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She has a multi-layered approach. For instance, as one way to encourage reflection on the here and now, Sutherland, who is also a licensed art therapist, leads art and yoga therapy classes. And she doesn't hesitate to delve deeply — even painfully so — into patients' past histories of trauma and abuse.
But a big piece is simply being accountable. She starts by asking patients to recount their emotions and what they ate the night before. "They need to report specifically what happened, put it very out in the open," she said. "A lot of the time they've been so used to the secrecy around it that that in itself can be a relief."
Sutherland's approach can also apply to other behaviors, including shoplifting. It's about strengthening the castle walls — in other words, taking control of your actions by undoing destructive behavioral patterns, and, hopefully, building up more constructive alternatives. Moreover, it's about recognizing that bingeing and purging will cause damage in the longterm, even while it relieves the immediate anxiety.
Jacky Duong remembered writing in her journal the first thing she did when she got home from the Alta Bates clinic: She ate a spoonful of yogurt. "To eat a snack — this tiny morsel of food — it was ...." She struggled for an analogy. "It's as if you were paralyzed for a really long time, and suddenly, you twitched."
She also remembered the next time she passed by a clothing store window. She stopped to glance in. But she didn't feel the urge to enter the store, and stealing didn't sound like a thrill.
"When I started trying to take control of my life, I stopped everything else," she said. "You kind of walk by the pretty things and you're, like, 'I could take that ... or walk away.'"
She walked away.
There is a grieving process that occurs when an eating disorder is confronted and a patient must let go of the behaviors that previously imbued them with a sense of control. It's a process that can be painful, difficult, and disorienting, Sutherland said. "It's like it's your best friend," she explained. "It's always there for you. It doesn't talk back ... and you can always come back to it. It becomes your identity."
Duong's two-week stay at the clinic cost $74,000, most of which was covered by her health insurance. She still owes hundreds of dollars in co-pays, and thousands more for withdrawing from school. But her work with Sutherland also put her on the path to recovery, which neither antidepressants nor therapy alone could do.
She still struggles. Sometimes, she feels empty, and other times, it's as if she's returned to the same spot. She doesn't weigh herself. But she speaks regularly with a therapist, and she can sometimes beat the bingeing urge by exercising or surrounding herself with friends.
Though the taunting voice inside her head will always be there — Sutherland said an individual with an eating disorder deals with it forever — she is learning to live with it.
And perhaps, as researchers like Marsh and Lock continue to unlock the mysteries of the bulimic brain, others will have an easier time as well.
A New Openness? Bulimia is coming out of the closet, but the same can't be said for shoplifting.
In recent years, there's evidence that the American public is taking the issue of mental illnesses, including eating disorders, more seriously. According to a survey released in February by the National Eating Disorders Association, an advocacy group for eating disorders prevention, 57 percent of respondents were "fairly well educated" about eating disorders, and 82 percent viewed them as "mental or physical illness[es]." The survey involved 1,000 randomly selected adults and was conducted by the independent research firm American Viewpoint.
"It's a new day," said Lynn Grefe, CEO of the eating disorders association. "For too long people just didn't talk about [eating disorders]. The public looked at it like a lifestyle choice, like people chose to have an eating disorder, terrible things. You wouldn't say that to somebody with brain cancer."
Since its formation in 2010, the association has existed to remind the public that eating disorders are serious, life-threatening illnesses. In fact, they claim the highest death rate of any psychological illness — 10 to 20 percent of all individuals hospitalized for anorexia will die in the next ten to thirty years due to their disease. There appears to be a new openness in the air, said Grefe, pointing out that social stigma is a key reason that eating disorders have remained under the rug over the years.
But while behaviors like bulimia are now becoming better understood, stealing is still considered morally repugnant. A shoplifter told her group leader at the National Institute for Shoplifting Prevention — which runs the only national program for shoplifting recovery — "If I were an alcoholic and I told my friends I was seeking help for alcoholism, they would be proud of me. If I told my friends I was seeking help for a shoplifting addiction, they would look at me like I was a criminal."