The under-reported story of Terri Schiavo’s eating disorder

The case of Terri Schiavo seems to have attracted a considerable amount of media attention in recent weeks, both in the U.S. and abroad.

As most are probably aware, Terri Schiavo is the 41 year-old American woman whose heart stopped beating in 1990, resulting in extensive brain damage. Her husband, Michael Schiavo, originally sought to keep her alive, hoping for a miraculous recovery. Instead of improving, however, her condition continued to deteriorate. She is currently in a “persistent vegetative state”; cerebrospinal fluid occupies the space where her higher brain centers used to be.

Eight years after the incident, Mr. Schiavo asked a Florida State judge for permission to remove his wife’s feeding tube and allow her to die. Her parents battled in the courts to keep the feeding tube in, insisting that therapy might bring about improvement. Ten courts have found the parents’ case without merit, and the feeding tube was removed. Most recently, President Bush and the U.S. Congress attempted to intervene by forcing the case into federal court, but to no avail. At the time of this writing, Ms. Schiavo remains without sustenance. Her death appears imminent.

It is not my intention to add to the volumes that have been written and said about the legal, ethical, and political issues raised by this tragic case. There is one aspect of the event which has been underreported, however, and it concerns the psychological disturbance responsible for producing Ms. Schiavo’s heart attack, an eating disorder known as Bulimia Nervosa.

Individuals suffering from “bulimia” episodically eat excessive amounts of food, usually in secrecy. Later, they attempt to compensate for the food intake to prevent weight gain. They do this most often by artificially inducing vomiting; however, other methods may be used, including fasting, excessive exercise, and the misuse of laxatives, diuretics, or enemas.

Prior to the heart attack that damaged her brain, health care providers failed to recognize that Ms. Schiavo suffered from an eating disorder, and thus failed to refer her to a specialist for appropriate treatment for her condition. The courts awarded Ms. Schiavo a medical malpractice award in the amount of two million U.S. dollars, or about 77,385,000 Thai baht.

Had Ms. Schiavo been treated for bulimia, the tragic events that followed could have been avoided. Frequently inducing vomiting disrupts the balance of electrolytes necessary for normal cardiac activity. In essence, Ms. Schiavo’s heart attack was self-inflicted, albeit indirectly and unintentionally.

One of the most interesting facts concerning bulimia is its tendency to appear at a relatively high rate of incidence in certain societies, while remaining conspicuously absent in others. It also appears with ten times greater frequency among those of a particular gender and age group.

Bulimia develops primarily among young females living in societies that stress the importance of a slender figure. Only about one in ten bulimia sufferers is male. It usually develops during late adolescence to early adulthood, a very tender and impressionable time in the course of human emotional development. Experts believe social pressures on young females to conform to an idealized body type plays an important role in the development of the disorder. Biological, personality, and family factors have also been suggested as contributing to the illness.

Messages that encourage young people to conform to socially-dictated standards of beauty and attractiveness seem rampant in our modern visually oriented media. Many contemporary young people appear lacking in the values and skills necessary to resist these powerful pressures toward conformity. Further, our societies often seem lacking in the sophistication and resources to recognize and treat eating disorders and other emotional problems.

It seems a cruel irony that the tragedy of the Schiavo case could be averted if a tiny fraction of the effort that has been mounted to litigate the issue of her right to die had been focused upon providing the treatment she needed to overcome her eating disorder.