"Desperate Measures"

I volunteered to take an emetic to help overcome my emetophobia

This is the experience of Sarah Heslam, a Gut Reaction member, who took an emetic drug to induce vomiting as a means of confronting her emetophobia. She didn't actually vomit - but this is what happened:-

Sarah writes: I have been undergoing cognitive therapy for about 6 months - probably longer. I find it helps to talk about my phobia although not in a practical way. I have suffered from emetophobia for 24 years. I don't think I'll ever know what started it or why I am so frightened of being sick. Over the years I have just lived with it, tried psychotherapy and hypnotherapy etc - all to no avail. There have been periods of time, years in fact, when it didn't seem to bother me too much, but then something would happen and it would rear its ugly head again. This time was the worst it had ever been and I have been trying everything to try to overcome it.

I was taking Prozac for 8 months, which worked really well for me in that it cured (or contributed to the cure of) my panic attacks and calmed me down a lot. However, when I tried Prozac again later, I developed the most severe 'sick-headaches' and will never try it again. The cognitive therapy has been fairly useful in that my therapist, as well as being understanding, has a good sense of humour which helps immensely. He supplied me with a video, aptly named "Vomit 96" which I watched with great amusement. A girl was shown in a small room being sick into a bowl. However, just before she was sick each time, she would lean over and take a mouthful of what looked like minestrone soup. It was a complete fake hence I told my therapist I wasn't stupid and could tell the difference!

About a month ago, I was having my usual 2-3 week meeting with Martin (the therapist) and he was talking about foods and fears of foods etc as he did most times when we met (amongst other things). I suddenly realised that, although I had come a long way, I was never going to get any further unless I actually faced the problem head on - the biggest decision of my life to date! I shared this thought with Martin, who was amazed at my show of bravery, and we chatted at great length about whether this was a good idea or not and what I felt I would get out of it. I explained to him that I couldn’t become any more frightened than I already was and that I felt ready to try and deal with it. He promised to speak to his supervisor and my GP.

I left feeling very pleased with myself. Although I knew I would be terrified, I was feeling so proud that I had actually suggested the confrontation myself.

I met with Martin two weeks later and he told me that his supervisor said the Ethics Committee would not entertain this idea. I felt so disappointed and let down and cried. I also felt angry that these people were making decisions about something they knew nothing about. Martin could see my despair and promised to speak to my GP again.

My next visit was more promising. My GP had agreed to take full clinical responsibility and so we were OK to go ahead, although he warned me not to pin all my hopes on it as there was no guarantee it would work in beating the phobia once and for all. I also knew I would have to go through the process several times in order for to have any beneficial longer-term effect.

IT would take place at my home in 2 weeks time. My partner or mother must be there and Martin would also be present. He sent me to the local Pharmacy to ask for an emetic. I thought it strange to be able to purchase this so easily over the counter - but I couldn't. Although I explained to the Pharmacist what it was for, he telephoned the surgery for confirmation. Then he agreed he would prepare the mixture for me and I was to collect it later. He admitted he had never prepared it for anyone before and was very intrigued!!

I collected the potion later in the day - ipecac paediatric emetic. Although it was a child’s emetic, the dose is merely doubled for adults. I was to take 30ml followed by a tumblerful of water. If nothing happened within 20 minutes then I was to repeat the procedure. I had to laugh when I was charged the standard prescription price for the bottle of it. I thought "Am I out of my mind - actually paying for something I know will make me sick?!".

The concoction was stored in the fridge door from where it stared at me for the next 2 weeks. I must admit that, although it was on my mind a great deal, I didn't panic and lose too much sleep over it - or rather, at least not as much as I thought I would. I began to grow nervous the night before and on the designated Friday morning of D-Day, I was up early, determined to keep myself busy until Mum and Martin arrived. Mum came at 10.30am and I was fairly anxious but managed to keep a grip on myself. Martin arrived at 11.15am and we sat and chatted about how I was feeling and what I hoped to get out of the day. He also asked what I had eaten for breakfast (poached egg on toast and a cup of tea) and what I was going to have after doing the nasty deed. They both convinced me that I should be brave and have something I normally would not be brave enough to risk after such an event - spaghetti on toast. I told them I would prefer nothing at all but they insisted that , if I was coming this far, I may as well go the whole hog! Martin asked me to sign a disclaimer and mum had to witness it. The formalities were now over and it was time for the procedure to start.

At 12pm I went into the kitchen to take the first 30ml. I swallowed it down in one gulp, all of it and then had the glass of water. As soon as I sat down, I burst out crying. I was so very frightened - but it was too late now - there was no going back. Martin sat me down and tried to help me relax - but it didn't work as I was so frightened. I was worried IT might happen without warning so mum brought a bowl into the living room - just in case. After about 10 minutes, I started feeling nauseous. It was horrible - even as I type this, it's all coming back to me. As I couldn't sit with my eyes closed and relax, mum and Martin continued to talk to me. I was feeling worse as the minutes ticked by. About 12.30pm, I suddenly got the horrible watery feeling in my mouth and knew that something was imminent. I ran upstairs, with Martin in hot pursuit. I knelt down by the toilet and waited. I started to retch and heave - but nothing came up. I was terrified but managed to somehow keep control of myself. This stopped after about 5 minutes. Then again, the retching and heaving, but still I wasn't sick. It was so horrible.

We went downstairs and Martin suggested I had a cup of tea. I didn't want this at all, but agreed to have the tea if it would speed up the process. After a mouthful, I was running back up the stairs, more retching and heaving, but still nothing came up. Martin then felt it was time to take a second dose of ipecac. He also suggested that if I were to drink a large glass of salt water, this should definitely make me sick. Reluctantly again, I agreed. I drank the remainder of my cup of tea followed by the next 30ml of ipecac and then a large glass of VERY salty water. I began to cry again. This was a terrible nightmare and I just wanted it over.

About 10 minutes after consuming this lot and thoroughly abusing my tortured stomach, I began the retching and heaving again, which now was growing more violent. Still, I wasn't sick. Martin couldn't believe it - and neither could I. I just wanted to die. I sat on the bathroom floor and cried more. I was terrified, of what, I don't know. I was coping OK'ish but I wanted the hideous nausea to go. I retched another 3 times. Still I wasn't sick.

We ventured downstairs again and mum and Martin said I should have something to eat. "No Way", I thought - I felt bad enough already. After much discussion, I was persuaded to have some soup - carrot and parsnip of all things! I drank a small bowlful. More violent heaving and retching followed with . . . nothing coming up. I actually put my fingers down my throat (something I thought I could NEVER do) to try and induce the vomiting - nothing, only more retching. I was shattered. I felt terrible.

The time was now about 2.40pm. Mum left and Dad arrived to take over - what a baby I felt - 31 and still needed my parents to look after me. I still felt very nauseous and was worried that this was going to go on forever. Martin said the longer time this went on, the less likely I was to start heaving and retching again. It got to 4pm and nothing had happened for over an hour by now. I started to feel that Martin was probably right - maybe it had stopped now. He chatted to me for a while and we arranged the next appointment and he then left at 4.30pm (what an afternoon for him this had been!) Dad and I sat and watched TV but the nausea became bad again. Next minute, I was dashing upstairs again and retched really violently this time - and for ages. Dad came up and said "You must feel better now?"; but I told him that even after all that, I still had not been sick! I was crying again - I felt terrible and wondered when it was going to stop. Twenty minutes passed and I was retching again. It was making me so sore and I felt like I was going to rupture something.

My partner, Alan, arrived home about 5.30pm and Dad left. More tears followed as I described to him what had happened and how awful I was feeling. I retched another couple of times and then went to lie down on my bed. I couldn't stand it any more. Alan phoned the pharmacist who'd dispensed the emetic to ask if there was anything I could take to stop the retching and maybe act as an antidote to the emetic. He admitted that although he had made up the mixture and knew what was in it, he didn't know exactly how it worked and ended up phoning the Poisons Information Centre in the Midlands - which suggested drinking plenty of water!

Twenty minutes passes and I still felt awful. I really would rather have died at this point. Alan phoned the Emergency GP at the hospital. I spoke to him and explained what had happened and what was now happening. He explained that the ipecac was an irritant and also used in small amounts in cough preparations to induce coughing. He then went on to say the ipecac I had been given had been diluted so all it would do is irritate the stomach - how true this is, I don't know - but could be worth finding out. He recommended I took an antacid - which he was also prepared to administer at the hospital, but I felt far too ill to travel. If I was not better by the following morning, I should go and see my own GP.

The thought of feeling bad all night filled me with dread. I popped two 'Rennies' (an indigestion remedy) in my mouth and after about 10 seconds was running into the bathroom for more of the same. After another 10 minutes, I was back to the heaving again and this time brought up a tiny bit of water - with blood in it. Yuck! I think I must have burst a blood vessel with all the heaving. This happened again a little later.

It was now 9pm and I was lying on the bed feeling as bad as ever. I was frightened to go to sleep incase I woke up and it started again and I would vomit. Hence, I lay awake all night long. In the morning I felt a little better, got up, showered and had some boiled water. I always find this helps when I am feeling sickly and anxious. Mum called and said she thought I should eat something. I argued that I didn't want anything but she felt I needed something on my stomach. I relented and had a small piece of toast. Half an hour later, I was feeling ghastly again. It was as if it had triggered the emetic again. I went back to lie on the bed. Dad called to take me out shopping but I couldn't face this. By the time he returned, I felt a little better.

The whole of Saturday I felt very fragile and ate just toast later on. By Sunday, I felt much better but was still very wary of eating anything too heavy or rich. More toast and I tried a little scrambled egg. Five days later I was still treating myself very gently and hadn't touched much solid food.

So, what has this experience done for me? I am still frightened of being sick and I still don't know why. However, I do feel that I coped with it in my own way. I also feel proud that I went through with it. Martin says I must have a very strong stomach. Consuming what I did - the two doses of emetic, plus water, salt water, tea and soup and still not being sick, was nothing short of a pure miracle. He thinks I have some built-in defence mechanism that just stops me vomiting. After 24 years of not being sick, willing myself not to be sick and taking all precautions to stop me vomiting, it is no wonder - he says. It has certainly made me more confident that it would take something pretty drastic to make me sick.

If someone asked me whether I would recommend doing this, I would definitely say NO - unless the emetic could be guaranteed to work effectively. I knew before I ever went ahead with this procedure that I would have to go through it several times in order to stand any chance of overcoming the phobia - however, I will definitely never do this again. NEVER!

I would be glad to hear from anyone who has been through a similar experience, or who is thinking about it. And I hope I haven't depressed everyone too much!

NOTES FROM LINDA DEAN: Ipecacuanha is used as an emetic in children or adults - providing they are fully conscious and have not ingested petroleum distillate or anything corrosive or liable to cause rapid onset of coma or convulsions. The side effects are listed as excessive vomiting and mucosal damage. There can also be cardiac effects if the drug is absorbed.

The mixture is prepared to a standard formula: 0.7ml or Ipecacuanha liquid extract, 0.025ml hydrochloric acid, 1ml of glycerol and syrup to make the mixture up to 10ml - the dose for a child of 6-18 months. Older children are prescribed 15ml and adults take 30ml - the ingredients being proportionately increased. This should be followed by a tumblerful of water (apparently this makes it 'easier' to be sick) and the dose can be repeated after 20 minutes - if necessary.

This is the only emetic preparation I can find listed, together with warnings that salt solutions, copper sulphate, apomorphine and mustard are dangerous and should NOT be used.

Since Sarah underwent this experience, I have become aware of two overseas emetophobes who experienced virtually identical outcomes and neither actually vomited. This begs the question - could there be some voluntary control over vomiting, which is normally considered to be an involuntary act? Feedback welcomed.

 Sarah is happy for readers of this page to contact her at : 7 ST GEORGES MOUNT, WALLASEY, MERSEYSIDE, L45 9LQ, ENGLAND. Please enclose a stamped, addressed envelope with any letters.

There have been some interesting responses to this story, including: