Living in a Vicious Cycle of Guilt and Shame

The furniture is tattered, and a lot of the art is homemade. There are a few storebought prints--one is of flowers in a flowerpot and hangs above a primitive, impressionistic crepe-paper poster also resembling a flowerpot. Distorted. Things often get distorted, like the self-images of healthy women and girls, women who think they would be worthier if only they were thinner or if they ate less or purged more.

There is literature in the room, papers and pamphlets for the counselors and visitors to read. It tells of the physical dangers of Bulimiarexia, binge eating often followed by purging through laxatives or self-induced vomiting, and Anorexia Nervosa, willful self-starvation.

It also gives disjointed figures for those affected by bulimia, which mainly strikes women and is considered the more prevalent of the two at Harvard.

Between 3.9 and 19 percent of young women are thought to suffer from the disorder.

Located in the F-entry of Quincy House, the room is the home of the Eating Concerns Hotline and Outreach (ECHO). There are two phones in the room. The 11 counselors who staff the hotline Sunday through Thursday use those phones to respond to calls from people concerned about eating problems. People who call to talk about the disorders, to ask questions about body images, to sob while the counselors listen.

And, says one counselor who works at the hotline, the counselors spend most of their time doing just that--listening.

"Nobody wants to be judged--nobody," she says. "We don't judge. We just listen to them, and that in itself is a big thing."

Talking is especially important because bulimia and anorexia are disorders of silence. Those who suffer from them do not usually tell others about the problem, and binging and purging is often done in secret.

And experts say that although bulimia and anorexia are serious disorders in and of themselves, more often they are symptoms of other, deeper problems.

"Different people have different ways of expressing pain and anxiety," says Dr. Deborah A. Pilgrim, a counselor at the Bureau of Study Counsel who works with students with eating disorders. "[Bulimia] is certainly an expression of pain, and there are a lot of questions about why it gets expressed this way."

Part of the problem is cultural. Pilgrim says American society places too much emphasis on women's bodies, often measuring a woman's worth by her external appearance, her shape and slimness. Slimness is frequently equated with high worth.

"The hope is that if [bulimics] diet, if they lose the weight, their problems will be solved," Pilgrim said.

For the bulimic, the purge is a release of stress. It is an atonement for having indulged in eating because the bulimic feels more comfortable depriving herself.

One woman who, when asked why she binged and purged, tells a story about her father, who would fast on religious holidays. Her mother would get upset and ask him not to fast, but he would respond, "A little penance never hurt anyone."

"I guess I just think a little penance never hurt anyone," she says.

As part of their training outline, ECHO counselors receive psychological profiles of bulimics that outline the importance of cultural factors, such as the notions that "beating the system is good" and "major transgressions require major atonement." For these women, bulimia is a way to repent for what they believe to be their sins, for them to accept roles as penitents for success and the ways in which the think they fall short of society's expectations.

"I really think guilt is at the heart of [bulimia]," says ECHO counselor Andrea Schwartz '91.

To protect the identity of the counselors and the students they help, the names of all ECHO staff quoted in this article have been changed.

But instead of comfort, bulimia brings with it more guilt.

Says Associate Professor of Psychology Penelope J. Davis, who teaches a psychology class entitled "Eating Disorders," "Bulimia becomes a vicious cycle so it gets out of control almost once it's started."

Not all the effects of bulimia are psychological. Vomiting damages the digestive track, tears the esophagus, erodes tooth enamel and can lead to anemia.

Most bulimics induce vomiting by gagging themselves with their fingers, but some estimate that about one-third of all bulimics use a toothbrush or other instrument to make themselves throw-up.

Regular consumption of laxatives causes abdominal complications and malabsorption of fat, protein and calcium. In extreme cases, bulimia may even cause an irregular heartbeat and sudden death.

Davis says there are signs she looks for to find people in her class who binge and purge.

Bulimics have teeth that are decayed, and sometimes their voices are hoarse, Davis says. Most noticeable of all, she adds, are swollen glands and puffed face.

"I could tell in class when people were having bulimic episodes because of the puffy face," Davis says. "In a few days, the faces would return to normal."

But bulimics often go to great lengths to keep their disorder a secret.

"If they're extreme bulimics, it's harder to hide it, but they're good at it because it's an obsession," Schwartz said.

Although Davis says she recognize the symptoms of bulimics in her class, she says she cannot even begin to speculate on the number.

"I don't think we can have a number for Harvard, but my hunch is that eating disorders are alive and well among undergraduates," she says.

Davis does say she suspects more students suffer from bulimia than anorexia because the protoype of an intelligent, demanding, well-off and attractive over-achiever fits many Harvard undergraduates.

Dealing With Bulimia and the Bulimic

In her first year at Harvard, "Lisa Morris" had a roommate whom she suspected was bulimic. Popular, efficient and of average weight, her roommate would eat and eat and then spend a lot of time in the bathroom.

Morris says she once went into the bathroom in their suite and checked under the rim of the toilet bowl. She saw traces of vomit, and she felt her fears were confirmed.

"It was hard--it was a double role," Morris says. "You had to be supportive, but you also always had to be suspicious."

When Morris told her roommate that she might have a problem, her roommate cried, repeatedly saying that she was under a lot of stress.

Davis says she does not recommend confronting a roommate or friend who may be builimic. She says this tactic often backfires precisely because the disorder involves shame and denial, adding that confrontation can compound the problem.

Physical Repercussions

Fear about physical repercussions can also cause the friends and families of bulimic women to stress the repair of physical damage rather than the underlying emotional hurt, Schwartz says.

"A lot of it, I think, is identity--being insecure, not having a strong sense of self--these are a lot of the psychological things," she says.

Schwartz says the best way to help someone with bulimia is to be supportive and non-judgmental and to avoid pressuring them into recovery. She says friends or relatives should not discuss weight, food or eating habits with a bulimic.

"The important thing to do is not to say, 'You have an eating disorder,' because that's secondary," says Schwartz. "Focusing on problems and issues in the person's life is more important."

Schwartz says that if she and ECHO could do anything they wanted in order to educate the public, she would hold a workshop that everyone on campus would be required to attend. They would discuss what in society encourages women to loathe themselves and to express the self-loathing by damaging their own, healthy bodies.

Says Schwartz, "We would discuss what it is we're doing that leaves women never feeling they're good enough, good enough with their own size and shape, that they can never be thin enough."

For Those With Eating Concerns or Disorders

Eating Concerns Hotline and Outreach

Quincy House F Basement. Provides drop-in counseling 8 p.m. to 11 p.m., Sunday through Thursday nights. Hotline is in operation 8 p.m. to 8 a.m., Sundays through Thursdays. Peer counselors are trained in helping those with eating concerns and they provide referrals (495-8200).

University Mental Health Services

75 Mt. Auburn St., Third Floor. Office hours: 9 a.m. to 5 p.m. Provides psychological counseling for drop-ins and can arrange for long-term therapy. This semester, they are also running a counseling group for bulimics, which will meet every week (495-2042.)

Bureau of Study Counsel

5 Linden St. Office hours: 9 a.m. to 5 p.m. Provides counseling and can arrange for long-term therapy. This semester, the Bureau is sponsoring a sevenweek eating concerns workshop that will begin in late October (495-2581).

Room 13

Basement of Stoughton Hall. Provides drop-in peer counseling and a hotline, 7 a.m. to 7 p.m., every day. Counselors are trained to deal with a wide range of student concerns. They also make referrals.

For Friends and Family of People With Eating Disorders

Eating Concerns Hotline and Outreach

Quincy House F Basement. Provides drop-in counseling 8 p.m. to 11 p.m., Sunday through Thursday nights. Hotline is in operation 8 p.m. to 8 a.m., Sundays through Thursdays. Peer counseling for undergraduates who are worried about friends or family, or who have questions about eating concerns or disorders (495-8200).

Bureau of Study Counsel

5 Linden St. Office hours: 9 a.m. to 5 p.m. Provides counseling and can answer questions about the psychology and dangers of bulimia, anorexia and other eating concerns. Holding a workshop in early December for friends, lovers and roommates of people with eating disorders.