Eating Disorders - fieldi

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Relationship to Food as to the World 87 continue irresponsible eating without acknowledging it beforehand. Then she undoes her binge by purging—she doesn’t pay, neither in reality nor symbolically, for the binge food. Kathryn had been going from one short-term work position to another, gaining recognition—everyone loved her—everyone thought she was doing a good job. She made sure she moved around a great deal and that no supervisor was regularly looking over her; she hated being totally accountable. Like an addict, she needed to manipulate her environment so she could slip away to binge and purge when so compelled. She was a master at creating plausible excuses. She knew she was cheating those she served. She knew, regardless of the rave reviews, that her performance was far below her abilities. Kathryn’s bulimia led her to betray her value system in several arenas. Kathryn manipulated the environment so she could be free to binge, but in reality she was a slave to her compulsion—never free—always trapped by her need to create space for destructive behavior. The dance of denial that she does with food is reflected in her professional life and her personal relationships. When someone comments on how beautiful she is and what a great body she has, she feels like a fake because of how she abuses her body. Recognition at work rings a hollow note in Kathryn’s conscience. When friends console her about these ex-boyfriends—saying they were “no good” or “screwed up”—Kathryn never looks at the total relationship. In every arena Kathryn ends up with the sensation of one who has just purged. She feels empty, guilty, alone—she has no plan for the next time. She feels her compulsions will override her judgment. She will binge on another man, a vulnerable supervisor, ice cream, and cookies—purge and then feel empty. These vignettes are only a tiny piece of each patient’s life, yet they embody an important element in each person’s pain. The eating disorder reflects, in metaphoric terms, the troubled themes of these women’s daily existence. The goal of our work is to reduce the need for metaphor, by first becoming immersed in the metaphor and then moving the patient to talk out feelings rather than managing them through ritualized and destructive behaviors. When we listen carefully to a story or a melody over and over
88 Relationship to Food as to the World again, we touch on meanings that are at first glance hidden. So it is with the stories our patients tell. At first we hear only their prose: how they feel, how they act, and how they understand their food obsessions. Later, these stories transform into ever changing poetry with many meanings. Marcel Proust wrote: “The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Recovery is nothing other than a healing voyage of discovery.
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editor BARBARA P. KINOY EATING DISO
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Eating Disorders New Directions in
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To our patients’ children and gra
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viii Contents 3. Psychiatric Consul
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x Foreword Although serious deficie
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preface In 1994, in the first editi
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Preface xv psychological hazards to
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Preface xvii partial, complete, or
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acknowledgments We wish to acknowle
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contributors Debra Bader, CSW, BCD:
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Eating Disorders
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Introduction diane w. mickley I am
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Introduction 3 needs of patients wh
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Introduction 5 therapy or on medica
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1 Medical Aspects of Anorexia and B
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Medical Aspects of Anorexia and Bul
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2 Recovery Through Nutritional Coun
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Recovery Through Nutritional Counse
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Lesson 1: Daily Caloric Need and Me
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ical activity to a normal level. If
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patient who binges, it may be helpf
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and allowing herself to consume a l
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Figure 2.3 Typical Hunger and Food
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Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
Page 78 and 79: Psychiatric Consultation 53 difficu
Page 80 and 81: Psychiatric Consultation 55 Obsessi
Page 82 and 83: 4 A Family Systems Perspective on R
Page 84 and 85: A Family Systems Perspective on Rec
Page 90 and 91: she calls her mother and tells her
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Page 104 and 105: iors—somehow to integrate the fra
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Page 110 and 111: Relationship to Food as to the Worl
Page 114 and 115: 6 The Therapeutic Use of Humor in t
Page 116 and 117: The Therapeutic Use of Humor 91 Amy
Page 118 and 119: The Therapeutic Use of Humor 93 was
Page 120 and 121: The Therapeutic Use of Humor 95 ass
Page 122 and 123: The Therapeutic Use of Humor 97 Ron
Page 124 and 125: Jodie’s Story 99 capacity to make
Page 126 and 127: Jodie’s Story 101 house and a ter
Page 128 and 129: Jodie’s Story 103 She did not do
Page 130 and 131: adness. The dream also revealed tha
Page 132 and 133: 8 Eating Disorders and Managed Care
Page 134 and 135: Eating Disorders and Managed Care 1
Page 136 and 137: Eating Disorders and Managed Care 1
Page 138 and 139: Cognitive-Behavioral Therapy and Ot
Page 152 and 153: 10 The Nurse’s Role in a Pilot Pr
Page 154 and 155: The Nurse’s Role in a Pilot Progr
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Page 158 and 159: 11 Individual Psychotherapy: A Long
Page 160 and 161: Individual Psychotherapy 135 Such p
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Individual Psychotherapy 137 empath
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weight and shape, as well as change
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Individual Psychotherapy 141 vomiti
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Individual Psychotherapy 143 During
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Individual Psychotherapy 145 and re
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Individual Psychotherapy 147 Mitche
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Young Adult Women 149 to surface an
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Young Adult Women 151 with their at
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Young Adult Women 153 ing; in fact,
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Young Adult Women 155 doomed, and a
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part of a treatment team where the
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13 Recovery margaret goldkopf-woodt
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Recovery 161 I can appreciate both
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Recovery 163 meant. I certainly cou
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Recovery 165 ate other uncomfortabl
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Recovery 167 connection between my
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Recovery 169 safe place, and our ow
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Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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