On Terri Shiavo, medical malpractice, and bulimia

In the ongoing discussion about Terri Schiavo, one of the forgotten topics is the disorder that started the whole thing: Schiavo had bulimia, and the doctors' failure to diagnose it is what led to the potassium balance, which led to the heart attack. The elected representatives who are screaming about the "injustice" of the courts are the same elected representatives who have fought day and night to prevent families like the Schiavos from having legal recourse against physicians who screw up. This is a matter that the news media has chosen to ignore, choosing instead to show endless close-ups of Schiavo in her disabled state. The Republicans in Congress believe that making a circus show of your family is far superior to providing some sort of compensation for medical malpractice.

That a physician should miss the diagnosis of what was obviously an advanced case of bulimia is alarming. Simple medical tests and interviews with family members point to the diagnosis, and a dental exam confirms it. It is a sad irony that a woman who had bulimia is spending her final days as the subject of an international feed her/starve her argument. Though there has been no public discussion of this irony, it has doubtless gotten the attention of mental health professionals everywhere.

Bulimia nervosa is a very serious disorder which causes the body's chemistry to go awry, as in the case of Schiavo. Though men suffer from it, it is primarily a disorder of girls and women. In my own psychotherapy practice, the majority of my clients with bulimia would not be considered overweight, but they perceived that they were fat. There is no doubt in my mind that the bombardment of images of rail-thin women via television, film, and magazines is a major contributor to women's distorted views of their own bodies.

But bulimia is about more than a distorted view of one's body. All of the bulimic females I have treated had significant issues with their mothers: There is a primal connection between food and mother for all of us. Many bulimic women also come from families in which food intake was constantly discussed and one or both parents nagged about possible over-eating. And all of the bulimic girls and women I have treated had very high anxiety. An eating binge--like a spending binge or any other kind of binge--temporarily relieves anxiety by permitting the eater to "space out." But after the binge, the person feels great shame, and therefore is led to perform another binge ritual in order to escape the shameful feelings.

In my experience, women with bulimia can get rid of their disorder by learning better ways to cope with their anxiety, by resolving possible conflicted feelings about their mothers, and by learning to like themselves enough that they no longer want to abuse their bodies. Though we have had many public discussions about both bulimia nervosa and anorexia nervosa, perhaps it is time to have another one. It would certainly be more productive than the freak show that is taking place now.