Never Tell a Bulimic, “Don’t Binge!”
Food, like sex, is one of the pleasures of life. But, just as with sex, if taken to an extreme the pleasure of food morphs into a compulsion. That is why eating disorders are one of the most difficult disorders to treat. Obviously, we can live without drugs and alcohol, but not food. One of my first questions at a screening interview to an overweight prospective group member is, “Are you happy with your weight?” Most say that they aren’t, but, despite knowing what has to be done to trim down, they are either unwilling or unable to do so. My next question is, “What are your favorite foods?” I believe that the type of food a group member chooses to over-indulge is indicative of the kind of internal void they are trying to fill—smooth, sweet, salty, crunchy, all have meaning. I’ll ask, “Do you eat even when you’re not hungry?” Then I ask, “What feeling are you stuffing down with food?” I want to know if the food is used to allay anxiety, like comfort food, or is it crunchy to relieve aggression, and so on. In most cases, my view of eating disorders is much the same as my view of addictions and OCD behavior—an attempt to control what can’t be controlled.
For example, during one group session, Andy, a middle-aged, 6’5”, 300+ pound food addict, told us that, before coming to group that night, he ate a whole pizza, washed it down with a liter of Pepsi, and then ate a pound of chocolate. The group was appalled and voiced concern for his health. Henry, half-jokingly said, “I’m worried that one day you’ll just explode!” I asked Andy, “What feeling were you stuffing down with food?” Andy was usually self-aware, and so he didn’t miss a beat and said, “I’m very anxious but I don’t know why. When I was a kid, my mother would soothe me with pizza and chocolate if I was scared…which was just about all the time.” Andy’s father was a raging alcoholic, who would take his frustrations out on his wife and kids. He would regularly beat them when he came home from work in a drunken fury. Andy’s mother adored Andy, but feared the father. To compensate Andy for her guilt in not protecting him from her cowardly husband, she indulged him with food. “Mother’s milk,” Alice said. “Pizza and chocolate are Andy’s mother’s milk.” I said, “That’s a very smart interpretation of Andy’s behavior. What’s your feeling toward him?” Alice said, “I completely understand Andy. I use food to soothe anxiety, too. I prefer pretzels and potato chips. I like the salty and crunchy taste.” Angela agreed, “I know I’m a food junkie too but I’m helpless to change it.” Andy replied, “True dat.” Everyone laughed. Vinny said, “I’ve been in 12-step programs and respect your honesty. Acknowledging your helplessness to control the disease is the first step.”
In another group session, Felix came to group and reported his binge-eating behavior since the last meeting. His psychiatrist had recommended a consultation with an eating disorder specialist who said the absolute worst thing to him. She directed him, “Don’t binge!” Without much emotion, almost boasting, he sheepishly told us, “After I left her office, I went home and ate 13 bagels and cream cheese. Then I threw it all up and had two quarts of ice cream.” Alarmed, the group wanted to fix him. Vicki said, “I’m so concerned about you. You’re hurting yourself.” But Jason understood Felix’s behavior. He said, “If I were Felix, I would have done the same thing. If some therapist told me not to binge, I wouldn’t listen. It’s like that idiot Nancy Reagan who said, “Just Say No to Drugs!” She might as well have said “Go do it!” Any self-respecting addict is going to defy authority.” As crazy as it may sound, I supported Felix’s defiant behavior and said, “It’s your body, you’ll do what you want with it!”
Felix laughed and said, “I feel so understood, but what can I do?” I said, “The next time you binge, don’t try to stop it. You can’t. That’s what makes you an addict.” He said, “But I want to stop.” I said, “You do and you don’t.” He said, “But I’ve developed acid reflux as a result of all the puking. The doctor said that I’m wearing away the lining of my esophagus!” Georgia anxiously said to me, “Can’t you help him to stop? This is making me so anxious.” I said, “Felix is not ready to stop. He has a high tolerance for pain. He’ll know when he’s had enough. As strange as it may sound, Felix hasn’t hit bottom yet. He’s not scared enough to change. Maybe he never will.” Felix said, “Funny, I feel understood and calmed but alarmed at the same time.” I said, “You’re having all the right feelings.” Mary asked me, “Isn’t there something he can do in the meantime? I’m afraid he’ll get really sick and die.” I said to Mary, “What are you feeling toward Felix?” She said, “I feel helpless.” I asked a rhetorical question. “What’s your objection to feeling helpless?” She said, “I hate it. I want you to do something to stop Felix’s bingeing. I asked, “What makes you think I have more clout with Felix than anyone else?” Lionel said, “Because you’re the therapist.” I said, “And you’re the patient. Now that we’ve established that, then what? Felix is not scared enough to stop. He may never be scared enough to stop. Right now, he gets too much pleasure and pain from bingeing.” I turned to Felix and said, “While you’re bingeing, ask yourself ‘What am I feeling right now? Why is the feeling so intolerable?’” Liam asked, “Will that stop the bingeing?” I replied, “Probably not. But it will put Felix on the road toward understanding the emotions that underlie his abuse of food. If he continues at it, there may come a time when he can make a conscious choice as to what he wants to do with his body.”