Identifying Starvation
My last post on eating said that I only truly became effective at treating eating once I met my patients where they were- which was starving.
From many of my patients and colleagues I often get the question- how do you know?
How do I infer that someone is starving? What are the cues- aside from a low weight? How can I tell when someone refuses to tell me that they are starving because they want it to be hidden? When they want to keep the secret from me?
I follow the path that they cannot hide….
They are in my office. So I have a basis for believing that there is a problem. No matter how much they deny it, either they themselves or someone who loves them have gotten them this far. So I have the lead on the ED out of the gate.
I listen closely to them. I listen for what they are actually saying and what they are not saying. Are they being vague or specific? Are they talking about food relentlessly and saying they are “fine” Are they talking about their friends but I am getting the sense that they do not have real intimacy? Do they eat alone? Do they always eat the same things? Do they have rituals and schedules and rigid specifics about their food?
I monitor how I am feeling. Do I feel like they are being elusive? Do I feel as if they are being cagey or indirect? Do I feel as if there is a barrier between us, and no matter how many questions I ask I cannot get through?
I ask them. What’s happening with the food? Why are people worried about you? Are you worried. I am direct. I am not afraid of them.
Then I tell them. I say to them if they had an issue with food, I bet they feel lonely. And scared. And mostly tired. Exhausted in fact. By the sheer weight of their secret. The fact that they know that they have a secret and are thinking about food all the time. I explain it is controlling their life and it is invading their relationships and their activities. That they have no space for themselves separate from their eating disorder. And I also tell them it is not because they are vain, or selfish or “crazy”. It is because their body has turned on them and what they used to be in control of now controls them.
Most importantly I have deep empathy for where they are, and compassion for their helplessness and loneliness.
