An Eating Disorder Psychiatrist's Journey
I am a traditionally trained, East Coast physician with board certification in both internal medicine and psychiatry. However, when I arrived at Mirasol, I knew little about complementary, alternative or naturopathic medicine, and essentially nothing about holistic treatment of eating disorders. I had been taught that eating disorders were very dangerous and difficult to treat, and that other than fluoxetine (Prozac) for bingeing and purging, off-label use of atypical antipsychotics for irrational thinking and appetite stimulation, and topiramate for appetite suppression, no medications have proven very effective for treating these dangerous conditions.
Arriving with an open mind, I was greeted during my first psychiatric evaluation by a very guarded, hostile young woman who quickly informed me that she had chosen Mirasol because she never again wanted to be controlled or tortured by psychiatrists in a "so called treatment center," and that there was no way she would take any medication. My floundering attempt to extract any useful information -- I had given up on any chance of prescribing anything -- was dramatically interrupted by the screeching of another patient who had accidentally sprayed liquid soap into her eye. My attempt to help by providing a bowl of water for irrigation of the eye was immediately rejected as a reckless attempt to cause further harm by infecting the eye. Caring attention from both staff and other patients had little effect on the inconsolable crying which was punctuated by demands to be taken to the emergency room. As I cycled through feelings of helplessness, anger, and frustration, I remembered what had been repeated over and over during my psychotherapy residence: the emotions provoked in the provider by the patient often reflect what the patient is experiencing. My initial impulse to retreat was replaced by intrigue and a sense of challenge. It was going to be very enlightening to see how the other providers worked with these women. It was going to take more than behavioral modification and 15-minute med checks to effect lasting change.
My first two patients had demonstrated several fundamental truths about people with eating disorders:
- They are in tremendous — and not easily consoled — psychic pain which is expressed in a variety of primal and harmful ways.
- The behaviors of the patients themselves, and the relationships they form with the doctor, staff and other patients, are fraught with transference (which can be a powerful tool).
- The medical establishment's use of coercive and punitive measures with these patients (ultimatums, feeding tubes, medication to affect appetite, etc.) does little to promote healing while eroding whatever trust the patient may have initially had.
For me, establishing rapport is the essential first step. I often think of the life-saving advice that one should not swim toward shore perpendicular to a riptide, but rather parallel to the shore until the riptide has passed. Butting heads with the patient is like swimming against the riptide; finding some commonality allows you and the patient to eventually swim together toward the shore.
As the provider who assesses patients when they arrive and then when they depart, I have been amazed at the changes I have observed firsthand. Why do so many patients who have "failed treatment" at the "best" of treatment facilities finally succeed at Mirasol? I believe it's because we establish ourselves as trustworthy, caring and competent providers with a wide range of skills. We look for the deep-rooted cause/meaning of the eating disorder and help the patient process this as part of her life narrative. We enhance personal, positive development and empower patients to surrender their eating disorders and enjoy the natural and normal bodily sensations associated with food. The clients leave Mirasol as more developed, competent women who are able to experience their emotions fully and safely, and who are better equipped to handle life's challenges. And, from now on, because they will choose to eat in a healthy manner, they will attain long-term medical and psychiatric balance.