In his book, “People and Predicaments,” Dr. Milton Mazer described the study he conducted on Martha’s Vineyard beginning in 1961, which showed that incidences of mental illnesses were much higher on the Island than on the mainland.
Mental illness affects one in four families, according to the National Alliance for Mental Illness (NAMI). On Martha’s Vineyard, that number is much higher.
What is mental illness? What causes it, and why is there such a high rate of it on Martha’s Vineyard? How is it diagnosed, and who is afflicted? And why is it so hard for people to talk about?
In our Jan. 26 edition, The Martha’s Vineyard Times launched an investigation into mental health on the Island with Hermine Hull’s personal account of her lifelong battle with depression.
Beginning today and in the months to come, Martha’s Vineyard Times contributor Jonathan Burke, who lives with mental illness himself, will be writing about Islanders who have suffered from depression, schizophrenia, bipolar disorder, anxiety disorder, and eating disorder.
We’ll be exploring why the Vineyard mental illness rates are so much higher, how police and public health officials treat psychological issues, and how mental illness on Martha’s Vineyard has changed since Dr. Mazer began to study it.
And each month, Martha’s Vineyard Hospital psychiatrist Dr. Charles Silberstein will write a column addressing questions about mental health.
Losing one’s life to food
By Jonathan Burke
Violet pulled the feeding tubes out of her nose.
It was the middle of the night, and she was in her bed at the Walden Behavioral Care center in Walden for folks with eating disorders. She was malnourished, and without help was at risk of dying. She does not remember how she came to Walden.
“I woke up there,” she says. “It’s like a prison, pretty much. There’s nothing. It’s these stark blue walls and these people walking around who are very gray and sick. I thought I was not one of them, but I was.”
For months, Violet (not her real name) had been caught in the grips of her eating disorder. It ruled her life — ruining her health, her relationships, and her employment. On some days, she threw up as many as 30 times.
Her fear of food and gaining weight was too powerful for her to see how dire her situation had become. “My perception is that I am never sick enough to die,” she says.
They posted a physical watch.
Violet stayed in Walden for six months, and then was discharged because she was not engaged in her treatment. They doctors decided she needed a change, and that the “real world” might inspire her.
Violet is not sure when her eating disorder began. As a child, she had some irregular behaviors surrounding food, such as skipping lunch for a month. But it seemed normal at the time. She started throwing up intentionally when she was 18.
Good and bad foods
Guilt around eating started to appear. Slowly, she started to have good foods and bad foods — foods she was allowed to eat and foods she was not allowed. If she ate a bad food, she later would need to purge it to rid herself of the guilt.
The rules around food, Violet says, give a sense of control and safety. Eating only oranges for two months, for example, may make one feel safe and in control. The sight of an apple, on the other hand, may induce tears. It does not always make sense. It does not have to make sense.
And there was her appearance: “I always want to have a nice body, and be active and attractive to the opposite sex.”
Violent went to college. She went to her classes. She socialized and had a boyfriend. She vomited four to five times a week. She hid the behavior. She managed.
Her father’s suicide during college knocked her off her feet. She lost too much weight, and was admitted to a treatment center for four weeks. She did well. And after her release, she was back on track for a few months.
The demons were still there.
“It just doesn’t go away that easy. I started throwing up again, and then more and more, and this snowballs over the years.” During one prolonged episode she spent $10,000 on food, alcohol, and rent.
“It takes over your entire brain and your entire life,” she says. She is now 30 years old.
Her fear of food is insidious, constant, and unrelenting. For example, pizza is to Violet what a drink is to an alcoholic. Violet cannot eat one piece of pizza. If she has one piece, then she will end up eating two entire large pizzas. And then because she has broken a rule against pizza — which is a bad food — she will have to rid herself of the food by throwing up. (This happened two days ago, she told me during an interview.)
Triggering a cycle
Violet eats the pizza and throws up. She then restricts her food intake for days because of the anxiety that was caused by the pizza. When she is too hungry to not eat any longer, she overeats again due to the hunger and then throws up again.
It is impossible to handle an eating disorder like Violet’s on one’s own.
Violet is aware of her disorder, and understands the behaviors are not good for her. But, she says, it does not matter if she understands. The compulsive urges to overeat and later to throw up are too strong.
There is guilty pleasure in overindulging — which she knows she can remedy later by purging. She loves food as much as she hates it. She becomes “crazed” during an episode: “My eyes get big, and I’m rifling through everything as fast as I can, shoveling my mouth full.”
There may be some string cheese in the fridge. She takes a bite. After the first bite, she knows she is going to become fat. She knows she will throw up later. So, she reasons, if she is going to throw up, why not eat as much as she wants?
“So I eat another string cheese, and then I eat a pound of pasta and then I eat a pizza … it snowballs into ‘I just ate everything in the fridge.’ Just because I ate one piece of string cheese.” And then she purges.
Safety foods like oranges do not trigger the cycle. They are, as their name implies, safe. But they pose their own problem. Living solely with safety foods is a slippery slope.
A salad with croutons and veggies with dressing and maybe some beans and chicken starts out OK. But then the next day, one may decide one does not need the croutons. And the next day it is the same with beans. “And then the next day you’re like, OMG, I’m eating dressing. I need to eat vinegar, which has no calories … I end up pretty much eating lettuce and vinegar.”
Violet’s eating disorder consumes every ounce of her energy. When she looks into a refrigerator, all of her mental energy goes automatically to memorizing everything inside and where it is placed. At work, she must focus on not leaving 10 times a day for something to eat.
It is really distracting. It is hard to have a conversation with her boyfriend if her mind is occupied with dinner. She becomes, as she says, “a shell because [her] mind is so far away.”
Taking the fun out of life
“Do I like to ride my bike because I like burning calories, or do I actually enjoy riding my bike? I don’t really know. Do I like broccoli? I don’t know. Or do I like it because there are no calories in it? I don’t know the real me.”
Social occasions and holidays are a challenge.
Folks eat nachos during the Super Bowl, and she has to refrain. Folks overindulge at holidays like Thanksgiving. They can take a nap in response to their overindulgence. Violet cannot. For Violet, overindulging may have an impact of weeks.
Violet was readmitted to Walden two weeks after her discharge. She was a wreck, she says, and went back on her own. She stayed another six months.
The effort at places like Walden is to normalize folks to food and help them gain weight. The day is centered around food. There is breakfast, morning snack, group, lunch, afternoon snack, dinner, and then an evening snack. “It feels like eating all day long. It really does. I hate it,” she says. Walden was not a happy place.
But it was safe, and it did provide needed relief. The triggers were not there to contend with. She did not have access to the kitchen: “It was miserable and boring, but I did not feel like I had to kill myself every minute of the day.” At the time, she said, the only other safe place for her would have been jail.
After Walden, Violet came back to the Vineyard with a desire for life and without a penny in her pocket. A friend bought her a bus ticket. She found a good job. Recently, she marked the one-year anniversary of her discharge from Walden. She is much better, if not where she would like to be.
Violet knows she will not stop throwing up tomorrow or next week. But there are small steps. She can be honest with her boyfriend and acknowledge when she has had an episode. She can not blow her whole paycheck on food.
She sees a counselor every week, and has worked with a nutritionist. With help, she is reining in some of the symptoms of her disorder.
She works at introducing new foods to her diet. Breakfast is her strongest meal — the one in which she feels most confident — so that is often where she tries new foods. Recently, she tried an egg. It was terrifying at first. But she tried a second time, and again and again. Now she likes eggs.
Violet is not sure she ever will be comfortable with food. But for now, that is OK. She is coping. She can go out with friends. She can go to a Super Bowl party. She will make a dinner ahead of time. She can socialize for a few hours and not eat, and have her dinner when she is home.
She has made some good friends on the Vineyard: “They are people who are going to put positive things in my life, whether it be a good conversation or going for a walk or going for a hike or going off-Island for a day. They just want to fill my day with fun stuff … the more fun things and happy joy I am feeling, the [more] the behaviors are going to … diminish.”
If she has a choice between bingeing and purging or going for a hike with a friend, she will go for a hike. She may binge and purge later. She may need some time to herself in the kitchen. But that is OK. The eating disorder is just sort of there. She has hope.
Unhealthy relationships with foods
What exactly is an eating disorder? What are the causes? What is the treatment? Prudence Athearn Levy has been a nutritionist on the Island for 13 years, and she says that basically, an eating disorder is when people have an unhealthy relationship with food: “Food or the absence of food becomes the driving force in most of life’s decisions.”
Gail Gordon, a counselor with Martha’s Vineyard Community Services, has a doctorate in psychology and has worked in the field for 40 years.
There is a continuum of eating behaviors, says Ms. Gordon.
On one end are those with anorexia who restrict food intake. On the other end are compulsive eaters. Their eating is “out of control.” In the middle, closer to anorexia, are folks with bulimia. They are consumed with food and calories and self-image. These people often binge on food and then purge the food later by throwing up. Also in the middle are those with so-called “normal” eating.
Dr. Gordon says there are different reasons for eating disorders. For some, often with women who have been sexually abused, it is about having control over their body. For a compulsive overeater, gaining weight may be about building a barrier against the outside world — keeping intimacy at bay. And some disorders are a coping strategy for uncomfortable feelings. Focusing on calories can distract from feelings of sadness or loneliness.
The media and culture are often a culprit.
“All the magazines saying you’re only attractive if you’re slender,” says Ms. Gordon.
And the chemical wiring of our brains can contribute. A pleasure sensor in the brain, says Ms. Gordon, is ignited when someone eats food. “Food can be love. It’s the reward center, and they want to do it again. Same thing as the purge. Even though the purge is not comfortable … it’s changing the neurochemicals in the brain. Every time they purge they get relief. The relief is like the reward.”
Usually it is women who suffer from eating disorders, but it can also be men. It is found most often in men where weight is a factor in their performance, such as in dance where they are expected to look a certain way, or in wrestling where there are weight classes.
Eating disorders are not the fault of the person suffering — the disorder simply drowns out reason.
Ms. Levy says, “That 90-pound person who knows they want to get better is held back by that eating disorder voice: ‘What are you thinking, you’re going to gain five pounds by eating that’ … even though they know they should and they want to gain the five pounds … [and] they know they could break a bone at any minute … it’s not strong enough when that voice is louder.”
The impact an eating disorder has on someone’s life can be severe and life-threatening. “Eating disorders wreck confidence,” says Ms. Levy. Someone may not be able to break off an abusive relationship. A person who is bingeing and purging all the time will not have the time to do well at work.
People with bulimia, according to Ms. Gordon, sometimes use a drug called ipecac to induce vomiting. The drug is for people who have ingested poison, and causes violent vomiting. It is said the musician Karen Carpenter died when she used ipecac. Constant purging on its own, said Ms. Gordon, can cause an electrolyte imbalance that also may lead to death.
People with anorexia ultimately will starve themselves if not helped. The malnutrition, before reaching starvation, will slow down “unnecessary functions” that really are necessary, says Ms. Levy — such as remembering, thinking, empathy, and movement.
Treatment is available
Ms. Levy says that as a nutritionist, she wants to rebuild her patient’s relationship with food, to make the relationship a more positive one. She wants to help create new pathways in the brain that are free of the disorder. She talks about food with her patients, and works to ensure their physical needs are met. She helps to incorporate food into her client’s life.
Ms. Gordon said, “From the beginning, I try and reassure the person that I’m not going to take their eating disorder from them … I don’t want to take away their main coping device until they’ve replaced it with other coping strategies.”
“They are a unique person who has many strengths and who is not fully living life because they are so consumed by the eating disorder,” she says. “If I can help them to appreciate those parts about themselves that are separate from the eating disorder, and start to help them make connections in the world with other people or other interests, with their work, their community — that’s helping to build their sense of self.”
Unfortunately, there is currently no eating-disorder treatment center on the Island. There is, though, a group based on the AA 12-step model for those with eating disorders. No clinician involved. Those who are interested should call Sue at 508-627-9946.