I knew I needed to do something different. I had been seeing Stacey for years and while some changes had occurred in her life for the better, I truly believed the eating disorder remained untouched. I had never really seen it this way before. I had never really seen the disease as such a separate entity. I had utilized narrative techniques, externalizing the eating disorder to the patient so that they are not so tied up in it. I had referred to the eating disorder as “ED” or “Ana”. However, I had never experienced it as separate during the work with the patient. I had never seen so clearly that other things can change in the patient’s functioning (anxiety, depression, irritability, assertiveness, sense of self) and in the family functioning (communication, boundaries, loyalties) but that the anorexia just could sit there untouched. I began to see the pure presence of it. The reality of it. I even began to dream about it. Anorexia finally stepped forward in all of its ghastliness and power and I was truly overcome. All of my “tools” were ineffective. It was like throwing jello on a wall…nothing stuck. I really believe it was this experience that for the first time showed me the “enemy” in its true form, without being veiled by my own projections, prejudices, or anxieties.

I know this sounds dramatic. I am reading it and thinking that unless you work with clients like this (or are a client like this) you will think I am being unnecessarily strong in my language. But that is just the point. I, like most of you, would have thought the same thing…”It is not like they are possessed by something… they should be able to fight this themselves”. But, I began to realize on that day years ago that these girls are possessed. Their thoughts are not their own. Their will is not their own. No amount of telling themselves to “use your voice” or “love their body” is strong enough to fight this voice inside of them that is telling them everything, all the time. All the time. They have no choice but to listen and Stacey had no choice but to submit to its demands – to eat limited calories, to exercise until her body ached, and to hate her thighs with utter disgust and repulsion. This was the disease’s demands and Stacey was drowning, losing herself to its rules.

I started thinking in a different way: “If this disease is so strong and its voice is so strong, how can I be a stronger voice?” “How can I get this patient to listen to me instead of the disease?” I had tried every technique in the book and she still wouldn’t eat. Everyone knows that getting an anorexic to eat is impossible. Right?  Well, family based treatment (FBT) thinks differently. FBT says that we, the grown ups and the treatment team create a situation in which it becomes impossible for the patient to NOT eat. The environment is changed around the child. Contingencies are given for doing what they are told to do. The parents are viewed as the primary change agent, not the child (at least in the initial work). The parents (as part of the team) become stronger than the disease. The voice of the unified, empowered team becomes more compelling to the patient than the anorexia. Strong and unwavering – a brick wall. With one message and one message only: “All life stops until you eat”.

Please check in next week for Closing the {Thigh} Gap, Part III. Thank you!