What if a person with anorexia refuses to eat?

Here is an excellent question from a commenter that I will attempt to answer to the best of my ability:

“What do you suggest as a better approach if a person is refusing to eat and on the verge of death? Surely you don’t let that person just fade away?”

I can only answer from my own experience as a person who has experienced severe starvation, that is, self-imposed starvation, and as a person who has again eaten.  And as a person who is alive and able to write these words.

Because this has happened to me, this self-starvation and then eating again, many times, and because I have an exceptionally good memory, I can look back and say, “Gee, what caused me to eat again? What are the more positive ways to get a person to eat again, and which ways are damaging to a person, long and short-term?”

Of course, history will tell us that for one thing, if you starve yourself to extreme and keep going, you are going to die. And if you starve and then eat again and screw that up, you can die in the process of eating again (I rather dislike the word “refeeding”).  It’s rather complicated.  I hear it mostly depends on the person’s prior medical history and the extent of the starvation as to whether there will be such screw-ups. The more complicated the medical situation is, the more screw-up potential there is, or so I hear.

I do know that our bodies are smarter than our minds.  I believe I provided a link a while back, or perhaps I didn’t, to a survival story I saw on weather dot com.  These stories on that channel tend to bug me cuz they tend to be sensationalist and tend to have a moral, almost “Christian” twist to them.  Like “good guy who prays will prevail” twist. These sensationalist stories that now pervade the media are seeping into our brains the idea that no matter what, the cops,  EMT’s, military, government, and medical folks are out for our best interest, which in fact, they aren’t. They are out to make a buck and if we are in their way or are inconvenient to them, they aren’t going to save us.  Instead, we’ll get disposed of in some way.  That’s in fact the way life is.

Our minds discriminate. Our minds see the different types of uniforms and read people’s name tags.  Our bodies know only the warmth of human touch, the expressions on faces, and know what a hug feels like.  Our bodies know what it feels like when we hold our dogs and cry.

Our minds read food labels.  Our minds think: calories, fat, fiber.  Our minds say, “I should.  I should not.”  Our bodies taste and feel the food in our bellies and feel digestion and the warmth of the food and feel when we eliminate our food.  Our bodies say, “I am hungry.  I am starving.  I am thirsty.”

At any rate, the survival story was about a couple that went for a hike. They got badly lost.  The wife became weak and told the husband that it was her choice at that point and she felt she couldn’t go on. She told her husband to try to get help and she would wait where she was to conserve energy.  She pleaded with him to leave her, even if it meant only one of them survived.

Yes, he went on.  And on and on.  He did find a car, eventually, and the person in the car got the husband to some rescue folks. They figured out where the wife had been waiting, and after a search, they all found the wife.  She’d been lying there clinging to life. But alive. They got her out. At the end of the story, the clip showed her at home with her kids.  Happy ending.

But here’s what I want to focus on: The little survival story showed just how desperate the body can get.  Our minds may in fact be unable to think clearly.  The couple had run out of food and water.  When the woman was alone and waiting, she was seriously dehydrated and as I figure it, this had now ceased being a moral issue that involved upper level human thinking.  She wasn’t capable of that right then and there. This is my own opinion because I’ve personally been through it.  What did she do?  She cut into her hand and attempted to suck out her own blood. That’s how thirsty she was.  Her body was determined to get water any way it could.

What I’ve been through wasn’t precisely that situation, of course.  Everyone’s situation is different and everyone does, in fact, have choices, but we do have to remember that in starvation, a person isn’t at a level of human morality.  It’s gut-level, or, if you wish, animal-level survival.  The body is going to take over. The body isn’t rational, but it’s damn smart.

So the actions you see of someone who is starved may in fact look quite irrational if you are watching as an outsider, or you may even wrongly judge that person as psychotic, but no, that’s not true.  The person is in survival mode and is in fact conserving every bit of energy he or she has. Every morsel matters and every second counts.

So in my own life, I can recall “good” ways that I began to eat again, and ways that were harmful.

The worst way to eat again, that will cause permanent harm, is the most forceful and shameful and dishonest, with the most restrictions. The best way  to eat again is the most loving and affirming and honest, with the most choices.

Most folks with anorexia aren’t, in fact, at that level of being completely unable to think at a human upper level.  Most are only partially slowed down or partially impaired and they are barely aware of it, or their thinking gradually erodes over the years so they don’t even notice the whittling away of their cognitive abilities.  Of course, should they enter “treatment,” they get coerced into thinking they “need” drugs or have “other” diagnoses and end up taking drugs.  The drugs themselves cause complications and mess with cognition, sometimes rather long-term.  Withdrawal causes problems and even after these drugs are stopped, years later, the body and mind can show signs of impairment that science is only now discovering.  Of course, many take recreational drugs anyway or get disillusioned with poor medical care that they feel they must take all sorts of pills to get relief, whether their doctors order these pills or not.

I can see how anyone can get into the situation of starving themselves and then be unable to make the conscious, mind-driven choice to take in food.  I can see how the person might make the mind-driven choice to refuse food. However, the body will prevail if the body is given the choice free of the mind’s interference.

Problem is, the way our psychiatric system insists on taking over and interfering via force, it doesn’t even allow for this. This “eating disorders care” first of all takes away all LOVE from the mix and proves to the patient:

YOU ARE HATED, SHAMEFUL, AND UNLOVED.

This is incentive, above all, to further refuse food if the patient has any mind left.  All belongings are taken from the patient and the patient’s bodily privacy is denied. In many cases, a tube, a foreign object, is forcefully driven into an orifice of the patient’s body.  How can this be “loving care”?  It is rape.  No one will have incentive to eat if they are treated with hatred.

Here is a story of a time I chose to eat all on my own.  I told the story once here years ago, and I will retell it now, then I’ll paste the story as I told it before when it happened, below today’s version.

It was days before Christmas, 2011…….

I guess I was feeling rather down.  I guess I’d met someone around the beginning of November, a new friend. She was full of promises, saying she was my best buddy, but immediately I saw “red flags” and warned myself that this friendship was likely to end badly.  I recall telling my therapist this, too. But I kept on with this friendship anyway, not heeding my own warnings.

That’s what happens when you are lonely.  You’ll settle for second-best.  Dumb?  Yeah, I admit it was dumb.  I felt like I was investing too much emotionally in her. Sure enough, she dumped me.  Not only that, it all coincided with two other “bad luck” events.

At the same time, I had started Imipramine.  You guys know what that drug did to me.  If not, I’ll tell you. About ten days after beginning the drug, my blood pressure went soaring, my pulse went up and was never under 90 from then on, and I also felt like I was physically crawling out of my skin. Nonstop.  I felt like I was always fighting that feeling.  Nonstop. It was that constant fight that is, in fact, the “black box warning” that causes suicide in teens.  I’m positive of it.  Also, I had enlarged breasts, most likely due to increased milk production.  No, I wasn’t pregnant.  I assumed that all those side effects were temporary and would go away after a week or two. However, this feeling persisted. And went on and on. It’s over now, though.  I asked to be taken off the drug the following February, 2012, and I’d say it took at least six months for the “black box warning” feeling to subside and even for my breasts to get back to normal.  I remember having that remnants of that “black box warning” feeling in September 2012 even.

So, anyway, back in 2011 I had just started the drug, and it was December and I was wondering when the heck the “black box warning” feeling was ever going to go away.  At that point, I sure was trusting my own shrink less and less and my therapist was turning out to be abusive, too, so I didn’t trust her, either.  This friend I thought I could trust had cruelly dumped me.

I ended up discovering, I guess near the end of November 2011, that I could go longer periods than I originally had thought without any food at all. So that’s what I did. I  had no clue that my blood sugar was dropping dangerously low.  The body can maintain okay blood sugar only for so long. After a while, your mind ends up in this nether world, which was what happened to me.  Many people go into a coma, but I didn’t.

My body was desperate to live, and my mind, as I figure it, began to make up fantasies so that my body would survive. So there it was, the end of December, right before Christmas.

My mind invented love.  My mind invented that someone actually loved me. Yep. Long-lost love was right there at my doorstep.  He was going to sweep me off my feet, pick me up in his arms, and carry me away.  And that person was going to show up shortly.  Fantasy?  Unrealistic? Delusion?  Mirage? That pool of water you see floating on the highway right before you while you are driving that’s never really there? The one just out of reach?

I don’t give a shit, folks.  Even though I was totally mistaken, I hopped to it. I told myself, “If he’s about to show up, I’d better eat and save myself.  I sure don’t want him finding my dead body.”

I was scared, too.  My mind wasn’t thinking straight.  Treatment?  Or no? Did I need a doctor?  Maybe I should…911?  Or would that be dumb as it always is?

Right before I phoned 911, I drank a tiny amount of juice, most likely no more than an ounce. This was thick banana-kiwi-strawberry stuff.  It actually burned going down.  Most likely, by the time the EMT’s did a finger stick, my blood sugar was in the safe range and no one had reason to believe I was telling the truth about not having eaten for a long time.  I know that’s the kind of thing my body does.

Again, at the cognitive level, I was totally confused about what I was doing and the reasons why I was calling 911. All I knew was that I wanted to live.  At the ER, I was told I was wasting the time of the ER personnel. The ER nurse obviously had no clue what anorexia nervosa was.

Here’s the entry, written a day or two later.

IN CASE I DO DECIDE, AT SOME POINT, TO CALL 911 AGAIN…

but I doubt I will, given the bullshit that happened last time

I AM WRITING THIS ON DECEMBER 26, 2011

I called 911 two days before Christmas and was taken to Mount Auburn Hospital.

The doctor, Dr. Gary Setnik, barely examined me. He did not listen to my heart. He did not listen to my intestines or stomach. He did not test my reflexes. He did not watch me walk. No one checked my orthostatic blood pressure. My temperature was not taken until two minutes before I left the ER. He didn’t do nearly as many tests that I recall doctors doing in emergency rooms. He must have spent two minutes with me. He barely asked any questions. Then I never saw him again. They sent a shrink, a social worker, I think. I was disgusted that they did this. Then they left me alone in the room for TWO AND A HALF HOURS while I was given no water or juice, nor did they ask me how I was feeling. I was tired so I dozed. When someone entered the room, I asked about my tests, but it was only the housekeeping person. I was barely aware of the passage of time.

The nurse entered and told me I could go after I had some lunch. I ended up with a fruit cup which I picked at and then found out it was spoiled. She told me all my tests came out normal. I know, however, that this is bullshit. Why? Because even when I am at my healthiest, one of my kidney levels are always slightly off. Also, the nurse, in the same breath, muttered something about dehydration, and said I should drink more, and that this was the reason my pulse was elevated. I had already explained to the doctor that my normal pulse is elevated (94) because of my medication. This is a common side effect verified by my doctor, the pharmaceutical companies, and any pharmacist.

When I was released, I was not offered a cab voucher. They kept on emphasizing that other patients were much more important than I was. I think they just wanted me out of there. I realized that for the entire time I was there, I had received no actual treatment.

When I got home, after many hours, I looked at the papers they gave me. My instructions consisted of three words: “Take it easy.” There was also a sheet on panic attacks. I have not had a panic attack since 1997.

I have anorexia nervosa, which is a serious disorder with 10-20% mortality rate depending on which study you look at. Apparently, no one listened to me or believed me. From December 14, 2011, sometime in the wee hours, until December 20, at 3:30, I consumed no calories. Between December 20 and the morning of the 23rd I consumed 433 calories. That’s not for each day but the total of all three days combined. I suppose no one thought this had anything to do with my feeling like I was going to faint that morning.

It is obvious to me that emergency people are not adequately educated about eating disorders.

I do monitor my blood pressure and pulse with a meter. I am not stupid. I have a bachelor’s and master’s degree, both earned recently. This statement will eventually appear on my blog. My blog is Googlable, and I have regular readers. Merry Christmas.”

Again, I wrote that last bit December 26, 2011, and am reprinting it today, which is Feb 21, 2014.