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The Anorectic in the ER

I just watched an episode of Katie Couric, who admitted her battle with bulimia.

I just watched a very helpful and courageous episode of Katie where Katie Couric admitted her battle with bulimia in college and beyond.

I can’t prove the following, but it may speak to some of you, especially some of you with eating issues. A certain amount of a child’s—and later adult’s —well-being comes from how much their parents like and enjoy each other. Also, conflict between parents is not as big a problem for the developing psyche of a child because conflicts are inevitable. The problem is when conflicts never get resolved and keep repeating themselves. Over time that “never-ending” conflict and the simmering bad just below the surface of parents toward each other can feel unsafe and disheartening to a child.

The reason for that is that for a child’s personality to feel solid, the child needs to feel that they are emotionally safe at home. When parents seem locked in conflict, children can viscerally feel that at any given moment, that what they are counting on to feel safe and secure, can explode and be gone in an instant. Sometimes children who feel out of control of what they need to feel safe from their inside out (i.e. the loving calmness in their home between their parents) will focus on things they can control on the outside. Eating disorders offers them such a focus.

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With bulimia, they get to feel great—or at least immense relief—when they binge, and then they get to feel guilty, ashamed and beat up on themselves afterwards. Given the choice between feeling great and then feeling awful towards themselves vs. feeling the terror that the psychological ground (their home and the relationship between their parents) on which they are standing is shaky and about to totally fall apart, it’s easy to understand why they might choose the former.

Many years ago, I was working in the UCLA ER as the psychiatric resident on call. At that time, UCLA had one of the nation’s preeminent eating disorders program.

On this particular night I saw a young woman I shall call Jenny, in her early twenties, who had anorexia and weighed close to 85 pounds. She looked ghastly. Like many of the similar anorectic patients, Jenny seemed to be a shell of a human being both physically and psychologically and to be nearly completely focused on her weight and need to exercise.

Also like many similar patients, her family had a high amount of conflict. To be fair to her parents and the parents of many of these frightened and frightening children, these parents’ understandable feelings of helplessness and fear for their child can manifest as being controlling, angry which can add to the feeling of conflict that the child may be reacting to.

The ER was quiet that night and I had some time to spend with Jenny while we awaited for her to be admitted upstairs to the in patient unit. As a psychiatric resident we had learned many approaches to treating a variety of psychiatric disorders. These included hypnosis and something called guided imagery, where you would have a patient close their eyes and guide them through a visualization. I intuitively had an idea and asked Jenny if we might try something that might help her relax.

As best as I can recall, the guided imagery exercise went something like the following:

Jenny, get comfortable in your chair.

Close your eyes and begin to breath slowing, taking in a deep breath 1-2-3, and now exhaling 3-2-1.

Do that again, breathe in 1-2-3, breathe out 3-2-1.

Do it once more, breathe in 1-2-3, breathe out 3-2-1.

Now place your left hand on top of your stomach, right on top of your belly button.

Breathe in 1-2-3, breathe out 3-2-1 and feel the warmth from your left hand laying calmly on your stomach and calming your stomach.

Now imagine that that left hand is the hand of your mother comforting your stomach.

Feel her warmth going through into your stomach and radiating around the area surrounding her hand on your stomach.

Feel the connection of her left hand exactly in tune with your stomach as you breathe in and out and your stomach rises up and down as your breathe.

Imagine her left hand taking all your pain and tension away from your stomach.

Now place your right hand on top of your left hand and on top of your mother’s hand and imagine the right hand is that of your dad resting on top of your mother’s hand.

Imagine your father now saying to your mother and to you, “Everything is going to be okay, you’re going to be okay, we’re all going to be okay.”

As you feel your dad’s right hand on top of your mom’s left hand and both of them on top of your stomach, feel that you have a center deep inside you that feels warm, secure and safe.

Feel what that feels like and breathe in 1-2-3 and then breathe out 3-2-1.

Repeat that again, breathe in 1-2-3 and breathe out 3-2-1.

Now feel that your dad’s right hand on top of your mom’s left hand on top of your stomach is leaving you with a core and center and that you can now begin to move both those hands from your stomach and when you feel ready, begin to blink your eyes as you come back to where you are sitting and being in this room.

Within a few seconds, Jenny began to blink, smiled and yawned with only a slight sense of embarrassment. She seemed to be more like a person than an object or a thing. About this time, people came down to say that Jenny’s bed was ready upstairs. She gathered some of her belonging together smiled at me and headed out the door. When she got there she looked at me and said, “Do you think it would be alright if I grabbed something to eat before I went upstairs?”

I smiled back at her and said, “I think we arrange that.”

Thank you Katie for helping me remember this moment 34 years ago.

Jenny, wherever you are, I hope you are doing okay and you're happy.

Also:

Mark Goulston, MD, is the author of the new bestselling book Just Listen: Discover the Secret to Getting Through to Absolutely Anyone.

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