No One's Immune

Open the covers of the magazines in your waiting room or turn on the television. America's fascination can be seen in everything that is sold. Messages communicated by Madison Avenue say, "If you aren't one of us [a model, superstar, athlete or millionaire], you're not doing something right." Our children are bombarded with messages indicating that their value is based on their appearance. These messages permeate children's minds even before they enter elementary school.

Last summer I visited Remuda Ranch, a Wickenberg, Ariz., treatment center for eating disorders. The psychiatrists at this facility are all too familiar with the damage these messages cause to one's self esteem, because they treat people who have been damaged by these and other negative messages about self worth.

It was an eye opening experience to see so many young women ages 11 to 23 being treated for anorexia and bulimia. Most of the patients I passed in the corridors looked as if they had been reduced to just skin and bones. They had no fat on their bodies, yet the staff shared that most of these girls felt they were too "fat" (compared to the average model) or weren't sick enough to be treated at the center (they weren't as skinny as their peers).

There were common threads among the patients. It was apparent that none of them felt they "measured up." In addition, many of them were from affluent families and a good number of them were from medical families. Unfortunately I was not allowed to ask patients questions. The sole interaction I had was with a nameless 13 year old who had completed eight weeks of rehabilitation. She said, "Oh, I've seen your magazine. My father gets it." Then she named an article she had read.

I suddenly realized I needed to find a medical family that would talk about their struggles with eating disorders, because this problem is so often ignored or hidden by society. I found that family in Somerset County, Pa. In a house hidden in rolling hills and lush autumn leaves, on a road that seemed to lead to nowhere, I visited Dr. Greg Mock, his wife, Marcy, three children, Talia, Emma and Evan, and the horses, dogs and other animals that inhabit their 70 acre farm. This rural family physician quickly erased my misconceptions of eating disorders.

In December 1996, Talia, Greg's then 13-year old daughter, was admitted to Remuda Ranch. When Talia, who is 5 feet 6 inches tall, and her father arrived at the ranch, she weighed about 85 pounds and hadn't eaten anything for two weeks. Talia's willingness to admit her problem allowed her parents to get her help, but not without a price. Her eight weeks of treatment cost well over $30,000, and insurance didn't cover the entire bill.

Wasn't it obvious?

Greg and Marcy didn't pick up on Talia's eating disorder until a couple of months before her confession. Greg had suspected a problem two years prior when Talia's friends told him she wasn't eating her lunches at school, and she was running incessantly. When he confronted Talia, she said the problem was under control. However, when he and Talia were on a medical missions trip to Haiti in October 1996 where the food is sparse and you eat everything that is given to you Greg noticed that his daughter was taking a long time to eat and was barely touching the food on her plate. After that trip, Talia's downward spiral began. She had many somatic symptoms, including gastrointestinal problems. She also had a preoccupation with fat. She stopped eating treats, then milk, cheese, vegetables and fruits.

The trigger that finally alerted Greg to the fact that there was a serious problem was when Talia, who loved spending time with the horses and was known to walk without shoes through the snow to the barn, became too cold to go see her horses. Her circulatory system had slowed down significantly. "Talia did the thing perfectly," Greg said. "When she got sick, she got really sick really quick. As I reflect on her past behavior, knowing what I know now, I should have picked up the patterns, but I didn't. As a family physician, my schedule was erratic. We always ate at different times. She would cook elaborate meals for us as a family, but wouldn't eat. She would play with her food. One night I found her meal wrapped up in a napkin in the garbage can. We didn't know that she was weighing herself up to six times a day. All of these behaviors are signs of disordered eating."

He continued, "In medicine, I was taught that anorexia was caused by dysfunctional upbringing, and that it was primarily a disease of the wealthy, or caused by abuse. We live on a farm in the middle of the country; not in suburbia. Talia and I had always been close. We were best buddies. Most nights we sang and read Scripture and stories together as a family. From all indications, she wasn't at risk for the disease, or so I thought."

Once Greg started researching the prevalence of eating disorders in his town, he found that a number of adolescent girls in Talia's private Christian school had an eating disorder. The school's percentage of students with anorexia or bulimia was off the national charts 10 percent of the girls were identified with an eating disorder and are in therapy. The national average is one percent. That's when Greg realized anorexia was a community wide problem and started looking for symptoms in his patients.

"Anorexia is a disease that sometimes goes undetected until it's too late to do anything. It's not a disease many physicians actively look for. We rarely see teenagers, and when they do show up in the office with a complaint, we solve that problem but don't look for additional ones.

"If anorexia is caught in the early stages, outpatient counseling and nutritional therapy can be effective. But Talia needed help that we couldn't provide. I told Marcy we had to find a place that could treat her, because as her parents, I knew we would destroy her if we tried to help. We were fortunate that Talia realized she needed help and knew she was really sick, so she didn't fight me when I took her to Arizona. A lot of parents have to fight their children into treatment because anorexics believe they can help themselves. Even after they have recovered, they feel they could have done it alone."

The next step

When Talia came home after eight weeks at the ranch, Greg knew follow up treatment was going to be difficult. Remuda offers an additional six week step down program for patients after they complete their in patient therapy. However, because of the expense and the fact that Talia was so young, the Mocks brought her home after her in patient work. They set up their own out patient program for Talia and the other girls in their community struggling with eating disorders. Modeled after the group-therapy program at Remuda, Talia's group was comprised of six girls who met together regularly to talk about nutrition, self esteem and other triggers that might cause a relapse.

"The best thing about group," Greg says, "is that the girls won't let each other think negative thoughts. They build each other up, and they give each other positive touch something all the girls crave. They also allow each other the freedom to vent. In my opinion, group' is more therapeutic for the girls than any other component of the treatment."

When asked what he was planning now that Talia is in recovery, Greg responded, "My motivation is to help the girls in my community avoid in patient therapy. As a family physician, I can provide the medical help and partner with other professionals so families that don't have the financial means can treat their girls without flying across the country for help. I am not a guru on eating disorders. I just have a desire to help educate others so they won't have to fight the battles our family has over the last year."

Before my trip was complete, Talia and I spent some time exploring the countryside. As we drove, she confirmed what her father had told me earlier. Unlike some of her friends, Talia's eating disorder wasn't caused by a boy teasing her, her mother saying she was too heavy or her coach asking her to drop a few pounds. Her eating disorder started because she didn't want to grow up. She didn't want to deal with the violence, destruction and other pains associated with adulthood. She says, "The news made me so sad. The world was such a scary place."

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