don’t feel hungry and don’t take good care of themselves very well around food. These people will do the program and start feeling hunger.

At that point, they simply begin eating again. This is because they don’t have the underlying emotional patterns attached to issues of self-care. These people often overcome starvation issues in three to five months, because no psychological processing is necessary.

I don’t know if you’d call these people anorexic, because they don’t have the psychological issues associated with anorexia. I don’t know if that’s classic anorexia, do you?

Cat: I wouldn’t call it that. The basic term “anorexia” simply describes the medical condition of not eating. However, the kind of anorexia I’m talking about here is an extremely complex illness. It’s an illness that arises from an interplay between many factors.  These include physical, emotional, neurological, familial, environmental, sociological, and spiritual factors.

Would you talk more about people with pons level hurt who don’t take good care of themselves? I mean cases where they don’t fit the psychological profile of anorexics.

Bette: I’ve noticed that this situation shows up more often in men than in women. Sometimes it happens for women, but it shows up more often in men. Brain dysfunction may show up differently in people with severe pons level dysfunction who don’t fit the psychological profile of anorexia. Their brain dysfunction may simply manifest as them not taking good care of themselves in other ways.

For example, they may simply “forget” to eat because they don’t get proper hunger signals, as mentioned before. They may take unnecessary risks that put them in danger. Or they might not have good self-care around survival issues such as keeping a roof over their heads.

Cat: That’s interesting. I’ve thought a lot about why the vast majority of anorexics are women. Again, I’m talking here about anorexics who also have its psychological profile. I’m not referring to anorexia when it’s only used to describe the medical condition of not eating.

Although anorexia is complex, it’s important to unravel whatever components we can discern. Then these issues can be addressed and hopefully healed.

Our culture treats males and females very differently, starting at birth. Messages bombard us daily in relation to what it means to be female and what it means to be male. 

As you know, these messages come from parents and relatives, schools and churches, peers and the media. These messages also come from various ethnic groups, the government, and from the culture as a whole.

For women, there is are pervasive messages that denigrate the feminine in one way or another.

Men also receive messages that are equally destructive to their physical and emotional well-being. However, we generally don’t teach men to consider themselves “second-class” citizens. Also, men typically have more leeway in regard to the size and shape of their bodies.

In terms of cultural conditioning, it unlikely that men would struggle with the same psychological issues as anorexic women. Men would probably not have such extreme body fears. Nor would they feel so strongly the need to be “invisible” and not take up space.

Bette: Men do have a lot more latitude about their bodies. For men, bigger is often considered better, stronger, and more male. Maleness is considered a good thing in our culture. So men will generally not experience the same psychological ramifications that women do in regard to their bodies.

On the other hand, pons level dysfunction in men may result in other kinds of self-care issues. Anorexic women might have some of these issues in addition to their eating disorder.

For example, men with pons level impairment may be more accident-prone than people with a healthy pons. They don’t recognize danger signals or they don’t realize when they’re hurt. They might accidentally cut their hands doing some task, but not notice until much later. Then they might forget how it happened in the first place.

Cat: I have a question about anorexia versus bulimia. Do you see anything different in regard to brain issues for these two kinds of eating disorders?

Bette: I see both anorexia and bulimia as arising from the same pons level hurt. Most people who have bulimia tend to have that same kind of neurological profile. I don’t know why they make a different choice in terms of behaviors, though.

One bulimic woman said she would eat a lot, but not know her stomach was hurting for a long time. You know those uncomfortable feelings that happen when you overeat? This person said she wasn’t even aware of any discomfort. That’s in the same category of not being able to feel and respond to pain or distress.  These are pons level issues.

Cat: I was bulimic from 1972-1980, which overlapped with 15 years of anorexia. When I binged, I remember that I could eat a ton of food before I felt uncomfortable. Then I would throw up so I’d feel completely empty. I went from one extreme to the other.

Bette: When you say that, it reminds me of people who cut themselves on their arms with razor blades. People sometimes cut themselves just to feel, because their pain threshold is so impaired.

Cat: I’ve thought about cutting in regard to the brain, too. That behavior does feel somehow similar to my own past experience with various forms of self-abuse.

Considering everything you’ve taught me, I remain stunned by the profound impact of brain hurt in relation to anorexia.

Sometimes I want to scream when I hear people say that anorexics just need to eat more. That’s like telling someone with diabetes that they just need to process sugar better. Not only is this kind of statement uncompassionate, it’s downright ignorant!

I wish you could be on Oprah to talk about the neurological component of anorexia. Then people could understand there’s a “missing link” piece that few people even know about in regard to eating disorders.

Anorexia arises from many factors that warrant increasing research. This includes research into the mind-body connection. Hardly anyone recognizes that the mind-body connection is not just a metaphor—it’s literal!

Everyone’s piece of the puzzle about anorexia is important. Many factors contribute to healing the complex issues related to eating disorders. It’s just that the neurological piece is not getting enough press time yet. That’s why I’m interviewing you and that’s why I’ve been such a mouthpiece for brain work.

Neurological repatterning is the single most important work I’ve done in 30-plus years of work on myself. And that’s coming from a longtime counselor who values all the other forms of healing work I’ve done.

If my pons and midbrain had not been compromised, I could never have become anorexic. Now that my pons and midbrain are “hooked up,” there’s no way I could be bulimic or starve myself again. My body simply wouldn’t allow it.

Bette: Yes. I think about what would happen if a woman in our culture had serious pons level hurt. I wonder what would happen if she was never shamed or abused as a woman? Never treated as a second-class citizen? And never encouraged to discount her own needs in order to take care of others?

If womanhood was honored in all its fullness, I think there would be very little incidence of anorexia as a psychological disorder.

This interview was updated by Bette and Cat in October 2007 and again by Cat in May 2017. Its original version was first published in 1993 as part of Cat’s doctoral dissertation about anorexia and functional neurology. The dissertation was titled “Canary in a Coal Mine: Anorexia’s Cry for Wholeness.”

For more information about Bette Lamont and her work, please visit Neurological Reorganization.

Cat Saunders, Ph.D., is a counselor in private practice in Seattle, Washington. She is also the author of Dr. Cat’s Helping Handbook: A Compassionate Guide for Being Human (available through Amazon). Contact Cat by emailing her or by calling 206-329-0125 (24-hour voicemail).