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Companion Guide for A Season in Hell

QUESTION 7: WHY DOESN'T SOMEONE HELP REGINA?

Secrecy

Although people with bulimia nervosa have periods when their eating is out of control, they are often remarkably adept at hiding shopping, food storage, bingeing, and purging from people who know them well. It is not at all unusual for people with bulimia nervosa to keep their problem a secret from roommates, sorority sisters, and even spouses, for a long period of time.

Denial

Regina. In the early stages of an eating disorder, the person often denies that she has any problems at all. Why should she change&emdash;Aren't other people just jealous?--if she is losing lots of weight, if she has succeeded in controlling hunger, or if she is apparently able to eat and not gain weight? As preoccupation with hunger, food, and calories intensifies, the person loses the perspective necessary to understand the extent to which her life is being consumed (pun intended).

After identification and treatment, the person may no longer deny she has an eating disorder. However, as in Regina's case, she may minimize the severity of her problems, insisting "it's under control," even when it is not. When pressed, Regina admits that she still has significant problems. Nevertheless, she just doesn't "want to deal with it," and she appears to think that a resolution to not let it "get out of hand" is a magical guarantee of control.

Regina's family. Many viewers will want to blame Regina's family or her fiancee for not recognizing the severity of her problems and insisting that she get help. Although her family bears some responsibility for the continuation of Regina's problems, it is important and instructive to consider the complexity of their situation before passing judgement. In the early stages Regina was a successful dieter, someone to be praised, not challenged, for taking control. When she lost control over dieting and eating and purging, she became emotionally unstable, argumentative, and in general very difficult to be around. By definition, this made her unreceptive to her parents' concerns. Moreover, many parents embrace the myth that such inconsistent, violent, indulgent, and disrespectful behavior is the norm for adolescents, a phrase they all go through. The combined weight of these factors&emdash;confusion about what is normal, a hostile child, a desperate child, a period when family roles are changing, a need to believe that "our little girl" can't be doing these things&emdash;works against a simple and definitive parental intervention.

Even after Regina has acknowledged her problems and the need for help, the social pressures for denial continue to operate. Her family, grateful that she survived and is doing so much better than she was at the time of hospitalization, is willing to disengage somewhat and to believe that jogging three miles per day is a confirmation of health, not a sign of her expanding need to purge. Her fiancee Mike, naturally, wants to please Regina and to believe her contention that his love is a healing force in her life. Consequently, he does not tell her parents about a bingeing and purging incident, and clings to the lame conviction that this was a one&emdash;time relapse.

In the final analysis, Regina's family and fiancee may indeed be "enabling" her eating disorder. Nevertheless, they are faced with an exceedingly difficult situation: How does one "reach" and adult who is (a) alienated and depressed; (b) frightened about the prospect of change; (c) intelligent and clever enough to rebut arguments for change; and (d) afflicted with a disorder which could kill her if she began to fall apart under too much pressure from others?

Anxiety and Ambivalence

The final minutes of A Season in Hell are proof that Regina's "season in hell" is far from over. Beneath her veneer of control and slenderness is real suffering&emdash;tension, pressure, preoccupation, and anxiety. She would like to be healthy, but she correctly anticipates that this would mean weight gain. Recall that in her thinking weight gain = bad = out of control. In addition, she probably knows at some level that weight restoration and elimination of her bingeing and purging habits will bring her face to face with threatening issues such as self-esteem, emotional expression, and interpersonal intimacy. Regina, like so many eating disordered people, has grown tired of her disorder, but she is till too frightened to face the complexities of health.

Legal Issues

Some students may wonder why her parents or professionals don't just hospitalize Regina against her will and force her to participate in therapy. I.e., make her get better. This suggestion should be treated as a forthright plan of action in response to sincere concern and not as an immature response to Regina's resistance.

There are two reasons why involuntary commitment is impractical. First, Regina would regard this as an extraordinarily hostile act. This resentment would make therapy an exhausting and useless battle of wills instead of a productive collaboration. Second, involuntary commitment is a deprivation of liberty. Therefore our constitution guarantees Regina and other citizens the rights and privileges commonly called "due process of law." Although commitment laws vary from state to state, in general Regina's parents and the State of Kentucky would have the burden of proving in a clear and convincing manner that she suffered from a "mental disability" which makes her either unable to care for herself, dangerous to others, or extremely dangerous to herself. Regina can care for herself and she is not dangerous to others. Her behavior is certainly "dangerous to self" in the long run, but the prosecution would have little chance of proving that Regina's present behavior is so imminently threatening that she should be institutionalized against her will.