The Secret Language of Eating Disorders
The Revolutionary New Approach to Understanding and Curing Anorexia and Bulimia
By PEGGY CLAUDE-PIERRE
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My journey as a therapist for eating disorders seems, in retrospect, both planned and spontaneous. I knew from a young age that I would become a psychologist. The well-being of the world's children has always been my primary focus.
As a young woman, I was fortunate enough to have two incredible daughters. When they reached early adolescence, I resumed work toward an advanced degree in psychology at the university. I ended an incompatible marriage and moved to a new town to accelerate my studies, leaving behind a comfortable home for a small apartment. I had planned to have Kirsten, then fifteen, and Nicole, thirteen, join me, but Kirsten initially stayed behind to live with my parents and finish her school semester.
It was during those intervening months that Kirsten developed anorexia. One evening, my mother alerted me to the problem of my daughter's diminishing weight. Kirsten was studying until two or three in the morning, which was not unusual since she had always been a hardworking student. But my mother had noticed that Kirsten had large dark pools under her eyes, and she had lost a tremendous amount of weight in a short period of time. Hearing this, I asked Kirsten to join me.
When she walked off the plane, I was shocked to see that my daughter, who was five foot nine, now weighed less than a hundred pounds. She must have lost over twenty-five pounds while we had been apart. Going back to school was out of the question; she needed help--now. I told her, "Honey, you know you are staying with me."
She just looked back at me and said simply, "Yes, Mom, I know."
Under the surface, I was in a state of panic. I immediately took Kirsten to a doctor to check her electrolyte balance. He was the first in a procession of professionals. They all told me the same thing: Kirsten had anorexia and there was no cure for it. At best, an anorexic lived with it--that was called maintenance.
"How serious is it?" I asked. I knew the mortality rate was high. The doctor shook his head to indicate that Kirsten's prognosis was bleak.
I started reading everything I could about anorexia. I wanted to discover how I had failed this child. "What did I do wrong to make her hate herself so much?" I asked over and over again. Until I understood that, I would not know what the right help was. Everything I read told me that bad parenting, childhood trauma, sexual abuse, and a string of other "issues" were the cause.
Had our temporary separation caused Kirsten's illness? I felt remorse and extreme guilt. Naturally, as a single parent I assumed total blame for my daughter's illness, and the ensuing parade of psychiatrists did nothing to change my mind.
However, I balked at the psychiatrists' conclusion that Kirsten was being manipulative and selfish, that she was losing weight on purpose to get my attention. I had known this child all her life; I could not accept that she could change so radically from the kind, giving person I had always known her to be. Kirsten had always been unusually sensitive to and aware of other people's needs, in fact she was diligent about attending to them.
I asked my daughter to explain what she was thinking and feeling so I could understand how to help her. She told me that there seemed to be some other louder thought pattern in her head that made no logical sense. Yet Kirsten had always been a very logical child. It became obvious that she did not understand what was happening to her and was powerless to stop it. She said she felt she was going crazy. The medical doctors told me that she could not go on much longer in this manner.
I soon became aware that Kirsten felt terrible guilt about anything connected with food. Whenever I tried to persuade her to eat, she either refused, or tears would roll down her cheeks while she struggled to force the food down to please me. I remember taking her to a restaurant for a muffin. She ate it, but as we were leaving, I could tell she was feeling immense guilt about it. As we drove away I asked her, "Kirsten, I'm good enough for a muffin. What makes you think you're not good enough for a muffin?"
We stopped at a traffic light. She said, "Mom, see that light over there? You see that it's green. Logically, I know it's green, but my head tells me it's red, and I'm not allowed to go. That's the best analogy I can make for you about something that makes no sense to me. That's why I'm doing something so illogical."
She gave me similar clues about how her head operated. Later I realized that Kirsten's traffic-light analogy first made me understand that two minds were warring inside Kirsten's head. She was a determined person, and I kept trying to persuade her to fight against whatever force was barring her from eating in peace.
The first two months were the most frightening. Occasionally at night, while Kirsten was sleeping, I would go quietly into her bedroom to check on her. Under her blankets, she was skeletal. I would slowly replace the blankets so she would not know I had been there, and she would not be concerned about my worry for her. It was hard to believe that she could survive; she was down to about eighty-four pounds. Fear almost paralyzed me.
She told me sadly one night, "Mom, you've never lied to me in your life, so I'm going to listen to you, even though the pressure is more than I can bear sometimes. Everything in me tells me not to trust anybody or anything at this point, but I've always trusted you. I'll continue to trust you, whatever it takes." To this day, I know that's what brought her through, and I stand in awe of her incredible courage against the unbelievable negativity of her mind.
In retrospect, I realize that her decision to trust me unconditionally was the turning point. She kept going to the doctors because I asked her to. Over the next six months, I worked with her every day. She even came to my university classes with me; I was loath to let her out of my sight. Intuitively I knew she should not be alone; otherwise this negativity, whatever it was, would gain strength in her mind when she was by herself.
After every meal, she would talk to me about the illogical thought patterns she could not get out of her head. She was direct about how she felt. Sometimes, she would look at some minuscule bit of food on her plate and tell me, "Mom, this hurts so much. I shouldn't be eating it. I should be eating a quarter of it. That's all I deserve." She felt almost subhuman, less than the rest of us. She never knew why she was less deserving, but she just knew she was.
In the first three or four months of her illness, Kirsten was suicidal and frightened, as if eating had some great negative consequence. I talked to her constantly. She was gentle, never abusive. Together we tried to work it out. For every illogical word or act, I responded gently with a logical discussion of the reality of the situation.
She cut off her hair and dyed it purple. At the time I did not pay much attention because I saw it as a natural consequence of being an adolescent. She dressed in layers as though she were trying to arm herself to fight the world; her natural gentleness began seeping away. It was as if she were on a search for self as she kept trying on different modes of appearance. She would wear outside what she seemed to lack inside for strength. (I would later learn that this is characteristic of many people with eating disorders.)
Since we had just moved to a new city, initially she no longer had any friends. I noticed that this normally outgoing girl did not even try to make new ones.
She became extremely agitated. She had to move all the time. If she needed to stay in one spot, she would walk in place; she could not sit in a chair without jiggling around excessively. She exercised all the time. I did not think that was such a problem, so I was not as on top of it as I might have been. Later I would know better.
Several times Kirsten made statements that told me she perceived herself to be the adult in the situation, capable of making decisions that seemed rational to her but were anything but. At other times, she would say, "Mom, just let me go, just let me die. This is too hard; I can't fight it." I never heard, "Mom, help me." She never asked for help; I gave it to her, but she did not feel she was allowed to expect it.
She would never say that she was worried about me, but she was always trying to make life easier for me.
Then Kirsten started losing the ability to make any decisions, any choices at all; it was as if she had lost faith in her ability to choose. She second-guessed every possible decision or choice. When I asked about her preferences, she would respond, "Mom, what do you think?" "What will serve other people better?" She could not make the simplest choices about the most basic issues: what to wear, what restaurant to go to, what to eat. She was unable to create any of her own structure at all.
It was such an unrelenting nightmare. Not only was I terrified that my daughter was losing her life, but I was convinced I was the cause of her torment. Everywhere I went, I felt and accepted the stigma. The public knew that someone had to be blamed--the parent, the child, or both. I was overcome by the numbness of hopelessness. How could my child be dying in front of me? I knew I had to do something, but I did not know where to begin. The information I was getting made no sense. So little of it seemed to apply to Kirsten. Certainly, I would not accept that my daughter's anorexia was incurable. On occasion I glimpsed an idea that felt right, but essentially I felt terribly, terribly alone, left to stumble along an unfamiliar road in a strange country, whose signs were in a language I could not understand.
I found myself of two minds. On one hand, I was petrified that someone could live with such agony--I was witnessing an emotional state that was unspeakably cruel on a continuous basis. On the other hand, I was irritated that I had allowed myself to see doctors as gods; I had expected physicians to have an answer for everything. Of course doctors are not wholly responsible for this deity complex; we put them on the pedestals ourselves. But how could I accept it when they told me my daughter was going to die, that she could never be cured? How could anybody give up on a psychological illness?
The doctors' explanations of Kirsten's illness were based on happenstance and theory, not on strict experience. I had so many questions: Why does an eating disorder affect one child and not another in the same circumstance? I had read that most siblings of anorexics did not get the illness themselves. Did sexual abuse cause it? I knew that Kirsten had not been abused. Family trauma was another commonly cited cause, but I knew that my daughter viewed my divorce as a positive event, not a traumatic one. I started searching for venues that would prove these issues to be the cause because I wanted desperately to find an answer that could reverse the consequences.
Never was I convinced that anorexia was primarily about weight. When Kirsten was sick, she expressed fears about getting fat, but it was not her main focus. She was much too composed to complain about her looks. She would tell me, "I need to be thinner. I don't know the reason why," and then she would start to cry.
Given the public view that anorexia attacked adolescent girls, a group famously obsessed with looking right and fitting in, I assumed--wrongly--that Kirsten's illness was in part bound up with concerns about body image. I now know that anorexia does not depend on gender, age, or looks.
I considered taking Kirsten to an eating disorders clinic. Every one that I investigated had a program based on behavior modification. The theory was that if you changed a person's actions, you would change the person. At these clinics, the therapists taught the patients that there were consequences to their behavior. They were given specific goals, such as finishing a particular dish, and told that if they did not achieve the goal, there would be a consequence or punishment. They would be prohibited from seeing their parents, using the swimming pool, or engaging in some other enjoyable activity.
I felt intuitively that I had to separate Kirsten's actions from their consequences. My daughter was experiencing such intense punishment internally already that for me to inflict more would be counterproductive to her recovery. Logically, behavior modification did not seem reasonable, at least for this child.
For six months, I talked Kirsten through every meal and prepared all of them myself. At each meal, I would distract her with funny stories to take the onus off the fact that she was eating.
Kirsten's little sister, Nicole, was an enormous help; she did everything to please her sister. She spent every spare moment sitting with Kirsten, talking and joking with her, giving her things, trying to make a difference. Nicole became a completely selfless person during her sister's illness and stood by her with every possible fiber of her being. I would later realize that she was being inadvertently set up for her own fall.
We combated Kirsten's illness with unconditional love and support. I refused to react to any rare bad behavior except with soothing statements like "I know you didn't mean to do that." I would never get angry under any circumstances. Intuitively I felt that something in Kirsten was testing me to find out how willing I was to be there for her. Kirsten was trying to let me know that she deserved nothing, but she was so gracious that the signals were not always apparent. It was a successful day if I just kept her alive.
I was becoming more and more physically exhausted. I felt it was unsafe for me to sleep. What if something happened to Kirsten when my back was turned? I had tried to engage yet another specialist for insight, but he had neither the time nor the inclination. He was probably exhausted and disillusioned himself from the dearth of answers. "You're just one of many. I have no time," he told me, and I was devastated.
I felt that I was operating on base instinct. If I could only find the cause, then I would know how to reverse Kirsten's anorexia. I used to comfort myself with this thought, but in my more selfish moments, I longed for some respite. I lived in a void of uncertainty and desperation. The most lonely thought is that there must be an answer, but my daughter might die because I could not find it in time. I fought for my own sanity during this time as much as I did for Kirsten's.
Ultimately, it was Kirsten's incredibly logical, lawyer-like mind that helped bring her through. Anorexia knows no logic, and part of Kirsten's mind would insist repeatedly that she was not allowed to eat, or that she could subsist on some ridiculously small amount of food. I would argue her through it for hours, and she generously let me.
"Honey," I would attempt to reason with her, "what would you expect me to eat for a day?" I had to explain the logic of the situation every time. "Write down for me what you eat; would you be happy if I ate only that much?"
Later I realized that asking her to write out her daily menu may have been a mistake; I know now that in creating a written table of contents, the negative part of her mind could use it to reprimand her for her indulgence. (At some point in therapy, however, this can be a positive, even worthwhile interim structure.)
Slowly she became stronger. The dread drained from me as the days marched on and she became more confident. Eventually I realized she would make it, at least this time. But almost every book I had read warned me of the high rate of relapse, so I felt I could not really relax. My aim was not only to save her life, but to find out how to prevent a recurrence. What, then, was the trigger?
I began to suspect that relapse occurred when this negative mindset was somehow ignited; the trigger was something other than the anorexia itself. It seemed improbable that anorexia was a direct result of a single issue or even accumulated issues; perhaps it was the straw that broke the camel's back. Now I know: It is not the ten issues that finally become too much, but rather one's attitude toward and perception of the issues that brings on the manifestation of the condition. A person's negative mindset becomes increasingly pessimistic and subjective so that it searches out any issue to turn into another negative to feed itself. On its hunt for confirmation, it perverts any issue wherever it can because it is so hungry for negativity.
During that year, I continued to attend classes to become a psychologist and kept taking Kirsten with me. My field of interest was children. I was engaged in a major research project that involved twenty-six countries, studying how to prevent recidivism in juvenile delinquents released from prison. Two nations, Japan and Sweden, invited me to study with them for a year each. I was finding that kindness, not punishment, worked miracles. Later I would see this as a metaphor for my own work with victims of eating disorders.
It was another six months after Kirsten's weight had stabilized and the doctors declared her out of the woods that I could begin to feel safe about her. I know she suffered more than she ever told me. She has always had immense courage. Kirsten told me later that it took her almost another year after she had regained her weight to feel she had an assured self with internal guidelines that she could live with comfortably. Even though she was over the manifestation of her condition, she had needed that year to gain strength, to become as whole as every person ought to be.
Within three months of Kirsten's recovery, I started recognizing the signs of an eating disorder in her little sister. Kirsten's illness had fortunately fine-tuned my antennae. Nicole began making excuses to avoid meals, subtly at first, then more noticeably. She would tell me she had eaten elsewhere and that she was just so full she couldn't eat, or that she had had a huge lunch and wasn't hungry for dinner. She began taking extended walks, sometimes disappearing for half a day; I would later discover she had been walking the whole time to burn off calories.
Even though her illness presented itself in a different way--she was evasive where Kirsten had been mostly straightforward--I began having an unhealthy fear about her. I was unable to sleep because I knew intuitively that, although I tried to deny it, Nicole too was in the grips of an eating disorder. The signs became too many, too often, to deny it any longer. I would see Nicole opening a can of tuna and pretending to make a sandwich. Later I would find the whole thing thrown out upside down in the garbage, so I would not readily notice that the can was still full.
Once I made the decision to face my inconceivable reality, I experienced again the dread I had just released myself from--dread that permeated me to the core. I was unsure if I had the physical energy to pull another daughter back from the precipice. I had been so exhausted for so long Would I have the strength? Could I outlast this illness once more? I was frightened that I would be unable to, but certainly Nicole deserved the same efforts I had made for her sister.
Nikki's illness was a nightmare that I could never have anticipated. At the worst, I was ready for a rematch of what I had gone through with Kirsten. I now know that the severity of an eating disorder depends on the sufferer's personality. As it turned out, Nicole's condition was many times worse than Kirsten's had been. Without the work I had done with Kirsten, I would have gone into Nicole's case completely unprepared. I thank Kirsten for teaching me. I was still, however, woefully unready.
From the beginning, Nicole was intensely suicidal and she went into a downward spiral very quickly. She was in a deep depression, which I now realize is partially caused by the lack of nutrition inherent in anorexia.
From the beginning, I knew I had to be with Nicole twenty-four hours a day or she would not survive. I tried to continue with school as I had with Kirsten, but Nikki refused to come along. She did not want people to see her; she was a failure, an imposter, inadequate in every way, a fool. It was a desperate situation. I had no means to invite anybody to help me deal with Nikki's illness, no money, no confidence that anyone else would take it seriously enough to protect Nicole. I knew of no clinic that would watch my child like I would. Without constant supervision, I knew she would find an occasion to harm herself.
She hated me. She hated everybody. She lashed out while simultaneously refusing all aid. "Don't you dare help me. I don't deserve it," she yelled. Once when I was rocking her with my arms loosely around her, she cried out, "Don't ever come near me. Go away."
"You don't have to love me," I replied. "You don't need to worry about that. I will always love you."
She broke down and began to cry on my shoulder. "I don't know why I said that. I don't think it. I don't mean it. I don't know why I'm doing this. I love you so much, and I would never want to hurt you."
Shortly after that, I realized that for the both of us to survive the ordeal, I had to leave my emotional self out of the picture. I knew better than to take Nicole's remarks personally. Every night I sat up trying to devise a way to separate my emotional mother self from my daughter in order to create the objectivity I knew I needed for her survival. I decided to create concrete steps for myself to follow to keep me balanced in order to buffer Nikki's condition.
I went to town and bought myself a thick notebook of lined paper and told myself that I was doing an immense research project. My diary would record Nikki's every move, behavior, bite of food, and emotion as well as my reactions. Having a well-defined task with a beginning, middle, and end gave me some hope in a bleak situation. My rational self needed this, because my emotional self could find no end to Nicole's illness; therefore I did not know where I would find the strength to fight it. My rational self had to choke back the sobs and panic that surged through me.
At night I crouched on the bathroom floor; the cold floor tiles and the stark lighting would keep me awake. I pored over a list of everything the textbooks said about the causes and characteristics of eating disorders and compared them to what I was seeing with Nicole. Nothing in her behavior computed with the theories. I played with the "begging for attention" hypothesis for a while. The public conception was that manipulative people used self-starvation as a "cry for attention." In this sense, a cry for help was construed as futile, but why would it be? I was certainly attentive to Nikki, yet her self-deprivation continued. Anorexia was no ordinary distress signal.
Theory 2 postulated that Nicole was selfish. That certainly did not make any sense; Nikki was the least selfish person I knew. She had just helped save her sister's life, and she was just a child.
Theory 3 supposed that Nicole was another example of "the best little girl in the world," a perfectionist running herself into the ground to please me because, supposedly, that was my expectation. But how could the Perfect Little Girl suddenly turn into her antithesis, as far from obliging as she could be? I had never implicitly or explicitly demanded perfection from her. Our relationship had always been warm and loving.
I took Nikki to psychiatrists and psychologists, but they would only frighten her, telling her that she was failing fast. Before long, she was given every possible psychiatric label. Finally, the threat of their involvement would make her try to eat more than usual, but even so, she soon weighed much less than her sister had at her worst.
Every night, I continued to write in my diary, to argue the experts' theories on paper. I still assumed that anorexia primarily affected teenage girls, so I compared my own feelings at that age with what Nikki was experiencing. Like her, I remember feeling undeserving, convinced that everyone else was better; I was unworthy of being in their company. I had not wanted to inflict myself on them. Though I had not become anorexic, I could see that same mindset intensify itself in my daughter. I had had inklings of this inclination in Kirsten when she was sick.
I was becoming more convinced that there was an underlying condition that predisposed people to eating disorders, not a life issue, but an interpretation of life caused by an inherent mindset. Could this explain why many people who live apparently worse lives come through relatively unscathed? I began waiting for the moments Nikki would sleep so I could work on my theories. I started adding and subtracting. This endeavor distracted my mind from the pain and apparent futility of trying to cure Nikki's anorexia and gave me purpose.
Two months into Nikki's illness, I began to find notes from her all over the apartment in every container. Most were written in the third person: "Nicole is a fat pig" "Nicole is no good." "Nicole doesn't deserve to live." "Nicole deserves to die." "Nicole needs to be tormented." Why was she not writing in the first person, I wondered, why not, "I am a fat pig?" No sooner would I throw the notes away in horror then the jars would fill up with them again.
My own health began to suffer. I slept only an hour and a half a night. What worse torture than lack of sleep? One night I purposely disrobed in front of a mirror and looked at my reflection. At that moment, I vowed to myself that I would make sure this body would die before I would let my darling child die. It was a pledge not to commit suicide or give up for even a moment. I was truly drained, but as long as there was a breath in me, there would be in her.
I made myself the platform for Nicole's survival. Anything else I may have needed---including finishing my doctorate, which I wanted to do so desperately--I had to put aside. There was no choice. I never blamed Nikki. I never felt the need. I was not angry with her for a second. I knew my daughters had not brought this on themselves; they were as confused about their condition as I was.
Psychiatrists, however, seemed intent on fixing blame. One diagnosed Nicole as schizophrenic after a seven-minute interview. Others prescribed every kind of medication, seven or eight drugs at the same time, none of which she took--she refused them all, and I would not force her for fear of undermining her faith in me. Although I felt medication was not the answer for my child, I did not have the faintest idea what was.
Nikki's behavior became progressively more bizarre. She would throw a plate at my head after she had eaten something off it or break a window because she was so upset at eating. She trembled in fear, crouched in corners of the room. It was as if there was a presence beyond the two of us that was so negatively powerful. Nicole kept saying, "Mom, you can't fight it. It's stronger than us both." That would send shock waves of alarm through me, but I knew intuitively it was imperative that I remain composed to her, that I present only strength and serenity. I don't know where it came from.
Nikki's body somehow sensed she needed potassium, so I drove her, sometimes for hours, hunting for the "right" banana. We would stop at six or ten or thirteen stores. I thought the right banana would be medium sized, yellow, with few marks. I was terribly wrong. To Nikki, the "right" banana was unfit for human consumption: blackened, hidden under others, destined to be thrown in the garbage, with only an inch of edible fruit. She could convince herself that she was not really eating if she allowed herself to consume such a lowly castoff. It was frustrating, frightening, and exhausting
One morning at 4:00 A.M., I was writing in my journal, sitting on the cold bathroom floor, when I heard Nikki creep into the kitchen. When I followed her, she had disappeared. Then I heard a sound. I found her under the table, eating dog food out of a dog dish. We had no dog.
I did not know where the dish or the dog food had come from. She was on all fours, weeping, as she crouched down to eat. I went over to her and held her and begged, "Don't do this, darling. You don't need to do this. We will figure this out."
She just sobbed in my arms and held on. "I don't know why I do this. I'm so bad."
"Honey, why are you so bad?" I asked.
"You don't understand. I just am."
"What have you ever done that's so bad? You've been such a good girl all your life--a wonderful child."
"I don't know the answer," she replied, "but I know it's in my head all the time."
I brought her back to bed and stayed with her. I knew I had to negate every possible bad thing her head told her. I also had to assume she was hearing negative thoughts constantly. She was obviously unable to reach out for help, even though she wanted it. Something was holding her back. Certainly she did not want to die.
At first I would wait until Nikki said something, and then I would answer her with logic. Soon I began to make comforting statements even when she said nothing. I would give her positive reinforcement, assuming that what was going on in her head was silent to me but terribly loud and powerful to her. She started letting me into her game of fooling the negative voice. She eventually realized that I was strong enough to work with her against it. Her negative thoughts became an "it," because in separating "it" from her, I could fight it: United, "it" could stand. Divided from her, "it" might fall.
I presented analogies to better explain the situation of her mind to her. I pictured "it" as a wolf stalking a flock of sheep. The wolf determines which sheep is the weakest and tries to separate that sheep from the fold. I used distraction or any other means to outsmart the wolf. I had to prove to Nikki that I could do it, that she could lean on me, that I would never give in, even as her mind bombarded her with cruelty.
One windy and blustery November day, Nikki slipped out of the house in a thin coat, telling me I was not allowed to come with her. I followed her without her knowing it, as I often would afterwards, the wind wiping away the sound of my steps. Nikki was concentrating on her forced march to burn off calories.
She hesitated when she saw a frail lady waiting to cross a major intersection. Even in her misery she tried to be kind. She tentatively approached the woman. Because the wind was so loud, the woman did not hear her coming. I knew Nikki had wanted to help the woman cross the street. She reached down to hold the woman's elbow. The woman turned and began to hit her with her purse. Nikki fell back in shock. She pushed herself even further that day because the woman had not let her help her. She must have done something wrong. On two other occasions she collapsed on the street. I carried her home, never knowing if she would still be breathing when we got there. In my head, I begged for her life: "Please, someone, anyone. Just let her live. Take me instead. She is just an innocent child."
I tried yet another specialist. I sent her up to his office. After twenty minutes, Nikki came running down to the car where I was waiting. Sobbing, she got in, slammed the door, and said, "Let's leave here, Mom."
"What's wrong, honey?" I asked.
"He wants to talk to you. He told me you were to blame for everything. He never even met you!"
In less than twenty minutes this doctor had decided he knew my child's life. "Nikki, let's go up and see what he has to say," I said gently.
"Are you sure you're strong enough?" she asked. Sick as she was, Nikki was trying to protect me! Why? Had I shown her vulnerability?
The doctor was as cold as his white lab coat. Nikki asked him, "How is my mother to blame? Tell her please, because it makes no sense to me."
I was so choked up by her pain that I could barely control myself. I asked the doctor, "Would you like to know what I think of my daughter? Would you like to know about us?"
"Not particularly," he responded. "Your daughter is sick because you haven't been able to handle your life."
"I am handling my life just fine, thank you," I said. "I need help handling hers."
"Nicole will live a subquality life," he continued. "You'll have to manage her condition, and she might die."
I told him that I had always been strong, that I was committed to curing her. I began to sound defensive, I'm sure, and he said "I'm not interested in dealing with you. I will deal with your daughter and I will not confide in you anything that goes on between me and her."
That was too much for Nikki. She raised her voice to him, "My mother has never done anything wrong that I know of. She's not to blame for this condition. You're insensitive! And you don't know me at all! It's fine that my mother knows anything you and I talk about. I am bad. Are there any secrets to be ashamed of?"
I said, "Honey, let's go. He just thinks differently than we do." I saw no sense staying with someone who was negative from the start. Who would be her structure if she were separated from me? In any case, Nikki refused to go back to see him.
After a while, Nikki's negative thought pattern, though cunning, became predictable, and I could fool it relatively easily. And so I began to trick what I had come to see as "the mind below the actual mind." I realized Nikki could not allow herself to eat if she had a plate of food in front of her, so I would take her out to dinner and order for myself. Everybody must have thought I was crazy, but I was conscious only of the task in front of me. I would cut chicken, her favorite, into small pieces and put them on a side plate under my left elbow so nobody else could see. I was not admitting to her negative mind that food was in front of her. It was "mine," and she did not have to take responsibility for it. I would look the other way as she slipped tiny pieces into her mouth. If I covered everything with a napkin so only one piece was visible at a time, she would take it. Slowly, ever so slowly, I was feeding her.
I looked for other strategies. I started saying, "Darling, while you were out for a walk [she would never admit that I had followed her; we both pretended I had stayed home], somebody called [nobody had, really]. Some friends want to come over for tea. Would you mind coming with me to buy ingredients for a cake?" I am sure she became the best baker in six counties. Everybody started sending her cookbooks. (I later learned that anorexics "eat" vicariously; they pore over cookbooks all the time, watch cooking shows, and cook food for other people without consuming any food themselves.)
I would never actually make the tea--no one came--but my ruse gave Nikki a reason to bake. When the batter was ready, she would allow herself to eat a little of it (which wasn't, technically speaking, "cake"), and fool the negative that way. Later, I would ask her if she would cut the cake so when "people came," we would have ladylike finger slices. That was a way for her to eat some of the crumbs--those were not "cake" either--without her negative thoughts making her responsible for allowing herself the favor of eating.
At about the same time, I also realized I had to weigh Nikki backward and never divulge her weight, although she would demand to know. Nikki was less able to respond to logic than Kirsten had been. I could not reveal her weight because no number would be good enough; she would always have to be less than whatever she currently weighed. When she was sixty-eight pounds, I tried to reason with her. "You know that you're in an impossible physical position. You can't last like this. You thought you were low enough at eighty. Now you're sixty-eight. Logically, you know better."
"I don't know anything," she replied angrily.
"If you have to be lower than eighty, are you satisfied at sixty-eight?" The negative condition was caught red-handed. "If you weighed only twenty pounds, would your negative condition be satisfied?"
She started to cry. "No. Only if I'm dead."
That night in my journal, I wrote that I knew this was a track to death. I began to question the famous myth that being model thin was the anorexic's ultimate goal. We were not dealing with a fashion statement here.
So much repetition. So much reiteration. So much counteracting the negativity inside Nikki. So much reinforcing that small kernel of hope I knew was there. In some moments, Nikki was desperate to respond. I could often see the pleading in her eyes. Through the small bits of food, she would have occasional bits of joy. The day she "graduated" from 1 percent to whole yogurt, she was laughing and crying at the same time. Everything was a baby step, because there were only baby steps. It takes incredible patience in a society that has no patience. I wrote in my research journal, "The turtle wins the race.... It takes time, but you'll only get there with patience."
One day when I was near the breaking point, I left Nikki with a dear friend for a half hour, just to do something "normal" for myself. It seemed a long time since I had interacted properly with society. I took my newspaper and went out to a restaurant. It was three in the afternoon. I imagined the place would be reasonably empty. In fact, a few people were having coffee there.
One of them, a woman whom I knew only slightly, came over to me and asked, "Could I talk to you for a moment? I want to ask you something." I told her I did not have much time. She pulled down my newspaper/shield and asked, "Don't you feel like a total loser, having two out of two daughters anorexic and you a counselor?" I cannot remember my response, but I do recall feeling the world did not understand us. I spent a few more nights pondering how I might have failed my daughters. Poor mothering genes?
But then I began using the notion of guilt for my research. If I felt guilty and I could not find a clear reason for it, then how could I wonder at my daughters' guilt? Both were equally unreasonable. My children could not tell me why they felt guilty; they just "knew" they were because somehow they were bad. That week I let go of guilt. I found it useless except as a motivator, and I was already quite motivated!
My journal became my best friend. It was my only sanity. It cherished my fear and pain yet nurtured my logic. Without its comfort, I would not have survived. It heard me and forgave me everything. In it I set out a long-term plan for how we would get through the next six to eight months. They were the roughest of my life.
One particularly exhausting day, after Nikki had been yelling obscenities at me, she demanded plaintively, "Mom, what do you see that I don't see?"
God, I thought, she is giving me an ultimatum. "Nikki," I replied, "give me your happiest moment ever."
She remembered it easily. It was walking on the boardwalk in Montreux in Switzerland. "The sunlight was shining through the leaves in the trees and the boardwalk was all mottled. I felt such a complete peace and understanding with myself and everything." Nicole felt honestly that if happiness were related to peacefulness, that was her best moment.
This gave me insight: Nikki was striving for peace and contentedness. She wished she could bring that moment and that feeling back. I held that thought. I presented a dream to her that I was certain, if I could get her better, I would make a reality. I was desperate, so what might have seemed extreme did not seem so then. I told her that, as I had told Kirsten, I was going to get her better. There was no alternative to that. I was uncertain how, but I was beginning to get a good sense of it. Then, after she got better, I would develop a practice that would get other children better. I told her that I would get my doctorate in psychology so people would believe us. I told her we would call the practice Montreux.
Nikki was wonderfully excited about that and held on to my dream; it distracted her. I used it as a continuing theme in her care, by presenting concrete hope. It would give her something to live for. I told her that eventually we would be in a position to open a clinic. When we knew we could do it, we would open clinics all over the world so children and parents would no longer be blamed. Everyone would finally understand. I told her it would take me ten years to convince the world, and that somehow things would fall into place. People would need and want to learn so children wouldn't die.
That became Nikki's structure. I continued to feed her with several small meals at home or in a restaurant, where she was both too embarrassed to overreact and distracted enough to eat. I knew she was not allowed to say she was hungry ever, so I would say I was hungry. We ate six times a day. Slowly, slowly, I brought her back to health. During this time I sought other help as well, because I was terrified that I would be unable to pull her through despite my efforts. But these experts were either negative, apologetic, or benign at best, which at least was inoffensive, but unfortunately offered no insight or relief.
It took me a year and a half to turn Nikki around. After ten months, I knew she was going to recover. So that she would not feel like an outcast and to prepare her for reentry in society, I started a group at my home for any child or teenager who felt dysfunctional. I wanted Nikki to realize this was a common plight of the human condition; she had not been singled out for negativity. One of my patients was a recovering heroin addict, several others were anorexic or bulimic.
Doctors who had heard of my experience with my daughters began to refer patients to me. I received calls asking if I would consider talking to this mother or that child. Within two years, much to my dismay, I had a lineup of patients I could not contend with. More than anything, I wanted to get my doctorate before I buried myself in my practice. But each life placed in front of me was someone for whom I felt such compassion and understanding--I could never allow myself preference over any one of them.
Montreux Counselling Centre began as an outpatient practice in 1988 as more and more referrals followed reports of my success with my own daughters. I did not put my name or number in the phone book because I did not want to invite more patients at this point. At some level I felt terribly burdened, because I had not had a gasp of air between treating my two daughters and the rest of the world's patients, and it was essential to me that I finish my degree.
I stuck to my plan and was halfway through when desperate parents placed a young anorexic child in front of me. The parents had exhausted every other viable option. Nothing was working, and their daughter was very ill. I had to make a conscious choice, once again, between my education ambitions and the life of a child. Naturally, the child was the only option. It was well worth it--what an angel this incredible child is.
As I confronted cases of increasing need, I began taking other patients into my home (and the homes of others) in order to create a more consistent atmosphere for them. Some of my early patients, and later my own daughters, became my coworkers in implementing these "localized environments of unconditional support" for dying patients. This experience helped me devise the medically monitored, one-on-one, twenty-four-hour-a-day individualized care plan from which we work with acutely ill patients today.
The Montreux Clinic opened in 1993 in order to meet the requirements of those individuals in extreme need who, generally, had been through many other programs and who were frequently labeled "treatment resistant." The clinic offers outpatient services as well.
Now, four years into our residential operation, we have been particularly encouraged by the emerging eagerness of professional colleagues to embrace more positive treatment modalities. We have been fortunate to work closely with excellent treatment teams in acute care hospitals where patients must often be stabilized before they are able to travel to us.
Health care insurers are realizing the highly cost-effective nature of our work and a number of companies have funded treatment for patients in our program. (Though the treatment terms called for are longer than those of programs that concentrate merely on feeding, the per diem rate is 25 to 50 percent less than the cost of treatment at acute care hospitals; moreover, when patients recover completely, they have no need for further treatment.)
We have successfully treated hundreds of people with eating disorders. I have counseled patients as old as sixty-four and as young as three. Our clinic offers a practical application of the theory elucidated in this book.
In several ways Montreux can also be seen as a social laboratory for positive change. If victims of what we call Confirmed Negativity Condition are indeed an altruistic segment of our society, then the gifts that they have to give the world are readily evident in the Montreux community. Their altruism is reflected in the wish of many recovered patients to become care workers themselves. (We encourage recovered patients to investigate other avenues for several years in order to explore their own needs before working with patients themselves; currently approximately an eighth of our care workers and counselors are former sufferers.)
For incoming patients, the possibility of spending time with fully recovered former patients helps create a bridge of hope, which is most helpful in plotting a course for the new patients' recovery. Our other care workers come from a cross section of the professional spectrum. They are chosen for training based on their ability to provide unconditional support to those in need rather than achievement in any particular discipline; we search for qualities of kindness, compassion, vision, and patience that go beyond the expected "norm." Most feel that the work itself, performed in an atmosphere of positive encouragement, provides immense rewards in terms of self-development and the motivation to surpass self-expectation.
We find Montreux an incredibly inspiring environment, a testament to the capacity of the human spirit.
(C) 1997 Peggy Claude-Pierre All rights reserved. ISBN: 0-8129-2842-3
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I’m cheating. This is not a real blog post.
I’m going to plug a piece I just wrote for another publication/blog (see below) called:
Anorexia Nervosa: The Ethical Dilemma of Force Feeding. Check it out, leave a comment.
I’m “cheating” in part because I’ve been busy (mostly writing my thesis, but also writing and editing other articles, editing essays, tutoring, and all sorts of fun things that leave me with less time for the blog), and in part because it is relevant and I think it will be of interest to SEDs readers.
Here is the story:
A friend of mine asked me to write an article for Inquire UofT. Inquire is an interuniversity publication and the University of Toronto chapter is at its infancy–as is their blog. My friend told me I could write about anything I wanted but the topic had to be current and controversial. She said to aim for 250-500 words. I wrote 1600, but managed to cut it down to about 1450.
The piece is considerablymore opinionated than anythingI’d write for Science of Eating Disorders . And keep in mind that, as I often do in situations where I want to provoke a discussion, I end up writing statements that can seem more “one-sided” or “extreme” than what I actually think or believe. (Isn’t that what being controversial is about, anyway?) The issue is very complicated and each case is unique, so don’t expect me to resolve the dilemma in 1500 words.