Contemplative Bulimia

"Here rests Linda, heir of the most famous horses of the Kentucky Derby. The thinnest woman in this cemetery here sleeps the eternal dream…. FEFL in La Bulimia Centrante.

Abstract

In this article we describe a variety of bulimia, which resembles Gerald Russell"s "ominous" category known as "bulimia nervosa".

Russell, in his seminal article, also describes his eponymous sign, the callous formation of the knuckle of the index finger, consequence of its being used to provoke the self- induced vomit.

This translation of yet another of my publications— otherwise available in Spanish — is offered here in response to the many requests I have received to that effect.

The unspoken, unlimited, and indescribable influences that the hypothalamus exerts over our destinies, are not included in the therapeutic arsenal of the "experts" that treat eating disorders, because they do not know of their existence.

Whatever the reason, this is an unjustifiable attitude because it denies patient and family an essential tool to assist them along the via crucis toward the final recuperation from their illness.

In a previous publication we studied the case of a woman victim of restrictive anorexia whose condition worsened by the flawed treatment approaches her physicians devised when prescribing drugs to stimulate her appetite to make her eat and gain weight.

But, instead of achieving their ends, what the good doctors attained was to disorganize her hypothalamic function with all its resultant negative consequences.

So it"s often the case in the treatment of bulimia, whose therapeutic approaches often are limited to basic mechanical measures, ignoring the patient, and not giving due attention to the structure of her personality and the dynamics of her family structure.

In this lesson we will speak about an atypical form of bulimia that does not form part of the standard nomenclature and that, perhaps for the same reason, very few know of its existence.

I am referring to the syndrome of centering bulimia (or bulimia centrante).

But first let"s take a look at the syndrome of bulimia nervosa

This condition is as polymorphous in its presentations as it is perverse in its resistance to treatment.

As Ernest Charles Lasègue averred more than two hundred years ago, when referring to the dogged resistance of the anorexia to treatment: "no entreaty, coercion or threat, will make the patient change her stubborn attitude of resistance to the treatment efforts of the doctors and the family to stop losing weight and renounce her illness".

Bulimia, for many women, is simply a disagreeable activity in which they are trapped because they cannot escape its tyranny.

For others — an extremely rare group — bulimia is addictive; as addictive as are drugs that can be purchased in the streets or in the supermarket, such as coffee, sugar, fast foods, alcohol and tobacco — neither more nor less.

And for the group that occupies us here, bulimia is an intrinsic part of their psycho-physiologic constitution.

For a formal definition and understanding of this subject, we direct the interested reader to any of the many articles I have published on this subject matter.

Centering bulimia

To better understand the scope of this scientific presentation, it would seem useful if we examine briefly the method known as "The Centering Prayer".

The method of the Centering Prayer

In accordance to its definition this is a technique designed to facilitate the process of contemplative prayer, through the preparation of the faithful faculties to cooperate in this "gift of the spirit".

In essence represents an effort at placing the act of contemplative prayer in a more profound and meaningful perspective.

Its objective is not to replace other types of prayers but to place the act of meditation in a different and more meaningful level.

Centering bulimia, thus, derives its name from this activity, because it becomes an immanent program in the epigenetic psychological constitution of its victims, becoming intrinsic and fundamental parts of their lives.

To those that suffer from centering bulimia, the illness itself is not egodystonic, but, on the contrary, it"s egosyntonic, what it means is that in this form of presentation the disease is accepted by the personality and becomes integrated within its own structures, making it almost impossible to eradicate.

Common bulimia, the one we read about in the majority of books, is a syndrome resulting from three factors interacting in amalgamation:

• Biologic. In some specific cases there is a hereditary or familiar component, which sustains its course after it appears. This means that genetics play a role as it has been shown in some isolated cases.

• Sociologic. Of all the causative factors, the one that depends on the social and environmental influence is the most outstanding, since the first cases of bulimia reported in the literature, occurred in dorms where the social contagion became manifest with the celebration of the famous "scarf-and-barf" parties held by young women, notorious by their abhorrence to being fat, and their love of the vicarious reward provided by the consumption of food in heroic proportions.

• Psychological. In our culture where being thin is enviable and fat is regarded with disdain, to do all one can do to lose — or at least — not to gain any weight is both desirable and praiseworthy.

To those with centering bulimia, the problem is different, because these women will be bulimics, no matter what.

No matter if they are thin, are overweight and want to lose weight, or if they want to improve their looks: they will have it, because it was fated.

A case history will serve as illustration

Linda: The skinniest corpse in the Cemetery of Louisville

Born as an the only surviving child left to wealthy parents in one of the most beautiful cities of the state of Kentucky, where the famous annual Derby is held, Linda was destined to be special.

Her grandparents had contributed to the luster of the famous races, running their own famous horses every year.

The girl"s only brother — her senior by ten years — had died in a boating accident when she was six years old.

Her parents, in sorrow, expressed to their young child: Linda, with the passing of your brother, you"re all we have…"

As a child, Linda grew up amidst the privileges assigned to the high and the mighty.

Shy, and by nature, retiring, she provided few pleasures to her parents as she was reluctant to partake in any of the social activities and functions that were accustomed in the society where she grew up.

As student she was mediocre. As an athlete she lacked merits, and as a person, only gained recognition for being the thinnest of all her friends.

Something that filled her with infinite joy, because she felt special being thin.

The drama begins

From her early childhood Linda suffered from many dental problems. This was because — despite having received proper instructions on oral hygiene — her teeth always showed cavities during routine visits to the dentist. Visits that, due to the poor condition of her dental pieces she was forced to make six times a year.

Her face had a perennial swollen appearance and her breath was fetid.

Tommy, her boyfriend often complained to her about the smell, but there was nothing prescribed by the dentist that worked in her case.

At age nineteen years, Linda married Tommy, moving in one of the many buildings that her family kept in the enormous farm where they kept their famous breeding stables.

With much struggle and with specialized treatment she was able to conceive and have their only daughter whom they called Jennifer in honor of the grandmother on her mother"s side.

Jennifer weighed ten pounds at birth something that was horrifying to the young mother, who despised fatness, including the slight abdominal paunch that Tommy was beginning to sport.

"I cannot understand why Jennifer was born so fat", she complained to the obstetrician, since her total weight gain during the pregnancy was only eleven pounds.

The questions

The doctor that delivered Jennifer, whose understanding of the situation was superficial at best, came one morning to ask questions about some unexpected complications since Linda"s electrolytes were low –– specially the potassium — and the serum amylase was elevated.

The nice doctor, looking at Linda in the face, concluded with: "maybe, she has the mumps", advising rest and avoidance of some activities until the swelling would remit.

But, the swelling did not come down

After giving birth, Linda started to gain weight, having increased three pounds since Jennifer"s birth.

The diets…

Linda, then, started a new series of diets, accompanied by auto-induced vomit.

But, the variety of vomit that Linda induced was different in all regards to the usual vomit that patients with bulimia provoke.

Swollen salivary glands

To Linda, in order to vomit, all she needed was to desire to vomit.

Then, she would manage to activate the vomit reflex by just wishing to vomit.

By these means, she would provoke vomiting, while she would indulge in rumination of food for "pleasure".

In Kentucky, several psychiatrists diagnosed her case as anorexia, owing to the extremely low weight of the patient,

And, as bulimia, for them, it did not seem to apply, since Linda never binged — as the whole bunch of "experts" ignored what they could not understand: the rumination and the regurgitation of the stomach content.

The clinical evolution of this case

At first, Linda refused treatment as she — in her mind — associated being "cured" with gaining weight, something that she dreaded.

But, more than anything else she feared to abandon the pleasure that she derived from her rumination and her self-induced vomiting.

Something that she was not ready to give up.

Linda reasoned this way:

"As a child, I had an enormous difficulty to be able to vomit, but, then, I was able to do it, and I liked it. What I liked the most was the feeling of doing it. The presence of vomit in my mouth and the pleasure that the activity gave me.

"It"s something that few understand, I know".

When Jennifer celebrated her fifteenth birthday — and as Linda was hospitalized to be tube-fed. Linda arranged her last will and testament with the assistance of a lawyer patient that was in the same ward with her.

She decided to be inhumed not far from her parents, adding that she would want her epitaph to read as follows:

"Here rests Linda, heir of the most famous horses of the Kentucky Derby. The thinnest woman in this world here sleeps the eternal dream…"

So said Jennifer.

Naso-gastric tube feeding

Pause

Bulimia treatment as it"s the case with any other ailment requires a most thorough understanding of all factors that impinge in any specific situation.

Linda did not enjoy the moral support of her aging parents who lacked all understanding of the reasons why any young woman would choose to suffer in order to be thin and beautiful.

Tommy was confused and inconsistent when often, swayed by her demands would remove her from treatment taking her home only to relapse.

Jennifer, for her part, grew up alone keeping company to her confused and desolate father.

Jennifer was always chubby, liked to read and write novels for the pleasure of doing something.

Still lives near the graveyard where her grandparents and mom are entombed.

She still keeps faithful company to Tommy.

In summary

Linda was the first case reported in the literature of rumination by a human being in 1986.

Perhaps this piece of information might have saved some lives of unfortunate women such as her.

We hope that Linda rest in peace with her most cherished desire fulfilled.

Bibliography

• Boskind-White, M: Bulimarexia: The Binge/Purge Cycle (1989) Bt. Bound

• Russell, G: Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa Psychol. Med. (3) 429-448 (1979)

• Larocca, F.E.F. and Della-Ferra, M.A.: RUMINATION: ITS SIGNIFICANCE IN ADULTS WITH BULIMIA NERVOSA, Psychosomatics, Vol. 27, No. 3, pp. 209-12, 1986.

• Larocca, F.E.F.: SELF-HELP IN ANOREXIA AND BULIMIA: PRINCIPLES OF ORGANIZATION AND PRACTICE (in The Eating Disorders: Medical and Psychological Bases of Diagnosis and Treatment, B.J. Blinder, B.F. Chaitin and R. Goldstein (eds.), PMA Publishing Co. pp. 477-81, 1988

• Larocca, F. E. F: Anorexia Nervosa. La Realidad y los Hechos: Así Hablan los Expertos Junio, 2007 (en monografías.com y en psikis.cl)

Louisville KY

Autor:

Félix E. F. Larocca MD