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The Use of Mandala in the Treatment of Eating Disorders: The Journey of the Soul from the Symptom to the Symbol

The Use of Mandala in the Treatment of Eating Disorders:
The Journey of the Soul from the Symptom to the Symbol

by Anna Scelzo, PsyD, MSc, LCP, LSATP


Mandalas entered my life about 30 years ago. At the time, I was studying at University and was traveling to Milan each day using the underground. In that place, down in the earth, where each day millions of people used to go back and forth just looking at their feet and wanting to meet the outside world by reaching their work or study place, there was a bookshop. The owner was a man with a long white beard and a strange gaze, one of those gazes that go right into your Soul and seem to read everything that is in it. Or at least this was my feeling.

That period of time was not one of the happiest for me and finding that bookshop was something that “magically” opened up my heart and made me see beyond my feelings, well beyond the constrained world of my sadness. There I met Mandalas. I didn’t know anything about them except that Jung (C.G. Jung, the Swiss psychiatrist and analyst) had contributed greatly to the knowledge of Mandalas by studying and using them in therapy.

Later, I read that Jung had once written that mandalas usually appeared in dreams to children or adults who were living particularly important moments in their lives, in which they were facing changes or were elaborating traumas, (this is the moment when a person starts to become aware of the link between her traumatic experience and the symptoms shown by the body and the mind). I sort of thought the “appearance” of a mandala was a way the psyche could heal itself when suffering. In Memories, Dreams, Reflections (Vintage Books, 1989, p. 196.), Jung wrote: “The self, I thought, was like the monad which I am, and which is my world. The mandala represents this monad, and corresponds to the microcosmic nature of the psyche”.

What Jung was mentioning was the spontaneous process by which a mandala comes into an individual’s life by bringing to light the conflict the person encounters in her/his inner world and a way to integrate this with the outer world. As we know, people usually experience an inner conflict which is not normally understandable straight away by the person and therefore, this comes out through the symptoms. This may be especially true when those symptoms arise from the psyche and are shown through the body by touching one of the things that human being in his/her entire life for centuries has considered the most natural thing in the world: Food.

How can we express by “simple” words the battle that a person is living inside herself when she finds it so difficult to nourish her body in a ‘natural’ way? How can she tell why this happens and how can she make other people understand she doesn’t mean to be nasty to parents or relatives when she refuses food? So, people suffering from an eating disorder, especially adolescents, find it very hard to express their feelings of fear and their thoughts of denial: emotions become frozen as if they are hidden deep down in the bones of the body.

When this happens, everything becomes all so real, so concrete, so material because everyone is concentrating on the fact the person is not eating or eating too much or vomiting, all behaviors that are categorized as “crazy,” or just “not acceptable,” or “sociable”. Well, in a way that is true, since the person suffering from an eating disorder hardly wants to enjoy herself. On the contrary, she will confine herself in her dark room or she will put a mask on her face so that no one will detect her secret tears.

If we look at this scenario from the inside, we will likely be overwhelmed with feelings of confusion, rage, despair, and anxiety. This density does not allow one to listen to the pain of the soul, and so many times even words can hardly give shape to this pain.

This is why at a certain point I started using Mandalas with my patients. The aim was primarily to allow the subconscious parts of the Self to come out and be expressed in a way that was not judgmental, but open and welcoming. Those parts are usually the ones that contain pain, rage, despair and that the person has, most of the time, felt were to be rejected or removed because these are feelings that people are, oftentimes, afraid of. Generally, from the history as told by my patients, I can understand that since they were quite young they have had the feeling of being “wrong” or that what they felt or said was not acceptable and therefore, they had to change their attitude towards life and others. Melanie Klein talks about the ambivalence of the mother who sometimes fails to be a “good container” for her child’s fear or distress, by giving a double message which generates confusion and creates a conflict between what “is felt inside” and “what should be shown in the outside”. This is where, I believe, eating disorders can arise. This area is the field where insecurity and body image misperception grow, the field where desires and needs get confused.

By drawing and coloring a mandala, the person can come in contact with her inner Self, thus allowing the birth of an intrapsychic relationship and therefore, a dialogue between the Unconscious and the Conscious, with the aim of creating an integration of the parts.

This is also connected with an important process which is the process of symbolization. I think that nowadays many adolescents are losing the ability to access their creativity since they live most of their day using virtual media or social networking. Those are the ‘places’ where their bodies are being pictured and virtually manipulated in order to fit the ‘social standard of beauty’. Those are the ‘places’ where life is lived in a bidimensional way, thus neglecting the variety that gives a non-virtual relationship. Those are the ‘places’ that are lived by many girls and boys suffering from an eating disorder, apparently smiling but with a heart and a body full of shame and pain.

What is a Mandala and why did I choose it in the specific therapy of eating disorders?

 “A Mandala is an integrated structure organized around a unifying center” (Longchenpa).

The word “mandala” comes from the classical Sanskrit Indian language and means sacred circle.

In many religious practices, mandalas are used to create circular images which are then used in order to create a holy space suitable for meditation or for dancing rites. We have all seen pictures of Buddhist monks drawing wonderful mandalas on the beach with the sand and then dissolving them in the air giving this process a particular meaning. Jung said that we can also find mandalas in some important dreams where conflicts are expressed and sometimes include psychopathologies, like schizophrenia. A mandala represents an alchemy, a combination of the four elements with opposite strength (water, fire, air, and earth). Jung found that a mandala could appear spontaneously in a person’s life and when this happened it had an important meaning: it was providing a significant message to the person. He wrote that in particular, children between the ages of 8 and 11 whose parents were in a difficult moment or adults living in a particular neurotic phase, could be interested because they were dealing with a conflict between two opposites. They were disoriented and profoundly disturbed by the inability to decide which strength to follow, which path to choose. Individuals with schizophrenia normally experience a version of a world confused and altered by the presence of unconscious contents which are not understood. These experiences clearly show the lack of something that can help one feel contained or held by someone or something. The mandala with its circular shape imposes an order, a determined line that can compensate the disorder and the confusion of the psychic state.

Jung felt the mandala a person spontaneously drew in any given moment was a gentle reminder or an urge to express his/her own potential, something that could lead him/her to individuation, the process that allows a person to be what she/he really is and that helps differentiate her/him from others (family, partner, friends). Jung wrote:

Mandala is the construction of a central point to which everything is related, or by a                      concentric arrangement of the disordered multiplicity and of contradictory and irreconcilable elements. This is evidently an attempt at self-healing on the part of Nature, which does not spring from conscious reflection but from an instinctive impulse. […] These situations are intense inner experiences which can lead to lasting psychic growth and a ripening and deepening of the personality. They are the age-old psychic experiences that underlie “faith” and ought to be the unshakable foundation – and not of faith alone, but also for knowledge” (Jung, Man and his symbols).

The circle (or the square) of the mandala contains a central point and these two points, the center and the circular line, are strictly related to each other: one does not exist without the other and this relation gives a sense to what is inside of it. Let’s use an example from our lives: we wake up in the morning and go to work and do all the things we do in our daily life. What we also do is go back home at night and there we find our family, our pets, our personal belongings. We depart towards the boundary (the circular line) and then we always come back to an inner center. We need this and we have learned to do this safely (as Bowlby teaches!) creating a healthy attachment with our mother or care-giver: we, as children, go exploring the environment and then we go back to our loved ones where we can find reassurance, comfort, love, holding. Holding…. We need to be held, we need to learn how to be held by others and we need to know how to hold ourselves when the others cannot do this (for various reasons). The mandala with its shape can help this process of holding when everything else around the person fails to do so. Jung found that the spontaneous process of dreaming or drawing a mandala represented an attempt made by nature itself to heal the person. This is not clearly a conscious process but rather comes from instinct. The mind ‘fishes’ from the unconscious world an ‘archetypal’ image, that is a primitive and fundamental scheme which belongs to all of humanity, and not just to the individual inner world of a person. We all know what an ‘archetype’ is: ‘nothing else that a determined formal aspect, frequently present, of the instinct, given a priori’ (Jung), so we can find in the mandala a special conformity.

By drawing a mandala, I have often found that patients give life to forms and symbols which attempt to represent their Self. Sometimes we can find this through the representation of a mandala where one half is clear and the other half is dark or one half is calm and the other half is rough. Here is an example.

Clara (fictitious name) started this mandala because she said she did not want to eat (her diagnosis was Binge Eating Disorder). We can observe that in the center there is a wide open mouth (the hole with teeth all around) and inside we can see pieces of glass (as she will tell me after the session). But Clara doesn’t like those cold glass pieces, therefore, she draws nice little flowers of which she only likes one. Regarding her mandala, Clara wrote: “The center is a wide awful hole that holds in it all the pieces of a glass: the food that I love so much and I hate so much… the food which fills me so much and that hurts me so… I have deep wounds into my soul. The big hole represents the emptiness I feel inside, the pieces of glass express my rage and feelings of violence. How many things I would like to say but I know that my words could hurt the people that say they love me and I could not bear it. So I prefer to punish myself for what I am thinking.” The little flowers give a glimpse at the attempt Clara is making to leave the outside image of herself nice and clean. As a matter of fact, Clara smiles. She is always smiling. The center of the mandala clearly shows her fragmented Self.

Normally, the drawing, as well as the sign and the symbol have the fundamental function of being an energy transformer (Spotti, 1991), that is, to allow a process in which the essence of a person is able to evolve, to renew itself, and then to transform what is already there but needs to grow and become more able to live the complexity of life. In the life of someone with an eating disorder, especially anorexia, this process of transformation is often blocked, as if it has been buried deep down in the Soul. This often has the effect of stopping the growth of the part of the person which is linked to sexuality, here seen as the impulse towards life, as a transformative attitude: if a girl does not eat properly she will lose her feminine characteristics and block the process of becoming a woman.

The round shape of a mandala often recalls for the women who work with me, the shape of the womb, or that of the tummy, thus reminding of the feeling of a warm motherly hug.

Description of a session

“A mandala consists of five “excellencies”: the teacher, the message, the audience, the site, and the time. An audience or “viewer” is necessary to create a mandala. Where there is no you, there is no mandala. (You are the Eyes of the World, by Longchenpa, transl. By Lipman and Peterson)

A Buddhist Mandala

The first thing a patient tells me when I propose to work with mandalas is: “Oh, but I am not good at drawing!” And I always smile reassuring them that coloring a mandala does not require any technical skill but just curiosity.

And they become curious!!

Mandalas can be used both in individual sessions or in group therapy.

In both therapies, I usually start by giving people the opportunity to choose a mandala among drawings already prepared and which only need to be colored.

They are all different. Then at the very beginning, I put on some soft, relaxing music which often reproduces natural sounds (like sea waves, or the singing of birds, or the sound of the wind). I also provide all sorts of colored pencils.

Then, all I ask the patients is to quietly color their mandala and when they finish, to write something on the back of the sheet (a thought, an emotion, a memory, a feeling, a poem, etc.) and to wait for the others to finish if we are in a group session.

At the end of each session, I always allow enough time to share thoughts and feelings about the experience. A session can last up to two hours.

Silence is a key element in order to quiet the critical voice inside their heads and to allow room for new feelings to be felt.

Here is an example of a mandala drawn by a patient at the very beginning of her therapeutic path with me. She suffered from bulimia and had undergone the terrible trauma of sexual abuse along with a childhood with a mother who was alcoholic and a father who was not known to her.

Stephanie (fictitious name) had never talked to anyone about her trauma. She had deep feelings of shame and anger. Here is her first drawing:

During the session, she never looked at me. Her hands were shaking. The colors she chose to represent her trauma are clearly marking her wounds. She came to say that she used red to represent the blood, the pain, the wound, but also the swords that penetrated and hurt her; while black was the tar (as she defined it) with its viscid, slimy, indelible mark, something that cannot be cancelled.

Black is also depression, chaos, a prison that surrounds her in a deadly war.

Black surrounds red: the pushing forward for life is completely imprisoned while the unforgettable event of the abuse gives her constant pain represented by the swords that plunge into her heart.

In the center, a black hole represents a Self which is trapped in a chaotic depression (mixed with anger).

After the session, Stephanie said: “Finally, with this drawing I feel I can “see” my pain, the picture of what happened. Nice or ugly, these are my true colors. I must learn how to use my resources and learn how to touch myself inside; through my mandala I can finally reconnect my thoughts with my emotions (the colors) and find a way out.”

Stephanie drew many mandalas and our therapy lasted nearly 5 years and ended with a complete remission of the symptoms of bulimia. She was free. When we met for the last session I asked her to choose a mandala and she created this:

At first glance, we probably won’t recognize that the mandala chosen by Stephanie is the same as the first session. But just look at the colors!! Red and Black are still there but with different shades and in different positions and therefore, with a different meaning. Flourishing in life is expressed and is no more blocked by the reminder of the abuse which is always there, but in a way that does not obligate her to be trapped and where she feels free to make other choices for her life. The great change can be seen in the presence of the blue in the center thus testifying to the process of the birth of her Self through the release of her unconscious material. She finally feels free from anger and rage. Here red means energy that gives her the strength to fight for her own identity.


Using mandalas allows opening to the awareness that the symptom is not a static status of the person, on the contrary, it has in it an energy that, when supported, becomes a means to transform our lives. Many times, people who have an eating disorder, (especially when this illness is active over a long period of time), feel that it is so difficult to change.

Mandalas gives a Hope. They empower the person to see her pain, stay in touch with it, learn from it, and then release it by learning a new way to overcome the fear of feeling his/her own emotions and to grow safely by building healthy relationships with the others.

Bringing mandalas into the treatment of my patients with eating disorders has been a privileged experience. My patients have allowed me to be part of their private worlds which often held them back from living full lives. Their transformative work has led them to realizations they cherish and grow from. My gratitude goes to their efforts and those of the great thinkers who shared the potential of mandalas.

About the author:

Dr. Anna Scelzo is a clinical psychologist and psychotherapist. She has been working in the field of eating disorders for 15 years and she is a lecturer both in Italy and abroad. She coordinates a day-practice at a local hospital for the treatment of ED in Italy and has a private practice in Chiavari and Genoa. She is founder of Shasta Association dedicated to the prevention of eating disorders and body image issues through work in schools. She is member of the British Psychological Society (UK) as well as SISDCA and AED. Since 2009, she has been a member of IAEDP and now Chair of the International Chapter in Italy. She is author of the book “D(e)i-segni dell’anima. L’uso del Mandala nella cura di pazienti con disturbo del comportamento alimentare” (ed. Zephyro, Italy) about the use of Mandalas in the treatment of ED.


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