my wife's phobias

[Mike]

My wife has had several health problems over the past few years and she was mistreated by physicians in the beginning (i.e., "it's just depression" etc.).  It got so bad that she started feeling guilty for not being healthy since no doctor could tell her what was wrong.  She has since been shown via diagnostic tests that she does have some gastrointestinal problems, but some of the negative thinking has persisted.  One thing is:  when she was not being diagnosed with anything, she felt that her weight was an issue.  She is extremely thin (5'7" and 105 pounds) and she seemed to feel like a very low weight was a validation of being ill.  She still worries about her weight.  The phobia I am asking about deals with her thinness.  When we were first married (prior to this episode with doctors), I thought she was insecure about her appearance because she was so skinny.  So, I said to her one night that when I first saw her legs I thought they looked nicer than what I had expected, since I figured they would be so horribly thin (of course, I did not word it in quite that way).  In any event, now three years later, she still often cringes when I look at or touch her legs because she fears I perceive her as larger than she is.  I have explained to her countless times that I only said that comment when we were first married because I thought that that was what she wanted to hear.  Of course, that was stupid, but I never thought it would lead to this. I cannot seem to get her to believe in me now when I tell her that of course she (and her legs) are skinny.  She has developed a fear of her own flesh - if she can squeeze any flesh on her thigh she seems to become afraid and again questions her worth to be ill.  She is not anorexic, but her mindset and her misperception of her own body is frightening.  I am the one who made her doubt the thinness of her legs with my comments when we were first married. Is there anything I can do to remedy what I have done?  She undertands now why I said what I said that night, she understands that I was only trying to improve her self-confidence, but her fear of me misperceiving her as larger than she is persists.  It interferes so much with the intimacy in our marriage.  I know she could be helped with counseling, which she is not getting right now, but I am wondering what I can do to have her believe in me more.  I welcome any suggestions.

[HFHS M.D.-SW]

Dear Mike,



Your letter expressed that you may have a sense of guilt for your wife's pereception of herself.  It is important to remember your wife is probably very sensitive to comments and that you meant well.



From the information you provided, your wife may have low self esteem, and actually may have anorexia nervosa.



Your wife may benefit from psychotherapy. This may give her an opportunity to explore issues that concern her and build self confidence.



Best Wishes,





HFHS M.D.-SW

[Mike]

Just a follow-up.  Are there any women out there who have struggled with similar problems with perception, worth, etc. as my wife is?  Have you been able to see, intellectually, that your fears and doubts are not founded in reality, yet they continue to persist?  Please do offer some advice to me.  Again, I know my wife should probably seek counseling, but I am just wondering what I can do.  Please help.

[Telula Que]

My duaghter, who is 21, is never happy.  She is rarely home. Will seek any oppoortunity to spend the night and/or day with friends (has been doing this since High School). On the rare occassions she is at home she is beligerant and angry. She is nasty to her syblings and finds fault with anything she is involved with at home.  She often seeks arguments with her dad and myself.  Most times it seems to be a form of entertainment for her.  She is never light-hearted or able to joke about anything with anyone in our family. She seems to have a very deep love for us however. She expresses this to me when she calls (by being chatty and accepting) and in holiday cards.  But never at any other time.

If I am anything but 100% positive about anything related to her she snaps and turns on me. We never have conversations, ever. Either she does all the talking or I do all the talking.  Our relationship is unable to develop.  She is so critical of everything I say and do that even if I buy her something to show her I've been thinking of her she looks for any fault it may have and promptly returns it wheather it's clothing or a tube of lipstick.

If we suggest she move out and find peace and happiness elsewhere, she goes into a depression and needs to hear that she of course can stay as long as she needs to and there will always be a place for in our home.

She is a very pretty girl, blond, shapely, petite, very bright and truely a pleasure to know (very sincere and lively).  She is a student at The Fashion Institute of Technology and involved with fashion merchandising.

You would think that someone with all that she has would be thankful, happy and content.  She is always miserable.  The only time she is realy happy is on the rare occasion when she meets a boy, then she is exhuberantly happy.  The highs and lows are extreme.  She always has some sort of physical ailment,her stomach, her hip, her foot and will go to physicians for treatment.

I have tried lecturing, writing her letters, talking to her in her room, taking her out to dinner with me alone, yesing her, ignoring her, treating her like a child, treating her like an equal. To date nothing has worked.  

My concern is not realy for my relationship with her anymore, it seems to be unlikely we will ever be friends. I don't think she is able to get along with others ether and her general happiness in later life will be minimal if at all.

What do we do?

[lisa]

Mike, The best thing you can do for your wife is to be supportive and loving.  I, and a lot of women, have struggled with the issues you desribe. I also have been diagnosed with GI problems and understand bad experiences with medical professionals.  Frankly, and I know you will not want to hear this, it sounds like your wife may have an eating disorder and the body image issues that come along with that.  I say this as someone who has dealt with an eating disorder most of my adult life.  Therapy was absolutely critical for me and I think it is for most people who deal with these issues.  Encourage your wife to seek counseling, if she has not already done so.  The therapist may want to see both of you eventually, but allow your wife the space she needs to work on her issues, while providing support and kindness.  



One other thing I noticed in your posting is that you seem to want to know how you can fix your wife's problems because you feel that you may have caused them by your comments about her legs.  Please understand that your one comment did not create what your wife is struggling with.  I'm sure you have a hard time seeing your wife unhappy and only want good things for her and your marriage, but my experience is that when someone tries to "fix me" or puts a lot importance on how I feel and act, I tend to withdraw from that person because I feel pressured to be better or whatever way I think the perosn wants me to be.  So, it may be helpful to put less emphasis on "undoing" the comment that you made and more emphasis on what will help your wife now.  She is the one who can do the emotional work to feel better about herself. I really don't mean to be harsh, I'm just trying to exlain my experience in the hope that it might be helpful to you and your wife.  Good luck to you both.

[Mike to Lisa]

Lisa, thank you very much for your comments.  I agree with what you said.  It is hard for me not to try to "fix" the problem, but I see how that only hurts things when I try to.



My wife, whose name is Sarah, does not deliberately starve herself or anything like that.  However, she does definitely show many of the traits commonly shared by people with eating disorders.  I think she should seek therapy.  But she does not want to at this time.  She is very wary of it since she is so tired and mentally unclear and is having a hard time expressing herself.  She does not feel she could express herself well enough to the therapist and that she would just end up feeling worse about herself.  She is so wary of people.  I am not sure how I can get her to take this plunge.  I can't make her go.  That has to come from her.  Also, she says she knows herself and that a therapist would not offer anything she doesn't already know.  I disagree with her.  I think she needs therapy and that a good therapist can help her.



What would you suggest I do?  How to encourage her to go?  I don't want to nag, but I also don't want to be passive.  Any suggestions?  Thanks very much.  This is very helpful to me.

[Lisa to Mike]

I'm glad my comments helped.  I thought maybe what I had to say would make you angry and I would get flamed.  Thanks for being open minded.  



Is it possible for you two to start couples therapy?  If you said you wanted to go because you were worried about her and your relationship would that motivate her to go?  It seems to me that might be a way for her to get some help and for you to learn more about how to be supportive without trying to fix the situation.  This would also provide an opportunbity for an assessment of the possibility that your wife is suffering from depression -- a very common thing in people who have food and body image issues.  Some of the symptoms you desribe sound like the symptoms I experienced when I was diagnosed with depression.  Taking medication and being in therapy were what worked to manage the depression and this is ususally the protocol used.



I understand your wife thinking that not being clear headed would hinder a relationship with a therapist and menas therapy wouldn't work, but that's really not true.  Most people who go to therapy do it because they are not clear headed and need some help figuring out what is going on.  The good news is that a good therapist will be able to help your wife articulate her feelings.



Are any of the doctors your wife has seen credible in her eyes?  If even one is, you might try talking with him/her about your conerns about your wife's health.  I think the informaiton the doctor could share with you about your wife is limited by law, but the doctor may be able to suggest some ways to get her some help.



One other thing.  And I don't mean to harp on this, but I guess I'm going to.  Eating disorders present in a lot of different ways.  Most people who are anorexic DO eat some -- especailly in front of other people, most bullimics do not binge and purge where anyone can see them, and most compulsive overeaters do not eat more than normal in public.  There are also people, like me, who do not fit perfectly into the definitions of eating disorders but still exhibit the symptoms, behaviors, and thought patterns of the disorder and still need to be treated.



Please keep in mind that I'm just one person who has some experience with the issues you have conerns about and I certainly don't have all the answers.  I hope this helps.

[Mike to Lisa]

Thanks so much for continuing this discussion.  It just helps me to have someone to "talk" to, since it is hard to talk about this with my wife.  She cries when these things are brought up.  



One major problem my wife is having is that she had been "diagnosed" with depression early on by the doctors, even without any diagnostic tests.  She then felt like the doctors were blaming her for her health problems, that she, through her depression, was the culprit.  Depression is a very touchy subject with her.  She readily admits, though, that she is depressed.  What she will not accept is that the depression is causing her health troubles, because, to her, that is blame.  It is a very difficult situation. She says the depression is a result of her physical problems, not a cause.



She is a perfectionist and she was held to a double standard in her family. She was the pure, quiet child who "never messed up" and was always the strong one for everyone in the family to lean on.  It was okay for them to break down and exhibit certain behaviors, but not her. I don't think these things were ever said aloud, they are just how she felt. She went to the doctor in the beginning only because I prodded her to, but then when she did not come back with a "title" or a serious physical diagnosis, she felt shamed and wrong, like people in her family (and I) would look at her differently then they had.  She had stood for ideals and she never would have gone to a medical doctor just for depression.  Understand, this is not me talking here, this is my wife.



It is very destructive.  This is how she began to feel unworthy to feel ill.  She has no peace.  She is not well, but she continues to struggle with the notion that she does not have the right to feel ill, even after several diagnostic tests have come back showing physical problems.  She needs help, definitely.  She is her own worst enemy.  I am at my wit's end.  I feel helpless. See, her eating disorder behavior comes into play here.  If she gets thinner, then she might be "worthy" to feel ill.  She says she would never do anything like that, she would never deliberately try to get thinner, but you have to wonder.  Besides, everything she eats gets her sick right away and she dreads eating.



And the very fact that she is struggling so much with issues of worthiness, etc. right now makes her feel like a failure.  To spend money on therapy is an admission of failure to her because, in her eyes, it means that she is a miserable emotional failure who cannot solve her own problems.  Of course, this is ****, but how do I get that through her head? How can she see that the problems she is struggling with are in no way a reflection of her "goodness" or "badness" as a person?  She tends to always feel "bad" and "wrong" about herself, and that is how she feels about this.  I have no idea how to get through to her anymore.



Sorry I have rambled.  It is refreshing to have a listening ear out there.  My wife has become so touchy about these things and it is hard to even approach her about therapy anymore. But that is what she needs in the worst way.  One thing she does that I cannot handle well is she cries and blames herself and has fits of sadness.  When she's like that, she will not be comforted.  But if I leave the room (which I sometimes do for my own sanity) she thinks I am deserting her.  Yet when I try to calm her down, she just cries more.  What should I do when those moments arise? I hope you don't mind my asking you these things.  It is a great comfort to me to have someone to talk to about this.

[Mike from Lisa]

Mike, I can definintely sense your frustration at your situation.  You didn't repsond specifically to my idea about couples therapy and I'm wondering if you might go by yourself?  Tell your wife that you are going to go to therapy to get some support and help with your issues and then go by yourself.  I think this might have a two-fold effect.  First, it would get you some help and might give you a better perspective on how to deal with the situation you're in and, two, it might encourage your wife to entertain the possibility of going as well.



As far as depression being the cause of your wife's physical problems or vice versa -- and it could be either way -- what does it matter?  Depression is an illness in and of itslef that needs to be treated.  Why or how it happened is sort of secondary until it's being managed successfully for the person who is ill.  I have seen both general practitioners and psychiatrist for anti-depressant medicaiton management and either can be effective.  It just needs to be someone knowledgeable.  I think it's quite likely that if your wife gets treated for depression she will be more able to deal with the bigger picture of what is going on.



It's hard to explain to someone who has not been depressed how debilitating it can be.  And when you're in the middle of it and you're not being treated, it's sometimes almost impossible to see that things can be better and that you deserve things to be better.  I believe that everyone has an emotional "bottom" (like addicts hit bottom) and until things get to that absolute bottom point, people don't usually seek help.  And it's really hard to watch someone you care about be in more emotional pain than you think is necessary or tolerable, but you can't make anyone want to get better.



I wish I had a plan or specific advice about how to handle this.  Do you read?  I have found that reading about these kinds of issues can be very helpful.  You might look for books about depression -- and not ones on how to solve it or fix it, but rather books about what it feels like and so on so you have some additional understanding of what it's like.  One of my favorite authors on food issues and body image is Geneen Roth.  I would recommend "Feeding the Hungry Heart