My colleague is working with a 20-year-old young man, whom we will call Martín. He is the oldest of four siblings, and his parents are immigrants. When he was 10, his father had a massive heart attack, and while he was revived by paramedics, he was left with a life not worth living. He now resides in a nursing home, unable to speak, dress, or feed himself. His wife visits him regularly with their two older children, whom he only sporadically recognizes. Financially, since Spain provides generous pensions, the family lives off his father’s pension: they rent an apartment and have food on the table, but without pretensions.
Martín had been an excellent student, winning several scholarships, and his future looked bright until, four years ago, he began suffering from paralyzing anxiety. It manifested around food: after eating, his heart rate increases significantly for almost four hours, and then miraculously decreases. As a result, he only eats once a day because the price to pay is very high. Additionally, due to his anxiety, he hasn’t been able to go out much and finished high school with teachers coming to his home. A couple of months ago, a therapist at his father’s nursing home, who had heard about his condition, met with him several times and, through gradual desensitization, helped Martín begin to venture into the world. He was then referred to an outpatient center where my colleague, Sara, works.
Sara has been working with me for a few years; she is intelligent and a good brief therapist. Her first words to me this morning were: “I don’t know why I’m stuck in this situation. I’m afraid I have to agree with my colleagues at the Center who see Martín’s ideations as almost… well, strange. He becomes very anxious and paralyzed by anything related to eating. He also tries to help his mother with the upbringing of his younger brother—who is now 10—and then scolds her. For example, he says that his younger brother shouldn’t be allowed to go to the park to play. Instead of being the one to voluntarily take his brother to the park, he sides with his mother and shouts at her, telling her what she should do. Luckily, his mother is very wise and calms Martín but also allows her 10-year-old son to go play in the park with his friends.”
The way Sara was viewing Martín was limiting her ability to intervene in the situation. As soon as she ‘bought’ the label of Martín’s actions as strange, she tied her hands in terms of where she could intervene.
I asked aloud why Martín’s actions couldn’t be seen as a more traditional eating disorder. It seemed to me that he was trying to control how much he ate, when he ate, and how he proceeded from there. I clarified that, like many clients with that label, the need to control his surroundings was an accepted rule—not always in every case, of course. If Martín was trying to have more control over his life and Sara could see it from that perspective, what could be different? How could she see Martín differently? There was an immediate smile on my colleague’s face, and she said: “If I can see Martín as someone dealing with finding himself and trying to control his environment, many of his ‘strange actions’ would fit in that place. If I can see him in that light, I can start talking to him about how difficult his life has been, being the oldest and probably the only son who remembers his father as he was, trying to help his mother, who alone and with four children, is doing the best she can. I can change my perception of him, see him in a different light, and from there, I’ll be able to talk to him more productively. It also allows me to have a different conversation with his mother, one that could lead us to change and a more useful interaction from Martín to his surroundings.”
As a supervisor, I had already done my job. Sara will do the rest.
And you, reader, what do you think?
