Journal December 2025 Release - Flipbook - Page 16
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Joanna refused to revisit anything related to anorexia or bulimia; she wanted to
focus on her current problems: Depression, Anxiety, Perfectionism, Temporal
Lobe Epilepsy, and Insomnia.
My concerns
I worried about all the medication at her disposal. Whenever she was discharged
from a clinic, she went home with three months of dispensed psychotropic
medications. The benzodiazepines disinhibited her even at the prescribed
dosages. Joanna had a love/hate relationship with medication and her diagnosed
conditions. There were times when she accepted the psychiatrists’ expertise, and
then there were times when Joanna protested, feeling like a “lunatic” whose life
was a waste.
Pieter’s job demanded extensive travel, leaving Joanna home alone with the full
responsibility of running a household and a small holding. When Pieter was away,
Joanna felt more vulnerable, and these were times when self-harm became more
evident and severe. Although she had helpers on the plot, the extent of such
responsibilities overwhelmed her, sparking “episodes” of temporal lobe epilepsy.
Periods of overwhelm easily translate into acts of overdosing and self-harm.
What on earth did I know?
I confess that I was very concerned about all the medication at her disposal, her
history of abusing it in suicide attempts, and about my preliminary psychiatric
knowledges of anorexia/bulimia. Dare I mention that my existing knowledge
regarding eating disorders was based on the belief that patients are wilfully
choosing to starve to manipulate, and that behavioural and cognitive therapies
were the approaches of choice?
I recall a young woman in an adolescent unit in Pretoria, who sat at the nurses’
station for full supervision over mealtimes. I can still see her furtively looking
around to see who was watching her, and cutting up her peas into tiny, tiny slices
without daring to put one morsel into her mouth. The staff called her
manipulative, disruptive, and non-compliant. I remember that she lost privileges
on the ward because of her refusal and manipulation strategies. I did not want to
think that way or treat people in such a manner.
An Apprenticeship in Extremis
Journal of Contemporary Narrative Therapy, December 2025 Release, p. 5-44.
www.journalnft.com
