Dr. Michael Strober, the director of the UCLA eating disorder program and a mentor of mine, wrote a seminal article (* link below). about how to approach the initial consultation with a patient with Anorexia Nervosa. I first read the article, written in carefully chosen, beautiful language, many years ago. As much as Dr. Strober was able to clearly explain the intricacies and demands of such a complex first meeting, the meaning of his words has only deepened with time.
It's a monumental challenge to alert a patient's eating disorder that the jig is up, a fencing match with the most subtle but effective of parries can set the patient on a path towards recovery, even someone seemingly unreachable. The practical effects of recovery may not be apparent for some time, but the first meeting can lay the groundwork for real change.
I have since spent many hours wondering about the ramifications of Dr. Strober's discoveries. Although people with eating disorders are unique individuals, their illnesses are remarkably similar, and the message they need to see a path towards wellness practically identical.
The eating disorder is so much more than the sum of its parts. It's a companion, a best friend, a lover and an all-knowing philosopher. It's a captor, abuser and torturer. It's a source of pride, an accomplishment in a sea of failure and an endless series of distorted mirrors. It's the primary basis of identity but also eclipses any true identity at all.
It's everything one could dream of, yet it's also an illness, a common one at that, just like everyone else's eating disorder.
It's a vast emptiness. It's nothing.
Dr. Strober states very clearly that a personal connection, one that obviates the need for the eating disorder, suddenly and completely calls into question the nothingness of this disease. The strongest eating disorders become personified, much like the personification of animals or inanimate objects in fiction.
Questioning that fallacy with an immediate and powerful personal connection can so disarm the patient that she can do little but listen in the open-minded way the illness had previously made impossible.
What has struck me even more in the intervening years are the implications of that initial connection, the first moment of meeting an eating disorder.
It insists on the creation of a true and real relationship. It opens the door, if the treatment is to be truly helpful, to a very real and powerful connection, something both therapeutic and affirmingly existential at its core.
That powerful moment needs to be much more than a chance encounter. It insists on the need to see the special, moving and cherished characteristics of both the person and the relationship. It lays bare a vulnerability of a most profound nature. It creates a truly special bond risen from the ashes of a devastating disease, something lasting, a way to envision closeness in a world without the disorder.
And in the wake of that intensity, pain and persistence against a wily and stubborn illness lies the foundation of a life in recovery, one that allows for the joy, pain, accomplishment and failure of an ordinary life.
That life no longer has the artificial drama and specialness of the eating disorder. It eludes the appeal of the supposed creation of a superhuman but false persona. After that devastating nightmare of an eating disorder wanes, what's left is a life that is very, very real.
The moment of meeting an eating disorder is now precious to me but fraught. Weighed down with the possibility of showing a very ill person a path towards relief, I see the import of Dr. Strober's words more clearly each day.
Eating disorders take away years of people's lives and cause endless suffering for so many patients and families. In that first meeting there is a chance to avoid years of pain.
If at all possible, I just can't pass up the opportunity to help someone escape that much suffering.