|
|
|
Thomas Holbrook during his illness
|
One Man's Battle
by Thomas Holbrook
In the spring of 1976, two years into my psychiatric
practice, I began having pain in both knees, which soon
severely limited my running. I was advised by an orthopedist
to stop trying to run through the pain. After many failed
attempts to treat the condition with orthotic surgery and
physical therapy, I resigned myself to giving up running. As
soon as I made that decision, the fear of gaining weight and
getting fat consumed me. I started weighing myself every
day, and even though I was not gaining weight, I started
feeling fatter. I became increasingly obsessed about my
energy balance and whether I was burning off the calories I
consumed. I refined my knowledge of nutrition and memorized
the calories and grams of fat, protein, and carbohydrates of
every food I would possibly eat.
Despite what my intellect told me, my goal became to rid my
body of all fat. I resumed exercising. I found I could walk
good distances, despite some discomfort, if I iced my knees
afterward. I started walking several times a day. I built a
small pool in my basement and swam in place, tethered to the
wall. I biked as much as I could tolerate. The denial of
what I only much later came to recognize as anorexia
involved overuse injuries as I sought medical help for
tendonitis, muscle and joint pain, and entrapment
neuropathies. I was never told that I was exercising too
much, but I am sure that had I been told, I would not have
listened.
Worst nightmare
Despite my efforts, my worst nightmare was happening. I felt
and saw myself as fatter than ever before, even though I had
started to lose weight. Whatever I had learned about
nutrition in medical school or read in books, I perverted to
my purpose. I obsessed about protein and fat. I increased
the number of egg whites that I ate a day to 12. If any yolk
leaked into my concoction of egg whites, Carnation Instant
Breakfast, and skim milk, I threw the entire thing out.
As I became more restrictive, caffeine became more and more
important and functional for me. It staved off my appetite,
although I didn't let myself think about it that way. Coffee
and soda perked me up emotionally and focused my thinking. I
really do not believe that I could have continued to
function at work without caffeine.
I relied equally on my walking (up to six hours a day) and
restrictive eating to fight fat, but it seemed I could never
walk far enough or eat little enough. The scale was now the
final analysis of everything about me. I weighed myself
before and after every meal and walk. An increase in weight
meant I had not tried hard enough and needed to walk farther
or on steeper hills, and eat less. If I lost weight, I was
encouraged and all the more determined to eat less and
exercise more. However, my goal was not to be thinner, just
not fat. I still wanted to be "big and strong"—just
not fat.
Besides the scale, I measured myself constantly by assessing
how my clothes fit and felt on my body. I compared myself to
other people, using this information to "keep me on track."
As I had when I compared myself to others in terms of
intelligence, talent, humor, and personality, I fell short
in all categories. All of those feelings were channeled into
the final "fat equation."
During the last few years of my illness, my eating became
more extreme. My meals were extremely ritualistic, and by
the time I was ready for dinner, I had not eaten all day and
had exercised five or six hours. My suppers became a
relative binge. I still thought of them as "salads," which
satisfied my anorexic mind. They evolved from just a few
different types of lettuce and some raw vegetables and lemon
juice for dressing to rather elaborate concoctions. I must
have been at least partly aware that my muscles were wasting
away because I made a point of adding protein, usually in
the form of tuna fish. I added other foods from time to time
in a calculated and compulsive way. Whatever I added, I had
to continue with, and usually in increasing amounts. A
typical binge might consist of a head of iceberg lettuce, a
full head of raw cabbage, a defrosted package of frozen
spinach, a can of tuna, garbanzo beans, croutons, sunflower
seeds, artificial bacon bits, a can of pineapple, lemon
juice, and vinegar, all in a foot-and-a-half-wide bowl. In
my phase of eating carrots, I would eat about a pound of raw
carrots while I was preparing the salad. The raw cabbage was
my laxative. I counted on that control over my bowels for
added reassurance that the food was not staying in my body
long enough to make me fat.
The final part of my ritual was a glass of cream sherry.
Although I obsessed all day about my binge, I came to depend
on the relaxing effect of the sherry. My long-standing
insomnia worsened as my eating became more disordered, and I
became dependent on the soporific effect of alcohol. When I
was not in too much physical discomfort from the binge, the
food and alcohol would put me to sleep, but only for about
four hours or so. I awoke at 2:30 or 3:00 a.m. and started
my walks. It was always in the back of my mind that I would
not be accruing fat if I wasn't sleeping. And, of course,
moving was always better than not. Fatigue also helped me
modify the constant anxiety I felt. Over-the-counter cold
medications, muscle relaxants, and Valium also gave me
relief from my anxiety. The combined effect of medication
with low blood sugar was relative euphoria.
Oblivious to illness
While I was living this crazy life, I was carrying on my
psychiatric practice, much of which consisted of treating
eating-disordered patients—anorexic, bulimic, and
obese. It is incredible to me now that I could be working
with anorexic patients who were not any sicker than I was,
even helathier in some ways, and yet remain completely
oblivious to my own illness. There were only extremely brief
flashes of insight. If I happened to see myself in a
mirrored window reflection, I would be horrified at how
emaciated I appeared. Turning away, the insight was gone. I
was well aware of my usual self-doubts and insecurities, but
that was normal for me. Unfortunately, the increasing
spaciness that I was experiencing with weight loss and
minimal nutrition was also becoming "normal" for me. In
fact, when I was at my spaciest, I felt the best, because it
meant that I was not getting fat.
Only occasionally would a patient comment on my appearance.
I would blush, feel hot, and sweat with shame but not
recognize cognitively what he or she was saying. More
surprising to me, in retrospect, was never having been
confronted about my eating or weight loss by the
professionals with whom I worked all during this time. I
remember a physician administrator of the hospital kidding
me occasionally about eating so little, but I was never
seriously questioned about my eating, weight loss, or
exercise. They all must have seen me out walking for an hour
or two every day regardless of the weather. I even had a
down-filled body suit that I would put over my work clothes,
allowing me to walk no matter how low the temperature. My
work must have suffered during these years, but I did not
notice or hear about it.
People outside of work seemed relatively oblivious as well.
Family registered concern about my overall health and the
various physical problems I was having but were apparently
completely unaware of the connection with my eating and
weight loss, poor nutrition, and excessive exercise. I was
never exactly gregarious, but my social isolation became
extreme in my illness. I declined social invitations as much
as I could. This included family gatherings. If I accepted
an invitation that would include a meal, I would either not
eat or bring my own food. During those years, I was
virtually friendless.
I still find it hard to believe that I was so blind to the
illness, especially as a physician aware of the symptoms of
anorexia nervosa. I could see my weight dropping but could
only believe it was good, despite conflicting thoughts about
it. Even when I started feeling weak and tired, I did not
understand. As I experienced the progressive physical
sequelae of my weight loss, the picture only grew murkier.
My bowels stopped functioning normally, and I developed
severe abdominal cramping and diarrhea. In addition to the
cabbage, I was sucking on packs of sugarless candies,
sweetened with Sorbitol to diminish hunger and for its
laxative effect. At my worst, I was spending up to a couple
of hours a day in the bathroom. In the winter I had severe
Raynaud's Phenomenon, during which all the digits on my
hands and feet would become white and excruciatingly
painful. I was dizzy and lightheaded. Severe back spasms
occurred occasionally, resulting in a number of ER visits by
ambulance. I was asked no questions and no diagnosis was
made despite my physical appearance and low vital signs.
Around this time I was recording my pulse down into the 30s.
I remember thinking that this was good because it meant that
I was "in shape." My skin was paper thin. I became
increasingly tired during the day and would find myself
almost dozing off while in sessions with patients. I was
short of breath at times and would feel my heart pound. One
night I was shocked to discover that I had pitting edema of
both legs up to my knees. Also around that time, I fell
while ice skating and bruised my knee. The swelling was
enough to tip the cardiac balance, and I passed out. More
trips to the ER and several admissions to the hospital for
assessment and stabilization still resulted in no diagnosis.
Was it because I was a man?
I was finally referred to the Mayo Clinic with the hope of
identifying some explanation for my myriad of symptoms.
During the week at Mayo, I saw almost every kind of
specialist and was tested exhaustively. However, I was never
questioned about my eating or exercise habits. They only
remarked that I had an extremely high carotene level and
that my skin was certainly orangish (this was during one of
my phases of high carrot consumption). I was told that my
problems were "functional," or, in other words, "in my
head," and that they probably stemmed from my father's
suicide 12 years earlier.
Physician, heal thyself
An anorexic woman with whom I had been working for a couple
of years finally reached me when she questioned whether she
could trust me. At the end of a session on a Thursday, she
asked for reassurance that I would be back on Monday and
continue to work with her. I replied that, of course, I
would be back, "I don't abandon my patients."
She said, "My head says yes, but my heart says no." After
attempting to reassure her, I did not give it a second
thought until Saturday morning, when I heard her words
again.
I was staring out my kitchen window, and I started
experiencing deep feelings of shame and sadness. For the
first time I recognized that I was anorexic, and I was able
to make sense of what had happened to me over the last 10
years. I could identify all the symptoms of anorexia that I
knew so well in my patients. While this was a relief, it was
also very frightening. I felt alone and terrified of what I
knew I had to do—let other people know that I was
anorexic. I had to eat and stop exercising compulsively. I
had no idea if I could really do it—I had been this
way for so long. I could not imagine what recovery would be
like or how I could possibly be okay without my eating
disorder.
I was afraid of the responses that I would get. I was doing
individual and group therapy with mostly eating-disordered
patients in two inpatient programs, one for young adults
(ages 12 to 22) and the other for older adults. For some
reason, I was more anxious about the younger group. My fears
proved unfounded. When I told them that I was anorexic, they
were as accepting and supportive of me and my illness as
they were of one another. There was more of a mixed response
from hospital staff. One of my colleagues heard about it and
suggested that my restrictive eating was merely a "bad
habit" and that I could not
really be anorexic. Some of my coworkers were
immediately supportive; others seemed to prefer not to talk
about it.
That Saturday I knew what I was facing. I had a fairly good
idea of what I would have to change. I had no idea how slow
the process would be or how long it would take. With the
dropping of my denial, recovery became a possibility and
gave me some direction and purpose outside of the structure
of my eating disorder.
The eating was slow to normalize. It helped to start
thinking of eating three meals a day. My body needed more
than I could eat in three meals, but it took me a long time
to be comfortable eating snacks. Grain, protein, and fruit
were the easiest food groups to eat consistently. Fat and
dairy groups took much longer to include. Supper continued
to be my easiest meal and breakfast came easier than lunch.
It helped to eat meals out. I was never really safe just
cooking for myself. I started eating breakfast and lunch at
the hospital where I worked and eating suppers out.
During my marital separation and for a few years after the
divorce from my first wife, my children spent weekdays with
their mother and weekends with me. Eating was easier when I
was taking care of them because I simply had to have food
around for them. I met and courted my second wife during
this time, and by the time we were married, my son Ben was
in college and my daughter Sarah was applying to go. My
second wife enjoyed cooking and would cook supper for us.
This was the first time since high school that I had had
suppers prepared for me.
After ten years in recovery, my eating now seems second
nature to me. Although I still have occasional days of
feeling fat and still have a tendency to choose foods lower
in fat and calories, eating is relatively easy because I go
ahead and eat what I need. During more difficult times I
still think of it in terms of what I need to eat, and
I will even carry on a brief inner dialogue about it.
My second wife and I divorced awhile back, but it is still
hard to shop for food and cook by myself. Eating out is safe
for me now, however. I will sometimes order the special, or
the same selection that someone else is ordering as a way of
staying safe and letting go of my control over the food.
Toning down
While I worked on my eating, I struggled to stop exercising
compulsively. This proved much harder to normalize than the
eating. Because I was eating more, I had a stronger drive to
exercise to cancel calories. But the drive to exercise
seemed also to have deeper roots. It was relatively easy to
see how including several fats at a meal was something I
needed to do to recover from this illness. But it was harder
to reason in the same way for exercise. Experts talk about
separating it from the illness and somehow preserving it for
the obvious benefits of health and employment. Even this is
tricky. I enjoy exercise even when I am obviously doing it
excessively.
Over the years I have sought the counsel of a physical
therapist to help me set limits to my exercise. I can now go
a day without exercising. I no longer measure myself by how
far or how fast I bike or swim. Exercise is no longer
connected with food. I do not have to swim an extra
lap because I ate a cheeseburger. I have an awareness now of
fatigue, and respect for it, but I do still have to work on
setting limits.
Disengaged from my eating disorder, my insecurities seemed
magnified. Before I had felt as though I was in control of
my life through the structure I had imposed on it. Now I
became acutely aware of my low opinion of myself. Without
the eating-disorder behaviors to mask the feelings, I felt
all my feelings of inadequacy and incompetence more
intensely. I felt everything more intensely. I felt
exposed. What frightened me the most was the anticipation of
having everybody I knew discover my deepest
secret—that there was not anything of value inside.
Although I knew I wanted recovery, I was at the same time
intensely ambivalent about it. I had no confidence that I
would be able to pull it off. For a long time I doubted
everything—even that I had an eating disorder. I
feared that recovery would mean that I would have to act
normally. I did not know what normal was, experientially. I
feared others' expectations of me in recovery. If I got
healthy and normal, would this mean I would have to appear
and act like a "real" psychiatrist? Would I have to get
social and acquire a large group of friends and whoop it up
at barbecues on Packer Sundays?
Being oneself
One of the most significant insights I've gained in my
recovery has been that I have spent my whole life trying to
be somebody I'm not. Just like so many of my patients, I had
the feeling that I was never good enough. In my own
estimation, I was a failure. Any compliments or recognition
of achievement did not fit. On the contrary, I always
expected to be "found out"—that others would discover
that I was stupid, and it would be all over. Always starting
with the premise that who I am is not good enough, I have
gone to such extremes to improve what I assumed needed
improvement. My eating disorder was one of those extremes.
It blunted my anxieties and gave me a false sense of
security through the control over food, body shape, and
weight. My recovery has allowed me to experience these same
anxieties and insecurities without the necessity of escape
through control over food.
Now these old fears are only some of the emotions
that I have, and they have a different meaning attached to
them. The feelings of inadequacy and the fear of failure are
still there, but I understand that they are old and more
reflective of environmental influences as I was growing up
than an accurate measure of my abilities. This understanding
has lifted an enormous pressure off of me. I no longer have
to change who I am. In the past it would not have been
acceptable to be content with who I am; only the best would
be good enough. Now, there is room for error. Nothing needs
to be perfect. I have a feeling of ease with people, and
that is new to me. I am more confident that I can truly help
people professionally. There is a comfort socially, and an
experience of friendships that was not possible when I
thought that others could only see the "bad" in me.
I have not had to change in the ways that I initially
feared. I have let myself respect the interests and feelings
that I have always had. I can experience my fears without
needing to escape.
Thomas Holbrook today
|
|
Thomas Holbrook, M.D., is Clinical Director of the
Eating Disorders Program at Rogers Memorial Hospital
in Oconomowoc, Wisconsin. He has been treating men
for 20 years in his psychiatric practice. This
article was adapted with permission from
Making Weight: Men's Conflicts with Food, Weight,
Shape, and Appearance,
by Arnold Andersen, M.D., Leigh Cohn, M.A.T., and
Thomas Holbrook, M.D. (Carlsbad, CA: Gürze
Books, 2000).
|
Photos: Courtesy of Dr. Thomas Holbrook
Ask the Experts
|
Watch the Program
|
Share Your Story
Help/Resources
|
Minority Women: The Untold Story
|
One Man's Battle
Body Needs
|
Transcript
|
Site Map
|
Dying to be Thin Home
Editor's Picks
|
Previous Sites
|
Join Us/E-mail
|
TV/Web Schedule
About NOVA |
Teachers |
Site Map
|
Shop
| Jobs |
Search |
To print
PBS Online |
NOVA Online |
WGBH
©
| Updated December 2000
|
|
|