ON LOVE AND HEALING: The Challenges at Home
(Excerpted from "The Secret Language of Eating
Disorders"
by Montreux founder, Peggy Claude-Pierre)
Take responsibility
for recovery from the victim
Offer unconditional love and support
Do not take behaviour at face value
Don't ever judge the individual
Be prepared for irrational or "manipulative"
behaviours
Expect to be tested
Use logic to combat every negative
with a positive
Do not comment on body appearance
Don't play a numbers game
Discourage competition
Encourage self-expression
If your child has been diagnosed with an eating disorder
that has not yet reached an acute stage, her situation cannot be ignored.
Just because this is not an emergency, it does not mean that you should
not take immediate action. Be aware of your child's growing subjectivity.
If she becomes exceedingly negative, her condition will only worsen
without appropriate intervention. The severity of her condition depends
not on her weight but on the entrenchment of CNC - something that cannot
be as easily measured. While the severity of the eating disorder lies
on a continuum, I believe that we must combat the underlying CNC in
the same way for both an acutely ill person and one who is only at the
beginning of the slide. Both people must traverse the five stages of
recovery; the difference lies in the relative ease with which someone
with greater access to her Actual Mind can absorb the recovery process.
Moderately ill eating disorder patients can be helped
with outpatient therapeutic care, as long as their families participate
in a loving manner. But first we must get theses people into care. At
this earlier stage, they may have more of their own "head space" intact
- the Negative Mind may still not predominate. In that case, parents
or other loved ones can happen to them if there is no therapeutic intervention.
You might say to your child, "I know you are trying
to manage a difficult situation in your head and that you are afraid
you are ruining the family. We love you and we know this isn't your
fault. It's happening because you're such a good, kind person. If we
don't get the right help now, the problem will just get worse. We're
all going through this together. We are going to get a therapist for
you so you won't have to worry anymore."
The key here is early intervention. Remember, no matter
where a patient is on the eating disorder continuum - in the early stages
or acutely ill - the steps for recovery must adhere to the guidelines
and principles I have set forth below and in my book. We must always
begin to reverse the confirmed negativity from the bottom up.
Eating disorders are insidious and difficult to treat
once they become acute, and they can become acute alarmingly quickly.
Reversing them requires a high degree of commitment, understanding,
and training that is beyond many. The firmly entrenched Negative Mind
is determined to sabotage every attempt of a helping person.
Once a person manifests an acute eating disorder,
the circumstances, which determine its progression, are much more difficult
to control. At this point the victim takes a highly subjective and negative
view of life, and will work overtime to translate any event or circumstance
in a negative way.
From this juncture, it is not impossible, but certainly
difficult, to reverse the Negative Mind without appropriate intervention.
A victim's Negative Mind will be confirmed much more easily than not.
As she heads toward self-destruction, her Negative Mind grows in importance
and magnitude. As Julie wrote to me early in her illness, "I hate myself
all the more and I feel more alone (rightly so) than ever before."
The victim's mind does not allow her to ask for help,
as badly as she wants and needs it. And she cannot be treated by the
ones who love her most and whom she loves because of the added burdens
of guilt and sense of responsibility to care for her parents. Julie
writes of this terrible dilemma: "It pains me to torment my mother so
and despite all requests of me to speak, to divulge my thoughts, it
is too dangerous for I increase my burden upon her too often. So many
times I speak without regret and further aggravate my own mind. And
too many times my workless tears bring on her tears. And so the terror
and pity, sorrow and hatred intensify within me. Each utterance I make
is done with overwhelming trepidation. I engage in a vicious cycle in
my head, pleading for my silence, praying for her peace, knowing only
death as an answer."
In a perfect world, every victim of an eating disorder
would have full access to a treatment facility that could treat not
just the symptoms of the disorder but the patient's interpretation of
her role in life, thereby restoring her sense of self and worth.
However, I am all too aware that access to such facilities
are few and far between, or beyond the reach of most people. Many lack
the financial resources, and unfortunately, insurance companies have
been slow to appreciate the severity of the disorder and the length
of time required to treat it fully; they therefore do not offer the
kind of full coverage many families need to have a loved one treated
effectively.
Other families may have access only to treatment programs
that they have either tried and found wanting or that they intuitively
recognize will not meet the needs of the sufferer. Still others may
be unable to convince a loved one that she needs help.
What, then, can families and friends do to help the
victim of an eating disorder? As a first step, I feel it is essential
to ally yourself with a caring medical doctor and other health professionals
to work as a team, a united front, to help your loved one.
As you have read in the last chapter, the care offered
by our clinic is not something that one can readily replicate at home.
I wish I could lay out a linear, step-by-step program for helping your
loved one; I wish it were that easy. Critically ill people with eating
disorders are in dire danger; their bodies are almost completely depleted
and they are often suicidal.
You need help getting your loved one through this
acute stage and on the road to recovery. In the next chapter I will
offer some advice about seeking professional help. Here I can share
with you the guidelines that I have found so helpful in my practice.
I hope that you can use them as you work as part of a team with medical
professional to help your loved one. I applaud you for your bravery
and tenacity.
TOP
As is clear by now, sufferers of eating disorders cannot
take responsibility for their condition. They have already taken responsibility
for much of the world and have been exhausted by their failure to make
a significant difference. They desperately need for you and the rest
of the health care team to take the burden from their shoulders.
I generally tell my patients, "Imagine a place where
people worry about you and you don't have to worry about anyone. Can
you think that maybe it's time you had a turn to be first? I know that
you want help. I know that you can't ask for it. I am going to give
you what you need without your having to ask for it." The patient needs
to be relieved of this crushing burden.
You might tell your loved one that you and the doctors
will be fully responsible for her recovery. You will make all the decisions
for now. Your loved one will no longer have to worry about preparing
or eating meals. You will schedule doctor's appointments. You will take
care of food.
At this point, sufferers are usually both enormously
relieved and terribly frightened and anxious. They will protest continually,
"I've got things under control; I don't need your help, "I'm not worthy
of your help." "You are going to make me fat." "I don't deserve to live."
You may answer each time by saying, "I love you and
I know that you deserve to live. I am not going to let you go until
I know you are better. I am not going to let you go until I know you
are better. I am not going to let you get fat; the doctors and I are
going to get you well. You can trust me. I am in charge and I'm going
to take care of you.
TOP
When our children are infants, it is easy and natural
to love them unconditionally. We do not blame them when they cry or
keep us awake. We know that they are not responsible for the hard work
required to raise them. We love them no matter what.
You need to recapture that same sense of unconditional
love and support while helping a person with an eating disorder. It
might be helpful for you to see the victim as an emotional child. That
may be a say to connect with the feeling of unconditional love and support
you would naturally give a baby.
Why unconditional love? It counteracts the harsh voice
of the Negative Mind and allows the possibility of connecting with the
Actual Mind.
In the early as well as the acute stages, the patient
must be bathed in unconditional love. A harsh word should never be spoken
because the Negative Mind will seize on it and use it against the patient.
Not reproaching the victim can be extremely difficult, especially if
the victim is behaving badly - cursing, throwing dishes or having a
tantrum. In these instances, draw a firm boundary between the person
and her bizarre and distressing behavior. Instead of punishing or rejecting,
I always say in a soft voice, "I know you're frightened. Can you sit
by me?" Your challenge is to love your child no matter how upsetting
her behavior.
Always treat your loved one with respect. From my
experience, it stops the behavior more quickly than any other response.
Giving love as a reward for only good behavior actually
reinforces the Negative Mind. Don't try to encourage someone to eat
by saying, "If you loved me, you would try some of this." It is saying,
"You are worthy of love only if you comply. There are terms to my love."
This gives the Negative Mind leverage to explain to the victim her unworthiness.
It might say to her, "See, they don't love you or they wouldn't have
punished you." As the patient recovers, a healthy, realistic balance
begins to establish itself between these polar opposites.
Sometimes our unconscious actions imply conditions
on our love. Think about your own reactions toward the victim. Might
you be praising only those efforts you consider to be her best? Are
you more responsive to her when she behaves the way you want her to?
Do you react negatively when she does something you find objectionable?
Such actions might send signals that tell victim your love is contingent
on her meeting your expectations. You are striving for consistent, positive,
loving support all the time - love and respect that depends in no way
on how the victim behaves, but in honour of who the victim is.
While some people believe that "Tough Love" may be
effective in moderating or controlling certain adolescent behaviors
such as drug use, shoplifting, and so on, we have found it to be entirely
counterproductive in treating eating disorders. Tough Love basically
says, "My love for you has many conditions. You can't rely on me."
Using this approach, doctors might tell parents to
set limits on their child - for example, to remove every source of pleasure
for a child unless she agrees to eat. Here is a typical letter describing
the failure of this approach:
The psychiatrist told us that they were "going
to make Jane's life miserable until she chooses to eat." His behavioral
approach of punishing Jane for not eating literally shattered our
daughter's soul. She said in this hospital you have to eat to get
love; she would not be able to see us unless she ate.
After a few weeks of hospitalization, where her
phone calls were monitored so she could not confide in us, she was
discharged having gained only a few pounds. She was returned to us
and for the next several months, we began the work of repairing the
damage they had done....Needless to say, whatever sense of herself
that she may have had before this trauma was gone.
TOP
It is essential to separate a victim from her behavior.
Remember that the child is plagued by the Negative Mind. She may become
abusive, or she may engage in degrading, self-mutilating, or bizarre
activities.
This negative behavior is not your child. When it
occurs, attempt to ally yourself with your child against the Negative
Mind. If you blame your child for that behavior or act repulsed by it,
you are reaffirming and supporting the Negative Mind and confirming
and strengthening the condition.
At this stage your child is extraordinarily suggestible
and will twist everything you say into a negative to feed the condition.
If you throw up your hands and say, "I can't take this anymore," the
Negative mind will have won. If your child tosses a dish at you, understand
that she is doing it out of fear. She is operating on negative instructions
to alienate the ones who love her the most. Indeed, the ones who love
her best must be the first target.
How should you respond in the face of all this horrifying
behavior? What I instinctively do is to put my arms around the patient,
first to take away the fear, then to comfort her, to attempt to persuade
her with logic, and most important, to convince her that I am stronger
than the condition. I must convince her that I am not vulnerable to
the pressure of the Negative Mind, and I am not going away, no matter
what.
You might tell your child, "I know that wasn't you
throwing that dish. I know the condition made you do that. No matter
what the condition does to try to push me away from you, I'm not going
to leave you. I'm here to stay."
Referring to the condition as a separate entity helps
your child draw a distinction between that negative part of her and
her Actual Mind.
Explain to your child about the Negative Mind. Tell
her that she is not crazy, that what she is thinking and feeling is
common among people with eating disorders. When you tell her that you
know that she may be experiencing negative thoughts, even voices, music,
or loud noises, that she is bound to be bewildered yet compelled by
them, she knows that you understand, that she is not alone. To take
away the stigma, liken it to a broken leg or pneumonia, except that
it is an emotional condition rather than a physical one. Explain that
you and she are going to be allies against this condition.
TOP
As and eating disorder wends its way to acuteness,
parents and friends become increasingly lost about what to do. The horror
at their helplessness only accentuates the plight of the victim who
is becoming aware of her own inability to control or remedy her situation.
Within their fear, parents can react, usually against
their child. Desperation persuades them to shout, demand, and lay on
guilt. It seems inconceivable to them that their youngster is truly
incapable of what is a most natural fact of living - eating. But remember,
the victim of an eating disorder believes she is not permitted to eat
because she has failed to save her parents or the world, and therefore
does not deserve to live.
I cannot emphasize enough how easy it is to reconfirm
the negative condition at this stage. The child already believes the
worst possible about herself. Parents must be excessively kind. It takes
great self-control to never react in the negative. It is unwise to tell
a child, "You have a problem." Rather, say, "We have a problem, and
we're going to fix it together."
TOP
I've put "manipulative" in quotes because these behaviors
are often misconstrued as a child's attempt to control others. In fact,
they are the consequence of the Negative Mind controlling the child.
As the Negative Mind attempts to control the child, so it attempts to
control us through the child.
These children are terrified and confused. They intuitively
know that their parents are their first source of help. Imagine the
victims' turmoil when the Negative Mind tells them to push their parents
away even as they pull their parents close.
It is helpful to regard these behaviors as the outcome
of fear or the Negative Mind's internal manipulation, not the desire
to control for its own sake. The child is loath to disrespect anybody.
Irrational behaviors in particular can appear as "control
issues." Sufferers often attempt to structure their eating or sleeping
habits based on illogical fears that harm might come to loved ones if
they do not adhere to the Negative Mind's dictates. The Negative Mind
threatens dire consequences to the sufferer's family members if she
does not obey. "If you eat this, then your mother will die," it may
say, or "If you don't run around the house a hundred times, your little
brother will be harmed."
One patient could only prepare food between one and
three in the morning. Another would not let her parents sleep together
in the same bed; she kicked her father out so she could sleep with her
mother and keep her as physically close as possible because she was
afraid something would happen to her mom if she didn't watch her all
the time. These behaviors are naturally exasperating to parents.
Kathleen had bought her daughter quart-size containers
to store her food. Later she casually asked Mara if she had bought the
correct item. Mara responded by sobbing uncontrollably, "What I really
wanted was the gallon size." Mara acted as though it were the end of
the world.
On the surface, this seemed like a bizarre overreaction,
but it was a major crisis for Mara. She had desperately wanted the gallon
size, but she was so grateful to her mother for purchasing any containers
at all, she did not want to impose on her further. There was nothing
she could do to redeem herself for not feeling utterly grateful and
satisfied for the quart-size containers. She felt unworthy being asked
to express a preference for herself.
TOP
Parents of children with eating disorders find that
they are tested at every turn. If they are unaware of the workings of
the Negative Mind, the destructive behavior will win, and the child
will become immediately more agitated because she will be more fearful.
Your child might be hurtfully rude to you, and you
may be tempted to break down and cry, a temptation you should do your
best to resist. She might hide food she was supposed to eat to see how
astute you are in finding it. (Some of my patients told me they have
purposely hidden tidbits to see if I was smart enough to figure it out.)
Conversely, a child might pretend to be overly cajoling or compliant
so you will give in to something. "Well, I've eaten most of it," she
might say when you are concerned about her nutrition. They may jump
up and down in place doing exercise to see what you will do. In all
cases, it is best to respond with distraction instead of anger. "Come,
let's work on a puzzle together" or "Let me tell you about a funny thing
that happened to me at work today."
Victims often present an illogical logic that draws
parents in. "I need to exercise because it relieves my stress," they
might say. Or "Yoga clears my mind." In my book I present many of the
tricks the Negative Mind will use to further its condition. Victims
will almost certainly know which foods have the most water, fat, and
calories. And they may resort to hiding uneaten food or exercising in
secret.
If you find your loved one engaging in these deceptive
behaviors, it is important to refrain from anger, disgust, or resignation.
Instead, you might say, "Hi honey, I know your head is giving you a
rough time. I know your head is making you do this. Come on, we will
figure it out together."
The victim will usually be embarrassed and relieved
at the same time. And you are proving that you can determine the difference
between the person and the condition. My patients, once cured, generally
laugh at how creative and inventive they were while in the grips of
the disorder.
TOP
Anorexia knows no logic as we understand it. Redirection
of the child's mind depends, then, on reiteration of logic. It is therefore
essential that you respond to each negative statement with a positive
one.
If your child says: "I'm a burden on society."
You might answer: "No, you're not. You are wonderful. You've
never done an unkind thing in your life. If you were a bad person,
you wouldn't worry about being a burden. Selfish people don't worry
about being a burden."
If your child says: "I'm so selfish. I don't deserve to take
up your time."
You might answer: "If you were selfish, you wouldn't care
about that."
Challenge subjectivity with objectivity. A victim will
translate anything said, no matter how positive, into a negative. If
you say, "Your hair looks so lovely today," she will think, "Oh, it
must have been a mess yesterday." If you say, "Good morning, dear. Thanks
for cleaning up the kitchen counter so well," the victim might translate
this as , "The kitchen counter...the kitchen counter...didn't I do a
good job dusting the living room? Or scrubbing the bathroom? Does she
mean I didn't do enough? Or maybe she's just saying she liked the job;
she doesn't really mean it."
Your child's words reflect the Negative Mind; your
reply will be what her Actual Mind will one day be able to tell her
objectively. If she says, "black," you say "white." In many ways, this
resembles the split-page journal exercise and the role-playing our patients
do at the clinic (see Chapter 5).
Your messages should convey unmistakably that you
will always be there:
"I will always listen to you if you get upset and
cry."
"You aren't supposed to be perfect."
"You are not crazy, and you won't always feel this way."
"I have to know how you're feeling in order to help you, but if you
can't tell me right now, I have a good idea anyway."
"Let's talk about it and work it out."
"I am nice to you because I love you a lot."
"Nothing you say or do could ever make me love you less."
"One day you'll be strong enough to be nice to others."
"I won't let your head hurt you."
"I know what I'm talking about. You can trust me."
TOP
Anorexics will try to maneuver you into commenting
on their appearance. This is the Negative Mind's attempt to collect
more ammunition to use against the child. If you say they look fine,
they will think they look normal. They will then think they have to
lose weight to prove they are subnormal and unworthy.
If you say, "You look great," the normal dieter will
feel a sense of satisfaction. But the person with the eating disorder
will feel unworthy. The Negative Mind translates such a comment as,
"You look fat and therefore unworthy."
If your child asks, "Do I look normal?" an unaware
parent might respond, "You look just fine." The victim will translate
this sadly as, "Now I have to lose more weight." It is hard for any
parent to "win" at this game; there is so little neutral territory.
If you must, comment on hair or eye color.
TOP
Parents or practitioners have been known to threaten
anorexics with statements such as "If you lose seven more pounds, you'll
have to go back into the hospital." Ironically, this is in fact giving
the victim permission to lose six pounds, fifteen ounces. Numbers are
best left unsaid.
Take the scale out of the house. Insist that your
doctor weigh your child backward so she cannot see the result, because
her Negative Mind will use any number, no matter how low, against her
to lose yet more weight. Get rid of measuring cups because to the patient
they are yet another means of determining her worth (I'm only allowed
to have two ounces of juice").
TOP
Ideally, it is absurd to expect us all to compete
with one another because we are all unique individuals. Yet society
advertently and inadvertently demands that we do. Any concept that demands
that some people be superior and some inferior has no place in a humanistic
society, and certainly not in the hoe of someone with an eating disorder.
This will only aggravate the condition; these children are already competing
to make the world a better place for everybody else.
If possible, send your child to a school that gives
written evaluations, where every child is an individual, instead of
a letter grade. It would be hurtful for her to be in a position in which
she would be ranked or measured, which again would measure worth. Refrain
from bragging about your child in front of her, because you are sending
her a message that you value her not as an individual but for her achievements.
Avoid displaying artwork and essays that you or the teacher believe
represent the child's best efforts. Consider talking with your child's
teachers or principal about what they can do to reduce your child's
pressure to compete. Tell your child over and over that you love her
for what she is, not just for what she does.
TOP
I would encourage self-expression that is individual
and that by its very nature does not demand perfection. Painting, poetry,
creative writing, and journal work are excellent tools. These are also
a wonderful outlet and a way to enhance communication. You might discuss
your child's creative output with her to gain a better understanding
of how her mind works. Rather than impose your own interpretation, you
might say, "Tell me more about this."
In fact, you might say, "I know your secret. There's
someone inside telling you what to do, telling you to hurt yourself."
It can help your child to let the Negative Mind out into the open because
she will be reassured that the onus is not hers alone to bear. The enemy
has been found out. It is imperative, however, not to ask your child
to agree with you. In so doing, the Negative Mind will punish her.
If there is another adult the child respects, invite
interaction with him or her too. Allowing our child other opinions will
increase her ability to be objective.
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