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Phenomenological case studies of bulimia

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Content PHENOMENOLOGICAL CASE STUDIES
OF BULIMIA
by
Kathryn Klassen Neufeld
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education)
August 1983
Copyright Kathryn Klassen Neufeld 1983
UMI Number: DP24927
All rights reserved
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UNIVERSITY O F S O U T H E R N CA LIFO RN IA
T H E GRADUATE SC H O O L
U N IV ER SITY PA R K
L O S A N G E L E S. CALI F O R N IA 9 0 0 0 7
This dissertation, written by
....._K a t h r y_n _ JK1 as s en _ _ N e u f_e 1 _d.......
under the direction of hsx.... Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by The Graduate
School, in partial fulfillment of requirements of
the degree of
D O C T O R OF P H I L O S O P H Y
Dean
Date August 2, 1983
DISSERTATION COMMITTEE ,
Chairman
ACKNOWLEDGEMENTS
j The author would lik e to thank the fo llow ing people:
1 I
! Ken, Kenley, Kerwin, and Katrina Neufeld for the manyj
i
I t i m e s th e y went out of t h e i r way to make i t p o s s i b l e fo r me
i
i
I to meet w ith c l i e n t s and work on th e w r i t i n g of t h i s
j
I d i s s e r t a t i o n .
t
I Dr. Paul B lo la n d , Dr. Frank Fox, and Dr. C a t h e r i n e
j Burke for t h e i r encouragement during t h is study.
i
(
j ‘ Dr. George Konrad for constant support and encourage-
j ment throughout the many hours of working with the s u b je c ts
j of t h i s s t u d y , t h e h o u r s o f w o rkin g at th e c o m p u te r , th e
J hours of reading and e d it i n g , and f i n a l l y the a s s i s t a n c e in
! preparing the f i n a l d r a f t .
' Dr. Judy C arl f o r b e in g a f r i e n d and b e in g t h e r e f o r
i
! me d u r i n g th e p r o c e s s and Rick C arl fo r p r o v i d i n g me w ith
I t h e t e c h n i c a l a s s i s t a n c e in t y p i n g and p r i n t i n g t h e
1
d i s s e r t a t i o n .
Mary Breuning for a l l her p atien c e, understanding, and
e n co u rag e m en t and fo r th e e d i t o r i a l work she has done and
Tina Konrad for the support and encouragement and the many
hours t h i s study was the to p ic of conversation.
F i n a l l y , s p e c i a l a p p r e c i a t i o n to Beth, Verna, and
Helen, the su b je c ts of t h i s study, for the hours of sharing
with me t h e i r experiences and becoming the te a c h e rs in t h i s
journey to gether.
i i
POEM BY BULIMIC GROUP MEMBER
To laugh is to r i s k appearing the fool,
To weep is to r i s k appearing s e n tim e n ta l,
To reach out for another is to r i s k involvement,
To expose f e e l in g s is to r i s k exposing the s e l f ,
To place ideas and dreams before the crowd is to ris k lo ss,
To love is to r i s k r e j e c t i o n ,
To liv e is to r i s k dying,
I To hope is to r i s k d e sp air,
| To t r y at a l l is to r i s k f a i l u r e ,
! But r i s k we must,
| Because the g r e a t e s t hazard of a l l is to r i s k nothing,
' For t h o s e who r i s k n o t h i n g , do n o t h i n g , h a v e n o t h i n g ,
are nothing. (Boskind-White & White, 1983, p. 149)
i i i
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS ....................................................................................... i i
P O E M ............................................................. i i i
Chapter
I. GROUNDWORK.............................................................................................. 1
Statement of Purpose
D e fin itio n of Terms
The Phenomenological Approach and The Development
of a Theory
S ig n ific an c e of the Study
Overview of the D i s s e r t a t i o n
I I . PSYCHOLOGICAL LITERATURE ON BULIMIA ................................. 18
Bulimia
C l in i c a l Aspects of Bulimia
Etiology of Bulimia
Treatment Approaches for Bulimia
Summary
I I I . PLAN OF PHENOMENOLOGICAL INQUIRY................................................. 49
T h eo re tica l Sampling
Methods of Data C ollection
The P a r t i c i p a t i v e Phase
The D escriptive Phase
The R e fle c tiv e Phase
Summary
IV. THE DESCRIPTIVE PHASE: THE BULIMICS'
SUBJECTIVE EXPERIENCES ................................................................... 68
Beth
Helen
Verna
IV
Chapter
V. THE REFLECTIVE PHASE: REFLECTIONS ON THE
DATA AND THE GENERATION OF A THEORY OF
BULIMIA ....................................................................... 127
P re se n ta tio n and D elineation of Themes
A Phenomenological Theory of Bulimia
Summary
VI. IMPLICATIONS AND CONCLUSIONS .................................................... 163
Im p lication s for the Therapeutic Process
Suggestions for Further Research
Conclusions
REFERENCES 179
v
CHAPTER I
GROUNDWORK
Much a t t e n t i o n has been given to a r e c e n t l y discovered
phenomenon of binging and purging c a lle d bulim ia, b u lim a r-
e x i a , or th e b i n g e - p u r g e syndrome. Though b i n g i n g and
purging is not new - g lu tto n s in Im p erial Rome would r e p a ir
to t h e i r v o m i t o r i a a f t e r m eals o n ly to be a b le to dine
a g a in - t h e p e r c e p t i o n of b u l i m i a as a s e r i o u s e a t i n g j
■ i
d iso rd e r or as a c l i n i c a l i l l n e s s is a recen t r e a l i z a t i o n .
Researchers have become i n t e r e s t e d in the almost epidemic
| p r o p o r t i o n of b u l i m i c s among young women in t h e i r l a t e
i
j teens, 20's, and BCPs. The phenomenon of bulim ia is at the
1 center of many d isc u ssio n s regarding what i t is, how i t has
d e v e lo p e d , and how i t i s to be t r e a t e d . I t was not u n t i l
th e t h i r d e d i t i o n (1981) t h a t b u l i m i a was i n c l u d e d in th e
Diagnostic and S t a t i s t i c a l Manual of Mental D iso rd e rs. The
c h a r a c t e r i s t i c s and a ss o c ia te d f e a t u r e s of bulimia are not
w ell known and the d ia g n o s tic l a b e ls are poor r e p r e s e n t a
t io n s of the inner world of the bulimic.
Two books on th e s u b j e c t of b u l i m i a have r e c e n t l y
a p p e a re d on t h e m a r k e t. The f i r s t , B u l im a r e x i a : The
Binge/Purge Cycle (Boskind-White & White, 1983), though not
a s t r u c t u r e d s c i e n t i f i c s t u d y o f b u l i m i a , o f f e r s
1
c o n s i d e r a b l e i n s i g h t i n t o th e phenomenon of b u l i m i a . The
a u t h o r s view b u l i m i a as a h a b i t r a t h e r th an an i l l n e s s , one
which i s l e a r n e d and, t h e r e f o r e , can be u n l e a r n e d . They
have come to t h e i r c o n c l u s i o n s a f t e r t r e a t i n g some 2000
b ulim ics in small marathon groups. Bulimics from a l l over
t h e United S t a t e s g a t h e r e d in groups of e i g h t to te n fo r
t h r e e day weekends to r e c e i v e t h e r a p y . The t h e r a p i s t s
p r i m a r il y worked with b u lim ics by looking at the s h o r t- te r m
payoffs and then helping them to unlearn t h e i r bad h a b its .
They view the purging behavior as a p u r i f i c a t i o n r i t e as a
means of overcoming s e l f - l o a t h i n g by gaining s e l f - c o n t r o l . I
i
j The authors a s s e r t t h a t s o c i a l i z a t i o n and the fam ily con-
j t r i b u t e to the development of the ha bit. They see maternal
! i
; o v e r p r o t e c t i o n , p a te r n a l censure and d e p riv a tio n , as well!
! as r i v a l r y w i t h s i b l i n g s ( g e n e r a l l y male) as f a c t o r s p r o
p e l l i n g women i n t o b u l i m i c b e h a v i o r . O u ts id e of th e
fam ily, bulim ic women continued to value the importance of
r e l a t i o n s h i p s w ith men above a l l e l s e and gave men th e
power to define how they should think, act, and fee l.
A second book which r e c e n t l y appeared on the market is
i H l i E i i i The B i n g e - P u rge Comp u l s i o n (Cauwels, 1983).
Though t h i s study provides a comprehensive overview of c u r
r e n t t h i n k i n g on t h e i s s u e s , i t i s b a s i c a l l y a c o l l e c t i o n
o f t a p e d i n t e r v i e w s w i t h i n d i v i d u a l s e x p e r i e n c i n g th e
bulim ic syndrome throughout the country at various t r e a t -
2
ment c e n t e r s or w ith p r o f e s s i o n a l s who have been w o rk ing
with bulim ics. The p resent study took the p o s itio n t h a t
bulim ia was not an i l l n e s s nor simply an eating d iso rd e r
but r a t h e r a way of v ie w in g t h e w o rld and an i n t e n t i o n a l
way of l i v i n g . F u r t h e r m o r e , i t was assumed t h a t b u l i m i a
was a way of l i f e chosen by th e i n d i v i d u a l as a means of
dealing with the p a in fu l aspects of one’s liv ed -w orld . The
author accepts Ofman’s (1976) notion t h a t the symptom does
; not a f f e c t th e p e rs o n but t h a t t h e symptom i s th e p e rs o n .
i
i
i
j Bulimia is not simply a symptom but the way the person is.
i
j In o t h e r words one is not s i m p ly l o o k in g a t one s m a l l
I
! a s p e c t of a p e r s o n ’s l i f e ; r a t h e r one i s l o o k in g a t a
!
! p e r s o n ’s f u n d a m e n ta l c h o ic e o f b e i n g - i n - t h e - w o r l d . The
1 (
i proposal is also made t h a t b u lim ics have viewed the world)
i
j and t h e i r experiences d i f f e r e n t l y than non-bulim ics; hence
I _ .
I they have rea cte d d i f f e r e n t l y to the mundane aspects of the
i
| world. In order to understand the almost incomprehensible-
i
choices made by the bulim ic, one needs to l i s t e n c a r e f u l l y
and t r y to understand l i f e according to the b e l i e f system,
meanings, and i n te n t io n s of the bulim ic.
Most of th e r e s e a r c h on b u l i m i a up to t h i s p o i n t has
f a i l e d t o e x a m i n e t h e r i c h n e s s and d i v e r s i t y o f t h e
b u l i m i c ’s in d iv id u a l experience. The methodology proposed
I in t h i s r e s e a r c h i s s u b j e c t i v e in n a t u r e . This in no way
negates the o b je c tiv e aspects of bulim ia but is a means of
i
3
p r o v i d i n g a more c o m p r e h e n s iv e a p p ro a ch to t h e u n d e r
s t a n d i n g of b u l i m i a th an j u s t an o b j e c t i v e a p p ro a ch . By
connecting theory with the live d experience, one is b e t t e r
a b l e to p r o v i d e th e t h e r a p e a u t i c i n t e r v e n t i o n s n e c e s s a r y
when w orking w ith b u l i m i c s . In a d d i t i o n , s u b j e c t i v e
resea rch also enables one to develop c a te g o r ie s within the
phenomena u se fu l for f u r t h e r rese a rc h ,
j This study is a c o l l e c t i o n of i n t e r n a l e x p lo ra tio n s of
j t h e b u l i m i c s 1 l i v e d - w o r l d . A ll of t h e s u b j e c t s were
d ia g n o s e d as b u l i m i c s by t h e m s e l v e s as w e l l as by th e
r e s e a r c h e r , using the DSM I I I d ia g n o s tic c a te g o r ie s . Since
t h e m a j o r i t y o f b u l i m i c s a r e f e m a le , t h i s stu d y i n c l u d e d
only females in the sample. Therefore, from t h i s point on
t h e s u b j e c t s in t h i s r e s e a r c h w i l l be r e f e r r e d to in th e
f e m i n i n e g e n d e r, though t h e a u t h o r i s f u l l y aware t h a t
m ales may a l s o choose a b u l i m i c way of b e in g .
Statement of Purpose
The purpose of t h i s resea rch was to make e x p l i c i t the
inner world and experience of the bulim ic. The i n t e n t was
to discover how the bulim ic organized her p r i o r i t i e s in the
w o rld and engaged t h e w o rld by a p a r t i c u l a r way of being
which can be c a lle d one’s personal myth or ’’p r o j e c t . ” The
a s s u m p t io n was made t h a t t h e b u l i m i c , as a l l o t h e r human
b e i n g s , c r e a t e s a w a y - o f - b e i n g in t h e w o rld around which
4
much of what the person does is i n t r i c a t e l y connected. The
purpose of the re s e a r c h e r was to unravel and make c le a r the
i n n e r w o rld o f t h e b u l i m i c t h r o u g h l i s t e n i n g c a r e f u l l y ,
without pre-conceived notions, to what the bulim ic had to
say about her s u b j e c t i v e e x p e r i e n c e . The g o a l was to
u n d e r s t a n d what was going on in th e p e rs o n , what she was
r e a l l y experiencing, how th in gs arose in her consciousness,
and what her f e e l in g s were.
S e co n dly , th e p u r p o s e of t h e s t u d y was to g e n e r a t e a
t h e o r y o f b u l i m i a , g r o u n d e d in t h e d e s c r i p t i v e d a t a
p r o v i d e d by t h e b u l i m i c s ' s e l f - r e p o r t s . As a c l e a r e r
( p i c t u r e of th e phenomenon of b u l i m i a r e v e a l e d i t s e l f
I
j through the persons' c o nversations and s e l f - o b s e r v a t i o n s , a
1 t h e o r e t i c a l framework was developed which could be used for
I
} the purpose of therapy.
i
D e f in itio n of Terms
Bulimia - the t h i r d e d itio n of the American P s y c h ia t
r i c A ssociation 's Diagnostic and S t a t i s t i c a l Manual of Men
t a l Disorders, (DSM I I I ) p r e s e n ts the follow ing d ia g n o s tic
c r i t e r i a for bulim ia:
A. R e c u r r e n t e p i s o d e s of b in ge e a t i n g ( r a p i d
c o n su m p tio n of a l a r g e amount of food in a
d i s c r e t e period of tim e, u s u a lly le s s than two
h o u r s ).
5
B. At l e a s t th ree of the following:
(1) consumption of h i g h - c a l o r i c , e a s i l y i n
gested food during a binge
(2) inconspicuous e a tin g during a binge
(3) te rm in a tio n of such e atin g episodes by
abdominal pain, sleep, s o c ia l i n t e r r u p
tio n , or s e lf -in d u c e d vomiting
(4) r e p e a t e d a t t e m p t s to l o s e w e ig h t by
se v e re ly r e s t r i c t i v e d i e t s , se lf-in d u c e d
vomiting, or use of c a t h a r t i c s or d i u r e
t i c s
(5) f r e q u e n t w e ig h t f l u c t u a t i o n s g r e a t e r
than ten pounds due to a l t e r n a t i n g b in
ges and f a s t s
C. Awareness t h a t the e a tin g p a tt e r n is abnormal
and f e a r of not- b e in g a b le to sto p e a t i n g
v oluntar i l y .
D. Depressed mood and s e l f - d e p r e c a t i n g thoughts
fo llo w in g e a tin g binges.
E. The b u l i m i c e p i s o d e s a r e not due to A norexia
N e r v o s a or any known p h y s i c a l d i s o r d e r .
(p. 70,71)
i "Pro je c t" or "Personal Myth” - Ofman (1976) d efin es a
i
| p e r s o n ’s b a s i c s e t of c h o i c e s or t h e b a s i c cosmology to
i
! which a l l the l e s s e r decisio n s and e l e c t i o n s are i n t i m a t e l y
I
[ r e l a t e d as o ne's p e r s o n a l " p r o j e c t . " Ofman f u r t h e r su g -
I
! ge sts t h a t each person has invented and organized h i s / h e r
i
j p r i o r i t i e s in the world, whether these are e x p l i c i t l y known
j to the person or not. These p r i o r i t i e s are i ll u m in a t e d by
| t h e p e r s o n 's way of b e in g in t h e w orld and a re known as
i
I
h i s / h e r "personal myth."
"Lebenswelt" or "Lived-world" - Husserl (1929) f i r s t
r e f e r r e d to L e b e n s w e lt or l i f e - w o r l d as th e s u b j e c t i v e
I p l a c e o u t o f w h i c h a l l o b j e c t i v e c o n c e p t s d e v e l o p .
i
i
j Lebenswelt or liv e d -w o rld is the world of common experience
and the everyday world where people liv e and function. I t
is immediately given and a c c e s s ib le to d i r e c t experience.
The Phenomenological Approach and the
Development of a Theory
F u n d a m en tal to u n d e r s t a n d i n g t h e p r e s e n t stu d y i s a
f a m i l i a r i t y with the phenomenological approach to research
as w e l l as th e d e v e lo p m e n t of grounded t h e o r y . This
s e c t i o n i s a d i s c u s s i o n of phenomenology and grounded
theory. To help c l a r i f y the phenomenological approach, the
I author w i l l b r i e f l y c o n tr a s t the more t r a d i t i o n a l approach
i i
i
j t o th e s t u d y of human b e h a v i o r , e x p e r i m e n t a l p s y c h o lo g y ,
*
j with the phenomenological approach.
I
! P sy cho lo g y has t r a d i t i o n a l l y used t h e s c i e n t i f i c
| method to understand the behavior and experiences of human
! b e in g s . This has u s u a l l y ta k e n t h e form of e x p e r i m e n t s ,
t
t
c l a s s i c a l l y i n v o l v i n g a r e s e a r c h e r who h o l d s a l l f a c t o r s
c o n s t a n t o t h e r th a n t h e i n d e p e n d e n t v a r i a b l e s and t h e
d e p en d e n t v a r i a b l e s . By means of s p e c i f i c methods of
c o n tr o l and m anipulation of the independent v a ria b le , the
r e s e a r c h e r i s a b l e t o d e t e r m i n e t h e e f f e c t s o f t h e
i n d e p e n d e n t v a r i a b l e on t h e d e p en d e n t v a r i a b l e . Georgi
(1965) suggested t h a t experim ental psychology has adopted
th e s c i e n t i f i c method to s t u d y p s y c h o l o g i c a l phenomena.
This i n c l u d e d a number of i m p o r t a n t c h a r a c t e r i s t i c s ;
7
nam ely, t h a t th e r e s e a r c h be: (1) e m p i r i c a l , t h a t t h i s
b e h a v i o r or phenomenon is s t u d i e d th r o u g h a c o n t r o l l e d
o b s e r v a t i o n ; (2) r e d u c t i o n i s t i c , t h a t t h e phenomenon i s
e q u a l to i t s o p e r a t i o n a l d e f i n i t i o n s ; (3) q u a n t i t a t i v e ,
t h e p h e n o m e n o n s h o u l d be a b l e t o be d e s c r i b e d by a
m a t h m a t i c a l e q u a t i o n ; (4) d e t e r m i n i s t i c , t h a t t h e
phenomenon can be d u p l i c a t e d s i n c e i t i s assumed t h a t a l l
phenomena have s p e c i f i c causes; (5) p r e d i c ti v e , in order
to be able to p r e d ic t behavior; (6) r e p e a ta b le , any other
i n v e s t i g a t i o n should be able to rep eat the experiment; and
(7) in d e p e n d e n c e o f t h e r e s e a r c h e r , t h a t t h e phenomenon
( u n d e r i n v e s t i g a t i o n i s not i n f l u e n c e d by th e o b s e r v e r .
Though not a l l t h e s e c h a r a c t e r i s t i c s a re e v i d e n t in every!
j
e x p e r i m e n t , t h e s e a r e i m p o r t a n t when c o n d u c t i n g aj
| p sychological experiment designed to study behavior.
A cco rd in g to C o l a i z z i (1978) th e major p u rp o se of
t
i
] e x p e r i m e n t a l p s y c h o l o g y i s t o m a i n t a i n o b j e c t i v i t y .
I
Psychology has defended the experim ental approach by saying
t h a t i t is thus e l i m i n a t i n g s u b j e c t iv e opinions and value
j u d g m e n ts . C o l a i z z i goes on to say t h a t o b j e c t i v i t y i s
achieved by the use of o p e r a t io n a l d e f i n i t i o n s which define
p s y c h o l o g i c a l phenomena by h a v in g as l i t t l e to do w i t h
human experience as p o ss ib le . An o p e ra tio n a l d e f i n i t i o n is
s o m e th i n g which i s m e a s u r a b l e , o b s e r v a b l e , and r e a d i l y
r e p l i c a b l e . In o t h e r w o r d s , a p h e n o m e n o n b e c o m e s
8
u n i v e r s a l l y u n d e r s t o o d and d e v o i d of any p e r s o n a l
experiences which may color i t s 1 o b j e c t i v i t y .
P h i l o s o p h e r s and r e s e a r c h e r s have w r e s t l e d w ith th e
problem of s u b je c tiv e experience, q u estion in g whether a l l
p sychological phenomena could be i n v e s t i g a t e d by means of
t h e e x p e r i m e n t a l method (Georgi, 1965; C o l a i z z i , 1978).
The phenomenological approach has been and continues to be
one a p p ro a ch which a t t e m p t s to i n c l u d e a l l of human
e x p e r i e n c e , b o t h o b j e c t i v e and s u b j e c t i v e , in t h e
j i n v e s t i g a t i o n .
The p h e n o m e n o l o g i c a l movement began w i t h Edmund
H u s s e r l as a d e f e n s e of t h e r i g h t s of t h e " s c i e n c e s of
essence" a g a in s t the domineering in flu e n ce of the "sciences
of f a c t s " ( S tra sse r, 1963). For Husserl (1975), the pheno-j
m e n o l o g i c a l method was a d e s c r i p t i v e a n a l y s i s of e x p e r
i e n c e . He a l s o i n t r o d u c e d th e c o n c e p t of i n t e n t i o n a l i t y
which i s a b e i n g - d i r e c t e d - t o w a r d c h a r a c t e r i s t i c of a l l
form s of e x p e r i e n c e . He saw th e t a s k of th e p h en om en olo-
g i s t to i n v e s t i g a t e t h e s e t y p e s and form s of i n t e n t i o n a l
experiences and reduce them to a primary i n te n t io n .
The p u rp o se of t h i s s t u d y was not t o d efend th e
p h e n o m e n o lo g i c a l p o s i t i o n nor to p r o v i d e an h i s t o r i c a l
overview of the phenomenological movement. This has been
j done adequately by Spiegelberg (1972). The purpose of the
i
j d isc u ssio n of phenomenology was to c l a r i f y for the reader
! 9 .
what was meant by an e x is te n tia l- p h e n o m e n o lo g ic a l approach
for t h i s p a r t i c u l a r resea rch and the r a t i o n a l e for choosing
the e x is te n tia l- p h e n o m e n o lo g ic a l approach in t h i s study.
Giorgi (1966) provided a phenomenological paradigm for
th e s t u d y of human b e h a v i o r . To do j u s t i c e to human
phenomena, he suggested we use another form of research to
adequately understand these phenomena, as w ell as those of
the n a tu r a l sciences. He said:
A b r i e f e x a m i n a t i o n of any c h a r a c t e r i s t i c a l l y
human phenomenon r e v e a l s t h a t th e q u a l i t i e s of
t h a t experience are im portant for the u n d e rs ta n d
ing of t h e phenomenon, and t h a t a d e s c r i p t i o n
t i o n of th e q u a l i t i e s l e a d s to t h e me a n i n g of th e
experience for the s u b je c t, and t h a t an e x p l i c i -
| t a t i o n of t h e phenomenon i s n e c e s s a r y , b u t not
| always s u f f i c i e n t , for a s c e r t a i n i n g i t s meaning.
The above th ree f a c t o r s are p o s s ib le only because
t h e s u b j e c t m a t t e r of t h e human s c i e n c e s a re
: human beings who respond i n t e n t i o n a l l y to the
i world, and whose phenomena are t h e m a t i c a l l y con-
; s t i t u t e d o n ly t h r o u g h v a r i e d m a n i f e s t a t i o n s ,
j L a s t l y , i t i s i n e v i t a b l e t h a t in c o n d u c t i n g
j r e s e a r c h th e e xper i me n t e r a l s o p a r t i c i p a t e s to
j some e x t e n t in th e phenomenon, th e s u b j e c t i s
i experiencing. (p. 27)
(
j The a u t h o r t a k e s t h e p o s i t i o n o f F i s c h e r (1978) and
i
Giorgi (1965) t h a t the emphasis is on the phenomenon as i t
r e v e a ls i t s e l f to the r e s e a r c h e r and to the s u b je c t in a l l
i t s p e rc eiv a b le dimensions and p r o f i l e s . There needs to be
an o p e n n e s s (on t h e p a r t o f t h e r e s e a r c h e r ) and a
w i l l i n g n e s s to susp en d or " b r a c k e t " a l l p r i o r knowledge
a n d / o r p r e c o n c e i v e d n o t i o n s a bout th e phenomenon. The
major question is always, "How does the phenomenon reveal
10
i t s e l f to me?” The phenomena must be p e rm itte d to emerge
w i t h o u t m a n i p u l a t i o n , w i t h o u t s e l e c t i o n of c e r t a i n p a r t s
for study, and without p r i o r d e f i n i t i o n s . The emphasis is
on ex periencing the phenomenon as close to t h e i r o r ig in as
p o s s i b l e . The i n t e n t i s t o e x p e r i e n c e and a c c o u n t f o r as
much of t h e phenomenon as p o s s i b l e and in t h a t se n se
r e q u i r e s an even more rig oro us and sy s te m a tic approach than
the t r a d i t i o n a l one. !
The aim of t h i s s t u d y was to g e t as c l o s e as p o s s i b l e
j
to the phenomenon of bulim ia in order to know i t d i r e c t l y .
The g o a l was to look f o r ways to d e s c r i b e th e q u a l i t y of
the experiences of the bu lim ic and to reveal i t s e s s e n t i a l
s t r u c t u r e . Through t h e r e s e a r c h e r ’s im m e rs io n in t h e
b u l i m i c ' s s e 1f - d e s c r i p t i o n s she was a b le to come to th e
e s s e n c e o f b u l i m i a f o r t h a t p e rs o n . The p u rp o se was to
know b ulim ia d i r e c t l y through the d e s c r i p t io n of concrete
e x p e r i e n c e s .
J a s p e r s (1 968) a s s e r t e d t h a t as p h e n o m e n o l o g i s t s we
are o r ie n te d towards s u b j e c t iv e psychic experiences and not
toward o b j e c ti v e m a n i f e s ta t io n s and t h a t the most valuable
s o u r c e of t h i s i n f o r m a t i o n i s good s e l f - d e s c r i p t i o n . .
J a s p e r s s u g g e s t e d t h a t by " s i n k i n g ” o n e s e l f i n t o t h e
i n d i v i d u a l phenomenon w i t h o u t th e a id of a t h e o r y or a
s y s t e m , one c o u l d a r r i v e a t a r e p r e s e n t a t i o n and
d e l i m i t a t i o n of the phenomenon. E s s e n t ia l to comprehending
I
1 1
any phenomenon is understanding how people experience t h e i r
b e i n g - i n - t h e - w o r I d . That i s where t h i s stu d y began. This
included a thorough immersion in to the liv e d -w o rld of each
p e rs o n i n v o lv e d in t h e s t u d y w i t h t h e aim of e m p h a s i z i n g
th e s u b j e c t ' s i n t e n t i o n a l i t y and h e r d i r e c t e d n e s s to w a rd
the world. The assumption was made t h a t in d iv id u a ls are
d i r e c t p a r t i c i p a n t s in t h e i r w o rld and t h a t th ey a re
i n v o lv e d in t h e r e s p o n d i n g , r e l a t i n g , and sh a p in g of th e
world around them.
P r i o r to d e v e l o p i n g a t h e o r y and t r e a t m e n t one must
i
understand the liv e d -w o rld of the bulim ic. To do t h i s , the
a u t h o r took s e r i o u s l y th e w orld of th e e v ery day. I t was
understood t h a t the a c tu a l l iv i n g of the person takes placet
; ' !
in a w o rld o f s o l i d , t a n g i b l e , and s u b s t a n t i v e m a t t e r .f
t
i Central to understanding the world of the bulim ic, one must
i {
j take s e r i o u s l y the experience of t h a t liv ed -w o rld.
i
i
One of the major purposes of a phenomenological study,
b e s i d e s t h o r o u g h l y u n d e r s t a n d i n g t h e l i v e d - w o r l d of t h e
s u b j e c t , i s t h e g e n e r a t i o n of a t h e o r y of th e phenomenon.
Glaser and S trau ss (1967) suggested t h a t theory needs to be
g e n e r a t e d from c o n c e p t u a l c a t e g o r i e s e m e rg in g from a
p a r t i c u l a r phenomenon. The discovery of theory from data
which was s y s t e m a t i c a l l y o b t a i n e d and a n a l y z e d in s o c i a l
r e s e a r c h , t h e a u t h o r s c a l l "grounded t h e o r y , " s i n c e i t i s
s o l i d l y grounded in t h e d a ta . The p r e s e n t stu d y r e l i e d
12
h e a v i l y on G l a s e r and S t r a u s s ’ m eth o d o f g e n e r a t i n g
s u b s t a n t i v e t h e o r y . The t h e o r y i s s u b s t a n t i v e i f th e
r e s e a r c h e r s t u d i e s a p a r t i c u l a r p h e n o m e n o n w i t h o u t
p r e c o n c e i v e d t h e o r y t h a t d i c t a t e s t h e c o n c e p t s and
hypotheses. In order to be f a i t h f u l to the phenomenon, the
concepts and hypotheses need to be allowed to emerge from
th e d a ta .
The p u rp o se of grounded t h e o r y , a c c o r d i n g to G l a s e r
and S trau ss is:
(1) to e n a b l e p r e d i c t i o n and e x p l a n a t i o n of
behavior; (2) to be u se fu l in t h e o r e t i c a l advance
j in s o c i o l o g y ; (3) t o be u s a b l e in p r a c t i c a l
a p p l i c a t i o n s — p r e d i c ti o n and e x planation should
I be a b le t o g iv e t h e p r a c t i t i o n e r u n d e r s t a n d i n g
and some c o n t r o l of s i t u a t i o n s ; (4) p r o v i d e a
p e r s p e c t i v e on b e h a v i o r - - a s t a n c e t o be t a k e n
i toward data; and (5) to guide and provide a s t y l e
fo r r e s e a r c h on p a r t i c u l a r a r e a s o f b e h a v i o r ,
j (p. 3)
G l a s e r and S t r a u s s go on to say th e e l e m e n t s of
i
i
grounded theory are conceptual c a t e g o r i e s derived from the
f a c t s and g e n eralize d r e l a t i o n s between them. The goal is
to generate as much d i v e r s i t y in the emergent c a t e g o r i e s as
p o s s i b l e , and th en to d i s c o v e r t h e r e l a t i o n s betw een th e
c a t e g o r i e s . As th e c a t e g o r i e s emerge from th e d a ta and
become r e l a t e d , the accumulated i n t e r r e l a t i o n s h i p s form the
core of the emerging theory. Throughout the development of
t h e t h e o r y t h e r e s e a r c h e r i s c o n s t a n t l y a l e r t to new
p e r s p e c t i v e s t h a t w i l l change and f u r t h e r d e v e lo p th e
13
theory. Since the c a t e g o r i e s are discovered d i r e c t l y from
th e d a t a and i n t i m a t e l y l i n k e d to i t , th e e m e rg in g t h e o r y
should be u nderstandable to the layperson as well as being
r e l i a b l e . In c o n t r a s t , t h e o r i e s which a re l o g i c a l l y
deduced are often based on ungrounded assumptions.
S ig n if ic a n c e of the Study
R e se arch on th e p ro b lem of b u l i m i a i s s t i l l q u i t e
i I
j l im i te d since an awareness of the e x is te n c e of the problem
i
j i s on ly as r e c e n t as th e l a t e 1950’s w i t h most of th e
s i g n i f i c a n t r e s e a r c h b e in g done in th e 1970's. S tu n k a r d
(1959) was the f i r s t to i d e n t i f y b in g e - e a tin g as an e atin g
d iso rd e r. Many stu d ie s on bulim ia have been concerned with
d e f i n i n g b u l i m i a (Beumont, George, & S m a rt, 1976; G u io ra ,
i
1967; Palmer, 1979; Rich, 1978), developing ways to measure!
bulim ia (Hawkins & Clement, 1980) or g a th e rin g inform ationj
about b i n g e - p u r g i n g t e n d e n c i e s (Halmi, F a lk , & S w a r tz ,
1981; Loro & O r l e a n s , 1981). Most of t h e s e s t u d i e s have
looked a t b u l i m i a e x t e r n a l l y , th r o u g h t h e eyes of an
o u t s i d e o b s e r v e r . The p r e m i s e o f t h i s s t u d y was t h a t a
more f r u i t f u l way of studying and understanding bulim ia is
i n t e r n a l l y , t h r o u g h t h e e x p e r i e n c e o f t h e b u l i m i c s
t h e m s e l v e s . The a s s u m p t io n was made t h a t th e b u l i m i c s
t h e m s e l v e s a re t h e e x p e r t s on t h e i r own i n n e r w o rld or
l i f e - w o r l d and i t is through t h e i r s e l f - d e s c r i p t i o n th a t we
14
w i l l understand and know bulim ia more i n ti m a t e l y . No other
i n v e s t i g a t i o n has s y s t e m a t i c a l l y stu d ied the l i f e - w o r l d of
the bulim ic.
The m ajor s i g n i f i c a n c e of t h i s i n v e s t i g a t i o n i s f o r
the c l i n i c i a n . According to Ofman (1976) one of the goals
of t h e e x i s t e n t i a l i s t t h e r a p i s t i s to h e lp p e r s o n s u t t e r
and c l a r i f y t h e i r p r i o r i t i e s and b a s i c p r o j e c t s , to h e lp
them assume o w n e r s h i p , v a l i d i t y , and r e s p o n s i b i l i t y fo r
t h e i r p r o j e c t s , and t o a c c e p t b o t h t h e n e g a t i v e and
i
p o s i t i v e aspects of t h e i r p r o j e c ts . This cannot be done by;
o b j e c t i f y i n g the p e rs o n s 1 e x p e r i e n t i a l world and tr y in g to
change them a c c o r d i n g to t h e t h e r a p i s t fs view of r e a l i t y .
This can be done, i n s t e a d , by u n d e r s t a n d i n g how p e r s o n s
I
e x p e r i e n c e t h e i r w o r ld and how th e y re s p o n d t o i t . Thei
» 1
j
j s i g n i f i c a n c e o f t h i s s t u d y was in i t s a t t e m p t t o
i
c o n c e p t u a l i z e t h i s s u b j e c t i v e w o r l d w i t h c a t e g o r i e s
in h e re n t in the b u l i m i c fs experience. An u nderstanding of
the b u l i m i c s 1 p e rs p e c tiv e as t h e i r c o r r e c t inv en tio n , thus
e n a b l i n g them to e x i s t in t h e i r s i t u a t i o n , sh o u ld h e lp
c l i n i c i a n s in t h e i r t h e r a p e u t i c in te r v e n t i o n s .
Overview of the D i s s e r t a t i o n
C h a p te r 1 - Groundwork: The i n t r o d u c t o r y s t a t e m e n t
was i n t e n d e d t o e s t a b l i s h t h e mood and p a r t i c u l a r
s i g n i f i c a n c e of t h i s s t u d y as w e l l as t h e s t a t e m e n t of
15
p u r p o s e and t h e a p p r o a c h u s e d , s p e c i f y i n g why t h e
d i s s e r t a t i o n was undertaken. The p re lim in a r y a r t i c u l a t i o n
i n c l u d e d some of t h e i n i t i a l r e f l e c t i o n s and i n t u i t i o n s
about the phenomenon of bulim ia.
Chapter II - The Psychological L i t e r a t u r e on Bulimia:
T h i s s u r v e y i n c l u d e d t h e m a j o r c o n t r i b u t i o n s on t h e
d e f i n i t i o n of b u lim ia, the c l i n i c a l aspects of b u lim ia, the
e tio lo g y , and tr e a tm e n t of bulim ia.
C h a p te r I I I - Plan o f P h e n o m e n o lo g ic a l I n q u i r y : In
t h i s c h a p t e r t h e a u t h o r d e v e lo p e d t h e s p e c i f i c s e t of
procedures u t i l i z e d in t h i s i n v e s t i g a t i o n . The s t r u c t u r e
i
of t h e r e s e a r c h , th e f i e l d work, and th e o r g a n i z a t i o n and
a n a l y s i s of the formal data were discussed.
C h a p te r IV - The D e s c r i p t i v e P h a se --T h e B u l i m i c s ’
t
[ S u b j e c t i v e E x p e r i e n c e s : T his c h a p t e r was th e c o re of th e
I
f s t u d y . The c h a p t e r i n c l u d e d t h e t h r e e c ase s t u d i e s upon
which the i n v e s t i g a t i o n was based. The o rg a n iz a tio n of each
case study included the p r e s e n tin g problem, the background
of the su b je c t, the p e rs o n ’s d e s c r i p t i o n of her Lebenswelt,
and the a u th o r ’s c l i n i c a l and s u b j e c t iv e im pressions. This
p
chapter presented the data for the study.
C h a p te r V - The R e f l e c t i v e P h a s e - - R e f l e c t i o n s on th e
Data: T his c h a p t e r p r e s e n t e d an a n a l y s i s of th e d a t a of
Chapter IV. The common themes, ty p o lo g ie s, and c a t e g o r i e s
16
were presented. The b u lim ic s ' p r o j e c t s and personal myths
were also discussed.
C h a p te r VI - I m p l i c a t i o n s and C o n c l u s i o n s : The
t h e o r e t i c a l and e m p ir ic a l fin d in g s were summarized and the
d i s t i n c t i v e c o n t r i b u t i o n s as w e l l as l i m i t a t i o n s of t h e
study were reviewed. Suggestions for f u r t h e r resea rch were
a l s o p r e s e n t e d . The r e s u l t s were d i s c u s s e d in t e r m s of
t h e i r i m p l i c a ti o n s for psychology and psychotherapy.
CHAPTER II
PSYCHOLOGICAL LITERATURE ON BULIMIA
The review of l i t e r a t u r e was organized in to four p r i n
c ip a l se c tio n s . The f i r s t se c tio n contains a d e f i n i t i o n of
b u l i m i a and a d e s c r i p t i o n of th e c o n t r o v e r s y t h a t has
surrounded the syndrome and d iagnosis of bulim ia. A sc ale
developed to measure bulim ia was also reviewed. This se c
t i o n c o n c lu d e d w i t h a d i s c u s s i o n o f t h e p r e v a l e n c e of
b u l i m i a as w e l l as a summary of s t u d i e s r e p o r t i n g on th e
I
frequency and d u ra tio n of the binge-purging behavior. j
!
The second se c tio n was concerned with p r e s e n tin g the
| c l i n i c a l a s p e c t s o f b u l i m i a i n c l u d i n g d e s c r i p t i v e
| in fo rm a tio n about the body weight of b u lim ics and whether
t h e r e was p r e m o r b i d o b e s i t y and th e urg e to e a t . S t u d i e s
d e s c r i b i n g t h e p s y c h o l o g i c a l m a n i f e s t a t i o n s in b u l i m i c
persons were presented. Inform ation on the devices used to
prevent weight gain and the problems of impulse c o n tr o l was
a l s o r e v i e w e d . The s e c t i o n c o n c lu d e d w i t h th e r e s e a r c h
! done on the p h y s ic a l and medical co m p lica tio n s of b ulim ia
and s e l f - i n d u c e d v o m i t i n g and b u l i m i a ' s i m p a c t on
m en struatio n, sexual a d justm ent, and f e r t i l i t y .
The t h i r d s e c t i o n looked a t some of th e t h e o r i e s and
i
p sycho lo g ical i n t e r p r e t a t i o n s of the e ti o l o g y of bulim ia.
18
T h i s b e g a n w i t h a d i s c u s s i o n o f t h e p s y c h o a n a l y t i c
i n t e r p r e t a t i o n which has been the major response u n t i l the
past few years. Other t h e o r i e s include a h i s t o r y of being
o v e r w e i g h t , r e s t r a i n t i n e a t i n g , s o c i o - c u l t u r a l
e x p e c t a t i o n s , poor s o c i a l r e l a t i o n s h i p s , s t r e s s - r e l a t e d
an te ce d en ts, major depression, and p h y sio lo g ic a l causes.
The fo u rth se c tio n reviewed tr e a tm e n t approaches for
b u l i m i a and t h e p r o g n o s i s fo r th e " c u r i n g " of b u l i m i a and
the purging syndrome. The t r e a tm e n t plans have e s s e n t i a l l y
been h o s p i t a l c a r e a n d / o r p s y c h o t h e r a p e u t i c a p p r o a c h e s
i n c l u d i n g b e h a v i o r m o d i f i c a t i o n , some f a m i l y t h e r a p y and
group therapy.
Bulimia
The fo llo w in g s e c tio n covers the various d e f i n i t i o n s
of b u lim ia, the controversy surrounding the d e f i n i t i o n of
b u l i m i a , a m easu re of b u l i m i a , and t h e p r e v a l e n c e of
bulim ia.
D e f in itio n of Bulimia
‘The s t r i c t d i c t i o n a r y d e f i n i t i o n of bulim ia r e f e r s to
"ox hu n ger" or v o r a c i o u s a p p e t i t e . However, in r e c e n t
y e a r s b u l i m i a has come to r e f e r more and more to b i n g e -
e a t i n g (C a sper, E c k e r t , Halmi, G o ld berg , & Davis, 1980).
S t u n k a r d (1959) was one of t h e f i r s t to i d e n t i f y b i n g e -
19
e a t i n g as an e a t i n g d i s o r d e r . He d i s c o v e r e d t h a t as much
as 20,000 c a l o r i e s were consumed at one t i m e , b e h a v i o r
which took on an " o r g i a s t i c q u a lity ."
Since S t u n k a r d 's work, a number of r e s e a r c h e r s have
a t t e m p t e d to d e f i n e b u l i m i a in a more c o m p r e h e n s iv e way
(Beaumont e t a l . , 1976; B u tto n & W h ite h o u s e , 1981; Casper
et al., 1980; Palmer, 1979; Pyle, M itc h e ll, & Eckert, 1981;
R u s s e l l , 1979; Wermuth, Davis, H o l l i s t e r , & S tu n k a r d ,
1977). All of these i n v e s t i g a t o r s found t h a t se lf-in d u c e d
vomiting and purgation was fre q u e n tly a s s o c ia te d with binge
e a t i n g . B ru c h (1973, 1978), in h e r s t u d y o f e a t i n g
d i s o r d e r s , d i s c o v e r e d a s i m i l a r p a t t e r n of b in g e e a t i n g
i
i
| followed by a r i t u a l i s t i c purging. Boskind-Lodahl (1976)
| coined the term "bulamarexia" to d escrib e what she saw as a
I
j n e u ro tic syndrome of gorging and purging.
Controversy over D e f in i t io n of Bulimia
The c o n t r o v e r s y o v er t h e d e f i n i t i o n of b u l i m i a has
c e n t e r e d around w h e t h e r b u l i m i a i s a v a r i a n t of a n o r e x i a
n e r v o s a or a d i s t i n c t c l i n i c a l d i s o r d e r . U n t i l very
r e c e n t l y b u l i m i a has been p r i m a r i l y a s s o c i a t e d w i t h
a n o r e x i a n e r v o s a . G uiora (1 967), in a s t u d y of s i x women
s u f f e r i n g from what was u s u a l l y d e s c r i b e d as a n o r e x i a
n e r v o s a or b u l i m i a , s u g g e s t e d t h a t a n o r e x i a n e r v o s a and
b u lim ia were not two se p a ra te and dichotomous syndromes but
20
were extreme ends of the same d is o rd e r. Boskind-Lodahl and
S i r l i n (1977) a l s o f e l t t h e r e was a c l o s e r e l a t i o n s h i p
b etw een b u l i m i a and a n o r e x i a n e r v o s a . Beumont e t a l .
(1976) f o u n d t h a t t h e r e w e r e s e v e r a l m eans by w h i c h
p a t i e n t s with anorexia nervosa brought about t h e i r weight
l o s s ; one was by food r e f u s a l and e x c e s s i v e e x e r c i s e and
the other was by s e l f - i n d u c e d vomiting and purgation.
Rich (1978) and Palm er (1979) both found t h a t t h e r e
were p a t i e n t s who did not f i t in to the d ia g n o s tic category
J o f a n o r e x i a n e rv o s a . Rich l o c a t e d two p a t i e n t s f o r whom
I
I s e l f - i n d u c e d v o m i t i n g was no t a s s o c i a t e d w i t h any o t h e r
i
I p s y c h i a t r i c d i s o r d e r . Pa lm e r, tho ug h he s t i l l f e l t t h a t
binging and purging were r e l a t e d to anorexia, suggested the
t e r m " d i e t a r y chaos syndrome" to d e s c r i b e th e b e h a v i o r of
] s u b j e c t s who reach a p o s i t i o n of bulim ic behavior without
i
ever having been in a s t a t e of anorexia nervosa.
R u s s e l l (1979) r e f e r r e d to b u l i m i a n e r v o s a as an
"ominous v a r i a n t of anorexia nervosa," f e e l in g t h a t i t was
p r e m a t u r e to t h i n k of b u l i m i a as a d i s t i n c t d i s o r d e r .
Casper e t a l . (1980), in a s tu d y of 105 fe m a le p a t i e n t s ,
concluded t h a t p a t i e n t s with bulim ia form a subgroup among
p a t i e n t s with anorexia nervosa. However, during the past
few y e a r s r e s e a r c h e r s a p p e a r to be a c c e p t i n g b u l i m i a as a
d i s t i n c t e a t i n g d i s o r d e r , s e p a r a t e from a n o r e x i a n e rv o s a
( F a i r b u r n , 1980, 1981; Halmi e t a l . , 1981; P y le , 1981).
21
As i s e v i d e n t , many of th e r e s e a r c h e r s have been
c o n c e rn e d p r i m a r i l y w i t h d e f i n i n g b u l i m i a r a t h e r th an
t e s t i n g s p e c i f i c t r e a t m e n t a p p r o a c h e s . Very l i t t l e
r e s e a rc h has been done on tr e a tm e n t m o d a litie s . Now t h a t
th e re appears to be g r e a t e r concensus about the d e f i n i t i o n
o f b u l i m i a , p e r h a p s f u r t h e r r e s e a r c h w i l l be done to
determine the natu re of b ulim ia as a way of being, as well
as t h e m o st e f f e c t i v e k i n d o f t r e a t m e n t f o r p e r s o n s
involved in the bing in g-p urging syndrome. |
: i
I
! Measure of Bulimia
♦ ... . ■ ■ ■ ......................— - I............................
I
Hawkins and Clement (1980) were t h e f i r s t to d e v e lo p
i
and v a l i d a t e a m easure of b in g e e a t i n g t e n d e n c i e s . T h e ir
n i n e t e e n i te m q u e s t i o n n a i r e was d e v e lo p e d to m easure t h e
b eh av io ral and a t t i t u d i n a l param eters of bulim ia. Of th ese
19 i t e m s , t h e f i r s t n i n e were r e p o r t e d to m easure t h e
s e v e r i t y o f b in g e e a t i n g . The t o t a l s c o r e on t h e s e n i n e
i t e m s y i e l d e d a Binge S c a le s c o r e . The r e m a i n i n g i t e m s
gave frequency data on the prevalence and c h a r a c t e r i s t i c s
of s e l f - r e p o r t e d binge eatin g .
No o t h e r m easu re of b in g e e a t i n g t e n d e n c i e s has been
developed. I n v e s t i g a t o r s have p r i m a r i l y used s e l f - r e p o r t
q u e s t io n n a ir e s to gather info rm a tio n about b in g ing-purging
t e n d e n c i e s (Halmi e t a l . , 1 981 ; Loro & O r l e a n s , 1981;
M itc h e ll, Pyle, & Eckert, 1981; Pyle et al.,1981).
22
Prevalence of Bulimia
A number of r e s e a r c h e r s have r e p o r t e d on c a s e s of
b u l i m i a e i t h e r in t h e i r c l i n i c a l work (B o s k in d - W h ite &
W hite, 1983; Cauwels, 1983; Casper et a 1., 19 8 0; F a i r b u r n ,
1980; L inden, 1980; Rich, 1978; R u s s e l l , 1979) or in
p r o s p e c t i v e s t u d i e s in u n i v e r s i t y o u t - p a t i e n t c l i n i c s
and/or samples of u n i v e r s i t y stu d e n ts (Hawkins & Clement,
1980; M itch ell et al.,1981).
»
I
I n v e s t i g a t o r s doing s t u d i e s on anorexia nervosa have
d i s c o v e r e d t h a t n e a r l y h a l f o f t h e i r a n o r e c t i c p a t i e n t
p o p u l a t i o n s e x h i b i t e d symptoms of b u l i m i a (Casper e t
i a l . , 1 9 8 0 ; Hsu, C r i s p , & H ardin g , 1979; Pyle e t a l . , 1 9 8 1 ) .
i . i
i
A n o t h e r i n v e s t i g a t o r f o u n d t h a t a n o r e c t i c p a t i e n t s ,
d e v e lo p e d b u l i m i c symptoms o n ly a f t e r r e g a i n i n g t h e i r
normal weight (Russell, 1979). Through the work of se v e ra l
r e s e a r c h e r s i t became c le a r t h a t bulim ia also occurred in
normal weight and overweight people (Boskind-Lodahl, 1976;
Boskind-Lodahl & S i r l i n , 1977).
S ta n g le r and P rin tz (1980) did a p s y c h i a t r i c diagn o sis
in a u n i v e r s i t y p o p u l a t i o n , e v a l u a t i n g 500 s t u d e n t s . Of
t h e t o t a l p a t i e n t s a m p le , 3.8% were d i a g n o s e d as h a v in g
b ulim ia: of these, 89.5% were women and 10.5% were men.
C u r r e n t l y t h e r e h a s b e e n o n l y one s t u d y on t h e
p r e v a l e n c e of b i n g e - e a t i n g and v o m i t i n g in a u n i v e r s i t y
23
p o p u l a t i o n (Hal mi e t a l . , 1 9 8 1 ) , a s u r v e y of 355 c o l l e g e
s tu d e n ts designed to determ ine the prevalence of b u lim ia,
u s i n g th e DSM I I I c r i t e r i a . The r e s u l t s i n d i c a t e d t h a t ,
w ith in the normal co lleg e p op u lation , 13% experienced a l l
o f th e m ajor symptoms of b u l i m i a : o f t h i s 13%, 87% were
fem ales and 13% were males. Considering the t o t a l sample,
the females r e p re se n te d 19% of the t o t a l female popu lation
and the males r e p re se n te d 5% of the t o t a l male population.
P u r g in g b e h a v i o r o c c u r r e d in an a v e r a g e o f 10% of t h e
stu d e n ts. This study also in d ic a t e d t h a t bulim ic symptoms
were more l i k e l y to occur w ithout the presence of anorexia
| n e r v o s a . :
i ;
J One of the weaknesses of t h i s study was t h a t only 66%j
| of the u n i v e r s i t y popu lation co n tacted p a r t i c i p a t e d . Some
i
of t h e r e m a i n i n g 3^% of t h e p o p u l a t i o n may a l s o have been
i n v o l v e d i n b i n g e - p u r g i n g b e h a v i o r . S i n c e t h e
q u e s t io n n a ir e t h a t the s t u d e n ts were asked to f i l l out was
c a l le d the "Binge-Eating Q u e stio n n aire," some stu d e n ts may
have r e f u s e d to p a r t i c i p a t e in t h e s t u d y b e c a u s e o f t h e i r
b in ge-purging p a tt e r n s .
T his s e c t i o n was a d i s c u s s i o n o f t h e d e f i n i t i o n of
b u l i m i a , t h e c o n t r o v e r s y s u r r o u n d i n g t h a t d e f i n i t i o n , a
measure of b u lim ia, and the prevalence of bulim ia.
24
Clinical Aspects of Bulimia
The c l i n i c a l a s p e c t s of b u l i m i a w i l l be r e v ie w e d in
the next se c tio n as fo llo w s: the body weight of b u lim ics,
p r e m o r b i d o b e s i t y , t h e u r g e t o e a t , p s y c h o l o g i c a l
m a n i f e s t a t i o n s such as d e p r e s s i o n , low s e l f - e s t e e m , and
g u i l t , various devices to prevent weight gain, the problem
.
of i m p u l s e - c o n t r o l , and the numerous p h y sic al and medical
c o m plica tio n s a tte n d a n t to bulim ia.
Body Weight of Bulimics
i
! A number of r e s e a r c h e r s have s t u d i e d th e body w e i g h t
! of persons e x h i b i t i n g bulim ia. They have found t h a t a l l of
j the b ulim ic p a t i e n t s were w ith in 15% of the standard body
| w e i g h t , u s i n g t h e M e t r o p o l i t a n L if e I n s u r a n c e Company
w e ig h t s c a l e s ( F a i r b u r n , 1981; Gawelek, 1980; Hudson,
L a f f e r , & Pope, 1982).
R ussell (1979) also found t h a t most of the 30 p a t i e n t s
he s t u d i e d were only s l i g h t l y u n d e r w e i g h t , n o rm a l, or
somewhat o v e r w e i g h t . This is s i g n i f i c a n t , e s p e c i a l l y in
view of t h e f a c t t h a t b u l i m i a has so o f t e n been view ed
s i m p l y as a su b gro up of a n o r e x i a (Beaumont e t a 1., 1 9 7 6;
Casper e t a l . , 1980; G uiora, 1967).
25
Premorbid Obesity
Beaumont e t a l . (1976), in a s t u d y of 31 f e m a l e s w i t h
a n o r e x i a n e r v o s a , d i s c o v e r e d t h a t most of th e h a b i t u a l
v o m i t e r s and p u r g e r s had p r e v i o u s l y been o b e se. This was
s i g n i f i c a n t l y d i f f e r e n t from the s t r i c t d i e t e r s .
In R u s s e l l ’s (1979) s t u d y of 30 p a t i e n t s e x h i b i t i n g
b ulim ic behavior, an examination of each p a t i e n t ’s weight
h i s t o r y revealed t h a t n e a rly a l l of them were s t r u g g l i n g to
m aintain a weight le v e l s i g n i f i c a n t l y lower than t h a t which
had p r e v a i l e d p r i o r to t h e s t a r t of th e b u l i m i c b e h a v i o r .
Some o f them had been obese and some only s l i g h t l y obese
p r i o r to the purging behavior.
| ;
; G arfin kel, Moldofsky, and Garner (1980), in a study ofi
• i
i j
r 155 a n o r e x i c p a t i e n t s seen c l i n i c a l l y betw een 1970 and
i
1978, found t h a t 32% of t h e b u l i m i c p a t i e n t s had been
premorbidly obese. Of t h i s group, 68 experienced bulim ia
and 73 d id n o t. O b e s i t y was d e f i n e d as a w e i g h t g r e a t e r
th a n 115% of t h e a v e r a g e w e ig h t f o r a p a r t i c u l a r age and
h e i g h t . This was s i g n i f i c a n t l y d i f f e r e n t from t h o s e
p a t i e n t s with anorexia nervosa.
Halmi e t a l . (1981) in a p r e v a l e n c e s t u d y of 355
co lle g e stu d e n ts re p o rte d t h a t the symptoms of bulim ia were
more l i k e l y to appear in those i n d iv i d u a ls who at some time
26
had been overweight or who tended to be heavy w ith in t h e i r
normal range.
Not a l l s t u d i e s have t e s t e d f o r p r e m o r b i d o b e s i t y ,
h o w e v e r a n u m b e r o f r e s e a r c h e r s h a v e fo u n d t h a t a
s i g n i f i c a n t number in t h e i r s t u d i e s have been prem orbidly
obese (Beaumont e t a l . , 1 976; G a r f i n k e l e t a l . , 1 980; Halmi
et al., 1981; R ussell, 1979), i n d i c a t i n g t h a t perhaps th e r e
i s a r e l a t i o n s h i p between premorbid o b e sity and the binge-
purge syndrome.
!
! The Urge to Eat
i
Perhaps the most o u tsta n d in g c l i n i c a l m a n i f e s ta t io n in
the b ulim ic person is the urge to eat. Pyle et al. (1981)
re p o rte d t h a t n e a rly a l l of the p a t i e n t s he stu d ied (29 of
j i
I 3*0 i n d i c a t e d t h a t t h e y had s t r o n g a p p e t i t e s and.
i
| u n c o n t r o l l a b l e urges to eat.
j
| Most b u l i m i c p e r s o n s r e p o r t e d t h a t t h e y a l m o s t
c o n s t a n t l y t h o u g h t about food, both in t h e i r waking s t a t e
and d r e a m in g s t a t e . Most of t h e b i n g i n g was done in
s o l i t a r y with high c a l o r i e and c a r b o h y d r a te - ric h foods as
t h e p r i m a r y food e a t e n . The am ounts of food consumed,
a c c o r d i n g t o s e l f - r e p o r t s , c o u ld amount to as many as
1 5 ,0 0 0 -2 0 ,0 0 0 c a l o r i e s (B o s k in d - L o d a h l & S i r l i n , 1977;
C asper e t a l . , 1 9 8 0 ; F a i r b u r n , 1980; Loro & O r le a n s , 1981;
M i t c h e l l e t a l . , 1 9 8 1 ; R u s s e l l , 1979; Thompson & S c h w a r tz ,
27
1981; Wardle & B ein art, 1981; Wermuth et al.,1977; Wilson,
1976).
M itch e ll et al. (1981) rep o rte d t h a t the mean d u ration
for b i n g e - e a tin g episodes was 1.18 hours with a range from
15 minutes to e igh t hours for the 40 p a t i e n t s they stu d ied .
They f u r t h e r r e p o r t e d t h a t th e mean number of b i n g e -
e p i s o d e s per week was 11.7 w i t h a ra n g e o f from 1 to 46
e p i s o d e s . This was c o n s i d e r a b l y h i g h e r th a n r e p o r t e d by
Wermuth et al. (1977). Wermuth and h is a s s o c i a t e s found an
a v e r a g e of t h r e e to fo u r e p i s o d e s per week in a group of
p r i m a r i l y n o rm al w e ig h t or o v e r w e i g h t i n d i v i d u a l s w ith
b u lim ia, most of whom had volunteered for the study.
A number o f r e s e a r c h e r s have r e p o r t e d on t h e b i n g e -
e a t in g episodes of anorexic p a t i e n t s . Casper et al. (1980)
r e p o r t e d t h a t 67% of t h e i r b u l i m i c p a t i e n t s a d m i t t e d to
b in g e e a t i n g at l e a s t once a week and 16% a d m i t t e d to b in g e
e a t i n g a t l e a s t once e v e ry day. G a r f i n k e l e t a l . (1 980),
in a n o t h e r s t u d y on a n o r e x i c s , found t h a t 37% of th e
b u l i m i c a n o r e c t i c s e x p e r i e n c e d e x c e s s i v e e a t i n g a t l e a s t
once a day, and an a d d i t i o n a l 41% experienced such episodes
a t l e a s t once p e r week. S in c e t h e s e s t u d i e s were done w i t h
a n o r e x i c s r a t h e r t h a n b u l i m i c s w i t h o u t a n o r e x i a , t h e s e
fin d in g s are not comparable.
Psychological M a n ife sta tio n s in Bulimic Persons
From a r e v ie w of th e l i t e r a t u r e i t i s e v i d e n t t h a t th e
p s y c h o l o g i c a l c o n s e q u e n c e s of t h e b i n g e - p u r g i n g syndrome
a r e some of t h e most s i g n i f i c a n t a s p e c t s of b u l i m i a .
R e s e a r c h e r s r e p o r t e d t h a t b u l i m i c p e r s o n s e x p e r i e n c e d
d e p r e s s i o n , low s e l f - e s t e e m , g u i l t and d i s g u s t ,
preoccupation with body s i z e , body image d i s s a t i s f a c t i o n ,
morbid fear of becoming f a t (Fairburn, 1980, 1981; Hawkins
& C lem en t, 1980; Pyle e t a l . , 1 9 8 1 ; R u s s e l l , 1979), and
an x ie ty and s o m a tiz a tio n (Bhanji & M attingly, 1981; Casper
e t a l . , 1 980).
Pyle and a s s o c i a t e s (1981) and Casper and a s s o c i a t e s ,
(1980) found t h a t b u l i m i c p a t i e n t s s c o r e d s i g n i f i c a n t l y
i
I h i g h e r on d e p r e s s i o n on t h e M i n n e s o t a M u l t i p h a s i c
l
P e r s o n a l i t y I n v e n t o r y (MMPI) th a n t h e no rm al p o p u l a t i o n .
Pyle e t a l. a l s o r e p o r t e d s i g n i f i c a n t l y h i g h e r s c o r e s in
o b s e s s i o n s ( r e c u r r i n g i n t r u s i v e t h o u g h t s of food, e a t i n g
o n ly c e r t a i n i t e m s of food, f e a r of b e in g f a t ) and h i g h e r
s o m a tiz a tio n (headaches, d i z z in e s s , stomach d iscom fo rt) in
c o m p a r is o n t o a n o r e x i c s . Pyle e t a l . r e p o r t e d s i m i l a r
r e s u l t s w i t h s i g n i f i c a n t e l e v a t i o n on t h e P s y c h o p a t h i c
D e v ia n t S c a l e ( r e p o r t i n g im p u1s i v i t y ), th e P s y c h a s t h e n i a
Scale ( r e p o r tin g anx iety , worry, and c o m p u l s i v i ty ) , and the
29
Schizophrenia Scale ( r e p o rtin g symptoms of rum ination and
f e e l in g s of a l i e n a t i o n ) .
B h a n ji and M a t t i n g l y (1981), u s i n g t h e C ro w n -C risp
E x p e r i e n t i a l Index, found t h a t "vomiters" in t h e i r group of
20 a n o r e x i c p a t i e n t s a l s o s c o r e d h i g h e r on th e a n x i e t y ,
som atic, and depression su bscales than did the d i e t e r s .
Many of t h e i n v e s t i g a t o r s r e p o r t e d t h a t p e r s o n s
involved in b u lim ic behavior su f f e r e d from extreme f e e l in g s
j of g u i l t and s e lf -c o n te m p t (Boskind-Lodahl, 1976; Hawkins &
i Clement, 1980; Moskovitz & Lingao, 1979; Wardle & Beinart,
| 1981; Wermuth et al.,1977), often accompanied by a reso lv e
i
not to binge and purge again.
A nother c h a r a c t e r i s t i c o f t h e b u l i m i c p e rs o n was a
preoccupation with body siz e and a morbid fear of becomingj
f a t (Beaumont e t al., 1976; Boskind-Lodahl & S i r l i n , 1977;
B u tto n & W h ite h o u s e , 1981; F a i r b u r n , 1980; Orbach, 1978;
Russell, 1 979).
Devices to Prevent Weight Gain
There a r e f o u r p r i m a r y methods of p r e v e n t i n g w e i g h t
gain used by persons involved with b u lim ic behavior: s e l f
in d u c e d v o m i t i n g , l a x a t i v e a b u se , use o f d i u r e t i c s , and
excessive e x e r c is e (Boskind-Lodahl & White, 1978; G arfinkel
i
| e t a l . , 1 9 8 0 ; Halmi e t a l . , 1 9 8 1 ; Pyle e t a l . , 1 9 8 1 ; R u s s e l l ,
I
I 1979; White & B o s k in d - L o d a h l, 1981). The most s y s t e m a t i c
30
s t u d y of t h e s e d e v i c e s was done by Halmi and a s s o c i a t e s
(1981) whose i n v e s t i g a t i o n rev ealed t h a t vomiting was more
f r e q u e n t l y employed th a n m e d i c a t i o n in p u r g i n g b e h a v i o r .
Nineteen percent of the 355 respondents i n d ic a te d t h a t they
vomited a f t e r they ate. Six of the 355 respondents vomited
more th a n once a week. Of t h o s e who i n d i c a t e d t h a t th e y
v o m it e d , 84.9% r e p o r t e d t h a t th e y v o m ite d l e s s th a n once
per month, while 8.5% did so one or more times per day.
t
In a d d i t i o n , 4.5% o f t h e t o t a l p o p u l a t i o n u s e d
e x e r c i s e , 8.1% used some form of d i e t , 0.8% used w e ig h t
l o s s a i d s , 0.3% were engaged in p s y c h o t h e r a p y , and 1.4%
belonged to a weight c o n tr o l o rg a n iz a tio n . The symptoms of
b i n g e - e a t i n g w e r e s i g n i f i c a n t l y c o r r e l a t e d w i t h t h e
frequency of d i e t p i l l usage. Laxative use was found to be
s i g n i f i c a n t l y c o r r e l a t e d w i t h a more s e v e r e form o f
b u l i m i a . The r e s e a r c h e r s a l s o d i s c o v e r e d t h a t w e i g h t
I
I change was n o t acc o m p a n ie d by t h e use of d i e t p i l l s or
v o m itin g .
Problem of Impulse-Control
The problem of i m p u l s e - c o n t r o l has been re p o r te d as a
general c h a r a c t e r i s t i c of the bulim ic person (Beaumont et
al.,1976; Boskind-Lodahl, 1976; Fairburn, 1980, 1981; Halmi
e t a l . , 1 9 8 1 ; Pa lm e r, 1979). There a r e , how ever, a number
of i n v e s t i g a t o r s who have s p e c i f i c a l l y examined alcohol and
31
drug abuse, s t e a l i n g , s u ic id e a tte m p ts, and s e l f - m u t i l a t i o n
( C a s p e r e t a l . , 1 9 8 0 ; G a r f i n k e l e t a l . , 1 9 8 0 ; P y l e e t
al.,1981) by bu lim ics.
Pyle et a l . (1981), in a s t u d y of 68 b u l i m i c s and 73
anorexics, found t h a t 20.4% of bu lim ics used alcohol weekly
or more o f t e n in c o m p a r is o n to 4.8% of a n o r e x i c s . S t r e e t
d rug s were used by 28.6% of t h e b u l i m i c s in c o n t r a s t to
11.6% o f t h e a n o r e x i c s . T w e l v e p e r c e n t o f b u l i m i c s
r e p o r t e d s t e a l i n g w h i l e none of t h e a n o r e x i c s r e p o r t e d
s t e a l i n g . In t h e b u l i m i c group, 9.2% had s e l f - m u t i l a t e d
and 23.1% had a t t e m p t e d s u i c i d e . T his was s i g n i f i c a n t l y
d i f f e r e n t f r o m t h e a n o r e x i c s o f whom 1.5% had s e l f
m u t i l a t e d and 7.1% had a t t e m p t e d s u i c i d e . A ll of t h e s e
d i f f e r e n c e s were found to be s i g n i f i c a n t at the 0.05 lev e l.
Casper e t a l . (1980) found t h a t t h e r e was.a s i g n i f i
c a n t ly higher frequency of kleptom ania in bulim ic p a t i e n t s
than in the anorexic group. Bulimic p a t i e n t s also rep o rte d
the use of alcohol while the anorexics did not. The study
was done with 105 female p a t i e n t s .
Pyle et al. (1981), in a study of 34 bulim ic p a t i e n t s ,
discovered t h a t s t e a l i n g was a common c h a r a c t e r i s t i c of at
l e a s t 22 of them. The primary item s t o l e n was food which
Pyle and a s s o c i a t e s f e l t was p a r t of th e b i n g i n g r i t u a l .
The major reason given by th e s e p a t i e n t s for s t e a l i n g food
32
was t h a t th e y were not a b le to a f f o r d t h e amount of food
needed for the binges.
Physical and Medical Complications of Bulimia
T h e r e a r e a n u m b e r o f p h y s i c a l a n d m e d i c a l
c o m p l i c a t i o n s e v i d e n t in p a t i e n t s w i t h b u l i m i a , most
commonly a very s o r e t h r o a t a f t e r t h e v o m i t i n g e p i s o d e s
( F a i r b u r n , 1 980; P y l e e t a l . , 1 9 8 1 ) . The m e d i c a l
»
c o m p l i c a t i o n s i n c l u d e d r e f l e x o e s o p h a g i t i s , l o w e r
r e s p i r a t o r y t r a c t i n f e c t i o n s , t h r o a t i n f e c t i o n s , and
s w o l l e n s a l i v a r y g l a n d s . R u s s e l l ( 1 9 7 9 ) n o t e d t h a t
e p i l e p t i c s e i z u r e s , t e t a n y , and re n a l c o m p lic a tio n s could
e nsu e as a r e s u l t of t h e b i n g i n g - p u r g i n g as w e l l as th e
p o t e n t i a l f a t a l r i s k of severe hypokalaemia. He also found
t h a t many o f t h e b u l i m i c s s u f f e r e d f r o m p o t a s s i u m
d e p l e t i o n .
S in c e p a r t of t h e b i n g i n g - p u r g i n g syndrom e i n c l u d e d
i
t h e c o n s u m p tio n o f l a r g e q u a n t i t i e s of l i q u i d t o a id
v o m i t i n g , F a i r b u r n ( 1 9 8 0 ) s u g g e s t e d t h a t t h i s c o u l d
c o n t r i b u t e to e l e c t r o l y t e imbalance.
A number of r e s e a r c h e r s r e p o r t e d t h a t m e n s t r u a l
i r r e g u l a r i t i e s were common among b u l i m i c s (Beaumont et
i a l . , 1 9 7 6 ; B o s k i n d - L o d a h l , 1977; F a i r b u r n , 1980; Pyle et
i
a l . , 1 9 8 1 ; R u s s e l l , 1979). T h e s e i n v e s t i g a t o r s a l s o
33
i n d i c a t e d t h a t t h e s e x u a l a d j u s t m e n t of b u l i m i c s was
f r e q u e n t ly b e t t e r than t h a t of anorexics.
The f o r e g o i n g s e c t i o n has been a d i s c u s s i o n o f t h e
c l i n i c a l a sp ec ts of b ulim ia as reviewed in the l i t e r a t u r e .
They h a v e i n c l u d e d d e s c r i p t i v e a s p e c t s o f b u l i m i a ,
i
p sy c h o lo g ic al m a n i f e s ta t io n s , and the numerous p h y sic al and
medical c o m p lica tio n s involved with bulim ia.
E tiolo g y of Bulimia
| Russell (1979) re p o rte d t h a t the causes of bu lim ia are
j l a r g e l y unknown. A s e a r c h of t h e l i t e r a t u r e has r e v e a l e d
\
j t h a t t h e r e a re many h y p o t h e s e s a b o u t t h e e t i o l o g y of
b u l i m i a b u t very l i t t l e c l e a r e v i d e n c e a bout th e a c t u a l
c a u s e s . Some o f t h e o n e s m e n t i o n e d h a v e b e e n e a r l y
I
i d e p r i v a t i o n in t h e m o t h e r - c h i l d r e l a t i o n s h i p (G u io ra,
|
1967), a h i s t o r y of being overweight (Beaumont et al.,1976;
Halmi e t a l . , 1 9 8 1 ) , s o c i o c u l t u r a l e x p e c t a t i o n s ( B o s k in d -
1
j L o d a h l, 1977), poor s o c i a l r e l a t i o n s h i p s ( G a r f i n k e l e t
j a l . , 1 9 8 0 ) , and s t r e s s r e l a t e d i n c i d e n t s ( B o s k in d - L o d a h l,
| 1 976; Pyle e t a l . , 1981).
I
P s y ch o an aly tic I n t e r p r e t a t i o n
U ntil very r e c e n t l y the most w idely accepted theory of
the e tio lo g y of b u lim ia held t h a t e a r l y d e p riv a tio n in the
m o t h e r - c h i l d r e l a t i o n s h i p was b a s i c to th e c o n d i t i o n
i
i
i_ 34
(Guiora, 1967). This was e s p e c i a l l y t r u e when bulim ia was
seen as another aspect of anorexia nervosa (Boskind-Lodahl,
1976; Guiora, 1967).
The p s y c h o a n a l y t i c i n t e r p r e t a t i o n o f a n o r e x i a ,
re p o rte d and r e j e c t e d by Boskind-Lodahl (1976), is t h a t of
r e j e c t i n g f e m i n i n i t y which m an ifests i t s e l f in the fear of
o r a l i m p r e g n a t i o n . The b u l i m i c syndrom e, a c c o r d i n g to a
p s y c h o a n a l y t i c i n t e r p r e t a t i o n , b e g in s w i t h a p r e o e d i p a l
r i v a l r y and an o r a l s a d i s t i c drive, and i d e n t i f i c a t i o n with
!
j a kind, passiv e f a t h e r and h o s t i l i t y towards an aggressive
j m o th e r. The s e x u a l r o l e c o n f l i c t may r e s u l t in b u l i m i a
j with an o v e r i d e n t i f i c a t i o n with f e m i n in i t y and a d e s i r e for
j p re g n a n c y . B o s k in d - L o d a h l r e j e c t s t h i s i n t e r p r e t a t i o n ,
! s u g g e s t i n g t h a t r a t h e r t h a n r e j e c t i n g f e m i n i n i t y , t h e s e
|
i women have never questioned the assumptions t h a t wifehood,
m o the rho o d, and i n t i m a c y w i t h men a r e t h e f u n d a m e n t a l
co m ponents of f e m i n i n i t y . B o s k in d - L o d a h l s u g g e s t s t h a t
th ese women spend t h e i r l i v e s t r y i n g to plea se o th e r s in an
a t t e m p t t o f u l f i l l t h e f e m i n i n e r o l e r a t h e r t h a n t h e i r
needs as an i n d iv i d u a l person.
H isto ry of Being Overweight and R e s t r a i n t in Eating
A number of r e s e a r c h e r s have suggested t h a t a h i s t o r y
of being overweight has some r e l a t i o n s h i p with the e tio lo g y
of b ulim ia (Garfinkel et al.,1980; Halmi et al.,1981; Pyle,
1981; R u s s e l l , 1979). S i n c e p r e m o r b i d o b e s i t y was
d i s c u s s e d in th e s e c t i o n on c l i n i c a l a s p e c t s o f b u l i m i a
th e r e w i l l be no f u r t h e r d isc u s s io n in t h i s s e c tio n .
In a s e r i e s of s t u d i e s on t h e e f f e c t of r e s t r a i n t
( d ie tin g concern) on e a tin g behavior, evidence was gathered
which showed t h a t d i e t e r s te n d t o b in g e e a t when th e y
b e l i e v e th e y have a l r e a d y o v e r e a t e n (Herman & Mack, 1975;
Herman & P o l i v y , 1975; P o l i v y & Herman, 1976; S p e n c e r &
Fremouw, 1979). These r e s e a r c h e r s found t h a t r e s t r a i n e d
s u b j e c t s tend to overeat when they are anxious or depressedj
i
w h i l e u n r e s t r a i n e d s u b j e c t s d e c r e a s e t h e i r c o n s u m p tio n .!
I
j They hypothesized t h a t stro n g emotions i n t e r f e r e with the!
! s e l f - c o n t r o l o f t h e r e s t r a i n e d e a t e r and t h u s p roduce!
b i n g e - e a t i n g . |
I
| The t h e r a p e u t i c i m p l i c a t i o n o f t h e s e f i n d i n g s , as
i
| suggested by Spencer and Fremouw (1979), is t h a t th e r e is a
powerful c o g n itiv e f a c t o r a s s o c i a t e d with e a tin g behavior.
They s u g g e s t t h a t t o c o n t r o l b in g e e a t i n g , c o g n i t i v e
r e s t r u c t u r i n g s t r a t e g i e s need to take place.
S o c i o c u l t u r a l E x p ectatio ns
S o c i o c u l t u r a l p r e s s u r e s f o r t h i n n e s s o f women have
come t o be a c c e p t e d more and more among th e c a u s e s of
anorexia nervosa (Bruch, 1973, 1978; Boskind-Lodahl, 1976),
j a s w e l l as f o r b u l i m i a ( B o s k i n d - L o d a h l , 1976). Bruch
I
36
(1978) has r e f e r r e d to t h i s as a " s o c i o c u l t u r a l epidemic."
She has s u g g e s t e d t h a t f a s h i o n ’s i d e a l fo r women may
i
| i n d i r e c t l y a f f e c t a d o l e s c e n t s who come to b e l i e v e t h a t
I
weight c o n tro l w i l l lead to success and happiness in l i f e —
and bring acceptance from men.
G a r f i n k e l e t a l. ( 1 980) have n o t e d t h a t a l l of t h e i r
p a t i e n t s , bo th b u l i m i c and a n o r e x i c , s h a r e a v i g o r o u s
p u r s u i t of a t h i n body, r e g a r d l e s s of t h e i r w e i g h t. They
suggest t h a t high performance e x p e c ta tio n s of women may be
f a c t o r s p r e c i p i t a t i n g a n o r e x i a n e r v o s a i n c e r t a i n j
a d o l e s c e n t s .
In a study of the c u l t u r a l e x p e c ta tio n s of th in n e s s in
j women, e x a m in in g d a t a from Playboy c e n t e r f o l d s and Miss
j Am erica c o n t e s t a n t s , G a r n e r , G a r f i n k e l , S c h w a r tz , and
I Thompson (1980) found t h a t t h e r e has been a n o t a b l e t r e n d
I
to w a r d a t h i n n e r s t a n d a r d or t h i n n e r i d e a l shape f o r
f e m a l e s in our c u l t u r e over th e p a s t 20 y e a r s . Over th e
same period t h e r e was a s i g n i f i c a n t i n c r e a s e in the number
o f a r t i c l e s on d i e t i n g in s i x l e a d i n g women's m a g a z in e s .
These c h an g e s were o c c u r r i n g a t t h e same t i m e as th e
average weights for young women n a t i o n a l l y were in cre asin g .
Orbach (1978) has p r o b a b l y w r i t t e n t h e most on th e
i m p a c t of t h e s o c i o c u l t u r a l e x p e c t a t i o n s of t h i n n e s s on
women:
37
Fat i s a s o c i a l d i s e a s e (as w e l l as a n o r e x i a and
b u l i m i a ) , and f a t i s a f e m i n i s t i s s u e . Fat i s
n o t a b ou t l a c k o f s e l f - c o n t r o l or la c k of w i l l
power. Fat is_ about p r o t e c t i o n , sex, nurturance,
s t r e n g t h , b o u n d a r i e s , m o t h e r i n g , s u b s t a n c e ,
a s s e r t i o n , and ra g e . I t i s a r e s p o n s e to th e
i n e q u a l i t y o f t h e s e x e s . F a t e x p r e s s e s
e x p e r i e n c e s o f women to d a y in ways t h a t a re
s e l d o m e x a m i n e d a n d e v e n m o r e s e l d o m
t r e a t e d . . . M e n a c t and women a p p e a r . Men look at
women. Women watch them selves being looked at.
This determ ines not only most r e l a t i o n s between
men and women, but also the r e l a t i o n of women to
t h e m s e lv e s . (p. 7)
Poor S o c ial R e la tio n s h ip s
A b a s i c i n a b i l i t y to form s t a b l e r e l a t i o n s h i p s and a
i
! sense of w o r th le s s n e s s have been seen to c o n tr i b u te to the
I
| o n s e t o f b i n g i n g - p u r g i n g b e h a v i o r (B u tto n & W h ite h o u s e ,
1 1981; Gawelek, 1980; G arfink el et al.,1980).
! I
Pyle e t a l . (1981) r e p o r t e d in t h e i r s t u d y of 3^!
' b u lim ic s , t h a t arguments with p a re n ts , spouse, or boyfriend)
|
j were r e l a t e d t o t h e o n s e t o f b u l i m i a . B o s k in d - L o d a h l
j (1977) s u g g e s t e d t h a t t h e f e a r of r e j e c t i o n was a c r u c i a l
j m o t i v a t i n g f a c t o r in t h e b e h a v i o r o f b u l i m i c s . T h is was
! u s u a l l y based on a p r i o r r e j e c t i o n t h e p e rs o n had a l r e a d y
I
I e x p e r i e n c e d .
S t r e s s Related I n c i d e n ts
A number of r e s e a r c h e r s suggest t h a t tr a u m a t i c events
a r e r e l a t e d t o th e o n s e t o f b u l i m i a . Pyle e t a l. (19B1)
r e p o r t e d t h e f o l l o w i n g : t h e l o s s o r s e p a r a t i o n o f
38,
im p o rtant person(s) such as leaving home, moving, r e j e c t i o n
by a boyfriend, temporary absence of a p aren t, graduation,
d e a t h of a s i b l i n g , d i v o r c e , or s u r g e r y . S e p a r a t i o n from
p a re n ts (Rich, 1978) and r e j e c t i o n of a boyfriend, r e a l or
p e r c e i v e d ( B o s k i n d - L o d a h l , 1976), a re a l s o t h o u g h t to
c o n t r i b u t e to th e o n s e t of b u l i m i a . No s i g n i f i c a n t work
has been done in any of th ese areas. They have simply been
r e p o r t e d in t h e l i t e r a t u r e as some o f t h e a n t e c e d e n t s of
bu lim ic behavior.
Other Antecedents
I
i
R ussell (1979) has said t h a t the causes of bu lim ia are
l a r g e l y unknown, an a s s e r t i o n s u b s t a n t i a t e d by t h i s search
i o f t h e l i t e r a t u r e . Most r e s e a r c h e r s a r e h y p o t h e s i z i n g
about the causes but, up to t h i s p o in t, the ante ce d en ts of
bulim ia are u nclear.
A number of p h y s i o l o g ic a l a n te ce d en ts were suggested
by i n v e s t i g a t o r s in t h e m e d i c a l a r e a (Green & Rau, 1974;
M o sk o v itz & L in g a o , 1979). Green and Rau (1974) f o r
ex am p le , s u g g e s t e d t h a t c o m p u l s i v e e a t i n g c o u ld be a
fu n ctio n of n e u r o l o g i c a l d istu rb a n c e . Moskovitz and Lingao
( 1 9 7 9 ) a t t e m p t e d t o p r o v i d e e v i d e n c e t o s u p p o r t a
J
i n eu ro p h y sio lo g ic mechanism for the b in g e - e a t i n g syndrome.
i They r a i s e d t h e q u e s t i o n of i t s f r e q u e n c y of a s s o c i a t i o n
i
with o r a l c o n tr a c e p ti v e use.
39
Hudson et al. (1982) looked for a r e l a t i o n s h i p between
b u l i m i a and a f f e c t i v e d i s o r d e r s in f a m i l y h i s t o r y . They
found a high prevalence of f a m i l i a l a f f e c t i v e d i s o r d e r s in
the ten b ulim ic p a t i e n t s they stud ied .
Though t h e c a u s e s of b u l i m i a a r e l a r g e l y unknown
( R u s s e l l , 1979) t h e r e has been s p e c u l a t i o n a b ou t th e
causes. The ones suggested have been e a r l y d e p r i v a ti o n in
t h e m o t h e r - c h i l d r e l a t i o n s h i p , a h i s t o r y o f b e i n g
o v e r w e i g h t , s o c i o c u l t u r a l e x p e c t a t i o n s , p o o r s o c i a l
r e l a t i o n s h i p s , and s t r e s s r e l a t e d in c i d e n t s .
Treatment Approaches for Bulimia
The l a c k of s y s t e m a t i c s t u d i e s of t h e t r e a t m e n t of
| b u l i m i a was o f s i g n i f i c a n c e . A s e a r c h o f t h e l i t e r a t u r e !
i t
p ro d u c e d o n ly f i v e s t u d i e s t h a t d e s c r i b e d or a t t e m p t e d a
s y s t e m a t i c t r e a t m e n t a p p r o a c h ( B o s k in d - L o d a h l, 1977;
Fairburn, 1981; Green & Rau, 1974; Linden, 1980; Wermuth et
a l . , 1 9 7 7 ) .
In view o f t h e f a c t t h a t no s a t i s f a c t o r y t r e a t m e n t
a p p r o a c h e s had been i d e n t i f i e d , i n v e s t i g a t o r s who were
p r i m a r i l y t r e a t i n g a n o r e x i a n e r v o s a p a t i e n t s or o bese
p a t i e n t s suggested t r e a t i n g b u lim ia with s i m i l a r approaches
(Fairburn, 1981, 1980; Linden, 1980; R ussell, 1981; Wilson,
1976). Hence a b r i e f r e p o r t on the t r e a t m e n t s for anorexia
nervosa appeared necessary.
40
Treatment of Anorexia Nervosa
In some comments on the c u rr e n t t r e a tm e n t of anorexia
nervosa, R ussell (1981) r e p o rte d t h a t no s p e c i f i c tr e a tm e n t
for the syndrome has been developed. A number of d i f f e r e n t
types of t r e a tm e n ts have been t r i e d but none have met with
o v e r w h e l m i n g s u c c e s s . P r o b a b l y t h e most f r e q u e n t l y
m e n tio n e d a p p ro a c h in t h e l i t e r a t u r e was some ty p e of
p s y c h o t h e r a p e u t i c t r e a t m e n t i n v o l v i n g t h e f a m i l y of th e
a n o r e x i c p a t i e n t (Bruch, 1977, 1978, 1982; C a spe r, 1981;
i
I D a l ly , 1981; Lagos, 1981-82; Liebman, M in u c h in , & Baker,
I
j 1974). W hile r e s u l t s of th e f a m i l y t h e r a p y a p p ro a c h have
j !
i been e n c o u r a g i n g , t h e l o n g - t e r m r e s u l t s have n o t y e t been]
I a s c e r t a i n e d (Russell, 1981). \
t
J R u s s e l l ( 1 9 8 1 ) s u g g e s t e d a c a r e f u l l y s t r u c t u r e d
I t h e r a p e u t i c regime for the anorexic p a t i e n t . This was best
1
accomplished with the p a t i e n t being ad m itted to a h o s p i t a l
in which t h e n u r s i n g s t a f f had t h e n e c e s s a r y t h e r a p e u t i c
s k i l l s . A r e l a t i o n s h i p o f t r u s t b e tw ee n t h e p a t i e n t and
the nurse was seen to be e s s e n t i a l to s u c c e s s f u l tre a tm e n t.
Once th e p a t i e n t had gained s u f f i c i e n t weight, th e r e was an
acc o m p a n y in g r e l i e f o f t h e d e p r e s s i v e symptoms and a
d i m i n u t i o n of t h e p a t i e n t ' s c o n c e rn f o r h e r a p p e a r a n c e .
R ussell f u r t h e r suggested su p p o rtiv e psychotherapy, a f t e r
t h e w e i g h t g a i n , a i m e d a t h e l p i n g t o r e s o l v e t h e
41
p s y c h o l o g i c a l c o n f l i c t s . During t h i s t i m e , as w e l l as
e a r l i e r in t h e t r e a t m e n t , t h e f a m i l y sh o u ld be i n v o l v e d .
C h r o n i c i t y of th e i l l n e s s was seen to be t h e d e t e r m i n i n g
f a c t o r in the prognosis, according to Russell (1981).
C r i s p (1 981-82) s u g g e s t e d o t h e r f a c t o r s which m ight
c o n t r i b u t e t o a p o o r p r o g n o s i s f o r a n o r e x i c s : (1)
p r e m o r b i d o b e s i t y , (2) i m p o v e r i s h e d r e l a t i o n s h i p s w i t h
o t h e r c h i l d r e n w h e n a c h i l d , (3 ) i m p o v e r i s h e d
r e l a t i o n s h i p between p a re n ts , (4) high l e v e ls of anxiety
and d e p r e s s i o n in p a r e n t s , and (5) lo w e r s o c i a l c l a s s
background. All of these f a c t o r s could a ls o c o n tr i b u te to
the outcome in the t r e a tm e n t of bulim ia.
S e v e r a l b e h a v i o r a l t e c h n i q u e s have been used f o r t h e j
t r e a t m e n t of a n o r e x i a n e r v o s a (B h a n ji & Thompson, 1974;
jB a c h r a c h , E rw in , & Mohr, 1965). One r e s e a r c h e r even
suggested a "novel approach"— punishment (Blue, 1979).
In 1976 Wilson made some c l i n i c a l o b se rv a tio n s lin k in g
t h e use o f b e h a v i o r t h e r a p y in w e i g h t c o n t r o l c l i n i c s and
b in g e e a t i n g . He found t h a t p e r s o n s i n v o l v e d in b in g e
e a t i n g had p a r t i c i p a t e d u n s u c c e s s f u l l y i n b e h a v i o r
m o d if ic a tio n programs. The p a r t i c i p a n t s re p o r te d t h a t they
had l i t t l e d i f f i c u l t y fo llo w in g the program between binges
b ut i t f a i l e d t o a f f e c t t h e f r e q u e n c y or i n t e n s i t y o f t h e
b in g e . W ilson (1981) s u g g e s t e d t h a t b e c a u s e s i t u a t i o n a l
c o n t r o l p r o c e d u r e s p roved i n e f f e c t i v e , t h e f o c u s sh o u ld
42
r a t h e r be on the i n t e r p e r s o n a l and c o g n itiv e f a c t o r s which
p ro d uce d t h e e m o t i o n a l d i f f i c u l t i e s . He recommended an
e m p h a s is on s e l f - a c c e p t a n c e and more e f f e c t i v e c o p in g
s k i l l s . Wilson hoped t h a t th ese su g gestio n s would be taken
i n t o c o n s i d e r a t i o n p r i o r t o t h e f o r m a l i z a t i o n o f
b e h av io ral t r e a tm e n t programs for binge eating.
Drug Treatment
I Two of the e a r l i e r a tte m p ts at t r e a t i n g b ulim ia were
i
made by Green and Rau (1974) and Wermuth e t a l . (1977).
Green and Rau hypothesized t h a t compulsive e a t in g could be
a f u n c t i o n of n e u r o l o g i c a l d i s t u r b a n c e . Nine of te n
p a t i e n t s were s u c c e s s f u l l y t r e a t e d with a n t i c o n v u l s a n t s , a
t r e a tm e n t which has not gained acceptance. The weakness of
t h e s t u d y was t h e a b s e n c e o f a c o n t r o l group u s i n g a
placebo for g r e a t e r c o n tro l.
Wermuth e t a l . (1977), in a 12-week d o u b le b l i n d
c ro ssov er study, compared phenytoin with a placebo in the
t r e a t m e n t of s e v e r e b in g e e a t i n g . The r e s u l t s o f t h e
t r e a tm e n t were u n c le ar. Again, t h i s method has not gained
a c c e p t a n c e .
Group Treatment
The s t u d y by B o s k i n d - L o d a h l (1977) was b ased on th e
t h e s i s t h a t b ulim ia was caused to a la r g e e x te n t by s o c i a l
43
l e a r n i n g . A group e x p e r i e n c e from a f e m i n i s t s t a n d p o i n t
was s u g g e s t e d as a means o f d e a l i n g w i t h t h e s o c i a l
l e a r n i n g co m ponents of th e d i s e a s e . This h y p o t h e s e s was
t e s t e d with th re e e x p erim e n tal groups. The r e s u l t s for the
p a t i e n t s were an improvement in s e l f - e s t e e m , g r e a t e r s o c i a l
b o l d n e s s , and e m o t i o n a l s t a b i l i t y . The b i n g i n g / p u r g i n g
j behavior was also a t t e n u a t e d in the m a jo r ity of cases.
i
The group a p p ro a c h f o r th e t r e a t m e n t of b u l i m i a was
a l s o s u g g e s t e d by C r i s p (1 9 8 1 -8 2 ). This s u g g e s t i o n wasj
!
based on the notion t h a t p a t i e n t s with the "abnormal normal
w e i g h t c o n t r o l s y n d r o m e , " ( b u l i m i a ) w o u ld be m ore
resp o n siv e to other group members' psychosexual and s o c i a l
I p r o b l e m s and would be a b l e to p r o v i d e g r e a t e r s u p p o r t f o r
each other in the same group.
j
B ehavioral Treatment
Both Linden (1980) and F a i r b u r n (1981) s u g g e s t e d a
b e h a v io r a l approach for the t r e a t m e n t of bulim ia. Linden
(1980) a t t e m p t e d a v a r i e t y o f b e h a v i o r a l p r o c e d u r e s ,
i n c l u d i n g c o n s t r u c t i o n o f a l t e r n a t i v e r e s p o n s e , s t i m u l u s
c o n tr o l , response delay, and i n d i v i d u a l i z e d a s s e r t i v e n e s s
t r a i n i n g with a 20-year old female u n i v e r s i t y student. The
t r e a t m e n t r e s u l t e d in a r a p i d d e c r e a s e , o f c o m p u l s i v e
behavior. No g e n e r a l i z a t i o n s can be made from t h i s study;
44
a l l t h a t can be s a i d i s t h a t t h i s one p a r t i c u l a r p e rs o n was
s u c c e s s f u l l y t r e a t e d .
F a i r b u r n (1981), a l s o u s i n g a b e h a v i o r a l a p p ro a c h ,
t r e a t e d e l e v e n b u l i m i c women. The t r e a t m e n t f o c u s e d on
in c r e a s in g c o n tr o l over e a tin g , e l i m i n a t i n g food avoidance,
and c h a n g in g m a l a d a p t i v e a t t i t u d e s . The r e s u l t s of t h e
t r e a t m e n t were p r o m i s i n g . Nine p a t i e n t s re d u c e d t h e i r
f r e q u e n c y o f o v e r e a t i n g and v o m i t i n g from an a v e r a g e of
l
t h r e e t i m e s d a i l y t o l e s s th a n once a month. There was!
i
►
| also a change in a t t i t u d e towards food and body siz e. One
o f t h e s i g n i f i c a n t f e a t u r e s o f t h e t r e a t m e n t used was t h e
requirem ent t h a t the p a t i e n t r e t a i n the r e s p o n s i b i l i t y for
change. Fairb urn suggested t h a t t h i s might account for the
i
p a t i e n t s * hig h d e g r e e of c o o p e r a t i o n and m o t i v a t i o n . The!
m ajo r g o a l o f t h e t r e a t m e n t was i n c r e a s e d s e l f - c o n t r o l . '
There was no s p e c i f i c attem pt to reduce the s e l f - i n d u c e d
i
I v o m i t i n g , s i n c e t h i s seemed to d e c r e a s e once food i n t a k e
was under c o n tr o l.
As can be s e e n , t h e r e i s a g r e a t n e e d f o r w e l l
s t r u c t u r e d and s y s t e m a t i c r e s e a r c h on t h e t r e a t m e n t of
b u l i m i a . A f u r t h e r s e a r c h o f t h e l i t e r a t u r e has a l s o
rev ealed t h a t the t r e a tm e n ts t h a t have been used have been
m o d e r a t e l y s u c c e s s f u l . In s p i t e o f t h e s e f i n d i n g s ,
I i n v e s t i g a t o r s have agreed t h a t the prognosis for b u lim ic s
| i s n o t good i f t h e b u l i m i a has d e v e l o p e d i n t o a c h r o n i c
45
stage (Becker, Koerner, & S t o e f f l e r , 1981; F a irb u rn , 1981;
Hsu et al.,1979; Palmer, 1979; Russell, 1979, 1981).
Summary
T his c h a p t e r has r e v i e w e d t h e l i t e r a t u r e on b u l i m i a .
As has been p r e s e n t e d , t h e s t u d y of and l i t e r a t u r e on
b u l i m i a i s s t i l l in i t s i n f a n c y . The r e s e a r c h r e v e a l e d
numerous c o n t r a d i c t o r y t h e o r i e s or fragm ents of t h e o r i e s j
about the e t i o l o g y of b u lim ia. At p r e s e n t, no one claim s a
t h o r o u g h u n d e r s t a n d i n g of or a c u re f o r b u l i m i a . B u l im i a
j i s p r i m a r i l y view ed as an e a t i n g d i s o r d e r s i m i l a r t o ,
i
| though d i s t i n c t from, anorexia nervosa.
I
i
] The s t u d i e s to date have p r i m a r i l y been q u a n t i t a t i v e
j i n m e th o d o lo g y , as a means o f g a t h e r i n g s c i e n t i f i c f a c t s
i
{ a b o u t t h e c l i n i c a l , m e d i c a l , a n d p s y c h o l o g i c a l
! m a n i f e s t a t i o n s of b u l i m i a . Most of t h e i n f o r m a t i o n was
c o l l e c t e d by means of s e l f - r e p o r t q u e s t i o n n i a r e s t o g e t
d e m o g r a p h i c d a t a and p s y c h o l o g i c a l t e s t s t o g e t
p s y c h o l o g i c a l d a t a and t h e y c o n t r i b u t e l i t t l e t o an
u n de rstan ding of the phenomenon of bu lim ia. These s t u d i e s
a p p e a r t o be p r i m a r i l y c o n c e r n e d w i t h f r e q u e n c i e s and
percentages. However, they do give us v alu ab le in fo rm a tio n
a b o u t t h e f r e q u e n c y and t h e t y p e s o f p e o p l e who a r e
b u l i m i c .
46
The l i t e r a t u r e p r e s e n t s e s s e n t i a l l y five p e r s p e c t iv e s
on t h e e t i o l o g y of b u l i m i a . P s y c h o a n a l y t i c t h e o r y has
l a r g e l y been r e j e c t e d as a v a l i d t h e o r y of b u l i m i a . The
other p e r s p e c t iv e s were based on one or more aspects of the
l i f e of t h e b u l i m i c t h u s c o n t r i b u t i n g s o m e th in g to th e
u nd erstan ding of bulim ia. The weakness of these t e n t a t i v e
i
j t h e o r i e s , r e v e a l e d in th e s t u d i e s , i s t h e y do not a d d r e s s
i b u l i m i a as a u n i t a r y way of b e in g in th e w o rld. They
I
| assume t h a t i f one can gather t o g e th e r enough data one w i l l
I
e v e n t u a l l y u n d e r s t a n d t h e whole. There a p p e a re d to be no
s y s t e m a t i c p h e n o m e n o l o g i c a l s t u d y o f b u l i m i a . No
r e s e a r c h e r has taken a c ase -stu d y approach with b u lim ics.
The r e s u l t of t h e la c k of i n - d e p t h s t u d y of b u l i m i a a re
s p e c u l a ti o n s about the causes of the problem r a t h e r than a
i
! rig o ro u s i n v e s t i g a t i o n of the phenomena.
I
I
The t r e a tm e n t approaches r e f l e c t the lack of knowledge
o f t h e p ro b lem . A t t e m p t s a re b e in g made, u s i n g some of th e
t r a d i t i o n a l a p p r o a c h e s s u c h as b e h a v i o r a l p r o g r a m s ,
i n d i v i d u a l t h e r a p y , f a m i l y t h e r a p y , and group t h e r a p y , to
have some e f f e c t on the binging and purging syndrome. All
of t h e t r e a t m e n t a p p r o a c h e s have had m o d e r a te s u c c e s s
though th e re doesn't seem to be a c le a r p i c t u r e of why each
p a r t i c u l a r approach may be e f f e c t i v e .
In conclusion, t h i s i n v e s t i g a t o r contends t h a t p r i o r
to g a t h e r i n g q u a n t i t a t i v e d a t a and d o in g p s y c h o l o g i c a l
47
t e s t i n g with bulimics and suggesting treatm ent approaches,
r e s e a r c h e r s n e ed t o t a k e a s e r i o u s l o o k a t what t h e
phenomenon of bulimia is a l l about. Someone has said that
when Newton theorized about the law of gravity, he studied
one apple. He then developed his theory, and then fu rther
r e s e a r c h was done to see i f i t a c t u a l l y was as he t h e o r i z e d
i t was. T h i s s t u d y was an a t t e m p t to lo o k at t h e
phenomenon of bulimia to provide a foundation out of which
f u t u r e q u a n t i t a t i v e r e s e a r c h can grow. C h a p t e r I I I
j d e s c r i b e s in d e t a i l the plan of th e p h e n o m e n o lo g ic a l
i inquiry of bulimia.
I
i
t
i
i
i
48
CHAPTER I I I
PLAN OF PHENOMENOLOGICAL INQUIRY
The p h e n o m e n o lo g i c a l p e r s p e c t i v e d i c t a t e s t h a t the
i n v e s ti g a t i o n develop systematic approaches to uncover the
b u l i m i c s t experiencing of t h e i r Lebenswelt. There needs to
be an e x p l o r a t i o n and d e s c r i p t i o n of the c o n s c i o u s n e s s of
the p erson. The u l t i m a t e goal i s to r e a c h and g ras p the
essences of things appearing in ones’ consciousness. This
r e q u i r e s a r i g o r o u s approach to the phenomena in o r d e r to
f i n d out p r e c i s e l y what they are made of. The purpose of
t h i s c h a p t e r was to p r e s e n t th e f i n a l i z e d m e t h o d o l o g i c a l ;
i
| p a r a d i g m which evolved d u r i n g th e p r o c e s s of c o n d u c t i n g
I
; t h i s i n v e s tig a tio n .
Since the purpose of the i n v e s t i g a t i o n was to uncover
>
and make clear the lived-world or Lebenswelt, a methodology
needed to be e s t a b l i s h e d to a c c o m p l i s h t h i s . The a c t of
knowing th e i n n e r - w o r l d of the b u l i m i c i s not sim p ly a
p a s s i v e o b s e r v i n g of what th e sen se organs m e c h a n i c a l l y
p r o v i d e about th e world, but r a t h e r a c o n s c i o u s , a c t i v e
experience involving an i n t e n t i o n a l act. According to Keen
(1970), i n v e s t i g a t o r s cannot see w i t h o u t i n t e n d i n g . This
means researchers are always influenced by i n t e r s u b j e c t i v e
b i a s e s . One of the a t t r i b u t e s of the s u b j e c t m a t t e r w i l l
49
alw ays be c o n s c i o u s n e s s , both fo r the s u b j e c t as w e l l as
j f o r the p a r t i c i p a n t o b s e r v e r . The b u l i m i c s in t h i s study
j w e r e n o t o n l y t h e o b j e c t s o f s t u d y , t h e y a l s o w e re
( s u b j e c t s , p e r s o n s who had i n t e n t i o n a 1 i t y w i t h t h e
*
I
researcher even as the researcher had i n t e n t i o n a l i t y with
them (Keen, 1970).
Since the author was i n t e r e s t e d in knowing more than
data about the person’s overt behavior such as her speech,
her gestures, her way of l i f e - themselves meaningless b i t s
of i n f o r m a t i o n - a plan of i n q u i r y was needed t h a t would
move beyond an o b jective gathering of information. Therej
was a need f o r a n o t h e r kind of meaning, a n o th e r s e t ofj
t
I
asso c iatio n s and categ o ries t h a t gave the data some meaning
for the i n v e s ti g a t o r . The question was not "What do these
I
j d a t a on b u l i m i a mean to me, th e i n v e s t i g a t o r ? " but "What do
these data mean to the bulimic h e rs e lf ? " This did not mean
th a t the i n v e s t i g a t o r had no opinion, viewpoint, or theory.
It meant t h a t the researcher needed to immerse h e r s e l f in
th e l i v e d - w o r l d of th e b u l i m i c , s u s p e n d i n g p r e c o n c e i v e d
n o t i o n s and s c i e n t i f i c t h e o r i z i n g , b e f o r e moving to th e
development of a theory. The question was how open was the
i n v e s t i g a t o r to the b u l i m i c s ’ point of view. The po sitio n
of t h i s s t u d y agreed w ith Keen (1970) when he a s s e r t e d
t h a t t h e more t h e p e r s o n u n d e r t h e i n v e s t i g a t i o n ’s
( b u l i m i c ’s) s u b j e c t i v i t y was i n c l u d e d in t h e
i n t e r p r e t a t i o n s , th e more o b j e c t i v e we were and the more
our point of view as observers was capable of dealing with
t h e p o i n t of view of the a c t o r ( b u l i m i c ) , th e b e t t e r our
psychology.
The author attempted to discover and describe bulimia
as i t was known and e x p e r i e n c e d in the e veryday world of
the persons in the study before th eo rizin g about i t . This
did not mean t h a t th e a u th o r could approach th e s u b j e c t
t abula rasa. This would be impossible since the author hadi
I
I |
h e r own s e t o f e x p e r i e n c e s w h ic h w o u ld i m p a c t t h e i
I
j o b s e r v a t i o n s . The major t a s k was to keep t h e s e to a
i
minimum and to be e x p l i c i t about them in order to keep themJ
from assuming a priviledged s t a t u s in the research.
i
To be able to understand the Lebenswelt of the bulimic
. the author needed to become i n t i m a t e l y involved with the
s u b j e c t s . I t meant to e n t e r t h e i r world as much as was
p o s s i b l e in o r d e r to gain f i r s t hand knowledge of b u l i m i a
as i t was experienced by them. This included an ignoring of
t h e o u t s i d e world or ’’r e a l i t y ” as i t was known to the
a u t h o r in o r d e r to make e x p l i c i t the s u b j e c t i v e world of
the bulimic.
T h eoretical Sampling
I
| The process of data c o ll e c t io n for generating theory,
i
j a c c o r d i n g to G la ser and S t r a u s s (1967), i s t h e o r e t i c a l
51
s a m p lin g . This s t u d y r e l i e d h e a v i l y on t h e i r method of
t h e o r e t i c a l c o l l e c t i o n of data. This was done th ro u g h
c o l l e c t i n g , coding, and a n a l y z i n g the da ta and d e c i d i n g
what data to c o l l e c t next, in order to develop the theory.
The p r o c e s s a l s o r e q u i r e d t h a t d a ta c o l l e c t i o n be guided
and c o n t r o l l e d by the t h e o r y as i t emerged. The t o t a l
sample size and composition were not known in advance but
were directed by the research process and the information
r e q u i r e d to g e n e r a t e a t h e o r y of b u l i m i a . This type of
1
j s a m p l i n g was j u s t i f i e d s i n c e the i n v e s t i g a t o r was not
j i n t e r e s t e d in v e r i f y i n g e x i s t i n g t h e o r y but r a t h e r in
developing a theory.
i
The s p e c i f i c plan of i n q u i r y to a c c o m p l i s h th e above |
i i
I !
was t h r e e f o l d : (1) P a r t i c i p a t i o n in the "everyday world"
of th e b u l i m i c where th e r e s e a r c h e r t r i e d to e x p e r i e n c e a
c e r t a i n " r e a l i t y " w ith th e b u l i m i c ; (2) D e s c r i p t i o n of
t h a t p a r t i c i p a t i o n in which there was an attempt to capture
th e e x p e r i e n c e in the s e r v i c e of u n d e r s t a n d i n g th e n a t u r e
of t h a t " r e a l it y " in which both the author and the subject
p a r t i c i p a t e d ; (3) R e f l e c t i o n on the data in o r d e r to
e x p li c a t e i t s e s s e n t i a l meaning. This f i n a l phase was the
attempt to come to some understandable meaning of bulimia
and some t h e o r e t i c a l framework from which t h e r a p y could
t a k e p l a c e . A f u l l e r d e s c r i p t i o n of t h e s e t h r e e phases
w i l l follow. Before these are discussed in g reater d e t a i l ,
i
52
the a u th o r w i l l comment f u r t h e r on th e s u b j e c t s and th e
approach taken for data c o llec tio n.
The s e l e c t i o n of s u b j e c t s was based on a d e s i r e to
find persons with richness of experience and who were able
to c l e a r l y a r t i c u l a t e t h a t e x p e r i e n c e . I m p o r t a n t to the
i n v e s t i g a t o r was t h a t th e s u b j e c t s were able to d e s c r i b e
t h e e x p e r i e n c e o f b u l i m i a , t h e i r i n n e r f e e l i n g s ,
perceptions, and emotions. The subjects also needed to be
i w i l l i n g to e x p l o r e i n - d e p t h , t o g e t h e r w ith th e a u t h o r , in
an atmosphere of t r u s t and openness.
This ty p e of i n v e s t i g a t i o n r e q u i r e d an approach of
( d i a l o g u e . According to C o l a i z z i (1978) t h i s type of
[ d i a l o g u e can only ta k e p l a c e when the r e s e a r c h e r and th e
i
i
s u b j e c t are " c o - r e s e a r c h e r s . ” This n e c e s s a r i l y i n c l u d e d
the e x i s t e n t i a l context wherein the Lebenswelt takes place.
This d i a l o g u e approach must occur in an atm o sp h e re of
t r u s t . Within t h i s atmosphere of t r u s t the co -researchers
a re a b le to i l l u m i n a t e th e e x i s t e n t i a l d im e n s i o n s of th e
I
b u l i m i c s ’ l iv e s. The author agreed with the conclusion of
Colaizzi (1978) t h a t t h i s t r u s t i n g dialogue approach goes
beyond research in i t s l im ite d sense and becomes a mode of
e x i s t e n t i a l therapy. This was true because ph.enomenologi-
cal research attempts to become involved in the t o t a l i t y of
th e human s i t u a t i o n , th e p e r c e p t i o n s and c o g n i t i o n s , the
53
e m o tio n s and a t t i t u d e s , th e a s p i r a t i o n s and e x p e r i e n c e s ,
and p a tte r n s , s t y l e s , and contents of behavior.
In c o n d u c t in g a p h e n o m e n o lo g i c a l i n v e s t i g a t i o n the
d e c i s i o n about when to t e r m i n a t e th e stud y is not c l e a r l y
defined. There are no clear guidelines as to when the time
has come to c o m p le te th e study. The a s s u m p tio n of th e
a u t h o r was t h a t s i n c e t h e a p p r o a c h was one o f c o -
! r e s e a r c h e r s , th e d e c i s i o n of t e r m i n a t i o n needed to be a
mutual one for both researcher and subject. Furthermore i t
was assumed t h a t s i n c e no person can be e x h a u s t i v e l y
r e s e a r c h e d th e p o i n t can never be r each ed where we havej
f u l l y uncovered the e x i s t e n t i a l s ig n if ic a n c e of bulimia for
th e p erso n. Heidegger (1962) a s s e r t e d , r e g a r d i n g th e
nature of Dasein (being o n t o lo g i c a l ly human), t h a t we never
»
I
j " a r r i v e " but are alw ays only "on th e way." L ik e w i s e in
I
our r e s e a r c h , we are a l s o alw ays on the way. This
i m p l i e s t h a t t h e d e c i s i o n of t e r m i n a t i o n i s in a se n s e an
a r b i t r a r y one, guided by the i n te n t io n s and i n c l i n a t i o n s of
the co-researchers.
S e v e r a l c o n c r e t e c r i t e r i a were used in making th e
I decision to term inate data c o ll e c t io n . The f i r s t c r i t e r i o n
I
! used in t h i s s t u d y was to e s t a b l i s h when t h e core of th e
i n v e s t i g a t i o n reached a level of development t h a t provided
th e r e s e a r c h e r w i t h p r o v o c a t i v e and m e a n in g f u l i n s i g h t s
i n t o th e phenomenon of b u l i m i a . The goal was to p r o v i d e
54
the reader with an adequate d e scrip tio n of the phenomenon
to produce new i d e a s , r a i s e new q u e s t i o n s , and s t i m u l a t e
f u rth er inquiry, both q u a l i t a t i v e and q u a n t i t a t i v e .
A s e c o n d c r i t e r i o n f o r t h e t e r m i n a t i o n of d a t a
c o l l e c t i o n was the i d e n t i f i c a t i o n of t h e p o i n t when the
c o - r e s e a r c h e r s f e l t t h a t the s e l f - d e s c r i p t i o n of th e
phenomenon of bulimia had reached a s a t i s f a c t o r y level of
s a t u r a t i o n . This occured when no a d d i t i o n a l data were
j
being uncovered in th e i n v e s t i g a t i o n and r e p e t i t i o n was
o c c u r i n g in the d e s c r i p t i o n of the l i v e d - w o r l d . At t h i s j
point the researcher could be confident t h a t some level of
t h e o r e t i c a l s a t u r a t io n had been reached.
The v a l i d i t y of th e d a ta was d e t e r m i n e d by a l l o w i n g
t h e s u b j e c t s t o r e - r e a d t r a n s c r i p t s of t h e i r own
j d e s c r i p t i o n s , a l l o w i n g them to r e f l e c t on what they had
s a i d in o r d e r t o v e r i f y t h a t the d e s c r i p t i o n s f i t w ith
t h e i r a c t u a l e x p e r i e n c i n g o f t h e p h e n o m e n a . The
r e s e a r c h e r was c o n f i d e n t o f t h e v a l i d i t y of t h e
d e s c r i p t i o n s when t h e s u b j e c t s s t a t e d t h a t t h e s e were
complete and accurate pres en ta tio n s of t h e i r inner world.
Throughout th e i n v e s t i g a t i o n th e s u b j e c t s were asked to
r e f l e c t on what th ey had s a i d and w r i t t e n in o r d e r to
v e r i f y and v a l i d a t e th e a c c u ra c y of t h e i r d e s c r i p t i o n s .
The author was s a t i s f i e d th at the d e s c r i p t io n s were a valid
r e f l e c t i o n of the lived-w orld of the subjects.
55
Methods of Data Collection
The method used to c o l l e c t data on b u l i m i a grew out of
the need to provide and implement a systematic study of the
s u b j e c t i v e e x p e r i e n c e of each person. J a s p e r s (1968)
a s s e r t s t h a t the i n d e p e n d e n t a c t i v i t y of r e p r e s e n t i n g ,
d e f i n i n g , and c l a s s i f y i n g p s y c h i c phenomena is what
c o n s t i t u t e s phenomenology. This i m p l i e s a s y s t e m a t i c
s tu d y , not sim p ly a c o l l e c t i o n of unconnected o p i n i o n s
I
based on some chance in cid ents. Furthermore, the study of'
p s y c h i c phe n o m e n a n e e d s t o be c l e a r n o t o n l y t o t h e
researcher but also understandable to the reader.
The aim o f t h e s t u d y was t o p r o v i d e a c l e a r
| r e p r e s e n t a t i o n of what was a c t u a l l y going on w i t h th e
I
[bulimic, what she was r e a l l y experiencing, how things arose
i
! in her c o n s c i o u s n e s s , and what her f e e l i n g s were. This
|
[demanded a serious e f f o r t on the part of the research er to
I
t free h e r s e l f from preconceptions or psychological t h e o r i e s
or c o n stru cts about bulimia. A concerted attempt was made
to look at th e g e n e s i s of b u l i m i a , th e c o n d i t i o n s f o r i t s
a p p e a r a n c e , i t s c o n f i g u r a t i o n , i t s c o n t e n t , and p o s s i b l e
c o n c r e t e c o n s t r u c t i o n s . F u r t h e r m o r e , as J a s p e r s (1968)
suggests, i t required the use of i n t u i t i v e comparisons and
t
j s y m b o liz a tio n s, d i r e c t i n g the observations in whatever ways
suggested themselves and being aware of the appearance of
56
I ___________________________________________ : __________________________________
any already known phenomena which played some part in the
formation of bulimia i t s e l f .
The o n l y a c c e s s t h e a u t h o r had to t h e b u l i m i c ’s
s u b je ctiv e world was her w illin gn e ss to share t h is with the
i n v e s ti g a t o r . This also required a w illing n e ss on the part
of th e r e s e a r c h e r to l i s t e n to th e s u b j e c t . All of the
s u b j e c t s came i n t o t h e s t u d y out of a need f o r he lp. The
| i n v e s t i g a t o r assumed that because they came into the study
to receive help in overcoming t h e i r problem they would have
no r e a so n to f a b r i c a t e so m e thin g about t h e i r L eb ensw elt.
Each subject was assured t h a t once the data were c o lle c te d
t h ey would r e c e i v e th e t h e r a p y they f e l t they needed. The
method used for c o l l e c t i n g t h i s data was threefold: (1) By
i m m e r s i n g h e r s e l f in t h e g e s t u r e s , b e h a v i o r s , and
e x p r e s s i v e movements of th e b u l i m i c , (2) by e x p l o r a t i o n
which i n c l u d e d d i r e c t q u e s t i o n i n g of th e b u l i m i c s and by
means of accounts which they themselves, under the guidance
of t h e a u t h o r , gave of t h e i r e x p e r i e n c e s , and (3) by means
of w r i t t e n s e l f - d e s c r i p t i o n s . The most v a l u a b l e of th e
t hree were the s e l f - d e s c r i p t i o n s . These s e l f - d e s c r i p t i o n s
were gathered through sessions with each subject which were
s u b j e c t - c e n t e r e d . Each person was asked to r e f l e c t and
d e s c r i b e what was r e l e v a n t and i m p o r t a n t to her. The
s u b j e c t s w e r e a s k e d t o d e s c r i b e t h e i r e x p e r i e n c e o f
b u l i m i a , what i t was l i k e f o r them, and how i t a f f e c t e d
57
them in t h e i r world. The c e n t r a l question always was "How
do you s e e y o u r w o r l d ? How do you s e e y o u r s e l f in
r e l a t i o n s h i p to th e r e s e a r c h e r , to o t h e r s , and to o b j e c t s
in th e world?" All of th e o t h e r q u e s t i o n s were in some
way r e l a t e d to the major q u e s t i o n in an e f f o r t to gain more
c l a r i f i c a t i o n and a more i n - d e p t h d e s c r i p t i o n of t h e i r
world.
The n a t u r e of th e i n t e r v i e w s was not m e r e ly a f r e e -
f l o a t i n g d i s c u s s i o n between r e s e a r c h e r and b u l i m i c nor a
i
monologue on the part of the bulimic but r a t h e r a rigorous
p u r s u i t of the s u b j e c t ' s i n n e r world. This r e q u i r e d the
r e s e a r c h e r t o c o n t i n u a l l y a s s i s t th e s u b j e c t in s t a y i n g
i
i with the d e scrip tio n of her inner world, making i t possible!
i
f o r her to d e s c r i b e i t in her own lan g u a g e w i t h i n an!
atmosphere of t r u s t and "psychological sa fety," unhampered
by th e r e s e a r c h e r ’s b i a s . F u r t h e r m o r e i t r e q u i r e d t h a t a
"we-relationship" be e s t a b l is h e d so the author could begin
t o c o m p r e h e n d t h e l i v e d - w o r l d o f t h e b u l i m i c . The
in terv iew s were concluded when both the researcher and the
b u l i m i c were s a t i s f i e d t h a t th ey had e x h a u s t e d a l l of th e
a v a i la b l e p o s s i b i l i t i e s .
The evolving theory of bulimia was p r i m a r i l y grounded
in the data derived from four months of interviews, once a
week, w ith t h r e e fe m a le s u b j e c t s . This p r o v i d e d a r i c h
j
s o u r c e o f d a t a f o r t h e d e v e l o p m e n t of a t h e o r y . In
a d d i t i o n t o t h e i n t e r v i e w s , o t h e r m a t e r i a l s su c h as
j o u r n a l s and r e f l e c t i o n s on t h e t r a n s c r i p t s of t h e
i n t e r v i e w s se r v e d as s u p p l e m e n t a l s o u r c e s . Once the
i n t e r v i e w s w e re t r a n s c r i b e d from t a p e s o n t o t y p e d
t r a n s c r i p t s th e s u b j e c t s were asked to read t h e s e and to
make a d d i t i o n a l comments to d e s c r i b e more f u l l y t h e i r
Lebenswelt.
In t h i s way the researcher accumulated explanations
| and d e s c r i p t i o n s from s u b j e c t s who were both w i l l i n g and
i ;
! a ble to r e v e a l t h e i r p e r s o n a l e x p e r i e n c e of b u l i m i a . Inj
4 j
j e x p l a i n i n g th e d a ta and s y s t e m a t i c a l l y comparing eachj
! * 1
j d e s c r i p t i o n , th e r e s e a r c h e r a t t e m p t e d to i s o l a t e t h e
i
| u n d e r l y i n g c o n s t i t u e n t s and meanings, t h e r e b y e v o l v i n g a
t
J
; theory of bulimia t h a t was f i r m l y grounded in the s u b j e c t s ’
!
r e p o r t e d e x p e r i e n c e s . The i n q u i r y c o n s i s t e d of t h r e e
p r i n c i p a l p h a s e s : p a r t i c i p a t i o n , d e s c r i p t i o n , and
r e f l e c t i o n . These are now described in d e t a i l .
The P a r t i c i p a t i v e Phase
The p a r t i c i p a t i o n phase began when the researcher and
th e s u b j e c t f i r s t met and a t t e m p t e d a d i a l o g u e . Since a
p h e n o m e n o lo g i c a l i n v e s t i g a t i o n i s not based on a f o r m a l ,
I s t r u c t u r e d i n t e r v i e w , t h i s i n i t i a l e n c o u n t e r was
e s s e n t i a l l y i n t u i t i v e . The goal was to i n i t i a t e a we-
!
r e l a t i o n s h i p , one which was r e c i p r o c a l and mutual. The
59
a u t h o r was concerned w i t h e s t a b l i s h i n g what M a rtin Buber
(1970) r e f e r e d to as "the e s s e n t i a l we" or th e "I-Thou"
r e l a ti o n s h i p . In the I-Thou r e l a t i o n s h i p , the researcher
is i m m e d ia te , d i r e c t , and f u l l y p r e s e n t . This s e l f
presence is described by Ofman (1976) as...
r e c i p r o c a l and m utual. In such a mode, th e
person to whom I come is i m m e d i a t e l y g r as p ed as
u n i q u e . . . t h e only one e x i s t i n g at t h e moment fo r
me, and I am s e r i o u s l y a f f e c t e d by t h a t person.
! I am, at t h a t moment, a v a i l a b l e to th e "we" and
i d e v o i d o f p r e c o n c e i v e d n o t i o n s , i m a g e s , or
J c a t e g o r i e s in which I p l a c e (her); I e x p e r i e n c e
I ( h e r ) , n o t a c h i m e r a o f ( h e r ) . I l i v e t h a t
moment w i t h (her) i m m e d i a t e l y . S p o n t a n e o u s l y ,
t o t a l l y r e s p o n s i v e l y , and w h a t o c c u r s i s
unplanned and unp redictable. (p. 121-122)
This phase then was b a s i c a l l y i n t u i t i v e in n a t u r e .
i
This m e a n t - t o have an a w a r e n e s s of so m e th i n g w i t h o u t
j c o n s c i o u s a t t e n t i o n or r e a s o n i n g or t h e q u a l i t y of,
I perceiving without conscious a tt e n t i o n or reasoning. The
aim was t o e n g a g e t h e p e r s o n i n t u i t i v e l y and p r e -
r e f l e c t i vel y. This t h e n , was th e f i r s t grasp of the
b u l i m i c ’s world a s - i t - i s .
The t a s k of t h e r e s e a r c h e r was not th e d i s c o v e r y of
connections between family r e l a t i o n s h i p s or past h i s t o r i e s
b u t r a t h e r a f o s t e r i n g o f e x p l i c i t a w a r e n e s s o f t h e
p r o j e c t s and p r i o r i t i e s in her l i f e . T o gether the a u th o r
and the subject sought to u t t e r and c l a r i f y the bulimic's
experience of the world, how she was present in and r e l a te d
to i t . Part of what i t meant to be open to the su b jective
60
e x p e r i e n c e of th e s u b j e c t was to a c c e p t t h a t her f e e l i n g s
were c o rr e c t and an appropriate response to her world. To
p a r t i c i p a t e in t h e L e b e n sw e lt r e q u i r e d th e r e s e a r c h e r ' s
aw a r e n e s s t h a t the f e e l i n g s and e m o tio n s of the b u l i m i c
were r e p r e s e n ta t io n s and symbolizations of her p r o je c t and
p r i o r i t i e s in the world.
The i n t e n t of t h e p a r t i c i p a t i v e phase was to have a
s h a r e d e x p e r i e n c e , a s h a red mood, and a s h a red p r e s e n c e .
Any a t t e m p t by th e r e s e a r c h e r to become th e s u p e r i o r
observer by evaluating, diagnosing, judging, or d i s c lo s in g
to th e s u b j e c t th e n a t u r e of b u l i m i a v i o l a t e d the i n t e n t of
the p a r t i c i p a t i v e phase. Furthermore, any attempt by the
i n v e s t i g a t o r to become i n d i f f e r e n t , m ere ly u n e n g age d ly
o b s e r v i n g th e b e h a v i o u r of t h e b u l i m i c , a l s o v i o l a t e d the
I
j p h e n o m e n o lo g i c a l methodology of th e p a r t i c i p a t i v e phase.
!
! Both of' t h e s e ap p ro a ch e s would have i s o l a t e d th e a u t h o r
I
| fr o m t h e i m m e d i a t e s h a r e d r e a l i t y o f t h e b u l i m i c ' s
I
! Lebenswelt and would have produced a monologue r a t h e r than
the desired dialogue.
The Desc riptive Phase
i C l e a r l y t h e p a r t i c i p a t i v e phase i s c e n t r a l to a
j phenomenological study. Without the bulim ic's d e s c r ip tio n
; of her L eb e n sw e lt t h e r e would be no u n d e r s t a n d i n g of t h a t
i
! i n n e r world. In o r d e r to dev elo p a t h e o r y based on t h e s e
61
e x p e r i e n c e s t h e r e must be a method of d e s c r i b i n g t h e s e
e x p e r i e n c e s in a c o n c r e t e way. The d e s c r i p t i v e phase was
an a t t e m p t at r e - c a p t u r i n g th e w e - r e l a t i o n s h i p of the
r e s e a r c h e r and th e s u b j e c t in a w r i t t e n form. Whereas the
p a r t i c i p a t i v e phase e s s e n t i a l l y used spoken language, the
d e s c r i p t i v e phase used w r i t t e n d e s c r i p t i o n s . All of the
sessions with the su bje cts were taped and tran scrib ed .
i
As has been sta te d , the aim of the p a r t i c i p a t i v e phase
was to e x p e r i e n c e as f u l l y as p o s s i b l e t h e r i c h n e s s of each
I
s u b j e c t and t o be p r e s e n t in e v e r y i m a g i n a b l e way,
i n c l u d i n g being a t t e n t i v e to th e s u b j e c t ’s nuances of
speech and g e s t u r e s . This i m p l i e s t h a t one cannot t a k e a
s t e p back d u r i n g t h e t i m e t o g e t h e r w ith t h e s u b j e c t to
r e f l e c t , i n t e r p r e t , a n d /o r a n a l y s e what i s o c c u r i n g . The
| r e s e a r c h e r needed to be c o n s c i o u s of t h e m o m e n t - a t - h a n d ,
t h u s l e a v i n g th e whole u n c l e a r and ambiguous f o r t h a t
moment. The aim of t h e d e s c r i p t i v e phase was to c l a r i f y
i
the e s s e n t i a l f e a tu r e s of the bulim ic's inner world.
The r e s e a r c h e r was i n t e r e s t e d in t h o s e e x p r e s s i o n s ,
i
| statements, and d e c l a r a ti o n s which revealed the meaning of
the world for the su bjects. As the su b je cts described what
t h e e x p e r i e n c e of b u l i m i a was l i k e f o r them, th ey a l s o
disclosed some aspect of the meaning of the phenomenon for
them. Each s u b j e c t had b u i l t and i n v e n t e d a b a s i c way of
organizing her p r i o r i t i e s in the world, whether these were
62
e x p l i c i t l y known to her or not. The p a r t i c i p a t i v e phase
proceeded to e x p li c a t e the fundamental or personal myth of
the bulimics. The assumption was made th a t everything the
b u l i m i c did or t h o u g h t was i n t r i c a t e l y c o n n ec te d to her
personal myth or project.
In the d e s c r i p t i v e phase th e r e s e a r c h e r c a r e f u l l y
J examined the t r a n s c r i p t s and w r i t t e n m a t e r i a ls provided by
the subjects to e x tr a c t from these a l l of the statem en ts of
the b u l i m i c s 1 inner and personal experience which manifest
the purely su b je ctiv e experience of t h e i r Lebenswelt. The
hope was to understand the bulimic in terms of the p r o j e c ts
I
in her l i f e and in l i g h t of her f r e e l y chosen i n t e n t i o n s . ;
! j
These did not i n c l u d e her t h e o r i e s of the o u t s i d e world butt
[
] her experience of the world r eg a r d less of f a c t i c i t y .
Chapter IV contains the extensive d e scrip tio n s of the
e x p e r i e n c e s of the b u l i m i c s . The d e s c r i p t i o n s of th e
L e b e n sw e lt i n c l u d e the e s s e n c e of the r e p r e s e n t a t i o n s
p r o v i d e d by th e s u b j e c t s . The d e s c r i p t i o n s p r o v i d e th e
n e c e s s a r y and s u f f i c i e n t e l e m e n t s of th e e x p e r i e n c e of
bulimia, those e s s e n t i a l f e a tu r e s by which bulimia is known
and by which i t is d istin g u is h ed from any other experience
t h a t i s n o t b u l i m i a . C l i n i c a l o b s e r v a t i o n s by t h e
r esearch er were also included in the d e s c r i p t iv e phase.
The R e fle ctiv e Phase
The t h i r d and f i n a l phase, t h a t of r e f l e c t i o n , i s
c l e a r l y dependent on the adequacy and richness of the f i r s t
two p hases. The aim of t h i s phase was to c l a r i f y and
communicate to others the meaning and experience of bulimia
for the subjects. Giorgi (1967)# s t a t e s th at i t is through
the power of r e f l e c t i o n t h a t we can r e n d e r e x p l i c i t th e
meaning of a p a r t i c u l a r act or behavior for a person.
The i n t e n t of t h i s s t u d y was to uncover th e meaning of
bulimia as a human experience and i t was in the r e f l e c t i v e
i
| p h a s e t h a t th e most f u n d a m e n ta l a s s e r t i o n s were made,
jgrounded in th e c o l l e c t i v e da ta of e x p e r i e n c e (Larkin,
I
1 979). At t h i s s t a g e , th e i n v e s t i g a t o r took a l l th e
knowledge of b u l i m i a t h a t had been a t t a i n e d in o r d e r t o
i
, f i n a l l y propose a d e ta il e d conceptual theory of bulimia.
j
In t r a d i t i o n a l e x p e r i m e n t a l psy ch o lo g y r e s e a r c h e r s
also deal with the question of meaning. This, however, is
always done within the measurement perspective. F i r s t one
measure s th e b e h a v i o r and then one d e r i v e s meaning from
t h a t behavior. In phenomonology one attempts to derive the
meaning d i r e c t l y from th e phenomena w i t h o u t measurement
c o n s i d e r a t i o n s . What t h i s means i s t h a t in o r d e r to
u n d e r s t a n d a b e h a v i o r one needs to know i t s f u n c t i o n a l
meaning or i t s r e l a t i o n s h i p to the whole w a y - o f - b e i n g .
Rather than taking a behavior such as bulimia and reducing
64
i t i n t o s m a l l e r p a r t s in o r d e r to u n d e r s t a n d i t s b a s i c
e l e m e n t s , th e a u th o r f o l l o w e d G i o r g i ' s (1967) approach of
conceiving the behavior as a u n ita ry part and e s t a b l i s h i n g
i t s f u n c t i o n a l r e l a t i o n s h i p to t h e w h o l e . T h i s was
possible through the r e f l e c t i v e phase.
Through the r e f l e c t i v e phas§ the., process of generating
a t h e o r y took p l a c e . The a u t h o r ' s e x p e r i e n c e w i t h the
s u b j e c t s made i t p o s s i b l e t o h a v e an i n t u i t i v e
u n d e r s t a n d i n g of th e b u l i m i c ' s l i v e d - e x p e r i e n c e as she;
revealed i t to the author. In order for t h i s experience to
jhave c o n c r e t e meaning f o r o t h e r s t h e r e was a need to
| r e f l e c t on i t in o r d e r t o e x t r a c t t h e p s y c h o l o g i c a l
| s t r u c t u r e s , common them es, and s e q u e n t i a l flow of th e
' p h e n o m e n o n . Of i m p o r t a n c e t o t h e a u t h o r was t h e
i
j c o m p r e h e n s i b i 1i t y of the b u l i m i c ' s e x p e r i e n c e to o t h e r s .
1 This n e c e s s i t a t e d cle ar e x p li c a t io n s of the experience and
a c l a s s i f i c a t i o n of t h e raw d a ta i n t o c a t e g o r i e s in o r d e r
to generate a theory. These categ o ries were not developed
in l i g h t of any p r e - e x i s t i n g t h e o r y of b u l i m i a but a ro s e
out of the raw data themselves.
The method used for e x tr a c t i n g the common themes was
to i n i t i a l l y examine th e typed t r a n s c r i p t s of a l l th e
j sessions to find only those statements which r e f l e c t e d the
J inner world of the bulimic. These inner-world statements
1 were then put i n t o one c o n n e c te d s t a t e m e n t (see C hapter
65
IV). As these accounts were read as a u n it, the researcher
wrote down the themes th at became cle ar from the reading.
After the completion of a l l three case stu d ies, the themes
t h a t had been e x t r a c t e d were compared for c o m m o n a l i t i e s .
The themes t h a t were common to a l l t h r e e a c c o u n ts were
se lected as the catego ries developed in Chapter V.
The c h a l l e n g e to th e r e s e a r c h e r was to t a k e th e raw
d a ta and g e n e r a t e a t h o u g h t f u l and f r u i t f u l t h e o r y . This
r e q u i r e d a g r e a t d e a l of r e s t r a i n t s i n c e th e t e m p t a t i o n
always was to draw from prior knowledge and pre-conceived
n o t i o n s of b u l i m i a . The a u th o r c o n t i n u a l l y a t t e m p t e d to
’’bracket o u t ” e a r l i e r ideas as a means of allowing the data j
to speak for themselves. The number of commonalities th at
i
jemerged from th e i n t e r v i e w s p r o v id e d th e r e s e a r c h e r w i t h
I th e r i c h n e s s needed to begin to d ev elo p a s u b s t a n t i v e
!
| t h e o r e t i c a l f r a m e w o r k . T h e s e c o m m o n a l i t i e s an d
1 r e l a t i o n s h i p s a r o s e out of th e r e f l e c t i v e a n a l y s i s of th e
d a ta . The t h e o r e t i c a l framework which emerged from t h i s
a n a l y s i s r e p r e s e n t e d a t h e o r y of t h e e x p e r i e n c i n g of
bulimia for the three subjects involved in the study.
In summary, t h e pu rp o se of th e r e f l e c t i v e phase of
t h i s stu d y was to c l a r i f y and communicate to the r e a d e r
meaning and i n t e g r i t y inherent in the i n t u i t i o n s captured
in the f i r s t two p hases. The i n t e n t i o n was to e x p l i c a t e
t h e e s s e n t i a l meaning of b u l i m i a f o r t h e s u b j e c t s as they
66
had described t h e i r Lebenswelt. The theory of bulimia was
d e r i v e d from t h i s phase. A f t e r the t h e o r y was g e n e r a t e d
h y p o t h e s e s f o r f u r t h e r r e s e a r c h were s u g g e s t e d . In
c o n c l u s i o n , th e methodology of a p h e n o m e n o lo g i c a l stu d y
included the examination of a phenomenon, the generating of
a t h e o r y , and the d e velopm ent of h y p o t h e s e s for f u r t h e r
r e s e a r c h .
t
i Summary
t
1
! The p u r p o s e o f t h i s c h a p t e r was t o p r e s e n t t h e
i
m e t h o d o l o g y u s e d t o d e v e l o p an u n d e r s t a n d i n g o f t h e |
phenomenon of b u l i m i a . A f t e r p r e s e n t i n g a p h i l o s o p h i c a l
basis for a phenomenological inquiry, the author described
| th e methods of d a ta c o l l e c t i o n as w e l l as a n a l y s e s of th e
th r e e phases of the methodology, namely the p a r t i c i p a t i v e
phase, the d e s c r i p t i v e phase, and th e r e f l e c t i v e phase.
Chapter IV is a p re s e n t a ti o n of the d e s c r i p t iv e phase, the
case stu d ies , which are the core of t h i s study.
67
CHAPTER IV
THE DESCRIPTIVE PHASE: THE BULIMICS’
SUBJECTIVE EXPERIENCES
This c h a p t e r i n c l u d e s the case s t u d i e s of the t h r e e
s u b j e c t s i n t e r v i e w e d in t h i s i n v e s t i g a t i o n . Each case
stu d y was o r g a n i z e d around t h e f o l l o w i n g framework: th e
b u l i m i c s ’ p r e s e n t i n g problem ; t h e i r r e l e v a n t background;
j t h e i r d e s c r i p t i o n o f t h e i r L e b e n s w e l t ; and t h e
( i n v e s t i g a t o r ’s c l i n i c a l and s u b je c tiv e impressions of thet
j t
j I
I subjects. This framework was based on the methodology usedj
1 [
| by Larkin (1979) in a s i m i l a r study on schizophrenia. j
j These s e l e c t i o n s , based on th e b u l i m i c s ’ p e r s o n a l
I
i
I e x p e r i e n c e , p r o v i d e d a f o u n d a t i o n f o r e v a l u a t i n g th e
I
p h e no m e n o n o f b u l i m i a and t h e t h e o r y g e n e r a t e d in
s u b s e q u e n t c h a p t e r s . The r e a d e r i s e ncouraged to read
slowly and c a r e f u l l y through the case stu d ies, allowing the
s i g n i f i c a n t a s p e c t s of th e phenomena to emerge, w h i l e
h o l d i n g t h e o r e t i c a l p r e c o n c e p t i o n s in abeyance. The
pu rpo se i s to begin to get a sense of th e phenomenon of
b u l i m i a r i s i n g o u t o f t h e p e r s o n a l e x p e r i e n c e s and
behaviors of the subjects.
68
Beth
Presenting Problem
Beth came to see me as a r e s u l t of an announcement
made in a g e n e r a l e d u c a t i o n c l a s s a t a u n i v e r s i t y
r e g a r d i n g th e p o s s i b i l i t y of g e t t i n g h e lp f o r b i n g in g and
p u r g i n g . She came t o my o f f i c e in an e m o t i o n a l l y
d i s t r e s s e d condition, requesting help for a problem she had
with binging and purging. I invited her to come to therapy
with me the following week.
Background
i
i
I saw Beth, a 20 year old Caucasian college sophomore,!
f o r a p e r i o d of f o u r months. She i s th e m id dle c h i l d of|
j
; t h r e e c h i l d r e n and has l i v e d most of her l i f e w i t h herj
j m o t h e r, a b r o t h e r , and a s i s t e r . Her mother and f a t h e r
t
j were d i v o r c e d w h i l e she was in th e 2nd grade. Her mother)
f i
jthen remarried. The mother stayed in t h i s marriage for two
y e a r s , d i v o r c e d a g a in and th en m a r r i e d B e t h ’s p r e s e n t
s t e p f a t h e r . During her j u n i o r year she d e cided to l i v e
w i t h her n a t u r a l f a t h e r . She l i v e d w i t h her f a t h e r for
about one y e a r , when she moved in w i t h a f r i e n d u n t i l her
( g r a d u a t i o n from high scho o l. She then moved back in w ith
her mother. A f t e r a ye ar of c o l l e g e Beth moved to the
n o r t h e r n p a r t of th e s t a t e on an im p u l s e . She was out of
69
sc h o o l a y ear and a h a l f , working as a w a i t r e s s p a r t of the
time. When her boyfriend was t r a n s f e r r e d to the c it y Beth
moved with him and returned to u n i v e r s i t y to continue her
e d u c a ti o n .
When Beth was in her j u n i o r year she got p r e g n a n t ,
which she terminated with an abortion. During the months
of her pregnancy a "big change" occurred in her body shape.
Prior to her pregnancy she had never dieted but has been on
a d i e t s i n c e . Beth a l s o began t h r o w i n g up o c c a s i o n a l l y
[during her junior and senior years of high school, "just a
i
I
j way to get th e food out of you." When she moved back in
>
I
j with her mother the. purging became regular.
» i
j B e t h ’s f a t h e r came up in t h e t h e r a p y s e s s i o n s )
i
( f r e q u e n t l y . She had not seen him or heard from him in at
!
! l e a s t two years. There was a great deal of pain associated
with her f a t h e r ’s r e j e c t i o n of her. She r e f e r r e d to him as
h a v in g "cut o f f c om m u n ica tion w i t h h e r , " as he had done
w i t h her b r o t h e r and s i s t e r . When B e t h ’s mother d i v o r c e d
her fath e r , he said he would not see the children anymore.
The b r o t h e r was th e f i r s t to be cut o f f and then th e
s i s t e r . Beth had alw ays had a good r e l a t i o n s h i p w i t h her
f a t h e r and, as a r e s u l t , d e cid ed to move in w i t h him d u r i n g
her j u n i o r y e ar. A f t e r she moved in w i t h him e v e r y t h i n g
changed.
70
Beth s a i d th e f o l l o w i n g about her r e l a t i o n s h i p w i t h
her f ather:
He t r i e d to , you know, c o n t r o l my l i f e too much
and would t e l l me he went th ro u g h a hard tim e
growing up and I t h i n k he wanted to show me th e
s h o r t c u t s too much and s t u f f l i k e t h a t . In the
m o r n i n g I would s a y , h e 'd be in h i s o f f i c e
work ing and I'd be going o f f to school and I'd
say, bye dad, and he w o u l d n 't say a n y t h i n g . So
i t got to the p o i n t where I'd say, bye dad, oh
bye Beth, you know, I'd say i t , you know, to me,
out loud, you know, f o r him, s a y i n g bye to me.
I t got bad in a l l ways l i k e t h a t , you know, he
would, he's a r e a l , he d o e s n ' t , t h e r e ' s not much
a f f e c t i o n with him, you know.
I did a lot of fun things with him. You know, he
t a u g h t me a l o t of t h i n g s . He was always t r y i n g
t o t e a c h me t h i n g s to save me tim e . He t a u g h t me
a l l about cooking and he t a u g h t me a l l about r e a l
e s t a t e . He alw ays wanted me to be a l l around.
I t was p r e t t y much me t h a t he was doing t h i s to
be ca u se he d o e s n 't r e a l l y l i k e my o l d e r s i s t e r ,
be ca u se she d i d n ' t l i k e to c l e a n house. Because
of t h i s he alw ays chose me to do t h i n g s w ith him.
And then he found out t h a t I w a s n 't p e r f e c t .
When th e going g e ts rough th en he backs o f f .
When t h e r e 's a person in his l i f e t h a t he doesn't
g e t a long w i t h he c u t s them o f f . He t o l d me t h a t
i f I ever moved o u t, y o u 'r e never coming back.
He t o l d me t h a t r i g h t when I moved in w ith him.
So...I d i d n ' t t h i n k t w i c e about i t but I t h o u g h t
of i t a f t e r w a r d s , you know. A f t e r I moved out
and l i v e d w ith a g i r l f r i e n d and her f a m i l y , I
thought about that.
My dad is r ea l se lf-c o n sc io u s about his dieting.
He's about 45 and he looks good. When I was
p u t t i n g on t h a t w e ig h t a f t e r t h a t a b o r t i o n t h a t
he n o t i c e d , he s t a r t e d t e l l i n g me t h a t you're
g e tt i n g a stomach and s t u f f l ik e th a t. I always
wanted to make him f e e l good and then when he
t o l d me t h a t I was l o o k i n g bad, I t h i n k t h a t ' s
why I think people won't lik e me i f I'm fat. Dad
alw ay s put a big e m p ha sis on h i s g i r l f r i e n d s
b e in g in shape and b eing t h i n , so I knew t h a t
t h i n to him was good, and to get o v e r w e i g h t was
bad.
71
I c a r e for him a l o t , but h e 's not good fo r me.
He's n o t a good man. He's g o t t o o many bad
q u a l i t i e s and i t ' s p r o b a b l y b e t t e r o f f t h a t I'm
not around him. I h a v e n 't bro u gh t the anger out
towards him. I always thought he was so neat of
a guy and I wanted to alw ays be l i k e him and h i s
l i f e s t y l e , I l i k e h i s l i f e s t y l e . But then I
wasn't accepted by him. I wasn't what he thought
an i d e a l g i r l was. An i d e a l g i r l is p r e t t y ,
s m a r t , in good shape...he wanted me to be a l l
a ro und,he wanted me to be e v e r y t h i n g , he d i d n ' t
want me to be one of those g i r l s t h a t didn't like
to cook. He didn't want me to be a g i r l t h a t was
a s i s s y , or a n y t h i n g l i k e t h a t . He wanted me to
be j u s t an a l l around lady. And i t ' s too hard to
be e v e r y t h i n g . I d o n 't want to be u n s u c c e s s f u l .
I didn't ever want to f a i l at anything.
A f t e r Beth 's a b o r t i o n and moving out of her f a t h e r ' s
home she had more d i f f i c u l t y with r e l a t i o n s h i p s . She had
i
I
sev eral r e l a t i o n s h i p s with men, a l l of which she terminated
when she began to fear r e j e c t i o n . She became more and more
concerned about her body, p a r t i c u l a r l y as i t began to take
th e shape of a woman. All of th e men w i t h whom she had a
r e l a t i o n s h i p were s i m i l a r to her f a t h e r , a t h l e t i c , f u n -
l o v i n g , and very s o c i a l . She d e s c r i b e d h e r s e l f , as having
"run away" from each of them.
For th e p a s t y e a r , Beth has been in a r e l a t i o n s h i p
w i t h a man e i g h t y e a r s o l d e r than h e r s e l f , whom she
d e s c r i b e s as " s o c i a l " and a lw ay s " t r y i n g to save me a l l
t h i s t i m e b e c a u s e h e ' s a l r e a d y d o n e a l o t o f
things...almost lik e he's my dad again." He reminds her of
her fathe r and she is determined not to run away from t h i s
r e l a t i o n s h i p . She wants the r e l a t i o n s h i p to work out.
72
At the present time, Beth is continuing in u n i v e r s i t y
and i s work ing on becoming more open in her r e l a t i o n s h i p
w i t h her b o y f r i e n d . As a r e s u l t of th e t h e r a p y she has
reduced her binging and purging and has made a decision to
find other ways of coping with her l i f e .
Be t h ’s Description of Her Lebenswelt
I want to cry but I d o n ’t f e e l l i k e c r y i n g r i g h t
now, but i t ' s going to come out though. I d o n 't
hold back c r y i n g cause I do cry a l o t , but I
t h i n k i t would be a w a ste of tim e r i g h t now. I
probably take care of everyone e ls e too much. I
always worry about, you know, lik e when you're an
e n t e r t a i n e r , about o t h e r p e o p le . I'm alw ays
w o r r y i n g about everyone e l s e and I d on't worry
about m y s e lf . I t ' s funny you p ick e d out how I
was worrying about whether you f e l t comfortable.
I t s t i l l i s a l m o s t a n y t h i n g I e a t , I want to
th row up. Sometimes when I'm not f e e l i n g good
about so m e th i n g , I ' l l c a t c h m y s e lf , a l l of a
sudden I ' l l be e a t i n g in the k i t c h e n and i t w i l l
be, I d i d n ' t t h i n k i t was going to happen, and
t h e n i t ' s j u s t one t h i n g , and t h e n I h a v e
a n o t h e r t h i n g , and th en I a t e a whole bunch and
th en I end up t h r o w i n g up, and a f t e r w a r d s I
u s u a l l y f e e l b e t t e r . I d o n 't t h i n k to m y s e lf , I
f e e l b e t t e r or a n y t h i n g l i k e t h a t . A l o t of
t i m e s I hold t h i n g s in to keep t h i n g s p l e a s a n t on
the outside, cause I want everyone to lik e me. A
l o t of times I ' l l be j u s t r e a l upset inside and I
t h i n k t h a t the food maybe, makes me f e e l b e t t e r
and s t u f f l i k e t h a t , and then I get r i d of i t .
I'm lonely. Like, I'm always with myself a l l the
tim e . I'm not aware o f w h a t 's happening i n s i d e
of Beth at the time t h a t i t ' s happening. I think
I p r o b a b l y t r y to avoid knowing. I have r e a l l y
bad dreams about i t sometimes. I dream about i t
a l l the t im e l a t e l y l i k e I'm g e t t i n g caug h t by
someone. I think g e tt i n g caught is going to make
me c o r r e c t i t .
73J
People d o n ’t u n d e r s t a n d i t . They t h i n k t h a t
cause people are ta l k i n g about the vomiting thing
and th ey say how g r o s s , how could anyone do t h a t ?
I d o n ’t u n d e r s t a n d , you know. Then I ’m t h i n k i n g
to m y s e l f , I do i t , you know. And then maybe
i t ’s j u s t what they would think about me i f they
knew what I do, they w o u l d n ’t t h i n k a n y t h i n g
good. Maybe i f they understood i t they would see
i t as being a problem and not as being something
r e a l l y g ro ss . I don’t t h i n k most peo p le look at
i t as a problem. I t ’s my way of d e a l i n g with
t h i n g s , you know, p ro b lem s, I guess. Cause
everyone t h i n k s of me as alw ays b e in g so n i c e ,
alw ays cooking up a g r e a t meal or, you knovt going
a l l out when peo p le come and v i s i t us, always
h a v in g l i t t l e t h i n g s going and s t u f f l i k e t h a t .
If they knew something t h i s bad about me, t h e y ’d
p r o b a b l y t h i n k a l o t d i f f e r e n t l y . I have a
stru g g le with myself.
Sometimes i t happens in another way, when you’re
not binging. There’s other times when I j u s t s i t
down and have a meal, a r e g u l a r meal and I f e e l
bad about i t . So I go throw up. The bad feeling
i s t h a t I ’l l get heavy, get o v e r w e i g h t , people
won’t l i k e you. I t seems l i k e when you get
o v e r w e i g h t p e o p le hold a d i f f e r e n t o p i n io n of
you. Sometimes when I feel lik e I ’m hungry I eat
one t h i n g and th en I t h i n k , god, you know, I a te
again and I might as w e l l f i n i s h o f f and e a t a
whole bunch. And I ’l l j u s t , I ’l l make everything
f e e l good, I ’l l e a t a whole l o t , and then I ’l l
ge t r i d o f i t a l l . While I ’m e a t i n g I ’m doing
i t so f a s t and som etim es I s t o p and t h i n k what
are you doing. I think I f e e l b e t t e r when I eat,
you know, I f e e l good. I t makes me put in more.
Even i f I don’t t a s t e i t . Sometimes I don’t even
t a s t e i t . I t ’s n o t l i k e I t a s t e i t . So. i t
doesn’t matter what you’re eating. Afterwards I
f e e l l i k e , when I throw up what I a t e , t h a t I
d o n ’t have to e a t ag ain and th en I d o n ’t gain
w e i g h t. The good f e e l i n g w h i l e I ’m e a t i n g is
t h a t I ’m doing what I want, i n s t e a d of doing what
everyone e l s e wants me to do. I cause Beth to
e a t and then I ’m not c o n t r o l l i n g m y s e lf so much
to what o t h e r people t h i n k . I j u s t go do i t and
i t ’s so m e th i n g I choose to do. I d o n ’t know why
I can’t j u s t eat one english muffin or something,
and s t o p t h e r e . I j u s t k e e p g o i n g . Then
a f t e r w a r d s — sometimes i t ’s j u s t you’l l be so f u l l
74
t h a t you have to do i t . Maybe I want to avoid
another r e j e c t i o n .
Last year I g ained some w e ig ht and everyone
noticed. I don't know why they notice. Everyone
n o t i c e d and Beth looked h e a l t h y and Beth looked
j u s t l i k e a mou ntain woman. I t ' s alw ays a joke
about Beth g a i n i n g w eight and then I was s e l f
conscious about gaining weight. I f e l t like, my
god, I'm so, l i k e I was so e m b a r r a s s e d about
b eing o v e r w e i g h t . I f e l t l i k e th ey d i d n ' t l i k e
me anymore. I f e l t l ik e they're looking at me as
a f a t p e r s o n a l l t h e t i m e . I t se em s l i k e
everyone, whenever I put on w e i g h t , everyone
n o t i c e s . I alw ays want to s t a y t h e same s i z e
maybe cause people think you're much b e t t e r when
you're t h i n .
I'm a f r a i d of b e in g u n s u c c e s s f u l . My dad wants
me to be successful at everything. I would never
go out for something t h a t I knew I wouldn't make.
I'm always t r y in g to do what my boyfriend wants,
but he t e l l s me to go do one t h i n g and I go do i t
and then he t e l l s me the other thing. He looks a
l o t l i k e my dad, t h a t ' s a bad t h i n g . I ' v e
avoided th at area, cause I know my dad i s n 't good
for me. I want a r e l a t i o n s h i p to work.
I t happens a l o t now. I'm r e a l l y unhappy when
i t happens a l o t . Now i t ' s j u s t I e a t and I
throw up. I t ' s not f u l l out b i n g i n g . Now i t ' s
got to such a regular thing t h a t I j u s t , I'm able
to e a t a l o t a l l th e tim e at meals i n s t e a d of
w o r r y i n g about i t . I can have a whole d i n n e r , I
can have dessert. And i t doesn't matter. I j u s t
go throw up t h e d i n n e r . A l o t of t i m e s i t ' s
ev ery meal. When I j u s t have an a p p le or an
e n g l i s h m u f f in then I d o n 't but i f I e a t a whole
meal i t ' s u su ally I want to throw i t up. I don't
f e e l l i m i t e d . I d o n 't f e e l l i m i t e d anymore. I
d o n 't f e e l l i k e anyone's c o n t r o l l i n g me, my
e a t i n g . Cause I am a b l e to do what I want and
e a t my d i n n e r , but then I'm a b le to throw i t up.
So I'm a b le t o do what I want then .
I know I'm ready t o make a change but i t ' s going
t o be h a r d c h a n g i n g . I g o t t o f i n d o u t i f
t h e r e ' s a problem behind t h i s t h a t ' s c a u s i n g me
to do i t , or i f i t ' s j u s t cause I l i k e t o e a t . I
don't want to do i t anymore. I know i t ' s bad for
me but I c o n t i n u e to do i t . I t j u s t makes me too
unhappy. I look f o r w a r d to l i f e l a t e r and I ’ve
got t o g e t t h r o u g h t h i s , and i f I d o n ’t g e t
t h r o u g h i t now i t ' s not going to get any b e t t e r .
I want t h e r e to be a l i t t l e hope. I know you
c a n 't cu re me. I d on't r e a l l y know why I do i t
som e tim es . I f e e l l i k e I c a n ' t e a t a n y t h i n g
w i t h o u t t h i n k i n g t h a t I'm going to gain w e ig h t.
I'm always concerned about my dumb weight.
I f I e a t a whole meal at n i g h t I j u s t c a n ' t
h a n d le i t . In th e morning I f e e l l i k e i t , the
food, h a s n ' t moved anywhere, i t ' s s t i l l r i g h t
t h e r e , and I'm r e a l f u l l , s t i l l in th e morning
andl know t h a t I 'v e sc rew ed up mysystem. I
c a n ' t even get food t h r o u g h my body. The only
time I wouldn't fe e l uncomfortable is i f I didn't
go t o bed and I k e p t moving around. Moving
around gets the food going or something. If I go
t o bed t h e food j u s t s i t s t h e r e . I'm s u r e i t
t a k e s a co u p le days t o get th r o u g h . I know my
system s t i l l works, cause I have bowel movements
and s t u f f l i k e t h a t but I know i t t a k e s a l i t t l e
b i t l o n g e r because i t ' s not used to doing i t .
There's got to be a way t h a t I can m a i n t a i n my
w e ig h t and not do t h i s . I want to be normal.
But I ' l l alw ays want to s t a y my same w e ig h t.
There are two kinds of bulimia you know. There's
t h e one where I j u s t d on't f e e l l i k e I can e a t a
normal meal without gaining weight. Then t h e r e 's
t h e t i m e s w h e r e I'm a l o n e a t t h e h o u s e or
something, I know what I'm doing, I s t a r t out and
I know i t ' s going to happen at the end and I know
I'm going to e a t a l o t of food and t h a t ' s th e
o t h e r one. It.'s when I'm r e a l unhappy about
s o m e th i n g , t h a t ' s not t h e r e g u l a r d a i l y t h i n g .
There's stages I've gone through where i t r e a l l y ,
the binging, the f u l l binging happens l i k e a lot.
And some days i t ' s happened a couple of t i m e s a
day. That one i s n ' t h a p p enin g t h a t much though,
r i g h t now. I guess because I 'v e kind of done
t h i s thing where t h i s happens every day but ju s t
with sm aller amounts.
I t o l d my b o y f r i e n d how unhappy I am r i g h t now.
He j u s t t e l l s me things could be a lot worse. So
I f e e l bad. I t seems l i k e every week I want to
run home. I have a bad h a b i t of ru n nin g away
from t h i n g s . And i t seem l i k e every weekend I
plan to go home and then I d e c id e I c a n ' t j u s t
run away. I always run away from problems and I
know i t . Hoping t h a t i t w i l l be b e t t e r on the
o t h e r s i d e of th e f e n c e , type t h i n g . I f I moved
down south i t wouldn’t be any b e tt e r . That’s why
I know t h a t I got to get t h i s thing solved, cause
w h e rev e r, I s t i l l have me. I s t i l l have to work
w ith me. This is th e f i r s t t im e I ’ve ever
st a y e d . I guess I ’m r e a l l y l o n e l y up here. I
j u s t want to go home. Seems l i k e I ’m always
alone. Even though I have people around me. I ’m
always t h i n k i n g to m y s e lf and j u s t f i g h t i n g the
whole t h i n g . I t j u s t f e e l s r e a l bad. I t j u s t
seems lik e a l l these things are going wrong. But
then t h a t ’s l i f e , I hear. I d o n ’t l i k e what I ’m
doing. I d o n ’t l i k e th e a c t i o n I ’m t a k i n g to
so lv e my p roblem s. So t h a t I can look l i k e I ’m
happy, you know.
I d o n ’t want p e o p le to t h i n k I ’m a b i t c h , I get
moody. My moods come out a lot more maybe l a t e l y
than before. I ’m not the sweet g i r l my boyfriend
th o u g h t I was. I t h i n k I need to get so m eth in g
going. I want to get in v o lv e d in so m e th in g . I
need to get s o c i a l l y involved with other people.
I w o u l d n ’t be so a lo n e a l l th e t im e . Maybe t h a t
would h e lp me out w i t h my problem. I could get
a c c e p t a n c e . The only p e rso n a c c e p t i n g me r i g h t
now i s my b o y f r i e n d . He’s alw ays t e l l i n g me I
s h o u l d n ’t be so unhappy. He d o e s n ’t t h i n k I
should get involved with anything else. He gets
o t h e r o u t e r s t i m u l a t i o n and he f e e l s so good
about h i m s e l f . I f he can go do t h a t , why c a n ’t
I. I got to do so m e thin g . I c a n ’t j u s t go to
sc h o o l and go to work. I ’m so a f r a i d of doing
o t h e r t h i n g s , though. I ’m a f r a i d i f I go to
s t a r t doing other things, th at w i l l be less time
w i t h my b o y f r i e n d and t h a t i t w i l l kind of r u i n
our r e l a t i o n s h i p . I c ould l o s e my a c c e p t a n c e
from him.
I f e e l l i k e I walk at s c h o o l a l l a lo n e a l l the
t im e . I know I ’m l o n e l y . I d o n ’t know why I ’m
even c r y i n g , but I know I got to get r i d of i t
a l l . I got to get r i d of t h i s whole t h i n g . I
only have one person to t e l l how t e r r i b l e I feel
r i g h t now, and every t im e he t e l l s me i t ’s not
t h a t bad. I wish he could know what I ’m going
t h r o u g h , but he d o e s n ’t and I t r y to e x p l a i n i t
to him but he says i t ’s not t h a t bad, you know,
you could have i t much worse. How can I get r i d
of t h i s bad f e e l i n g ? I have t h i s t h i n g about
w o r r y i n g a b o u t w h a t o t h e r p e o p l e t h i n k .
Sometimes, at a p a r t y , when my b o y f r i e n d and I
have g o t t e n i n t o a d i s a g r e e m e n t I f e e l so bad the
n e x t d ay t h a t o t h e r p e o p l e h a d t o f e e l
uncomfortable. I feel bad that I made them feel
l i k e we d i d n ’t have t h i s p e r f e c t t h i n g going.
Most people t h i n k t h a t i t ’s p r e t t y good. I want
t o g e t t h i s o v e r w i t h . I t ’s g o t t o be
removed. .. the t h r o w i n g up. I c a n ’t j u s t g o - -
t h e r e ’s o t h e r t h i n g s t h a t have to be worked out
i f t h a t ’s going to be worked out, cause I have
t r i e d to cold t u r k e y i t , but i t alw ays comes
back. I alw ays have high i n t e n t i o n s , but i t
always comes back. I j u s t end up doing i t . Even
worse than throwing up is not being accepted. My
fath e r didn’t say i t d i r e c t l y , but somehow I took
i t t h a t to be a c c e p t e d I w ould have t o be
p e r f e c t . I know o t h e r people d o n’t t a k e such a
burden l i k e I do about being p e r f e c t . I t h i n k
t h i s i s p r o b a b l y th e f i r s t t im e I ’ve r e a l l y
s t a r t e d f e e l i n g t h i n g s . Cause I h a v e n ’t been so
busy.
I want to q u i t my job. One t h i n g I want i s to
not w a i t r e s s anymore. I don’t l i k e i t . I t ’s
j u s t enhancing my problem. I probably should get
something set up though, before I quit. I always
t r y to make s u r e t h a t when I q u i t t h i n g s t h a t I ’m
not running away from i t . Because I know t h a t ’s
a bad problem. You s h o u l d n ’t run away from
problems, r i g h t? For awhile there I was q u i t t i n g
jobs a l l the time.
I t r e a l l y has been s c r e w i n g up my l i f e l a t e l y .
Dreaming about i t at n i g h t i s th e w o r s t . I t ’s
m ain ly me g e t t i n g c au gh t in th e a c t t h a t s c a r e s
me most about my dreams. Usu ally, i t ’s someone
c l o s e to me t h a t c a t c h e s me in t h e a c t . When I
analyze my dreams i t ’s qu ite obvious th at I have
major g u i l t going on. I t ’s so m e th in g I want to
stop sooo bad. I know i t ’s very d e s t r u c t i v e both
p h y s i c a l l y and e m o t i o n a l l y . I keep doing i t
though. I f e e l l i k e a wreck h a l f the t im e s i n c e
i t ’s always on my mind haunting me. It r e a l l y is
messing up my boyfriend and my r e l a t i o n s h i p . I ’m
watching i t happen. I can’t deal with some of our
p roblem s so I r e l i e v e i t t h r o u g h e a t i n g and
purging. Afterwards, I feel so g u i lt y and angry
t h a t I r e v e r t some of t h i s anger t o w a r d s my
b o y f r i e n d , w h i c h i s c o m p l e t e l y u n f a i r . He
doesn't have a clue on what he did wrong'.
We've been h av in g a sex problem l a t e l y . I was
f e e l i n g t h a t i t was j u s t to p l e a s e him, i t ' s
ov er, t u r n o v e r . . . I s t a r t e d to f e e l l i k e we j u s t
did i t fo r him. So I h a v e n 't had a very good
a t t i t u d e about sex at a l l . I didn't even want to
do i t , why should I want to do i t ? I t ' s an
i n v a s i o n of me, I f e l t l i k e i t , and i t reminded
me of, too much of the l a s t t h r e e o t h e r guys I
used to go out w i t h t h a t were a l l l i k e my age.
You know how guys are in high school, they're not
i n t o making lo v e , or a n y t h i n g l i k e t h a t . With
them i t was sex and t h a t ' s why I t h i n k I had t h i s
bad a t t i t u d e , because I d i d n ' t l i k e what I was
doing about i t , and I knew I s h o u l d n ' t be doing
t h i s , and I, h e re I was doing i t , and I got
p r e g n a n t and had an a b o r t i o n and I d i d n ' t l i k e
t h e id ea of sex cause i t seemed l i k e what i t was.
I don't have t h a t many s e x u a l d r i v e s . I d on't
even want to do i t . I would n ever s t a r t i t . He
d o e s n ' t u n d e r s t a n d i t why I d o n ' t s t a r t i t .
Don't even w a n t t o . I a l w a y s have t o be
c o n t r o l l e d by men or so m e th ing . Maybe t h a t has
to do l i k e w ith sex, c o n t r o l l e d , you know. I
f e e l t h a t what was ha p p en in g was t h a t I was used,
t h a t ' s what I was f e e l i n g but th en he says i t
w a s n 't , so I guess i t w a s n 't . I s h o u l d n ' t have
to f e e l used by him. I t r y to avoid hav in g bad
f e e l i n g s , c a u s e I d o n ' t f e e l t h a t t h e y ' r e
n a t u r a l , to f e e l bad. Then I w o u ld n 't be Miss
Nicey a l l th e tim e . For some r e a s o n , I'v e been
doing some mean things l a t e l y . I have never told
him something bad about himself.
I've always had boyfriends. I've never j u s t been
me. I t seems l i k e i t would be r e a l l o n e l y . I'd
have to get to know m y s e lf . I would d e f i n i t e l y
get t o know m y s e l f l i k e t h a t . I j u s t avoid i t .
I always se t something new up. And make i t work
out. And i t seems l i k e a year a f t e r t h i n g s get
r e a l l y bad and t h i s i s t h e r e a l l y bad p a r t .
U s u a lly I break up at t h i s p o i n t . But I s t i l l
f e e l s h i t t y inside.
I d o n 't get a l o t of fe e d b a c k , maybe because I
do n't have a l o t of f r i e n d s r i g h t now. I got to
get more confidence in myself and I think t h a t ' s
a way I would get i t , is i f I had a l i t t l e more
feedback. Maybe i t ' s I don't accept the feedback
t h a t I d o n 't get i t . My god, I got t h e f i d g e t s
today. F i r s t I s t a r t e d p l a y i n g w ith my gum and
then my watch and now my shoes. I f e e l r e a l
t e a r y . I f i g h t going to sc h o o l a l o t . I t ' s hard
c a u s e I d o n ' t h a v e an end g o a l w h e r e i t ' s
r e a l i s t i c . I'd l i k e to be more p lanned out.
I'm so unhappy. I wish t h i n g s would get b e t t e r .
I d on't know. I d o n 't know, because I'm not
r e a l l y in touch with myself. I t ' s hard to be. I
don't know why I'm unhappy. Sometimes i t j u s t
g e ts so bad and I d on't know why i t ' s g e t t i n g so
bad. I d o n 't r e a l l y know why I'm s i t t i n g here
c r y i n g r i g h t now. I'm g e t t i n g r e a l t i r e d of
making my l i f e go around my b o y f r i e n d . And
t h e r e ' s no commitment and I know I'm not ready
fo r a commitment. I got to get s t a r t e d on my own
l i f e , and I d o n't. Cause I keep working around
h im , and t h e n I g e t f r u s t r a t e d . I g u e s s I'm
a f r a i d . I want to get t h i n g s going. A l o t of
t i m e s I f e e l l i k e I'm t r a p p e d . I t seems l i k e he
has a big control over my l i f e , which he does.
The r e a so n I s t a y w i t h him is t h a t ev ery o n e l i k e s
him so much. Cause he's a neat guy. I t ' s me and
my odds l a t e l y t h a t ' s s c r e w i n g e v e r y t h i n g up.
You know, me and my l i t t l e games I'm t r y i n g to
p lay on him so he d o e s n ' t l i k e me anymore, I
d on't know. A l o t of t i m e s I t h i n k I'm r i g h t
about so m e th i n g but by th e t im e we f i n i s h the
c o n v e r s a t i o n t h a t I j u s t f i g u r e I was, I was
wrong. I f e e l l i k e I l i v e my l i f e too much
around him. I'm not t h i n k i n g t h r o u g h m y se lf.
I'm alw ays t r y i n g to work around him. Once in a
w h i l e I ' l l t h i n k , w e l l , g o s h , h e ' s h i s own
p e r s o n , h e's t h i n k i n g h i s own t h o u g h t s a l l day
long. He's not t h i n k i n g t h r o u g h me. Then I
think t h a t ' s dumb what I'm doing.
I d i d n ' t do the t h i n g s t h a t I wanted to do in
high sc h o o l . I alw ays wanted to do c e r t a i n
things and Dad would t e l l me th a t i s n 't the r ig h t
way or t h a t i s n ' t w h a t you s h o u l d be d o i n g .
T hat's p r o b a b l y where I l o s t i t a l l . Where he
d e c id e d t h a t I w a s n 't good enough f o r him to be
his daughter or something. He was kind of an a l l
or n o t h i n g type of guy. E i t h e r I did th e t h i n g s
t h a t he l i k e d and was t h i s p e r f e c t t h i n g or I
knew what was coming. I guess I d i d n ' t r e a l l y
f i g u r e i t , I w a s n 't a n t i c i p a t i n g i t . Now I do
80
p r e t t y much what people want. I don’t even know
what I w a n t . I n e v e r have my own o p i n i o n .
Everyone e l s e d o e s n ' t l i v e l i k e me and t h e y ' r e
doing okay. This s i t u a t i o n i s n ' t r i g h t . I got
to get around i t . I f e e l t h i n g s could get a l o t
b e t t e r i f I l e a r n e d how to be my own person.
Maybe then I wouldn’t have t h i s problem anymore.
I Tm going to do something to make t h i s awfulness
go away. I t Ts not h a ppening as much. And I
t h i n k i t ’s because I ’m s t a r t i n g to r e a l i z e t h a t
I ’ve got to l e t p e o p le know when I d o n ’t l i k e
something.
A l o t o f t i m e s I ’m o u t t h e r e l o o k i n g , I am
p a r t i c i p a t i n g and doing my own thing. I do a lo t
of t h i n k i n g a l l th e t im e . I d o n ’t t h i n k o t h e r
p e op le t h i n k as much as I t h i n k . I d o n’t f e e l a
p a r t . I d o n ’t ever s i t down. I ’m alw ays kind
of watching. I ’m always evaluating the s i t u a t i o n
and a s k i n g what I ’m going to do. J u s t alw ays
r eal concerned about what I ’m going to do instead
of j u s t going out and doing i t . I should j u s t do
t h i n g s as they come i n s t e a d of s i t t i n g alw ays
w a t c h i n g w h a t I ’m g o i n g t o do. N o t h i n g i s
s p o n t a n e o u s . I u s u a l l y d o n ’t do what I want to
do spontaneously.
I f e e l l i k e I hold s o m e th i n g in I know t h a t ’s
when i t happens. Something makes me r e a l l y mad
l i k e maybe I ’m j u s t so t i r e d of b eing n i c e to
ev er y o n e — cause I c a n ’t y e l l about i t at work.
So i t happens l i k e t h a t at work, b ecause you get
a b r e a k . And t h e n t h i n g s a r e okay. I h e l d
everything in and then I go eat and then I get i t
out. Then I f e e l b e t t e r . My whole a t t i t u d e is
changed. I have to get r i d of th e aw fu l in me.
I can be in a r e a l l y bad mood and maybe I have a
chance to go e a t and do so m e th i n g , about a h a l f
an hour or an hour,. I can do i t , and I can j u s t
come out of t h a t bathroom f e e l i n g g r e a t . I t ’s a
bad way to e x p l a i n i t , but you know, i t g e ts
e v e r y t h i n g o ut, and th en my whole a t t i t u d e is
changed. I d o n ’t know i f i t ’s r e p r e s s e d d e e p e r,
b u t I know I ’m n o t h o l d i n g i t i n s i d e o f me
anymore, and not h o l d i n g i t in and t r y i n g to be
n i c e and s m i l i n g , b e ca u se I d o n ’t have i t in me
anymore. With th e v o m i t i n g the bad f e e l i n g s go
away. I mean, th e y a re gone. And I ’m not j u s t
p r e t e n d i n g t h a t t h e y ’re gone. Because I know
before, even though i f I'm you know, looking good
on th e o u t s i d e . On th e i n s i d e , god, t h e r e ' s so
much a d r e n a l i n , so much, so much j u s t want to
say, f o r g e t i t . I j u s t t h i n k of, t h i s i s j u s t
g e t t i n g r e a l l y bad, I c a n ' t h a n d le i t . I d o n 't ,
I d o n 't b r i n g i t out, because I don't want to
sound l i k e I'm a b i t c h a l l t h e t im e . I'm angry,
h o s t i l e , f r u s t r a t e d . I used to have temper
t a n t r u m s when I was younger. I used t o , but i t
came out, which was good.
I j u s t f e e l l i k e I'm always t r y i n g to do what
e v e r y o n e e l s e w a n t s me to do. When I f e e l
t r a p p e d I have to vomit. I t h e l p s to get r i d of
the feelings. I think th a t 's the only thing that
keeps me sane. Cause then things are a l l b e t t e r
a g ain . I go back and we b u i l d i t up a g a i n , and
then i t comes back. Right now i t ' s not happening
as much because I'm l e t t i n g l i t t l e t h i n g s s l i p
out h e r e and t h e r e so t h a t I d o n 't , i t d o e s n 't
build up as f a s t , whereas sometimes i t j u s t gets
r e a l bad. I t ' s th e on ly way I can go back and be
normal Beth. I can j u s t be, you know, r e a l .
B e sid e s b e in g a p l e a s a n t p e rs o n to be around, I
f e e l p l e a s a n t w ith m y s e lf , I f e e l c o m f o r t a b l e ,
and I'm j u s t ready to do things. And I can have
l o t s of e nergy, I'm not so much t h i n k i n g about,
I'm not so i s o l a t e d by t h a t t i m e . When i t ' s
about to happen i t ' s p r o b a b l y I r e a l l y am alone
at t h a t t im e . I t ' s only j u s t r i g h t a f t e r t h a t I
feel re al comfortable, because everything is out.
I u s u a l l y go ahead and e a t b r e a k f a s t w i t h my
b o y f r i e n d , j u s t a normal b r e a k f a s t , but then he
l e a v e s and th en I c o n t i n u e to e a t . I t ' s j u s t
happening. Nothing. T here's no c o n n e c t i o n . I'm
not in to u ch w i t h m y s e lf at a l l . I d o n't know
what I'm doing, I'm j u s t doing things, mechanical
things. I t ' s not lik e , I'm not saying t h i s feels
good, you know, l e t ' s e a t more. I'm j u s t
e a t i n g , and I'm not e n j o y i n g t h e food, I'm j u s t
g r a b b i n g , f i n d i n g more t h i n g s to e a t . This is
where I'm g e t t i n g i t in me and g e t t i n g i t out of
me. I d o n 't know why I c a n ' t j u s t go throw up
b reakfast and then, instead of j u s t continuing to
e a t a f t e r he l e a v e s . And j u s t get t h a t out.
Maybe I f e e l l i k e I have to g e t a l o t in me,
maybe as much as the f ee lin g s are I'm holding in
me. So t h a t I could get i t a l l out. Maybe i t
t a k e s a l i t t l e b i t more food to, i n s t e a d of j u s t
t h a t l i t t l e b r e a k f a s t , I have to get more in me
so t h a t I can have t h i s big, big t h i n g out of me.
I d o n ’t f e e l l i k e I ’m one w i t h him l i k e y o u ’re
supposed to be. I f e e l so bad i f I don’t get up
and do a l l t h e s e t h i n g s for him t h a t , i t ’s kind
of i r o n i c I ’l l f e e l so bad about i t and I ’l l be
so mad about i t i n s i d e . I get e v e r y t h i n g done
and i t d o e s n ’t look l i k e I ’m ru n n in g around as a
mad woman t r y i n g to get e v e r y t h i n g done. But
th e n , I ’m a b le to, l u c k i l y , a f t e r he l e a v e s , you
know, I can get everything out.
He’s always looking at g i r l s as objects and th at
may be my big d e al about k e ep in g in shape and
keeping a good figure. I don’t like how men look
at women, I d o n ’t l i k e i t at a l l . Sometimes I
f e e l l i k e i f I t e l l him more and more about th e
bad t h i n g s then I c o u ld j u s t get him away from
me. I t ’s so hard cause the f i r s t time I ’ve t r i e d
i t i s w i t h D e b b i e j u s t r e c e n t l y and I k e ep
catching myself tr y in g to get away from her.
I f e e l c o n n e c te d to you. I d o n ’t f e e l l i k e I ’m
ta l k i n g to you. I don’t feel like I ’m t a l k i n g to
you h e r e , b u t o v e r t h e r e , you k n o w , my
body...c ause I do t h a t w i t h people. Some pe o p le
think I ’m spacey cause I ’l l be so busy over there
t h a t I ’l l miss s o m e th i n g h e re . I n s t e a d of, i f I
c o n n e c t t h i n g s , i f I ’d get t h a t only one t h i n g ,
I ’d get a lot, you know, more things out of l i f e ,
you know, I ’d get.
I d o n ’t f e e l as bad a b o u t i t a n y m o r e . I t
happens, l i k e , ev ery two or t h r e e days now, you
know. I got to be r e a l c a r e f u l , cause t o d a y ’s
the day i t can happen because I work a l l day. At
lunch I have a s a l a d and I a l r e a d y f e e l bad. I
f e e l I got to throw i t up. So I e a t a l i t t l e b i t
more because i f I ’m going to throw up I might as
well have a couple more goodies. I know i t ’s not
a l o t of c a l o r i e s but I f e e l bad i t s t a y s t h e r e ,
lik e a couple of days. Because I ’m not r eal good
at making i t go t h r o u g h . I j u s t f i g u r e t h a t
s i n c e I ’ve been doing t h i s fo r so long t h a t I
c a n ’t , my s t o m a c h h a s a d a p t e d to i t and i t
f i g u r e s i t d o e s n ’t have to d i g e s t food. I ’ve
r e v e r s e d th e c y c l e . I t ’s m essing i t up. I know
th at I feel p r e t t y icky when eating and going to
bed and I f e e l l i k e r e a l f u l l in th e morning
s t i l l , so I know i t hasn’t done anything.
I d o n ’t know, i t happens to me where I, m y s e lf ,
when I ’m t a l k i n g to you, I want to sto p but then
i t ’s so m e th in g e l s e , i t j u s t ha ppens, I c a n ’t
e x p l a i n , i t j u s t h a p p e n s a t t h a t b r e a k on
F r i d a y s . I ’m not m y se lf and i t j u s t happens.
I t ’s not me s i t t i n g down w ith a whole bunch of
p e o p le , the o t h e r g i r l s on my break and j u s t
kind of e a t i n g a lunch. I t ’s l i k e I go s i t down
and I e a t t h a t s a l a d . I t ’s d i f f e r e n t . I c a n ’t
e x p l a i n . I t ’s not l i k e I ’m in c o n t r o l of m y s e l f
or in touch with myself or s i t t i n g down thinking,
maybe s t u d y i n g w h ile I ’m e a t i n g the s a l a d . I ’m
j u s t , I ’m o ff somewhere else. I don’t lik e what
I ’m d o i n g in my l i f e r i g h t now. I d o n ’t
understand i t . I ’m confused.
I ’m l i v i n g around o t h e r people. I ’m not l i v i n g
my l i f e . I did th e l a s t c o u p le of days, you
know, I did my own thing. It f e l t good.
I q u i t my job. I t makes me too unhappy and i t
d e f i n i t e l y c au se s t h i s problem to oc cur more.
Not j u s t cause the food’s there but cause I ’m not
in to uch w i t h m y s e lf , I ’m o f f in t h a t world which
I have to l e a r n to get away from. The world
where I ’m not being myself, I ’m try in g to be th at
p e rs o n t h a t everyone e l s e wants me to be. You
have to do t h a t when you’re a w a i tr e s s , you know,
cause you g e t a l o t of c o m p l a i n t s . Here I am,
b eing n i c e , but I ’m n o t . . . I ’m t h i n k i n g o t h e r
things inside and so I ’m not r e a l l y with my body
t h a t ’s doing a l l t h i s o t h e r s t u f f . I ’m w ith my
r e a l s e l f even though I ’m not a c t i n g t h a t way.
I t j u s t d o e s n ’t happen w i t h w a i t r e s s i n g , i t
happens with people, you know.
I ’m nearing g e ttin g t h i s thing over with. I feel
l i k e I am. Maybe i t happens s t i l l but I, I
r e a l l y f eel in touch with myself, where before I
c o u l d n ’t r e a l l y t a l k about how I was unhappy at
t h e s e t h i n g s . I knew t h a t I was going to be
unhappy, but I d i d n ’t ever b r i n g i t out in the
open, so I f eel kind of good about that.
I f e e l more in k e y . . . f e e l i n g more in tune w ith
m y s e lf . I know what I ’m doing a l l day long,
whereas before I was running around, not knowing.
Sometimes Beth i s a n o t h e r p e r s o n , cause s h e ’s
doing t h i s o t h e r t h i n g . This is when I am doing
o t h e r t h i n g s to p l e a s e everyone e l s e but not
r e a l l y w a n t in g t o , b eing a l l mad i n s i d e then.
I t ’s the other person is what causes the problem
o f t h r o w i n g up. I was n e v e r l i k e t h i s ,
s u b m i s s i v e and e v e r y t h i n g l i k e t h a t , but at th e
same t im e when I moved out w ith my dad I moved in
w i t h my b e s t f r i e n d and s h e 's t h a t way. S h e ’l l
j u s t do e v e r y t h i n g fo r anyone. And l e t h e r s e l f
g et to a wreck. I was never l i k e t h a t but then
I found out r ea l quick t h a t she was accepted for
th e way she was a c t i n g . I t h o u g h t when she was
being accepted for being the submissive way, i f I
would be l i k e t h a t then maybe I would make i t . I
t h i n k why I h a t e i t so much is because I know
what i t ' s l i k e t h e o t h e r way. I used to be th e
o t h e r way. I alw ays had good i d e a s . I was a
r e a l o r g a n i z e r . Now I j u s t don’t give m y s e l f a
c h a n c e t o t h i n k th em . I f e e l good. I l i k e
coming here. I l ik e talking.
I guess I'm j u s t a f r a i d of going out and doing
t h i n g s on my own. Being a lo n e r e a l l y s c a r e s me a
lot. I have t h i s big thing about being thin and,
I 'v e a c c e p t e d i t so much t h a t i t ’s a l m o s t no big
d e a l . Maybe f o r c e r t a i n people I have to be
t h i n . I ’d l i k e to g e t to th e p o i n t where I was
c o m f o r t a b l e w i t h my w e i g h t but I d i d n ' t worry
about t h a t . R ight now I'm s w i t c h i n g over how I
f e e l a l i t t l e b i t . . . b y hav in g o t h e r i n t e r e s t s .
I t se e m e d l i k e a l l my b o y f r i e n d s p u t a b i g
em p hasis on being t h i n . T h a t ’s why i t was so
important, because I wanted them to l ik e me.
I t seems like I ’m g e tt i n g more r e l a t i o n s h i p s with
p e o p le and I ’m s t a r t i n g to get my food under
c o n t r o l to o , and t h e y ’re happening at t h e same
time, so there must be a connection. Because I ’m
r e a l l y s t a r t i n g to do s t u f f w i t h p e o p le and
t a l k i n g to them in my c l a s s , and I'm t a l k i n g
through me, you know, through me. So, t h a t makes
a d ifference. I ’m not in t w i l i g h t zone, because
t h a t ' s what i t was. I t ’s n ic e to look good, but
you d on ’t have to be skinny to look good. I ’d
r a t h e r look h e a l t h y . But I ’m kind of mad at
m y s e lf , cause I h a v e n 't sto p p ed t h r o w i n g up,
c o m p l e t e l y , you know. I f e e l l i k e I r e a l l y
dev elo p ed my p e r s o n a l i t y . I f e e l good about
t h a t . But I d o n ' t f e e l good a b o u t how I ’m
ch o o sin g to throw up some of t h e s e meals, and I
want to.
My C l in i c a l and Subjective Impressions of Beth
My c l i n i c a l d i a g n o s i s of Beth was b u l i m i a . When we
f i r s t met I found her to be e m o t i o n a l l y d i s t r e s s e d and
always close to tea rs. She smiled a great deal, even while
she was crying. She was extremely cooperative and always
wanted to make sure I was c o m f o r t a b l e . She was very
anxious to get help with her "problem."
I soon learned that she b a s i c a l l y perceived h e r s e l f as
a v i c t i m in a l m o s t every way. She appea re d to do very
l i t t l e t h a t w a s n 't planned for her by someone e l s e . When
she f i r s t came to t h e r a p y she found i t d i f f i c u l t to know
what was hap p en in g to her i n t e r n a l l y . All she seemed to
know was t h a t she was very unhappy and f r e q u e n t l y found
h e r s e l f crying.
I f o u n d B e th e a s y t o t a l k t o and to d e v e l o p a
c o n n e c t i o n w ith . This was l i k e l y because I was the only
p erson w i t h whom she had s h a r e d her "problem." She was
very anxious for me to "cure" her since she f e l t she had no
c o n t r o l of h e r s e l f . She c l e a r l y saw her b i n g i n g and
p u r g i n g as happening to her and t h a t she was somehow
another person when "it" happened.
In s p i t e o f t h e f a c t t h a t B e th was o u t g o i n g and
f r i e n d l y , she f e l t very d i s c o n n e c t e d from people. She
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o f t e n d e s c r i b e d h e r s e l f as b e i n g in a t w i l i g h t zone
w a t c h i n g everyone around her. She lac k ed s p o n t a n e i t y ,
r i g i d l y f o l l o w i n g th e p l a n s made fo r her by her b o y f r i e n d
or even by h e rs e l f . I was aware of how l i t t l e she valued
her own perceptions. I f anyone disagreed with her she knew
t h a t she was the one who was wrong. As a r e s u l t she spent
a great deal of time c r i t i c i z i n g h e r s e l f .
One of her p r o j e c t s in l i f e was p e r f e c t i o n . She
attempted nothing t h a t she would not do p e rf e c t l y . Somehow
she f e l t t h a t by b e in g p e r f e c t she would not be r e j e c t e d .
Her p r i m a r y a r e a of p e r f e c t i o n was w i t h her body. Beth had
an obsession with thinness, since she knew th a t t h i s would
b r i n g her f r i e n d s . She found i t d i f f i c u l t to u n d e r s t a n d
t h a t she was a l r e a d y t h i n and t h a t she s t i l l was very
i
i
| l o n e l y . She o f t e n t a l k e d about th e l o n e l i n e s s or th e
j
aloneness th at she f e l t , even when others were around.
Beth had a g r e a t need f o r fee d b ac k from me. She
frequently asked what I thought about her. She seemed very
unaware of what o t h e r s t h o u g h t about her and she craved
some feed b ack , though even when I gave i t , i t d i d n ' t seem
to impact her.
Beth was t e r r i f i e d of l e t t i n g o t h e r s know i f she was
angry or h u r t about a n y th i n g . Her g r e a t e s t f e a r was
r e j e c t i o n ; hence she always t r i e d to say what others would
like. The way she got rid of her negative f e e lin g s was to
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e a t l a r g e amounts of food and then vomit i t ou t. In t h i s !
way she was able to rid h e r s e l f of the negative feelings.
As we n e ared th e end of the s e s s i o n s Beth began to
take r i s k s in t e l l i n g others how she f e l t . She was shocked
to f i n d out t h a t when she did t h i s she d i d n ' t f e e l a need
to vom it. She began t a k i n g s i g n i f i c a n t r i s k s w ith her
b o y f r i e n d and began doing t h i n g s "on her own." She a l s o
began " s p e a k i n g t h r o u g h h e r s e l f " r a t h e r than " s p e a k i n g
through him."
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j Helen
Presenting Problem
Helen appro ached me b ecause she had h eard t h a t I was
working with people with binging and purging problems. She
came at a t i m e when she f e l t t h a t she was b e g i n n i n g to have
c o n t r o l over her problem but t h a t she would l i k e to have
some h elp. She was in t h e r a p y w ith me f o r a p p r o x i m a t e l y
l
four months.
H elen’s Background
Helen, a 23 year old Caucasian, was the middle child
in a f a m i l y of t h r e e g i r l s . All of th e g i r l s were 20
months apart. They were described by f r ie n d s and family as
the three ,,B”s with Evelyn having the brains, Helen having
t h e b e a u t y , and Ruth hav in g th e brawn. Evelyn was th e
o l d e s t of th e t h r e e . When Helen was two y e a r s old she
remembered the f i r s t move the family made. From then u n t i l
she was s i x she s a i d she ne ver s m i l e d . By th e tim e she was
in th e s i x t h grade the f a m i l y had moved 18 t i m e s , each move
was a t r a u m a t i c e x p e r i e n c e fo r her. Helen d e s c r i b e s the
moving experiences as follows:
When we moved, I c r i e d f o r t h e f a m i l y . I
remember sometimes I would tr y to commit suicide.
E s p e c i a l l y when we were moving or so m eth in g.
Because, see, on the one hand, th e y needed me to
be e m o t i o n a l , b e c a u s e t h a t ’s how t h e y w e r e
f e e l i n g . But y e t , th ey d i d n ’t want t h a t because
I would be t h r o w i n g t a n t r u m s and I would be
c r y i n g and I would be mad and f r u s t r a t e d . And
they would be calmly packing everything nice and
n e at and o r d e r l y . And I would be in t h e i r way.
But y e t , th ey would need me to do t h a t . I would
a sk Mom, d o n ' t you e v e r c r y when you move?
Because I was sad. Moving was sad. And th ey
would never acknowledge t h a t t h e r e was such a
thing as sadness. Except for saying, yeah, there
is sadness.
By the time Helen entered school the family had moved
t o o v e r s e a s where her p a r e n t s were m i s s i o n a r i e s . They
; s p e n t f i v e y e a r s o v e r s e a s . She d e s c r i b e d h e r s e l f as b eing
one of th e "dumb k i d s " who c o u l d n ' t l e a r n . She had to
repeat the f i f t h grade twice. About t h a t time she decided
she would be th e b a l l e r i n a , t h e homemaker. That i s a l s o
J t h e t i m e she went on her f i r s t d i e t s i n c e she remembered
i
i
i
| being calle d "piggy" a l l the time.
j She d e s c r i b e d her r o l e in th e f a m i l y d u r i n g t h o s e
years as follows:
To me, being in the family was being stupid, was
a l l these things th at they said were good, but in
e s s e n c e in our f a m i l y th e y are n o t: e m o t i o n a l ,
s u p p o r t i v e , s o c i a l l y o r i e n t e d , c h i l d - l o v i n g ,
n u r t u r i n g , f e m i n i n e - in our s o c i e t y s t a n d a r d s ,
t h a t ' s who I was. And th ey s a i d , t h a t ' s okay,
t h a t ' s who you a re . But t h a t w a sn 't okay a t a l l
in our family. My parents were embarrassed. I
remember t h a t . From two y e a r s old on t i l l about
s i x , I w o u ld n 't s m i l e , and I was r e a l v i o l e n t
w i t h Mom, and Evelyn and Ruth. They have l i k e
s c a r s from my b i t i n g and s t u f f . And th ey would
remind of t h a t l a t e r on. "Do you remember when
you were t h a t old you w o u l d n 't s m i l e ? You were
always hard to get, you know." I was the problem
of th e f a m i l y . And a l o t of i t f o r me stemmed
w i t h f e e l i n g very, very s t u p i d in a very b r i g h t
f a m i l y . I t was r e a l l y t e r r i b l e . I f e l t so
e m b a r r a s s e d and h u m i l i a t e d around Evelyn and
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Ruth. I h a te d being around them. And t h e n ,
a f t e r I s t a y e d back in f i f t h grade, one of t h e i r
f a v o r i t e things to do was t e l l everybody t h a t I
flunked. We would meet f a m ilie s. That’s one of
the f i r s t things they would b l u r t out, was, Helen
f l u n k e d t h e f i f t h g r a d e . And t h a t was
embarrassing to me.
Helen described her parents as being embarrassed with
her. She s a i d t h a t the s i x t h grade was about the peak of
t h e o v e r t y e l l i n g , s c r e a m i n g , b i t i n g , p i n c h i n g , and
f i g h t i n g with her parents. They threatened to take her to
a p s y c h i a t r i s t i f she didn't shape up. What made Helen so
angry was th a t she thought i t was " th e ir " problem, not only
"her" problem. She was p a r t i c u l a r l y angry with her father.
She wondered why everything t h a t went wrong in her family
was a lw ay s her f a u l t . She s a i d t h e f o l l o w i n g about her
f ather :
He was r a i s e d in a f a m i l y t h a t you don’t d e a l
w i t h s e x u a l i t y . He never saw h i s s i s t e r in a
s l i p , o k a y , o u t o f a l l t h r e e o f u s, I am
d e f i n i t e l y t h e " m o st f e m i n i n e " , as f a r as
s t a r t i n g my p e r i o d in f i f t h g r a d e , alw ays from
e a r l y o n - - t h e d o l l s , th e b a l l e t , th e p r i n c e s s -
t y p e — I was t h a t t y p e . I t h i n k t h a t ’ s
t h r e a t e n i n g to him, my s e x u a l i t y . Always has
been t h r e a t e n i n g to him. I knew he h a te d me. I
knew he was e m b a r r a s s e d . I knew he tho u g h t I was
s t u p i d , and I f e l t t h i s w a y - - w e l l even today I
f e e l t h a t way. He's j u s t a f r a i d of emotion.
When I ’m u p s e t and cry, Dad g i g g l e s . T h a t ’s h i s
way of d e a l i n g w i t h i t , and you know, I ' l l say,
"I know i t ' s hard f o r y o u - - I ' l l l e t y o u - - d o n ' t
f e e l bad about g i g g l i n g , " when in r e a l i t y , I'm
going, gees, t h i s is an adult man, and I'm r e a l l y
f e e l i n g down about so m e th in g , u p s e t and c r y i n g ,
and t h i s man giggles.
Dad i s a t o t a l l y c o g n i t i v e p e rs o n . I never saw
him c r y . I d o n ' t r e m e m b e r Dad or Mom e v e r
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h i t t i n g us out of c o n t r o l , but th ey did spank.
And, somehow now I am very a f r a i d of being b e aten
by a man, by my husband, by b o y f r i e n d s I'v e had.
That's the one thing Dad did express. I remember
one Sunday I was r e a l l y naughty in chu rc h , j u s t
making a l o t of n o i s e and s t u f f , and he had to
spank me when he got home. He would say, you
know, I r e a l l y do n't want to do t h i s , t h i s makes
me f e e l sad, but I have to spank you. And then
he w o u ld s p a n k me. But I l o v e d i t when he
spanked me, b ecau se he showed me some emotion.
He touched me, he h eld me--he had to hold me to
spank me. He had to be angry to spank me. And I
got a r e s p o n s e out of him. I asked for i t , you
know.
Helen said s i m i l a r things about her mother as she said
about her father. She also experienced her as cognitive:
She can't be touched, and she would push me away!
We were m i s s i o n a r i e s i n ________and Mom h a te d i t .
And she would t a k e w a lk s, or she would s i t in th e
entryway of the house, depressed. And I would go
touch h e r , and she c a n ' t t a k e t o u c h i n g . I j u s t
wanted to c o m f o r t h e r, because I knew she was
d e p r e s s e d , but she, i t ' s j u s t very ha rd f o r her
to be to u ch ed. Unless I b l o w - d r y her h a i r , you
know. And then I say, Mom, i t ' s nice t h a t you're
l e t t i n g me do t h i s , cause you r e a l l y d o n't l e t
me t o u c h you t h a t much. And t h e n i f I sa y
something--I should never say anything lik e t h a t,
b e c a u s e , th en she g e t s a l l , she sa y s, I j u s t
d on't l i k e e x p r e s s i o n t h a t way. I t ' s d i f f i c u l t
f o r her.
A f t e r g r a d u a t i n g from high s c h o o l , Helen went to a
l o c a l c o l l e g e where her f a t h e r t a u g h t . During her j u n i o r
year at c o l l e g e th e b u l i m i a s t a r t e d . She t r i e d very hard
t o become what her f a t h e r wanted. She got a l l "A"s. She
had to prove to her f ath e r t h a t she was decent. Helen also
had a r e l a t i o n s h i p with a man th a t year, eight years older
than h e r s e l f , who, a f t e r declaring his love to her "dumped"
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j h e r b e ca u se she was too c o g n i t i v e and w a s n ’t e m o t i o n a l
enough. He t o l d her t h a t she was too much l i k e him, too
d e ta c h e d and c o g n i t i v e and b r i g h t . He s a i d he wanted a
woman. I t was then th a t Helen decided to take 20 un its in
s c h o o l and worked 20 h ours a week and ran si x m i l e s a day.
Helen c o m p le te d her c o l l e g e in a p r i v a t e e a s t e r n c o l l e g e
a f t e r which she returned to the west and began therapy with
me. During her f i n a l year of c o l l e g e she was a l r e a d y
beginning to make some sense out of her l i f e .
P r e s e n t l y , Helen is p l a n n i n g a m a r r i a g e to a very
c a r i n g man. Even though at t i m e s she has f e a r s about her
r e l a t i o n s h i p w i t h her f i a n c e e , she f e e l s " h e a l t h y ” and
ready to begin a l i f e with him.
H elen’s Description of Her Lebenswelt
I was a problem c h i l d . I d i d n ’t want to get
b e tt e r . Getting b e t t e r meant g e ttin g along with
them ( p a r e n t s ) . I d i d n ’t want to at t h a t p o i n t .
I d i d n ’t want them to t h i n k I was okay, e i t h e r .
G e t t i n g b e t t e r w o u ld mean b e i n g s u c c e s s f u l
according to what they thought was successful. I
would have had to get s t r a i g h t "A"s, to not l i k e
boys, to not have b r e a s t s , to not have a s o f t
voice. I remember p r a c t i c i n g at night lowering my
v o ice . To be what th ey wanted was not being a
g i r l a n y m o r e . I l i k e d b e i n g a g i r l . To be
acceptable I would have to be a t o t a l l y cognitive
p e r s o n .
The f i r s t t i m e t h a t I induced v o m i t i n g was a
f r a n t i c kind of parent f e e l i n g — punitive. I was
a g o v e r n e s s f o r t h i s very w e a l t h y f a m i l y . They
own a m arket so at t h e i r house t h e r e was food,
food, food. When I t h i n k of b a b y s i t t i n g I t h i n k
of eating. They also had t h i s medicine to induce
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vomiting, a f t e r you have had an overdose of some
kind of drug. I had t r i e d v o m i t i n g w ith my
finger but I couldn't so I j u s t used t h i s b o ttle .
I had my u s u a l s a l a d lunch and then tons of
donuts. And I f e l t s i c k and d i s g u s t e d w ith
myself. And then I went to the m i r r o r — they had
a powder room w i t h m i r r o r s a l l around. And I
took o f f my p a n t s , and I t h o u g h t you are j u s t
d e s p i c a b l e . I used a l l of th e syrup to induce
v o m i t i n g and then c a l l e d the drug s t o r e and had
them d e l i v e r a n o t h e r b o t t l e . The n e xt t h i n g I
did was I went to t h r e e or four T h r i f t y ' s in town
and I bought a b o t t l e at each and k e p t i t in my
underwear drawer.
I w ould p l a n when I c o u l d b i n g e and i n d u c e
v o m i t i n g cause I knew my roommates w o u ld n 't be
home. When t h e y would, I would t e l l them I had
t h e f l u or i t was my p e r i o d and I d i d n ' t f e e l
good. I t ' s a w fu l. I always bing ed on b rea d y
t h i n g s . I t would t a k e , i f I'd d r i n k i t , i t ' d
p r o b a b l y t a k e 45 m in u t e s . Or I'd be l y i n g down
w i t h j u s t , l a y i n g down w ith j u s t t o t a l nausea.
T o ta l. And then I'd vomit. And th en i t t a k e s
about 12 to 15 hours of bed t i l l I could f e e l
okay a g ain . I t would t a k e me about a day to
recover. That was the f i r s t year.
Then I moved back home. I t h i n k I on ly induced
v o m i t i n g i n t e n t i o n a l l y once t h a t summer. But
th en I got more i n t o l a x a t i v e s . Cause i t was
s a f e r l i v i n g at home. I'd have a binge about
f i v e days a week. Cause I was s u r r o u n d e d by
food. I'd probably go through a pack of Ex-Lax a
week. Sometimes I'd be up to six or twelve a day
of Ex-Lax. There a g ain . B a b y s i t t i n g . Being
around b a b i e s . Gets me f r u s t r a t e d , and I ten d to
e a t .
I t e a c h a c l a s s at church. Each week I t h i n k ,
Helen, how dare you even t h i n k you could do t h i s
cause you're so lousy at i t . You're embarrassing
th e whole group. I s i t t h e r e and I f e e l s o r r y
f o r th em . B e c a u s e t o me, I f e e l t h e y ' r e
embarrassed for me and they're j u s t coming cause
t h e y f e e l s o r r y f o r me and I t h i n k , oh, you poor
p eo p le , you know, I can t a k e i t . Why don't you
ju s t t e l l me you've r e a l l y not i n t e r e s t e d and I'm
doing a l o u s y job and you don't need to w a ste
your t i m e h e re anymore. I e n jo y b eing asked to
do t h i n g s t h a t I never im agined I would do. And
yet, through the process I c o n tin u ally think I'm
f a i l i n g at i t.
I t doesn't f i t together yet for me. I don't lik e
dualisms, I mean we see our world in dualisms a l l
th e t i m e , th e two s t r o n g p a r t s of who I am a r e ,
th e dumb, cheer l e a d i n g , baby-m aking, b r e a s t e d
Helen, v e r s u s th e c o g n i t i v e , c o n f i d e n t Helen.
And when I got "A"s at c o l l e g e , I knew t h a t the
t e a c h e r s f e l t s o r r y f o r me be ca u se of my Dad.
When I went to c o l l e g e in the e a s t I got "A"s. I
didn't know what to do about th at. I t ju s t can't
be r i g h t . I d o n ' t know how t o f i t i t a l l
t o g e t h e r .
This Saturday I ate one cookie. I t was very much
a physical need of sugar. Once I had the cookie,
i t was l i k e a more p h y s i c a l need than i t ever was
b e f o r e . Then I was more r a t i o n a l . I must have
e a t e n s i x or e i g h t c o o k i e s , and then l a t e r on I
a t e s i x or e i g h t more, cause I baked c o o k ie s .
But I w a s n 't s a y i n g to m y s e lf , you j e r k , you've
got to e a t , you know, a l l t h a t . I n o t i c e d t h i s
t i m e I w a s n ' t s a y i n g , y o u ' r e f a t , y o u ' r e a
f a i l u r e , you're a louse. I was saying, wow, you
r e a l l y c a n ' t t a k e su g a r . Your body c a n ' t t a k e
i t , i t ' s dangerous and t h e r e f o r e you shouldn't do
i t . I'm d e p r e s s e d , I s h o u l d n ' t have done i t .
I ' l l have to make up f o r i t tomorrow. I f e e l
angry. I f e l t t h o s e t h i n g s but i t w a s n 't the
s e l f - d e g r a d a t i o n . When I w e n t home I t r i e d
t h r o w i n g up, b u t I s a i d no, t h i s r e a l l y i s
p a i n f u l , I do not need to do t h i s . So i t was
v e r y d i f f e r e n t . A f t e r L i s a d i e d i t was
d i f f e r e n t . That was what I would c a l l my binge
of emotional s t r e s s and lack of control.
The day Lisa died Vern came over and t o l d me she
had died. No, he t o l d me on th e phone. And I
was a l l by m y s e l f , and I t h o u g h t , s h i t , he
d o e s n ' t even t h i n k about where I might be and who
I might be w i t h . I'm j u s t by m y s e lf . Then he
came down and p ic k e d up t h e paper and d i s c u s s e d
L i s a ' s d e a t h v e r y c o g n i t i v e l y . ( L i s a was a
f r i e n d of H e le n 's ) I knew when Mom and Dad got
home I c o u l d n ' t cry w i t h them. I j u s t d i d n ' t
know what to do. I c a l l e d Brian ( f i a n c e e ) but I
didn't express how sad I was. I f e l t very out of
c o n t r o l . T h e r e 's no c o n t r o l over l i f e .
I c a n ’t c o n t r o l a n y t h i n g about my l i f e . I was
p h y s i c a l l y hungry. I h a d n ’t e a t e n . So I s a i d ,
w e l l , I ’l l l e t m y s e lf e a t a bowl of c e r e a l . And
a bowl of c e r e a l and a bowl of c e r e a l and a bowl
of c e r e a l and a bowl of c e r e a l and a bowl of
c e r e a l . And t h i s and t h a t , I c a n ’t even
remember. I f e l t s i c k , I f e l t awful and I j u s t
was c r y i n g , and I kept e a t i n g and c r y i n g and
eating and crying. And I knew t h a t the next b ite
d i d n ’t t a s t e good, but I d i d n ’t have to t h i n k
w h i l e I was e a t i n g , cause I ’d t h i n k , what am I
going to e a t n e x t ? I did not t h i n k about L i s a ’s
d e ath as long as I was e a t i n g . And th en I f e l t
s i c k so I could t h i n k about how p i s s e d o f f I was,
how mad I was, how f a t I was, I d i d n ’t have to
think about L i s a ’s death. And then the next day,
of c o u r s e I f e l t s i c k . I woke up and my eyes were
glued s h u t , j u s t t h a t look of how you look when
you h a v e n ’t s l e p t . I t ’s a f e e l i n g of no c o n t r o l .
I j u s t c a n ’t c o n t r o l my world. I c a n ’t c o n t r o l
my l i f e , I c a n ’t c o n t r o l my w o r l d , I c a n ’t
c o n t r o l my e m o t i o n s , I c a n ’t c o n t r o l who I am, my
p a s s i o n s . E a t i n g i s an u n c o n t r o l l e d way of
c o n t r o l l i n g . The b i n g e i s n ’t e x p l i c i t l y
c o n t r o l l e d , b u t i t ’s a way o f c o n t r o l l i n g
something more important.
I t e l l B rian t h a t a f t e r we’re m a r r i e d , i f I have
t o t e l l you I ’ve b inged, what t h a t means i s what
I r e a l l y needed was to ta l k , about an emotion or
to cry. When I binge i t means t h a t I ’m u p se t.
I ’ve t h o u g h t a b o u t t h i s a l o t . T h e r e i s an
i n c r e d i b l e t e n s i o n and a n x i e t y in my l i f e . I ’ve
t r i e d to f i g u r e , i s i t th e d a i l y t h i n g s you have
to get done? No. Is i t marriage, r e l a t i o n s h i p s ,
f a m i l y , n o - - i t ’s t h e o l o g i c a l . I am so a f r a i d of
my t h e o l o g i c a l q u e s t i o n s r i g h t now. And i f I’m
wrong, I’m going to h e l l . And L i s a ’s d e a t h , fo r
e x a m p l e , makes you t h i n k a b o u t t h e o l o g i c a l
q u e s t i o n s , and i f I would have d ied t h a t day,
would I go t o heaven or to h e l l ? I am so a f r a i d ,
a f r a i d o f h e l l , t h a t I’m wrong, I’m going to
h e l l . Death is r e a l l y very much a p a r t of the
t h i n g t h a t I ’m t r y i n g t o run away from. I ’ve
t r i e d to make m y s e lf so busy t h a t I c o u l d n ’t
think about th e o l o g i c a l things. That’s what I ’ve
caught myself doing. I r e a l iz e d that I was doing
th a t up u n t i l t h i s past week. What’s the purpose
of my l i f e ? What’s th e p o i n t ? All t h i s t i m e , I
thought the whole prince syndrome, my meaning in
l i f e would come when I was engaged. Now, you
know, a c t u a l l y , no. I alw ays knew t h a t was
s t u p i d e v e r s i n c e I b e ca m e a f e m i n i s t . But
somehow t h a t was s t i l l th e r e a l i t y t h a t would
give me pu rp o se in l i f e . Well t h a t ’s b u l l . I
s t i l l have to f i n d th e meaning in l i f e . I j u s t
don’t know how to f i t the b ullc rap of the church,
and the new u n d e r s t a n d i n g s I have of t h e B i b l e ,
e s p e c i a l l y t h e q u e s t i o n s o f i n t e r p r e t a t i o n .
E i t h e r God is so big t h a t we’re a l l r i g h t , or
t h e r e ’s only going to be s i x peo p le going to
heaven and I might not be the one. E i t h e r I can
r e l a x and say w e l l God i s . . . i n my mind I r e l a x .
God i s a huge god. God not only is God, but God
is the g r e a t e s t s o c i o l o g i s t . God is the g r e a t e s t
psychologist and God r e a l i z e s we understand l i f e
from our own l i t t l e s e l v e s . And God’s j u s t got
to understand where we’re coming from. Otherwise
God i s n ’t God. In my h e a r t , in my s o u l , I ’m
t h i n k i n g , I d o n’t have d a i l y d e v o t i o n s in th e
morning w i t h my c a n d l e , and t h a t ’s what y o u ’ve
got to do, and I was a bad c h i l d , and I ’m s t i l l
angry at my parents. See, t h a t ’s why i t was hard
f o r me, t h a t , and a man’s touched my b r e a s t s and
I ’m n o t m a r r i e d , and I ’m a f e m i n i s t , and I
q u e s t i o n t h e r e s u r r e c t i o n , I q u e s t i o n t h e
v i r g i n i t y of Mary, and I might j u s t as w e l l go to
h e l l i f I die to day . In my head, God is yes
fa t h e r , God is yes mother, and God is also always
other things much bigger. And I often imagine God
as b e in g a womb. And t h a t t h e e a r t h is w i t h i n
t h e womb and i t ’s s e p a r a t e . And God is t h e
n u rtu rin g flow. But t h a t doesn’t erase 23 years
of experiencing God as the male parent. And then
I f e e l bad b ecau se y o u ’re l o o k in g a t me w i t h
s y m p a t h y .. .okay empathy, maybe, I f e e l l i k e i t ’s
okay f o r me to f e e l t h i s way w i t h you, okay? I ’m
f e e l i n g t h a t i t s h o u l d n ’t be okay because I have
no r i g h t to fe e l t h i s way. Because my childhood
w a s n ’t t h a t bad and l i f e i s n ’t t h a t bad. They
t o ld me a l l those years t h a t I was overreacting.
I was playing the martyr.
I d o n ’t want to a c c e p t t h e a s s e s s m e n t of o t h e r s .
All these years I could hide behind being stupid
and be ing u g ly and b e in g f a t , and now to s t a r t
r e c o g n i z i n g t h a t t h e s e t h i n g s a r e n ’t t r u e , is
more fr ig h te n in g , and more t h r e a te n i n g than being
s t u p i d . Then i t m e a n s I h a v e t o t a k e
r e s p o n s i b i l i t y for my successes and my f a i l u r e s .
When y o u ’re s t u p i d , y o u ’re not going to succeed
anyway, so why t r y ? But I have p o t e n t i a l . I
know t h a t now. I have p o t e n t i a l , to r e a l l y be
who I want to be.
I t ’s e x c i t i n g . Sometimes I j u s t t a k e walks and
go, ’’I ’m not dumb, I ’m...” I c a l l i t my own
l i t t l e party, no one has to know how stupid they
are. They’re not s t u p i d . They’re good, t h e y ’re
happy. Or I ’l l s t a n d in f r o n t of th e m i r r o r and
I have big h i p s and big t h i g h s , and t h a t ’s okay.
I ’m j u s t a good s t r o n g woman. I b e t I can do
more s i t u p s than anyone I know. I t f e e l s good.
And y e t, then I go, no, no, no, no, no, no. Look
a g a i n , look a g ain . You a r e n ’t, i t i s n ’t okay.
I t ’s t h r e a t e n i n g to me to g e t on th e s c a l e and
say, so, you weigh 142, big d e al. No, no, no, no,
no, no. You c a n ’t, t h a t ’s not okay, d o n’t. I
don’t want to lose touch with being emotional and
b e i n g w i t h p e o p l e . Even in c l a s s when I ’m
t e a c h i n g . I d o n ’t l i k e t o be t h a t c l a s s i c
p rofessor t h a t distances himself. I p a r t i c i p a t e ,
I r e v e a l m y s e lf , and I ’m e m o t i o n a l and I laugh
and then I go home t h i n k i n g , t h a t i s not a good
p r o f e s s o r . A good p r o f e s s o r d o es n o t have
emotions.
When you give someone power, t h e y ’l l t a k e i t
whether they want to or not. And three years ago
I gave Dad t h i s much power. He was up th ere , and
I ’ve been s l o w l y c h i p p i n g away a t t h a t . And i t ’s
b r o u g h t him down. He, he r e s p e c t s me way more
now than he ever has. And I s t i l l want h i s
a p p r o v a l so bad. I s t i l l need h i s a p p r o v a l so
d e s p e r a t e l y . I know, as long as I ’m who I want
to be, I won’t . Cause I want to love k i d s . I
want t o e x e r c i s e . I want to wear makeup. I want
to no t wear makeup when I d o n ’t want to. I want
to hug and t o me he c a n ’t , t h a t won’t ever be
w h a t i s g o o d and r i g h t . B e c a u s e h e ’s
uncomfortable with that. At the same time I have
had t h i s i n c r e a s i n g se n se of h i s awe of me, and
his jealousy.
How does a p e rs o n l i k e me, how do I s t o p b eing
o b s e s s e d w i t h what I e a t ? When am I normal and
when am I b u l i m i c ? When do I g e t to be j u s t a
normal person who is t r y in g to lose a l i t t l e b i t
more weight and when am I...is i t lik e alcoholism
t h a t you never are over i t ? B u l im i a , t h a t word
98
is so n i c e . That word is a word t h a t I t h i n k
brings comfort to bulim ics, cause then they have
a problem . I want to have a s i c k n e s s . Because,
then I r e a l l y f e e l t h a t ’s when I get a t t e n t i o n
from Mom and Dad. Mom w i l l go out of her way to
buy me groceries th a t are sp ecial for me and she
asks me how my s i c k n e s s i s . I t ’s i m p o r t a n t to
have a word f o r i t . To have i t . But I ’m r e a l l y
g e t t i n g s i c k of i t . I t h i n k I u n d e r s t a n d why
i t ’s so c o m f o r t a b l e and so n i c e , but I ’m j u s t
g e t t i n g r e a l l y t i r e d of i t . I t ’s b o r i n g , i t ’s
i m p r i s o n i n g , i t ’s f r u s t r a t i n g , i t ’s demeaning,
i t ’s m a n i p u l a t i v e of m y s e lf and of o t h e r s . I
j u s t d o n’t want i t anymore. P a r t of me does,
though. The p a r t t h a t ’s an e xcuse, an excuse
f r o m l i v i n g l i f e f u l l y , f r o m t a k i n g
r e s p o n s i b i l i t y .
This weekend I went to see Ruth and we watched
film s on nuclear ho locast, and kids responses to
nuclear, the t h r e a t of nuclear d e str u ctio n . And
t h a t w o u l d h a v e b e e n a t i m e , h ad I t h e
o p p o r t u n i t y , where I would have j u s t loved to
binge. What I was f e e l i n g w as...I j u s t c a n ’t
t a k e t h i s . T h e r e ’s no, I have no o p t i o n , i t ’s
j u s t h a ppening to me. I j u s t have no c h o i c e , I
might as w e l l j u s t g ive up and e a t . I have no,
i t ’s j u s t not f a i r and I have no, no power, no I
j u s t d o n ’t want to d e a l w i t h i t . And i f I, as
long as I put food in my mouth I d o n ’t have to
d e a l w i t h i t . And se e , I ’m a f a i l u r e anyway, I
c a n ’t even do t h i s r i g h t . All I have to do i s
not e a t and I c a n ’t even do t h a t r i g h t . I t ’s
such a s i m p l e t h i n g , j u s t sh u t your mouth. See,
you can ’t even do i t . All these things happen to
me, I j u s t have no c h o ic e . I am th e v i c t i m .
I t ’s a way of b e in g i r r e s p o n s i b l e . Poor Ruth,
she c a n ’t do a n y t h i n g about i t e i t h e r . I wish I
c ould h e lp h e r , but she c a n ’t e i t h e r . I ’m angry
at her, cause sh e ’s doing something about i t , and
I ’m n ot. At l e a s t s h e ’s work ing a t t h e r e s o u r c e
c e n t e r , and I ’m n o t , t h a t shows I ’m j u s t not
coping with i t as good as she is, and t h a t pisses
me o f f . S h e ’s my l i t t l e s i s t e r . S h e ’s doing
so m e th i n g about i t . But you know what? I love
to watch her. I want her to have b u l i m i a too,
and t h a t ’s r e a l bad f o r me to f e e l t h a t . That
she, she’s s t a r t i n g to r e a l l y show some symptoms,
ever since her boyfriend r e j e c t e d her, and s h e ’s
g e t t i n g more and more i n t e r e s t e d in b u l i m i a and
s h e 's f a s t i n g fo r two days and then p i g g i n g out,
and I enjoy t h a t . I made b i s c u i t s , and I wanted
to watch her e a t t e n of them so t h a t when I a te
t h r e e I was b e t t e r . I f e e l bad but t h a t ' s the
t r u t h . I want someone e l s e to f e e l th e same
s t r u g g l e as I do. So t h a t then we t a l k about i t
t o g e t h e r . I want s o m e o n e t o s h a r e i t and
u n d e r s t a n d i t w i t h me. And t h a t n i g h t I wanted
to watch her pig out for me.
T h e r e ’s such a p r e s s u r e to produce. She's doing
something physical, ta n g i b l e , m a t e r i a l, about the
s i t u a t i o n . S h e ’s p r o d u c i n g at l e a s t so m e th in g
w e i g h a b l e . I f e e l judged by my p a r e n t s and God
because I ’m not p r o d u c in g . I ’m r e a l i z i n g t h a t I
do some t h i n g s r e a l l y w e l l . T h a t ’s good. But
th e t h i n g s t h a t I do w e l l are not p r o d u c t s t h a t
you can see. They are not things t h a t I can hold
up and say, look, t h i s i s what I do w e ll. Ruth
does t h i s , Dad does t h i s , Mom does t h i s , B rian
does t h is . I do th is . I t ’s much more ambiguous.
And t h a t is hard to be proud of. In my f a m i l y
y o u ’ve got to be a t i t l e , a l a b e l , a grade, a
G F A, a t h i n g . I t ’s got t o be s o m e th in g you can
see or hold. So I do b u l i m i a . T h e r e ’s o t h e r
t h i n g s I want t o do now. I ’m s i c k of t h a t . I t ’s
j u s t , at the same time i t ’s hard for me to accept
t h a t you can a c c e p t me w i t h o u t t h a t . I won’t
have an i d e n t i t y then. See, I w i l l no l o n g e r be
the problem child.
S o c i e t y p e r p e t u a t e s much more of a d e s i r e to be
t h i n . I t h i n k t h a t ’s r e l a t e d to t h e w h o l e
h o p e l e s s n e s s t h a t we f e e l , t h e d e s i r e to s t a y
young, to concentrate on the i r r e l e v a n t . I don’t
even im a g ine t h a t B rian and I w i l l ever t a l k
about g r a n d k i d s , much l e s s my c h i l d r e n l i v i n g
t i l l t h e y ’re t e n . I c u t o f f my daydream ing of
our f u t u r e t o g e t h e r at about 26. T h a t ’s where I
see i t end ing. And I dream a l o t about l i f e
e n d i n g . . . a b o u t m u rd ers, about my c l o s e f r i e n d s
dying, about th e world coming to an end. And I
think t h a t ’s a lot r e l a t e d to my fear of God, the
ju dg m e n t, and b eing i r r e s p o n s i b l e w i t h n u c l e a r
s t u f f . Here I am, not even doing a n y t h i n g to
s t o p t h e madness, and a r e a l f e e l i n g of l o s s of
c o n t r o l . Because, so what i f Mom and Dad are on
t h i s l e v e l r i g h t h e re of judgment. Above and
beyond i t is th e n u c l e a r t h i n g t h a t I f e e l a
t o t a l l o s s of c o n t r o l . I can l e a r n to overcome
what Mom and Dad t h i n k of me. But beyond t h a t I
cannot control my destiny. And t h a t is t e r r i b l y
f r i g h t e n i n g . The f e e l i n g of n e e d in g to e a t is a
way of not p e r m i t t i n g m y s e lf to t h i n k of th o se
fee lin g s . I j u s t think about what the next thing
is going to t a s t e like.
The stro n g e st fe e lin g th a t leads me to bulimia is
d e s p a i r , because i f I'm f e e l i n g d e s p a i r , then I,
l i k e say, okay, where I used to work t h e r e were
Oreos. T h a t 's what I remember the most when I
was g o v e r n e s s . I t h i n k , I ' l l j u s t go e a t one
Oreo. I deserve an Oreo. Knowing f u l l well what
I was headed i n t o . Knowing f u l l w e l l t h a t I'm
going to go th ro u g h a binge now. And t h a t ' l l
f e e l so good fo r about th e n ext 45 m in u t e s , not
to t h i n k of w ha t's c a u s i n g t h i s d e s p a i r . And I
went, oh, oh, oh, I ' l l have to get a n o t h e r , ha,
ha, ha, ha, you'r e a f a i l u r e , e a t a n o t h e r , oh,
d o e s n ' t t h i s f e e l good? I t f e e l s a w f u l , I'm
m i s e r a b l e . Why am I doing t h i s to m y s e l f ? Oh,
but I ' l l eat another one, because I don't want to
t h i n k about how awful I f e e l . On and on and on,
and t h e r e ' s a donut, oh, I'm s i c k of Oreos. Oh,
now t h a t I 'v e blown i t , might as w e l l e a t one
donut. On and on and on. Oh, two d on u ts. I've
blown i t , might as well eat three donuts. Yeah,
you're a f a i l u r e , might as well go for four. Oh,
I f e e l s i c k . Well, I ' l l e a t a n o t h e r one cause
tomorrow I won't, I won't e a t at a l l , and I ' l l be
hungry and I b e t t e r eat a n o t h e r one. So I could
e a t e i g h t d o n u t s , and t h e n - - o n c e I f e l t so s i c k
and so s tu ffed th at I couldn't deal with one more
t a s t e , then I could avoid th e d e s p a i r , see,
because I'd spend the next s ix hours t h i n k i n g
about how bad I f e l t fo r what I a t e . W r i t i n g how
many c a l o r i e s over and over a g a i n , t r y i n g to
e s t i m a t e how many c a l o r i e s . How am I going to
deal w ith t h i s ? Tomorrow I ' l l have to run, no,
t h a t won't f i t in. I could spend th e ne x t s i x
hours then d e a l i n g w i t h th e binge. Oh, good. I
d o n 't have to d e a l w i t h Problem A. The cause of
t h e d e s p a i r . So i t ' s a b o u t t w e l v e h o u r s of
freedom.
I'm in a t r a n s i t i o n w i t h so many t h i n g s . With
myself being one versus the other. The old me is
a d i p s h i t , a i r h e a d , cupcake c h e e r l e a d e r . Can't
do a n y t h i n g r i g h t . Talks in t h i s high voice. I
even have two d i f f e r e n t v o i c e s when, how I'm
dealing with people, and I learned t h i s voice in
high sc h o o l. And s h e ’l l get m a r r i e d when sh e 's
18 or 19 and have k id s r i g h t away, cause she
r e a l l y can’t do anything else anyway. She's very
e m o t i o n a l . I r r a t i o n a l . Loses her keys, j u s t a
r ea l loser. Real insecure loser. And t h a t ’s the
way s h e ’l l be, s h e ’l l make i t in l i f e by s e l l i n g
h e r s e l f , s e l l her body, to s e l l her, her mind. To
s e l l her being. T h a t ’s her way of s u r v i v i n g .
Compromise. And she is responsible, her goal in
l i f e is to make someone else happy. And through
t h a t , h o p e f u l l y she can be happy. She does t h i s
by cooking th e r i g h t t h i n g s . Keeping a p e rso n
s a t i s f i e d s e x u a l l y . K e e p i n g h i s ego f e d ,
p r o v i d i n g f o r her c h i l d r e n . Giving s u r p r i s e
b i r t h d a y p a r t i e s f o r her f r i e n d s . Being a good
l i t t l e g i r l , not s a y i n g or t h i n k i n g a n y t h i n g
t h a t ’s d i f f e r e n t . That was how I used to see
myself and a l o t of me s t i l l does.
The other person is so rt of aloof, proud, has her
s h i t t o g e t h e r . She can le a d d i s c u s s i o n s , she
can, i t ’s j u s t no sw ea t. And t h o s e o t h e r peo p le
out there t h a t have problems, well, they, t h e y ’re
j u s t in the cheerleaders...you know, they're t h i s
kin d of perso n I d e s c r i b e d b e f o r e . And then so
what i f they have problems? You know, i t ’s very
d i s t a n t . I t ’s very r e v e n g e f u l . I want t o get
revenge on t h o s e , th e p e o p le t h a t put me t h e r e .
So anyone who’s t h e r e - i s h . . .I j u s t give them h e l l
l i k e I f e l t i t .
Then t h e r e ’s th e p e rs o n in th e m id d le who c a n ’t
under stand...why t h a t has to be. Why...it j u s t
d o e s n ’t make se n s e . Makes no se n se t h a t , t h a t
I ’m d o i n g a l l t h e s e t h i n g s . I j u s t d o n ' t
u n d e r s t a n d how me, d i p s h i t can do t h e s e t h i n g s
t h a t I ’m doing. I t d o e s n ’t , i t c a n ’t be r i g h t .
S o m e t h i n g ’s got t o be wrong. I t c a n ’t be r i g h t
t h a t people l i k e me. I t c a n ’t be r i g h t t h a t I ’m
c o m p e te n t . I t c a n ' t be r i g h t t h a t I ’m doing
s o m e th in g w e l l . I t j u s t c a n ’t be. Makes no
sense. This is the one t h a t binges. It would be
e a s i e r fo r me to f i t one or the o t h e r , to s l i d e
i n t o one t r a c k or t h e o t h e r and t u r n o f f my
emotion completely.
The one in t h e m id d le i s more, r e a l l y what I ’m
becoming. I mean, well, the other, the good, the
good middle part. The good middle p a rt is t h a t I
can say yeah, I want to t e a c h t h i s c l a s s at
c o l l e g e . But I d o n ' t w a n t t o t e a c h i t in a
s t a n d a r d , s t e r e o t y p i c a l way. So I d i s c l o s e
m y s e lf . And I say t h i s i s what I 'v e read and
t h i s i s how I'v e e x p e r i e n c e d t h i n g s , and t h i s is
t h e d i f f e r e n c e , and I want to s h a r e m y s e l f w i t h
you. T h a t 's b a s i c a l l y what I'v e done in t h a t
c lass, and I think i t ' s gone r e a l l y well. So the
s u c c e s s f u l p a r t of me is in t h e m iddle to o , and
t h a t p a r t of me d o e s n 't know what to do. Wow,
a l l of a sudden, I'm okay. I'm p r e t t y n e a t . Oh!
How do I d e a l w i t h t h a t ? T h a t's so s c a r e y .
Doesn't make sense y e t . I need to e x p e r i e n c e
more of t h a t before i t s t a r t s a c t u a l l y being r eal
enough to make sen se of me. I'm a f r a i d i t ' l l go
away. I'm a fra id I'm wrong.
I f I b e l i e v e t h a t r e a l l y i t might be t r u e . . . s e e ,
I have t h i s f a n t a s y t h a t pe o p le pay, you know,
p e o p le , my p a r e n t s paid Brian to be engaged to
me. My p a r e n t s pay you t o l i k e me, and my
p a r e n t s , b e ca u se i t ' s a l l a f a n t a s y . And i f I
l e t m y s e l f r e a l l y b e l i e v e i t , I'm in t r o u b l e
b e ca use i t m ight not be t r u e . And maybe th e
reason t h a t you lik e me and see any p o t e n t i a l in
me i s c a u s e y o u ' r e j u s t as j e r k y as I am.
There's got to be a catch. People th a t I respect
c a n ' t r e s p e c t me. E i t h e r t h e r e ' s g o t t o be
s o m e th i n g wrong w i t h them or someone's paying
them o f f somehow. They're g e t t i n g something out
of i t . Free, free resp ect and mutual friendship,
t h e r e ' s got to be a n i t c h somewhere. Or you
could be j u s t as nerdy as I am.
When I walked in th e door a f t e r l a s t t i m e , Mom
s a i d , "Well, i s your s i c k n e s s over?" In some
ways i t ' s r e a l l y i r r i t a t i n g . I want her to
n u r t u r e me in th e a r e a s I t h i n k are i m p o r t a n t ,
l i k e f e e l i n g sad over l e g i t i m a t e t h i n g s , l i k e
Lisa's death. Or nuclear war. Not nurture me by
bu ying me t h e s e s t u p i d foods. I t ' s t h e wrong, I
want to p u l l away from t h a t . T h a t 's not where I
want to stay anymore. Don't concentrate on th at
s t u p i d b u l i m i a a n y m o r e . I w a nt t o be h e r e
b e ca use I'm sad about Lisa. Not because you
didn't buy hoop cheese.
J u s t be ing in a f a m i l y and b e in g "loved" as a
child, you believe that. I f over and over again,
you a re t o l d t h a t you a re not r e a l l y a c c e p t e d ,
l i k e i f th e words say a c c e p t i n g words, th ey are
a c c e p t i n g words fo r you, and yet over and over
a g a i n you a r e t o l d in many ways y o u ’re n o t
a c c e p t e d , y o u ’ve been t r i c k e d . That i s such a
f e a r . Like when I l e f t to go e a s t to c o l l e g e , I
had a l o t of good f r i e n d s . And then as soon as I
got back h e r e , I knew t h e r e was a c o n s p i r a c y
about me. I t was a l l a t r i c k . They’re making
fun of me now and j u s t l a u g h i n g , ha, ha, ha. I
w rote to Evelyn and asked her, you know, I s a i d ,
every time I move I feel t h e r e ’s a conspiracy. Is
there anything going on out there? People saying
bad t h i n g s about me. I get caught up on, h e re
comes th e t r u s t w ith you and me. I t h i n k to
m y se lf , okay, what does Kathy t h i n k of a l l t h i s
as I ’m t e l l i n g h e r t h i s ? She p r o b a b l y
i n v a l i d a t e s what I ’m s a y i n g too. Even as I t e l l
you t h i s , I f e e l f o o l i s h . Like I ’m blow ing
everything out of proportion and you know i t , and
y o u ’re l a u g h i n g at me. Because y o u’ve got to
f i n d out what a nerd I am. You’re go ing to f i n d
out what a j e r k I am sooner or l a t e r . I t ’s l i k e
I liv e in a facade. I ’m fooling these people th at
I ’m r e a l l y an okay p e rs o n , and t h e y ’ve got to
find out t h a t I ’m not. Because they l i k e me. So
there must be a catch.
I w i s h i t d i d n ’t h a v e t o be t h i s way. I t ’s
t e r r i b l y p a i n f u l to t r u s t p eo p le. And to f e e l
t h a t any t i m e I t u r n t h e c o r n e r I m i g h t be
r e j e c t e d . I t ’s s c a r y . And i t ’s s c a r y to t r u s t
my opinions. I think I have experienced too much
p o s i t i v e in th e p a s t few y e a r s to not b e l i e v e
t h a t I ’l l c o n t i n u e d o i n g so. And t o n o t . . . I
b e l i e v e t h a t i t ’s a p r o c e s s of growth, and I ’m
going to l i c k t h i s thing.
I f e e l r e a l t o r n betw een s o m e th in g t h a t I f e e l is
n a t u r a l fo r me, and r e a l at the core of who I am,
and then what I t h i n k would make them ( p a r e n t s )
approve of me. I have often thought of the way I
p r o s t i t u t e m y s e lf . T h a t ’s th e word I use. I ’m
my dad’s p r o s t i t u t e . And more and more my mom’s.
I ’ve seen t h a t more and more. How she uses dad
for an excuse to manipulate us.
I was t r y i n g to t h i n k in th e c ar how I would
e x p l a i n t h i s t o you. I f you s e e i t as a
s i c k n e s s , th en y o u ’ve got to get h e a l t h y . I ’ve
got to get h e a l t h y . And I see i t more now as a
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way of dealing with something. That I can choose
not to do, or choose to do, or do in d i f f e r e n t
varying degrees. In some ways I ’ve r e a l l y liked
being bulimic. I t gives me an i d e n t i ty . I t gave
me a way to get back at them, to throw in t h e i r
face. I t ’s a l s o been good to know t h a t I ’m not
the only one. That there is such a thing, called
b u l i m i a , t h a t i t ’s not s o m e th i n g t h a t a p erson
makes up in t h e i r head, but i t ’s, I have been
b u l i m i c be cause of r e l a t i o n s h i p s . I t ’s not,
t h e r e ’s a r e a s o n f o r i t . And i t ’s p r o b a b l y
s o m e th i n g , w e l l , t h e r e ’s r e a l a m b i g u i t y of when
you are and when you a r e n ’t. If someone asked me
r i g h t now i f I was b u l i m i c I would say no. I
would say t h a t I t h i n k t h a t as many women in my
g e n e r a t i o n , I d i s l i k e my body, and I f e e l a l o t
of p r e s s u r e to look d i f f e r e n t l y th an I do. But
I ’m not b u l i m i c . T h a t ’s what I would say. I ’m
not p e rp e t u a l l y thinking about i t the way I used
t o . I'm n o t s h o w i n g s i g n s o f , I t h i n k , I
s t r u g g l e w i t h how I f e e l about my body, but I ’m
not b u l i m i c . Like, th e o t h e r day I walked four
m i l e s and th e whole way I d i d n ’t t h i n k once,
u n t i l the very end, about my figure. I thought,
what a victory. I've never done t h a t before.
The o t h e r day I t o l d Mom and Dad so m e th in g r e a l
i r r e l e v a n t as f a r as I was c o nce rn e d and Mom
s a i d , so you're going to blame t h a t on us too.
Because she r e a l l y p i c k s up on how I l i k e to
blame e v e r y t h i n g t h a t ' s wrong in my l i f e on my
c h il d h o o d . Like I r e a l l y dance th e m a r t y r ' s
dance. I t ' s r e a l p r o t e c t i v e fo r me. Because
then I don't take r e s p o n s i b i l i t y for my choices.
I think the hard thin g about t h a t is, I feel like
in o r d e r to do t h a t , I have to deny t h e i r e f f e c t
on me. And I don't want t o l e t go of t h a t yet.
I f e e l l i k e to t a k e r e s p o n s i b i l i t y for who I am
to d a y , and not play the m a r t y r , I f e e l l i k e th e
only a l t e r n a t i v e t o t h a t i s sa y i n g , i t was a l l my
f a u l t and I have to take r e s p o n s i b i l i t y for those
c h o i c e s . And i t ’s e i t h e r a l l my f a u l t and I was
a f a i l u r e and I am a l o u s e , or i t ' s a l l t h e i r
f a u l t and th ey did t h i s to me. I t ' s hard f o r me
t o see a n y t h i n g o t h e r than t h o s e two o p t i o n s .
I d o n 't want to t a k e r e s p o n s i b i l i t y f o r m y se lf .
I t ’s r e a l h a r d . I t h i n k t h e s c a r i e s t t h i n g
beh in d s e p a r a t i n g from my p a r e n t s i s t a k i n g
r e s p o n s i b i l i t y fo r m y s e lf . T h a t ’s what I d o n ’t
want to do. I want to have alw ays someone to
blame f o r th e c h o i c e s t h a t I make. T h a t 's the
hard, t h a t ' s what I'm a v o id i n g . T h a t 's why I
l i k e to screw up t h i n g s t h a t I'm c a p a b l e of
d o i n g . B e c a u s e t h e n I h a v e t o t a k e
r e s p o n s i b i l i t y t h a t c o u l d , I c o u l d g e t a
M a s t e r ' s . So I have to screw up on the way to
avoid t h a t p o s s i b i l i t y . Do you see what I'm
saying?
I j u s t r e a l l y h id e under th e m a r ty r and the
victim business. There's something very scary to
me about f a c i n g l i f e , and f a c i n g th e world and
facing myself. And facing healthy r e l a t i o n s h i p s ,
and facing happiness. To be s a t i s f i e d and happy
is more t h r e a te n in g and fr i g h te n in g to me than to
be m i s e r a b l e . S a t i s f i e d and happy means being
r e s p o n s i b l e , v u l n e r a b l e . I don't know. I j u s t ,
I always have to ld myself I was a problem child.
I am a p r o b l e m p e r s o n , and I am a p r o b l e m .
T h a t ' s s a f e f o r me. I h i d e in t h i s l i t t l e
problem bubble. To be happy is so frig h tenin g .
I c r e a t e l i t t l e p r o b le m s in r e l a t i o n s h i p s i f
t h e y ' r e g o i n g t o o w e l l . I c r e a t e l i t t l e
p ro b lem s. J u s t l i k e t h a t n i g h t when I l i k e d my
body, I came over, t h a t was h o r r i b l e . That I
would l i k e my body. That was very f r i g h t e n i n g .
Cause t h a t ' s h a p p i n e s s , t h a t ' s s a t i s f a c t i o n .
T h e r e 's got t o be a h i t c h . I t ' s kind of l i k e , my
l i f e can't go smooth. When I s t a r t to r e a l l y like
me I j u s t f e e l such trem en d o u s freedom f o r a
m inute. I j u s t f e e l w o n d e r f u l. And then I j u s t
c a n ' t t a k e i t anymore and I have t o t h i n k of
s o m e t h i n g , i t ' s j u s t . . . o h , my g o s h , I d o n ' t
believe, and I'm j u s t f l o a t i n g around, and then I
go, I c a n ' t , oh, j u s t what do I do w i t h t h a t , and
I, but Helen, remember so, such and such. I t ' s
l i k e what i f I'm wrong. I might be a r e a l nerd.
And t h i n k I'm okay. I t j u s t p r o v e s I'm s t u p i d .
I t ' s l i k e I have v i s i o n s of be ing happy w i t h
B rian and b e in g happy w i t h f r i e n d s , and then
going on and g e tt i n g a Master's degree in women's
s t u d i e s , which I r e a l l y want to do. What i f I'm
wrong, and th a t I'm r e a l l y stupid and I can't get
a M a s t e r ' s d e g r e e ? I'd r a t h e r not t a k e t h a t
r i s k . I t comes back to my p a r e n t s . I f e e l r e a l
s t r o n g l y t h a t th ey d on't want me t o t u r n out
okay. T h ere 's t h e s e l i t t l e r e m i n d e r s a l l the
time. But Helen! You're kind' of i r r e s p o n s i b l e ,
and y o u're kind of imm ature. You s h o u l d n ' t be
e a t i n g t h a t Helen, or a re you s u r e you can to
t h a t ? J u s t r e m i n d i n g me. I f e e l l i k e I ’m a
walking apology for my existence.
I ’ve been t a u g h t , and I t h i n k our whole f a m i l y
f e e l s t h a t to s i m p l y be is not of v alue. You
have to have a p r o d u c t . Produce s o m e th i n g , buy
your worth. And t h a t ’s where I think a lot of my
problems come, because b a s i c a l l y the things I do
w e l l are not t a n g i b l e . And I d o n’t have a t h i n g
t h a t I can say, t h i s is what I do w e l l , t h a t ’s
t a n g i b l e . I t ’s back to th e whole f e a r of being
strong and fear of being, taking r e s p o n s i b i l i t y .
I f I have people t h a t I r e s p e c t r e s p e c t i n g me
back, t h a t must make me okay. Somehow t h e r e ’s
j u s t something there t h a t won’t l e t me j u s t liv e
l i f e and be happy.
I f e e l trem en d o u s g u i l t . I t h i n k I c a r r y a l o t
of g u i l t and when any l i t t l e thing goes wrong in
th e f a m i l y or w i t h Brian or i f t h e dog g e t s s i c k
i t ’s cause I h a v e n ’t given him enough a f f e c t i o n ,
or i t ’s my f a u l t .
I can’t take c r i t i c i s m . I j u s t f e e l lik e I can’t
ta k e i t , I don’t know why. I know what f e e l i n g s
come i n my h e a d w hen I i m a g i n e s o m e o n e
c r i t i c i z i n g me. I j u s t want to b a r f . I t ’s j u s t
awful. I get nauseated and sick. I t ’s l ik e they
f i n a l l y f i g u r e d i t o u t, y o u ’re r i g h t . I ’m a
jerk. I want to t e l l people before they figure i t
out. I t ’s kind of lik e i f you drop food coloring
on a p a p e r t o w e l , i t j u s t , I e x a g g e r a t e
completely. I f they c r i t i c i z e one l i t t l e aspect
of my b e in g , I e x a g g e r a t e t h a t i n t o a l l r e a l m s of
who I am, t h a t have even n o t h i n g to do w ith them.
What I ’m b a r f i n g is th e a w fu l d e p r e s s e d lump in
my s t o m a c h ... t h a t a w f u l f e e l i n g . I t ’s l i k e
h o l l o w . You k n o w , a f t e r y o u ’ve e a t e n a
wintergreen l i f e s a v e r or something and you blow?
There’s a kind of hollowness. I t ’s kind of a big
p i e c e of t h a t in my stomach. I never t h o u g h t of
i t t h a t way b e f o r e but i f I would t a l k about a
s e n s a t i o n , t h a t ’s what i t would be. J u s t a
h o l l o w b u z z i n g k i n d o f f e e l i n g . When I ’m
c r i t i c i z e d I e x i s t in a way. But I ’m a mess.
I ’m s o r t of a w a ste of -life. I t would be b e t t e r
i f I d i d n ’t e x i s t , but I do e x i s t . I'm kind of a
b o t h e r t h a t e x i s t s . But I ’m very much e x i s t i n g ,
t h a t s i c k , r e j e c t e d f e e l i n g , i f I s t u f f m y s e l f ,
i t goes away. Because th en I f e e l s i c k and a l l I
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t h i n k about i s how s i c k I f e e l , but not t h a t
r e j e c t i o n . I have no space fo r t h a t . The food
f i l l s up th e h o l l o w n e s s . When t h e food is gone
t h e n a u s e a f i l l s i t up. N a u se a and t h e n
e v en tu ally I think of regret.
I have a problem w i t h t h i n k i n g t h a t my o p i n i o n s
are valuable. And for me to do something simply
b ecause I see i t as being w o r t h w h i l e . T h a t ’s
something I haven’t been able to do very much of.
How do you put t h a t i n t o b a l a n c e w i t h o t h e r
p e o p le and how t h e i r o p i n i o n s a f f e c t and shape
you? I ’m a f r a i d of j u s t becoming r e a l , uh, I
d o n ’t c a r e what you t h i n k , I ’m j u s t going to do
what I want to do. And your o p i n i o n and your
l i f e i s i r r e l e v a n t . I ’m a f r a i d of t a k i n g t h a t
f l i p . The other extreme of where I am at now. I
t h i n k t h a t I ’ve got a l o t of anger i n s i d e of me
and I could choose to say ’’screw e v e r y b o d y ” and
do t h a t . I ’m a f r a i d t h a t once I r e a l i z e I ’m an
okay perso n I ’l l t a k e i t by t h e b u l l h o r n s and
j u s t r e a l l y say, you know, ’’screw you, screw you,
screw you.” I ’m okay, and I d o n ’t c a r e what you
say anymore, I ’ve had enough. I ’m a fr a id I don’t
have a c h o ic e. I want my p a r e n t s to see i t l i k e
I do. When o t h e r p e o p le won’t d e a l w i t h i t
h o n e s t l y , you d o n ’t have t h a t c h o ic e . You can
choose how t o r e s p o n d , but you c a n ’t f o r c e t h a t
p e rs o n . And t h a t i s so hard f o r me. And I have
a r e a l hard t i m e t h i n k i n g of, a re t h e r e any
c h o i c e s t h a t I ’ve made t h a t a r e n ’t r e a l l y
d i r e c t l y because of t h e i r deciding for me.
I ’m l e a r n i n g not to t h i n k of i t as a s i c k n e s s .
But y e t I was j u s t going to say, I wonder when
I ’l l be o v e r w i t h i t . . . t h e i n s e c u r i t i e s and
d e p r e s s i o n and doubt a n d ...to me, i t s t i l l i s a
sign of being unhealthy, or unnormal or to even,
i t ’s l i k e t h e r e ’s s o m e th i n g s e l f - c e n t e r e d and
wrong with being aware of your feelings.
My Subjective and C l i n i c a l Perceptions of Helen
My c l i n i c a l d i a g n o s i s of Helen was t h a t of b u l i m i a
with paranoid tendencies. The following perceptions were
108
j made over a four month period during therapy though I knew
j her for se veral years p r i o r to t h a t time.
i
Helen presented h e r s e l f as an a t t r a c t i v e young woman.
From the f i r s t s e s s i o n i t was c l e a r t h a t she was h i g h l y
a r t i c u l a t e and had a keen a w a r e n e s s of what was going on
around her. She appeared to be very aware of her f e e l in g s
but s e r i o u s l y doubted t h e i r v a l i d i t y . She seemed extremely
aware of how o t h e r s were f e e l i n g , n o t i c i n g the s m a l l e s t
nuances in the flow of r e l a t i o n s h i p s .
T h o u g h H e l e n a p p e a r e d t o be c o m f o r t a b l e i n
r e l a t i o n s h i p s and i n i t i a t e d conversa tions e asily , beneath
t h a t was a great fear t h a t others did n ’t take her s e r i o u s l y
nor have r e s p e c t f o r her. She a lw ays f e a r e d t h a t p e o p le
were n i c e to her out of some du ty to her p a r e n t s . She a l s o
f r e q u e n t l y seemed t o be won d ering w h e th er p e o ple were
t a l k i n g about her behind her back; hence she appeared to be
very s u s p i c i o u s of o t h e r s . When someone would begin to
d e v elo p a r e l a t i o n s h i p w i t h h e r, as I did d u r i n g the
t h e r a p y , Helen a p p ea re d to f i n d ways to b r i n g s t r e s s i n t o
th e r e l a t i o n s h i p . This a r o s e out of her f e a r t h a t she
w a s n 't r e a l l y l i k e d and t h a t b e f o r e I could t e r m i n a t e th e
r e l a t i o n s h i p , she would do i t . There seemed to be a r e a l
f e a r of c l o s e r e l a t i o n s h i p s . As a r e s u l t of her f e a r , she
would a t t i m e s f e e l w ith d r a w n and even somewhat h o s t i l e ,
c r e a t i n g th e very t h i n g she f e a r e d - - a d i s t a n c i n g in the
109
! r e l a t i o n s h i p .
i
j H e len a l s o w a n t e d f e e d b a c k f r o m me a b o u t how I
i
p e r c e i v e d h e r , though t h e r e was some a m b i g u i t y in the
r e q u e s t . I had a se n se t h a t i f I did give her p o s i t i v e
fee d b ac k she would r e j e c t t h a t and i f I gave her n e g a t i v e
feedb ack she would become d e p r e s s e d . In t h a t s e n s e , the
r e q u e s t f e l t m a n i p u l a t i v e . Though i t was hard for her,
H e l e n d i d t r y t o be d i r e c t w i t h me in how sh e was
experiencing me. She had a great fear of r e j e c t i o n so th a t
each t i m e she t o l d me what she f e l t was a r i s k f o r her. I
b e l i e v e she e x p e r i e n c e d c o n f l i c t s about how c l o s e she
i
| wanted people to be.
| Helen perceived h e r s e l f e s s e n t i a l l y as a victim of her
*
| u p b r i n g i n g and s o c i e t y . She had d i f f i c u l t y w ith s e e i n g
| h e r s e l f as h a v in g had a n y t h i n g to do w i t h h e r ”problem."
! She d e sp era tely wanted to blame others , p a r t i c u l a r l y her
p a r e n t s as w e l l as h e r s i b l i n g s a t t i m e s f o r t h e
d i f f i c u l t i e s she was having in her l i f e .
Helen seemed to have a need f o r a q uick "cure." From
one s e s s i o n to th e n e x t, i f I began t a l k i n g to her about
bulimia she became somewhat angry because she ’’d id n ’t feel
t h a t way anymore.” At times there seemed to be a need for
her to deny the d i f f i c u l t i e s she was having. I experienced
th e b i n g i n g and p u r g i n g to be a way she had chosen to cope
w i t h some of t h e h e a v i e r , e x i s t e n t i a l i s s u e s in her l i f e
110
J such as d e a t h , l o n e l i n e s s , d e s p a i r , and freedom. What;
1 !
i i
I Helen f e a r e d most i t seemed, was assum ing r e s p o n s i b i l i t y ]
I
| f o r h e r s e l f . She had l i t t l e e x p e r i e n c e in l i v i n g l i f e as
i
someone other than a "problem person."
i
| I c o n t i n u e to see Helen o c c a s i o n a l l y and am aware of
i
I
I how she is attem pting to make choices for h e r s e l f . She is
J g e t t i n g married t h i s summer and hopes th a t sometime in the
i
I n e ar f u t u r e she w i l l be a b le to go back to s c h o o l f o r a
*
| m a s t e r ' s d e g re e . She i s b e g i n n i n g to f e e l more c o n f i d e n t
i
I
! about h e r s e l f and has found o t h e r ways of coping w i t h her
!
!
j s t r u g g l e s than binging and purging.
111
I r
! :
J Verna i
i
t
I Presenting Problem
I
t
Verna a p p ro ached me about t h e r a p y be ca u se she was
h av ing problem s w i t h "b in g in g and p u r g in g ." She appeared
to be s e c r e t i v e and somewhat f r i g h t e n e d so I made an
a p p o i n t m e n t w i t h her to see me at my o f f i c e .
Background
Verna, a 25 y ear old Caucasian f e m a l e , had l i v e d in
t h e same c i t y f o r her whole l i f e . She came from a f a m i l y
of three ch ild ren , the middle child with two brothers. Her
p a r e n t s had been d i v o r c e d f o r about s i x y e a r s and Verna
lived with her mother and her two brothers. She described
h e r s e l f as "coming and going as she p l e a s e s " w i t h no
pressures at home.
She say s t h a t t h i n g s were very rough w h i l e she was
gro wing up, l a r g e l y b ecau se her f a t h e r was an a l c o h o l i c
from b e f o r e she was born. She d e s c r i b e s her f a t h e r as
f o l lo w s :
I
I t ' s hard, because he's s t i l l drunk a l l the time,
and he s t i l l l i v e s in town and I j u s t r e f u s e to
see him when h e 's t h a t way. That b o t h e r s me a
l o t because I t h i n k , he's about 15 y e a r s o l d e r
than my m other, around 60 or so, and i t j u s t
bothers me t h a t i f something happens to him, I'm
going to f e e l g u i l t y f o r a l l t h e s e y e a r s t h a t I
d i d n ' t know, h e lp him when he needed h e lp , or
t a l k to him. I d o n 't f e e l angry t o w a r d s him. I
112
j u s t d o n 't l i k e s e e i n g him h u r t h i m s e l f . He's
hurting h im self a lot. I have no angry f e e l in g s
t o w a r d s him. He n e v er b e a t me, but my mother
somewhat. My older brother would stop the f i g h t s
b e f o r e t h a t would happen. When h e 's so ber he
a p o l o g i z e s , h e ' s a s w e e t p e r s o n when h e ' s
s t r a i g h t . But he's hardly ever t h a t way.
Verna's l i f e at home as a c h i l d was very unhappy and
v e r y l o n e l y . T h i s was l a r g e l y due t o h e r f a t h e r ' s
a l c o h o l i s m and th e f i g h t s between her p a r e n t s . She
expressed the following about growing up:
When I was growing up I never had f r i e n d s over.
I couldn't, you know, not knowing how he would be
l i k e , and I j u s t remember a l o t of f i g h t s t h a t my
p a r e n t s would have and a l l th e y e l l i n g . J u s t
b e in g in my room t r y i n g to to l i s t e n to i t . But
yet, wanting to, to p r o t e c t my mother because the
t h r e e of us k i d s t h e r e , we would have t o , you
know, p r o t e c t her, be on her side, whatever. You
know I was r e a l l y happy when she f i n a l l y got up
t h e c o u r a g e t o d i v o r c e him. S h e ' s c h a n g e d
c o m p l e t e l y , to not r e a l l y - - f o r th e b e s t . I t ' s
g r e a t . I'm happy she did t h a t . For a l l t h e
rough times t h a t he gave us when we were l i t t l e ,
I'm not mad at him cause I, you know, alcoholism
i s a d i s e a s e too. He j u s t won't do a n y t h i n g
about i t . And t h e r e ' s n o t h i n g I can do i f he
doesn't want to. When I was growing up and when
I was hid in my room and h e a r i n g them f i g h t , then
I was angry at him. Then I was mad at him. I
remember p l a n n i n g i t back t h e n - - s u i c i d e . I was
in t h e 5th or 6th grad e . P l a n n i n g , you know, I
j u s t d i d n ' t want to put up w i t h i t anymore. You
know, I would p l a n , a g a i n , s u i c i d e . I was t i r e d
of the screaming and y e l l i n g , and j u s t having to
go to my room, as soon as I got home from s c h o o l ,
i f my dad was home. And I j u s t c o u l d n ' t see an
end to i t , or a change. Then my p a r e n t s got a
divorce and a l l t h a t went away and everything was
f i n e .
Verna had very l i t t l e to say about her mother e x c e p t
t h a t e v e r y t h i n g was f i n e between them. She does f i n d i t
1 13
' hard to be very i n t i m a t e w ith h e r , how ever, because her,
mother seems to have d i f f i c u l t y in l i s t e n i n g to Verna's
problems. Verna f e l t very p r o t e c ti v e about her mother and
t h e r e f o re t r i e d not to burden her with her problems.
Verna remembered t h a t the binging and purging s t a r t e d
about two years ago, though she couldn't remember anything
t
p r e c i p i t a t i n g th e b i n g i n g . During t h e t h e r a p y i t was
r e v e a l e d t h a t two y e a r s ago was the tim e when her o l d e r
b r o t h e r , who n o r m a l l y " r e s c u e d " t h e f a t h e r f ro m
d i f f i c u l t i e s such as being found drunk in a lley s and j a i l s ,
l e f t th e c o u n t r y and Verna was l e f t r e s p o n s i b l e f o r th e
f a t h e r ' s c a r e . When c a l l s came to p ick up the f a t h e r in
h i s drunken c o n d i t i o n , Verna was now th e one who had to
i
| p ick him up. Verna did not know w h e th e r her b r o t h e r ' s
I l e a v i n g had a n y t h i n g t o do w i t h t h e b u l i m i a but i t did
s t a r t when her brother l e f t home.
Verna has worked most of the time since she completed
high school and one semester of college. For the past five
y e a r s she has worked at t h e same p l a c e . Her job has been
u n e v e n t f u l and r o u t i n e . S e v e r a l y e a r s ago her p h y s i c i a n
put her on a n t i - d e p r e s s a n t s which she abused e i t h e r to get
a "high" or as a minor s u i c i d e a t t e m p t . She has f e l t
s u i c i d a l much of the l a s t two years and has w r i t t e n several
l e t t e r s to her mother in p r e p a r a t i o n f o r a s u i c i d e . Once
she had d e c i d e d not to k i l l h e r s e l f she d e s t r o y e d th e
1 14
| l e t t e r s . Since her b r o t h e r i s a gun d e a l e r , she had
I
t
| planned to shoot h e r s e l f .
; Verna has been d a t i n g a man f o r the p a s t seven y e a r s
|
and during the time of therapy, she struggled a great deal
w i t h the p o s s i b i l i t y of m a r r i a g e or of t e r m i n a t i n g th e
r e l a t i o n s h i p . In the end she decided to move in with him.
This t u r n e d out to be a very t r a u m a t i c e x p e r i e n c e , though
e x c i t i n g in some ways, s i n c e she had l i v e d in th e same
i
»
j house for 25 years and t h i s was her f i r s t move. During the
j
I months of therapy she also had a r e l a t i o n s h i p with another
man and s e r i o u s l y c o n s i d e r e d l i v i n g w i t h him. When she
i
I t e r m i n a t e d t h e r a p y she a l s o q u i t her job and moved out of
j town t o l i v e w i t h her f i r s t b o y f r i e n d . She was b e g i n n i n g
I
i
I to f e e l much l e s s of a need to binge and purge and had
| red u c ed from p u r g i n g e very day t o p u r g i n g about once per
i
| week. I have t o l d her t h a t she i s welcome to come back
I
into therapy whenever she f e e l s a need for i t . Verna f e l t
she has made good p r o g r e s s in her l i f e , f e l t much l e s s
s u i c i d a l , and was e x c i t e d about b e g i n n i n g a home of her
own .
Verna 's Description of Her Lebenswelt
T a l k in g about b i n g i n g and p u r g i n g d e p r e s s e s me.
I d o n ’t l i k e to t a l k about i t . I d on't l i k e
a d m i t t i n g i t . Or j u s t g e t t i n g th e f e e l i n g s out
and t a l k i n g about i t . I t ' s not what you w i l l
t h i n k but a d m i t t i n g i t t o m y s e l f . I d on't l i k e
a dm itting I have a problem, although I know I do.
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Cause t h a t ’s why I 'v e come to you, and I do want
to get r i d of t h i s . I'm t r y i n g to get i t out,
I'm t r y i n g . I'm s t i l l a l i t t l e shy about i t . I
am j u s t a quiet shy person. So t h a t has a lot to
do with i t too. Is everybody else as scared as I
am?
V om iting makes me f e e l c l e a n e r i n s i d e . T h a t's
th e reason I do i t . I j u s t f e e l s t u f f e d . I t
makes me f e e l empty and b e t t e r . I f i t makes me
f e e l b e t t e r , then why s t o p ? Okay, I'v e read a
l o t of th e d a n g e r s of i t . I guess t h a t j u s t
s c a r e s me. And I j u s t know i t ' s wrong. I j u s t
know i t ' s not healthy and normal or whatever. I
could eat sensibly and not have to be doing th is.
Don't you a g r e e ? I t ' s a h a s s l e to have to do i t ,
a f t e r you eat, to have to force y o u r s e l f to throw
up. I c a n ' t e njoy a meal, w i t h o u t . . . i t depends
upon, when I'm o u t, and I have to e a t so m e th in g ,
i t kind of makes me mad f o r a w h i l e , you know,
i n s i d e . When I know I c a n ' t get r i d of i t , you
know, and t h a t f e e l i n g goes away a f t e r a w h i l e ,
b u t i f I h a v e t o e a t s o m e t h i n g , you, j u s t
t h i n k i n g , i t b o t h e r s me h a v in g t h a t food i n s i d e
me .
A l o t has to do w i t h b e in g f a t . I j u s t d on't
want t h a t . I f I can get r i d of i t , I j u s t don't
want t h a t food t h a t ' s going to make me fa t. I ' l l
f e e l b e t t e r i f I'm t h i n . I ' l l f e e l b e t t e r
m e n t a l l y . I t has to do w i t h people. I j u s t f e e l
b e t t e r about myself, because lik e some days I ' l l
go, not very often, but sometimes I ' l l go without
e a t i n g too. Not fo r very long, maybe a day or
two. And then I know i t ' s j u st water t h a t you're
l o s i n g , but I f e e l good. I t ' s a l l in th e head,
i t ' s a l l m e n t a l . I t f e e l s l i k e a t r a p b ecau se I
have to do i t and i f I don't i t b o t h e r s me. I
have to g e t th e food out of me.
F r u i t and v e g e t a b l e s a re the only t h i n g s t h a t
d o n 't b o t h e r me. They a re c l e a n foods. I d on't
know why. That seems dumb t o me. You know,
they're j u s t n a t u r a l type foods, j u s t nothing--my
b r o t h e r ' s i n t o h e a l t h f o o d - - t h a t type of s t u f f .
T h e r e 's n o t h i n g added t o them. They're j u s t
f r u i t s and v e g e t a b l e s . They're pure. I d on't
remember t h i n k i n g about food l i k e t h a t b e f o r e
''this'' s t a r t e d . All I t h i n k about is food, you
know, what I can e a t and what I d o n 't . T h a t 's
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a l l t h a t ’s on my mind. Sometimes I ’l l stay away
from anything th at I don’t want in me. But other
t i m e s I, i f i t ’s t h e r e I ’l l e a t i t , i f I have to
e a t . I know as I ’m e a t i n g i t or as I ’m doing i t
I t h i n k , w e l l I c an e n j o y i t r i g h t now
b e c a u s e . . . I want to s t o p , though, because I ’m
t i r e d of t h r o w i n g up. I t ’s j u s t a problem to
me.
Sometimes I t h i n k I have too many e m o t i o n s . I
f e e l too much. You know, and I ’m j u s t t i r e d of
f e e l in g fee lin gs. So I t r y not to feel anything.
I do have a l o t of f e e l i n g s and som etim es I go
through a depression, r e a l l y bad, and i t j u s t , i t
h u r t s a l o t . My b r a i n j u s t c a n ’t han d le i t . I
d o n ’t know. I c a n ’t t a l k about t h i s . Like I
t h i n k s u i c i d e a l o t . Can t h a t be c o n n e c te d to
t h i s in any way? Sometimes I j u s t , everything
seems so dumb to me. Just l i f e in general. I t ’s
r e a l l y , t h e r e ’s no p u rp o se to i t , as f a r as I ’m
c o n c e rn e d , a l o t of t i m e s . Other t i m e s , you
know, e v e r y t h i n g i s f i n e . But h a l f th e t im e i t
j u s t seems th e same old s t u f f day a f t e r day.
T h e r e ’s no r e a so n t h a t I can see. Dying d o e s n ’t
b o t h e r me. I go t h r o u g h my t i m e s when I
s e r i o u s l y c o n t e m p l a t e i t . I ’d j u s t use a gun.
I t ’d be so easy t o me so m e tim e s . I d o n ’t know
why, I a lw ay s c h ic k e n o u t , or w h a t e v e r. I keep
t h i n k i n g t h a t t h i n g s w i l l g e t b e t t e r . But
s o m e t i m e s ... i t j u s t d o e s n ’t seem l i k e i t .
E v e r y t h i n g ’s f i n e today. I can get m y s e l f i n t o
these moods. I can s t a r t thin k in g how things are
j u s t dumb. Why t h i n g s are j u s t dumb, same old
s t u f f . And i t ’s j u s t d e p r e s s i n g . I j u s t c a n ’t
understand why I ’m here. There’s j u s t no point.
Do o t h e r p e o p le f e e l t h a t way t o o , t h a t do t h i s ?
I want to be lik e other people.
And t h e n I ’ ve g o n e t h r o u g h . . . I d o n ’ t
k n o w . . . d e s e n s i t i z i n g . I r e a d an a r t i c l e in
N a t i o n a l E n q u i r e r about i t . People t h a t cut
t h e m s e l v e s , you know what t h a t means? C u t t i n g
y o u r s e l f ? I t h u r t s , you know. I t ’s j u s t when I
get so depressed, so mad at everything, j u s t when
I ’m s t a r t i n g to t h i n k , you know, s u i c i d e , and
i t ’s funny because l i k e I n ever r e a l l y t h o u g h t
about i t . Whenever I find I have these problems
I a l w a y s t r y t o r e a d a b o u t i t , j u s t t r y t o
understand why I ’m doing i t , or something. When
I s t a r t f e e l i n g t h a t way, w ith a r a z o r , r a z o r
1 17
b l a d e s , I c u t my a rm s and i t m akes me f e e l
b e t t e r . I t g e t s i t o u t o f me. One of t h e
r e a s o n s t h a t I want to q u i t doing t h i s p a r t of
i t , b ecau se I, I j u s t f e e l l i k e t h e r e ' s so much
going on i n s i d e of me t h a t some, I have to s t a r t
g e t t i n g r i d of t h e bad t h i n g s t h a t I do. The
t h i n g s t h a t a re wrong. I want to r e a c h out for
h e l p , b u t I d o n ' t know a n y b o d y t h a t would
u n d e r s t a n d and would want to h e lp . I fm su re
there are people who care about me who would want
to help, they j u s t donft understand.
You know about women who are a f r a i d to go out
around p e o p le ? Sometimes t h a t happens to me.
Like i f I fm by m y s e lf , l i k e in a grocery sto re and
I T11 be s t a n d i n g t h e r e and I p a n ic . I have to
get out of t h e r e . I t h a s n ' t happened fo r a few
months. Like at work too. I fl l be th ere at work
and a l l of a sudden I j u s t , I c a n ' t ta k e i t .
I t fs no t th e p r e s s u r e of t h e job. I 'v e done the
job f o r s i x y e a r s . I j u s t have to le a v e . Walk
out of t h a t p l a c e . Sometimes I d o n 't go out
because I donft want to be around people.
My n e r v e s a re making me warm in h e re . I had a
l o t of, I get t i r e d o f . . . i t Ts t h o u g h t s of s u i c i d e
and t h e r e ' s n o t h i n g in p a r t i c u l a r t h a t makes me
unhappy. ThatT s what I was thinking today. I t fs
j u s t ev ery s i n g l e day, I j u s t t h i n k why, you
know, but t h e r e ' s n o t h i n g , I mean I do n 't have
problems. What problems have I got? Compared to
a l o t of p e o p l e . . . I want t o see i f I fm norm al. I
would f e e l norm al i f o t h e r p e o p le f e e l t h e same
and s t u f f . Like on th e o u t s i d e I g u e ss I look
okay, t h a t I look happy, norm al. I t fs a l l in my
head, I t h i n k . I t fs j u s t a l l i n s i d e me. I j u s t
wonder why I fm so d i f f e r e n t . I mean, or is
everyone else lik e th at, and t h e y fre j u s t pu ttin g
on an a c t ? But i t fs in t h e r e and I fm j u s t t i r e d
ot i t . A l o t of c o n f u s i o n . I t j u s t seems l i k e
so many t i m e s I f e e l l i k e , you know, my b r a i n is
j u s t overloaded. I get t i r e d of people f l i r t i n g
w i t h me. T h a t fs a l o t of i t , too. I g e t t i r e d
of...and I get angry at men, you know. T h a t fs
a l l t h a t ' s on t h e i r mind i s sex, and I d on't
know, so m e tim es I can j u s t laugh i t o f f and go on
w i t h w h a t e v e r. But deep down i t r e a l l y b o t h e r s
me. On th e o u t s i d e I have to go along w i t h i t ,
you know, t e a s e a long w i t h them, but when I
r e a l l y t h i n k about i t , I donft. I don't f e e l
l i k e a p e rso n to them b e ca u se y ou 're j u s t an
o b j e c t t h e r e f o r them t o say t h e s e t h i n g s to.
I t ' s j u s t w i t h i n t h e l a s t two, t h r e e y e a r s t h a t
I ' v e f e l t so s t r o n g l y a b o u t t h i s . I g u e s s
b e ca use I'm growing up. I need to do so m e th i n g
w i t h my l i f e . That might have s o m e th in g to do
w i t h i t . And I c a n ' t j u s t do what I'm doing
f o r e v e r . As long as i t ' s busy at work I s t a y
away from men. But s t i l l , I mean every t im e a
g i r l walks in th e door, t h e y ' r e s t a r i n g , making
comments about her, and I'm s t i l l hearing i t . It
doesn't r e a l l y bother me about these other women,
but i t ' s j u s t when t h e y make comments t o me. Why
do t h e s e guys s a y d i r t y t h i n g s t o me? My
boyfriend says t h a t I must have been leading them
on. He says i t ' s my f a u l t and s t u f f .
I haven't r e a l l y expressed my f e e l in g s because I
c a n ' t . I'm s c a r e d . But I want help . I want you
to u n d e r s t a n d me. So I'm j u s t going t o t e l l you
a n y t h i n g and e v e r y t h i n g t h a t I t h i n k and do. Do
you t h i n k I'm t r y i n g to d e s t r o y m y se lf ? Am I
p u n i s h i n g m y s e lf ? Reading about i t d i d n ' t h e lp
me. But I need to know now. I c a n ' t go on. My
brain can't take i t t h i s way. I want to not have
t o f e e l t h i s anymore. To not have to t h i n k
anymore. I j u s t d o n 't want t o t h i n k . I f I c a n ' t
f i n d an an sw er, or i f I c a n ' t s t o p f e e l i n g my
feelings,, my bad f e e l in g s , which seem to be with
me a l l t h e t i m e , th en f o r g e t i t . I ' l l g ive up.
I d o n 't know what i t ' s l i k e when you 're dead but
t h a t w o u ld be j u s t , no f e e l i n g s , n o t h i n g ,
w h a t e v e r . I'd be gone. See, from growing up
w i t h my dad b e in g an a l c o h o l i c , t h a t t u r n s me o f f
r i g h t t h e r e f r o m a l c o h o l and d r u g s an d
everything. I shouldn't tease my mom, but I t e l l
h e r, I ' l l s t a r t t a k i n g drugs or so m e th in g . Like
I t r y , you know, I j u s t needed, f o r so long I
k e p t a l l t h i s i n s i d e of me, and I j u s t , b e f o r e I
met t h i s S h e r i g i r l , my mother and I were r e a l
c l o s e . And I t r y b r i n g i t up som e tim es when I
g e t so u p s e t and s t u f f , but she, i t j u s t u p s e t s
her. I do n't want to h u r t her.
Up u n t i l my p a r e n t s g o t d i v o r c e d , I was t o
m y se lf . I was a l o n e r , which r e a l l y I s t i l l am.
I t ' s hard. You d o n 't h a t e p e o p le . I d o n 't know
why, i t ' s j u s t th e way I was b ro u g ht up. You
j u s t d o n 't h a t e pe o p le . I j u s t want to d e s t r o y
m y s e lf . And i n s t e a d of, I d on't have th e nerv e
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to do i t t o t a l l y , completely yet...I guess i t a l l
goes along w i t h t h i s b i n g i n g and p u r g i n g and
c u tt i n g myself. I l ik e f ee lin g empty inside. It
j u s t makes th e pain go away. You know, th e pain
in my head or th e h u r t t h a t I was f e e l i n g . J u s t
h u r t i n g m y s e lf . I do n ’t know. Most of th e t im e
when I ’m f e e l in g pain, I ’m r e a l l y h u r tin g inside
e m o t i o n a l l y or w h a t e v e r , and I t r y not to cut
m y s e lf , I r e a l l y t r y hard. But j u s t doing i t ,
j u s t f e e l i n g t h a t , I guess i n s t e a d of up h ere
i t ’s j u s t coming out down h e r e and s e e i n g the
blood and e v e r y t h i n g and then a f t e r a w h i le I'm
f i n e . S o m e t i m e s t h e p a i n i s when I'm r e a l
l o n e l y , h u r t w h a t e v e r . I f i r s t did i t when my
b o y f r i e n d had to work or s o m e th in g . I d o n 't get
u p s e t anymore when he has to work. But l a s t
weekend. I t h u r t me when he blamed me but then
he a p o l o g i z e d . I had t h o s e t h o u g h t s of j u s t
en d in g i t , j u s t , I g u e ss I ’m r e a l l y g lad t h a t we
made up b e f o r e he. l e f t , because then I was f i n e .
How can I change j u s t from one m in u te to th e
n e x t ? One m in u te I ’m ready to end i t a l l and
th en t h e n e x t m inu te...
I'm j u s t t i r e d of going to work everyday, coming
home, d o i n g t h e same o l d r o u t i n e . I need
s o m e th i n g to look f o r w a r d to. L i f e i s so dumb to
me. I j u s t c a n ' t u n d e r s t a n d why we 're here.
T h a t ’s a l l . I ’m not s e r v i n g any p u r p o s e . What
good am I? What do I do th a t makes anything any
b e t t e r ? I j u s t d o n ’t u n d e r s t a n d why t h e r e are
p eople. I f e e l very l o n e l y . What good does i t
do to cry? I cry r i g h t . . . a n d th en tomorrow my
eyes w i l l be a l l puffy.
I ’ve w r i t t e n l e t t e r s to my mother, to my friend,
and to my two b r o t h e r s . In th e l e t t e r s to my mom
i t would be a p o l o g i z i n g , t h a t I'm s o r r y f o r
doing what I ’m doing. And I could have been
b e t t e r to my b r o t h e r s , cause we’re not c l o s e . I
t e l l th em I ’m s o r r y I c o u l d n ’t be a b e t t e r
s i s t e r . Picked a c r a z y one, d i d n ' t you? Seems
l i k e w h a te v e r I do t h a t makes me f e e l h u r t or
u p s e t , i t seems l i k e I did i t , so i t ’s my f a u l t .
I f I k i l l e d m y s e lf I w o u l d n 't have t o l i s t e n to
i t . I w o u l d n ’t h a v e t o be t h e r e . K i l l i n g
myself, everything would be over. No thinking, no
n o t h i n g .
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I j u s t am t o t a l l y confused. I take the blame for
everything. I don’t get angry at people th at are
r e a l l y r o t t e n . A l o t of r o t t e n t h i n g s have
happened at work. But then peo p le are p u t t i n g
t h e b l a m e on me f o r t h e s e t h i n g s t h a t h a v e
happened. How am I coming on to these people to
make them... I mean, why did t h a t guy go and say
what he did, be ca u se he was changing t h i n g s
around or making t h i n g s j u i c y . Why am I being
t h e v i c t i m , or w h a t e v e r ? I d o n ’t g e t mad.
I n s i d e I do, but not to somebody t h a t ’s doing
something. I f somebody’s doing something to make
me mad, I j u s t ignore the person because g e tt i n g
mad is a u s e l e s s t h i n g . I f I ’m mad at somebody,
i f I j u s t sh u t up, keep i t to m y s e lf , then i t ’s
over. But i f I argue, we argue back and f o r t h ,
i t j u s t keeps going. I t ’s b e t t e r j u s t to cut i t .
I j u s t w i t h d r a w and d o n ’t t a l k to t h e s e people.
I j u s t r e f u s e t o do a n y t h i n g . I ’d r a t h e r be by
m y s e lf . I t ’s e a s i e r j u s t to go home and be by
myself than to go out and do something.
T h a t ’s a l l on the o u t s i d e to go out and have fun.
T h a t ’s what b o t h e r s me about p e o p le . So many
p e o p le t h i n k t h e y ’re h a v in g fun. T h a t ’s the way
I see them. They j u s t look l i k e t h e y ’re h a v ing
fun. How can th ey be h a v in g fun, g e t t i n g drunk
and doing what t h e y ’re doing. I t ’s j u s t a l l so
s t u p i d . And I h a t e when I get t h a t a t t i t u d e ,
l i k e I ’ve got to be t h e r e , h a v in g fun.
This week I f e e l b e t t e r . All my e n e r g i e s are
g o i n g i n t o h e l p i n g my f r i e n d . She had an
a b o r t i o n today. I ’ve s p e n t e very evening w i t h
her and her husband. I n s t e a d of w o r r y i n g about
myself, I ’ve been tr y in g to help her. I ’m going
over t h e r e t o n i g h t to f i x food. I ’m hungry but
I ’m w o r r i e d b ecause i t ’s too l a t e to e a t . I f I
e a t i t won’t wear o f f b e f o r e I go to bed. I t
j u s t s i t s t h e r e . Anytime I e a t in th e l a t e
a f t e r n o o n i t b o t h e r s me. I wake up f e e l i n g
yukky. I ’ve chosen to t a k e c are of her a l i t t l e
b i t and I h a v e n ’t t h o u g h t about m y se lf . I f I do
I ’l l s t a r t thinking about suicide, s t a r t thinking
about how lo u sy t h i n g s a re f o r me, and s t a r t
t h i n k i n g about how t h e r e ’s n o t h i n g w o r t h w h i l e
whatever.
I f e e l a lo n e . I ’m n o t , I d o n ’t f e e l l o n e l y . I
guess t h e r e ’s a d if f e r e n c e between them. I j u s t
f e e l a lo n e . I j u s t f e e l t h i n g s are p o i n t l e s s .
The everyday s t u f f . The everyday going to work,
p u s h i n g my b u t t o n s . T h i s i s day a f t e r day.
T h e r e ’s got to be more to i t than t h a t . I ’ve got
to move on to s o m e th i n g or do so m e th i n g .
I ’m j u s t t h e r e and e v e r y t h i n g e l s e is happening
around me. A l o t of t i m e s worse th an o t h e r
t i m e s . R e a l l y s t r a n g e . You know, i f I was on
d ru g s, I could u n d e r s t a n d i t . But i t ’s w eird.
I ’m up here and a l l these things are j u s t buzzing
around me, you know. You know, I ’m j u s t not
t h e r e . J u s t not. I' don’t know where I ’m a t,
i t ’s not l i k e I ’ve, I ’m p u ttin g myself some other
p l a c e , I ’m t h e r e b u t n o t . . . I mean, I ’m n o t
p u t t i n g m y s e l f l i k e some o t h e r p l a c e . I ’m
f e e l i n g t h e r e , but not i n c l u d e d in e v e r y t h i n g
t h a t ’s h ap p en in g around me. I f e e l s e p a r a t e .
I ’m j u s t back w a t c h i n g . I ’m p a r t i c i p a t i n g in
what I have to do. Doing t h e r o u t i n e s t u f f , but
I ’m not r e a l l y t h e r e . Between me and t h e r e i t ’s
j u s t sp ace. I t ’s j u s t a spacy f e e l i n g when I
r e a l l y get i n t o i t so m e tim es . I t ’s j u s t l i k e I
g e t , i t ’s kind of l i k e I ’m in a daze. I t happens
m o s t l y at work. I d on ’t f e e l t h e space here.
Like I s a i d , i t ’s not a l l t h e t i m e . Maybe i t ’s
not t h e r e when I f e e l q u i t e c l o s e to the person
t h a t I ’m w i t h or t a l k i n g to. Or when I j u s t
d o n ’t l i k e w h a t ’s g o i n g . . . t h a t too, I guess i t ’s
an e sc a p e . I d o n ’t l i k e w h a t ’s going on around
me. I j u s t draw back and I l e t t h i n g s j u s t
happen around me. I ’m j u s t in round w i t h th e
world. Sometimes I can get m y s e l f out of i t i f I
r e a l i z e w h a t ’s going on and I t h i n k I can snap
m y s e l f out of i t . Most of t h e t im e . I f I j u s t ,
th in g s are going wrong and I don’t r e a l i z e i t for
a long t i m e , t h a t t h a t ’s h a p p en in g , then I j u s t ,
I s t a r t t h i n k i n g , god, you know, I f e e l . . .
d i f f e r e n t and I can j u s t t h i n k , put m y s e l f back
i n t o where I ’m supposed t o be a t . I t t a k e s
a w h i l e so m e ti m e s f o r me t o r e a l i z e t h a t I ’m
s e p a r a t e d . I ’m aware of t h e s e p a r a t i o n . But I
d o n ’t t h i n k t h a t I have to get back i n t o i t a l l
the time. Sometimes I ’l l accept being separated.
I t d o e s n ’t b o t h e r me. Cause I d o n ’t want to be
down th e r e , or whatever. I don’t get the suicide
f e e l i n g s when I ’m s e p a r a t e d . J u s t once in
awhile. I j u s t have t h a t , those f e e l in g s with me
a l l t h e t i m e , th e s u i c i d e . I t ’s alw ays t h e r e .
Even when I ’m happy, h a v in g a good t i m e , I can
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g e t m y s e l f t h i n k i n g a b o u t i t . The s u i c i d e
t h o u g h t s a re alw ays t h e r e . They've been t h e r e
about two years except for when I was in the 5th
or 6th grade. I draw back i n s t e a d o f . . . b e c a u s e
I'm a f r a i d of a c t u a l l y doing i t . I f I g e t i n t o
one of t h o s e moods and I have such a c c e s s to a
gun. The mood is j u s t alone. Just f e e l in g alone
l i k e everyone e l s e is out doing s o m e th i n g . I'm
j u s t t h e r e a lo n e . And, I d o n 't know. That kind
of s c a r e s me, i f I w a s n 't a b le to get m y s e l f out
of i t . I j u s t wish I had never been born. I
can't understand why people are here. What's the
point of, of people? I mean, t h i s planet?
When my parents got divorced then everything was
fine. I thought everything was fine there for a
few y e a r s . U n t i l r e c e n t l y . All we had to l i v e
f o r was j u s t p r o t e c t i n g my mom a l l t h e t i m e or
j u s t t a k i n g c a r e of t h a t s i t u a t i o n . I s t i l l
don't hate my fath e r. I was tr y in g to fig u re out
why I don't a f t e r everything he's done.
I ne v er want to have k i d s . I d o n 't ever want to
have...I'm not s a y i n g th e y would but I do n 't ever
want to t a k e t h e chance t h a t th ey would have to
e x p e r i e n c e t h e f e e l i n g s t h a t I have, of not
wanting to be here. I j u s t don't want them to go
t h r o u g h th e p ain t h a t I'm f e e l i n g . I wish I'd
never been born but yet I don't blame my parents.
My brother says he doesn't hate me, he j u s t hates
e v e r y t h i n g I do. That h u r t f o r a long t im e . I
j u s t wish we were c l o s e r . I j u s t wonder how my
b rothers feel. My older brother is a r e a l loner
too. We had to be l o n e r s because we c o u l d n ' t
have f r i e n d s . We c o u l d n ' t you know, we had to be
l o n e r s .
I'm always conscious, I'm always aware of, maybe
I'm j u s t t h i n k i n g too much of m y s e l f a l l th e
t im e . I'm alw ays aware of what I'm t h i n k i n g .
Even when I'm t a l k i n g w i t h someone. I c a n ' t
d e s c r i b e i t . T h e r e 's th e p e rs o n t h a t ' s t a l k i n g
and then t h a t ' s s t i l l going, s a y i n g w e l l you'r e
t a l k i n g to t h i s p e rs o n you d o n 't want to t a l k to
t h i s p e rso n so l e t ' s get i t over w i t h . I'v e got
two v o i c e s . T h a t 's why I g e t my c o n v e r s a t i o n s
over as f a s t as I can.
I have t h e s e r e l a t i o n s h i p s , f r i e n d s h i p s , u n t i l
they s t a r t h urting and then I turn them off. I
alw ays end up t u r n i n g them o f f . When p e op le
s t a r t g e t t i n g c l o s e I push them away. Like the
f r i e n d I was h e l p i n g . She was depending on me
too much. She won't make d e c i s i o n s by h e r s e l f .
I was making t h e s e d e c i s i o n s f o r her. And t h a t
was bothering me. What i f something went wrong,
i t would come back on me. I need a v a c a t i o n
f r o m . . . e v e r y r e l a t i o n s h i p r i g h t now. What’s
r e a l l y b o t h e r i n g me i s t h a t I ’m pu sh in g S h e r i
back too. She s t i l l c a r e s about me but I ’m j u s t
pushing th a t closeness. Any time I s t a r t g e tt i n g
close to somebody, I cut the r e l a t i o n s h i p .
My C l i n i c a l and Subjective Perceptions of Verna
My c l i n i c a l d i a g n o s i s of Verna was b u l i m i c and
s u i c i d a l . The following pe rceptions were made over a four
month period in in d iv id u al therapy.
Verna is an a t t r a c t i v e young woman. When I f i r s t met
her she seemed composed and o u t w a r d l y q u i t e c o n t e n t .
Whenever she spoke to me she looked d i r e c t l y into my eyes.
I soon became aware of a kind of g l a z e d look in her eyes,
as i f th e r e were a c u r t a in there. My f i r s t impression was
t h a t she wanted to be very open and she e x p r e s s e d t h i s
f r e q u e n t l y in t h e f i r s t s e s s i o n s . H o w e v e r , I soon
r e a l i z e d how d i f f i c u l t i t was f o r her to a llo w anyone to
come close to her. She seemed to avoid close r e l a t i o n s h i p s
because she feared g e t t i n g hurt. Whenever people t r i e d to
be f r i e n d s w i t h h e r , she r e p o r t e d t h a t she would c u t o f f
the r e l a t i o n s h i p .
Verna asked a g r e a t number of q u e s t i o n s , f r e q u e n t l y
asking what I thought about things. She presented h e r s e l f
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as not knowing very much, p a r t i c u l a r l y about her fee lin g s.
She was very aware t h a t she had pain and th a t her l i f e was
f u l l of h u r t . She was s e e m i n g l y u n a b le or u n w i l l i n g to
know what the hurt was. She was very preoccupied with the
f u t i l i t y of l i f e .
Verna was very judgmental of others in i n d i r e c t ways,
p a r t i c u l a r l y of men. She almost always experienced men as
w a n t in g to be s e x u a l w i t h her and s a i d th ey made many
s e x u a l comments to her. She g r e a t l y r e s e n t e d t h i s but
u s u a l l y " p l a y e d ” along w i t h them. I se n se d a deep anger
a g a i n s t men, though she would deny any an g er, e s p e c i a l l y
towards her f a t h e r who had only caused her a g reat deal of
pain .
Verna s e e m e d t o be v e r y o u t o f t o u c h w i t h h e r
f e e l i n g s . She t a l k e d about l i k i n g e v ery on e, not being
angry a t anyone, and c o n t i n u e d to r e p o r t how o t h e r s were
t a l k i n g a b o u t h e r , s p r e a d i n g r u m o r s a b o u t h e r , and
g e n e r a l l y h u r t i n g h e r. I f she was asked w h e th e r she was
angry about t h i s her response would always be "no."
Verna seemed to be most aware of th e f u t i l i t y of l i f e .
She completely lacked understanding about why she was alive
and o f t e n f e l t s u i c i d a l . All of l i f e , f o r h e r s e l f and
o t h e r s , seemed m e a n i n g l e s s and f u t i l e . In g e n e r a l , I saw
Ve rn a as s o m e w h a t c h i l d l i k e w i t h a g r e a t d e a l o f
i n t e r n a l i z e d anger and pain. She e x p e r i e n c e d f e e l i n g s of
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s e p a r a t i o n from o t h e r s , e x p e r i e n c i n g h e r s e l f as b e in g in
" a n o t h e r p l a c e . " She was a l s o very much alone but a f r a i d
of any i n tim a te or close r e l a t i o n s h i p s .
The l a s t few weeks before Verna terminated, she made a
decision to move in with her boyfriend of seven years. She
e x p r e s s e d t h a t h i s r e l u c t a n c e to commit h i m s e l f was th e
r e a s o n f o r h e r d i f f i c u l t i e s . I saw h e r as s o m e w h a t
u n r e a l i s t i c about her future since she f e l t t h a t everything
would be ta k e n c a r e of now t h a t she had her own a p a r t m e n t
and could t a k e care of him. Her b i n g i n g and p u r g i n g had
r edu c ed from once or t w i c e a day to about once in two
weeks. Her i n v o l v m e n t w i t h her b o y f r i e n d as w e l l as
therapy seemed to account for the reduction in the bulimia.
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CHAPTER V
THE REFLECTIVE PHASE: REFLECTIONS
ON THE DATA AND THE GENERATION
OF A THEORY OF BULIMIA
In the previous chapter there was an attempt to make
e x p l i c i t the meaning of bulimia by p res en tin g the s u b j e c t s 1
d e s c r i p t i o n s of t h e i r Lebenswelt. The f i n a l aspect of the
phenomenological method was the r e f l e c t i v e phase where the
t a s k was to r e f l e c t on the d e s c r i p t i o n s g e n e r a t e d in t h e
d e s c r i p t i v e phase in order to a rr iv e at t h e i r fundamental
s t r u c t u r e . The i n t e n t was to u n cover th e meaning of t h e
b u l i m i c ^ p ro jec t and personal myth as a human experience.
T h i s c h a p t e r was an a t t e m p t t o p r o v i d e a c o n c e p t u a l
framework t h a t was grounded in the c o l l e c t e d d a ta of the
b u l i m i c ’s e x p e r i e n c e . This i n c l u d e d an e x p l i c a t i o n of
common themes a r i s i n g out of the s u b j e c t s 1 d e s c r i p t io n s of
t h e i r L e b e n s w e l t . Based on i n t u i t i o n s d e r i v e d from th e
p a r t i c i p a t i v e and d e s c r i p t i v e p h a se s , the r e s e a r c h e r
proposed a d e t a i l e d conceptual and phenomenological theory
of bulimia.
One of the purposes of t h i s chapter was to r e f l e c t on
th e e x p e r i e n c e s of th e b u l i m i c . There was a need to be
co n ce rn e d w i t h g e t t i n g to know th e " t h i n g s t h e m s e l v e s 1 1
127
(Zaner, 1970). What t h i s meant was t h a t one needed toj
s t e p back and r e f l e c t on t h e p e r s o n a l e x p e r i e n c e s of the
s u b j e c t s , w i t h o u t any p r e s u p p o s i t i o n s and p r e c o n c e i v e d
t h eo ries . Zaner has aptly put i t :
This a t t i t u d e r eq u ire s a T ste p p in g -b a ck T from any
p h ilo so p h ical (or other) theory and an inspectin g
of i t with o u t presupposing e i t h e r acceptance or
r e j e c t i o n , (p. 72)
The meaning of r e f l e c t i o n is to be d i r e c t e d t o w a rd s
th e a c t u a l e x p e r i e n c e and i s based upon i t (G i o r g i , 1970).
This is in c o n t r a s t to s p e c u l a t i o n which t a k e s th e a c t u a l
as a p o i n t of d e p a r t u r e and a t t e m p t s to speak about the
p l a u s i b i l i t y of c e r t a i n k i n d s of p o s s i b i l i t i e s . The
purpose here was to r e f l e c t on the s u b j e c t ’s protocols.
In t h i s s t a n c e t h e b u l i m i c was not seen as an o b j e c t
for one’s examination, as someone ’’out t h ere ," but was seen
as a s u b j e c t who e x p e r i e n c e s t h e world in a p a r t i c u l a r way.
According to Zaner (1970), phenomenology i n s i s t s on a
rigorous examination of t h i s experience.
Up to t h i s p o i n t th e e x p e r i e n c e of t h e b u l i m i c has
been known i m p l i c i t l y t h r o u g h s e l f - d e s c r i p t i o n s and
c l i n i c a l observations. These l i f e - w o r l d experiences needed
to be made e x p l i c i t in o r d e r to u n i f y and p r o v i d e some
s t r u c t u r e f o r th e i d e a s and themes. There was a need to
s y s t e m a t i c a l l y and methodologically explore in depth what
had been disclosed by the subjects. Zaner says t h i s needs
to be d o n e ...
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in the s e t t i n g of and through r e f l e c t i v e wonder,
o f t h i s 'new l a n d ': t h a t ' w o r l d ' in so f a r as i t
i s e x p e r i e n c e d by us, and o u r s e l v e s in so f a r as
we e x p e r i e n c e i t. (p. 50)
A b r i e f d i s c u s s i o n of t h e need f o r a t h e o r y a p p e a r e d
necessary . Van Kaam (1966) claimed t h a t since th e r e was an
awareness of i n t e n t i o n a l i t y in human b ehavior, th e r e was a
t h e o r e t i c a l q u e s t f o r a u n i f y i n g s t r u c t u r e of i d e a s . In
ord er to comprehend and u n derstan d human behavior one needs
an i n t e l l i g i b l e u n i t y . The u n i f y i n g s t r u c t u r e of i d e a s
lea d s to th e theory. To t h e o r i z e i s to adopt a c e r t a i n way
of looking at something. The r e f l e c t i v e phase presupposed
t h o u g h t f u l o b s e r v a t i o n w i t h t h e f i n a l r e s u l t b e i n g a
t e n t a t i v e theory. Van Kaam suggested t h a t the f i n a l r e s u l t
of r e s e a r c h was never a closed system but only a t e n t a t i v e
one .
The purpose of th e phenomenological method i s to make
e x p l i c i t , in a s c i e n t i f i c way, the fundamental s t r u c t u r e s
o f t h e o b s e r v e d phenomenon. T h is i n v o l v e s t h e p r o c e s s of
e x p l i c a t i o n , which means to f o r m u la te e x p l i c i t l y what was
e x p e r i e n c e d i m p l i c i t l y i n a w a r e n e s s . D u r i n g t h e
p a r t i c i p a t i v e phase the r e s e a r c h e r was able to exp erien ce
i n t u i t i v e l y t h e L e b e n s w e l t o f t h e b u l i m i c s . In o r d e r t o
g e n e ra te a th eo ry th ese i m p l i c i t e x p erien c es or aw arenesses
need t o be made e x p l i c i t and u n d e r s t a n d a b l e f o r o t h e r s .
Van Kaam (1966) s a y s t h a t e x p l i c a t i o n a lw a y s s t a r t s from
awareness and t h a t awareness a ls o c o n s t i t u t e s the f i n a l aim
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o f e x p l i c a t i o n . Through e x p l i c a t i o n one p r o d u c e s an
e n lig h te n e d awareness or one changes a vague awareness in to
a more d e t a i l e d con cep tu al knowledge.
The p u r p o s e o f t h e t h e o r y i s t o make t h e w o r l d
meaningful to o t h e r s . The phenomenological th e o ry proposed
in t h i s s t u d y was g rou n ded in a n * a n a l y s i s of t h e human
s i t u a t i o n of t h e b u l i m i c s 1 L e b e n s w e l t . T h is l e d t o a
complex q u a l i t a t i v e d e s c r i p t i o n of t h e i r e x p erien c es w ith in
t h e i r world and th e development of a u n i f i e d s t r u c t u r e from
which f u r t h e r t e s t a b l e hypotheses may be deduced. The aim
was t o p r o v i d e a t h e o r y w hich was e x p a n s i v e and which
h e l p e d t h e r e a d e r t o u n d e r s t a n d more of t h e phenomenon of
b u l i m i a and i t s m eaning. The a p p l i c a t i o n o f t h e t h e o r y
would p r i m a r i l y be for the t h e r a p i s t as s /h e attem pted to
un d erstand th e l iv e d - w o r l d of th e b u lim ic.
To a r r i v e a t a t h e o r y t h e r e was a need t o o r g a n i z e t h e
data derived from th e d e s c r i p t i v e phase in to parsim onious
u n i t s . Common themes were chosen as a means of o rg a n iz in g
t h e d a t a . The c a t e g o r i e s w hich a r o s e from t h e d a t a were
n o t b a sed on some p a r t i c u l a r t h e o r e t i c a l p e r s p e c t i v e b u t
e m e r g e d f r o m t h e d a t a . T h e s e b e c a m e c l e a r as t h e
t r a n s c r i p t s of the e x p re s s io n s of the b u l i m i c s ’ inner world
were c a r e f u l l y read .
The c a t e g o r i e s t h a t emerged were: (1) abandonment by
t h e f a t h e r ; (2) need f o r p e r f e c t i o n and f e a r of f a i l u r e ;
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(3) fear of r e j e c t i o n ; (4) p reoccu patio n w ith body s i z e and
s h a p e ; (5) f e a r of s e p a r a t i o n ; (6) f e a r of a l o n e n e s s ; (7)
b e i n g - f o r - o t h e r s ; (8) f e a r o f and i n t e r n a l i z a t i o n o f
f e e l i n g s ; (9) l a c k o f c o n t r o l and b e in g a v i c t i m ; (10)
deep s e n s e of g u i l t ; (11) s e n s e of o b l i v i o u s n e s s and
d e p e r s o n a l i z a t i o n o f s e l f ; (12) need to p u r i f y ; (13)
f e e l i n g l i k e a sex o b j e c t ; (14) f e a r o f fre e d o m and
r e s p o n s i b i l i t y ; (15) death, d e s p a ir , and m e a n in g le ssn e ss;
(16) f e a r of r e l a t i o n s h i p s ; (17) f e e l i n g s of w o r t h l e s s n e s s ;
and (18) i n v a l i d a t i o n of p e rc e p tio n s .
P r e s e n t a t i o n and D e l in e a t i o n of Themes
Abandonment by the F a th e r
One o f t h e f i r s t t h e m e s t o a r i s e from t h e s e l f
d e s c r i p t i o n s was the r e l a t i o n s h i p of th ese women with t h e i r
f a t h e r s . Though each of them had d i f f e r e n t e x p e rie n c e s in
r e l a t i o n to t h e i r f a t h e r , they a l l f e l t abandoned by t h e i r
f a t h e r s in some way. A ll o f them r e f e r r e d t o t h e i r f a t h e r s
r e g u l a r l y in t h e s e s s i o n s . B e t h 's f a t h e r c u t o f f a l l
r e l a t i o n s h i p s w i t h h e r d u r i n g h e r j u n i o r y e a r in h ig h
s c h o o l . T his was a c o n t i n u i n g s o u r c e of p a in f o r h e r .
Somehow she f e l t she had n e v e r been good enough f o r him.
She f e l t t h a t i f she would have been more " a l l a ro u n d " he
would not have r e j e c t e d her.
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H elen , th o u g h she s t i l l l i v e s w i t h h e r f a t h e r , n e v e r
f e l t accepted by him. She f e l t t h a t in order for her to be
a c c e p t e d by him she would need to r e j e c t h e r f e m i n i n i t y .
She a l s o f e l t t h a t she would have to p r o d u c e s o m e t h i n g to
be a c c e p ta b le . In s p i t e of the f a c t t h a t she was t o ld t h a t
she was lo v e d she f e l t she was t o l d in many o t h e r ways
t h a t she was s tu p id and a ’’problem ” for the family.
Verna grew up w i t h an a l c o h o l i c f a t h e r who was n e v e r
t h e r e f o r h e r . He was a l c o h o l i c b e f o r e she was b o rn.
Because of her f a t h e r ’s d i f f i c u l t i e s , Verna was never able
to develop r e l a t i o n s h i p s w ith o th er c h il d r e n . Home became
a n i g h t m a r e f o r h e r b e c a u s e of a l l t h e v i o l e n c e . P a r t of
her r e s p o n s i b i l i t y in the fa m ily was to p r o t e c t the mother
and rescue the f a t h e r when he got in tr o u b le .
A l l o f t h e women d e c l a r e d t h e i r l o v e f o r t h e i r
f a t h e r s . Both Beth and Helen were a l s o a b l e t o e x p r e s s
t h e i r a n g e r t o w a r d s t h e i r f a t h e r s . They b o th had a g r e a t
deal of ambivalence in r e l a t i o n s h i p to t h e i r f a t h e r s . All
t h r e e d e s p e r a t e l y w a n ted a good r e l a t i o n s h i p w i t h t h e i r
f a t h e r s , th o u g h b o th Helen and Verna s a i d t h e i r f a t h e r s
were not good fo r them. Verna claim ed she had no n e g a tiv e
f e e l i n g s t o w a r d s h e r f a t h e r , th o u g h she did when she was
l i t t l e .
All of them experienced t h e i r f a t h e r s as unem otional
and u n a f f e c t i o n a t e . The r e s u l t of t h i s abandonment by the
1 32
f a t h e r s produced d i f f i c u l t i e s in r e l a t i o n s h i p s with men in
! g eneral. All of them expressed anger and h o s t i l i t y towards
a l l men, e v e n t h o u g h t h e y w e r e a l l i n a s i g n i f i c a n t
r e l a t i o n s h i p with a man at the tim e.
Need for P e r f e c t i o n and Fear of F a i l u r e
Another theme t h a t emerged from the d e s c r i p t i o n s was a
need for p e r f e c t i o n along w ith a fe a r of f a i l u r e . Beth and
Helen f e l t they needed to be p e r f e c t , e s p e c i a l l y for t h e i r
f a t h e r s , in o r d e r t o be a c c e p t e d in t h e w o r ld . They o n l y
w a n te d t o t r y t h o s e t h i n g s w hich t h e y know t h e y would
s u c c e e d in. However, b e c a u s e o f t h e i r f e a r o f f a i l u r e ,
t h e y f r e q u e n t l y f e l t i m p o t e n t and u n a b l e t o move ahead in
making d e c i s i o n s . T h ere a lw a y s seemed t o be a s e n s e of n o t
I
being able to do anything r i g h t .
T h is f e a r of f a i l u r e was e v i d e n t in how o f t e n t h e y
wanted feedback on what they were doing or had done. They;
saw most t h i n g s t h e y d id as a " p r o b le m ." They t a l k e d
a b o u t how t h e y were " s c r e w i n g up" t h e i r l i f e . S in c e t h e y
knew t h a t t h e y c o u ld n o t be p e r f e c t t h e y e x p e r i e n c e d a deep
s e n s e o f f a i l u r e . At one p o i n t one of them even s a i d t h e y
c o u ld n 't "do b u lim ia" r i g h t .
They a ls o f e l t t h a t they had f a i l e d in r e l a t i o n s h i p to
t h e i r b o d i e s . A ll of them had a s e n s e t h a t t h e y had
d i s t u r b e d t h e b o d y 's n o r m a l d i g e s t i v e s y s t e m . They had
133
f a i l e d in ta k in g care of t h e i r bodies, in s p i t e of the f a c t
t h a t t h e y had been so c a r e f u l n o t to g a in w e i g h t . A ll
t h r e e of them f e l t t h a t t h e i r food did not d i g e s t n orm ally
and t h a t i t j u s t s t a y e d in t h e i r sto m a c h l i k e a lump.
They, f u r t h e r m o r e , f e l t t h a t i f t h e y s t o p p e d t h e b i n g i n g
and purging they would again f a i l in a deq u ately ta k in g care
of t h e i r bodies.
Fear of R e je c tio n
A l l t h r e e o f t h e women l i v e d w i t h a c o n t i n u o u s f e a r o f
r e j e c t i o n . The p r e s s u r e t h e y e x p e r i e n c e d t o p e r f o r m in a
p a r t i c u l a r way t o g a in a c c e p t a n c e r e s u l t e d in an e v e r
p r e s e n t f e a r t h a t someone would r e j e c t them. The s e v e r e
r e j e c t i o n t h e y had a l l e x p e r i e n c e d from t h e i r f a t h e r s
a p p e a r e d t o c o n t r i b u t e t o t h e i r f e a r of r e j e c t i o n from
o t h e r s . They saw t h e m s e l v e s as a p r o b l e m f o r p e o p l e .
H e l e n s a i d t h a t i f s h e g a v e up b u l i m i a s h e w o u l d be
nothing. She r e l a t e d how she had been t o l d as a c h il d t h a t
she was accepted, however, she f e l t t h e r e were many ways in
which she was t o l d t h a t she was not accepted. She somehow
f e l t she had been t r i c k e d . This made i t d i f f i c u l t for her
t o t r u s t t h e s i n c e r i t y o f p e o p l e . She s a i d , "Anytime I
t u r n t h e c o r n e r I m i g h t be r e j e c t e d . " T h i s f e a r o f
r e j e c t i o n caused them to be very c a u tio u s in r e l a t i o n s h i p s
s i n c e t h e y a lw a y s n eeded t o be a l e r t t o what o t h e r s m ig h t
1 34
be t h i n k i n g . To a s s u r e t h e m s e l v e s t h a t t h e y would n o t be
r e j e c t e d , they t r i e d to f i g u r e out what o th e r s wanted from
them and t r i e d to g i v e t h a t to them . C r i t i c i s m was a l s o
d i f f i c u l t f o r th e m t o a c c e p t . H e l e n r e p o r t e d t h a t
c r i t i c i s m c a u s e d a h o l l o w , k in d o f b u z z i n g f e e l i n g in h e r
sto m a c h . T h is t o l d h e r t h a t she was j u s t a m ess, a w a s t e
o f l i f e . The f o o d d u r i n g h e r b i n g e s f i l l e d up t h e
hollow ness she f e l t . Beth f e l t she needed to sta y t h in in
order to avoid r e j e c t i o n sin c e people had n e g a tiv e opinio n s
of f a t people.
Preoccupation with Body Size and Shape
The fea r of r e j e c t i o n appears to be d i r e c t l y lin ked to
t h e p r e o c c u p a t i o n w i t h body s i z e and sh a p e . None of them
l i k e d t h e i r b o d i e s . They a l l f e l t an o b s e s s i o n t o s t a y
t h i n . They a l l f e l t s t r o n g l y t h a t p e o p l e would n o t l i k e
them i f t h e y were to o f a t . S in c e a l l o f them c r a v e d
acceptance and fea re d r e j e c t i o n , i t was im p o r ta n t to them
t h a t th e y m a i n t a i n an a p p r o p r i a t e body w e i g h t and shape.
Beth s a i d t h a t she was a lw a y s c o n c e r n e d w i t h h e r "dumb
w e i g h t . " T his was g e t t i n g t o be a r e a l b u r d e n f o r a l l
t h r e e of them sin c e i t occupied so much of t h e i r th in k in g .
P r e o c c u p a t i o n w i t h body s i z e and shape began a t th e
tim e of the move from puberty in to adulthood when the major
body c h an g e s were t a k i n g p l a c e . They had c o n c e r n a b o u t
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t h e i r b r e a s t s and t h e i r h i p s in p a r t i c u l a r . Verna s a i d
t h a t she f e l t b e t t e r m e n t a l l y when she was t h i n . A ll of
them had been on a p e r p e t u a l d i e t f o r many y e a r s , moving
between s t a r v a t i o n and binging. They a l l f e l t a g r e a t deal
o f p r e s s u r e t o look d i f f e r e n t l y th a n th e y d id . They a l s o
f e l t p r e s s u r e from men to make s u r e t h e y r e m a in e d t h i n or
even l o s t weight.
Fear of S e p a ra tio n
i
B u l i m i c s se e m t o h a v e d i f f i c u l t y w i t h s e e i n g
t h e m s e l v e s as s e p a r a t e p e r s o n s . B e th t a l k e d a b o u t
" s p e a k i n g t h r o u g h " h e r b o y f r i e n d . T hough t h e y a l l
e x p e r i e n c e d p a in in r e l a t i o n s h i p t o t h e i r f a t h e r s th e y
seemed to be fused to them in some way. I f the f a t h e r was
n o t p r e s e n t t h e y c o n s t e l l a t e d t h e i r l i f e around someone
e l s e . Helen f e l t t h a t i f she s e p a r a t e d from h e r p a r e n t s
she would have t o b e g in a s s u m i n g r e s p o n s i b i l i t y f o r
h e r s e l f . T h is was v e ry f r i g h t e n i n g f o r h e r. Then she
would no l o n g e r be a b l e t o blam e them f o r th e p a in in her
l i f e . Beth had n e v e r had a t i m e when she was w i t h o u t a
b o y f r i e n d . As she sa y s i t , "I have n e v e r been j u s t me."
Being j u s t her was a lso a s s o c i a t e d w ith a l o t of fe a r . She
was very a f r a i d t o do a n y t h i n g on h e r own. Verna was
f r i g h t e n e d o f moving in w i t h h e r b o y f r i e n d . In 25 y e a r s
she had n e v e r l i v e d in any o t h e r p l a c e th a n w i t h h e r
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m o th e r. She had had t h e same b o y f r i e n d f o r se v en y e a r s
w ith o u t f e e l i n g much p r e s s u r e to s t a r t of l i f e of her own.
Her move to her b o y f r i e n d 's apartm ent was q u i t e a t r a u m a t i c
e x p e r i e n c e . She c o n t i n u e d t o s e e h e r s e l f m ore as a
r e f l e c t i o n of him th a n someone on h e r own. For B eth,
s e p a r a t i o n meant h a v in g to g e t to know h e r s e l f , which
seemed both e x c i t i n g and very f r i g h t e n i n g .
i Fear of Aloneness
E s s e n t i a l to u n d e rs ta n d in g the b u l i m i c s 1 Lebenswelt i s
t h e i r f e a r of alo neness. Verna said t h a t her g r e a t e s t pain
was a l o n e n e s s . When she was a l o n e she s u f f e r e d . The
binging, purging, and s e l f - m u t i l a t i o n occured when she was
alone. All of them r e p o r te d a sense of a lo n e n e s s, even a t
tim e s when o t h e r s were p r e s e n t. They f e l t s e p a r a te d from
o t h e r p e o p l e and t h e a l o n e n e s s t e r r i f i e d them . Verna
c o u ld n ft understand why' t h e r e were people sin c e they d id n ft
seem t o be in a c o n n e c t i o n w i t h h e r . They f e l t a l o n e in
t h e i r pain, alone in the u n d e rs ta n d in g of t h e i r ex p erience,
and a l o n e in t h e i r s u f f e r i n g . The s e n s e was t h a t nobody
u n d e r s t o o d . They a l l f e l t t h e y were t h e o n ly ones who
e x p e r i e n c e d l i f e as t h e y d id b u t seemed r e l i e v e d t o know
t h a t o t h e r s f e l t the way they did.
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B e i n g - f o r - o t h e r s
C e n tra l to u n d e rs ta n d in g the b u lim ic is t h e i r sense of
b e i n g t h e r e f o r o t h e r s . T here was a need to a n t i c i p a t e
what o t h e r s were t h i n k i n g or f e e l i n g a b o u t them , and
g uiding t h e i r e x t e r n a l l y observed behavior so as to have a
c e r t a i n kind of e f f e c t on o t h e r s , to make a c e r t a i n kind of
i m p r e s s i o n . Verna c a l l s i t " p u t t i n g on an a c t . " T h e i r
g o a l was t o make o t h e r s happy, even i f t h a t meant l o s i n g a
sense of th em selves. Beth says s h e ’s " l ik e an e n t e r t a i n e r ,
l i t t l e M iss N icey." They a l l t a l k e d a b o u t b e i n g p l e a s a n t
on t h e o u t s i d e s i n c e th e y w a n te d e v e r y o n e t o l i k e them.
They did p r e t t y much what people wanted them to do, to the
p o in t of not knowing what they wanted for them selves. Part
of t h i s means t h a t they have an o u t e r / i n n e r s p l i t . On the
o u t s i d e t h e y d id what t h e y t h o u g h t p e o p le w anted them t o
do. On t h e i n s i d e t h e y were r e s e n t f u l and an g ry . They
f e a r e d t h a t i f t h e y l e t p e o p l e know who th e y r e a l l y were
i n s i d e t h e y would be r e j e c t e d . They were p a r t i c u l a r l y
c o n f u s e d when t h e m e s s a g e s changed r e g a r d i n g how t h e y
s h o u l d be. Helen e x p e r i e n c e d g r e a t c o n f l i c t in who she
s h o u l d be. On t h e one hand she t h o u g h t she s h o u l d be t h e
one t o make o t h e r s happy, cook t h e r i g h t t h i n g s , s a t i s f y
someone s e x u a l l y , and g e n e r a l l y be t h e good l i t t l e g i r l .
The o t h e r p e r s o n s h e f e l t s h e n e e d e d t o be was t h e
c o g n it i v e , t o g e t h e r , alo o f, and d i s t a n t person. This would
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b r i n g h e r s u c c e s s in t h e a c a d e m ic w o r l d . The i n t e r n a l
b a t t l e was whom she s h o u ld p l e a s e . T here seemed to be
l i t t l e sense of p e rs o n al i d e n t i t y .
Beth r e p o r t e d t h a t she d i d n ’t even know what she
w a n ted . She s a i d , ’’I ’m n o t l i v i n g my l i f e . I ’m l i v i n g
around o ther p eo p le.” The one sense of i d e n t i t y t h a t they
do have i s t h a t t h e y a r e " b u l i m i c . " T his gave them some
s e n s e o f b e i n g - f o r - t h e m s e l v e s . In t h e i r a t t e m p t to f i l l
t h e e m p t i n e s s o f t h e i r l i f e by b e in g " f o r - o t h e r s , " t h e y
o ften drove people away r a t h e r than b r in g in g them c lo s e r ,
thus only i n c r e a s i n g t h e i r sense of r e j e c t i o n .
Fear of and I n t e r n a l i z a t i o n of F e e lin g s
B ulim ics see t h e i r f e e l i n g s and emotions as th e source
| o f t h e i r p r o b l e m s . They f e l t t h e y had to o many f e e l i n g s ,
] too many emotions. Verna was t i r e d of f e e l i n g f e e l i n g s and
t r i e d n o t to f e e l a n y t h i n g . She s a i d h e r b r a i n c o u l d n ’t
h a n d l e t h e f e e l i n g s . She s u p p r e s s e d h e r f e e l i n g s as much
as p o s s i b l e to t h e p o i n t w here i t was h a rd f o r .her to be
a w are s p e c i f i c a l l y o f what t h e f e e l i n g s w ere. She had
p a r t i c u l a r d i f f i c u l t y i n f e e l i n g a n g e r , t h o u g h ,
n o n v e r b a l l y , she was a b l e t o e x p e r i e n c e a g r e a t d e a l o f
a n g e r and r e s e n t m e n t . Helen s a i d t h a t she was j u s t to o
e m o t i o n a l and good p e o p l e d o n ’t have e m o t i o n s . For h e r ,
emotions meant r e j e c t i o n so she f e l t i t would be b e t t e r to
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tu rn o f f emotions com pletely. All of the women attem p ted
t o drown ou t t h e i r f e e l i n g s t h r o u g h food. The s t r o n g e s t
emotion t h a t they feared was anger. Beth said t h a t she had
n e v e r b r o u g h t o u t h e r a n g e r t o w a r d s h e r f a t h e r , h e r
b o y f r i e n d , or t h e p e o p l e a t h e r jo b . Verna o f t e n was n o t
aware t h a t she was angry. She v ig o r o u s ly denied any anger
e v e n i f t h e t o n e o f h e r v o i c e and h e r b o dy l a n g u a g e
i n d i c a t e d o t h e r w i s e . A ll o f them found t h a t t h e most
e f f e c t i v e way o f d e a l i n g w i t h u n w a n ted and n e g a t i v e
f e e l i n g s was t o b i n g e and p u r g e . Once t h e n e g a t i v e
f e e l i n g s had accumulated, Beth ate the a p p r o p r i a t e amount
o f food. With s e l f - i n d u c e d v o m i t i n g she was a b l e t o g e t
r i d o f a l l t h e n e g a t i v e f e e l i n g s and r e s e n t m e n t s . I f she
h a d n ’t e a t e n e n o u g h f o o d t o e q u a l t h e a m o u n t o f bad
f e e l i n g s , she a t e more and e l i m i n a t e d t h e r e s t . The
b i n g i n g and t h e p u r g i n g was a way t o e l i m i n a t e t h e
f e e l i n g s .
Lack of Control and Being a Victim
B u l i m i c s f e e l t h e y a r e v i c t i m s of s o m e t h i n g "out
th e r e ." Something or someone i s doing t h i s to them. They
c e r t a i n l y do n o t see t h e m s e l v e s as h a v in g much t o do w i t h
t h e i r binging and purging. They wish they could get r i d of
" i t , " g e t "aro u n d i t , " and somehow be f r e e of " i t . " They
f e e l t h e y c o u l d n ’t c o n t r o l a n y t h i n g a b o u t t h e i r l i f e ,
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n e i t h e r t h e i r e m o t i o n s or t h e i r p a s s i o n s . O t h e r s were
a lw a y s in c o n t r o l . They f e l t t h a t b u l i m i a was a t r a p
t h e y Td l i k e t o g e t o u t of. As Helen d e s c r i b e d i t so w e l l ,
"I r e a l l y dance the m a r t y r ’s dance." Rather than saying i t
was a l l t h e i r f a u l t , t h e y p r e f e r r e d to t h i n k t h a t i t was
a l l someone e l s e ’s f a u l t . They moved b e tw ee n t a k i n g a l l
t h e blam e and none of t h e blam e. Beth s a i d t h a t when she
f e l t trapp ed , she had to vomit.
One s e n s e in which th e y f e l t c o n t r o l l e d was by o t h e r
p e o p l e in t h e i r l i f e . Beth s a i d h e r f a t h e r t r i e d to
c o n tr o l too much of her l i f e and now her bo y frien d c o n t r o l s
h e r . Helen s a i d she gave h e r f a t h e r a l l t h e power and in
some ways she would r a t h e r be the v i c t i m than face l i f e on
h e r own. Helen s a i d t h a t e a t i n g was an u n c o n t r o l l e d way o f
c o n t r o l l i n g . I t was a way o f c o n t r o l l i n g s o m e t h i n g more
i m p o r t a n t . In a w o rld o f t o t a l c o n t r o l one t h i n g t h a t
they could c o n t r o l was what they a te and what they vomited.
In one s e n s e t h e b i n g i n g and p u r g i n g was t h e one c o n t r o l l e d
asp ect of t h e i r l i f e . The immediate sense w hile e a t in g was
one o f v i c t o r y and s e l f - c o n t r o l . No one was d e t e r m i n i n g
how much t h e y a t e or d i d n ’t e a t . Beth s a i d t h a t "when I
e a t and t h r o w up I d o n ’t f e e l l i m i t e d anym ore. I d o n ’t
f e e l l i k e anyone c o n t r o l l i n g my e a tin g ."
Besides f e e l i n g l i t t l e or no c o n tr o l over the mundane
a sp e c ts of t h e i r l i v e s t h e r e was a deeper e x i s t e n t i a l sense
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o f no c o n t r o l o v e r t h e i r l i f e or d e s t i n y . Helen f e l t she
c o u ld n ’t c o n tr o l anything in her world. She was t e r r i f i e d
of a n u c le a r h o lo c a u st and yet t h e r e was n o thing she could
do. There d i d n ’t seem to be any o p t i o n s . B i n g i n g and
purging helped to r e l i e v e the a n x ie ty of no c o n tr o l .
Deep Sense of G u ilt
To u n d e r s t a n d t h e w o rld o f t h e b u l i m i c one must
u n d e r s t a n d t h e e x t r e m e g u i l t t h a t th e y f e e l . T here a r e
e s s e n t i a l l y two k i n d s o f g u i l t b u l i m i c s f e e l . The f i r s t
was a g u i l t over what t h e y had done. They f e l t t h a t t h e y
have c ho sen b a d l y in t h e p a s t and a r e c o n t i n u i n g t o do so
in t h e p r e s e n t . They f e l t g u i l t over n o t h a v i n g been
b e t t e r d a u g h t e r s , n o t h a v i n g been b e t t e r c a r e t a k e r s , n o t
! h a v i n g t a k e n b e t t e r c a r e of t h e i r b o d i e s , and so f o r t h .
T here was l i t t l e t h a t t h e y d i d n ’t f e e l g u i l t o v e r . When
t h in g s went wrong in t h e i r f a m i l i e s they f e l t they must be
a t f a u l t . Verna somehow f e l t g u i l t y about what her f a t h e r
was d o in g . She e x p e r i e n c e d g u i l t when she was not ’’t h e r e
fo r her f a t h e r . ” She had g u i l t when she was not t a l k i n g to
him , even th o ug h he was drunk most of t h e t i m e . Helen f e l t
g u i l t y when t h e dog g o t s i c k b e c a u s e p e r h a p s she h a d n ’t
lo v e d i t enough. They a l l f e l t m ajo r g u i l t o ver t h e i r
b i n g i n g and p u r g i n g b e c a u s e t h e y knew ’’i t ’s w r o n g . ” T his
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was e s p e c i a l l y e v i d e n t in t h e i r d re a m s which f r e q u e n t l y
involved them g e t t i n g caught ”in the act."
More s i g n i f i c a n t than g u i l t over what they were doing
was th e second t y p e , th e g u i l t t h e y a l l f e l t f o r b e in g .
Helen s a i d she was a " w a lk i n g a p o lo g y f o r my e x i s t e n c e . "
The p u n i s h m e n t th e y had e x p e r i e n c e d as c h i l d r e n , p e r h a p s
not p h y s ic a l but punishment n e v e r - t h e - l e s s , had made them
f e e l t h a t t h e i r very being was wrong. They experienced the
punishment through th e abandonment by t h e i r f a t h e r s . The
s t a n d a r d s e x p e c t e d by t h e f a t h e r s were n o t i n t e r n a l i z e d
i n t o a s p o n t a n e o u s and p e r s o n a l l y f e l t p r e f e r e n c e f o r
b e i n g , b u t were i n t r o j e c t e d c o m p l e t e l y r e s u l t i n g in a
b e i n g - f o r - o t h e r s k i n d o f l i f e . They seemed t o have a
nagging awareness t h a t they were not t h e i r own. They were
c a u g h t in a s t r u g g l e t o a p p e a s e and t o r e b e l , a l t e r n a t e l y
or s i m u l t a n e o u s l y . Not o n ly d id t h e y s t r u g g l e b e tw ee n
good-bad but a ls o between w eak -stro ng , s u c c e s s - f a i l u r e , and
m a l e - f e m a l e . The p r o c e s s o f d e v e l o p i n g a b e i n g - f o r - t h e -
w o r ld and b e i n g - f o r - m y s e l f was l o s t in t h e c o n f u s i o n o f
l i f e for th e b u lim ic .
Sense of O b liv io u s n e s s and D e p e r s o n a liz a tio n of S e lf
These b u l i m i c s c r e a t e d a s e n s e o f o b l i v i o u s n e s s t o
c o p e w i t h d i f f i c u l t o r u n l i v e a b l e s i t u a t i o n s . They
perceived th em selv es as s e p a r a t i n g th em selves from t h e i r
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b o d i e s and th e n l o o k i n g down on t h e i r b o d i e s . Verna
d e sc rib e d t h i s "eve ry th in g happening around me...things are
j u s t b u z z i n g a r o u n d . . . I ’m n o t t h e r e . . . I ’m in some o t h e r
p lac e...I f e e l s e p a r a t e , back watching." She sa id t h a t she
was p a r t i c i p a t i n g in what she had to do bu t t h a t she f e l t a
s e p a r a t e n e s s between her and o th e r s . She exp erien ced t h i s
when she d i d n ’t l i k e w hat was h a p p e n i n g a ro u n d h e r . She
d e s c rib e d h e r s e l f as always back t h e r e t h in k in g , even while
o th e r s were t a l k i n g to her. Beth was a lso always watching
and f r e q u e n t l y f e l t s e p a r a te d from people. She was o f f in
a w o r l d she w a n ted t o g e t away from . P e o p le a s k e d h e r i f
she was on drugs because she was a c t in g so "spacy." Beth
sa id she had the f e e l i n g of being in " t w i l i g h t zone" or "0-
zone." She did t h i s o u t o f a need f o r b e in g t h e k in d of
l
i p e r s o n e v e r y o n e w a n t e d h e r t o be. W h i l e s h e was i n
!
t w i l i g h t zone she was out of t o u c h w i t h h er f e e l i n g s .
Helen e x perienced l i f e in d u alism s. She h e r s e l f was t h r e e
p e o p l e : one, the dumb, c h e e rle a d in g , baby-m aking, b re a s te d
woman; t h e s e c o n d , t h e c o g n i t i v e , c o n f i d e n t , r e v e n g e f u l
woman; and t h e t h i r d , t h e one c a u g h t in t h e m id d l e t r y i n g
t o make some s e n s e o u t o f t h e w o r ld . The t h i r d was t h e one
doing the binging and purging.
Bulim ics also d e p e r s o n a liz e d the s e l f by causing the
s e l f to remain uncommitted and undefined. One way in which
t h i s was e v i d e n t was s p e a k i n g o f t h e m s e l v e s in t h e t h i r d
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p e r s o n r a t h e r th a n u s i n g t h e pronoun "I." By d o in g t h i s , !
d i r e c t c o n t a c t w i t h r e a l p e o p l e and w i t h r e a l t h i n g s was
denied from th e s e l f . By d e p e r s o n a l i z i n g th e r e l a t i o n s h i p
to th em se lv e s, b u lim ic s turned t h e i r a li v e n e s s in to a being
t h a t was som ewhat dead and l i f e l e s s . They were aw are of
t h i s p r o c e s s and g e n e r a l l y saw what t h e y were doing as a
way of "sta y in g sane."
Need to P u r if y
Bulim ics m aintained t h a t they needed to p u r if y t h e i r
b o d i e s t o e l i m i n a t e t h e bad t h a t was in them. V o m itin g
g ot e v e r y t h i n g o u t f o r them . S i n c e t h e y a r e u n a b l e or
u n w i l l i n g to l e t o t h e r s know how they a c t u a l l y experienced
t h e w o r l d , t h e o n l y way t h e y found o f e l i m i n a t i n g t h e bad
f e e l i n g s was t o v o m it them o u t. Once she had v o m it e d ,
Beth s a i d she was n o t h o l d i n g i t i n s i d e h e r anymore. She
was a b l e t o r i d h e r s e l f o f t h e a n g e r , h o s t i l i t y , and
f r u s t r a t i o n . Verna found s e v e r a l ways o f c l e a n s i n g ,
n a m e ly , t h e v o m i t i n g and t h e s e l f - m u t i l a t i o n . She a l s o
d e s c r i b e d t h e c u t t i n g a s " g e t t i n g i t o u t o f h e r . "
Somehow t h e e m p t i n e s s made t h e p a in go away. They f e l t
c l e a n e r i n s i d e once t h e y had th r o w n up. There was a l s o a
s e n s e in w h i c h t h e p u r i f i c a t i o n was a way o f s e l f
punishment. The f i r s t tim e for Helen had a p u n i ti v e a sp ect
to i t . Verna had a need to punish h e r s e l f . The immediate
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f e e l i n g a f t e r t h e v o m i t i n g was t h a t o f c l e a n n e s s and
p u r i t y . The food t h e y had i n g e s t e d was n o t " p u r e " and s a t
in t h e i r s to m a c h s l i k e a "lump." The o n l y way to g e t r i d
of the bad, or the im p u r ity , was to e l i m i n a t e i t .
F e e lin g Like a Sex Object
The f e e l i n g s of being a sex o b je c t was r e l a t e d to how
b u l i m i c s f e l t a b o u t men. T hough t h e y w e r e a l l in a
r e l a t i o n s h i p w i t h a man t h e y e x p r e s s e d i n n e r r e s e n t m e n t
towards them. They e s s e n t i a l l y saw men as wanting them as
sex o b j e c t s , r a t h e r than having a r e l a t i o n s h i p w ith them as
p e r s o n s . Verna s a i d t h a t t h e o n ly t h i n g men had on t h e i r
mind was sex. She t r i e d to sta y away from men because she
was t i r e d o f them f l i r t i n g w i t h h e r. She s a i d t h a t she
d i d n ’t f e e l l i k e a p e r s o n w i t h men b u t l i k e an o b j e c t .
Beth experienced sex as an in vasion of her. Sex f e l t l ik e
a n o t h e r way of c o n t r o l by men. She g e n e r a l l y saw men as
a lw a y s l o o k i n g a t g i r l s as sex o b j e c t s ; t h e r e f o r e , she
n eed ed t o " s t a y in s h a p e " even tho u gh she s a i d she d i d n ’t
l i k e i t . Even th o u g h Helen was in a r e l a t i o n s h i p w i t h a
man who t r e a t e d h e r l i k e a p e r s o n she was b a s i c a l l y
s u s p i c i o u s o f men, f e e l i n g t h a t t h e o n ly way she would
t r u l y be a c c e p t e d in a man’s w o r l d was by b e i n g a sex
o b j e c t .
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Fear of Freedom and R e s p o n s i b i l i t y
One of t h e g r e a t e s t f e a r s of b u l i m i c s was s e p a r a t i o n
and assuming r e s p o n s i b i l i t y for t h e i r l i v e s . They did not
s e e t h e m s e l v e s as f r e e and r e s p o n s i b l e . Though t h e y
assum ed " t h e b lam e" in some s e n s e by s a y i n g i t was a l l
t h e i r f a u l t , t h e i r f u n d a m e n t a l p e r c e p t i o n was t h a t t h e y
were not f r e e and they were not r e s p o n s i b l e . They p r e f e r r e d
to hide behind what they p erceiv ed to be the assessm ent of
o t h e r s r e g a r d in g who they were. For Verna t h i s meant t h a t
s h e was s e d u c t i v e e v e n t h o u g h s h e w o u l d n o t a s s u m e
r e s p o n s i b i l i t y f o r h e r s e d u c t i o n . Helen p r e f e r r e d t o h i d e
b e h i n d b e i n g u g l y a n d f a t r a t h e r t h a n a s s u m i n g
r e s p o n s i b i l i t y f o r h e r s u c c e s s e s and f a i l u r e s . She knew
she was a f a i l u r e , she was a louse, and she co uld n 't r e a l l y
c h a n g e t h a t . T h e r e was i n t e n t i o n a l i t y in how t h e y
s t r u c t u r e d t h e i r world sin c e they pu rposely, though perhaps
n o t a l w a y s c o n s c i o u s l y , " s c r e w e d t h i n g s up t h e y were
c a p a b l e o f d o i n g " so t h e y w o u l d n ' t h a v e t o a s s u m e
r e s p o n s i b i l i t y . Whenever t h in g s went bad fo r Beth, she ran
from i t so she would n o t have t o f a c e t h e c o n s e q u e n c e s of
h e r a c t i o n s . Helen s t a t e d i t w e l l when she s h a r e d t h a t
" b u l i m i a i s an e x c u s e from l i v i n g l i f e f u l l y , from t a k i n g
r e s p o n s i b i l i t y . "
147
Death, D espair, and M eaninglessness
At t h e c o re of t h e b u l i m i c s ' L e b e n s w e l t was th e
m e a n i n g o f t h e i r e x i s t e n c e . The s t r u g g l e was w i t h
o n t o l o g i c a l b e in g . Why were t h e y h e r e ? L i f e seemed so
p u r p o s e l e s s . E v ery d a y was g oing to work and " p u s h in g
b u t t o n s " or g o in g t o s c h o o l w i t h no g o a l s . The e x i s t e n c e
of people in the world l e f t Verna b a f f l e d . There seemed to
be no p o i n t . The b u l i m i c s w ondered what i t was t h a t t h e y
w ere d oing t o make t h i n g s any b e t t e r . The o n l y m eaning
t h a t Verna c o u ld f i n d f o r h e r l i f e was p r o t e c t i n g h er
m o th e r. Once t h e r e was no l o n g e r a need f o r t h a t , h e r
l i f e was p u r p o s e l e s s . The m eaning f o r Helen was t o be a
p r o b le m . The p a i n o f t h a t seemed t o o g r e a t , y e t f i n d i n g
a n o t h e r m eaning was to o f r i g h t e n i n g . P e r h a p s she d i d n ' t
r e a l l y e x i s t i f she w e r e n ' t a p r o b l e m . For Beth t h e
m ean ing o f l i f e was p e r f e c t i o n , s o m e t h i n g she c o u ld not
a t t a i n . The f e a r was how c o u ld she make i t in t h e w o r ld
w ith ou t being p e r f e c t .
The e x i s t e n t i a l s t r u g g l e o f l i f e and d e a t h was very
much a p a r t of t h e d a i l y s t r u g g l e f o r t h e b u l i m i c . The
t e r r o r o f n u c l e a r a n n i h i l a t i o n and t h e w o r ld e n d i n g was
always c lo se to the su r f a c e for Helen. Despair about l i f e
seemed to be c e n t r a l to the world of the b u lim ic. One way
in which the d e sp a ir could be avoided was by e a tin g . Helen
s a i d t h e s t r o n g e s t f e e l i n g t h a t " l e a d s me t o b u l i m i a i s
148
d e s p a i r . ” She would move i n t o fo o d , n a u s e a , and th e n
v o m i t i n g so she w o u l d n ’t need t o t h i n k a b ou t t h e d e s p a i r .
This would give her "12 hours of freedom.”
Verna l i v e d w i t h d e a t h on her mind much of th e t i m e .
For h e r d e a t h meant an end to t h e p a i n , an end to t h e
f e e l i n g s , and an end to t h e m e a n i n g l e s s n e s s . D a i ly she
planned her s u i c i d e , except t h a t she was also too a f r a i d to
a c t u a l l y c arry i t out. She was e s p e c i a l l y f e a r f u l t h a t at
a tim e when she was se p a r a te d i n t e r n a l l y she would go ahead
and do i t and not be aware. This was q u i t e t e r r i f y i n g for
her .
Fear of R e la ti o n s h ip s
Bulim ics in t h i s study f e l t they needed to keep o th e r s
|
at some d i s t a n c e from them selves. On the s u rfa c e t h i s was
b e c a u s e t h e y had t h i s a w f u l s e c r e t a b o u t t h e i r l i v e s so
they could not get too close. However, t h i s seemed only a
s m a l l p a r t o f t h e i r f e a r o f c l o s e n e s s . T h e i r f e a r was
r e l a t e d t o t h e h u r t t h e y h ad e x p e r i e n c e d i n p r i o r
r e l a t i o n s h i p s . They were t e r r i f i e d of r e j e c t i o n so b efore
they could be r e j e c t e d they would cut o f f the other person.
T h ere a l s o seemed t o be a f e a r t h a t o t h e r s would become to o
dependent on them and they would be "used." Since they had
d i f f i c u l t y in s a y i n g "no" t o o t h e r s and b e in g a b l e to
s e p a r a t e from o t h e r s in t h e i m m e d i a t e s i t u a t i o n , t h e y
149
r a t h e r c r e a t e d d i f f i c u l t i e s in t h e r e l a t i o n s h i p so t h e
person would back off. For Verna t h i s at tim es r e s u l t e d in
an a g o r a p h o b i c r e s p o n s e to p e o p l e . I f p e o p l e got too
c l o s e , she f e l t a need to l e a v e and g e t some a i r . Helen
s a i d t h a t i f t h i n g s were g o in g to o w e l l in a r e l a t i o n s h i p
she " c o u l d n ’t t a k e i t . " Her f e a r was t h a t p e r h a p s she
wasn’t r e a l l y e x p e rie n c in g the r e l a t i o n s h i p c o r r e c t l y and
t h a t she would s u r e l y be r e j e c t e d . They seemed to have a
b a s ic d i s t r u s t of o th e r s .
F e e lin g s of W orthlessness
The b u l i m i c s in t h i s s t u d y f e l t t h a t t h e y had l i t t l e
or no w o r th . They c o n t i n u a l l y c r i t i c i z e d t h e m s e l v e s ,
p e r h a p s b e f o r e o t h e r s would be a b l e t o do i t . Helen had
a l w a y s h ad a f e e l i n g o f b e i n g s t u p i d , a f e e l i n g o f
e m b a r r a s s m e n t o v er h e r body and h e r v o i c e , as w e l l as
g e n e r a l l y f e e l i n g l i k e a problem c h ild . When she did begin
to f e e l t h a t p e r h a p s she was c a p a b l e o f d o in g t h i n g s w e l l
she q u i c k l y changed t h a t t o "how d a re I t h i n k I c o u ld
t e a c h " or "how d a r e I t h i n k t h a t I c o u l d s u c c e e d . " Beth
saw h e r s e l f as h a v in g a bad p ro b le m . She d i d n ’t l i k e how
she s o l v e d h e r p r o b l e m s and s a i d she d i d n ’t l i k e what she
was d o in g . G e n e r a l l y , b u l i m i c ’s f e l t t h a t t h e y were
" s c r e w i n g " up t h e i r l i f e and t h a t t h e y d i d n ’t r e a l l y
150
d e s e r v e a n y t h i n g b e t t e r . They d i d n ’t d e s e r v e t o be lo v e d
or to be s u c c e s s f u l in l i f e .
I n v a l i d a t i o n of Their P e rc e p tio n s
The reason for t h e i r sense of w o r th le s s n e s s seemed to
come f r o m o t h e r ’s i n v a l i d a t i o n o f w h a t t h e y w e r e
p e rc e iv in g . Rather than t r u s t i n g t h e i r own p e r c e p t i o n s and
e x p e r i e n c e s as v a l i d th e y l i s t e n e d to what o t h e r s were
t e l l i n g them. When t h e y t r i e d t o s h a r e w i t h o t h e r s t h e
p a in o f t h e i r i n n e r w o r l d , t h e y were t o l d t h a t t h i n g s c o u ld
be w o r s e , w h a t 's wrong w i t h them b e c a u s e t h e y ’r e n o t f a t ,
and why did t h e y t h i n k t h i n g s were so bad. Not o n ly did
t h e y have d i f f i c u l t y in t r y i n g t o p u t t h e i r p e r c e p t i o n s
t o g e t h e r w i t h t h o s e o f o t h e r s , t h e y d i d n ' t seem t o know
whose p e r c e p t i o n s t h e y s h o u l d t r u s t . They did know t h a t
t h e y c o u ld n o t t r u s t t h e i r own s i n c e th e y so o f t e n d i f f e r e d
from th o se of o th e r s .
In summary, t h e f o l l o w i n g t h e m e s em erged from t h e
b u l i m i c s ' d e s c r i p t i o n s of t h e i r Lebenswelt: (1) b u lim ic s
e xperienced a lo s s of r e l a t i o n s h i p w ith the f a t h e r , as well
as a deep s e n s e o f aband o nm en t by him, a l o s s which l e f t
them in g r e a t pain; (2) b u lim ic s f e l t a c o n f l i c t between
a need f o r p e r f e c t i o n and a f e a r o f f a i l u r e . They knew
t h e y c o u l d n ’t be p e r f e c t and t h e y c o u ld n o t r i s k f a i l i n g
f o r t h a t w o u l d mean f u r t h e r r e j e c t i o n ; (3) b u l i m i c s
151
c o n t i n u a l l y feared r e j e c t i o n by o th e r s in t h e i r world; (4)
b u lim ic s were preoccupied with the siz e and shape of t h e i r
body. T h is seemed t o be a r e s u l t of t h e i r need to p l e a s e
o th e r s and gain the acceptance they so d e s p e r a t e l y wanted;
(5) b u l i m i c s f e a r e d s e p a r a t i o n from o t h e r s , p a r t i c u l a r l y
from t h e i r f a m i l y . They d i d n ’t have a s e n s e t h a t th e y
could make i t on t h e i r own; (6) b u lim ic s also feared being
a l o n e . The t i m e s when t h e y were a l o n e were t h e most
f r i g h t e n i n g and i t was at th e s e tim es t h a t they binged and
purged; (7) b u l im i c s had l i t t l e sense of who they were and
what they wanted fo r th e m se lv e s; (8) b u lim ic s were a f r a i d
of t h e i r f e e l i n g s and t h e r e f o r e i n t e r n a l i z e d them or "threw
them up;" (9) b u l i m i c s had a s e n s e t h a t t h e y were b e i n g
c o n t r o l l e d by o t h e r s and t h a t they were simply v i c t i m s of
s o m e t h i n g " o u t t h e r e ; " (10) b u l i m i c s had a deep s e n s e o f
g u i l t b o th f o r what t h e y had done and f o r b e in g ; (11)
b u lim ic s c r e a te d a world of o b l iv i o u s n e s s where they f e l t
se p a r a te d from t h e i r bodies, but continued to c a rry on the
mundane t a s k s o f l i v i n g ; (12) b u l i m i c s f e l t a need to
p u r i f y th em selv es of t h e i r e v i l by inducing vom iting; (13)
b u l i m i c s f e l t t h a t th e y were s i m p l y s e x u a l o b j e c t s f o r
o th e r s to look at and, t h e r e f o r e , they needed to keep t h e i r
b o d i e s in s h a p e ; (14) b u l i m i c s had a f e a r of fre e d o m and a
fe a r of assuming r e s p o n s i b i l i t y for what was happening in
t h e i r l i v e s ; (15) b u lim ic s were at a lo s s about what to do
152
w i t h d e a t h , d e s p a i r , and m e a n i n g l e s s n e s s . R a th e r t h a n
f a c in g t h a t f u l l y , they p r e f e r e d to o b l i t e r a t e the f e e l i n g s
w ith food, vom iting, and nausea; (16) b u lim ic s m aintained
I - I t r e l a t i o n s h i p s b e c a u s e c l o s e n e s s w i t h a n o t h e r would
somehow b r i n g them p a i n . B ecau se t h e y f e a r e d r e j e c t i o n
t h e y f e l t a n e e d t o k e e p o t h e r s a t a d i s t a n c e ; (17)
b u l i m i c s had l i t t l e s e n s e o f s e l f - c o n f i d e n c e or s e l f
esteem. This l e f t them to ex p erien c e s e l f - d e g r a d a t i o n and
a l o s s o f s e l f - w o r t h ; (18) b u l i m i c s d e n i e d t h e i r own
p e r c e p t i o n s b e c a u s e o f t h e i r need f o r th e a p p r o v a l of
o t h e r s . This l e f t them with i n t e r n a l c o n f l i c t sin c e they
had d i f f i c u l t y in knowing what to do with t h e i r own way of
se ein g th in g s .
A Phenomenological Theory of Bulimia
The case s t u d i e s provided the i n v e s t i g a t o r with a r ic h
s o u r c e o f d a t a and a p l a t f o r m from which t o e v o l v e a
meaningful theory. A number of com m onalities emerged from
i
t h e L e b e n s w e l t d e s c r i p t i o n s g i v i n g t h e b r e a d t h n eeded to
d e v e l o p a s u b s t a n t i v e t h e o r y of b u l i m i a . An a n a l y s i s of
t h e s e themes provided the t h e o r e t i c a l framework to c r e a t e a
dynamic, h o l i s t i c s t r u c t u r e of the phenomenon of b u lim ia.
The i n t e n t was to i d e n t i f y the o v e r a l l s e q u e n t i a l flow and
s t r u c t u r e of the s u b j e c t s 1 ex p erien c es to b e t t e r understand
th e phenomenology of b u lim ia .
153
[
The s e c t i o n on common th e m e s p r e s e n t e d a d e t a i l e d
r e d u c tio n and d e s c r i p t i o n of the phenomenon as i t a c t u a l l y
a p p e a r e d or was e x p e r i e n c e d . The aim now was to c l a r i f y ,
t h r o u g h r e f l e c t i v e and i n f e r e n t i a l a n a l y s i s , t h e
p s y c h o l o g i c a l s t r u c t u r e and s e q u e n t i a l f l o w o f t h e
phenomenon. The p r o c e s s of e x a m in i n g t h e i n t e r r e l a t i o n
s h i p s b e tw e e n t h e t h e m e s , m o d i f y i n g t h e t h e m e s , and r e
d u c in g them i n t o p a r s i m o n i o u s u n i t s was how th e t h e o r y
d e v e lo p e d .
)
A study of o th e r r e l e v a n t t h e o r i e s in the l i t e r a t u r e ,
such as Keen's (1970) e x i s t e n t i a l - p h e n o m e n o l o g i c a l approach
t o n e u r o s e s and van den B e r g ' s ( 1 9 7 2 ) p r i n c i p l e s o f
p h e n o m e n o l o g i c a l p s y c h o p a t h o l o g y , was h e l p f u l in
i n t e r p r e t i n g and p r o v i d i n g some s t r u c t u r e t o t h e common
th e m e s e m e r g i n g from t h e c a s e s t u d i e s on b u l i m i a . The
! c o n s t i t u e n t s and t h e i r i n t e r r e l a t i o n s h i p s in the developing
t h e o r y of b u l i m i a were f u r t h e r c l a r i f i e d and a r t i c u l a t e d
with r e f e r e n c e to o th e r phenomenological t h e o r i e s .
P r o j e c t and Personal Myth
The i n t e n t of the theo ry was to provide a parsim onious
e x p l a n a t i o n o f how t h e b u l i m i c had c o n s t r u c t e d h e r w o r ld
and how s h e h a d r e l a t e d t o i t , w i t h r e s p e c t t o t h e
phenomenon u n d e r i n v e s t i g a t i o n . T h is t h e o r y was f i r m l y
g ro u n d ed in t h e b u l i m i c s ' p e r s o n a l r e p o r t s and g i v e s t h e
154
reader and therapist a different look at these individuals1
i
e x p e rie n c in g of b u lim ia. O r g a n i z a t i o n a l l y t h i s was done by
means of d e s c r i b i n g t h e b u l i m i c ’s p r o j e c t and p e r s o n a l
myth. The p r o j e c t was seen as t h e i n d i v i d u a l ’s b a s i c way
of o r g a n iz in g her l i f e and p r i o r i t i z i n g her goals and aims
in r e l a t i o n s h i p t o h e r c o sm o lo g y , (Ofman, 1 976). The
p r o j e c t was f u r t h e r s e e n as t h e t h e o r y by w h i c h an
i n d i v i d u a l viewed her world and p r i o r i t i z e d her i n t e n t i o n s
based on t h a t world view. The p r o j e c t was her way of being
in t h e w o r l d , i . e . h e r b e h a v i o r , t h e u l t i m a t e e f f e c t of
w h a t s h e d i d , and t h e u l t i m a t e c o n s e q u e n c e s o f h e r
b e h av io r.
A c c o r d in g t o Ofman (1 976), t h e p e r s o n a l myth i s th e
meaning which the i n d i v i d u a l a t t a c h e s to the p r o j e c t . The
I
p e rs o n a l myth gives the p r o j e c t r a t i o n a l e and su bsta n c e and
p u t s i t i n t o an o r g a n i z e d , v a l i d a t e d , and d e s c r i p t i v e
p i c t u r e by which one l i v e s o ne’s l i f e .
The p r o j e c t and p e r s o n a l myth of b u l i m i c s i s t h e i r
r at io n a 1 a tte m p t at s u r v i v i n g in a world w ith c o n f l i c t i n g
demands and confusing e x p e c ta ti o n s . Their p r o j e c t is a way
of o rg a n iz in g and u n i f y in g t h e i r u n d e rstan d in g of the world
in view of t h e i r e x p e rie n c e s , memories, and h i s t o r i e s and
h e l p i n g them t o c o n t r o l t h e a n x i e t y and f r u s t r a t i o n th e y
e x p e r i e n c e in t h e i r e x i s t e n c e . F u r t h e r m o r e , t h e p r o j e c t
and p e r s o n a l myth i s an i n t e n t i o n a l c o n s t r u c t i o n , th o u g h
____________ _ _ 155.
t h e y may n o t be aw are of i t , d e s i g n e d to h e l p them " s t a y
sane" with t h e i r inner pain.
The r e s e a r c h e r saw the bulimics* l i v e s as i n t e n t i o n a l ,
p u r p o s i v e , and a c t i v e ; no t s i m p l y th e r e s u l t of some
o u t s i d e f o r c e . Even t h o u g h t h e c o n d i t i o n s o f t h e i r
childhood were i n f l u e n t i a l , the c o n s t r u c t i o n of t h e i r s e l f
world was never the le s s c r e a t i v e and i n t e n t i o n a l . Out of
t h e i r e x p e rie n c e s , they have c re a te d a world view and they
have acted in r e l a t i o n s h i p to t h a t world view. This is not
to say t h a t p e r s o n s a r e "blam ed" in a p u n i t i v e s e n s e f o r
how t h e y may h a v e c o n s t r u e d t h e w o r l d , b u t t h e y a r e
r e s p o n s i b l e for the way in which they have "created" t h e i r
view o f t h e w o r ld . T h e i r u n d e r s t a n d i n g o f t h e w o rld and
t h e m ea n in g s t h e y have a t t a c h e d t o t h e o b j e c t s in t h e i r
world have c o n t r i b u t e d to the c o n s t r u c t i o n of t h e i r p r o j e c t
and p e rso n al myth.
A Theory of Bulimia
The b a s ic c r i s i s for b u lim ic s , as i t emerged from the
d a t a , was one of b e in g . There a re t h r e e a s p e c t s of b e i n g
which a l l humans s t r u g g l e w i t h , n a m e ly : (1) t h a t w hich
f o c u s e s on an o b j e c t in t h e w o rld and r e s u l t s in t h e
ex p erien ce of knowing o n e s e l f as something o ther than the
o b je c t; (2) t h a t which focuses r e f l e c t i v e l y on o n e s e lf ; and
(3) t h a t w h ich f o c u s e s on o n e s e l f as seen by o t h e r s . The
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b u l i m i c s 1 m ajo r c o n t e x t o f m eaning was w h e t h e r t h e y were
a c c e p t e d or n o t. When b u l i m i c s r e f l e c t e d on t h e m s e l v e s
they experienced confusion and lacked a s t a b l e o r i e n t a t i o n .
They did n o t have a c l e a r s e n s e of t h e m s e l v e s nor a s e n s e
o f what i t was t h e y w an ted in t h e w o r ld . When t h e y t r i e d
t o i n t e r p r e t o t h e r s ' i n t e r p r e t a t i o n s of them t h e y h e a r d
d i f f e r e n t p o i n ts of view, lea v in g them in i n t e r n a l c o n f l i c t
1 as to how th e y s h o u l d "be."
B u l i m i c s seemed u n a b l e t o e x p e r i e n c e t h e m s e l v e s as
s u b j e c t s for any perio d of time. Through the ex p erience of
o n e s e l f - a s - s u b j e c t , t h e w o r ld t a k e s on m eaning. Not o n l y
d id th e y e x p e r i e n c e o t h e r s as o b j e c t i f y i n g them bu t t h e y
a l s o o b j e c t i f i e d t h e m s e l v e s . They saw t h e m s e l v e s as an
I
! o b j e c t t o keep t h i n and t o p u r i f y in o r d e r t o p r o t e c t
I
I
| th em selv es from f u r t h e r r e j e c t i o n .
i
j Because t h e p r i m a r y c o n c e r n f o r b u l i m i c s was to be|
a c c e p t e d and t o f i n d a m eaning f o r t h e i r e x i s t e n c e , t h e y
| s t r u c t u r e d e v e r y t h i n g i n t h e i r w o r l d a r o u n d m a k i n g
! th em selv es a c c e p ta b le . They did t h i s through subm ission to
i
j o t h e r s , s m i l i n g as much as p o s s i b l e , and b e in g as p e r f e c t
I
j
j as p o s s ib le . Much to t h e i r dismay, they never seemed to be
i
able to a t t a i n t h a t fo r which they were s t r i v i n g . To some
e x te n t t h i s was due to c o n f l i c t i n g messages about how they
s h o u l d be. To cope w i t h t h e i n n e r p a in of a s e n s e of no
c o n tr o l over what o t h e r s thought of them, they attem p ted to
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o b l i t e r a t e t h e f e e l i n g s and e m o t i o n s t h r o u g h b i n g i n g and
p u r g i n g . The r e s u l t i n g g u i l t b r o u g h t c o n f u s i o n and
u n h a p p i n e s s , y e t t h e p a in o f t h e g u i l t was l e s s th a n t h e
p a in of th e r i s k of b e i n g - f o r - t h e m s e l v e s . As a r e s u l t of
t h e i r a t t e m p t t o l i v e f o r o t h e r s t h e y e x p e r i e n c e d
m eaninglessness and em ptiness in t h e i r l i v e s .
B u l i m i c s f e a r e d s e p a r a t i o n from t h e i r f a m i l i e s and
a c t e d as i f t h e y were u n a b l e to s u r v i v e in t h e w o rld
w i t h o u t t h e a c c e p t a n c e o f t h e i r f a t h e r s , in p a r t i c u l a r .
They s t i l l s u f f e r e d from the a n x ie ty of s e p a r a t io n from the
p re m o rd ia l exp erien ce of fu sio n with the paren t. When the
p a r e n t was n o t p r e s e n t t h e y f o u n d o t h e r s t o a t t a c h
t h e m s e l v e s t o , s i n c e b e in g " a l o n e 1 1 was to o t e r r i f y i n g .
The b u l i m i c s in t h i s s t u d y f e l t t h a t in o r d e r to s u r v i v e
they needed to m ain tain another presence in t h e i r l i v e s to
give t h e i r l i f e meaning. They then found t h e i r meaning in
"being t h e r e " for the o th er person. At th e same tim e they
feared "being th e r e " because they had been r e j e c t e d before.
T h is c a u s e d them t o s a b o t a g e r e l a t i o n s h i p s in some way,
f u r t h e r v e r i f y i n g for them t h a t they were u n accep tab le and
u n l o v a b l e .
The b u l i m i c s d id n o t se e t h e m s e l v e s as a c t i v e a g e n t s
in r e l a t i o n to the world around them. They f e l t pow erless
in c h a n g i n g a n y t h i n g i n t h e i r w o r l d . To e x p e r i e n c e
o n e s e l f - a s - s u b j e c t , one ne ed s to be a b l e to have some
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c o n t r o l o v e r w h a t one e x p e r i e n c e s in t h e w o r l d .
F u r t h e r m o r e , one n e ed s t o e x p e r i e n c e o n e s e l f as an a c t i v e
p a r t in a r e l a t i o n s h i p . W it h o u t t h i s one e x p e r i e n c e s
m e a n i n g l e s s n e s s , d e p e r s o n a l i z a t i o n , and a n x i e t y . The
b u lim ic s had d i f f i c u l t y in seeing them selves as having any
c o n t r o l over t h e w o r ld and saw t h e m s e l v e s as p a s s i v e
p a r t i c i p a n t s in r e l a t i o n s h i p s . They were e s s e n t i a l l y in
r e l a t i o n s h i p s to " a c t " as o t h e r s w anted them t o , or how
t h e y t h o u g h t o t h e r s w a n t e d t h e m t o a c t . T h i s was
p a r t i c u l a r l y t r u e in r e l a t i o n s h i p to t h e i r b o d i e s . They
"knew" t h a t o t h e r s w a n ted them t o be t h i n and in good
sh a p e , t h e r e f o r e t h e y did e v e r y t h i n g p o s s i b l e to be t h i n ,
a t t h e c o s t o f d am ag in g t h e i r own b o d i e s . Not o n l y d id
t h e y f e e l l i k e an o b j e c t f o r o t h e r s bu t th e y p e r p e t u a t e d
i t h i s by a c t i n g l i k e an o b j e c t , o f t e n w i t h o u t a w a r e n e s s .
They d i s l i k e d h e a r i n g s e x u a l comments from men b u t th e y
continued to spend g r e a t amounts of tim e making sure t h e i r
bodies were a c c e p ta b le .
The anguish b u l im i c s f e l t was r e l i e v e d through binging
and p u r g i n g . The i n v e s t i g a t o r m a i n t a i n s t h a t b u l i m i c s
v i e w e d t h e w o r l d a r o u n d th e m c o r r e c t l y . They saw
them selves as the o b j e c t of the o t h e r s 1 gaze and sin ce they
had c ho sen n o t t o s e e t h e m s e l v e s as o t h e r t h a n t h a t th e y
c o n t i n u e d to s u f f e r . As a r e s u l t , t h e y had found a way o f
r e l i e v i n g t h e t e n s i o n and a n x i e t y t h r o u g h b i n g i n g and
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purging. The purging became an i n t e n t i o n a l act of r id d in g
t h e m s e l v e s o f t h e a n g u i s h t h e y f e l t . The c h o i c e t o e a t
huge am o un ts o f food e q u a l t o t h e amount o f n e g a t i v e
f e e l i n g s in order to e l i m i n a t e a l l of the f e e l i n g s was one
o f i n t e g r i t y , in s p i t e o f t h e p a i n f u l a s p e c t s o f t h a t
choi c e .
The a b n o rm a lity of b u lim ic s was not in t h e i r behavior
or p e r s o n a l i t y s t r u c t u r e but in t h e i r experience. Bulimia
was not sim ply a m atter of h a b i t s which v i o l a t e d c u l t u r a l
norms but i t was a l o g i c a l response to a way of p e r c e iv in g
t h e w o r ld . What i s i m p o r t a n t t o u n d e r s t a n d i s how t h e
b u l i m i c e x p e r i e n c e d r e a l i t y , as was r e f l e c t e d in t h e i r
s e l f - d e s c r i p t i o n s , and t h a t t h e b u l i m i c ’s b e h a v i o r was
purposi v e .
The p r o j e c t of b u lim ic s was to find meaning fo r t h e i r
e x is te n c e and to be accepted through changing t h e i r bodies.
The g o a l was t o somehow "make i t ” in t h e w o r l d by b e in g
w h a t t h e y t h o u g h t o t h e r s w a n t e d th e m t o be. They
e x p e r i e n c e d a g r e a t n e e d t o be w h o l e p e o p l e w i t h a
m e a n i n g f u l e x i s t e n c e . They had a need t o f e e l a s e n s e of
some c o n t r o l o v e r t h e i r own l i v e s . The one way in w hich
t h e y c o u ld c o n t r o l one s m a l l a s p e c t o f t h e i r l i v e s was by
f r e e l y d e t e r m i n i n g w hat t h e y a t e and th e n b e in g a b l e t o
e l i m i n a t e t h e food. The b u l i m i c s ’ b e h a v i o r was in t h e
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s e r v i c e of p r o t e c t i n g them selves from f u r t h e r r e j e c t i o n and
p ro v id in g a means of some personal sense of s e l f .
The b u l i m i c s 1 p erson al myth was t h a t by changing t h e i r
bodies and by doing what o th e r s wanted they would find what
they were looking for - acceptance. The p erso n al myth gave
t h e m t h e r a t i o n a l e f o r w h a t t h e y w e r e d o i n g . T h e i r
*
b e h a v i o r , th o u g h r e p u l s i v e t o o t h e r s and a t t i m e s even to
t h e m s e l v e s , was t h e i r a t t e m p t a t g i v i n g m eaning to t h e i r
world. By m a in ta in in g t h i s myth they never needed to find
o u t w h e t h e r t h e y would be a c c e p t e d f o r who t h e y w ere, nor
did they need to assume r e s p o n s i b i l i t y fo r who they were.
Summary
In summary, the p r o j e c t and p e rso n al myth of b u lim ics
i
was t h e i r a tte m p t to surv iv e in the world, t h e i r a ttem p t at
f i n d i n g m eaning in t h e i r l i f e , t h e i r a t t e m p t a t g a i n i n g
a c c e p t a n c e from i m p o r t a n t p e r s o n s in t h e i r l i f e , t h e i r
a t t e m p t a t d e a l i n g w i t h t h e i r a n x i e t y a b o u t t h e i r b e i n g ,
and t h e i r a t t e m p t a t h a v in g some c o n t r o l over t h e i r own
e x i s t e n c e .
In t h i s c h a p t e r t h e r e s e a r c h e r p r e s e n t e d t h e common
th e m e s e m e r g in g from t h e c a se s t u d i e s in t h e f o u r t h
chapter. These themes were chosen as a means of o rg a n iz in g
t h e d a t a and d e v e l o p i n g a t h e o r y o f t h e phenomenon of
b u lim ia. The c h ap ter f u r t h e r explained and d e scrib e d the
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b u l i m i c fs p r o j e c t and p e rs o n a l myth. The theory of b u lim ia
and t h e d e s c r i p t i o n o f t h e p r o j e c t and p e r s o n a l myth were
gro u n d ed in t h e b u l i m i c s ’ L e b e n s w e l t e x p e r i e n c e . The
t h e o r y was a c o n s t r u c t i o n which r e p r e s e n t e d a c o n c e p t u a l
u n d e r s t a n d i n g o f b u l i m i a g a i n e d t h r o u g h a s y s t e m a t i c
a p p l i c a t i o n of the phenomenological method. The th eory was
p r e s e n t e d t o p r o v i d e a new f r a m e o f r e f e r e n c e , a new
c o n s t r u c t i o n , and a new a p p r o a c h f o r v i e w i n g b u l i m i c s in
r e l a t i o n s h i p to t h e i r p e rc e p tio n of th e world.
The l a s t c h a p t e r w i l l show t h e i m p l i c a t i o n s o f t h i s
t h e o r y f o r t h e r a p y w i t h b u l i m i c s and w i l l s u g g e s t a r e a s
for f u r t h e r rese a rc h .
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CHAPTER VI
IMPLICATIONS AND CONCLUSIONS
The i n t e n t i o n of t h i s ch ap ter was to show what i m p l i
c a tio n s the phenomenological theory of b u lim ia has for the
t h e r a p e u t i c process, to suggest q u e s tio n s for f u r t h e r r e
s e a r c h g r o w in g out o f t h e p r e s e n t s t u d y , and to c o n c l u d e
th e study by a d d re ss in g i t s l i m i t a t i o n s .
I m p li c a t io n s For The T h era p eu tic Process
The s u g g e s t e d t h e o r y o f b u l i m i a was b a s e d on a
p h e n o m e n o l o g i c a l s t u d y of b u l i m i a . The t h e o r y , as i t
em erged from t h e c a s e s t u d i e s , m a i n t a i n e d t h a t t h e b a s i c
c r i s i s for the b u lim ic was one of being. Therefore, th e r e
was a need for a t h e r a p e u t i c process which took "being” as
a s t a r t i n g p o i n t . The e x i s t e n t i a 1 - p h e n o m e n o 1 o g i c a 1
a p p ro a c h t o t h e r a p y was one which p o s i t e d " b e in g " as
c e n t r a l to the t h e r a p e u t i c process.
Be Open To Hearing Bulimics
The t h e r a p i s t m ust be w i l l i n g t o e n t e r t h e p e r s o n a l
w o rld o f b u l i m i c s by l i s t e n i n g t o them d e s c r i b e t h e i r
w o r l d , w i t h o u t c o n d e m n i n g o r j u d g i n g , and w i t h o u t
p sych o lo g iz in g about t h a t world. Through the experience of
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l i s t e n i n g to the b u lim ic s in t h i s study, i t became apparent
t o th e r e s e a r c h e r t h a t b u l i m i c s did not f e e l t h a t anyone
was l i s t e n i n g to them. They also had a sense t h a t they did
n o t d e s e r v e to be l i s t e n e d to . The b u l i m i c s ' e x p e r i e n c e
n eeds to be u n d e r s t o o d in i t s o n t o l o g i c a l m eaning s i n c e
from t h e i r p e rc e p tio n of r e a l i t y , i t is r a t i o n a l and makes
s e n s e . T h e r a p i s t ' s need to s h a r e in t h e r e a l i t y of t h e
Lebenswelt of the b u lim ic in the way in which they p re s e n t
i t to them. The hope o f th e t h e r a p i s t i s t o u n c o v e r th e
e s s e n t i a l s t r u c t u r e or p r o j e c t of the b ulim ic.
Help Bulimics C l e a r ly Describe Their Lebenswelt
One way the t h e r a p i s t can e n te r the world of b u lim ic s
and a s s i s t them in d e s c r i b i n g t h e i r L e b e n s w e l t i s t o
b rac k et out a l l p r i o r o b j e c t i v e knowledge about b u lim ia and
a l l o w t h e r e l a t i o n s h i p t o u n f o l d n a t u r a l l y . C r i t i c a l to
c l a r i f y i n g t h e L e b e n s w e l t i s t h e r e v e a l i n g o f t h e
commonness of the b u l i m i c ’s world. I f people approach the
b u lim ic w ith preconceived no tio n s about the problem, they
w i l l f i n d what t h e y a r e l o o k i n g f o r r a t h e r t h a n a l l o w i n g
t h e phenomenon t o r e v e a l i t s e l f . A d m i t t e d l y , b r a c k e t i n g
out p r i o r knowledge is not an easy task. S e lf - a w a r e n e s s on
t h e p a r t o f t h e t h e r a p i s t i s n e c e s s a r y t o m i n i m i z e t h e
n u m b e r o f p r e c o n c e i v e d n o t i o n s f r o m e n t e r i n g t h e
r e l a t i o n s h i p .
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Im p o rtan t to working with b u lim ic s is g e t t i n g a c l e a r
p i c t u r e o f t h e L e b e n s w e l t o f t h e i n d i v i d u a l . S i n c e
b u lim ic s f r e q u e n t l y f e e l vague or u n c le ar about t h e i r inner
w o r l d , t h e r o l e o f t h e t h e r a p i s t i s an a c t i v e one. The
t h e r a p i s t needs to see h i m s e l f / h e r s e l f as a p a r t i c i p a n t in
the process of e x p l i c a t i n g the l iv e d - w o r ld of the b ulim ic.
T h is i s s i m i l a r to t h e r o l e t a k e n by t h e i n v e s t i g a t o r in
t h e p r e s e n t r e s e a r c h , t h a t o f a c o - r e s e a r c h e r w i t h th e
b u l i m i c . H e l p in g to c l a r i f y and make e x p l i c i t t h e i n n e r
i
s t r u c t u r e s of the b u l i m i c T s p e rc e p tio n s is im p o rtan t to the
t h e r a p e u t i c pro cess. What is known p r e - r e f l e c t i v e l y by the
b u lim ic needs to be brought in to conscious awareness. The
goal i s to help the b u lim ic r e f l e c t on t h a t world. This is
n o t an easy t a s k , s i n c e many p e o p le c h o o se to l i v e in a
h a z e r a t h e r t h a n making t h e i r l i f e e x p l i c i t and c l e a r .
T h is was e s p e c i a l l y t r u e of t h e b u l i m i c s in t h i s s t u d y .
The t h e r a p i s t needs to move g e n tly and w ith o u t v i o l a t i o n in
t h i s pro cess, always r e s p e c t i n g the wishes of the bulim ic.
V a lid a te The B u l i m i c s 1 Choices
Of c r i t i c a l importance i s the t h e r a p i s t T s a f f i r m a t i o n
o f t h e b u l i m i c ' s L e b e n s w e l t . P a r t o f t h e d i f f i c u l t y t h a t
b u l i m i c s have e x p e r i e n c e d in t h e i r l i v e s i s t h a t t h e i r
p e r c e p t i o n s of t h e w o rld have not been v a l i d a t e d . The
t h e r a p i s t i s t h e r e t o v a l i d a t e t h e e x i s t e n c e of t h e i r
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p e r c e p t i o n s . B u l i m i c s need to know t h a t t h e y see t h e
world c o r r e c t l y as based on t h e i r own perso nal exp erien ce,
t h a t t h e y have r e s p o n d e d w i t h i n t e g r i t y to t h e i r w o r l d no
m a t t e r how m i s c o n s t r u e d t h a t may seem to t h e t h e r a p i s t .
B u l i m i c s have n o t seen t h e m s e l v e s as p a r t i c i p a n t s in t h e
s t r u c t u r i n g of t h a t world and t h e r e f o r e have had d i f f i c u l t y
in c o m p r e h e n d in g t h e a n q u i s h t h e y f e e l . Through t h e
a f f i r m a t i o n and v a l i d a t i o n of the t h e r a p i s t , the b u lim ic s
w i l l b e g in t o f e e l more f r e e in a l l o w i n g t h e t h e r a p i s t
e n t r y i n t o t h e i r w o r l d , t h u s r e d u c i n g t h e i s o l a t i o n t h e y
f e e l .
j Give C o n s is te n t Feedback To Bulimics
4
4
I B u l i m i c s l a c k d i r e c t f e e d b a c k from o t h e r s . Most of
w h a t t h e y t h i n k o t h e r s w a n t f r o m t h e m , t h e y h a v e
c o n s t r u c t e d w i t h i n t h e m s e l v e s , b ased on o b s e r v a t i o n and
g e n eral s t a te m e n t s made by tho se around them. For example,
t h e b u l i m i c s in t h i s s t u d y a l l f e l t t h a t o t h e r s saw them as
f a t , even th o u g h t h e y had l i t t l e d i r e c t f e e d b a c k a b o u t
t h e i r siz e . Hence, i t is c r i t i c a l t h a t the t h e r a p i s t begin
t o p r o v i d e t h e f e e d b a c k t h e y so d e s p e r a t e l y need. The
t h e r a p i s t needs to r e l a t e to them as u n d e rs tan d a b le human
b e i n g s , n o t s i m p l y as p e o p l e who have an e a t i n g d i s o r d e r .
T h e r a p i s t s need to be aw are of t h e i r own r e s p o n s e to t h e
b u lim ic. I f t h e r a p i s t s d isc o v e r t h a t they are re p u lsed by
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t h e b e h a v i o r of t h e b u l i m i c , t h e y a l s o need to be a w are
t h a t the b u l im i c s w i l l know t h i s i n t u i t i v e l y and t h a t t h i s
a t t i t u d e w i l l d r i v e t h e b u l i m i c away, t h u s p e r p e t u a t i n g
t h e i r p a i n . B u l i m i c s a re w e l l aw are of how o t h e r s f e e l
about t h e i r behavior and t h a t people are h o r r i f i e d at t h e i r
s e l f - i n d u c e d v o m i t i n g . The t h e r a p i s t n eeds to exam ine
c a r e f u l l y h i s / h e r own responses to t h e i r behavior. To t e l l
b u l i m i c s t h a t t h e y s i m p l y have f a u l t y t h i n k i n g f u r t h e r
v e r i f i e s f o r them t h a t t h e y c a n n o t t r u s t t h e i r own
p e r c e p t i o n s .
Develop A Mutual R e la ti o n s h ip With Bulimics
Of g r e a t i m p o r t a n c e in w o r k in g w i t h b u l i m i c s i s t h e
development of an a u t h e n t i c t h e r a p i s t - c l i e n t r e l a t i o n s h i p .
T his means a r e l a t i o n s h i p o f m u t u a l i t y , r e c i p r o c i t y ,
symmetry, and a u t h e n t i c r e l a t i n g . Fundamentally, t h i s is a
r e l a t i o n s h i p o f e q u a l i t y , n ot one of d o c t o r - p a t i e n t . The
r e l a t i o n s h i p s h o u l d be d i r e c t , n a t u r a l , and f r e e from
a r t i f i c i a l i t y . This r e q u i r e s t h a t the t h e r a p i s t be w i l l i n g
to be in f lu e n c e d and impacted by the b u lim ic. Bulimics are
e x t r e m e l y p e r c e p t i v e and w i l l q u i c k l y become aware of
d i s h o n e s t y i n t h e r e l a t i o n s h i p . The t h e r a p i s t m u s t
t h e r e f o r e be w i l l i n g to d e c la re h i m s e l f / h e r s e l f ho n e stly .
Part of the a u t h e n t i c r e l a t i o n s h i p is th e w i l l i n g n e s s
on t h e p a r t of t h e t h e r a p i s t to t r u l y d e v e lo p a human
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c o n n e c t i o n w i t h t h e b u l i m i c . The t h e r a p i s t needs to ask
t h e b u l i m i c t o a l s o s e e h i m / h e r as a u t o n o m o u s and
i n d i v i d u a l . There needs to be freedom in the i n t e r a c t i o n s
w i t h a w i l l i n g n e s s to e x p r e s s n eeds on th e p a r t of both t h e
t h e r a p i s t and t h e b u l i m i c . B u l i m i c s must know t h a t t h e
t h e r a p i s t has an a p p r e c i a t i o n f o r them. They w i l l know
t h i s by t h e t h e r a p i s t ’s w i l l i n g n e s s t o s u b m e r g e
h i m s e 1 f / h e r s e 1 f i n t o t h e b u l i m i c s ’ w o r l d o f p r i v a t e
f e e l i n g s and experien c es. The t h e r a p i s t can o f f e r to e n te r
t h e i r w o r l d and t h e n w a l k w i t h t h e m as a g u i d e and
companion in t h e i r s t r u g g l e towards wholeness and selfhood.
Provide S e l f - D i s c l o s u r e To Bulimics
An a u t h e n t i c r e l a t i o n s h i p r e q u i r e s h o n e s t y and
openness in p erson al sh a rin g . This means a w i l l i n g n e s s on
t h e p a r t of t h e r a p i s t s t o s h a r e h o n e s t l y how t h e y a r e
a f f e c t e d by t h e b u l i m i c w i t h i n t h e m om ent o f t h e
r e l a t i o n s h i p because b u lim ic s need to be aware of how they
a f f e c t o t h e r s . B u l i m i c s in t h i s s t u d y a l s o e x p r e s s e d a
need t o know how o t h e r p e o p l e e x p e r i e n c e d l i f e . They a l l
f e l t t h a t t h e y were t h e o n ly ones t h a t s u f f e r e d as t h e y
d id . S e l f - d i s c l o s u r e on t h e p a r t o f t h e t h e r a p i s t would
help b u lim ic s know t h a t o th e r s also ex perience r e j e c t i o n ,
f e e l i n g s of m ean in glessness, and f e e l i n g s of g u i l t .
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Help Bulimics Take R e s p o n s i b i l i t y For Their Choices
The g o a l of t h e r a p y w i t h b u l i m i c s i s to h e lp them to
assume r e s p o n s i b i l i t y f o r t h e i r b e h a v i o r and t h e c h o i c e s
t h e y have made. D uring t h i s s t u d y t h e r e s e a r c h e r was n ot
a t t e m p t i n g t o c h a n g e t h e b e h a v i o r o f t h e b u l i m i c s .
However, as t h e b u l i m i c s were asked to c l e a r l y exam ine
t h e i r L e b e n s w e l t and become aware of how th e y had made
c h o i c e s , t h e y began t o f e e l l i k e t h e y c o u ld make new
c hoices in r e l a t i o n s h i p to binging and purging. They began
to see t h a t they were in c o n tr o l of t h e i r l i v e s . All th r e e
o f t h e b u l i m i c s in t h i s s t u d y d e c i d e d t o f i n d o t h e r ways
b esid es binging and purging for so lv in g t h e i r problems.
The g o a l of t h e r a p y w i t h b u l i m i c s i s t o h e l p them
become aware of t h e i r e m ptin ess, f r u s t r a t i o n , depressio n,
and l o n e l i n e s s with e x p l i c i t n e s s . B ulim ics know they f e e l
bad and t h a t th e y a r e in p a i n , b u t t h e y do n o t seem t o know
what t h a t i s a b o u t. The t h e r a p i s t i s t h e r e t o h e lp them
become aware of them selves more f u l l y , to help them become
a w are o f t h e i r p r o j e c t and t h e i r p e r s o n a l myth. The g o a l
i s t o c l a r i f y t h e i r s i t u a t i o n and t o make t h a t e x p l i c i t .
Furtherm ore, the goal i s for the b u lim ic to become aware of
the consequences of t h e i r way of being in the world and to
h e l p them se e how t h e y have chosen t h i s way f o r t h e i r own
good r e a s o n s . B u l i m i c s g e n e r a l l y f e e l t h e y have had no
c h o i c e in t h e p a s t and t h e y have no c h o i c e in t h e p r e s e n t .
169
The g o a l o f t h e r a p y i s to have them see t h a t t h e y have had
c h o i c e s in t h e p a s t and t h a t t h e s e have been made w i t h
i n t e g r i t y and t h a t th e y c o n t i n u e to have c h o i c e s in t h e
p r e s e n t. The t h e r a p i s t needs to a s s i s t them in d isc o v e r in g
t h e p o s s i b i l i t i e s o f free d o m . T h is i n c l u d e s c o n f r o n t i n g
t h e m a b o u t t h e i r i n t e n t i o n a 1 i t y i n t h e w o r l d and
c h a l l e n g i n g them t o t a k e up t h e t a s k of b e in g r e s p o n s i b l e
for t h e i r i n t e n t i o n a l i t y , always remembering t h a t no m a tte r
what t h e i r choice, t h e r e w i l l be n e g a tiv e consequences as
well as p o s i t i v e ones.
The r o l e o f t h e t h e r a p i s t i s t h a t o f a f e l l o w
t r a v e l e r . The t h e r a p i s t i s t h e r e as a p a r t i c i p a n t and
s h a r e r o f t h e L e b e n s w e l t o f t h e b u l i m i c . The t h e r a p i s t
w i l l help e s t a b l i s h a foundation of being, i f t h a t is what
t h e b u l i m i c c h o o s e s . T h r o u g h o u t t h i s p r o c e s s , t h e
i n t e g r i t y o f t h e b u l i m i c must be r e s p e c t e d . Hence, t h e r e
s h o u l d be no c o e r c i o n in t h e r e l a t i o n s h i p . The t h e r a p i s t
does n o t make b u l i m i c s change b u t s / h e i s t h e r e i f t h e y
decide to tak e a leap of f a i t h in to another way of being.
In summary, the i n v e s t i g a t o r sees the behavior of the
b u l im i c s as a c t i v e , p u rp o se fu l, i n t e n t i o n a l , and aimed at
m a i n t a i n i n g t h e i r way of b e in g in t h e w o rld t h a t seems
m e a n i n g l e s s and empty. The t h e r a p i s t n e ed s to e n t e r t h a t
w o r l d in o r d e r t o u n d e r s t a n d i t . T h i s r e q u i r e s a
b r a c k e t i n g of o b j e c t i v e knowledge about b u lim ia in order to
170
become a p a rt of the l iv e d - w o r l d of the b u lim ic. Once the
t h e r a p i s t has become a p a r t of th e L e b e n s w e l t , s / h e needs
t o a f f i r m t h e v a l i d i t y o f t h a t w o r l d . An a u t h e n t i c
r e l a t i o n s h i p , based on m u tu a l it y , r e c i p r o c i t y , and symmetry
is re q u ir e d as w ell as honesty and p erson al sh a rin g on the
p a rt of the t h e r a p i s t . The goals of therapy are to a s s i s t
t h e b u l i m i c in making h e r w o rld e x p l i c i t , h e l p h e r in
s e e i n g how she has ch o sen w i t h i n t e g r i t y , and a id h e r in
s e e i n g t h a t she c o n t i n u e s to have c h o i c e s t o d a y , n o t i n g
t h a t t h e r e w i l l a lw a y s be p o s i t i v e as w e l l as n e g a t i v e
c o n s e q u e n c e s o f t h o s e c h o i c e s . The r o l e o f t h e t h e r a p i s t
is t h a t of a fello w t r a v e l e r and guide b rin g in g the b u lim ic
to a g r e a t e r sense of being.
Suggestions for F u rth e r Research
The purpose of phenomenological re s e a r c h is to examine
a p a r t i c u l a r phenomenon in a s y s te m a t i c and in -d e p th way.
The purpose of t h i s study was to examine the phenomenon of
b u l i m i a in a s y s t e m a t i c way. One o f t h e r e a s o n s
phenomenological s t u d i e s are done is to g e n erate a theory
about the phenomenon. A fter the th e o ry has been developed
t h e r e is need for f u r t h e r development and v e r i f i c a t i o n of
t h e t h e o r y g u i d e d by t h e d i s c o v e r i e s made i n t h e
phenomenological i n v e s t i g a t i o n .
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A n u m b e r o f a r e a s s t o o d o u t as b e i n g in n e e d o f
f u r t h e r s t u d y and r e s e a r c h . F i r s t , i t i s i m p o r t a n t t h a t
t h e p r e s e n t s t u d y be e x te n d e d u s i n g more c a s e s t u d i e s in
order to f u r t h e r t e s t and r e f i n e the th eo ry of bulim ia. I f
we looked at more case s t u d i e s , would more c a t e g o r i e s and
common th e m e s d e v e lo p or would we f i n d t h e same t h e m e s ?
Would t h e e m p h a s i s of t h e th em es c h a n g e ? Would c e r t a i n
themes or c a t e g o r i e s become more im p o rta n t than the o th e r s ?
The o v e r a l l q u e stio n which needs to be answered is whether
the th eo ry i s v a lid only for the t h r e e women in t h i s study
o r w h e t h e r i t i s v a l i d f o r o t h e r women as w e l l .
F u r t h e r m o r e , i s t h e t h e o r y a l s o t r u e f o r male b u l i m i c s ?
P h e n o m e n o l o g i c a l s t u d y o f male b u l i m i c s i s n e c e s s a r y to
understand how they exp erien ce b u lim ia.
Second, one f a c t o r which was n o t a d d r e s s e d in t h i s
study was t h a t a l l the b u lim ic s in t h i s i n v e s t i g a t i o n were
middle c h il d r e n . This may sim ply have been a coincidence,
however, in view of o th er l i t e r a t u r e on middle c h ild r e n i t
seems i m p o r t a n t t h a t f u r t h e r r e s e a r c h be done to f i n d ou t
whether t h e r e is a s i g n i f i c a n t number of b u lim ic s who are
middle c h ild r e n .
T h i r d , a them e t h a t became a p p a r e n t in t h e b u l i m i c s '
s u b j e c t i v e d e s c r i p t i o n s was t h e r o l e o f t h e f a t h e r in t h e
r e l a t i o n s h i p . A c o m p a r a t i v e s t u d y n e ed s t o be done to se e
whether more b u lim ic s than n o n -b u lim ics were abandoned by
172
t h e i r f a t h e r s . There is an i n d i c a t i o n t h a t t h i s r e l a t i o n
s h i p p l a y s a s i g n i f i c a n t p a r t in th e d e v e l o p m e n t of t h e
b u l i m i c ' s w o r ld view. An i n - d e p t h s t u d y of t h e r e l a t i o n
s h i p b e tw ee n f a t h e r s and b u l i m i c s i s n e c e s s a r y to se e
w h e t h e r t h e l a c k o f r e l a t i o n s h i p b e tw ee n women in t h i s
study and t h e i r f a t h e r s is s i g n i f i c a n t only in t h i s study.
| F o u r t h , t h e q u e s t f o r b e in g and t h e c h o i c e o f t h e
b u l i m i c o f b e i n g - f o r - o t h e r s a l s o r e q u i r e s much i n - d e p t h
s t u d y . S i n c e no r e s e a r c h has r e v e a l e d t h i s p a r t i c u l a r
s t r u g g l e fo r the b u lim ic , f u r t h e r work needs to be done. A
study could be done comparing b u lim ic s with n o n -b u lim ic s in
t h e i r quest for being. One could i n v e s t i g a t e the degree of
independence versus the degree of dependence in the l i f e of
t h e b u l i m i c . One c o u ld f u r t h e r s t u d y b u l i m i c s in view of
lea rn e d h e l p l e s s n e s s in e a r l y childhood.
F i f t h , t h e q u e s t i o n o f a l o s s o f c o n t r o l has been
! d isc u sse d throughout the l i t e r a t u r e on b u lim ia. This r e -
i
s e a r c h e r c o n t e n d s t h a t t h e b i n g i n g and p u r g i n g b e h a v i o r
does n o t r e p r e s e n t a l o s s o f c o n t r o l b u t i s r a t h e r an
a t t e m p t t o g a in some c o n t r o l o v er o n e 's l i f e . F u r t h e r
s t u d y n e ed s t o be done t o see i f t h i s may in f a c t be t h e
c a s e w i t h b u l i m i c s . A s t u d y c o m p a r in g b u l i m i c s and n o n
b u lim ic s in term s of l o c u s - o f - c o n t r o l could be done.
Sixth, more r e s e a r c h needs to be done on the q u estio n
of fre e d o m v e r s u s d e t e r m i n i s m w hich i s so much a p a r t of
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the b u l i m i c s ’ world. Bulim ics f e e l h o p e l e s s l y determined
by t h e i r environment, t h e i r h a b it , and t h e i r d riv es. They
do n o t seem to know what th e y want w i t h o u t f i r s t f i n d i n g
out what o th e rs want of them. A com parative study could be
done examining whether b u lim ic s f e e l more determined than
n o n - b u l i m i c s . T his c o u ld p r o v i d e a f r u i t f u l a re a of r e
search in th e f u tu r e .
Conclusions
The i n t e n t of t h i s study was to d isc o v er how b u lim ic s
s e e t h e i r w o r ld and t o u n r a v e l t h e i r p r o j e c t and p e r s o n a l
myth. The work was based on the assumption t h a t b u l im i c s
c o n s t r u c t a way o f b e i n g in t h e w o r l d known as t h e i r
p r o j e c t and t h a t t h e y l i v e in t h e w o r ld b a sed on t h i s j
i i
| p r o j e c t . A f u r t h e r assumption was t h a t b u lim ic s are i n te n - j
I
i
t i o n a l and purposive in t h e i r l i f e . The i n t e n t i o n of t h i s
study was also to g e n e ra te a s u b s t a n t i v e th eo ry grounded in
the l iv e d - w o r ld of the b u lim ic s . From t h i s theory a t h e r a
p e u t i c a p p r o a c h was d e s i g n e d t o a s s i s t t h e t h e r a p i s t in
t
working w ith b u lim ic s . The case s t u d i e s provided the c l i n i
cian with some u n d e rs ta n d in g of the s u b j e c t i v e world of the
b ulim ic. The i n t e n t was to make the Lebenswelt e x p l i c i t to
the rea d e r and/or c l i n i c i a n to aid them in knowing i t more
i n t i m a t e l y .
174
The a p p r o a c h used in t h e s t u d y was p h e n o m e n o l o g i c a l
w i t h t h e aim of r i g o r o u s l y c o l l e c t i n g d a t a a b o u t th e
s u b j e c t i v e p e rc e p tio n s and e x periences of the b u lim ic. The
case study approach was used to grasp the e s s e n t i a l s t r u c
t u r e s of the b u l im i c s ' Lebenswelt and to v i s u a l i z e them as
a u n i t a r y way of b e in g . The a s s u m p t i o n was made t h a t th e
b u l i m i c ' s r e a l i t y had i n t e g r i t y and was t r u e f o r them and
t h a t out of t h i s r e a l i t y a t h e o r y of b u l i m i a c o u ld be
i
developed. |
f
To make the f e a t u r e s of b u lim ia e x p l i c i t a t h r e e - f o l d l
r e s e a r c h a p p r o a c h w a s u s e d w h i c h i n c l u d e d : (1)
t
p a r t i c i p a t i o n in the everyday world of the b u lim ic in orderj
I
f o r t h e i n v e s t i g a t o r t o e x p e r i e n c e as c l o s e l y as p o s s i b l e I
t h e " r e a l i t y " o f t h e b u l i m i c ; (2) d e s c r i p t i o n o f t h a t
p a r t i c i p a t i o n so as t o u n d e r s t a n d what took p l a c e in t h e
p a r t i c i p a t i v e p h a s e ; and (3) r e f l e c t i o n i n o r d e r t o
e x p l i c a t e the e s s e n t i a l meaning of the " r e a l i t y , " b rid g in g
the gap between the o r i g i n a l ex perien ce and the d e s c r i p t i o n
of t h a t experience.
The p a r t i c i p a t i v e phase involved weekly s e s s io n s with
t h e b u l i m i c s over a p e r i o d of f o u r m onths. The a p p ro a c h
used in the s e s s io n s was t h a t of c o - r e s e a r c h e r s e x p lo rin g
and e x a m in i n g t h e i n n e r w o r ld of t h e b u l i m i c s . The g o a l
was to make the Lebenswelt as e x p l i c i t as p o s s ib l e and to
e n te r the b u l im i c 's world as f u l l y as p o s s ib le .
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The d e s c r i p t i v e p h a se grew o ut o f t h e p a r t i c i p a t i v e
p hase. T h is i n v o l v e d t a p e r e c o r d i n g a l l t h e s e s s i o n s and
having them t r a n s c r i b e d so t h a t they could be read by both
t h e b u l i m i c and t h e t h e r a p i s t . T h is ph ase a l s o i n c l u d e d
some p e r s o n a l w r i t i n g s by th e b u l i m i c s t h e m s e l v e s . In
a d d i t i o n to t h e a c t u a l t r a n s c r i p t i o n s of th e i n t e r v i e w s ,
t h e r e s e a r c h e r p r o v i d e d c l i n i c a l o b s e r v a t i o n s from t h e
s e s s i o n s . j
The f i n a l s t a g e of t h e p r o c e s s was t h e r e f l e c t i v e !
4
phase. There was a need to organize the data derived fromj
t h e d e s c r i p t i v e p h a se i n t o p a r s i m o n i o u s u n i t s . Common!
themes were chosen as a means of o rg a n iz in g the data. The I
i i
c a t e g o r i e s t h a t em erged from t h e c a s e s t u d i e s w ere: (1)
abandonment by the f a t h e r ; (2) need for p r o t e c t i o n and fe a r
o f f a i l u r e ; (3) f e a r o f r e j e c t i o n ; (4) p r e o c c u p a t i o n w i t h
body s i z e and sh a p e; (5) f e a r of s e p a r a t i o n ; (6) f e a r of
alo neness; (7) b e i n g - f o r - o t h e r s ; (8) fe a r of and i n t e r n a l i
z atio n of f e e l i n g s ; (9) lack of c o n tr o l and being a v ic tim ;
(10) deep s e n s e o f g u i l t ; (11) s e n s e o f o b l i v i o u s n e s s and
d e p e r s o n a l i z a t i o n o f s e l f ; (12) need t o p u r i f y ; (13)
f e e l i n g l i k e a sex o b j e c t; (14) fea r of freedom and r e s p o n
s i b i l i t y ; (15) d e a t h , d e s p a i r , and m e a n i n g l e s s n e s s ; (16)
f e a r of r e l a t i o n s h i p s ; (17) f e e l i n g s of w o r t h l e s s n e s s ; and
(18) i n v a l i d a t i o n of p e rc e p tio n s.
176
From t h e s e t h e m e s t h e r e s e a r c h e r p r o p o s e d a
phenomenological th eo ry of b u lim ia based on the assumption
t h a t t h e b u l i m i c s ' l i f e was i n t e n t i o n a l , p u r p o s i v e , and
a c tiv e . The p r o j e c t and personal myth of b u lim ic s was seen
as t h e i r a t t e m p t t o s u r v i v e t h e w o r l d , t h e i r a t t e m p t to
f i n d m e a n i n g in t h e i r l i f e , t o g a i n a c c e p t a n c e f r o m
i m p o r t a n t p e r s o n s in t h e i r l i f e , and to d e a l w i t h t h e i r
|
a n x i e t y a b ou t t h e i r b e in g . B ecause b u l i m i c s e x p e r i e n c e d )
i
t h e m s e l v e s as h a v in g l i t t l e c o n t r o l over t h e i r l i v e s and
they f e l t a g rea t need to gain some c o n tro l. I
T his t h e o r y has i m p l i c a t i o n s f o r t h e t h e r a p e u t i c j
I
} process for i t is in th erapy t h a t c l i n i c i a n s hope to "help"
! t h e b u l i m i c o u t o f t h e i r d ile m m a . The f i n a l c h a p t e r
s u g g e s t e d ways in w h i c h c l i n i c i a n s c o u l d w ork w i t h
b u l i m i c s . The a s s e r t i o n s were made t h a t t h e t h e r a p i s t :
(1) be open to h e a r i n g what b u l i m i c s have to say; (2) h e l p
| b u l i m i c s c l e a r l y d e s c r i b e t h e i r e x p e r i e n c e ; (3) v a l i d a t e
! t h e b u l i m i c s c h o i c e s ; (4) g iv e c o n s i s t e n t f e e d b a c k to
b u lim ic s ; (5) develop a mutual r e l a t i o n s h i p w ith b u lim ic s ;
(6) p r o v i d e s e l f - d i s c l o s u r e to b u l i m i c s ; and (7) h e l p
b u lim ic s assume r e s p o n s i b i l i t y for t h e i r choices.
T his i n v e s t i g a t i o n c o n c lu d e d t h a t t h e f i n d i n g s and
i m p l i c a t i o n s of t h i s i n q u ir y were a p p li c a b l e s o l e l y to the
s p e c i f i c i n d i v i d u a l s and s e t t i n g s of t h e s t u d y s i n c e t h e
e v o lv e d t h e o r y was gro u n d ed in t h o s e d a t a . B e f o r e t h e
177
f i n d i n g s can be g e n e r a l i z e d beyond t h i s bounded a r e a th e y
m ust be c a r e f u l l y checked f o r v a l i d i t y by e x t e n d i n g th e
study to more b u lim ics . The c o n te n tio n was made, however,
t h a t the theory was s u f f i c i e n t l y e x p la n ato ry and provided
a d e q u a t e i n s i g h t i n t o t h e l i f e o f b u l i m i c s t o become
u s e f u l i n t h e t r e a t m e n t o f b u l i m i c s . The f i n a l
r e s p o n s i b i l i t y for d e te rm in in g i t s u s e f u l n e s s l i e s with the
c l i n i c i a n .
The hope was t h a t t h i s t h e o r y would p r o v i d e a new
frame of r e f e r e n c e , a new c o n s t r u c t i o n , and a new p o in t of
view w hich would e n a b l e t h e r e a d e r a n d / o r c l i n i c i a n t o
u t i l i z e a d i f f e r e n t way of s e e i n g b u l i m i c s and a s s i s t i n g
them in f in d in g wholeness in t h e i r l i v e s .
1X8
< References
!
[Bachrach, A. J . , Erwin, W. J . , & Mohr, J. P. The c o n tr o l
j of e a tin g behavior in an anorexic by operant condi-
j t i o n i n g te c h n iq u e s. In L. P. Ullmann & L. Krasner
(E d s.), Case s t u d i e s in behavior m o d i f i c a t i o n . New
York: Holt, 1965.
Becker, H . , K o erner, P., & S t o e f f l e r , A. Psychodynamics
and t h e r a p e u t i c a sp e c ts of anorexia nervosa.
Psychotherapy and P sych o so m a tic s, 1981 , 3j3, 8-16.
Beumont, P. J. V., George, G. C., & Smart, D. E. ’D i e t e r s 1
and ’vomiters and p u r g e r s * in anorexia nervosa,
j P sy ch olog ical Medicine, 1976, 6>, 617-622.
iB h a n ji, S ., & M a ttin g ly , D. Anorexia nervosa: Some
| o b s e r v a tio n s on " d i e t e r s ” and "v o m ite rs ," c h o l e s t e r o l
I and c a r o te n e . B r i t i s h Jo urnal of P s y c h ia tr y , 1981,
: 139, 238-241.
i
jB h a n j i , S ., & Thompson, J. Operant c o n d itio n in g in the
j tr e a tm e n t of anorexia nervosa: A review and
I r e t r o s p e c t i v e study of eleven c ase s. B r i t i s h Journal
of P s y c h i a t r y , 1974, 124, 166-172.
Blue, R. Use of punishment in tr e a tm e n t of anorexia
n ervosa. P s y cho lo g ica l Reports, 1979, 4_4, 743-746.
i
B oskind-L odahl, M. C i n d e r e l l a ' s s t e p s i s t e r s : A f e m in is t
p e r s p e c t iv e on an orexia nervosa and b u lim ia. S i g n s :
Journal of Women in C ulture and S o c ie ty , 1976, 2, 342-
356.
i
] Boskind-Lodahl, M. The d e f i n i t i o n and tr e a tm e n t of
b u lim a re x ia: The g o rg in g /p u rg in g syndrome of young
women (Doctoral d i s s e r t a t i o n , Cornell U n iv e rs ity ,
1977). D i s s e r t a t i o n A b s tr a c ts I n t e r n a t i o n a l , 1978,
38 , 7147A. (U n iv e r s ity Microfilms No. 7807776)
Boskind-Lodahl, M. & S i r l i n , J. The gorg in g-p urgin g
syndrome. Psychology Today, March 1977, pp. 50, 55,
82.
Boskind-Lodahl, M., & White, W. C. The d e f i n i t i o n and
tr e a tm e n t of b ulim arex ia in c o lleg e women - a p i l o t
stu d y. Journal of American College Health A s s o c ia tio n ,
October^ T9787 84-97.
179
Boskind-W hite, M., & White, W. C. Bulim arexia: The
b in ge/purge c y c le . W. W. Norton & Company, New York,
1983.
Bruch, H. Eating d i s o r d e r s : Obesity, anorexia nervosa, and
the person w i t h i n . New York: Basic Books, 1973.
Bruch, H. Psy ch olog ical a n te ce d en ts of anorexia nervosa.
In R. A. Vigersky (E d.), Anorexia n e r v o s a . Raven
Press, New York, 1977.
Bruch, H. The golden cage: The enigma of an orex ia nervosa.
New York: Vintage Books, 1978.
Bruch, H. Anorexia nervosa: Therapy and th e o ry . American
Journal of P s y c h i a t r y , 1982, 13 9, 1531-1538.
/ B u b e r , M. I and thou. Charles S c r i b n e r ’s Sons, New York,
1970.
Button, E. J . , & Whitehouse, A. S u b c l i n i c a l anorexia
nervosa. P sy c h o lg ic a l M edicine, 1981, V\_, 509-516.
Casper, R. C., E ckert, E. D., Halmi, K. A., Goldberg, S.
C., & Davis, J. M. Bulimia. Archives of General
P s y c h i a t r y , September 1980, _37, 1030-1035.
Cauwels, . J. M. Bulimia: The binge-purge com pulsion.
Doubleday & Company, I n c . , Garden C ity, New York,
1983.
C o l a i z z i , P. R e f le c t i o n and re s e a r c h in psychology: A
phenomenological study of l e a r n i n g . Kendall Hunt,
Dubuque, Iowa, 1973.
C risp, A. H. Anorexia nervosa at normal body w e i g h t! — The
abnormal normal weight c o n tr o l syndrome. I n t e r n a -
t i o n a l Jou rn a l of P s y c h ia tr y in Medicine, 1981-82, 11,
203-233.
Dally, P. Treatment of anorexia nervosa. B r i t i s h Journal
of H o s p ita l Medicine, May 1981, pp. 434, 436, 438,
■ pro:
D iagnostic and s t a t i s t i c a l manual of mental d i s o r d e r s , 3rd
e d i t i o n . 1981. American P s y c h i a t r i c A sso c ia tio n :
W ashington, D. C.
180
F a irb u rn , C. G. S e lf-in d u c e d vomiting. Journal of
j Psychosomatic R ese arch , 1980, 24_, 193-197.
F a irb u rn , D. G. A c o g n itiv e b e h a v io ra l approach to the
tr e a tm e n t of bu lim ia. P s y cho lo g ical Medicine, 1981,
JM, 707-71 1.
F i s c h e r , W. F. An em pirical-phenom enological i n v e s t i g a t i o n
of b e in g -a n xio u s: An example of the meanings of
b e in g -e m o tio n al. In R. S. V a lle , and M. King,
E x is te n tia l- P h e n o m e n o lo g ic a l A l t e r n a t i v e s for Psy ch o l
ogy , New York: Oxford U n iv e rs ity Press, 1978.
G a rfin k e l, P. E., Moldofsky, H., & Garner, D. M. The
h e t e r o g e n e i t y of an orexia nervosa. Archives of
General P s y c h i a t r y , September 1980, 3_7, 1036-1040.
Garner, D. M., G a r f in k e l, P. E., Schwartz, D ., & Thompson,
M. C u l tu r a l e x p e c ta tio n s of t h in n e s s in women. Psy
c h o lo g ic a l R e p o r ts , 1980, 47_, 483-491.
Gawelek, M. A. The b i n g e r - p u r g e r : A d e s c r i p t i v e study.
(Doctoral d i s s e r t a t i o n , Boston U n iv e rsity School of
Education, 1980). D i s s e r t a t i o n A b s tr a c ts I n t e r n a - ;
t i o n a l , 1980, 40, 4209-B. (U n iv e rs ity Microfilms No.
8005248) 1
G io rg i, A. Phenomenology and ex p erim ental psychology I.
Review of E x i s t e n t i a l Psychology and P s y c h ia tr y , 1965,
5, 228-238.
^ G i o r g i , A. Phenomenology and ex perim en tal psychology: I I .
Review of E x i s t e n t i a l Psychology and P s y c h ia try , 1966,
6, 37-50.
j.Giorgi, A. The exp erien ce of the s u b j e c t as a source of
* data in a p sy c h o lo g ic al experiment. Review of E x is
t e n t i a l Psychology and P s y c h i a t r y , 1 967^ 7\ 1 0(7-TT3T
j
/ G l a s e r , B. B., & S t r a u s s , A. L. The d iscov ery of grounded
th eo ry : S t r a t e g i e s for q u a l i t a t i v e r e s e a r c h .
Chicago: Aldine P u b lic a tio n CoT~ 1967.
Green, R. S ., & Rau, J. H. Treatment of compulsive e a t in g
d is tu r b a n c e s with a n ti c o n v u l s a n t m edication. American
Journal of P s y c h i a t r y , 1974, 131, 428-431.
Guiora, A. Z. Dysorexia: A p sycho p ath o lo g ic a l study of
anorexia nervosa and bu lim ia. American Jo urn al of
P s y c h ia tr y , 1967, 124, 391-393.
181
Halmi, K. A., Falk, J. R., & Swartz, E. B in g e-e atin g and
vomiting: A survey of a c o lle g e p o p u la tio n . Psycho
l o g i c a l M edicine, 1981, V}_, 697-706.
Hawkins, R. C., & Clement, P. F. Development and c o n s tr u c t
v a l i d a t i o n of a s e l f - r e p o r t measure of binge e a tin g
t e n d e n c i e s . A ddictive B e h a v io r, 1 980, 5», 219-226.
Heidegger, M. Being and time. New York: Harper- and Row,
1962 .
Herman, C. P., & Mack, D. R estrain ed and u n r e s t r a i n e d
e a t in g . Jo urn a l of P e r s o n a l i t y , 1975, 4_3, 647-660.
I
Herman, C. P., & Polivy, J. Anxiety, r e s t r a i n t , and eatingj
b ehavior. Jo u rn al of Abnormal Psychology, 1975, 84, j
666-672. I
Hsu, L. K. G., C risp, A. H., & Harding, B. Outcome of
anorexia nervosa. The L a n c e t, 1979, 8107, 61-65.
Hudson, J. I . , L a f f e r , P. S ., & Pope, H. G. Bulimia r e
l a t e d to a f f e c t i v e d is o r d e r by family h i s t o r y and
response to the dexamethasome su p p re ssio n t e s t .
American Journal of P s y c h ia try , 1982, 139, 685-687.
j
j H usserl, E. The p a r i s l e c t u r e s . The Hague, N etherlands:
\ Martinus N ijh o ff, 1975.
i
^ J a s p e r s , K. The phenomenological approach in psychopath-
/ ology. B r i t i s h Jo urnal of P s y c h ia tr y , 1968, 114,
1313-1323.
/ K e e n , E. Three faces of b e i n g . New York: Meredith, 1970.
i
| Lagos, J. M. Family therapy in the tre a tm e n t of anorexia
nervosa: Theory and tec h n iq u e . I n t e r n a t i o n a l Journal
of P s y c h ia try in M edicine, 1981-82, JM _, 291-302.
L arkin, K. Phenomenological c a s e s t u d i e s of the s c h i z o
p h r e n i c ’s p r o j e c t and personal myth (Doctoral D i s s e r
t a t i o n , U n iv e rs ity of Southern C a l i f o r n i a , Department
of Education, 1979).
Liebman, R., Minuchin, S ., & Baker, L. An i n te g r a t e d
t r e a tm e n t program for anorexia nervosa. American
Journal of P s y c h i a tr y , 1974, 131, 432-436.
182
[Linden, W. Multi-component behavior th erap y in a case of
: compulsive b i n g e - e a t i n g followed by vomiting. Journal
j of Behavior Therapy and Experimental P s y c h ia tr y , 1980,
: JM, 297-300.
i
;Loro, A. D., & Orleans, C. S. Binge e a t in g in o b e s i ty :
j P relim in ary f i n d in g s and g u i d e l i n e s for b e h av io ral
j a n a l y s i s and t r e a tm e n t. Addictive B e h a v io r s , 1981,
! 6, 155-166.
i
t
| M i t c h e ll , J. E., Pyle, R. L., & E ckert, E. D. Frequency
and d u r a tio n of b i n g e - e a t i n g episodes in p a t i e n t s with
bu lim ia. American Jo u rn al of P s y c h ia tr y , 1981, 138,
835-836.
I
Moskovitz, R. A., & Lingao, A. Binge e a tin g a s s o c i a t e d
with o r a l c o n t r a c e p t i v e s . American Journal of Psy-
c h i a t r y , 1979, J36, 721-722.
f Ofman, W. A ffirm a tio n and r e a l i t y . Los Angeles: Western
I P sychological S e rv ice s, 1976.
I Orbach, S. Fat is a f e m in is t i s s u e . Berkley Books, New
York, 1978.
Palmer, R. L. The d i e t a r y chaos syndrome: A u s e f u l new
| term? B r i t i s h Journal of Medical Psychology, 1979,
' 52, 187-190.
i
| Polivy, J . , & Herman, C. P. C l i n i c a l d e p re ssio n and weight
' change: A complex r e l a t i o n . Journal of Abnormal
! Psychology, 1976, J35, 338-340.
Pyle, R. L., M itc h e ll, J. E., & Eckert, E. D. Bulimia: A
r e p o r t of 34 case s. Journal of C l i n i c a l P s y c h ia tr y ,
1981, 42, 60-64.
Rich, C. L. S e lf-in d u c e d vomiting: P s y c h i a t r i c c o n s i d e r
a t i o n s . Journal of American Medical A s so c ia tio n , 1978,
239, 2688-2689.
R u s s e ll, G. Bulimia nervosa: An ominous v a r i a n t of
anorexia nervosa. P sy ch olog ical Medicine, 1979, 9,
429-448.
R u s s e ll, G. The c u rr e n t tre a tm e n t of anorexia nervosa.
B r i t i s h Journal of P s y c h ia tr y , 1981, 138, 164-166.
183
[Spencer, J. A., & Fremouw, W. J. Binge e a tin g as a func-
i t io n of r e s t r a i n t and weight c l a s s i f i c a t i o n . Journal
I of Abnormal Psychology, 1979, _88, 262-267.
1
l
j S p i e g e l b e r g , H. Phenomenology in psychology and p s y c h ia -
& t r y . Evanston: Northwestern U n iv e rs ity , 1972.
1
J S t a n g le r , R. S., & P r i n t z , A. M. DSM-III: P s y c h i a t r i c
f d ia g n o s is in a u n i v e r s i t y p o p u la tio n . American
Journal of P s y c h i a t r y , 1980, 137, 937-940.
i
Stunkard, A. J. Eating p a t t e r n s of obese persons.
P s y c h i a t r i c Q u a r t e r l y , 1 959, 3_3, 284-292.
j^ S tr a s s e r , S. Phenomenology and the human s c i e n c e s . P i t t s -
® burgh: Duquesne U n iv e rs ity Press, 1963.
Thompson, M. G., & Schwartz, D. M. L ife adjustm ent of
women with anorexia nervosa and a n o r e x i c - l i k e be
h a v io r . I n t e r n a t i o n a l Jo urn a l of Eating D iso rd e rs,
Winter 1981, 47-60.
^ van den Berg, J. H. A d i f f e r e n t e x i s t e n c e . Duquesne
! U n iv e rs ity P ress, P it t s b u r g h , 1972.
!
(| van Kaam, A. E x i s t e n t i a l Foundations of Psychology, Du-
h quesne U n iv e rs ity P r e s s , Pi 11sbu r gh , 1 966•
i
;Wardle, U., & B e in a r t, H. Binge e a t i n g : A t h e o r e t i c a l
i review. B r i t i s h Jou rnal of C l i n i c a l Psychology, 1981,
2 0, 97-109.
Wermuth, B. M., Davis, K. L., H o l l i s t e r , L. E., & Stunkard,
A. J. Phenytoin tr e a tm e n t of b i n g e - e a t i n g syndrome.
American Jo u rn a l of P s y c h i a t r y , 1977, 134, 1249-1253.
White, W. C., & Boskind-Lodahl, M. An e x p e rim e n ta l-
b e h a v io r a l approach to the tr e a tm e n t of b u lim a re x ia.
Journal of Psychotherapy: Theory, Research, and P ra c
t i c e , 1981 (In p r e s s ) .
Wilson, G. T. Obesity, binge e a t in g , and behavior therap y :
Some c l i n i c a l o b s e r v a t i o n s . Behavior Therapy, 1976,
7, 700-701.
Zaner, R. M. The way of phenomenology. New York: Western
Pub lish in g Company, 1970.
184

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Project for a phenomenological psychology: An investigation into the philosophic bases of contemporary American psychology and the proposal of a phenomenological method as a foundation for psycho...

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Creator Neufeld, Kathryn Klassen (author)

Core Title Phenomenological case studies of bulimia

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Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA