Overcoming Anorexia
Peggy Claude-Pierre's controversial eating-disorder cure
She is a pale young woman dressed for a much colder day in long jeans and a heavy blue sweater. She stands motionless as a group of young adults attempts--somewhat comically--to learn to country-dance on the lawn in front of her. Although her clothes are bulky, they appear almost empty. At 26, Anja is nearly 6 feet tall but weighs only 81 pounds, a ghost of a woman, made even more ghostly by the glare of the bright sun on her sunken cheeks and bone-thin limbs. She can't imagine, she says, what it would feel like to have the strength to dance. Her heart is weak and her body fragile after years of self-starvation. She expected, she says, to be dead long ago.
So did many of the others dancing on the lawn of the Montreux Counseling Centers in Victoria, British Columbia. Like Anja, they were wasted to near nothingness by years of anorexia and bulimia, and left without hope after repeated hospitalizations and endless hours of therapy produced only relapses. Often given up for dead by doctors, they, too, sought help from this small clinic and its charismatic founder and director, Peggy Claude-Pierre, whose unconventional methods for treating the most severe eating disorders have earned her a reputation as everything from saint to witch doctor.
Claude-Pierre, though she has received some publicity, is still relatively unknown outside the eating-disorder treatment community. That could change dramatically this month with the publication of her book, The Secret Language of Eating Disorders (Times Books, $25), one of a handful of high-profile new offerings on women and their bodies, including The Body Project by Joan Jacobs Brumberg (Random House, $25) and the re-release of Hunger Pains by Mary Pipher (Ballantine, $10). Times Books reportedly paid Claude-Pierre a celebrity-style advance of $1 million for her manuscript.
Deathtrap. Seven million girls and women in the United States currently suffer from serious eating disorders, according to the National Association of Anorexia Nervosa and Associated Disorders. Of those, 30 percent will have continuing difficulties, and 5 to 6 percent eventually will die of the illness, most from either suicide or heart failure. Although researchers cannot be sure if deaths from anorexia and bulimia are increasing, they believe the incidence of eating disorders is rising, particularly among men, who now account for roughly 1 million victims, and among preadolescent girls and boys.
Anorexia is an ancient disease yet its cause remains unknown. Over the years, explanations have ranged from a bad mother-child relationship to a culture that prizes thinness above all else. Most experts now believe eating disorders stem from a complex mix of biological, psychological, and environmental factors. But there is no way to predict who will develop one and no simple or universally effective treatment for those who fall ill.
Claude-Pierre's clinic is sought out by parents who are desperate, their children actively flirting with death. Doctors, however, view her skeptically, questioning her methods and her success rate. She has no formal training in treating eating disorders yet says both that she knows what causes anorexia and bulimia and that she can cure anyone who gives her the chance. In the most simple terms, Claude-Pierre believes that eating disorders stem from an extreme "negative mind-set," which may be present even at birth. Anorexics and bulimics, she says, want to make everything right. When they realize they cannot, they turn their sense of worthlessness inward in an unconscious attempt at suicide. "Anorexia isn't about thinness," says Claude-Pierre. "It's about death. Victims starve themselves in order to disappear." But anorexia and bulimia can be completely reversed, she believes, with unconditional love, freedom from feelings of responsibility for the illness, and "objectivity training," a technique that teaches patients to separate their illness (the negative mind) from their true selves.
Claude-Pierre developed her theory while reclaiming her own two daughters from anorexia nearly 14 years ago. First, Kirsten, then 15, dropped to 80 pounds. Doctors told Claude-Pierre, a graduate student recently separated from her husband, that her oldest daughter was a hopeless case. Claude-Pierre responded by spending the next three months hand-feeding her teenager and giving her round-the-clock affection. Kirsten got better, but then Nicole, two years younger, began to starve herself. As Nicole's weight fell below 70 pounds, Claude-Pierre followed her around day and night, carrying her inside when she collapsed on the lawn after exercising for hours--a common symptom of anorexia--and gently reassuring her after finding her eating dog food from a dish on the kitchen floor at 4 a.m. It took a year and a half but Nicole, too, got better.
Last chance. Soon after, Claude-Pierre started treating patients in her home and counseling others on an outpatient basis. "I was told over and over that I would never get well," says Mackenzie Stroh, an anorexic who had contemplated suicide and several times had come close to death. Stroh, an artist, began seeing Claude-Pierre in the early '90s. She spent the next two years in treatment and has not, she says, relapsed.
Montreux opened in 1993. Today, Claude-Pierre operates amid the beeping and whirring of pagers, cellular phones, and fax machines. Hundreds of parents and potential patients contact the clinic each month. But, located in a restored mansion in a wealthy neighborhood of Victoria, it can handle only nine acutely ill patients at one time and up to 40 others in various stages of recovery. The waiting list is 15 years long. Grave illness is virtually an entry requirement.
What distinguishes Montreux from nearly all other eating-disorder programs is the high level of individual attention given to patients and the focus on relieving both victims and their parents of responsibility for the illness. This shift greatly eases the burden of many parents, who have spent years being blamed by doctors--or blaming themselves--for their children's refusal to eat.
At Montreux, every new patient is assigned five "care workers," who provide around-the-clock emotional support and keep patients from hiding food or exercising secretly under the sheets. If patients won't feed themselves, they are hand fed. If they toss their breakfast out the window, it is replaced. Unlike many hospitals, Montreux does not link patient privileges to weight gain and food consumption. Nutritional drinks come in opaque sports bottles to mask the amounts. Meals are small, frequent, and healthful. Food is never larded with excess fat and calories, which might send anorexics into a panic. During checkups, patients face away from scales so they don't see their weights.
Anything that can be construed as negative--or even body-conscious--is prohibited in the Mansion, as the main living quarters at Montreux are known. Newspapers and news programs are off limits, as are fashion magazines and discussions of tabloid topics like the JonBenet Ramsey case. One patient was told she could not check out a library book on the Titanic. The news of Princess Diana's death has yet to reach some Montreux patients. There are no scales or full-length mirrors, and nearly everything a patient does is rewarded with a hug. In the early stages of their recovery, the most emaciated patients are separated lest they turn thinness into a competition.
In one-on-one counseling sessions, patients concentrate not on how they got sick--little attention is paid to early childhood, for instance--but on practical strategies for getting well. They keep journals with two columns on each page: one for recording the self-hating voice of anorexia or bulimia, the other for the voice that argues against the negative thoughts. After months of this "objectivity training," patients learn to distinguish the "negative mind" from the self and to put things in perspective. "Hospitals put weight on me but they never did anything about the voice in my head," says Mary Kavanaugh, 25, who's been at Montreux just over a year. Before she entered the program, Kavanaugh not only starved herself but exercised compulsively. After her parents took away her sneakers and locked up her bike, she tried sit-ups--so many she wore away the skin covering her tailbone. She was hospitalized more than 10 times over the years but each time quickly shed the weight she'd gained after being discharged. "My parents were frantic and I didn't feel anything," says Kavanaugh. "Now it's like I've been reincarnated in my own lifetime."
No hard numbers. Montreux, which costs roughly $1,000 a day (a fee comparable to that of many private hospitals) and is covered by some insurance plans, is full of stories like Kavanaugh's. The walls are lined with pictures of former patients. What's impossible to know, however, is how long these patients stay well after they leave the clinic's atmosphere of unconditional support. Claude-Pierre claims that Montreux has a nearly 100 percent recovery rate for patients who complete the program. (Not all do.) But there are no scientific studies to support her claims; no independent outcome evaluations to determine which patients responded best to which treatments or how long a patient remained well--mentally and physically--after treatment. Most eating-disorder experts agree that a patient is only cured after spending at least five years at normal weight and free from compulsive thoughts and behaviors. "By saying she can cure any patient with anorexia, Peggy Claude-Pierre, by definition, delegitimizes what she does," says Dr. Allan Kaplan, director of the Toronto Hospital's eating-disorders program, who has treated former Montreux patients. "In the best hands, you will still have people who just do not get better."
Critics find other aspects of the Montreux program troubling as well. Claude-Pierre holds no advanced degree. Few, if any, of the clinic's more than 100 counselors and care workers (they include Claude-Pierre's two daughters) have any outside training as therapists. Many counselors are former patients and all received their training in-house at Montreux. Some patients complain that the clinic's counselors lack professionalism and that the atmosphere can seem almost cultlike. "There is no such thing as confidentiality at Montreux," says one former patient, citing instances when other patients were discussed during her private therapy sessions. Others at Montreux complain that the clinic's emphasis on positive thinking is sometimes used against them. "Any problems you may have with the clinic are dismissed as the workings of your negative mind," says one patient. Confronted with complaints about Montreux, Claude-Pierre responds that victims of eating disorders can be irrational and tend to distort reality.
Yet whatever Montreux's shortcomings, they matter little to those who have put their trust in Claude-Pierre. "We have our daughter because of Peggy," says Carol Iantorno of San Francisco, close to tears as she describes her 23-year-old daughter Erica's past 12 years: hospitalized 50 times, weight down to 44 pounds, so lacking in muscle mass that she had to crawl, her family torn apart emotionally and nearly ruined financially. Erica has been at Montreux for eight months and is progressing. She is still afraid of dessert, and she calls ahead to the hairdresser to make sure the full-length mirror is mostly covered when she gets there. But she has moved "off care"--she lives and gets counseling at Montreux but can come and go freely. She takes voice lessons, attends classes, and often eats in restaurants. "Erica's being alive now is an absolute miracle," says Iantorno. Erica, who is writing a book about her battle with eating disorders, sees things a slightly different way. "It's over," she says. "I will never be that tiny person in the hospital bed again."
This story appears in the September 29, 1997 print edition of U.S. News & World Report.