S1 E10: Mike Gurr on When Food Is the Enemy
Executive Director of The Meadows Ranch, Mike Gurr, joins host David Condos to discuss the life-and-death situations facing women with eating disorders and how his team helps patients and their families build a sustainable, healthy relationship with food.
Mike Gurr: I’m Mike Gurr. I’m the executive director of the Meadows Ranch and it’s great to be here with you today.
David Condos: Absolutely. Thank you for being with us, Mike. Let’s start with introducing yourself, your story, the journey you took to getting started in this work.
Mike: Honestly, if you would have told me or asked me if I was going to work with eating disorders, I would have said no. How I really got involved was really working with adolescence in the beginning. I’ve always had a passion for families. I think families are the most important unit in our society, so if I can help strengthen those units, sign me up. That’s really where I began even in this industry. Actually, how I got down to the meadows is I actually started working with all of our families. We have family workshops.
David: That was at the Ranch?
Mike: Yes, at the Ranch. Very powerful work and then, slowly, I became the clinical director and then the executive director. That’s a very short version of how I got here.
David: To give an introduction to The Meadows Ranch now, what are the patients coming in with? Who are the patients? What’s your approach?
Mike: The Meadows Ranch is an eating disorder program. We’ve got 44 beds on our property. We sit on 45 acres in the beautiful Sonoran Desert. We do both adolescence and adults and we’re all female. The oldest patient I’ve had since I’ve been here is 73. The youngest patient that I’ve had has been 10, but we can take as young as eight. So, really, 8 to 17 years old, we can work with.
David: When you’re looking at the populations that is 10-year-olds, people up to 70-year-old, I assume there are some similar threads going through all of those people but what are the differences? Are there some challenges or different ways that you approach different pieces?
Mike: I’ll talk about both, about the similarities and differences. The similarities that we have found is we have done a lot of temperament testing with our patients, and so we’ll use the Taylor-Johnson Temperament Assessment. We also have a Brain Center and in that Brain Center, we will do neurofeedback and initial assessment of all of our patients. What we have found over the years is there really has become a profile no matter if you’re coming in with a diagnosis of anorexia, bulimia, binge eating.
What’s, I think, cool about that is our eating disorder patients would come in and they will compare themselves and they will compare themselves and say, “I’m either not sick enough to be here,” or, “I’m not as bad as her,” or, “I’m worse than her,” when they actually start finding out the temperament or how they respond to stimuli in their life, how they do it is actually very similar. Whether I’m restricting food, doing the binge-purge or just bingeing, the reason I’m doing that is very similar. Once they realize that, there’s safety in that, that I’m surrounded by like-minded people who get it, who get my suffering, who get my struggle.
As far as the differences, obviously, how sick somebody is, how malnourished they are can be very different as far as what we’re going to do with them, the type of work we can do with them, the depth of work we can do with them. Again, we’ll have patients coming in as low as 70% of idle body weight. We’ll have some coming in the 90% range but I would say, probably the hardest thing with eating disorders as we just talked about is the complexity. It’s the most complex mental illness out there. It has the highest mortality rate. Anywhere between 9% to 12%.
Our staff, because you’re working with this kind of a patient, you actually understand that we’re dealing with life and death. The cool thing, and not the cool thing, is when you get an email back from a loved one and they say, “You saved my wife’s life,” or, “You saved my daughter’s life.” In other agencies and programs I worked at, it felt cliche. Maybe you did a little bit, but it felt cliche, but I’ll tell my staff, when you get that email or you get that phone call, “You did. You saved that person’s life because if they would not have come here, it’s very likely and, statistically speaking, in a few weeks, they probably would have been dead.”
It’s rewarding but at the same time, an eating disorder will test everything you have as far as a therapist, a dietician, a psychiatrist. The work is not easy but, again, as we continue in patience and understanding and education, the results are amazing. Now, I will say this, we’re unique and we have three different levels of care. We have an in-patient hospital level. I’ve got a residential. I’ve got a partial hospitalization. We really want to stabilize them. That’s how I conceptualize what we do is that that highest level of care, we’re stabilizing the patient, medically, nutritionally, psychologically.
At our residential, this is where we are going to start doing the work. Both in the eating disorder, the trauma, the substance, you name it. We’re going to dive deeper there and then our PHP is really application. We have stabilized you. We’ve given you tools and skills and now, can you apply it?
David: Yes. That’s interesting how the stabilization part is that it is such a life or death thing like you were saying. You really have to work physically, medically, with them before they’re even ready to take that next step.
Mike: Yes. If you come in so malnourished– We’ll have patients that will come in and you have a conversation with them, the next day, you will go in and they don’t remember who you were. They don’t remember the conversation because their brain is just so malnourished. They can’t process, they can’t retain, they can’t hold anything. They’re very much in a fog. It’s fascinating what happens to the body when it’s malnourished but it’s also rewarding when you see that nourishment take place. Then we’ll tell our patients in the beginning, the medicine that you’ll have is food.
The hard part about that is they view that as the enemy, obviously. What do we do to help them be able to have a relationship with something that they really are so afraid of?
David: How do you help them rewire the brain for that? Because it’s, I’m sure you’ve heard this comparison before, as opposed to alcoholism, you can’t tell them, “Just avoid food.” How do you get that-
Mike: There’s a few things that we’ll do and two of them are, I’d like to say, cutting edge or definitely makes us different as far as our treatment. One is, as I’d mentioned before, our Brain Center. In our Brain Center, all of our patients will go up and they will have their initial assessment on their neurofeedback machine. On that machine, it will basically tell and give feedback on a screen of how their brain is functioning. What we have found over time is that most of our eating disorder patients come in with low alpha, high beta, high theta. What’s interesting is that actually mimics or really parallels the temperament testing that we have done prior to having the Brain Center.
The cool thing is they’re able to see, “There’s my brain.” Initially, they are unable to really hold any state of regulation. If you can picture the screen and what we want, we really want all of these levels to look like layers of lasagna noodles. Nice and even, but when they come in, it’s spiking all over the place because they can’t regulate. Their mind is not calm. Their mind is in chaos.
David: That’s what’s fueling the disorder.
Mike: It’s a big part because what happens is, now, if I introduce them to food, guess what happens? I’d become dysregulated and here comes the anxiety. Here comes just the flood of emotions and I’m not going to eat. Here comes the fear. I’m either not going to eat or if I eat, then I feel terrible and I got to get rid of it or I can’t stop eating. That goes back. The similarity. Whatever the eating disorder is that you’re struggling with, it might be a different behavior, but the reason is very similar. If we can start calming down the mind and really what we know, they have really started to create these electrical networks, these pathways in their brain. We want to be able to basically rewire that electric circuitry. Through our neurofeedback and biofeedback, that’s exactly what we were able to do. It’s a lot like I’ll tell people if you were seeing yourself in your mirror, you’re walking, you looked over and you saw yourself in a mirror and you saw yourself slouched over, hunched over a little bit. A lot of times, what would you do if you saw yourself?
David: Try to correct yourself.
Mike: Yes, “Oh, I’m hunched over. I didn’t realize that.” You would correct yourself. That’s exactly what we’re doing with our brains with the neurofeedback. They actually get to see this device. We get to really take what we need as far as the frequency, where the brain needs to be and based upon these games, these exercises, we train the brain to get there and it gets rewarded.
When the patients start to experience a more sense of calm, when they can start sensing, “Holy cow, I’m not as agitated,” or “Things are more clear,” or “I’m not in this fog,” or, “I can relax,” it’s very empowering for them to be like, “Hey, guess what? It can be different. I don’t have to be in this constant battle every single day.” As they learn that, the cool thing is they start having hope because so many of these patients have lived with this and have fought this and are so tired of this, when they can actually experience two minutes of calm. Never done that before, it’s been a long time now they can build on that. That’s really what we do in the Brain Center.
The other thing I was going to tell you about is we have what’s called a metabolic cart. The beautiful thing about that is that we’ll actually tell our patients exactly what their body is doing with the food we are giving them. Because obviously what starts to happen is as we give them a meal plan, number one, they don’t want it, then number two, we actually will increase the meal plan as we go through that nutrition rehabilitation process.
David: Because you need to build them up physically?
Mike: Yes. What will happen is they won’t trust our dieticians as to, “Why you’re doing this to me, it’s too much. I feel full, I don’t want to do it.” With this metabolic cart, they’re able to be in this canopy and in about 15 minutes, it’s going to measure their metabolic rate. Not to get too complicated, but what it’s basically going to tell them is that your body at rest, this is what it would need. Just if you didn’t do anything to the whole- if you just sat on the couch all day, this is what your body would need to do to function.
David: In terms of nutrition?
Mike: In terms of nutrition. The other thing it will do is as they actually start to intake food, it’s going to show them what it’s doing. What is my body doing with the carbs, with the protein, with the sugars because what will happen is if your body hasn’t had food for a long time and all of a sudden, you give it food, it doesn’t believe you’re going to do that. It doesn’t believe that this is going to a constant thing-
David: It doesn’t want to trust you because it’s been scarred.
Mike: It doesn’t trust you. Your body will take it and you actually become hypermetabolic. It just goes fast, fast, fast. Therefore, that’s where we need to increase your meal plan because your body is taking it and breaking it down. They don’t even understand. They’re like, “No, you’re lying to me. That’s not– I feel full.” Now with this, we’re going to be able to say, “Look, here’s what’s happening. This is why we’re doing what we’re doing.”
That’s going be an amazing tool for how we treat, why we do what we do to again to help calm their anxiety and really help them stay in treatment longer and to give them a better understanding. This is what my body is doing.
David: That’s fascinating as you’re describing the metabolic cart. It seems like that’s almost parallel to what you’re just saying in the Brain Centers. The Brain Center is showing them, scientifically this is what’s going on in your brain, and the metabolic cart is showing them scientifically like, this is why your body needs food and this is how much it needs of what.
Mike: Yes. One thing with the metabolic cart, there’s this idea or this mantra is we’re trying to heal you from the inside out. We want to show them what is happening internally because they’re focused on what?
David: How they look.
Mike: “I look fat.” If they’re focused outward and really this is another thing that this metabolic cart will do is say, “No, we’re going to transform you from the inside out.” They’re actually going to get that understanding of, “Holy cow, this is exactly what is happening on the inside.”
David: I know nutrition is a big part of this and I’ve heard you talk about this before. I think it’s really cool how you involve the patients in that hands-on. Talk about why that’s important and how you implement that into the program.
Mike: Once you leave that inpatient level of care, because at that stage, like I said, where it’s about stabilization, our kitchen is actually played in their food for them. All they need to worry about is obviously following the meal plan. As soon as you hit our residential level of care, we have a beautiful big kitchen, huge kitchen, and they are the chefs. Our adults are preparing, cooking, cleaning, lunch, breakfast, dinner, everything.
Our dieticians do an amazing job. We have 16 culinary classes that they are educated on, they have to pass tests. The importance of that, especially with adults is as they leave here, they’re going to go back out into the real world. The idea is, what’s my relationship with food? Just two quick stories. One, we had a patient that was so, so fearful of food. I still remember the day she emailed her mom, again, we wouldn’t think this is a big deal, but she’s like, “Mom, actually I touched lettuce today. I made a sandwich today.”
Now, me and you’d be like, “So what?” But for her, that was such a big deal because her distortion is “Even if I touch the food, I’m going to get calories. Just by touching the food, I’m going to get fat.” As we educated and again gave her a new experience, she was able to have a relationship with food. Like you said, this is an absolute, I can’t– I have to have a relationship with food. I’m going to be around food every day.
David: You have to break down that barrier one way or another.
Mike: That was a really, really cool story. The other one, we had a patient here. She actually came via The Doctors and that’s a show on CBS. After she’d left our program, they wanted to do a follow-up story. She was with us for 90-plus days and she was able to experience everything we could offer her. They were asking her, “You’ve been at The Meadows Ranch for X amount of days. What was the one thing, the biggest thing that you took away from your experience?”
There was a lot of things that had happened to her during her stay. In my mind, I’m like, “Okay, we’re on national TV, please don’t say something that wasn’t good.” She could’ve said anything. I sat there with bated breath and she sat there for a minute and her response was, “I was able to learn to live with the enemy.” She talked about being in the kitchen and being able to be around the food and handling it and cooking it. I just thought that was interesting that everything she had experienced because like I said, she got everything. That was the one thing that stood out for her.
David: Like you’re saying, education is a big part of this, but not just for the patient, for the family as well. Especially for the adolescents who are going back home But even for the adults who have a spouse, a partner, children or whatever. How do you involve the family, get them caught up on all of this from an education standpoint?
Mike: Great question because as we know in any treatment, not just here, but any treatment, if that family hasn’t changed and our patients go back to that exact same environment, the likelihood of them relapsing is huge. To me, family work is a critical component of what we’re doing here. We will have weekly Zoom sessions. With our adolescents, that’s a guaranteed given. Sometimes the adults, they will not sign a release of information. [chuckles] They don’t want-
David: They don’t want their family-
Mike: They don’t want them to be involved or they don’t want to do that. Obviously, if we have that, we’re going to include that with our adult’s, but with the adolescents, you know it’s a done deal. They have a weekly family session. Where I would say also that we do great work is we have what’s called a family week. We’ll have the patient and two loved ones. Typically that’s obviously for adolescents, it’s for them and their mom and dad.
For adults, that could be their husband, that could be a boyfriend, that could be their mom and dad. It might be a friend. Whatever combination that that support’s going to be. What happens is we teach them very quickly what you think is the correct approach actually creates the opposite, that when you are just telling them, “Don’t do this, do this, why are you doing this? Stop doing this.” It actually exacerbates the eating disorder. You create the very thing that you are afraid of.
That is mind-blowing to them because once again, if you see somebody engaging in these life-threatening behaviors, well, stop it or eat. That right off the bat I think is a big thing for them is just to understand. Understand really what is an eating disorder. Understand why they’re struggling with the eating disorder and what is your role? Very quickly, we fire them from being the police. We fire them from being the food police and we teach them, what does support look like? That week is just such a life-altering week. Both for the loved ones, but also for the patients. Those are the two components that we look at when you look at the family involvement.
David: Taking a step back and looking at a bigger picture now, what would be one thing that you wish the general public understood better about this? I know you’ve already talked about how you educate the families, but looking at the general public, what’s one thing you wish they understood?
Mike: Probably I would say this, that when you see the behavior, whatever compensatory behavior they’re engaged in, whether that’s restriction, whether that’s over-exercise, whether that’s purging, whether that’s bingeing, self-harm, whatever behavior they’re engaged in, understand there’s a function behind it. Meaning that when they engage in that behavior, to me, it’s a sign of struggle. As a loved one, as a husband, as a mom, as a dad, instead of me overreacting to the behavior and reacting in a fear-based way, which I understand, think of it as, “Okay, this behavior is showing to me that a person I care for and love is struggling. What would I do? How would I help somebody that’s struggling?”
I’m not going to berate them, I’m not going to yell at them, I’m not going to say, “You need to stop doing that.” If I could help people understand that, then the approach, the compassion, the understanding, eating disorders creates such a disconnect in relationships.
David: Yes. It can be hard to understand why this happens.
Mike: If I can teach a loved one, I can connect when you’re doing that versus the approach of disconnecting, I think that would be a huge, huge piece in helping them in that struggle.
David: What would be one book or resource related to this that you would recommend to people?
Mike: One of the highlights of eating disorders is just this utterly huge piece of shame. “I’m not good enough, I’m not pretty enough, I’m not skinny enough,” you name it. I’m not, you fill in the blank. When you think about that, shame doesn’t just disappear. I would like to teach them how to become more resilient to that because you’re going to get that probably every single day. Whether I’m comparing myself to you, whether it’s because there’s a trigger with food or what somebody said, how to become more resilient to that. A book that I like it’s called The Gifts of Imperfectionby Brene Brown, Dr. Brene Brown.
I think it does an amazing job of, “Hey, you know what, we don’t have to be perfect. I am enough. I am okay just who I am.” If that’s a message that people can get that, “You know what, who I am, that’s enough. I am enough. I’m valued. I’m worth it.” Whatever that message is, but especially with eating disorders, if they can gain some tools, some understanding, some self-compassion to help become more resilient to shame, awesome.
David: To wrap up, what would be one piece of advice that you might give someone that has either meant a lot to you or that you find yourself giving that means a lot to others?
Mike: You can use this I think in anything. I know we’re talking about an eating disorder and recovery, but I use this with my kids, I mean with everybody. There’s a phrase, “By small and simple things, great things will come to pass.” As you do this work, it’s just one step at a time. It’s one little thing at a time. If you keep doing those one little things over and over, great things will happen, recovery can happen, change can happen. To me, it’s just this principle of just line upon line. It’s not all going to happen at once, but truly, by small and simple things, great things can happen.
David: Mike Gurr serves the Executive Director of The Meadows Ranch, an eating disorder treatment program for adolescent and adult women in Wickenburg, Arizona. You can find out more about Mike’s team and what that program offers at www.meadowsranch.com.
To check out more episodes of this podcast and to find all kinds of other resources and tools for Meadows Behavioral Healthcare, visit www.beyondtheorypodcast.flywheelstaging.com. Finally, thank you for listening. I hope you’ll join us again next time for another episode of Beyond Theory.