First, my
confession: I lied to a patient yesterday, and I feel the need to come clean;
it’s not my norm to lie. I told this new client struggling with an eating
disorder that I have never lost a patient—and that I am determined to do all
I’m able to keep my patients safe.
The truth is a bit different. I’ve lost one patient in the
26 years supporting patients with anorexia, bulimia and binge eating disorder.
And while statistically one patient is a tiny percent of the thousands of
individuals I’ve seen over the quarter century, one lost patient is one too
many.
I think about her every time I open my dresser drawer—she
gave me a gift just two weeks before she left this world—following my
compliment of the shirt she was wearing. She knew I’d get a kick; she wore it
to amuse me, for sure. I don’t think it was a parting gift; her death was
rather impulsive.
And I think about her whenever I bike ride past the train
station upon whose tracks she ended her life. She was being treated by a qualified
eating disorder team and by all accounts she was doing quite well—based on what
she shared with us, at least.
Objectively, her eating had normalized and
medically she was stable. I can’t recall now just how long it had been since
she had purged, but she was doing well enough that we were spreading visits out
a bit.
I’m not quite sure why I lied. Perhaps I wanted yesterday’s
patient to know how determined I am to keep her safe and to know that one way
or another I’ll support her and work with her to recovery. Maybe it has to do
with my sense that Dahlia’s death was not because of her eating disorder, but
her depression. Was it even a lie when her cause of death was not directly due to her eating disorder? Regardless, it made me think about this topic of lying,
particularly as it pertains to recovery.
Years ago I had a new patient who, after introducing
herself, immediately shared that she is a pathological liar. And that she
steals. It’s a bit of a conundrum, then, to know if I should believe her. And
should I hide my purse when I head out to retrieve some materials from the next
room? Do I trust her—ever?
But more typically, I encounter patients whose lying is
slowly revealed and we both need to make sense of it. And we both need to learn
to move on after they’ve lied or mislead.
Daniel found himself in a bind several months ago when I
proposed he increase his intake given his inappropriate weight loss. He looked
me right in the eyes and emphatically swore he’d stuck with the recommendations
from the preceding week—every single one of them. Yet he was well aware why he
had lost weight. And he didn’t want to admit that he was struggling with
following through with my recommendations. He silently hoped that his method of
skimping on his intake would still hold his weight steady—even though I advised
him otherwise. And now, if he agreed to my new add-ons, he’d have to lie
again—because he had no intentions of eating more. Now he regretted lying as
things had gotten quite complicated.
When this happened again
some weeks ago, I knew that his eating disorder was at work and could not be
trusted. Yes, Dan wanted to recovery, to head off to college, but his eating
disorder had a voice all its own. I made sure that he was returning for medical
assessments to help verify his progress—as his eating disorder was not
tolerating his being honest with me. Surely he didn’t like not feeling trusted.
Yet this was the only way I could begin to trust him again and keep him safe.
Sometimes lies aren’t so apparent. You know, like the lies
of omission. “So you had the sandwich and the glass of milk?”, I’d confirm. “Yes, and the fruit”, she’d add. But only when I
probed further with “And how much of the sandwich did you manage to get
through?” did I hear “less than the half”. Or, when I asked about how the
exercise limits were adhered to and told that she stuck with the agreed upon 30
minutes, for example. But when I asked “And what was the maximum time spent exercising?” I heard “Well, 40-45 minutes—on
most days”.
And then there’s the lying to your self. You look at the
cereal and you think surely that’s about the right amount, when truly you know
that your portioning falls short. Or you ignore the fact that gardening and
compulsively cleaning count as exercise too. You underestimate the number of planned
binges or your need to throw out food so no one knows you even bought it and
ate it, and you eat mindlessly so you can even fool yourself about your eating.
Your therapist can better explain the role lying plays for
you and why you rely on it. But from my perspective, your feelings of shame
about eating, of not being deserving, and of needing to be in control are just
a few of the contributors. You want to please us providers so we won’t abandon
you and truly you’d like to believe
you’re doing as well as you state you are.
But like the boy who cried wolf, you leave us struggling
with trusting your word. It makes it hard to know just when we need to offer
more guidance and support if things always sound great. I worry when you say that things are always
going perfectly—really I do. How will you learn to pick yourself up when you
slip if you never share your struggles?
I know this is hard. Nobody talks about it. But as a
provider who is determined not to lose another patient to an eating disorder
and its comorbidities, I urge you to push yourself to be honest—on your food
records, in your sessions, about your difficulties. Volunteer the answers—even
if your doctor or your other providers don’t know enough to ask. Tell your
supports when your struggling. Hiding beneath your binging, your restricting, or
your purging with vomiting or exercise or laxatives is only lying to your self.
I came clean. Now it’s your turn.
Thanks for your honesty. And thanks for reading and
commenting.
