The Story of Peggy Claude-Pierre, the Eating Disorder Healer Who Promised Everything

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The Story of Peggy Claude-Pierre, the Eating Disorder Healer Who Promised Everything

In 1994, Margaret Bruce, the mother of David Bruce, a toddler who wasn’t eating, caught an episode of 20/20 about Peggy Claude-Pierre, the supposedly visionary founder of an eating disorder clinic. Though her son was only two at the time, the Bruce family had already visited numerous doctors. David’s pediatrician initially diagnosed him with anorexia nervosa, but other healthcare professionals insisted that was impossible. They told Margaret that she was being over-protective, or imagining things, or—worst of all—that it was actually she who was sick, with Munchausen’s-by-Proxy, a rare disorder in which a caregiver makes a dependent ill to engender sympathy from others. Once, when the family visited a local emergency room because David was dehydrated, the staff tried to have her arrested. Another time, a highly regarded family therapist suggested that Margaret put out food at designated mealtimes and allow David to do what he chose. The experiment lasted two days, during which time he ate nothing.

The episode of 20/20 began with narration: “Well, you are about to be part of an extraordinary experience. A journey into a bizarre world where young people, most of them girls, are bent on their own destruction, and one woman leads an inspiring battle to save their lives.”

With that, the viewer is whisked to the Montreux Counseling Centre in Victoria, British Columbia, and introduced to Claude-Pierre. Each successive image of anorexia is more harrowing than the previous: a lingering shot of the lips of a teenager, the light illuminating the soft hair on her face that grew to keep her warm, as she whispers, “It makes you feel bad when you eat”; another adolescent, gaunt but walking confidently down a hospital hallway, dragging a nasal tube and IV drip behind her; a new admission weeping, clutching her fists so tightly you can see the sinews surrounding her knuckles; numerous patients, bedridden and being hand fed, “as physically and psychologically as helpless as baby birds,” host Lynn Sherr says in voiceover. Claude-Pierre—a pretty, middle-aged blonde with a quiet manner—is shown at their bedsides, smoothing their hair, kissing their cheeks, telling them she loves them. A melancholy piano tune plays as footage of her carrying a skeletal 24-year-old woman down the mansion’s spiral staircase to be weighed rolls; at the show’s end, as that same 24-year-old takes her first steps down that staircase, a new song plays in a major key.

Margaret Bruce immediately felt the pull of Claude-Pierre and her methods. By the following year, David Bruce was living and Canada and undergoing treatment at Montreux.

When I first saw this 20/20 episode as an anorexic preteen, I too felt this pull. I was beset with longing: to be sick enough to be worthy of Claude-Pierre’s affection, to be in a place where all one’s problems could be cuddled away, to be as pure a victim as the emaciated altruists featured. For years, I wondered what had become of Claude-Pierre, even after my views on anorexia sharply diverged from hers. I wasn’t the only one enchanted: to this day, she receives fawning letters from those who have fashioned her into a transference object so powerful it would make Sigmund Freud weep. “I… used to go to sleep listening to the audio version of [your book]. I have searched for how to find you for years,” one woman wrote in a letter Claude-Pierre forwarded to me. “I just wish that for even a moment I could have been held in your arms as young adult [sic] to know what it felt like to be loved,” wrote another.

At that time in my life, it didn’t occur to me for even a moment to be skeptical. But when I saw the 20/20 episode again, years later, I couldn’t get the questions posed by academic Michelle Stack out of my head: Why take the risk and carry the patient downstairs, if she’s so fragile? Wouldn’t it have been easier and safer to just bring the small scale upstairs to her?

I was beset with longing: to be sick enough to be worthy of Claude-Pierre’s affection

These were not the types of questions many people seemed to be asking back in the mid-1990s when Peggy Claude-Pierre was arguably the most famous eating-disorders treatment provider in the world. Her expertise did not come from academic study—she never earned her bachelor’s degree—but from life: She claimed to have cured her two daughters of anorexia with a proprietary mix of unconditional love and informal therapy. She granted interviews to local newspapers in British Columbia, and began counseling a handful of local women; with her burgeoning reputation, she was able to purchase a Tudor mansion and establish Montreux Counseling Center in 1993, which catered to treatment-resistant anorexics and bulimics. Eighteen months later, 20/20 aired an almost unprecedented full-length episode on Montreux (the only previous time they had spent an hour on one subject was when they covered the Romanian orphan crisis), the one that made such an impression on me.

In the interview with Sherr, Claude-Pierre said that for many, she represented a “last hope,” and that to outsiders she was a “witch doctor.” Back in the studio, when Barbara Walters asked about the “long-term success”—meaning, did Montreux alums avoid relapse—Sherr told the audience the crew had seen “no evidence of failure whatsoever” while researching the story.

After the show aired in December of 1994, the clinic claimed to have received thousands of calls from across the globe; parents like Margaret Bruce were checking their kids out of hospitals, sometimes with feeding tubes still inserted into their stomachs, and leaving them on Montreux’s doorstep. Claude-Pierre wrote a book, The Secret Language of Eating Disorders, in which she claimed that anorexics suffered from “confirmed negativity condition” (CNC), her term for an ego so disintegrated it resulted in a complete lack of self. Often congenital, CNC manifested in a relentless, demonic inner monologue—Claude-Pierre called it the “negative mind”—which encouraged sufferers to starve to atone for imagined sins, or to do bizarre things to injure or denigrate themselves (in a particularly arresting example, Claude-Pierre described finding her severely anorexic daughter weeping as she ate dog food from a bowl on the kitchen floor, even though the family had no dog.)

Past traumas, familial dysfunction, or underlying psychiatric pathologies, she wrote, had nothing to do with the anorexia, a welcome message for parents, many of who were guilt-ridden over child’s illness, or had been blamed for it outright by physicians (this included Claude-Pierre herself, who wrote of being vilified and brushed aside when her daughters were ill). Treatment had come a long way since stricter behaviorist philosophies of the ’70s and ’80s—where treatment centers emphasized weight restoration over therapy—but still, most clinicians looked first to the family, or the anorexic him or herself, to find fault.

To feel worthy enough to eat again, Claude-Pierre theorized, the anorexic needed to be inundated with support and affection 24 hours a day, at least in the acute stages. They couldn’t be asked even to make the simplest of decisions. The treatment methodology, therefore, consisted of constant supervision of each patient by a rotating team of designated “care workers,” who would redirect the patient every time he or she said or did something deemed “negative.” They used terms of endearment when addressing their charges, and physical affection—hugging, stroking, and rocking—were considered tools of “great therapeutic value.” (This is in contrast to most mainstream treatment programs: Both then and now, physical contact between staff and patients is strictly forbidden, and staff-to-patient ratios are usually three to one or higher at more conventional facilities.)

At Montreux, food was presented in small, manageable portions, six times a day, as serving large quantities to anorexics, or asking them to choose their own menu, was considered to be “extremely unkind.” Patients would stay as long as was necessary, some remained residents of the clinic for up to five years. Some then transitioned to become care workers themselves, another unusual practice. Claude-Pierre’s method, supporters said, was the kindness cure to the establishment’s strict disciplinarianism. Where doctors offered nasogastric tubes, she offered hand feeding. Where conventional doctors locked patients alone in isolation rooms, she gave them constant companionship. Where medical hospitals acquiesced to insurance companies and sent patients home after weeks, she let them stay for years, maybe even interminably. Where they offered cruelty, she offered boundless love.

According to reporting in Canadian journalist Barbara McClintock’s definitive 2002 book on Claude-Pierre’s rise to fame, she allegedly spent increasingly long periods away from Montreux on speaking tours or visiting potential patients (at one point, she became a confidante of Princess Diana, who had struggled with bulimia.) When she was gone, her staff—former patients, or local people with little or no conventional medical training—was charged with caring for Montreux’s fragile patients. Claude-Pierre went on Oprah, twice. On the January 17, 1996 episode, she brought along a new client, three-year-old David Bruce. On air, he said that he couldn’t eat because “the man under his hair” wouldn’t let him. The audience was astounded, and Oprah fought back tears as she heaped more praise on the demure “angel on earth.” Claude-Pierre deflected the compliment, but the message was clear: This was a woman who worked miracles.

A more grim reality had begun to set in outside the Chicago soundstage. Some of the clinic’s high-profile patients had recently left and were in peril. In October of 1997, British talk show fixture and Montreux alum Samantha Kendall died; later Scottish singing phenom Lena Zavaroni and then a young woman named Donna Brooks, who had been featured on 20/20, also died. Meanwhile, the Vancouver Island Health Authority (VIHA) had started investigating Montreux based on tips from former staff. Many said they had been encouraged to pry patients’ mouths open with spoons when they refused to eat. McClintock’s reporting revealed claims that they had been actively discouraged from phoning outside physicians during crises (the clinic had no medical personnel in-house.) The argument was that “the medical establishment” had no understanding of “the negative mind.” The place had developed a cultish atmosphere, some former staff members said; rather than training in suicide awareness, for example, new staff members were reportedly shown the hagiographical episode of 20/20. Others claimed they were told to refuse to let patients speak to their families or check themselves out of treatment.

Strangest of all, the former employees alleged that young David Bruce had been living at the facility for over a year—he was often left in the care of a patient with a history of self-mutilation, and allegedly deliberately kept from his mother—despite the clinic only being licensed to house adults. Eventually, Montreux was summoned to licensing court. A five-month trial ensued, which featured agonized testimony from both patients and parents—including David’s mother, Margaret—who said their children would be dead if it weren’t for Claude-Pierre. But their pleas were not enough to save “the Lourdes of anorexia,” as one reporter dubbed it: On December 1, 1999, the VIHA revoked Montreux’s license.

The clinic pursued an appeal for a while; staff also discussed the possibility of the clinic reinventing itself under a new name. This new iteration, however, was not to be. Some say Claude-Pierre chafed under the increased governmental interference; the official word from Montreux was that they had been “emotionally exhausted and financially depleted.” In the summer of 2000, Claude-Pierre and company announced they would drop their appeal. McClintock’s book on Claude-Pierre ended prophetically: “[Montreux] would emerge in another incarnation, or in another place… [Anorexics and their families] needed an angel, even a fallen one, too much to turn their backs on the person who professed to work miracles.” But for years, the world heard nothing from Claude-Pierre, save a few posts on a now-defunct blog titled “Kindness Always Matters.”

I got in touch with Margaret Bruce years later, when she emailed me after reading a short blog piece I wrote in which I asked what had happened to the little boy I saw on television many years earlier. (No clips of his appearance are available on the web, which Margaret suggested is because Oprah pulled them when the controversy started; Jezebel’s requests for comment to OWN—Oprah’s home on television since 2011—went unanswered.) At the time of my posting, I mused, he would have been in his mid-20s. Had he actually had anorexia nervosa, unheard of in a child of that age? Or had he, as expert witnesses suggested during the hearing, been exhibiting early signs of Obsessive-Compulsive Disorder (he was fanatical about cleanliness) or perhaps Asperger’s Syndrome, which often leads to rigid eating habits, as sufferers are acutely sensitive to texture? Indeed, in the past few years, researchers like Simon Baron-Cohen and advocates like Sharon DaVanport have publicly spoken about the comorbidity of anorexia and autism.

Had David’s true affliction been mislabeled, and then exploited by Claude-Pierre, a media-savvy woman with a savior complex? Or was Margaret Bruce unfairly maligned by a narrow-minded medical establishment insistent on its self-created categories, and David soothed to health by a misunderstood, prolific empath?

To my great surprise, Margaret commented on the post and asked me to write to her. In our ensuing correspondence, she confirmed that in 1997, after two years in Canada, she and David had returned to New York, where he was diagnosed with Asperger’s (the Canadian government, she says, guilty over the interruption to David’s treatment, footed the psychiatrist’s bill.) Yet Margaret told me she still believes that David had anorexia nervosa as a child and that it was a condition entirely separate from Asperger’s, which no clinician had ever brought up before or during his time at Montreux.

“David [as a child] was no different from teens or adults who suffer from an ED,” she wrote me, “and without ever hearing how others were expressing their suffering, David expressed his daily turmoil the same way.” She described how he would often tell the care workers in Canada that the man under his hair wouldn’t let him eat because he was bad, and that he would “be dead before [he] was potty-trained” or he grew out of his pants. (This jibes with Claude-Pierre’s description of the anorexic mind: She has always focused more on the self-loathing and suicidal fixations of the anorexic than the more oft-cited calorie counting and weight obsessions.) Without Claude-Pierre, she told me, he would be far worse off than he is currently, and if the clinic hadn’t closed, even his Asperger’s might be less pronounced. “Peggy has the answers and the ‘cure’ and I know that sounds scary,” she wrote. “But it is true.”

In early 2016, Margaret and I met at a restaurant in midtown Manhattan. With voluminous dark hair and a gravelly voice, she is brash, yet warm in person. David, she told me, was now 23; he worked part-time and had a steady girlfriend. He didn’t remember much of his Montreux days, though he did occasionally exchange niceties with some of the people he met, including Claude-Pierre. He had no residual issues with his size—Margaret said as a child, David was more terrified of “growing up” than gaining weight—but she conceded that he still had a lot of neuroses around food. He loved pizza and pasta, Margaret said, but he wouldn’t eat anything another person prepared unless provided with an exhaustive account of its ingredients. “If he saw this,” she said, motioning to the brie, crackers and sliced fruit on our table, “it would scare him, not because he would think that [it] is going to put weight on him. It’s just that he doesn’t know what it is.” Though it may look like splitting hairs—isn’t a reluctance to eat a problem for a former anorexic, regardless what logic underpins it?—she insisted it was a vast improvement over the food anxiety David experienced as a child, when he would memorize the nutrition facts on the back of soup cans and scream when faced with any food but Cheerios.

“I want people to understand his success,” she said, more censorious than sad. She said sometimes at barbecues, when David brought his own food along, her friends would look at her pityingly. But David is alive, has never been re-hospitalized, and actually wants to bulk up his still-wiry frame. He had recently tried pistachio ice cream with tiny pieces of nuts in it, a huge step for someone with a limited palate and texture aversions. To Margaret, these were miracles.

Implicit in the idea of David’s success is Claude-Pierre’s, which Margaret also insists on. Yes, she and David were kept separate for long stretches of time, but even though she “hated it,” she came to view it as necessary. Yes, force-feeding did occur, although it wasn’t anything she hadn’t already tried herself. “I knew they did it, because even when David was living with me and I would bring him to the clinic, when he was behind the door I heard him screaming,” she said. The mother in her balked, but she did nothing. “Actually, I would have been pissed if I traveled 3,000 miles, left my job, left my family… and then you weren’t going to try to feed my son?”

Most people associated with Montreux fall into one of two camps: Either they feel it was a utopian place of rebirth that was unfairly persecuted, or it was a torture chamber run by a very soft-spoken Svengali. Despite the overwhelmingly negative coverage during the hearing, many people, including Margaret, still fall into the first. Now in her 40s, Courtney Lange arrived at Montreux in 1996 after she met Claude-Pierre when they were both guests on Oprah. By that time, Lange had been suffering from anorexia for three years. “Broadly I would characterize [Montreux] as the best treatment experience that I had. I never, ever saw anybody treated badly for one second,” she says of her five years at the clinic, after which she was never hospitalized again.

Carolinda Towsley had been in almost 40 hospital programs by the time she went to Montreux in 2002, when she was 32. By then, the residential facility had closed, but the treatment model was the same, so care workers would stay around the clock at patients’ private apartments and ferry them to therapy appointments, of which there could be up to five sessions daily. Towsley is critical of the treatment she received before she went to Canada—she told me she felt “like a number on a chart”—and fervently supportive of Claude-Pierre, with whom she remains close. “I never would have gotten well if it hadn’t been for her.”

Either they feel it was a utopian place of rebirth that was unfairly persecuted, or it was a torture chamber run by a very soft-spoken Svengali.

Others feel the criticisms of Montreux were warranted. Jennifer Reink, who sought treatment there in the mid-’90s after numerous hospitalizations, made progress at first, then started to plateau. “When I mentioned my frustration, I was always told that I could not go anywhere else,” she wrote to me from her home in British Columbia. “Only Peggy could cure anorexia… If I left, I’d be writing my own death sentence.” She eventually abandoned Montreux and admitted herself to St. Paul’s Hospital in Vancouver; she now considers herself recovered. An early admission, Shelley Lane started treatment with Claude-Pierre in 1992. Lane describes the experience as “claustrophobic.”

“I literally jumped out a window one time and ended up breaking both heels. And [Claude-Pierre] didn’t take me to the hospital.”

For two years, Lane, then in her late 20s, was torn between accepting the trademark Montreux affection—she is disabled as a result of the abuse she suffered as an infant, and spent most of her childhood in foster care—and feeling deeply unsettled by what she felt was a lack of staff professionalism. Then, she claimed, a friend from a prior hospitalization came to Montreux for an assessment, only to have Peggy apparently tell her she couldn’t admit her if she couldn’t pay (Lane herself wasn’t paying for treatment). Not much later, Shelley’s friend ended her life.

“I called Peggy and I said to her, ‘[My friend] just killed herself because you said no.’ And she didn’t say anything to me. Dead silence on the other end of the line. And I just hung up.”(Claude-Pierre declined to speak “negatively” about Shelley Lane, but added that she did not “recognize” the incident.)

One of the few people to take a middle-of-the-road view is Penelope Baily, whose teenage son was treated at Montreux in the mid-1990s. When her son was unwell, Baily began setting up a clinic in the family’s native England in hopes it would be a place where he might recover, but the opportunity for him to go to Canada arose before the facility was operational. (Work was eventually completed, and Newmarket House, which is accredited by all necessary British regulatory bodies, opened in 1996.)

As someone who has worked in the field now for over 20 years and as the parent of a sufferer, Baily says she has mixed feelings about her dealings with Montreux: “I think [the patients] were indoctrinated,” she told me. “We sent our two older boys over to see [our son] without us when he’d been there for about six months, and they were quite shocked. They said, ‘Mum, there isn’t a thought in their heads that hasn’t been put there by the clinic.’” Claude-Pierre had an “absolutely superb” understanding of the condition, and Baily thought the staff was top-notch, but what she saw as a lack of medical oversight was disconcerting to her, and the practice of distancing—figuratively and literally—patients from their families was, in her view, “highly questionable.” But in the end, she felt that “What was actually toxic was having one person from whom the whole thing emanated.”

“We have a great deal to be grateful for,” she says, noting that her son, a psychologist and father in his mid-30s, is now thriving, “but purely objectively there were a lot of things that were wrong with it. And if it was still operating today, and someone came to me and asked if they should send their child there, I would hesitate.” She pauses briefly and reconsiders: “Well, I would almost certainly say no.”

In April 2016, I traveled to the Algarve, a tourist region in southern Portugal, to talk with Peggy Claude-Pierre, who has largely avoided English-language media since the late ’90s. We met in the cheerful, breezy lobby of a beachside hotel in the tiny town of Alvor. Claude-Pierre settled here in 2010, after a Portuguese internist who treated his daughter using her book as a guide contacted her and, according to Claude-Pierre, “begged” her set up a facility nearby. She named the clinic Cegonha Retreat (“cegonha” means “stork” in Portuguese; storks are revered in Portugal for their nurturing instincts.) Claude-Pierre’s signature soft blond locks, thick eyeliner, and disarming, attentive demeanor have not changed much since her appearance on Oprah, nor, I was to discover over the course of our three-hour conversation, has her philosophy.

Although Claude-Pierre spoke about the events in Canada without detectable bitterness, her story has all the far-fetched trappings of a conspiracy theory: Ulterior motives of a powerful bureaucracy, a colluding media, spies in the midst, and a trail of dead bodies. In her view, the Canadian government, fiercely protective of its public healthcare system, pursued her because she operated a private clinic, and because she embarrassed them by curing patients mainstream medicine had failed. She recalled one meeting in which a group of lawyers told her Montreux was all but doomed. “You’ll never win because they won’t let you win,” she claims they told her. “They make up things if they have to.”

Some of the accusations made in court she obliquely confirmed—she admits David Bruce and his mother were kept apart, but says it made the experience easier for David—while others, like that force-feeding, ever occurred or that patients were restrained, she vehemently denied, although she coyly implied that nasogastric tubes, commonplace in other facilities, amount to force-feeding. There are some problems with this logic: While a nasogastric tube is a form of force in patients physically capable of eating, the law in Canada was then and is now that a person can refuse treatment of any kind unless deemed legally incompetent by a court order, which was not the case for any Montreux patient. Furthermore, nasogastric tubes are inserted in hygienic environments under the auspices of a physician; Montreux staff were accused of physically restraining patients and occasionally whacking patients’ teeth with spoons to get them to instinctively open their mouths, without medical supervision.

Her story has all the far-fetched trappings of a conspiracy theory.

Claude-Pierre, who is not a physician, said she would have gone to the Supreme Court, but ultimately decided against it because licensing wanted to make Montreux more medicalized, something she says greatly upset her patients, who had been traumatized by their stints in conventional hospitals. Montreux was able to continue as an outpatient service for a further five years—outpatient operations in British Columbia do not have to be licensed—before eventually, Claude-Pierre accepted a lucrative contract to treat a woman from a “very high profile” family in Europe she declined to name. Claude-Pierre’s husband, her two daughters, and her youngest daughter’s children left Canada with her in 2005. (Treating eating disorders has always been a family affair for them; while her eldest daughter eventually moved back to Canada, her youngest, Nicole, remains in the Algarve with her four sons, the eldest of whom works as a caregiver at Cegonha.)

For the next five years, the group lived semi-itinerant lives, holing up with the wealthy client and other patients in apartments scattered in far-flung locales like Malta and Rome. Claude-Pierre claims, with characteristic optimism, that she wasn’t sad to leave Canada: Her Swiss father had taken the family to Europe for swathes of time when she was a child, so she felt comfortable in her new home. Most importantly, she had come to see Canada “as devoid of the compassion” that she found in Europe.

“Compassion” remains a favorite word for Claude-Pierre, as has “kindness” and “humanity.” She spoke of her patients, who, at the moment I met her, were all well over 18, as “kids,” uniformly “adorable” or “precious.” In language that fit comfortably into the philosophy all this suggests, she said her therapy could be seen as a type of re-parenting. “We are actually taking those children and bringing them up in their rational mind,” she told me. This idea—salvation through infantilization—has always been the cornerstone of her philosophy, but she seemed to have added a neuro-scientific spin: “I’ve been steeped in neuroscience for the last 15 years,” she explained excitedly, adding that she had read “every book [she] can grab” on the subject. (A few months after I visited, Claude-Pierre told me they were changing the clinic’s name, to the very cutting edge-sounding Mater Global Neuroplasticity Center.)

She dropped names like Bruce Lipton, the controversial biologist who believes that belief can overcome a person’s genetics, and terms like “cognitive dissonance” and “cortisol receptors,” and talks a lot, albeit vaguely, about brain imaging. It was unclear whether this interest in neuroscience had a concrete manifestation in her treatment method, but she did tell me there is a retired psychiatrist she knows in Spain who wants to do brain imaging scans on her past patients to prove the effectiveness of her treatment. (There have always been big plans swirling around Claude-Pierre—consultancies, major studies, teaching clinics—few of which have come to fruition.) For someone who “love[s] the brain,” though, she doesn’t seem much moved by the neurodevelopmental explanation for David Bruce’s childhood eating difficulties, which she dismissed as “Asperger’s or whatever whatever,” calling him “a little worrier.”

The core of the treatment methodology, she told me, remains at Cegonha the same as it was at Montreux: A period of 24-hour observation followed by a gradual step-down in care through “the five stages of recovery” she devised and cites frequently. To contrast with traditional facilities, the client supervision is much more vigilant: At Cegonha, an individual care worker remains with each patient when they sleep, use the restroom, and speak with their families on the phone, which they are allowed to do at set times and for set intervals. Plus, the duration of convalescence is much longer, lasting up to three years. Compare that to the U.S. industry average of 83 days. For all of Montreux’s flaws, its costs were comparable to those of more traditional residential treatment facilities; Cegonha costs around 30,000 euros a month, and residential treatment in the U.S. costs on average $30,000 for the same duration. At Montreux and Cegonha, the staff has worked with insurance companies to help fund patients’ stays, though the percentage of cost covered varies widely from provider to provider for eating disorders treatment generally.

While most clinicians agree that insurance companies are unduly stingy in paying for care, they also say long inpatient stays run the risk of fostering an unhealthy dependency, a criticism that was frequently lobbed at Montreux—an independent physician brought in by the government to evaluate Montreux during the trial, for example, strongly suggested in his written report that patients becoming employees of the clinic should be banned, so “that they work towards becoming independent of the Centre rather than becoming more enmeshed and dependent on it”—and that short inpatient stays followed by continuing outpatient treatment can be equally effective (and considerably cheaper).

Still, aspects of Claude-Pierre’s methods seem logical. For example, although it is the mainstay of most treatment programs, there is little group therapy at Cegonha because Claude-Pierre believes patients learn bad habits or “tricks” to resist treatment from one another; patients are never told what they weigh, a now-common practice, and there is no talk of “maintenance” or management. Complete recovery, she says, is absolutely possible—in fact, she says it is the only possible outcome if a patient finishes their program, which is refreshingly optimistic.

On the other hand, even though she says she “never stop[s] caring,” her views leave little sympathy for those who spent years in her care but eventually succumbed to their illness. At least seven of her patients have died in the past 20 years, and when these tragic cases come up in conversation she says she isn’t to blame for their deaths. She chalked it up to the patient’s family undermining the treatment, for example, or claimed that government’s interference interrupted it. In these moments, she sounded like a doomsday prophet the day after the divined apocalypse, with myriad excuses for why the sun still shines.

I expected to meet a diminished figure in Portugal, someone still reeling from a very public court battle and the media’s total abandonment; maybe, I thought, she had tinkered with her theories, or adjusted her expectations for long-term outcomes for chronic anorexics, who are notoriously difficult to treat. Not so. Claude-Pierre made it clear that she saw herself the same way she did when she was the beneficiary of Oprah’s accolades: as a rogue warrior on behalf of the world’s anorexics, so often let down by an unfeeling, callous medical establishment. When she railed against the injustices perpetrated by “the doctors,” it sounded to me as if she was still fighting a late-20th-century conception of eating disorders and their treatment. The predominant stance, in her mind, remains that people with eating disorders are selfish, vain, and incurable. In fact, these presumptions have been loudly and persuasively combated since at least the time when Claude-Pierre first made her appearance. As early as 1978, pioneer therapist Hilde Bruch described anorexia as primarily an issue of low self-esteem, lack of control, and feelings of guilt rather than vanity: “In endless repetition anorexic girls speak about having felt ‘undeserving,’ ‘unworthy,’ and ‘ungrateful.’”

Claude-Pierre had another big concern on her mind when we met: Money. Unprompted, she spoke at length about how often she and Harris subsidized care for her patients, whose families often run out of funds after three or four months. Cost had always been a point of contention for both Claude-Pierre and her detractors, the latter claiming Montreux’s price, at around nearly $1000-a day, was criminal, with some claiming Claude-Pierre was just out to get rich. She retorted that she often took in pro-bono cases, funding their treatment with her book royalties or leftover money from full-freight families and that ultimately, it’s cheaper to have a patient in pricey but effective treatment than it is to repeatedly hospitalized them with no improvement. “All I want is money,” she scoffed. “The only reason I want money is to save one more life. I don’t ever keep it for myself.”

she sounded like a doomsday prophet the day after the divined apocalypse, with myriad excuses for why the sun still shines.

Claude-Pierre and Harris rented an apartment to cut down on expenses, and she rarely purchases anything for herself. She can’t buy a budget plane ticket or a cotton shirt at the discount store without feeling guilty, she says. To illustrate, she describes a scene in Schindler’s List, in which Oskar Schindler breaks down looking at a gold ring because he realized if he could have used the money the ring was worth, he could have saved more lives. For a moment I sat quietly, stunned: did she really just compare herself to a man who risked his life to save over a thousand Jews? Her earnest, downcast expression answered my question.

The day after I met Claude-Pierre, a young Cegonha employee who was hired as a care worker after doing property maintenance for the facility drove me over to the clinic for a visit. Claude-Pierre had mentioned more than once that the facility I’d be visiting was a temporary rental, and that they were shopping for a new space. “We’re moving out to the country,” she told me dreamily, “to a place with organic gardens.” When we arrived, it was not what I’d been picturing: It looked nothing like the pictures on the clinic’s website, which showed a hotel-like space with plush queen-sized beds and a dining area with floor-to-ceiling windows. (The Cegonha Retreat’s website is now down, but the photos are still accessible via the Way Back Machine.) Instead, the clinic was on the second floor of a mostly vacant strip mall. Inside, the walls were bare, and there was little natural light. The patients sat in a living area, watching Forrest Gump.

I was ushered to a small room where, one by one, I met four out of the five residents, all women in their 20s. A few staff members stayed in the room, occasionally offering verbal encouragement or input to the patients, most of them noticeably frail. One, a German who had been there for six months and who Claude-Pierre had told me was a victim of trauma by healthcare providers, was so withdrawn I felt sadistic asking her to respond to even a “yes” or “no” question; another, an Israeli woman who was coming up on her two-year anniversary at Cegonha, still appeared visibly underweight, although she proudly reported she was now able to prepare her own meals. All the patients told me about the many ineffective treatments they’d endured prior to Cegonha, how they felt like they were finally treated with respect here, and how comforting it was to have someone at their side 24 hours a day.

Only when I asked what they hoped to do when they left did they falter. A nurse from Canada with the face of a porcelain doll said she wanted to have a family and return to her job, but the others seemed to have not thought much about a future beyond Cegonha. An Israeli woman responded that she wanted to help other girls, but didn’t specify what that might mean. Another patient from Sweden, who had originally hoped to find employment at Cegonha but then became a patient instead, and had remained so for two and a half years, looked vaguely perplexed, and said she wanted “to help people or inspire people like for the greater good or whatever.” A waifish dog somehow affiliated with a dental clinic downstairs roamed the outdoor patio, occasionally interrupting with loud barking. Rita Spedding, an employee who began working for Claude-Pierre after she treated Rita’s sisters in Canada over 20 years prior, laughed. “He can be a bit aggressive because he wants attention.”

Meeting with the staff of Cegonha, it became clear that some protocols had changed since the Montreux days. The clinic worked in close conjunction with the local Hospital Particuar, where many of the patients were medically stabilized upon arrival. There was a pediatric surgeon affiliated with that facility who started working full-time at Cegonha, a nurse on staff, and a trained psychologist who saw each patient roughly three times a week. (Claude-Pierre required him to be a care worker for a year before performing traditional therapy.) There was also a psychiatrist who came down from Lisbon on occasion. Charlene Clark, an early patient of Claude-Pierre’s from British Columbia who relocated to Portugal four years prior, did the bulk of the nutritional counseling, despite not being a clinical dietitian (there is also a consultant dietitian, but Clark said she was in charge, as they do things their own way at Cegonha). Clark also acted as a family liaison, and is fluent in Claude-Pierre-ese, peppering her speech with frequent references to the “negative mind” and “objectification” and claiming the treatment they do “changes pathways in the brain.”

It seemed strange to me that Claude-Pierre would employ classically trained doctors at Cegonha, when she was once dead-set against a medical presence. At times, things the doctor and psychologist said to me during my visit sounded heretical: The psychologist, for example, mused that he’d like to collaborate with other facilities because, after all, some patients do get better with different treatment regimes. But many Cegonha medical professionals said outside of the psychiatric rotation during residency, they had barely even heard of eating disorders, the illnesses having a much smaller public profile in Portugal that they do in North America. Claude-Pierre had to teach them almost everything they knew on the topic. Their deference showed in the way they behaved: Allowing Clark—who confirmed that they preferred to pick compassionate employees over-educated ones, because “what they learn in school is different from our philosophy”—or Rita to be primary spokespeople, relating everything back to the negative mind and the patients’ “lack of selves” and generally parroting Claude-Pierre.

“You can’t have esteem if you don’t have a self,” Cegonha’s sole full-time doctor, Miguel Duarte, explained to me, “and it’s step by step, and whoever finishes the program, for the five phases, normally you don’t get a relapse.”

At the end of my visit, Rita drove me back to my hotel, and I asked her what would happen if a patient decided not to comply with the Cegonha program. What if they began to refuse food, or they wanted to discharge themselves? She shrugged. “Usually if you talk to someone, you can get them to see what’s right.”

Later that night, I thought of something the psychologist had said that afternoon. When we were discussing Claude-Pierre’s presence at the clinic, he told me she was rarely there, but that her spotty attendance was ultimately a boon. “Because when she comes here,” he explained, the patients “stay alert.”

Why is that? I asked.

“She’s the cure.”

Months after I visited Cegohna, Claude-Pierre got wind of the fact that I had interviewed a former employee she believed had a vendetta against her. After little communication, she went on a charm offensive, sending me multiple emails a day, begging me to speak to this former employee or that former patient, vaguely threatening litigation, and flattering my writing style. I eventually stopped writing back.

It may seem like I favor the narrative that casts Claude-Pierre as charlatan faith healer, but it’s more complicated than that. All eating disorders treatment remains something of a faith-based operation, because the success rate of any type—inpatient, outpatient, mindfulness-based, equine—is spotty at best, particularly for the kinds of patients Claude-Pierre sees. For those for whom a cure has proved elusive, someone asserting that they can and will provide one is seductive, and can even be restorative. Sufferers will flock to her if she’s beloved by Oprah or toiling in obscurity.

Just as the zeal of a religious convert can incite positive and permanent change in a person, so too can a healthcare guru, even one with a complicated history, successfully persuade lost souls to drop their burdens and follow her toward lasting wellness.

Kelsey Osgood is the author of How to Disappear Completely: On Modern Anorexia. She is working on a book about fringe therapies.

Emily Simone Lukaszek contributed reporting from British Columbia.

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