There are a lot of misconceptions about anorexia nervosa that should be addressed. I’m not saying “corrected” because I’m layperson and can only offer opinions and observations culled from living with a person with post-eating disorder anorexia.
Anorexia has long been identified with body image. A woman feels inadequate because of how she looks compared to the images presented in the media. To be accepted she must somehow assume the shape or size of those she sees presented as the ideal.
The presumption is that, from this motivation alone, the person will begin starving herself. But this leaves too many holes and doesn’t cover all circumstances. Yes, body image and media examples play a role in encouraging starvation, but something else has got to come into play to cause a person to loathe themselves to such an extent.
This theory does nothing to explain why some people stop eating as young as five. In other words they are almost born anorexic. Controversial, but successful, practitioner Peggy Claude St. Pierre, who works with anorexics in Victoria B.C. Canada, was the first person to reveal that there was more at work then simple body image. In one interview she was accompanied by a five year old boy who had stopped eating.
With his limited communication skills, it was hard to decipher what had caused the ailment but it eventually became clear that he was suffering from a surfeit of guilt. From what little he said, those treating him understood that he could not bring himself to eat while he knew that others were going without. What made him better that he should deserve to eat when someone else wasn’t able?
The full story of that young boy was never revealed, except to say he was recovered. What had destroyed his self esteem to that point of degradation wasn’t said. Perhaps he was being sexually abused or ignored by his parents. Or it could just have been as simple a case as he claimed. As young people, we have not yet built up shields to defend us from the horrors of the world and sensitivity to another’s plight could become over exaggerated in the mind of one so young.
As a teenager the woman I love was starving herself to death; she had stopped menstruating, her heart rate was stopping, the full deal. She had the strength to pull herself out of that hole and carry on. But there has been more to her recovery then simply to begin eating.
We were both getting on in years when we got together (at least by today’s standards), thirty–five, so we had already ruled out the prospect of children and decided on a life for the two of us. Neither of us had what could be called easy lives up to that time and we looked on each other as safe havens in what had been stormy waters. This is what precipitated the events that followed, events that have led the two of us to understand how a so-called eating disorder is far more then that.
When you have spent your whole life running, looking over your shoulder for the next horrible thing to happen to you, and you finally can stop and catch your breath, you start to think, and you start to remember. We had a lot of sleepless nights those first few months. She would wake up crying, or not even be able to get to sleep, from the whirring of her brain. Gradually a picture began to appear, a portrait of a person in pain.
It was not pain caused by the others wounding, rather pain from other’s wounds. Her empathic nature is such that she feels other people’s hurts, they leave scars on her soul. She has been like this as long as she can remember. With this sensitivity comes the desire to make things better, to take away the pain and make everything all right. When she can’t, she feels guilty and it becomes her fault that this person is in pain. That’s only the beginning.
Then take this person and place them into a dysfunctional home: her parents were nineteen and seventeen when she was born. Her father is an alcoholic, and her mother ignored her. Whenever there were problems in the home, which there were on a weekly basis, they became her fault. She was not the cause, but because she could not fix the situation, it was her fault.
It was when the inevitable happened, her parents split up, that she entered the eating disorder stage of her anorexia. She felt she must pay the ultimate punishment for her failure. She did not deserve the nourishment necessary for survival. Ironically, it was only guilt feelings about abandoning her mother that saved her. It was not self preservation that started her eating again but the same feelings that had made her stop in the first place.
To assuage the guilt of that first failure she spent the next twenty years looking for people to heal, people to save from themselves. In the process she was beaten, raped, and emotionally abused. Through it all she felt guilty. She felt must be doing something wrong in order for people to treat her so bad, how else to explain people’s behavior toward her?
Even if they were bad people it was her fault because she had been stupid to have gotten involved with them in the first place. How could she have listened to the voice that told her that she should try and help these people, even if they were beyond help? What was wrong with her? Who did she think she was anyway, believing she could heal everybody?
Those were a few of the things the voices in her head were saying, some of which people on the outside were only too glad to reinforce. Looking at the abuse, they would question her judgement, thus perpetuating her feelings of inadequacy and guilt and driving her deeper into herself. Maybe they were right and her desire to help people was wrong, and so she questioned that which motivated her whole being.
We can say that her initial motivation for healing was selfish, i.e. to make her home life better as a child. But how can you blame a child for wanting to have a happy home? How can you blame a child for wanting to stop her father hitting her mother? That is not selfish but self-preservation. What happened was that instead of looking for people who wanted to get better, she kept looking for chances to heal her broken family, and thus searched out those who were least likely to respond in her endless quest to heal her parents.
After years of trying to fix everyone else’s problems she started to help herself. She’s had to retrain the way in which she thinks, learn how to tell the subconscious soundtrack in her head to shut-up whenever it gets out of hand, and replace it with positive thoughts.
Coming to respect and like herself was the first and most important step in the healing process. From there, it became a matter of going beyond adequacy and getting back to having a life. For the first time ever, that was based on what she felt and wanted, not on her misconceived notions of what she should do for others.
When we went looking for assistance there were few books out there at the time which offered any help or insight. Few people had published anything that offered the care giver a course of action to assist those afflicted.
There don’t seem to be any hard and fast theories on how to treat anorexics. In fact the different courses of treatment are as much a controversy as the disease itself. The aforementioned Peggy Cloud Pierre has often been at the centre of this because of her tendency to ignore conventional wisdom and yet at the same time achieve remarkable results.
The first thing that she advocates is complete separation of the client from her family (as this is still a disease that primarily effects women I will use the feminine pronoun throughout). Clients come and live in her facility and, until the staff decide, they are allowed no contact with relatives.
Since the family situation usually has played a significant role in the generation of the illness it is considered essential for the client to be free of all potentially negative influences. Families had to agree to this at the onset of treatment as a condition for acceptance into the program. Not surprisingly, this is was what caused most of St. Pierre’s problems, families complaining they were not being allowed to see their children.
Too many people are still unwilling to believe that a mother or father can be the problem in a child’s life not the solution. Having heard some of these parents or read quotes of what they have said, I have come away feeling that there are good reasons for the child to be apart from them. Their words were never about worry for the child, but about themselves and how they felt.
When someone says things like “it’s a mother’s role” or “a parent knows their child” and that same child has been starving to death for three years you question what role that mother played or how well she knew that child. If that truly were the case why did that parent need to turn to someone else for help in the first place and agree to their terms? In my mind these people sound embarrassed; initially by the disease and now by the fact that they are being seen to be responsible for the illness to some degree.
Those motivations are the precise reasons that separation was deemed essential. A person who is willing to let herself starve to death has to really hate themselves, or think so little of themselves that they don’t care whether they live or die. How can that be countered? Pierre and her staff would say it could be countered with unconditional love.
No matter how they acted or what they did and said they would be continuously told they were worthy of love and affection. That’s not to say they would be allowed carte blanch in their behaviour and get away with everything, but they were treated with respect and dignity. Everything and anything possible was done to ensure the restoration of their self respect.
While this may sound overly simplistic in it’s methodology, in practice it’s another story altogether. To break through the walls that an anorexic has built around herself takes patience and perseverance. Years of self belittlement and guilt must be chipped away slowly and carefully. Pushing too hard and showing the slightest impatience will spoil any hope of establishing the trust so essential between care giver and client.
The first step is to build the client back up to a place where they are willing to fight for themselves. There comes a point when they must be willing to try and fight the impulses that cause the symptoms and to start seeking out their root source. But that will only happen when they believe they are worthy of living. Even then, it is essential that positive reinforcement be a continual part of their lives. Without it, the chances of relapse are high.
Due to a high number of complaints from parents, testimony of fired and vindictive staff, the British Columbia medical board rescinded Pierre license to run her facility. The pity of it is that she of anybody working with anorexics had the highest rate of success without relapses of any facility or doctor on record.
I didn’t know my wife when she was in the throes of her eating disorder, only when she had started dealing with the mind set that caused it’s onset. I witnessed the struggles she went through and still goes through these days, and am grateful for the inspiration that Ms. Pierre provided then and still provides us now. Without the key she gave us through her example we may never have unlocked the door that had prevented my wife from living the better life she has now.
My wife and I liken being an anorexic to being an alcoholic; everyday is a struggle against the compulsion to fall back on bad old habits and beliefs. But everyday you’re clear of it is another step closer to freedom. There is more to this disease then a desire to look like a fashion model (although their example feeds the self loathing) and the sooner we start treating it for what it is the better.
It’s a pity that the woman who was doing the most good for people was closed down over the belief that family is the be all and end all in our society. Too often the cause of anorexia rests in the home, not the pages of a magazine. Until we wake up to this fact, there will be too many young girls continuing to starve themselves near on to death.