When I first went to see Charles at the beginning of 2009, I could not have imagined that I would ever be able to describe myself as anything but broken. But, midway through 2010, a year and a half later, I feel that all of the words above describe how I feel about myself now.

I am quietly and confidently taking care of myself, and most importantly I am looking after myself in a balanced way. I am socialising and making new friends, I am much more active and outgoing. I’ve lost 30 kg’s. I am happy. It’s not all smooth sailing, some weeks are better than others, but that’s life and I now cope with the ups and downs in much more constructive ways.

When I first went to see Charles I really was desperate. I just didn’t know what else to do. I had been having issues with food for as long as I can remember, and although I hadn’t developed a traditional eating disorder (ie. Anorexia or Bulimia) I had a severely dysfunctional and destructive relationship with food. My eating was out of control, my health on a downward spiral, I felt wretched and grotesquely unhappy about myself and my life and I was desperately hoping that he would be able to ‘help me’.

Charles listened to my story, but didn’t let me dwell on it. He challenged me by involving my family and friends in our sessions – forcing me to confront what I was doing and sharing with them the part of my life I had kept to myself, I had alienated everyone from the reality of what I was going through and doing to myself.

My experience with Charles was slightly puzzling to begin with, Charles didn’t seem that interested in talking about food. “It’s not about the food” he would say. “It’s about your relationships”. And what I learned from my time with Charles is – that it really is about your relationships – and it starts with the relationship you have with yourself. This in turn, affects all the relationships you have – family, friends, colleagues. And in the end, he just helped me to help myself by letting my family and friends help me too.

The time and energy I invested in my therapy with Charles was the best thing I could have done for myself. It was the beginning of the rest of my life. A good life.

Clare (not her real name)

Additional note from Charles Fishman:

Clare doesn’t mention it but she worked hard to transform her relationships. When we started, she was isolated: “I have one friend…maybe.” At work, she would walk with her head down and eat alone.

In the process of her recovery, she made many friends at work. She related to me at one point her twittering the other woman frequently during the day. At one point, her office threw a surprise party for her.

Clare accomplished this dramatic transformation by focusing on addressing the areas conflict in her life – and one major one was her shyness. One by one, she got allies on her side to support in her in addressing stressful situations and difficult people.

Our new website will focus on aiding sufferers to understand how important it is to address conflicts – and getting supports behind you to help in the task.

You are not alone.

I understand completely how you feel. I was anorexic at age 12-14 and then became bulimic and have lived with this ‘controlling’ disease for over 24 years. I, like you, am intelligent and energetic, once with a strong willpower but completely helpless to this disease. For years and years I have wanted to overcome it and have continued down the same shameful path. My family have been aware of my situation for years, and I continue to (try to) deceive them but I am sure they know what I am still doing. I feel so ashamed of myself and any meal I have with them I feel I have to be on my best behaviour and pretend I am ‘normal’. I often think about being granted three wishes and I would use all three on turning my life around as I can’t seem to do it myself. I also feel so lonely trying to deal with a constant and obsessive battle. I just wish it was as simple as turning off a switch to change things but I realise it is a very difficult journey, especially when I have !
been doing it for so long. I also suffer from depression which I think was triggered by my anorexia. Like you, I also believe there will be a turning point for me. It will be like winning lotto!

Kindest regards, M

I know I have a serous problem but I can’t stop. I am a solo mum. I have suffered from clincal depression and PTSD post traumatic stress disorder. My family knew I had had bulimia but think that I have stopped. I did for a month when I came out of hospital. I have worn all my teeth and the more that goes wrong with me, the more I do it. Help me please

I had been given many diagnoses and opinions from many well-meaning specialists in the mental health field. They included manic-depressive with rapid mood swings, severe anxiety disorder, borderline personality disorder, depression, bulimia, and anorexia. I was on seven different medications; all prescribed in an effort to enable someone as sick as me to live a somewhat normal life. I was very dependent on my medicine. I would not consider missing a timed dosage of any one of them for fear that I (or one of my many disorders) would break through.

On a particularly frustrating day I would use my diagnosis as a consolation: “It’s O.K.,” I’d say, “I’m too sick to expect much of myself anyway.” I was hospitalised a number of times and spent a year in a day-program that was designed to help ‘mentally ill’ people cope with their daily lives and learn to become independent. It was a wonderful program that included things like goal setting, time management, support groups, and daily meetings with professionals in the mental health field. All I had to do to receive the maximum benefit from this program was to accept that I had a mental illness, that I would always have a mental illness, and that I would need to be on medication for the rest of my life.

Daily, I would tell doctors in one way or another that I was not willing to accept that as fact, and that I was interested in getting well and moving on with my life. Daily, they would tell me that I not only needed to accept my ‘mental illness’ status, but that they could not help me until I did.

Eventually, I stopped talking with them about it, but secretly hope I could prove them wrong someday… It became a private vendetta, one which I eventually found difficult to maintain. Well-meaning people would tell me or insinuate that this sort of denial thinking was, in fact, part of the ‘illness’ itself. I did eventually graduate from this program, considered ‘stable’ on my seven different medications (I was, however, still bulimic, had frequent anxiety attacks, and resorted to self-destructive behaviours when things got too stressful.)

My release was conditional; I needed to find a psychiatrist who would monitor my medication. I met with this doctor once a month and he refilled my prescriptions. We spoke very little. I needed more. I wanted to work on my life, my relationships, figure out why I was so angry all the time. I had one or two sessions with 5 different doctors, all of which I walked out of very disappointed and/or angry. I didn’t know what I was looking for but I did know that none of these were it.

Dr Fishman – a different approach

My sixth try led me to Dr Fishman’s program in New Jersey. I was still terrified of my medication lapsing, so our first interaction was on the phone; me pleading with him to refill my many prescriptions. I made an appointment for a few days later.

The minute I met him, I knew something was very different. He didn’t want to hear long stories of my mental health history. As a matter of fact, he didn’t want to talk about my past very much at all, except to find out briefly what brought me here. He basically wanted to know how I was doing right now. Where did I want to go, and what were my plans for getting there?

A part of me reacted violently to this ‘taking responsibility for my life’ approach. “How dare he!” I thought. “Doesn’t he know I’m ‘sick,’ way too sick to be expected to participate in this line of reasoning?” I was very angry. I almost left, but I didn’t. You see, there was another (very medicated) part of me that was yearning for this sort of recognition, this kind of opportunity, this chance to use my own inner strength to make something of my life. Here was someone who believed in me, who validated my strengths.

My therapy became about what I could do well, and looking for ways to do more of it. No longer was I focused on the limitations of my ‘illness’. As a matter of fact, it seemed to be a sort of unspoken rule in this place to leave ‘limitations’ and ‘illness’ outside the door before you came it. In this process, I came to believe in myself again and I began to flourish.

Soon I was able to stop my medications, one by one. I was required to bring the people I was in close relationships with into my sessions, one at a time. This was a very important part of my treatment. We didn’t talk ‘about’ my life, we worked within it.

One of the things I discovered is that I tend to isolate myself, especially when things get tough. We had worked on this in my previous day program a bit, but we called for support only within our groups in the program. Dr Fishman essentially was asking me not only to do this in my daily life, but to bring my friends and family right into his office, so I could get my support network set up right here and now.

There were times when this was the last thing in the world I wanted to do. (I would have much preferred to talk about how hard it was.) But as difficult as it was, I felt like ‘I’ was really doing my life; I was at the helm. I discovered in this process why I was so angry all the time. I felt alone (I isolated myself), I felt powerless (I hung around with amateur ‘shrinks’ and let them define me). ‘I’ was disappearing.

In our sessions, I let people in my life know, one by one, that I wanted their support in where ‘I’ was going. I established that I was strong and capable and that I could be even more so with their support. I learned to ask for this support in effective ways.

I would say that the most impactful insight for me has been the realization that I am, in fact, not ‘mentally ill’, I am very, very sensitive. I’ve had difficulty setting boundaries, and I tend to take on too much, which I try to do alone. Once we broke it down into these basic components, it was much more manageable. I’ve been able to make powerful changes. I actually keep a note which I read when things get hard and I need to remember. It begins with: “I am not mentally ill – I am a very sensitive person”.

I look to see what I need to do to take better care of myself. Mostly it begins with calling a friend; telling the truth about something uncomfortable, or telling someone how much they mean to me. Above all it means remembering that I am a super-woman to do what I do in my life, and that I need to let up on myself.

Bulimia disappears!

Another incredible outcome: my bulimia began to disappear. I felt like I just didn’t have a craving to overeat anymore. We never worked directly on my eating disorder; as a matter of fact, we rarely mentioned it. Instead we worked on making effective changes in how I do my life.

I began to see that my eating was directly related to who is in charge of my life. If I let others tell me how it is, if I can’t tell someone the truth when I need to, or if I’m withholding love in any way; it directly affects my eating. The more I worked on these areas, the more my eating became normal. My bulimia is basically not ‘my’ bulimia anymore. I’ve learned to see my now very occasional bouts wit it as a signal – a signal that something is out and that it’s time to take a look at what I can do to take care of myself better.

I have been suffering from bulimia since I was 14. I got treatment for it but a year later it began again and has been on-going since then. I just want to be better. I hate the way I am, and I can feel my body is taking the affects. Please advise me on how can go about getting help.”

This is a letter I received some time ago. My initial reaction was, What a lost opportunity for this young person and her family. The earlier eating disorders are treated, the easier they are to treat. The flip side of that is the longer you wait, of course, the tougher they are to treat. When the gains from the original course of treatment were not maintained, her parents should have found a way to get her back into treatment. Eating disorders are tenacious; the family must keep up the pressure against them.

The second issue is her question inquiring where to get treatment in New Zealand. There are public facilities provided by the District Health Boards. There are also private programs such as the New Zealand Eating Disorder Specialists. From our perspective, treatment should involve the family: indeed the family should be welcomed and included in the therapy for maximum effectiveness.

This question is potentially fraught. The danger is not that her 3-year-old may have a disease that manifests itself fully in adolescence, but that the family could be too focused and become transfixed by the concern that this is an “eating disorder”. This can result in struggles at every meal regarding food, and could indeed, in my experience, perhaps increase the likelihood that the child could ultimately develop an actual eating disorder.

Dear Dr. Fishman,

I was wondering if it’s possible for a mother to pass on an eating disorder to her daughter even if the daughter has never really known her mother. My partner’s daughter is 3-years-old and refusing to eat. She won’t eat anything except for potatoes and spaghetti, but even that is a struggle. We have tried a lot of different methods to try and get her to eat but she’s just not interested and often gets upset over it. It’s now at the point where she’s not gaining weight and losing her hair.

I am taking here to the doctor this week as I feel it can’t go on. Any ideas would be gratefully appreciated.

Concerned Stepmother,
Amanda*

*Not the stepmother’s name, which has been kept private for confidentiality reasons.

My reply was as follows:

Dear Amanda,

This is not an eating disorder like anorexia nervosa. It sounds like she does eat – just not the right things. And her eating gets more reluctant when the struggle emerges. It is a fine line to be concerned and vigilant and yet not have every meal turn into a power struggle. Your GP should be helpful in advising you of her ideal weight according to the norms for her age and build.

When there is enough food on the table, no child starves. They have a built-in hunger mechanism. For children this young, the parents are the ones who control the access to food. Limit the choices to better foods – but be flexible. In moderation, even occasional sweets are alright. The important point here is that meals don’t become battle grounds. That in itself is more dangerous than ice-cream!

Regards,
Dr Charles Fishman