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Integrative Medicine and Eating Disorders:
An Interview with Carolyn Coker Ross, MD, MPH
Interview by Matt Laughlin
UH (Unified Health): One of the most rewarding aspects
of preparing to interview guest clinicians is the opportunity to
read your work and, at a distance, catch a glimpse of the
unfolding of your personal/professional life. Before we dive
into the specifics of your expertise in the field of eating disorders
and integrative medicine, it would be great to hear more
about some of the significant influences in your life that
shaped your approach to medicine. In your first book,
Miracles in Healing, I was especially struck by your honesty
and openness about your own experience recovering from a
chronic illness. Looking back on that time in your life, what
were some of the most significant influences that are present
in your work as a physician today?
CCR (Carolyn Coker Ross, MD, MPH): Back then I
was using some alternative therapies in my women’s centers
in San Diego. I was always relatively open to alternative
medicine; however, I never really saw it as something that
had a direct impact on how I practiced. It was the experience
of my own illness that was really pivotal in terms of how I
approach my work now.
I had a very severe viral illness that just never went away
and I had extreme fatigue, pain, recurrent fevers, all that
stuff. Western medical doctors could not help me and so I
turned to alternative therapies. Basically, that experience
really shifted my whole perspective on healing as being integral
to the whole person. My illness affected my emotions,
my body and my spirit. Today, my approach to working with
patients is to address their illness on multiple levels, rather
than just focusing on the physical ailment.
The other significant thing that happened during that period
of my life is that I was very blessed to meet people who had had
miraculous healings from a variety of life-threatening illnesses.
It was amazing. They were coming out of the wood work.
UH: I recall reading in your book, Miracles and Healing,
how synchronistic and numerous these meetings were.
CCR: Yes. These were people who had everything
from brain tumors and cancer to serious forms of arthritis.
When they would share their stories, I heard them talk about
a set of characteristics that became for me the key to answering
a very important question – what does it take for people
to heal? Listening to their experiences, I picked up that they
all shared five or six different traits which answered this question.
UH: Reading your work it seemed in that period of your
life you were stepping into an acknowledgment of the
miraculous; that despite the fact that such things may not
necessarily be explicable by science, they are still useful
clinically. An aspect of your work I appreciated was this
notion that one can simultaneously value science and logic,
but also useful approaches that may not be explicable.
CCR: It’s interesting that you picked up on that
because I think that was one of the most significant challenges
in this change in my approach as a physician. I really
believed in the scientific paradigm and was always one to
base my practice on what the science said. Yet, from the
beginning of my career, I had always noticed that some
things just could not be explained within that paradigm.
Probably three years into my practice, I had a patient who I
still remember very clearly to this day. She came in with
severe abdominal pain. I did the full medical workup on her
and I dreaded having to tell her the results suggested there
was nothing wrong, because I knew that she was suffering. I
remember sitting with her and just saying, all the tests are
fine, but tell me, what is going on in your life? And she actually
said the words, “I just can’t stomach my marriage,” and a
bell went off within me. Here is something I can’t explain
based on the test results; yet, she was having severe abdominal
pain and it was because of this. That stayed in the back
of my mind and I didn’t know what to do with it.
Later, when I started to see these miracles it was yet another
thing that could not be explained. I remember going on the computer
and the internet looking for articles (Laughter), just trying
to find an explanation. It finally came to me that I could not
explain, nor could science, all that happens in people’s lives.
UH: Another observation you make in your work, which
doesn’t appear to be completely explicable by science alone, is
that to grow inwardly, emotionally and spiritually, is also to become
more physically immune to illnesses. Can you speak to that?
CCR: Sure. The thing I learned about my experience
of being ill is that illness is a call for us to look at things in our
lives that are not working. And I don’t buy into this notion that
if you hold in your anger it is your fault if you get sick. There
is that whole discussion around breast cancer, for instance,
which claims breast cancer patients are just angry and couldn’t
express their anger, and therefore it is their fault they have
the disease or their anger caused it. That being said, I did
begin to see illness as an opportunity. If you were to take
advantage of the opportunity you would need to really look
beyond the physical manifestation of the imbalance and really
look at your life as a whole because illness doesn’t exist in
a vacuum.
Getting to your question, you’re asking if one were to be
mentally and emotionally stronger would that strengthen the
body in a way that would make one more immune. To a certain
degree I think that is possible. I was just at an addictions
medicine conference recently, and it was the first time in my
entire 25 plus years of medicine I heard someone at such an
event talk about the pliability of our DNA. In other words, you
could have a gene that predisposes you to cancer, or in this
case, to addictions. Yet, we’re seeing that gene may or may
not ever be expressed, depending on other influences. Even
though genetics is “hard science” we’re now starting to see
that there are many other factors that influence our DNA,
something which is the core building block of who we are.
That seems like a good example of how emotional, mental or
spiritual growth can influence physical wellbeing.
UH: In the acknowledgments of your second book on
eating disorders, Healing Body, Mind and Spirit, you cited the
death of one of your sons as the inspiration behind your work
today and your commitment to the fields of mental health and
integrative medicine specifically. Would you speak to that?
CCR: If you’re a parent you understand each of your
children has a special kind of hook into you. My middle son,
Noah, was always a very spiritual child; much of my spiritual
learning actually came through him and his death was no
exception to that. Having a child who was diagnosed with
major depression when he was 18 and suffered tremendously
for the next 10-11 years until his death has been very influential
in my work as a physician. There is such a huge stigma
when you look at the public’s feelings about mental illness. I
saw him struggle with that stigma of being a person diagnosed
with depression and how that affected him.
At the core of it all, I feel the quintessential thing that
changes your spiritual practice and life is that feeling of helplessness.
Here I was a doctor; I had all this knowledge and
I had even gone through my own spiritual growth and transformation,
and at every turn the message I got was: there is
nothing I can do.
People would assume that because I was into alternative
medicine I didn’t encourage him to take medication. That is
absolutely not true. I encouraged him to do everything he
could do to get better. And there were so many things that
he tried in order to change his life, and it just didn’t work.
About two years before his death he had a psychotic break;
I think at that point he knew on some level it was the beginning
of the end and he left home. I wasn’t in contact him for
two years and it was terrifying.
In the middle of that time I had another one of these miraculous
experiences, which had an indirect but powerful influence
on my practice. I found out that he was in Los Angeles
through some various means that I had been trying, so I
decided to join my ex-husband and look for him. In LA – I
mean, come on, who did I think I was? (Laughter)
About two weeks before I made the trip I had a series of
dreams about it. In each of these dreams I would be looking
for him but would find him by happenstance. In each of the
dreams I kept getting the message – you have to be aware, you
have to keep looking, you are going to find him by accident.
We went out and we looked all around the areas we
thought he might be; homeless shelters, parks and places
where homeless people stayed. We talked to hundreds of
people living on the streets who had their own problems, but
I found they were so kind. They would also say things such
as, if only my mother or father were looking for me, if only
someone cared about me that much. We spent the whole
weekend looking for him; a lot of people had seen him, which
was interesting. He was quite a dramatic looking guy, very
handsome, about six foot two and just a very attractive person.
We had exhausted our search when one man suggested we
go to this bus station. Our last hope, we went to this station,
and just as I turned away in frustration from a conversation my
ex-husband was having with someone, a bus pulled up and he
stepped off.
The good news is we found him. I was able to hug him and
tell him how much I loved him and I tried to get him to come
home; he wouldn’t and that was the last time I saw him alive.
I had to do the toughest thing I ever did as a mother and
leave my son, knowing how very ill he was.
I can say one thing I know for sure is that he’s still here.
This is something I may have heard before in church or in an
ashram; but despite that conceptual knowledge, I still wasn’t
sure about the presence of the spirit after death. I’ve had
personal experiences of his presence. This is something I
have drawn upon in my practice, for people who have lost a
loved one, to reassure them that the person is still with them.
That’s very powerful for me.
UH: To go from a conceptual belief that the spirit carries
on to the certainty about that. That certainty comes through
in your voice.
CCR: I am certain. There were just so many experiences
after his death that confirmed that – dreaming about
him, feeling his presence, hearing his voice – and I don’t
think it’s just that I’m crazy. (Laughter) The other part for me
is I no longer have any fear of death; I also have little to no
fear of living. For me, it was like, okay; you’ve done the worst
you can do, life – so, bring it! (Laughter)
UH:(Laughter) Another example of something inexplicable
yet knowable.
CCR: Sure, and when patients, or even close friends
hear me talk about it, they feel that knowing. I think it goes a long
way in reassuring people. There is just so much fear around
death. The other thing that has become a real mission for me is
remembering that I really had no one to help me. I made an
inner commitment that I would do as much as I could to help
parents or others going through this, because mental illness
gets shortchanged in today’s culture. The work I’m doing now
includes addressing this stigma around mental illness, and
also anything I can do to help people get through some of the
systems and help them find what they need to get better.
UH: After your two-year fellowship in Dr. Andrew Weil’s
Integrative Medicine program at the University of Arizona,
you went on to pioneer an integrative approach to eating disorders
at a well-known inpatient hospital, Sierra Tucson.
What were some of the lessons learned in that time with
regard to what works and doesn’t seem to work in the application
of integrative medicine for eating disorders?
CCR: What I noticed when I started the job there was
that there were several issues not being addressed. I felt
strongly that integrative medicine could address these, and if
it didn’t, it would do no harm. So when I arrived I took a look
at what was lacking in the clinical practice; one thing I found
lacking was recognition of the importance of nutrition in the
treatment of eating disorders – which sounds stupid. You
think, well anyone would know that. But I am referring to
nutrition on a functional level, which is often referred to as
functional medicine. A recognition that there are missing
nutrients in people who don’t eat well, and when those nutrients
are missing or diminished this affects mood, digestion,
energy, sleep, etc.
So I developed a nutracuetical program that addressed
mood issues, sleep disturbances, missing nutrients and
digestive issues. Around that I built a program that included
psychotherapy and family therapy, the use of medications as
needed, and so on. But I also brought in a number of alternative
therapies, such as acupuncture, chiropractic, shiatsu,
zero balancing, reiki and many others. Even though those
were available to all of the patients, I actually prescribed
them for my patients, so the majority of my patients experienced
most, if not all of those modalities.
I then collected and reviewed their patient comments about
these therapies, and the patient comments were amazing.
There were comments like – I couldn’t cry in group or with my
therapist, but when I had reiki I just wept and left a lot of baggage
on the table. Another might be that they were able to
eat without having the discomfort of bloating and gas. Then
we started to hear from people who worked with our patients
once they finished at Sierra Tucson, and they were saying,
wow, your patients are so much farther along in their recovery
and why is that?
We later did an evaluation study and looked at what we
were doing differently. It was really amazing to me to see how
an integrative approach impacted people on all these levels.
UH: Among all those cornerstones of your integrative
approach, I understand you published an article discussing
the nutrition protocol and what was observed. Would you say
more about that?
CCR: Sure. The nutraceutical approach was designed
to address three core issues: what is missing nutritionally;
how to address mood issues; and symptoms such as insomnia,
sleep disturbances and digestive problems. We applied
this protocol and then did a retrospective study where we
looked at a group of patients who were on the protocol compared
to a group of people from the year before I started who
did not have this protocol. The study was published in the
peer-reviewed journal Explore. The results showed a very
dramatic decrease in problems with sleep, including prescription
medication use for sleep – which is huge for working with
addictions, as sleep medications are addictive and have a lot
of side effects and a lot of risk. We also observed the digestive
complaints reduced to almost zero.
The nurses and the therapists particularly appreciated the
integrative team approach. The nurses found relief from having
the eating disorder patients constantly needing various
things for their symptoms. And the therapists said they were
able to do more work in therapy with our patients without the
distractions of not sleeping and digestive complaints.
UH: It rippled everywhere.
CCR: It really did.
UH: In your work, you contextualize the process of working
through the layers of recovery from eating disorders in
what seems to be a unique and practical way. Would you
summarize that approach for the reader? I especially wanted
to also ask you to explain the healing process you
observe unfold, which you described as moving “down the
cascade of behaviors, emotions, bodily sensations and core
beliefs” into the deepest level of the “deeper urges of the
soul” and then back out again
CCR: Well, as I mentioned, by this time I had the
understanding that illness could be a portal through which we
could learn more about ourselves. In terms of bringing that to
bear with eating disorder patients, what I found is that there
really are levels in recovery. The first level, what I call the
superficial level, gets most of the attention, where we focus
most of our therapies. That level includes the eating disorder
behaviors, the use of drugs or alcohol, depression, anxiety –
all of those observable things. But when we just treat this level
alone we see that patients relapse over and over. I found that
underneath the superficial level is what I call the emotional
soup; this is where you cannot control your emotions – your
emotions control you – and those emotions drive behaviors. In
this work, we all have an understanding that eating disorders
are related to emotional issues and so on. The emotional level
is very important to connect up to the behaviors.
Under the emotional level is what I call the sensate level,
or the level of body sensations. Most eating disorder patients
don’t have any sense of their bodies. If you ask them, what
does it feel like in your body when you’re angry? They’ll say,
well you know I feel bad and I just can’t stand this person!
And if you ask, well what does that feel like in your body,
they’ll say, well, I just can’t believe…. and so on. Sometimes
it will take four or five questions to get them to really pause
and check in with their body.
That really is a powerful place to become reconnected
with. If you can connect to those body sensations you can
also connect to the absolute perfection of our physiology, in
which we are always getting cues from the body with regard
to what we feel, whether we’re in danger, whether we’re hungry,
etc. Without that there is a whole chunk missing in
terms of your information system. It’s like trying to work with
a computer where the motherboard is cut in half.
UH: What is it like for patients to reconnect in that way?
CCR: When people are able to connect to that it’s like
a wake-up call. I remember one of my patients saying, yeah,
now that I look back I see I was just a head on legs, because
I lived in my head and I had no connection with my body.
Beyond the sensate level is the level of beliefs, which
stand in the way of someone getting what they really want in
life. These beliefs usually come from experiences when we’re
younger, whether intense and traumatic or just experiences
that made us fear for our wellbeing or survival. As a child
what we do is we drop anchor into the safe harbor of our
beliefs. That safe harbor may be “If I stay thin then I will be
loved.” So, that could be the source of an eating disorder. Or,
“If I am able to please everybody then I won’t get hurt.” They
find that safe harbor, whatever works for them as a child. But
as they grow up, that doesn’t work anymore. In the recovery
process, what we have to do is teach them to pull up that old
anchor and find a new safe harbor that is anchored in adulthood.
Because if you’re an adult and you have your anchor
back in childhood then you’re constantly going back and forth;
we all meet people like that, who are very immature – they’re
childlike in their relationships and immature in their actions.
The last level is the biggest anchor of all, which is taking
them into these deeper urges of their soul or their true self.
The self that exhibits the behaviors of eating disorders is really
a false self that developed as a result of all these layers. If they
can hook back into life or anchor into the deeper urges of
their soul, then they start to have something to live for beyond
the next day, beyond the next score, or beyond simply wondering
how I can get through the day without eating, etc.
As patients go through this process of recovery they may
find themselves suddenly thinking or saying, well I always
wanted to be a nurse but I don’t know why I never went to
nursing school; I am going to do that! Or, you know, wow, I
really wanted to focus on my children and become a better
mother. Those are the things that you begin to see which tell
you they are on the road to recovery. And in terms of these
layers of healing you see the whole thing flips. Now these
anchors that they have in the deepest urges of their soul
begin to run the show, and the beliefs that they form come
out of that, and the emotions and the sensations are driven
by this renewed passion for life and their behaviors transform.
UH: As a psychotherapist, I very much appreciated how
you contextualize recovery as a journey, and not merely the
alleviation of symptoms. You wrote of a case that seems to
reflect something that occurs very often, where an individual
presumes the absence of a formerly destructive behavior
implies that they have healed completely or wrapped up their
recovery. You spoke to it when you wrote, “This journey
should not end when the siren call is less insistent, but rather
become part of the fabric of a life well lived in search of wellness
of body, mind and spirit.” Again, this notion of the
process seems essential.
CCR: Just as you mentioned, as clinicians we all see
the person who wants to get to recovery. I can’t tell you how
many times a patient or family member has said to me, well
I know there is no time limit, but can you tell me how long
we’re going to have to deal with this – like, what’s the time
limit? (Laughter)
UH: When can we wrap this up?
CCR: Of course, whenever I get asked this question it
reveals a lot to me. Our culture is very goal-oriented. But in
these situations, that really handicaps us. In my own experience,
even in the grief process of grieving my son, there
were so many different levels on which I had to address my
own issues, over and over again. Just when I thought, okay
I am moving forward, something else would come up. That
is just the way it seems to go with major life challenges,
whether divorce or the lost of loved ones or a major illness.
In my own experience with illness and loss, if you look at
the experience as a process in a journey rather than a destination
you can really reap the benefits that it offers you. I
often see people shut down that opportunity as quickly as
they can because it is painful. Many of my patients spend
their whole life not expressing emotions; to have to go
through anger and grief is painful.
I don’t think of recovery as linear, I see people swinging
back and forth in it. What you commonly see is as soon as
they feel like they’re doing well, then they don’t want to look
at anything ugly or feel any pain. This is especially so if you
have an avoidant personality type. The illness and its call to
action is what forces us to make needed changes.. But as
soon as you’re a little bit better you want to move on and say
I don’t need to go there again.
What I found in my personal experience is that when you
do avoid it the universe just finds a bigger challenge to open
you back up again. (Laughter) Why not just stay in the
process and realize that you have to constantly be opening
yourself back up to opportunities to heal?
UH: What are some of the more overlooked or misunderstood
aspects of working with eating disorders which might
be valuable for clinicians to know?
CCR: That’s a really good question. The first one that
comes to mind is that food is medicine and something to pay
close attention to in to eating disorders as we discussed.
Western medicine has a penchant for reductionism.
Everyone has to have a specific diagnosis and a matching
medication to treat it. I tend to agree more with traditional
systems of healing that see illness as an imbalance and one
that manifests in very individualized ways. For example,
depression is not one diagnosis in Chinese medicine, its
many different diagnoses.
In other words, you can learn a lot about how to work with
patients if you see them as having more in common than
necessarily being so distinct. Other than that I would say that
while I am not the most experienced in the world on this topic,
I can say I don’t see a lot of people talking about these various
levels in the recovery process. And probably the number
one thing that I see missing in a lot of eating disorders or
addictions work is helping people find their hook into life.
Without that they don’t end up living very long.
UH: This being their anchor or the spiritual level you
described?
CCR: Yes; whatever anchors them in a way to keep
them on the planet. We have to recognize that some people
are naturally that way. Take myself, for instance. I am naturally
that way with some exceptions. My son’s death was probably
one of the only times in my life that I thought, well maybe I don’t
want to be here. But all throughout life I have always had a
hook into life. I’m sure in your work as a therapist, Matt, you
probably see a lot of patients who don’t have anything like that.
UH: That’s true. And it actually reminds me of our feature
interview in our last issue with Michael Bernard Beckwith, in
which he described the value of “catching a vision for one’s life.”
CCR: Yes. What is it that makes you want to stay
here? And working with patients with severe trauma, it really
does take them off course from a meaningful or inspiring
vision. A key part of our work in helping patients heal is helping
them find their path again. I like the way Michael Beckwith said
it – catching a vision for your life. Or, find your new safe harbor,
your bliss, the urges of the soul – I think it’s all the same.
UH: Before we wrap up, I wanted to ask you about your
new book coming out soon.
CCR: Yes, I have a new book coming out called The
Overcoming Binge Eating Disorder and Compulsive
Overeating Workbook, which is being published by New
Harbinger and will be out in June of 2009. I am really proud
of this book because it speaks to this “war on obesity” a
phrase to which I take exception. The book takes this struggle
of obesity to a different level, looking at the whole person
rather than just their weight.
UH: What else is on the horizon?
CCR: Could I reveal the deeper urge of my soul which
hasn’t yet been fulfilled?
UH: What a perfect question – please do. (Laughter)
CCR: (Laughter) There is one thing that I have tried
on a number of occasions which I haven’t been able to do
yet; I would love to have a television program that is all about
the many, many roads to healing. I want to study miracles,
because it is my feeling that those things I learned and discussed
in my Miracles and Healing book are teachable. If we
can teach people the characteristics or conditions that are
associated with miraculous healings, more people might be
able to learn to heal from illnesses. There doesn’t seem to
be anything in the mainstream media that really explores the
different levels on which healing occurs, the characteristics of
people that heal, and all the many ways that we have at our
disposal to heal.
UH: That’s a beautiful vision! You have a warm and
approachable presence, not to mention a great deal of
expertise and experience – I can see that happening.
CCR: I can see it, too! I have had a number of visions
and dreams about it but haven’t yet quite figured out how to
do it. That is the big one – the thing I want to accomplish
before I join my son on the other side. (Laughter)
UH: I really appreciate your sincerity and how your own life
experience really reflects the way you work with people – this
understanding that life is a journey and to remain open to what
lies ahead. Thanks for taking the time to interview with us!
About Carolyn Coker Ross, MD, MPH
Dr. Carolyn Coker Ross is a nationally known author, speaker and expert in
the field of eating disorders and integrative medicine. She completed medical
school at the University of Michigan, did a residency in preventive medicine
at Loma Linda University and completed a two-year fellowship at Dr. Andrew
Weil's Center for Integrative Medicine. She was the chief of the eating disorders
program at Sierra Tucson and currently is a consultant for treatment
centers in eating disorders and integrative medicine. Her most recent book
is Healing Body, Mind and Spirit: an Integrative Medicine Approach to the
treatment of Eating Disorders. Her next book The Overcoming Binge Eating
Disorder and Compulsive Overeating Workbook is due to be published in
late 2009. Dr. Ross has also developed a line of supplements as a result of
her research, designed to support the recovery of patients with eating disorders
and obesity. She is currently in an integrative medicine private practice in
Denver and Boulder, CO, specializing in treating eating disorders and obesity.
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