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Reena Keren was a child with an eating disorder. In the early 1960’s, no one recognized that this was her cry for help. Only many years later did Keren herself begin to accept this reality. She gradually understood that she had lost control of her food and of her life. She began to accept the responsibility for her addiction and subsequent rehabilitation. Now, twenty six years into her recovery, using techniques that she herself developed, Keren has become an expert in treating others who suffer from eating disorders and addictions.
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TIKKUN[i]
The following paragraph appeared on the cover of the article & was accompanied by a picture
By: Orit Merlin Rozenzweig, English translation: Susanne Woyciechowicz, Reena Keren
Initially she thought that the words were coming out of her mouth. It took her some time to realize that someone else was talking. Even today, Keren very clearly remembers her first session in Overeaters Anonymous, the 12 Step group for eating disorders. She remembers well the warm feeling that of having finally come ‘home’. “I burst into tears”.
Today, 26 years later, it is still a very emotional memory. “I felt like I had dug deep into the depths of my soul. I was suddenly aware that this was a poignant moment of my life. The person who was telling his story spoke of eating from a trash can in his home. “I so very much identified with him; after all, I did it myself. More than once I threw away some ‘forbidden’ junk food, then retrieved and ate it.”
Keren (61), a psychotherapist and a senior therapist in the field of eating disorders and addictions in Israel, holds a Masters’ degree in Educational Counseling from the University of Pennsylvania. As well, she completed certification in the areas of family therapy and substance abuse prevention. She contends, however, that LIFE itself has been her biggest teacher. It is her own journey that allows her to penetrate into the heart of her patients. She was ‘there’, where they are now.
From early in her childhood through age 34, she suffered from severe compulsive eating which also manifested in bulimia. “Anorexia, bulimia and compulsive eating are the same ‘jail’. The borders between them help therapists and doctors offer a diagnosis but are often blurred. There are several different manifestations of bulimia alone. Unfortunately, no one identified her disorder. No one connected her obvious sadness to the patterns of her eating and dieting. It took a very long time until she received proper therapy.
Raised in Philadelphia, she was the middle daughter of Rabbi Sidney Greenberg. Rabbi Greenberg, known throughout the United States and in the Conservative Movement in Israel as well, was an intellectual scholar, the author of 33 books and an eloquent preacher. He wrote a weekly column in the Philadelphia Inquirer. Jews and non-Jews came in the hundreds to hear him preach. Ironically, she notes, many of her father’s books were about the meaning of life. The titles include “Hidden Hungers” and “Finding Ourselves”. Outwardly, their family seemed a perfect family. Inwardly, it looked different.
“My father was an extremely serene human being, almost like a Buddha. My mother, who carried the bulk of the responsibility of raising us, was often angry, controlling and judgemental. She spoke to me in harsh tones that grated on my soul. She was, as well, obsessive about food. It was important to her that we would finish all of the huge quantity of food put on our plates. My sisters and I had to drink four cups of milk a day. Once, when a babysitter forgot to give us a cup of milk before bedtime, she was dismissed.
“Eating was the only way that I felt I pleased my mother. But, of course, the overeating itself gave me additional reasons to be angry and sad. I focused most of my rage on my mother. As an adolescent, I thought that my middle name was ‘crazy’ because my mother called me ‘crazy kid’. The more she attempted to control me, the more I rebelled. In the end, I inwardly blamed myself.”
When did you realize that food had such a significant role in your life?
“I started to develop a love-hate relationship with food as far back as my memory reaches. When I was eight, I attended a Zionist summer camp. Away from home and from mom’s demands, I lost 12 kg. At the end of the summer, my bunk counselor said to me: “when you came here you were like a ball and now you are leaving as a girl”. She meant it as a compliment, but it made me realize that others also noticed my extra pounds. Her comment changed my life.”
From that summer on, Keren started to gain and lose weight dramatically. She gained and lost weight at record-breaking speed. Nevertheless, it was the America of the late fifties early sixties. “It did not occur to my parents that a girl who eats and then starves herself was suffering from an eating disorder.” Even at a later stage, when she stopped menstruating, began to loose her hair and teeth decayed, no one appeared to take notice. Feeling much like others who experience a similar suffering, she was ashamed to talk about her secret life with food. Over the years, she lost and gained hundreds of kilograms. At her minimum, she weighed as little as 40 kg. Her weight peaked at more than double this.
What kind of girl were you?
“Sad. I was successful at school, but this meant little to me. When you hate yourself and the way you look, nothing else matters. Today, after 20 years of working with food, alcohol and drug addicts, I know that all addicts are filled with feelings of self hate and guilt.
“In high school I was in a Jewish youth movement. I was part of the leadership. I was a star. But at the same time, I did not date nor did I have a social life. My life was about eating, dieting, running away from myself and my mother. Only many years later I learned what is common knowledge today: a significant percentage of eating disorders stem from a troubled mother-daughter relationship”.
We are talking about the fifties and sixties. What was known then about compulsive overeating, bulimia and anorexia?
“Anorexia nervosa was documented as early as 1800. During most of the 20th century, anorexia and bulimia were the two disorders recognized with, “binge eating syndrome” mentioned infrequently. It was only in recent years that compulsive over eating and accompanying obesity has been categorized as an eating disorder. Today I know that these are forms of addiction. They are all about using food, including self starvation, for emotional reasons.
Did anyone understand what you had been going through?
“No. Maybe to some extent my sisters saw it. Though my parents tried their best to be good parents, neither of them connected the dots. Obesity was perceived in those days as a physical condition and something that you can control. And in my mother’s view of things, a fat child was considered a healthy child. Fortunately, I never became truly obese. (Obese is a person whose weight is 20% above that of a person with normal weight.) This is, perhaps, because all my life I danced, trained for marathons and alternated between binging and starving. Today we know that excessive exercising is a common form of bulimia.
“At home, we were given unspoken but clearly understood labels: my older sister Shira, of blessed memory, was the ‘smart’ one. I was the ‘crazy’ one and my younger sister Adena was the baby. Some years ago I asked my two sisters if our mother was especially tough on me. Both of them answered: ‘yes’. They also saw it. They confirmed that it was not my imagination.”
So, you never went into therapy?
When I was in eleventh grade, my overweight and troubled soul became obvious to my parents. One morning I woke up and my parents announced: ‘today, instead of going to school, we are going for a checkup’. I soon understood that this ‘check up’ was actually a psychological assessment. Following the assessment, I had one session with a psychologist before leaving for a visit to Israel.
“I traveled to Israel that summer on a program of Zionist youth. I remember landing in Israel and remembering the familiar smells from the year I spent here with my family when I was six years old. Wonderful memories filled me immediately after touching Israeli soil! I was happy to return to Israel. I suddenly had a boyfriend friend. Within six weeks, I lost 10 kg. And, to my surprise, my menstrual cycle returned. In short, I had a 2 month reprieve from my inner suffering. When I returned to the United Stated it was decided that I did not need therapy anymore.”
Keren’s disordered eating was still not diagnosed nor was her depression. “I took diuretics, laxatives and ate only when I was alone. No one saw me- literally and figuratively. Bulimia, which includes compulsive over eating, is a secretive illness. I lost and gained weight and my mother seemed not to care because I was eating. This was the best way I could please her. I was also emotionally heavy as I carried the family problems on my back”.
When she was 18, Keren met her husband and father of her two children. Keren and her husband met just before of her first year of university and married a short time later. Her son, 40, is a musician and father of one, who resides in Nashville, Tennessee. Her daughter, 37 and a physical therapist, lives in Rishon Le ’Zion with her husband and three young children.
“My husband was the first guy who loved me. I thought ‘Ok, here’s my chance to get married’. I was very young, and like many other addicts, made bad choices in my life. I was not ready for marriage. I thought I was because together we earned enough money from part time jobs in order to support ourselves. The truth is that I probably tried to run away from my mother.”
When did you understand that you had a problem?
“I do not really know when I made the connection between my eating disorder and my unhappiness. Throughout my childhood, what provided some salvation were the late night chats with my sister Shira, of blessed memory. We talked well into the night about our lives and our souls. But as we spoke we also ate ‘kamish bread’ (mandel bread) which was always ‘in stock’ and in large quantities in our house. At 19, as a young married woman, I took myself to therapy. I knew I needed to fix my broken life. I knew also that I needed to lose weight. At the time, I studied family therapy which attributes the origins of eating disorders to dysfunctional families. In retrospect I now know that I carried my family’s problems on my back the. I was the ‘identified patient’”.
Keren separated from her husband twice. The first time, she was 26 years old. It took them four years to return to each other. In 1981, following her husband in becoming more religiously observant, they decided to travel to Israel for a year. The year turned into seven. Keren, who had been a school counselor in the United States, worked with foreign high school students as an educational counselor and advisor.
How did you manage to have children with such a severe eating disorder in the background?
“During my early years I ate well because of my mother’s obsession about nutrition. Daily portions from the various food groups were counted. When I was gaining weight, it was not only because of eating junk. I also ate lots of healthy food. Only during the years after I gave birth, did I begin to really starve myself and deprive my body of vital nutrients. However, the more I dieted, the more severe my binges became.
In Israel, everything worsened. “I realized that Israel is a difficult country to live in. Because of the stress, inner struggles are intensified. My addiction worsened. I have a very painful story that is difficult to tell, but it illustrates how addiction and binge eating took over my life. Maybe it will help someone to hear it..
“One day, my daughter fell in her bedroom. I was bingeing in the kitchen. I remember exactly what I was binging on. My daughter was in fifth grade at the time and was crying. My addiction was so severe that I was not able to get up out of my chair in the kitchen to see what had happened to her! I continued to eat. And, more than once did I leave my two young children in order to run to the store to buy junk food. I am far from being proud of these stories.”
In 1984, Keren divorced for the second time. “I awoke one night and finally understood that I repeated the story of my childhood in my marriage. I had built another dysfunctional family. I had replaced my mother with my husband. Both of them used the same harsh, critical tones when talking to me. Neither of them treated me with respect.”
During the years, Keren tried countless times to rescue herself. She sought out therapists, spiritual counselors and support groups. In 1979, she heard about Overeaters’ Anonymous, the 12 Step program parallel to that of Alcoholics’ Anonymous but addresses the addiction to food.
“I wore a tent-size dress to my first meeting. I had a broken spirit and was miserable. I wanted to be taken care of. O.A. offered me a program of a daily support and many loving people who experienced struggles similar to my own. I began to combine the tools of the 12 Steps with the insights I had gotten in therapy. Today I know that therapy and the 12 Step Program are different than one another and both are vital for recovery. In my work, I integrate the spirit of the 12 Steps, traditional psychotherapy and other holistic techniques.”
Reena’s life was saved thanks to an appendectomy that she had 26 years ago. “It exposed my secret life with food- bingeing and starving.” This minor surgery uncovered the fact that my body had become severely malnourished. Recovering from this surgery became another turning point for her life. She attributes the disease that attacked her body to her emotional state.
“One Friday, I awoke from an afternoon rest with terrible pains. I was rushed to the hospital and underwent an appendectomy. The operation, whose normal recovery time is a week to ten days, left me sick in bed for three months. An infection began to attack different places in my body. It moved from my teeth to my uterus to my throat etc. As a result of years of abusing my body, I had reached a state of anemia, protein deficiency and malnutrition. Whatever nutrients I did eat, my body could no longer absorb. A series of doctors prescribed antibiotics for each infection, but the medicines only weakened my body and did not prevent me from getting sick again and again. I lay in bed with quite a desperate body and soul.
“Finally, after much searching, I found Dr Moshe Berman who was a medical doctor and also a naturopath. He had an enlightened approach to health and was the first doctor to understand that my problem was both related to food and to my emotional state. I still remember his words, 26 years later: ‘No medication will help you; you have to learn to eat again’.
“I surrendered my insistence on trying to control my food. I listened to him and understood that I was exhausted and completely without control of my life. Admitting this is the first step of the 12 Step program and of my rehabilitation, as well. The more an addict tries to control of his/her drug of choice, the worse the situation becomes.
“The doctor started me eating soft white cheese because that’s all I could digest. Gradually I began to eat other foods and very gradually I regained my health. I feel as though I am still making a ‘tikkun’ on my health. But most important is the fact that I concurrently started an internal process. I began to make significant changes in my life. Changing one’s life is what really allows an addict to recover.
“Today, I know the difference between using versus eating food. Today I can buy a piece cake or cookies or what ever, but I will eat them only when I am emotionally calm. In the middle of emotional turmoil, eating is very tricky. When I realize that I am in any kind of emotional stress, I will stay with foods that are considered “safe”. In her private clinic, she teaches that “there is no forbidden food! What is forbidden is to use the food to deny our feelings.”
You actually got divorced only when you had become healthy.
“To begin the ‘tikkun’ on my life, I understood that divorce was the first change that needed to be made. I had done everything that I could to save the marriage but realized that I could not be healthy there. What finally convinced me that there was no other choice was when the tension was so intense that, for a one week I lived on milk and Valium. I did not do this in order to loose weight! My body had learned not to eat when in emotional stress. And this stress was unbearable. Nothing would go down.
“When I divorced, many other things in my life began to change as well. Without ever consciously deciding to do so, my work began to change. I began giving workshops incorporating movement, music and guided imagery. I used all of the techniques and tools that brought me inner peace! I had danced almost since I was born. And during my journey I learned that there is no separation between body & soul. They are one. So workshops inevitably began to include movement.
“The day my recovery began, so did a deep commitment to becoming a better mother for my children. I tried to make up for everything (emotionally) that I had denied them when my addiction ruled my life. For the most part, it was about ‘dishing out’, in huge quantities, unconditional love! Today my efforts to love them unconditionally and to become a better and better mother still continue in a very conscious way.
“I know I have an addiction”.
Twenty six years have passed since Keren started the process of her rehabilitation. Since then, she has treated dozens of drug and food addicts. “I also treat people, especially Anglo Saxon immigrants who want to increase their sense of well being.” She has worked as coordinator of volunteers in the non-profit organization ELEM (Youth in Distress), where she rehabilitated drug-addicted, homeless people; she served as a psychotherapist for drug addicts and alcoholics who were incarcerated in Ramle Prison. As well, she has worked in the department of eating disorders at the Schneider Children’s Medical Center for Children. During the years, she gained qualifications for the position of a qualified counselor for substance abuse; she completed a family therapy certificate and studied at the Child Guidance Clinic, in Philadelphia pioneers in the field of eating disorders were teaching. She studied movement therapy in Leslie College and Haifa University, as well.
She calls the therapeutic process that she developed “Life Dance”, with ‘life dance’ being but a metaphor for our lives. “Each one of us has a ‘life dance’”, she notes. Understanding the healing power of music and movement, Reena incorporates them into her work. Included also are guided imagery and journal writing. “I give lots of homework! It helps make the process more significant”.
Today, she is writing a book already entitled “You transformed my sorrow into dancing” [hafakhta mispadi lemahol li]. This verse, taken from Psalms, 30:12-13, has become the motif of her life. She transformed her own sorrow into a peaceful and even joyous existence.
Reena gives workshops and lectures “The Hungry Soul”. In recent months she has begun to work with severely obese patients who are considering gastric “LAP BAND” surgery with Dr Eliezer Avinoach of Assuta Hospital. In group sessions called “What’s Eating Me?” she tries to help them understand that the physical solution is only part of the process. For the long run, emotional and spiritual efforts must accompany the quite drastic operation. “Among other things, you must build a new relationship towards yourself and towards food.”
At the entrance of her apartment in Tel Aviv, an antique heirloom welcomes guests with the prayer: “Shema Yisrael”. The prayer is hand written and translated into several languages. “Often I encourage clients to say ‘Shema’- Listen to yourself’!! Hear your physical and emotional hungers!” She explains why this prayer has become the motto of her life. “People use drugs or food because reality is painful. They anaesthetize themselves so that they do not have to HEAR. An addict escapes from himself because he cannot cope. Today I know that the way out involves our reconnecting to ourselves on all levels. To recover means to take responsibility for yourself- for your feelings as well as your behavior. Recovery, as opposed to addiction, is not a ‘quick fix’. It takes time. But it is forever.”
What is the difference between eating disorders then and today?
“The pace of today’s highly technological society is so incredibly fast- almost inviting addiction, as I call them a “quick fix”. Children and adolescents these days are under constant pressure to become slim. When I was growing up, girls did not necessarily dream of becoming models. Today’s efforts to be slim too often result in disordered eating, while, historically, the root of the disorders was the dysfunction of nuclear families. Despite parents’ best efforts, children today often grow up emotionally starving. With little control over their lives, I see children as ‘victims’. When a parent does recognize his/her limitations or his/her child’s distress and says: ‘We will get you help ‘, this child is lucky”.
How can you rescue a girl who has anorexia for many years?
“Anorexia affects not only girls. That is a very common misunderstanding. Ten percent of those suffering from anorexia are male. And, when it appears in males it is most often more severe. I knew two young men who as a result of this disorder. In all cases, family therapy is best combined with individual therapy. In my childhood, including family therapy was more common practice. But no one thought that our whole family needed therapy. I carried the dysfunction. I was, what is known in family therapy terminology as, ‘the identified patient’. An anorexic male or female can transition into compulsive overeating and obesity or vice versa. Like with any emotional or physical disorder, early detection increases the chances of a full recovery.”
What helps you today to remain outside the eating disorder cycle?
I do with myself exactly what I do with my clients. I never allow myself to take my recovery for granted. I have an addiction, and as long as I nourish my body/soul, I will be able to continue my precious recovery. Movement is of critical importance- all kinds of movement. We need to move for our souls! ‘Therapeutic movement’, moving in repetitive motions like walking & swimming, is very helpful for quieting our insides. It affords us the opportunity to identify and say ‘hello’ to our feelings. Repetitive, mindless movement allows the subconscious to surface and to release stress. If I feel ‘inside out’, it helps a lot to go for even a very short walk. This helps to regain body/soul balance. The right/left, right/left repetition helps to awaken our wise inner voice and to figure out what we need at a particular moment. This is the way I live. I am not a psychotherapist who lives a messed up life. Each day I try to repair myself. I continue my own ‘tikkun’”.
What relationship you have today with your mother?
“I have forgiven her indeed! My mother always says that she gets an “A” for effort. And she does. She did her best. Today I understand that she did not mean that I was a crazy girl, but a special one. Today we have a wonderful relationship. Each of us not only loves but appreciates and values the other so very much. And I am so keenly aware of her unselfishness because, despite the fact that I live so far away from her, she is happy for me because she understands and respects my need to live in Israel.
But what is most important today is beyond knowing that I am not crazy. Today I know that I am special. Indeed, I have paid a dear price to learn this.”
[i] Tikkun is a short form of Tikkun Olam – repairing and perfecting the world. The imperative to repair the world reflects the Jewish values of Justice (tzedakah), Compassion (hesed) and Peace (shalom). The concept, originally formulated by Rabbi Isaac Luria in sixteenth century Safad, has come to symbolize the quest for social justice, freedom, equality, peace and the restoration of the environment. For me, it can be understood on a very personal level. To bring tikkun to our lives we must treat ourselves with hesed. This is the way to bring inner peace. As well, we can achieve inner peace if we live in accordance to our own, inner truth.
Laisha Original Interview w Reena Keren
Until the mid-’80s, Keren, a native of Philadelphia, had been a compulsive overeater for nearly 35 years. “I couldn’t tolerate my feelings,” she explained. “I’d go into a binge for two hours, and after, I’d be disconnected from the pain. [Eating] helps you forget, but if you forget, you can’t deal with the feeling.”
Keren described eating disorders as “living in prison.” But 27 years ago, after a series of life events helped her “break free” of her own shackles, she began developing a therapeutic approach to anorexia, bulimia, and compulsive overeating, based on what she had learned in her own journey. The approach, which she calls “Life Dance,” combines expressive therapies, traditional dialogue, music, writing, meditation, and “conscious eating” to help her clients learn new ways to cope with their emotions, whether in group workshops or private sessions. Having recently returned to Israel after an absence of several years, Keren is now helping Israeli adolescents as well as adults overcome the emotional demons underlying their physical illnesses.
Keren, echoing other experts in eating disorders, says such illnesses stem not from ignorance over what constitutes a healthy diet, but from emotional traumas and self-hatred. “Any kind of discomfort,” she said, “pain, rejection, even physical discomfort, all translates into hunger, a need for food.
“There is self-hate in all the eating disorders,” Keren continued. “A lot of [my approach] is dishing out unconditional love. Patterning it, modeling it. Helping them understand there is a reason they started to hate themselves … you can’t just say `ok, love yourself.’ That is too simple.”
Survival kits
A typical Life Dance workshop is accompanied continuously by soothing music, such as variations of Pachelbel’s Canon. Participants are guided through breathing exercises, slow movement, and guided imagery in which they picture themselves healthy and happy. They then move on to journal writing and expressing their feelings in drawings, using crayons and pastels. After a segment with traditional psychotherapeutic dialogue, there may be an exercise in which the participants choose from a variety of foods and practice eating. Each workshop ends with a “dance of joy” and a homework assignment: to create a “survival kit,” a list of healthy alternatives to binging, starving, or vomiting. Elements of the 12 Step program for recovery from addictions are woven into both group and individual sessions.
A 17-year-old from Tel Aviv, O., who has been under medical care for two and a half years for fasting and vomiting, told Anglo File that her weeks in Keren’s workshops has “helped me accept myself and make a new connection to food. I love Reena and the other girls. Reena knows what it’s like and she’s seen it all. She really understands.”
Keren said the breathing and movement exercises are one of the most important aspects of her approach. “The connection with their bodies has been broken,” she explained. “They don’t know when they are hungry or when they are full. The activities help the person connect with her body, listen to herself, hear what’s going on, and to start to express it and move with it.”
The exercises in which participants eat food also strengthen the mind-body connection, Keren said. In this component of Life Dance, participants learn to differentiate between different types and levels of hunger, and to pay attention to what foods appeal to them in that moment and why.
A metaphor for pain
Keren admitted that none of her techniques are unique, but said the combination of different exercises in one setting is her own creation. The name “Life Dance,” she said, is a metaphor for all the emotions and experiences that make up a person, including one’s eating patterns. “Each of us has a different Life Dance,” she said. “The premise [behind my approach] is that a person will ‘dance’ with food, whether starving, throwing up or overeating. It’s really a metaphor for the pain in their life.”
Keren is the daughter of Rabbi Sidney Greenberg, who was a prominent figure in America’s Conservative movement until his death in 2003. Keren’s own life dance included marriage at age 19, two children, divorce, several moves between the U.S. and Israel, and degrees in education, counseling, family therapy, and movement therapy.
A health crisis in 1984 brought on by a severe protein deficiency and malnourishment “uncovered my secret that I’d been abusing my body for 34 years,” she said. While on bed rest for three months, she gazed every day at a wall-hanging in her bedroom with the words of a traditional prayer – “Hear O Israel, the Lord is our God, the Lord is One” – and decided it was “time to hear myself,” she said, “I have to live consciously. I can’t afford to fall asleep.” As she learned to listen to her body, her specialty in eating disorders grew and her approach evolved. Over time she gave thousands of workshops, including “Jewish Life Dance,” which incorporates texts and traditions from various holidays.
Galia Rabinovitz, an expert in child psychology and Gestalt therapy at Tel Aviv University who is familiar with Keren’s work, told Anglo File that Life Dance is “as successful as any other therapeutic approach, which in eating disorders is very good.” Generally, she reported, only about 10 percent of those with eating disorders see significant improvement through psychotherapy; Keren’s clients have an improvement rate of approximately 30 percent, she said, closer to the improvement rate among those who undergo psychotherapy overall.
“It doesn’t always help me, but it is helping,” O. said of Life Dance. “When I feel upset, I leave the house instead of throwing up. It’s giving me new choices for how to live my life. It’s very liberating. Slowly, slowly maybe I’ll succeed.”
Haaretz Magazine, August, 2004
