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