A Starving Madness
Tales of hunger, hope & healing in psychotherapy
by Judith Ruskay Rabinor, Ph.D.
A Crack in the Wall
Excerpt from A Starving Madness
"The sorrow that has no vent in tears makes other organs weep." - Henry Maudsley
Growing up is a precarious journey. Especially during the teenage years, children hit occasional rocky patches as they struggle to come to grips with their changing bodies and fast-paced lives. Many young people's inner resources are stretched to the limit by all that they have to deal with, but if they can draw strength from the people closest to them, especially their parents, they usually manage to ride the ups and downs. However, some cannot make nourishing connections with anyone, least of all their parents, because they have built a protective wall around themselves. Chipping down that wall is a long, painstaking process...
"It's Marilyn Schwartz again. I hate to bother you with so many messages, but I have to talk to you about my daughter. It's urgent. Please call."
Replaying my answering machine on that cold November night, I listened to the three messages from the same unfamiliar caller. She sounded desperate. Even more than her words, her tone of voice drummed on my heart.
Dialing her number, I glanced at the time - just after 11 P.M. Should I be calling a new patient at this hour? Would she think I was a workaholic or just disorganized? "Over-extended" was closer to the truth. With two children to carpool, errands to run, dinner to fix, and homework to supervise, in addition to seeing clients, returning calls sometimes got lost in the blur.
When I introduced myself, Mrs. Schwartz sounded relieved. "Thank you for getting back to me at this late hour," she said. "I'm truly grateful." A muf▀ed sob punctuated a long silence. "Forgive me for breaking down. It's my daughter, Mia. She's 19, and we're in trouble." Mia and her mother had been seeing a psychiatrist, Dr. Laufer, for six months. "I don't think he understands her, me, or anything at all about her problem - bulimia." Just that day Marilyn had telephoned Dr. Laufer about a snag in the insurance reimbursement. The call was an eye-opener because she discovered that he hadn't seen Mia in two weeks. "When I confronted her, Mia said she stopped going because she wasn't getting anything out of it. Then she stormed out of the room, sneering, 'You can't make me go back.' Of course, she's right. I can't make her." "You certainly can't," I agreed.
"She dropped out of college last May, right before finals. As soon as she came home, all she could talk about was how fat she was, even though she was painfully thin. I didn't pay a lot of attention to her and her 'fat' talk, but now I realize I should have. I work in a high school and know about eating disorders, but when it came to my own daughter, I was in the dark. I think she might even be taking laxatives. That's a symptom of bulimia, right?"
Before I could respond, she continued breathlessly. "Mia hasn't had her period in six months. She's 5'7" and weighs only 107 pounds, so I'm worried. She's impossible to get along with, too. She's always moody and can be really nasty. Another thing - she just lost her job, the third since she dropped out of school. And the bathrooms . . ."
"Let's stop right here," I interrupted, feeling overwhelmed. "You've got a lot going on. Why don't we set up an appointment?" "That's part of the problem," said Mrs. Schwartz. "She's had it with shrinks." "Does she know you're calling me?" I asked. Mia did not. "Without knowing you or Mia, it's difficult to give you advice," I told her, wondering whether Marilyn was afraid to push her daughter too hard and risk making her angry. Perhaps she was worried that she would lose her. "As a start, try being open and honest. Tell her in a straightforward way exactly what you see - she's lost weight, is hardly eating, and seems unhappy. Let her know you're worried."
Mrs. Schwartz's frustration spilled over. "I just told you - she won't listen to anyone, especially me! She thinks I'm a loser."
"Raising kids is not easy," I said. "Let me make a suggestion. Tell her you called me because you love her and are concerned about her. Take care not to let her think therapy is a punishment for bad behavior - let her know it's more of a gift. If she still won't see me, why don't you come in first and we'll see if we can get her to follow? How does that sound?"
Marilyn paused. "If it's her problem, why would I come in?"
"Because you're her mother and you are worried that she's in danger. When Mia hurts, so do you. You're right, it is her problem, but she's not ready to do anything, and you are. So let's give it a try. Are you available Thursday at 5:30?"
Marilyn Schwartz introduced herself with a firm handshake and a wide smile, but as she sat down and began speaking, her voice shook. "Obviously, Mia refused to come in," she told me. "I couldn't get her to budge and I'm at my wit's end."
"How do you usually get her to do things you want her to do, like chores around the house?" I asked. Although bulimia is clearly a more serious problem than a messy room, I wanted Marilyn to see that her everyday parenting skills might help get Mia into therapy. But my question bombed. Marilyn no longer considered herself an effective parent in any arena.
"You've got to be kidding. She doesn't listen to anyone, especially me. That's why I'm here! Her bulimia is getting worse, no doubt about that. There's something else, too. Yesterday I found some matchbooks in her car. I wouldn't have thought twice about it, but I saw another pack on her bureau, and she doesn't even smoke. I asked myself, Why matches? Then I remembered a newspaper article about kids cutting and burning themselves on purpose. It seems that's the new 'rage.' I asked Mia if she was burning herself, and she denied it, but I don't know whether to believe her."
Marilyn sounded frantic and I was growing increasingly concerned. Although I had never treated anyone who had self-mutilated, I did know it could be a serious problem. But before I could respond, Marilyn had moved on to her next complaint.
"She's out until all hours of the night with her boyfriend, Brett. When she's home, she's usually in her room, which is a mess, eating or sleeping. I can't count on her for anything. If I ask her to do any chores while I'm at work, forget it. Often she doesn't get out of bed until I get home." Marilyn's voice sounded like the moan of a wounded animal.
"And when you two do get together?"
"I never know what to expect. If I knock on her door, she'll either scream at me to go away or be happy to see me." One recent evening, Marilyn had come home to find Mia crying hysterically. "She was standing there in front of the mirror, staring at herself, grabbing her thighs as if they were pieces of meat, and shrieking, 'How am I going to get rid of this flab?' She can spend hours berating herself for what she calls her 'fat.'"
"How do you handle this?" I asked.
"Sometimes I tell her, 'Mia, everyone has parts of their body they dislike - we just learn to live with them!' Or I'll say, 'Listen, Mia, I hate parts of my body, too. Take a look at the flab under my arms and my sagging chin.' I tell her that other people don't even notice the parts of our bodies that bother us. Is that wrong for me to say?"
Although Marilyn's dissatisfaction with her own body wasn't unusual, it was making me increasingly uncomfortable. Research has consistently concluded that mothers who are self-critical of their own bodies send unspoken messages to their daughters that their bodies, too, are not good enough. Eventually, Marilyn would need to help her daughter feel proud of herself for who she was on the inside, and she could start by not focusing on Mia's appearance. For example, when Mia complained about her weight, Marilyn could change the subject and ask about her interests or friends. But this was not the time to give Marilyn a lesson on parenting. . . .