Hunger for Connection

Finding Meaning in Eating Disorders

Alitta Kullman

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351972086
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Who develops which eating disorder and why? When do eating disorders begin and what fuels them? In Hunger for Connection, psychoanalyst and eating-disorder specialist Alitta Kullman expands on the "body/mind" personality organization she calls the "perseverant personality, " illustrating how food and thought are linked from infancy, and for some, can become the primary source of nurturance and thought-processing for a lifetime—leading to what we call an eating disorder.

Writing in a highly accessible style, Kullman brings humor and gentleness to her interactions with patients, offering health professionals and mainstream readers alike an essential guide to understanding and/or working with cyclical eating disorders of all types. From psychoanalysts, psychotherapists, and counsellors, to eating disorder specialists, researchers, and students, Hunger for Connection not only provides guidelines for therapists of varying theoretical orientations and levels of expertise, but help and hope to people suffering with eating disorders and those who care for and about them.

Part one
Making the connection

one
reaching for connection

“I JUST CAN’T LIVE THIS WAY anymore,” Megan said to me in a barely audible whisper. “My whole life circulates around my eating disorder. I can’t go any where without making sure I have access to a bathroom so I can throw up. I can’t wait for my husband Jon to leave in the morning so I can binge. Lately, he’s been getting suspicious. I just don’t know what I’m going to do.”

The image of Megan’s face on the day she began her therapy is etched in my memory. Tall and slender, with long dark hair, porcelain skin, and pale glistening lips, Megan’s eyes exuded a mixture of warmth and terror that instantly captivated my attention as they latched onto mine. Meeting for the first time in the waiting room of my office, Megan extended her hand in greeting, the warmth of her manner belying the fear in her eyes. But, as she settled herself on the couch and began telling me about herself, it quickly became apparent that her demeanor had been carefully crafted to conceal a lifetime of pain.

“I was always the fat girl,” Megan’s voice quivered, her façade already threatening to crumble. “I remember weighing sixty pounds when I was just six years old and hearing the pediatrician tell my mother that I was ‘just too fat’. I was mortified. After that, my mother started watching everything I ate. My brothers could eat anything they wanted, but anything I put into my mouth—from a celery stick to a spoonful of ice-cream—got analyzed or commented on in some way.”

I nodded, encouraging her to go on.

“I know now that my mother was totally obsessed with her own weight, and that my father put a lot of pressure on her for us both to be thin. But then, it was like living under a microscope. By the time I was nine, my mother was carting me from one diet doctor to another, to weight-loss clinics, even hypnotherapy. But in between the diets and the promises, I couldn’t ever stop thinking about food.” She sighed deeply. “ I guess I learned really early how to hide things from everyone.”

Megan reached for a tissue and blotted the tears beginning to streak her makeup. “They never understood what it was like for me,” she whispered when she could speak again. “How humiliating it was to have other kids make fun of me or not want me on their team. How I felt like my Dad only loved me if I was thin or losing weight. If I cried because I was being teased, my mother would tell me to ignore it. ‘You’re just too sensitive, Megan’, she would say. ‘Just start eating healthy and everything will be fine’. Or she would stare at me with that ‘look’ in her eyes and say, ‘You have such a beautiful face, Megan. Why can’t you just try a little harder?’ But no matter how hard I tried, no matter how many promises I made to myself or to her or my father that this time would be different, every diet ended with me weighing more than before.”

By the time she turned thirteen, standing five-foot-six inches tall and unhappily overweight, Megan determined never again to suffer the humiliation of being called ‘fat’. She carefully constructed a six-hundred calorie diet and refused to budge from her prescribed plan. Before long, she became a “walking fat-and-calorie-counter,” refusing to take in even an ounce of fat. She scrutinized nutritional labels, studying the exact composition of every food she even considered eating. Soon, almost no food felt safe. She cut her lettuce leaves and cucumbers into tiny bits and pieces; she mixed her small packet of oatmeal with two cups of water and left most of it in the bowl.

“Why are you so stubborn?” her mother now argued. “Why won’t you eat?”

Megan was hospitalized in an eating disorder treatment unit when she was fifteen, weighing less than eighty pounds. But soon after her release, she began having difficulty maintaining the strict diet she still tried to adhere to, and her hunger, long kept under wraps, erupted. At first, she would stop for a candy bar or hot chocolate at the convenience store on her way home from school. But those secret encounters with chocolate soon turned into massive binges. On weekends, she would wait for everyone to leave the house so she could melt into the bags of food she kept hidden in her closet. She could eat a dozen eggs at a time, followed by six pieces of toast and three bowls of cereal. Then, when she could take in no more, she would purge until she tasted bile, the physical emptiness providing familiar relief.

“I felt like I was caught in a vise,” Megan said intently. “I needed the food so desperately I can’t even begin to describe it. But I couldn’t bear the thought of being fat again.”

Bingeing and purging seemed like her only way out.

As college loomed on the horizon, Megan felt a mix of emotions. On the one hand, she couldn’t wait to get out from under her parents’ constant scrutiny; on the other, she was afraid to leave. Being away from home had always terrified her. She felt so unsure of herself, so used to being told what to do and how and when to do it, she was afraid she wouldn’t be able to manage on her own. But, finally bolstered by an academic scholarship, a new wardrobe, and assurances that she could come home whenever she wanted, Megan took off for her father’s ivy-league alma mater. Schoolwork hit like an avalanche. Her professors expected her to think, she told me, and it seemed as if they all wanted her to do it on the same night. Megan could barely get through a sentence in her textbooks without grabbing for her stash of candy or eating an entire bag of popcorn. Her frequent trips to the bathroom to purge began irritating her roommate, and soon there was a strained silence between the two. Megan called her mother every night and begged to come home. At first it was just for a weekend, but then she pleaded with her mother to let her leave school.

“Just pull yourself together, Megan,” her mother insisted. “It’s almost winter break. Just hold on. You’ll be fine!”

Her father wasn’t much help either.

“You have a brilliant mind, Megan,” he said somberly. “You are carrying on our family tradition. I know how disappointed you will be in yourself if you let this opportunity get away from you.”

Megan sank deeper into despair. She became increasingly isolated and dependent on her binges to get her through the endless days and nights. But, despite her purging, she began to gain weight. By winter break she had doubled the “freshman fifteen,” leaving her bursting out of her new college wardrobe and living in sweats. Home for the holidays, she once again tried to avoid her father’s scrutinizing glances and her mother’s nutritional advice. Concerned about her weight gain, her parents urged her to get back into therapy when she returned to school—something she had refused to do after her hospital experience. But Megan felt that her college counseling center therapist “just didn’t get her,” and she was uncomfortable with sharing in the group setting. Convinced that she just needed to have “more willpower” and work harder at overcoming her eating disorder by herself, she moved into a single room and returned to the bulimia and isolation that by then had become an integral part of her life.

Megan managed to complete college with honors and graduate three years later at the top of her law school class. Her parents beamed with pride on graduation day and bragged to their friends that they were looking at the future managing partner of her father’s prestigious law firm. Even her weight seemed to have stabilized, with Megan assuring her parents that anorexia and bulimia were long buried in her past. She had passed the Bar and was working as a Junior Associate at her father’s law firm when she met Jon, a young, politically-ambitious consti tutional lawyer. Their wedding had been the social event of the season.

But neither Jon nor anyone else knew the terrible secret Megan still closely harbored: That her bulimia was indeed far from dead and buried. In fact, she still felt like she needed it to keep her alive. Megan knew that Jon suspected and was terrified he would leave her instantly if he knew the extent of her bingeing and purging. But, try as she might, she could not interrupt the cycle on her own. Megan was desperate: How could she continue to hide the truth from Jon? What would she do if he found out?

“Have you considered letting Jon in on your struggle?” I asked gently, waiting for her tears to subside.

“I’ve thought about it,” she replied. “But I’m scared to. What if he doesn’t understand? What if he’s repulsed? I couldn’t blame him. I am repulsive.”

I looked at this beautiful, accomplished young woman hunched over on my couch, cowering in shame. How hard she had worked to keep herself hidden, to keep from being exposed. How convinced she was that anyone who really knew who or how she was would inevitably reject or abandon her.

“What makes you think Jon would find you repulsive?” I asked quietly.

Megan looked at me incredulously. “Do you have any idea what I look like when I’m eating?” she asked. “Or what it’s like to hang over a toilet half your life?”

“I think I have a pretty good idea,” I replied. “But I’m not nearly as concerned about what you look like on the outside in those moments as I am about what’s happening with you on the inside. It seems to me that there’s an awful lot of sadness and hunger all tied up inside you that you feel you have to deal with alone.”

Megan looked away, tears again trickling down her face.

“I don’t know why I am so self-destructive,” she whispered, hiding her face in her hands.

“I know that’s the way it may appear, Megan,” I said softly, noting how quickly she had turned her anguish against herself. “And I know a lot of people might see it that way. But to my mind, your bulimia isn’t a way you are trying to hurt yourself or anyone else. You obviously have experienced quite a lot of pain in your lifetime. Why would you intentionally try and inflict even more? The only thing that makes any sense is that, in some very meaningful way, you are trying to help yourself by bingeing and purging. It will be our job to make sense of it together.”

Megan was relieved to learn that I was not about to hand her a “‘ten-point program’ for recovery.” Her bulimia was far more than a bad habit I expected her to break in thirty days or less. I had seen far too many people invest their own (or their parents’) life-savings in eating disorder recovery programs, only to be emotionally devastated when they returned to ‘real life’ and fell back into their old patterns. I explained that the work I do is not short-term, nor would it reap instant results:

“Therapy for me is not a food plan or a set of ‘techniques’,” I said candidly. “It is about helping you un-cover how and why bingeing and purging has become the way you process your emotions. Our work together will be about helping you learn to think about and manage your feelings with your mind instead of your body; to make choices that come from the inside of you rather than from the outside.”

Megan nodded in agreement. She’d had enough of trying to “white-knuckle” a recovery, she told me.

Finalizing the arrangements for our work together, I was relieved to learn that Megan had recently confided in her medical doctor, who had checked her heart and blood pressure and ordered a panel of blood tests. Her health, it appeared, was still holding up. Nor did I need harp on the dangers of severe purging with Megan. She told me herself she knew she was playing Russian roulette with her life.

* * *

Peering into the inner world of an eating disorder, the uninitiated might see only the obvious. They would see people like Megan, eating with uncontrolled urgency, ingesting thousands of calories in a single sitting. They would observe her rituals of bingeing and purging, her compulsive exercise, her physical and verbal self-abuse. From the outside looking in, eating disorders defy understanding. But from the inside looking out, every enactment conveys a profound message: Every binge is an act of desperation; every purge or bout of starvation an effort at managing the thoughts and feelings the mind can’t contain.

Megan had spent much of her life ‘re-covering’ (up) the painful thoughts, feelings, and memories she hadn’t known how to think about or work through on her own. I knew that learning to think together, to tolerate thinking with her mind rather than her body, to confront the isolation and secrecy that were the high-octane fuels of her eating disorder, would not be easy for her. Still, I could feel her determination to break the cycle that had dogged her for so many years and now seemed to be threatening her future. I was very glad she had reached out for connection to me. I looked forward to being part of her journey.

two
hung...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• prologue
• introduction
• PART ONE Making the connection
• PART TWO ‘Thinking’ with the body: the perseverant personality
• PART THREE Thinking with the mind
• epilogue
• glossary
• bibliography
• acknowledgements
• index