Louise (17) suffers from anorexia with bouts of bulimia. In this script, she and her sister, Marie (16), talk about the illness and its impact on their once close relationship.
Marie: I just get so tired of it, Louise. You know, we’ve both got exams, we are both under a lot of pressure. I try, I really do try to understand where you’re coming from but sometimes it just seems like you do this out of spite…you know trying to get attention. Mum and Dad are at their wits end and it’s just sometimes so difficult to accept that it is an illness and it’s not you being a total pain in the ass.
Louise: I get angry with myself. You know I start off every day, every day when I wake up, I think ‘today, I’m going to try so hard….stick by that meal plan. “Today’s the day for change”…then it all goes belly up.
Marie: You seem so trapped away from us within the illness. I want my sister back. Can’t you see that? I want to go and play tennis with you again. I want us to go to the movies and just do normal things like we used to…buy a box of popcorn for example…. even that suggestion could spark off a third world war these days.
Louise: I guess it’s difficult for you to understand, for any of you to understand. I think Dad thinks I’m doing it on purpose, for the attention seeking bit. It just breaks my heart to see the hurt I’m causing, you know? Sometimes I feel it would be so much better if I wasn’t around.
Marie: I read in a book that your anorexia thoughts stops you understanding us. We hurt when you hurt. We would have immense pain every day of our lives if you were no longer around. You have always faced life’s challenges brilliantly. You can do the same with this. I know you can.
Louise: I would like to think I can but sometimes the challenge seems insurmountable.
Marie: This illness freaks the living daylights out of me. I see you undress at night and I just freeze with fear….and it is not just that, you know, we don’t talk any more, we don’t laugh or joke about stuff anymore. You don’t come with me on our dog walks any more. I
miss all that. I miss our chats about everything and nothing. It seems like an eternity since we have had a real carefree conversation about guys, clothes and just normal stuff. Conversations like that are such a thing of the past and it makes me feel so sad.
Marie is honest and open with her sister over her own emotional reactions, responses to her sister’s illness and lack of understanding. She reminds her of the bigger picture, of happier times in the past and how she misses those times. She sets her own boundaries by refusing to listen to harm talk by affirming her own love and support for her sister. Again, she looks to the bigger picture in the future to do this. Yet, she is open and honest on her own fears for the future, that although she is hopeful of a return to these days, she is nevertheless aware and fearful that there could be a not so positive alternative.
Louise: I am sad too. I feel I do not deserve to eat.
Marie: It is so difficult for us to get our heads around why someone we love cannot love herself, starting with giving her body the nourishment it needs.
Louise: I know to other people, it is totally irrational. But I just sit down and all these thoughts come into my head, how if I eat the chicken salad or whatever …by tonight I’ll have put on half a stone and I’d rather die than… sorry…. I do not mean that.
Marie: Let me see if I’m understanding this. Every time you sit down to dinner and we’re all starting to eat, your thoughts are going haywire, like if you eat a piece of salmon, you’re gonna wake up the next morning looking like em …a sumo wrestler, for example?
Louise: Yeah, well I guess when you put it like that, yep that sounds about right. I know it must sound crazy to you.
Marie: So, I guess the big question for now, is what we can do about these thoughts. I guess it doesn’t help us telling you that they’re stupid thoughts or untrue thoughts or anything else because they seem to be real to you, otherwise you’d be able to tell them to bugger off yourself wouldn’t you?
Marie: We need all to come up with a plan on how best to support you through this, yourself included. We all need each other to close ranks against this asshole monster that’s strangling you. I know we’ve been trying to do this but perhaps reassuring you or us telling you that you need to eat, we don’t want you to die…. and on and on and on…perhaps that’s not the best response.
Louise: Nope, kinda puts more pressure on me actually – I feel bad enough about not being able to eat.
Marie: So what other techniques could we use…you know to quieten or, at least, reduce these thoughts a bit more, both before and after dinner time….because not only do you need to eat but you need to keep the nutrition inside the temple so to speak, for your body to become healthy again because I find that really frightening – you know, the actual long lasting damage you could be doing to your body right now.
Louise: The six million dollar question…
Marie: We don’t have to come up with anything right this minute, but it is definitely worth reflecting on. I’m wondering how some dinner games would work?
Louise: Dunno. Suppose I’m open to suggestions. I’ll have a think about it, OK?
Marie turns the conversation round to a more proactive tone, in that she is interested in the thought processes that are stopping her sister eating. She assumes a more creative problem- solving role in coming up with possible helpful solutions or ideas to tackle the issue of the obsessive-compulsive thoughts during mealtimes.
Marie: That would be brilliant – we really need to work on this together. We realize you are the only one who can do it but hey…we are all right behind you in anything you need from us that may help make that journey a bit easier.
Siblings are able to bring the bigger picture of life outside the eating disorder more into focus and they are a particularly good resource to help foster social relationships and break down the isolation that occurs.