copyright © 2008 Betsy L. Angert
Once you label me, you negate me.
~ Soren Kierkegaard [Danish Philosopher]
An article in the New York Times grabbed my attention instantly. It appeared in the health section. The title, “One Spoonful at a Time.” This writing was heartfelt. Author, Harriet Brown tells a gripping tale. It took me to memories of my own struggle with anorexia and bulimia and how these affected my family. In this exposé, the dilemma of how to treat the condition was thoroughly discussed. I wish to share my response to this situation and story. My personal experience of this is vast. I hope my thoughts, realizations, and rejoinders on this topic will be helpful to those grappling with similar issues. I trust that the effects of anorexia and bulimia are trials and tribulations for all those afflicted by these.
The subject of weight alone is a sensitive probing. An individual need not starve, binge, or purge in wrestling with weight. On the same day another New York Times essay loomed large entitled “Big People on Campus.” This commentary contemplated the plight of being “fat.” I was once that too. Many may muse in this moment, all anorexics believe they are chubby, and while that may or may not be true, I actually was at times in my life. My weight rarely was stable; nor was I when reflecting upon it. However, my weight was never the issue; it was a distraction, a symptom of what was within.
As I read the articles mentioned above, when I turned on the television and saw a report on the increasing male bulimic and anorexic population, and as I listened to a discussion focusing on the media, and the message of being thin, I wondered. Why are Americans obsessed with their weight and avoiding the truer concern?
Americans spend billions of dollars on books, diet programs, professional weight trainers, and behavioral experts that might deliver them from “evil” otherwise known as “eating disorders.” Some recount, “I eat too much,” others muse, “I eat too little.” There are those that think they do not make healthy choices, those that believe themselves fine; their family worries about their physical condition.
I lived in a plump body; a buff body, a slender body, and one that was sickly thin. As a child I over ate. It was what most members of my family did. As an adolescent, I dieted. That is what teenagers do. However, weight was not the trepidation it appeared to be. My problems with body image were not pressing; nor did my peers influence me. It was my life at home, in my heart. Much was disquieting. My parents were together; yet, they were not. My natural father was rarely home and when he was, it was not fun for me. My sisters were close in age and seemed to have a connection with me; however, it felt incomplete. For me, school began at an early age. I love learning and welcomed the opportunity; still, there were demands, those I placed on myself. Life progressed and it seemed perfect.
I had goals, visions, and dreams. In my late teens, I wanted to lose my virginity. That seemed the natural progression, at least in my neighborhood, or among my peers. Oddly enough, a young man began paying attention to me. This may not seem unusual; yet, it was. Those that are closely familiar with my ways and thoughts recognize that this was quite striking.
I was never “boy crazy.” I had no thoughts of marriage or even being in a relationship. I was and still am extremely comfortable with my own company. Perhaps, I am a little too independent. While I have always had very close friends, I was not one to seek physical intimacy. I did not need company or companionship. It could be imposing. I needed time to be me. Nevertheless, this gentleman delighted in my presence.
Yes, we did “connect;” we did the deed; still he wanted more! Imagine that! Eric wanted a real relationship, with all the bells and whistles. I later learned Eric wanted to marry me. Years, before realizing that his intention was to wed, I freaked. When confronted with the fact that he wanted us to spend all our time together I panicked.
Eric was and is an extraordinary man. Physically, he is quite the “looker,” not my type. I love brains; brawn does little to warm the cockles of my heart. He is kind, tender, and evenly tempered. Eric is infinitely considerate, and amazingly enough, he does love to learn.
Women fell for him, flocked to him, and fought for his attention, all but me. Initially, I just saw him as a vehicle for losing my virginity. I never expected he would fill my mind. I did not plan to take time and be with him beyond the bed. I never imagined he would enter my heart. Yet, he did and that scared me. I put on weight, lots, and lots of pounds. I did this as I do most things. I am exceptionally thorough. If I am to do a job, I will do it incredibly well. I grew fat! Perchance, obese might be a better word. Eric said nothing. He still wanted to be with me.
Now, what was I to do? All this weight, I wore poundage that poured over the edges of my clothing. I was uncomfortable in my body. I needed, no wanted to loose all this excess mass. I began dieting. I did it well depending on your standard, and not well, if health is a main concern. At first, I only wanted to lose what I had gained. I did this. Then as the pressures of life grew, my apprehension for food and what would follow were I to eat it grew.
Years passed, as did my obsession with weight and food. After a time, apprehension for my impending graduation from college consumed me. The more I thought about this the more I struggled. Careers, professions, being more a part of the “real” world, more responsible for my self, it all seemed a sacrifice. What was I to do or be now?
While attending the University, I never hesitated. I chose my majors and pursued each discipline with zeal. My course of study never changed. However, I never expected to graduate. That was not part of my plan. I had no desire to leave the sanctuary of school. I first enrolled in classes at the age of two. Academia was the world I knew. What next?
Next, or soon, I would become a statistic. Not unlike the “Kitty” in the tale her author mother, Harriet Brown tells. I was anorexic. Ultimately, that lifestyle was too difficult. Starving my self was such a struggle. I chose bulimia instead. I “thought” that would be an easier avenue to pursue. It was not. I had no control over my life, my weight, my worries, my ways. A person such as myself that prefers infinite tranquility, found herself in a world of chaos, chaos I created!
For decades my family deliberated, what would they do? What could they do? Some pondered what had they done. Who was at fault and would the circumstances ever change? There was much guilt, theirs, mine, and ours!
I share this revealing story with reason. Harriet Brown, the parents, the professionals in her tale all do as people customarily do. They look for facts, quick fixes, simple solutions, thirty-second spots, immediate gratification, and spontaneous change. I acknowledge the year or more this family invested in re-parenting and feeding their child; one spoonful at a time was overwhelming. Yet, in the end, wonderment still fills the void of not knowing.
Ms. Brown discusses in depth the niche, a role, the pondering, the play, the place, and the label each person holds. Yet, for me, she misses the nuances. The world within will determine whether Kitty again chooses an addiction with food or the lack of it. I believe and experience that our compulsions cannot be broadcast through numbers. I understand the fascination with facts, the need to look for answers. Nevertheless . . .
Programs may not be profound no matter what they cost or what their supposed success.
we asked Kitty’s pediatrician where her other anorexic patients went for treatment. “When they’re this sick, they go away,” she said, referring to inpatient eating-disorder clinics, where people often stay for two or three months. The nearest was an hour away and cost $1,000 a day, most of which would not be covered by our HMO.
There is ample reason for alarm.
Anorexia is one of the deadliest psychiatric diseases; it’s estimated that up to 15 percent of anorexics die, from suicide or complications related to starvation. About a third may make some improvement but are still dominated by their obsession with food. Many become depressed or anxious, and some develop substance-abuse problems, like alcoholism. Almost half never marry. It is thought that if anorexia is not treated early on, during adolescence, it tends to take an average of five to seven years for the person to recover – if it happens at all.
There are behavioral modification plans and they tout great success.
Among the few studies done on anorexia treatment, I came across one from 1997, a follow-up to an earlier study on adolescents that assessed a method developed in England and was still relatively unknown in the United States: family- based treatment, often called the Maudsley approach. This treatment was created by a team of therapists led by Christopher Dare and Ivan Eisler at the Maudsley Hospital in London, in the mid-1980s, as an alternative to hospitalization. In a hospital setting, nurses sit with anorexic patients at meals, encouraging and calming them; they create a culture in which patients have to eat. The Maudsley approach urges families to essentially take on the nurses’ role. Parents become primary caretakers, working with a Maudsley therapist. Their job: Finding ways to insist that their children eat.
The two studies showed that 90 percent of the adolescents recovered or made significant gains; five years later, 90 percent had fully recovered. (Two other studies confirmed these results.) In the world of eating disorders, I was coming to understand, this was a phenomenally high success rate.
Yet, I think it is essential to consider what works for one person may be the kiss of death for another. I personally, would have rebelled and reacted more overtly had my parents spent their every waking hour with me, as the Brown’s did.
I would not have felt loved, quite the contrary. I would have felt as though they did not trust me. I grew up in a family whose primary principle was “No one has the right to tell you what you “should,” think, say, do, feel, or be!” Granted coupled with this was the belief, “Do whatever makes you happy, as long as it does not hurt anyone” and of course, my reactions were hurting everyone; nonetheless, they were mine to choose. In my mind and in the family I was raised in, it was accepted, in order to learn we must error. It is part of our evolution. To force another to be, as we believe is best gives them no room to grow and discover for themselves.
Harriet Brown acknowledges that
The idea that parents should be intimately involved in the re-feeding of their children can be quite controversial, a departure from the conventional notion that the dynamic between parent and child causes or contributes to the anorexia. Many therapists advocate a “parentectomy,” insisting that parents stay out of the treatment to preserve the child’s privacy and autonomy. They say that a child must “choose” to eat in order to truly recover.
However, she chose to believe as Maudsley advocates “no one else knows the child as well or has the same investment in the child’s well-being. She states, “That felt right to us.”
As I read Ms. Brown’s re-counting, I was continually struck by the specifics of the feeding process and the lack of luminosity. There was so little of Kitty’s feelings expressed. While I trust that her parents spoke to her of her fears, apprehensions, and worries, the details of these discussions were not shared with the reader.
As I reflected on Kitty’s approaching entrance into high school, my own memories flooded my mind. I knew while living through anorexia and bulimia, it was never about the weight. It was the wait, the anticipation of the unexpected, unknown, unidentified, and unfamiliar. It was the strange, the strain, the mysterious, and the mystifying musings that strangled my soul!
I do understand the dynamic; the habit becomes the pattern etched into the brain and physical memory. I comprehend the ever-present question, which comes first the chicken or the egg. I recognize the theories
Over the last few years, most eating-disorders researchers have begun to think that there is no single cause of anorexia, that maybe it’s more like a recipe, where several ingredients – genetics, personality type, hormones, stressful life events – come together in just the wrong way.
What I think is in error is the prospect presented by
Maudsley practitioners say that focusing on the cause is secondary, ultimately, because once the physiological process of starvation kicks in, the disease takes on a life of its own, unfolding with predictable symptoms, intensity and long-term consequences. Anorexics become almost uniformly depressed, withdrawn, enraged, anxious, irritable or suicidal, and their thinking about food and eating is distorted, in part because the brain runs on glucose, and when it has been deprived over a long period of time, when it’s starved, it goes haywire. It’s important to get the patient’s weight up, fast, because the less time spent in starvation, the better the outcome. Adult anorexics who have been chronically ill for years have much poorer prognoses than teenagers.
In my own life and search for a cure, I found professionals that believed as these do. I contend, the obsessions of medical professional almost killed me. Killing with the kindness of tough-love, prescribed by parents or physicians has the potential of doing a person in. It certainly would have taken a toll on me.
Thankfully, I located others, those that treat with love, just as my parents did and do. I discovered “experts” that acknowledge they are not. They understood the notion that a person that has never experienced an illness cannot fully understand it. Thus, they turned to me. My parents and physicians reflected on who they knew me to be as a person. They thought me wise.
I was trusted to resolve the situation for myself. I was given only potassium and talk therapy to keep me alive. Those in my life trusted my intelligence, my reflective nature, and my ability to be introspective. The professionals, my parents, and my peers believed in me when I did not. This was confusing, though extremely meaningful to me.
Those close to me knew of the tens of hours I devoted daily to eating, isolation, and purging. They hoped, based on their history and knowledge of me that I was not simply doing binging and purging, but that I was also thinking. I was working through my concerns and circumstances. Indeed, I was. When I finally, she says with great exasperation, found myself, discovered what Harriet Brown might refer to as my demons, I met them with delight. I no longer; nor did my family or friends need to contemplate the possible impending doom. I would not, will not return to those trying days of old anorexic or bulimic beckoning.
Four months after the “change of life” [no, not menopause] giving up my ways, I was thrown into a situation that truly tested my will. I was in a serious accident. Unexpectedly, my life went topsy-turvy. I was badly injured and unable to walk. The prognosis was grim. It would be half a year before I could again return to a standing position. I had perfected the bulimia process through many a situation, and in the past, I would have found a way to again engage. I had the will and there was always a way. However, on this occasion I did not return or resort to my decades old pattern. I did not consider the option.
Ms. Brown, I share this with you for you are questioning, anxious, what might the future bring. I myself think behavior modification programs such as the Maudsley plan may be nice. Their success rate may seem comforting; however, I caution, it is my experience that unless or until the cause is addressed, the emotional effects are evaluated the likelihood that there is true resolution is “slim.” Many experts say anorexia and bulimia are chronic conditions. Years after my coming of age, I still do not experience sweaty palms. I do not white knuckle my way through stressful situations. I think the emotional, intellectual work is essential. Kitty may have done the work that you did not speak of. I know not. Nonetheless, I worry. I think “cures” and certainty come with more than one spoonful at a time.
Please weigh your options. Read the references. Reflect who you are, more than your mass.
- pdf One Spoonful at a Time. By Harriet Brown. New York Times November 26, 2006
- pdf “Big People on Campus. By Abby Ellin. New York Times November 26, 2006
- One Spoonful at a Time, By Harriet Brown. New York Times. November 26, 2006
- Big People on Campus, By Abby Ellin. New York Times. November 26, 2006
- Assessing and Treating Men With Eating Disorders, By D. Blake Woodside, M.D. Psychiatric Times March 2004
- Harriet Brown
- South London and Maudsley NHS Foundation Trust.
- Parents Play Key Role In New Anorexia Treatment. Duke University
- Maudsley Method: New Treatment for Anorexia National Association of Anorexia Nervosa and Associated Disorders
- Eating Disorder Statistics South Carolina Department of Mental Health
- Statistics: Eating Disorders and their Precursors. National Eating Disorders Association
- Anorexia Nervosa. MedicineNet
- Anorexia Nervosa: Signs, Symptoms, Causes, Effects, and Treatments. Helpguide.org
- Bulimia Nervosa The National Women’s Health Information Center U.S. Department of Health and Human Services
- Weight Gain Often Doesn’t Mean Anorexia Cure. MedicineNet
- Eating Disorders: Facts About Eating Disorders And The Search For Solutions The National Institute of Mental Health (NIMH)
Dear reader, you may wish to peruse Chapters One through Six, of my life as an anorexic, bulimic, a person. Please do.
A reader asked that I share this information.
The National Eating Disorders Association’s “Every BODY Is Beautiful” Online Fundraising Auction currently running through Wednesday, December 6th! There are some unique holiday shopping (jewelry, handbags, clothing, celebrity-autographed collectibles – featuring customized jeans from The Sopranos’ Jamie-Lynn Sigler and singer Sarah Evans – and much more) while at the same time contributing to an amazing, life-saving cause!
You may wish to read of the artist in an LAWeekly essay, The Art of Spooning, By Caroline Ryder, or of the fundraiser at SpoonFed Art on MySpace.com.