Team Player: Eating disorders therapist believes that life can be good again

One thing that comes up repeatedly in conversation with psychologist Susan Mengden is her preference for teamwork:

“I look back at my life, and I realize that everything I did and everything I’ve accomplished has been as part of a team. I really like that. I don’t like working solo. I am happy that Kay and I met and that we founded this clinic. It’s the right thing for me.” The clinic she is referring to is Eating Disorder Center at San Antonio (EDCASA), which Mengden co-founded with licensed professional counselor Kay Watt a year ago. Housed in a small office building adjacent to Frederick’s restaurant on Broadway, the place is positively humming with team activity. Besides the two founders, it employs the services of several additional counselors, a nutrition staff, a physician and three office assistants. All except the physician are women. The clinic’s approach is multidisciplinary, explains Mengden, as people who suffer from eating disorders (ED) need medical, nutritional, psychological and spiritual care. In addition, clients get intensive daily consultations with therapists and nutritionists, with a lot of hand-holding.

“What inspired us to open a facility like this was the need in our community,” she says. “Our city and state didn’t have nearly as many resources in this field as other states. We have no eating disorder hospitals in either San Antonio or Austin. San Antonians had to go out of state for treatment. I personally had to send about 60 people, including children, to out-of-state hospitals. Often doctors and schools do not possess the knowledge to recognize and deal with these conditions. In many cases, by the time clients walked into my (former) practice, they needed to be hospitalized because they had not received the treatment they needed for too long. “The other reason we created this kind of facility — and we are only one of three such clinics in the country — is that I discovered that the usual once-a-week therapy sessions of a typical private practice did not work. Seeing someone once a week is not enough. We are now a comprehensive outpatient program that works with clients every day. We even eat with them.” Though we have all heard of young women starving themselves or binge eating, most people feel that such behavior is basically an individual’s choice. Not so, emphasizes Mengden; it’s a mental illness and one that has the highest death rate of all such illnesses. It isolates the sufferers, forcing them into a very painful lifestyle.

And it doesn’t affect only adolescents and the twentysomethings. Mengden has treated a 46-year-old woman, for example, who was brought in by her husband because she was too emaciated to walk. At 5 feet 7 inches, she weighed only 99 pounds. “I was so worried when I saw her that I sent her first to the hospital (in New Orleans),” recalls the therapist. “Her pulse and blood pressure were so low. She had serious body image distortion issues. Despite the fact that she was abnormally thin, she felt fat.” After two months in the hospital, this client, Tina, gained 30 pounds but returned to Mengden’s office angry about the weight gain. And in no time, she managed to lose half of it. Still, she was healthy enough at this point to start both individual and family therapy and work with a dietitian. Gradually, she started getting better. “I think what turned Tina around is that I helped her find her own importance, helped her discover that she has talents and value, and she stopped obsessing about her body,” says Mengden. Nevertheless, six years later, Tina still needs some maintenance therapy to prevent her from relapsing into old habits.

A more typical client, however, was Sally, a 13-year-old who had moved with her military family to San Antonio and suddenly found herself without friends in an unfamiliar environment. A good kid and an athlete, Sally reacted to the loss of her previous life by eating less and less while exercising more and more. At first, the teen denied having an eating disorder, which is typical behavior. Like other young victims, she resolutely maintained that she was fine.
It took Mengden three months to get her to open up about what was troubling her. What ultimately helped the girl was an intense therapy program of the kind EDCASA offers now. Clients like Sally are taught how to deal with unhealthy urges and troubling situations without resorting to punishing their bodies.
According to the national Academy for Eating Disorders, there are three common forms of ED: anorexia nervosa, bulimia nervosa and binge eating. Anorexic individuals are irrationally afraid of becoming fat, even when they are substantially thinner than what’s considered healthy. They either drastically restrict their food intake or try to get rid of food by vomiting or using laxatives or even enemas.

Bulimics are somewhat different. They tend to engage in overeating for a period of time but then try to compensate for that by using some of the same methods mentioned above. Binge eaters, on the other hand, just overeat. No one knows for sure what causes these illnesses, but certain aspects are fairly clear. “When our media and society in general promote thinness as a beauty ideal, the result is eating disorders,” notes Mengden. “Look, the current Miss America admitted that she had ED. It’s definitely heavily influenced by society, but personality plays a part too. These people tend to be competitive, goal-oriented and anxious. So these traits, combined with their perception that they must change something about themselves to be better liked or more successful, produce their determination. They become good at starving themselves.” Sexual abuse or loss of any kind can be the trigger that gets this unfortunate ball rolling. At first it’s a coping mechanism that makes the sufferer feel temporarily better, but after a while they can no longer stop themselves. Tina had been abused as a child, for instance, and had been anorexic ever since. It is telling that only 11 percent of men develop ED, usually the overeating type.

With so many young people out of school, EDCASA was “packed” this summer, says the counselor. For girls attending college in other cities, the clinic provides referrals, but its own therapists are only a phone call or a text message away. At our second meeting, in Mengden’s home, the therapist pulled out her cell phone to find a heartwarming message from one of her college clients. It said: “I haven’t had a single slip-up since I left.” A message like that makes it all worthwhile, notes Mengden.


One thing that Mengden teaches her clients is the importance of resilience. Misfortunes, losses and problems of all sorts will happen, but it’s crucial to understand that you can face whatever happens, suffer and survive it. “I believe in resilience,” she says. “When clients are in the room with me, there may be a lot of crying, sometimes yelling. They have all those feelings to deal with. I help them express and understand their feelings. When you can express and live through these feelings and see that the emotions did not destroy you, you can incorporate the painful experiences into who you are and then forge ahead. It won’t be the end of the world.” Mengden knows that this works because she has used it herself. As with most of us, life has thrown her a few curveballs, too. For most of her 50 years, however, she had been a happy person. She enjoyed an idyllic childhood on a turkey farm near Comfort, where young Susan first learned the value

of teamwork. In farming, no one person does it all, she notes. She later attended Texas Military Institute, which she credits for encouraging her to become a leader. Then, following studies of economics at UT Austin, Mengden pursued a business/ banking career for a while until it became clear that that was not really her cup of tea. One day, a bank VP gave her a piece of advice she took to heart. Your work should be an extension of who you are, he said. Boldly, Mengden quit the next day, turning to career counseling to find her true calling. “I am interested in people, in how they think and feel,” she explains. “As a therapist, you have to hold a lot of people’s lives in your head. I find that intellectually challenging and satisfying.” What followed was years of professional education at Boston College, where she ultimately obtained a Ph.D. in counseling psychology in 1994. It was also in Boston, while working at Westwood Lodge Hospital, that she first encountered and decided to specialize in eating disorders. Now her career was on the right track and, when, at 35, she married a longtime friend, Peter Ellis, life seemed perfect. But fate had a few surprises in store for the newlyweds. The first blow came when the couple’s first child, Catherine, was born with Down Syndrome. It hit Mengden hard. “I thought I would never be happy again,” she admits. “I had a crisis of faith, too. I struggled. Finally, I realized that I didn’t lose me. I was still who I was. All I had to do is get through (this setback) emotionally, develop resilience.” Which is what she did, with help from Ellis and other parents with similarly afflicted children. And once again, Mengden had the opportunity to witness the value of people’s pulling together toward the same goal.

While both spouses devoted extra time to Catherine’s care, Mengden even started a special camp, Animal Botanical, at the Botanical Garden for kids like her daughter. That did not stop them from having three other children, all of whom were born healthy. The couple’s lives started revolving around the kids. Both husband and wife worked part time for eight years in order to be there for their offspring. That’s when Mengden started a private practice, working only one or two days a week. In the Ellis-Mengden home, framed photos of Catherine and the three boys seem to cover every inch of wall space in the hall and the living room. The children’s presence is felt even when they are not at home. “We like a high level of activity around us,” notes the mistress of the house. “Peter is always out there playing ball with one or the other of the boys, and I am in here helping with homework. On weekends, it’s one sporting event after another. Once a month we try to have a date night for just Peter and me.” In 2006, fate administered another blow when Mengden was diagnosed with thyroid cancer. Always the believer in team effort, she chose to be treated at the M.D. Anderson Cancer Center in Houston, where a group of specialists work with each patient. Again, she had to overcome her fear and anxiety and become resilient. What made the crisis even scarier was her youngest son’s response to her illness. Frightened by his mother’s cancer, 5-year-old Michael became anxious about his own health. “When I came back after treatment, I got home to a child with a full-blown obsessive-compulsive disorder,” recalls Mengden. “It took us a while to figure out what was going on. He started drinking too much water because in his mind that was going to keep him from getting sick. And he lost five pounds. On a 5- year-old that’s a lot. That was hard for our family. We adopted the Maudsley method (a family-based treatment approach). We would all remain at the table until Michael finished his food. I took him to a therapist, too. I really believe in therapy. He eventually regained the weight, but he stayed in therapy for a year. He is fine now, thank God.”

These painful personal experiences have made her a better therapist in her own field, believes Mengden. She empathizes not only with ED sufferers but their families as well, who are usually angry and scared that their loved one is going to die. Though people associate ED with young white women, no ethnic or societal group is immune to it. Even military families are affected. In fact, Mengden ran an ED program at the Brooke Army Medical Center for five years before starting her private practice. The frequent moves and the loss of control over their fate that military families experience, including active-duty military members, are the likely triggers that precipitate the ED spiral. As we wrap up our interview at the clinic, Mengden takes me around on a tour to introduce me to Kay Watt and the rest of the staff. A tantalizing smell of garlic emanates from the small kitchen-dining room, where dietitian Lori Jones is cooking roasted garlic potatoes for lunch. Several clients will soon come out of group therapy to share lunch with Jones and other staff members. The good news is that while at the clinic they all eat and do not throw up. That’s what a supportive environment can do.

Sadly, not everyone recovers from ED. Mengden lost two clients while she was in private practice. Both died of a heart attack caused by long-term nutritional deprivation. But the structured, comprehensive approach at EDCASA gives her good reasons to hope for all her charges. “I have learned that life can be good and fulfilling even after major setbacks,” she observes softly. “And when my clients walk in the door here, I always hope that life can be turned around.”

Author: Jasmina Wellinghoff

Photographer: Liz Garza Williams

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