Ask Dr. Frank

--Lonesome

Dear Lonesome,

I am not surprised that your high IQ fails to attract women. Dorothy Parker, a very smart and miserable woman, was not alone in requiring "only three things of a man. He must be handsome, ruthless, and stupid." You seem to be none of these. Most men substitute charm and/or passion for one or more of Parker's three attracting qualities, but you clearly lack those two as well.

There are hordes of women who would make themselves available to you sexually for a fee, and there are even larger hordes who would marry you for a bit of civil security. There are many lonely women who would follow you anywhere in exchange for just a little attention.

I don't know how you are repulsing women. If you can get one to sit down with you, but then she runs away when you start eating pizza, it's possible that the problem is not your physical appearance but your table manners. You need someone to tell you when you are acting repulsively; that's one of the functions friends perform.

Until you can have friends and hang out with people, you really aren't ready to fall in love. You surely have plenty of free time, so join whatever group will have you. Mensa is a group that caters to people with very high IQs, and your dentist may refer you to organizations for people with particularly healthy teeth.

You may have all manner of mental health problems, but you are most urgently in need of charm school. You can combine the two by joining a therapy group.

Dear Dr. Frank,

I have been a bulimic all of my adult life. I couldn't take my outpatient program seriously, and it interfered with work, so I decided to read all about my illness and cure myself. I can go for a week or two before a binge-purge cycle begins again. If I am by myself I do pretty well, but when I'm with others (including my husband), I have a difficult time. I can't afford one of these inpatient programs that costs a minimum of $10,000. Overeaters Anonymous is depressing, and all the therapists at the mental health center want to focus on my diet rather than what triggers my illness. I want to learn to control myself and gain the self-esteem I need. I need help, but I don't know where to turn.

-- Bulimic in Distress

Dear Bul,

If you were as picky about what you eat as you are about who you'll let treat you, your problem would be solved.

Binging and purging has long been a popular habit among those who want to eat everything they hunger for, but don't want to gain weight, i.e., they want to look tightly controlled without having to actually control themselves. Sometimes the habit gets out of hand. Bulimics frequently try to look as if they are seeking therapy without actually addressing their symptoms. You, for instance, hunger for whatever therapy is not in your budget, just as you hunger for whatever food is not on your diet.

You're eating from the wrong plate. There is no convincing evidence to suggest that expensive inpatient programs work any better for eating disorders and other habit disturbances than less expensive outpatient therapy. And there is not likely to be any hidden pathology underlying the eating disorder. Making a production out of therapy will not be helpful; dramatic therapy may just make you feel more helpless as you bloat and shrink in the throes of a compelling habit, a habit you alone can control.

Eating disorders are highly "addictive" habits, in that people can feel physically uncomfortable and go through depressions when they stop the behavior. Part of the reason is physiologic, so antidepressants (believe it or not) work rather well as an adjunctive therapy with bulimia. (They work less well with anorexia, but are still worth a try.) Group therapy can be extremely helpful; psychoeducation and dietary training are crucial; family therapy has strong adherents; and supportive psychotherapy, with an element of sensitive bullying, can make all the difference. All of these approaches address the symptom directly. They are also fairly affordable and available.

"Deeper" psychotherapy may not be helpful at all. Of course, insight-oriented psychoanalytic psychotherapy is probably good for most people, bulimic or not, if the focus is on revealing hidden strengths. If the focus is on revealing hidden weaknesses it can be debilitating, and if the focus is on exposing hidden victimization, it can be crippling. Eating disorders, like alcoholism or drug addiction, are habits for which there may be physiologic predispositions and certainly emotional and interpersonal triggers, but for which there are no agreed-upon "deeper" psychological causes.