Co-Researching Anti and Pro Bulimic Practices in Therapy
LINDA [18] AND DAVID EPSTON
David: Before we started recording, you were reflecting on Sally commenting- “I am shrinking inside’ when with her consent, I asked her some ‘assessment’ questions. Do you mind repeating yourself?
Linda: That is absolutely a typical feeling. I have been assessed on three or four occasions. I feel like I fly back in the chair into the corner and just sort of sit there, tensed up. It’s horrible!
David: I am quite sure those people feel pretty strongly that they are asking good and helpful questions. What it is that they are asking that makes you respond that way?
Linda: Well, bulimia is really a very personal thing. I don’t know if people realize how personal it is. And when people sit there- there were three of you- and it’s like someone asking you the most intimate questions while expecting you to give them a straight up answer, just like normal. And I mean they didn’t even ease into it. They are just blatant questions. It makes you feel like they are sort of sizing you up.
David: A lot of people think that questions are innocent but I am not convinced of that. After all, every question has some meaning implicit in it.
Linda: Yes, you feel as though you have to give a right answer. That there is a right or wrong answer. You don’t feel you can tell the truth. I was always thinking- ‘Oh, what is the right answer? What are they asking for here? What do they want? It’s a test!
David: A test in the sense of an evaluation? That could very well help me understand a comment of Shelly’s. She told me she had lost weight for her psychiatrist. And when I enquired why she did so, she said- “Well, I wanted to be a good anorexic for them”. Can you explain that to me? I’m not at all sure I’ve got the gist of that. I can see you are laughing and nodding. Tell me what it’s all about.
Linda: When they were asking me questions….I mean, I had read a lot about bulimia. I’d answer the questions like….I don’t know whether I was scared they weren’t going to take me seriously so I’d give them the answers that I know the books say. Like the books say you do such and such..you know a typical bulimic will do this and feel this and will say these things.
David: Were you, by any chance, trying to pass a bulimic test?
Linda: (laughing) Yes, be a PERFECT BULIMIC!!!
David: I am starting to get it. Shelly’s comments were pretty much the same as yours.
Linda: You don’t feel as though you’re a good enough bulimic for them?
David: Did you have an experience like Shelly of being somewhat surprised by my questions?
Linda: Yes, I remember saying to you when I first came that you didn’t know what I was going through because you didn’t follow the same line of questioning. I sat here and was really fazed.
David: Couldn’t you figure out how to be a good bulimic for me?
Linda: Well, we didn’t really even talk about bulimia. I thought to myself- ‘what is the story here?’ And I couldn’t understand what was going on. I mean I went away feeling happy for the first time but I didn’t understand what had really gone on.
David: Were you concerned that sooner or later I would come up with….
Linda: (interrupting) Yah, I was waiting for them. I thought- ‘Oh, he’s lulling me into a false sense of security and then he will get me!’
David: I see. I didn’t know you were expecting that of me.
Linda: I think anybody that has seen anyone else would.
David: Did the other people you consulted do the same things?
Linda: It was almost as if they were reading out of the same book. Or were taught by the same teacher.
David: When did you realize I wasn’t trying to trick you by lulling you into a false sense of security and then give you what you called ‘bulimia’ questions?
Linda: Probably the second or third visit. After all, I started to feel better and I thought to myself- “Well, it’s working?. I hadn’t thought what you were doing was going to work. I kept thinking- “when is he going to give me the cure?’ When would we get into the heavy stuff? But then I started to realize that it was working.
David: How did you know it was working? You mentioned something about feeling better. What was that about?
Linda: Do you remember me saying to you that I don’t feel I am getting any better because I’m still making myself sick? When you explained to me that that wasn’t how we would gauge things. That it had a lot more to do with how I felt about myself. And I knew I felt better. Things were happening that I normally wouldn’t have done. I was acting differently that I had for ages.
David: When did you realize that I wasn’t ever going to ask you those evaluation questions? Oh, I remember you confronting me and looking back now, I guess I may now understand what you meant. I think you said something like- “Look, what is this all about? When are you going to get on with it? Look..it’s just vomiting. That’s all it is!” And I said to you in jest- “Linda, if it is merely a matter of vomiting, why don’t you sit on your hands!” And you broke out laughing. And perhaps there was wisdom in your laughter because it is obviously more than that.
Linda: But the assessors in the hospital would have you believe that it is to do with vomiting, not how she is feeling inside. For example, there was a girl in hospital and if she put on two pounds, they would tell her she was a ‘good girl’ and that she was being cured and getting better.
David: Isn’t it interesting when you think about it that anorexia and bulimia requires you to concern yourself with your bodily shape and the treatment reproduces that by having you get even more conscious. Is it something like this- anorexia requires you to be conscious of our body and you then have to be conscious of their consciousness of your body? Does that make any sense to you?
Linda: Absolutely! When I first saw people in the hospital, I would come away thinking if I weighed 70 pounds, they would have helped me. Because I didn’t, they won’t. I wasn’t bad enough…I wasn’t at death’s door and until I was at death’s door, they weren’t going to do anything for me. They were telling me- ‘Go away! Heal it yourself!” That made me really bitter! It made me think- “God, what do I have to do?”
David: This could have been a trap because I am not so sure they have any better ways if you were to weigh 70 pounds, except to force feed you. And no one has convinced me that being force fed had them develop as a person. I have met people who have had to be subjected to that but looking back, they see it only as saving their lives, not making them into persons. After all a person is more than calories, don’t you think?
Linda: Yes, I agree.
David: You know when you responded to your evaluation here the other day. You told me that you felt immediately suicidal and drove around for a few hours across the Harbour Bridge. But somehow you recovered yourself but then started vomiting for hours on end. How do you understand the relationship between your evaluation and those events?>
Linda: I don’t know whether I felt like I had failed their test. Yah, I think that’s how I felt.
David: How would you have passed their test, given you had considered that you failed it?
Linda: If I had sat there and said, “Yes, I am suicidal. Yes, I do want anti-depressants. Yes, I am really bad” and threw in the key words and phrases that a typical suicidal or a typical bulimic would say. Then they would have said, “Yes, you are bad. You are definitely da..de..dah. Come with us and we will take you away”.
David: I have come to realize through you and Sally and Caroline that it is quite possible that a lot of the ways we think we are being helpful could be exceedingly unhelpful. To assist us, how would you suggest a professional person might approach a woman struggling with bulimia? What questions would we be advised to ask?
Linda: I think very much like you do. You don’t focus on…I know. Never ever mention weight! I think that should be taboo. You were just sort of cool and calm and we talked like a couple of friends would talk to one another. You helped put things into perspective.
David: You have used ‘perspective’ once or twice before. What was the ‘perspective’ we created for this struggle you were having with bulimia?
Linda: You gave me some direction. It was like I came in with a whole lot of building blocks and you showed me how I could build them. After all, I had accomplished a lot of things but they weren’t accomplishments to me. I didn’t even recognize them as such. And you just sort of(she trails off)
David: I’d just ask you to consider this description and see if it fits for you. This is the way I have been thinking about it. You had a kind of bulimic story in which bulimia was really the central character in your life and in fact was shaping your very life. And what we did was find a way to introduce you into your life and make you central to your life’s story. And I assisted you to put some of those events into what I might call a ‘narrative’. Another word for that might be story-line in which you were making things happen for yourself but the story bulimia was telling about had frozen..paralyzed your development as a person.
Linda: Yes…yes. Bulimia shouldn’t be the main focus for what we are talking about. It gets enough attention as it is.
David: It seems to me that we pinpointed or dated when you started taking action in your own life instead of being acted upon and there are so many examples I can recall. It is almost as if you took the authorship in our own story rather than bulimia ‘telling’ your life. Does that make any sense? Did you feel at any point that you were starting to make things happen in your life?
Linda: I think I was doing it before meeting you but I never recognized it. So you just don’t think you are.
David: That is possible, isn’t it?
Linda: I mean that you wouldn’t recognize it.
David: And do you think the letters that were a record of such discussions were helpful?
Linda: Brilliant! Speaking with you for an hour or so and then going away, it’s quite easy to forget. But if it is down on a piece of paper…..I used to go back and read it and see what…it just gave me time to digest it and think about it, because as I mentioned, it is quite easy to forget when you come away from a meeting.
David: Especially, I suppose, if they are new things that have to be added to our memories unlike old things that are already in our minds. As this recording was made to inform others about this work, would you like me to ask them to make comments back to you?
Linda: Yes…good! Thanks for that.