Reviving Ophelia (26 page)

It helped that Gail was enjoying her life. She liked the other volunteers and many of the clients at the soup kitchen. The homeless all had stories and the time to tell them. When she saw homeless people on the streets, she often knew their names and stopped to chat. She knew she would be fixing them soup later. Even though her contributions were small, they took the edge off her despair.

By now Gail’s appearance had changed slightly. Her hair was returning and shone a lovely auburn color. The last session we invited her parents to join us.

Shelly said that Gail was laughing again and playing with her younger sisters. The phone was ringing now and she had the most interesting friends. Stephen said that he was pleased that Gail was again working on her art. The tone of her work seemed slightly more optimistic. She had rejoined the land of the living. Gail gave some credit for her changes to therapy, which she compared to spring-cleaning. “You get the dust off everything and sort through stuff. You get to throw a lot of junk away.”

WORSHIPING THE GODS OF THINNESS

Heidi arrived in my office after gymnastics practice. Blond and pretty, she was dressed in a shiny red-and-white warm-up suit. We talked about gymnastics, which Heidi had been involved in since she was six. At that time, she was selected to train with the university coaches. Now she trained four hours a day, six days a week. She didn’t expect to make an Olympic team, but she anticipated a scholarship to a Big-8 school.

Heidi glowed when she talked about gymnastics, but I noticed her eyes were red and she had a small scar on the index finger of her right hand. (When a hand is repeatedly stuck down the throat, it can be scarred by the acids in the mouth.) I wasn’t surprised when she said she was coming in for help with bulimia.

Heidi said, “I’ve had this problem for two years, but lately it’s affecting my gymnastics. I am too weak, particularly on the vault, which requires strength. It’s hard to concentrate.

“I blame my training for my eating disorder,” Heidi continued. “Our coach has weekly weigh-ins where we count each others’ ribs. If they are hard to count we’re in trouble.”

I clucked in disapproval. Heidi explained that since puberty she had had trouble keeping her weight down. After meals, she was nervous that she’d eaten too much. She counted calories; she was hungry but afraid to eat. In class she pinched the fat on her side and freaked out. The first time she vomited was after a gymnastics meet. Coach took her and the other gymnasts to a steak house. Heidi ordered a double cheeseburger and onion rings. After she ate, she obsessed about the weigh-in the next day, so she decided, just this once, to get rid of her meal. She slipped into the restaurant bathroom and threw up.

She blushed. “It was harder than you would think. My body resisted, but I was able to do it. It was so gross that I thought, ‘I’ll never do that again,’ but a week later I did. At first it was weekly, then twice a week. Now it’s almost every day. My dentist said that acid is eating away the enamel of my teeth.”

Heidi began to cry. “I feel like such a hypocrite. People look at me and see a small, healthy person. I see a person who gorges on food and is totally out of control. You wouldn’t believe how much I eat. I shove food into my mouth so fast that I choke. Afterwards, my stomach feels like it will burst.”

I explained that bulimia is an addiction that’s hard to break. It requires enormous willpower to fight the urge to binge and purge. And unlike people with other addictions such as alcohol or cocaine, bulimic women can’t avoid their drug of choice. Heidi would need to learn controlled eating. Fighting the urge to binge is just one part of the treatment. She also needed new ways to deal with her own psychic pain. Bulimia, like all addictions, is a way to run from pain. Heidi needed to learn to face her feelings. I suggested Heidi record how she felt at the time of binges. Later we would examine her writing.

I asked about her family. Heidi’s father was a local pediatrician and her mother a homemaker who worked with the Junior League. She was the oldest of three children. Heidi said that she had a wonderful childhood. Her family took trips every summer—one year to the coast of Maine, another to Sanibel Island in Florida and another to Alaska.

She loved elementary school. She’d been busy with her family, church and gymnastics. She was the kind of girl other kids like—easy-going and energetic. Heidi paused. “I had the perfect life—great parents, good friends and my own bedroom with a canopy bed and a balcony. I had walls full of ribbons and trophies.”

I asked, “When did it stop being perfect?”

“After my thirteenth birthday things got tough. I graduated from my neighborhood school and moved into a consolidated school. I made friends there, but I felt under more pressure. School was harder; gymnastics was harder. I gained weight when I started my periods. Coach put me on a diet.”

Heidi sighed. “Social life got harder. The girls were competitive. I hated the gossiping. With boys, everything got sexual. I was friends with some of the guys in the neighborhood, but we stopped hanging out together. We didn’t know how to handle stuff.”

I asked how Heidi felt about her appearance and wasn’t surprised to hear that she had felt ugly in junior high. “Appearance was all we talked about. I tried not to get caught up in it, but I couldn’t help it. I wanted to be pretty like everyone else.”

As is often the case, Heidi’s bulimia began with anxiety about weight gain. She was in a high-risk category—women who make a living or have an identity based on being thin. This category includes gymnasts, dancers, actresses and models. Many acquire eating disorders as an occupational hazard. However, once bulimia is entrenched, it functions, like alcohol or other chemicals, as a stress reducer. Young women binge to relax, and afterward they feel better, temporarily.

We ended our first session with a talk about expectations. Heidi felt pressured to be attractive, athletic and popular. She was amazingly successful at meeting these expectations, but she was paying a big price. Her perfectionism was taking its toll on her physical and emotional health. She needed to strive to be ordinary and to cut herself some slack. Eventually, unless she conquered bulimia, she wouldn’t be athletic, attractive or popular.

Next session Heidi came with careful notes on her bulimia. She had binges at home, in the kitchen late at night after all her work was done. Usually she went to bed and tried to sleep, but almost always she was too anxious to settle down until she had binged and purged. Then she slept, only to wake the next morning hung over and ashamed.

Heidi wrote that before bingeing she felt tired, she worried about her tests or was upset about practice or her boyfriend. We discussed ways she could deal with those feelings besides bingeing: She could talk to someone, write in a journal, listen to music or learn relaxation techniques. Heidi agreed to write in her journal before she binged. She didn’t think it would stop her, but it might slow her down and maybe she would learn something about herself.

We talked about how bulimia had changed her life. She no longer liked family dinners or social occasions where food was served. It made her nervous to be around normal eaters. She could either pick at her food or binge, but she’d lost the ability to have an ordinary meal. She was afraid that Sunday dinners with her grandparents would cause her to lose control, so she avoided them. She missed her grandparents and she knew they missed her. They felt hurt by her lack of attention.

Heidi was exhausted from the time and planning that bingeing required. Sometimes she stayed up past midnight to have the kitchen to herself. Sometimes she missed outings because she knew the house would be empty and she could binge in private. She said, “My parents don’t try to stop me, but I hate to do it when they are around. I don’t want my little brothers to find out.”

She continued, “My boyfriend knows and is real supportive, but it hurts our relationship. I won’t eat out with him. Sometimes I want him to take me home so I can binge. I’ll make up an excuse to end our date.”

She looked at me. “I hate to say this, but I’d rather binge than make out.

“I get real moody if anything interferes with my bingeing,” she continued. “I’m irritable before and depressed afterwards. It seems like I’m never happy.”

I congratulated Heidi for being in therapy. “You have the discipline and capacity for hard work that will be required to fight this. You’ll make it back, I can tell.”

Bulimia is the most common eating disorder in young women. It starts as a strategy to control weight, but soon it develops a life of its own. Life for bulimic young women becomes a relentless preoccupation with eating, purging and weight. Pleasure is replaced by despair, frenzy and guilt. Like all addictions, bulimia is a compulsive, self-destructive and progressive disorder. Bingeing and purging are the addictive behaviors; food is the narcotic.

Over time young women with bulimia are at risk for serious health problems: Often they have dental problems, esophageal tears, gastrointestinal problems and sometimes dangerous electrolytic imbalances that can trigger heart attacks.

They experience personality changes as they grow to love bingeing more than anything else. They become obsessed and secretive, driven for another binge and guilty about their habit. They experience a loss of control that leads to depression. Often they are irritable and withdrawn, especially with family members.

While anorexia often begins in junior high, bulimia tends to develop in later adolescence. It’s called the college girl’s disease because so many young women develop it in sororities and dorms. While anorexic girls are perfectionist and controlled, bulimic young women are impulsive and they experience themselves as chronically out of control. They are more vulnerable to alcoholism than their anorexic peers. Unlike anorexic girls, bulimic young women come in all shapes and sizes.

Estimates of the incidence of bulimia run as high as one-fifth of all college-age women. Bulimic young women, like their anorexic sisters, are oversocialized to the feminine role. They are the ultimate people pleasers. Most are attractive, with good social skills. Often they are the cheerleaders and homecoming queens, the straight-A students and pride of their families.

Bulimic young women have lost their true selves. In their eagerness to please, they have developed an addiction that destroys their central core. They have sold their souls in an attempt to have the perfect body. They have a long road back.

Prudence and her mother came to my office one sunny winter afternoon. Mary was a plump, middle-aged lady dressed in a stylish red wool suit with a fur collar. Prudence, also plump, wore blue jeans, a faded sweatshirt and Birkenstocks.

Prudence told me that she started bingeing three years ago and now binged twice a day, sometimes three times. She described her binge episodes as a kind of craziness when she fell into a trance and inhaled whatever was around. Her preferred foods were breads, cereals and graham crackers, but she ate anything. “Once I lose control, I’ll eat whatever I can find.”

Mary added, “We tried locking up the food, but Prudence bashed open the pantry with a hammer. When she wants to binge, there is no stopping her.”

Prudence said, “I’ve tried to stop, but I can’t.”

Mary said that Prudence never ate normally. If she wasn’t bingeing, she was starving herself. She said, “She’s always on a diet. She won’t eat anything except when she binges.”

Prudence said, “I want to lose weight, but I can’t. I weigh more now than ever.”

“This is all my fault.” Mary sighed. “I’m always on diets.”

I asked about the family. Mary worked at the telephone company, as did her husband. In fact, they met there eighteen years ago. Mary said, “I’m definitely not one of those modern women who stands up for herself. I have a hard time saying what’s on my mind.”

“She’s the family servant,” Prudence said. “She lets Dad push her around and apologizes for any mistake she makes. She needs to get a life.”

I was struck, as I often am, by how closely daughters observe their mothers and by how strongly they feel about their mothers’ behavior. Prudence described her father as a good provider, but quiet. Mary put it this way: “Prudence means the world to him, but he doesn’t have much to say to her. He’s not the type to show his feelings.”

“Are there other children in the family?”

Suddenly the tone of the interview changed. Mary sighed and Prudence bit her lip. Mary said, “Prudence’s older brother was killed three years ago in a car accident.”

“I don’t want to talk about Greg,” Prudence said.

I looked at the two frozen-faced women. I suspected that the family had hardly discussed Greg’s death and that most of their grieving was still ahead of them. I knew this work needed to be done, but not in this first session.

Instead we talked about Prudence’s school, which was in the wealthiest part of town. The population was suburban and homogenous. Most of the girls had designer clothes, straight white teeth and beautiful hair. Hardly any girls were even chubby. Nobody even wore glasses. It was a breeding ground for eating disorders.

Prudence laughed. “When I first went there, all the girls looked alike to me. It took a while to learn to tell them apart.”

She gestured toward her somewhat unconventional outfit and said, “I refuse to play the designer-clothes game. I’m not a Barbie doll. I’m embarrassed to have bulimia. It’s such a preppy disease.”

The next time I saw Prudence I asked to see a picture of Greg. She pulled out her billfold and showed me his senior-class picture. “Greg wasn’t like most brothers. He was my best friend. He didn’t mind having me around, even when his buddies were over. He gave me advice and protected me. The worst thing Greg could say was that he was disappointed in me. That would shape me up fast. He got on my case if I made Bs. He taught me to pitch and to ice-skate.”