Purge
Page 1
Table of Contents
Title Page
Dedication
Prologue
Diagnosis
Selected Journal Entries - (2001—2004)
Euphemisms
The Last Year - (OF YOUR LOVE AFFAIR WITH EDNOS)
The End Is the Beginning ·
Day One—Admission
Psychiatric Evaluation
Day Two- Weight and Vitals
Breaking the Fast
Dr. Lorensky
Observation
The Middle
Meal Plans
Snack Time
Scenes from the Dining Room - OF THE EATING-DISORDERED
Individual Therapy - WITH THERAPIST ELAINE
Group Therapy - WITH THERAPIST ELAINE
The Vibrator Policy - AT THE EDC
Confession
Scars
Autobiography
Horseback Riding
Psychodrama
Geriatric Skate
Parents’ Visit
Transformations
Some of Us Are Just Passing through
Birthday
Desperation
Repeat Offenders
Heart Trouble
Nutrition Group
johannsonator Sessions
Art Therapy
Thin Clothes Bonfire
Black Market and Contraband
Knowing My Weight
Safety Contract #1
Periods
Fat Is Not a Feeling
Dairy Queen
Crack Kills
Voodoo House Field Trip
Fight Club
Team Building
Playground Love
Safety, Contract #2
People Are Hell
Evoking Emotion - IN THE UNEMOTIONAL
An Exercise - IN COMBATING MY PERFECTIONISM AND SUPPOSED OCD
Revelations
Extended Metaphors
Prelude to Anger management
Anger Management
Tornado Warnings
Nursing Students
Prank-Calls
It’s Fun to Weigh at the YMCA
Thin/Fat Spectrogram
Body Image and Comparing
Sex and the City
Julia doing My Makeup
Master Treatment Plan - 8/13/04
Therapeutic Exercise: - GETTING READY TO LET GO
Spontaneous Solo Outings
A Surreal Moment
Therapeutic Exercice: - THREE STAGES OF RECOVERY
Skinny-Dipping
Epilogue
Acknowledgements
About the Author
Selected Titles from Seal Press
Copyright Page
DEDICATION
For those who haven’t found their way out yet; and for those of us who have, and will always remember.
Prologue
We are, I am, you are
by cowardice or courage
the one who find our way
back to this scene . . .
—FROM “DIVING INTO THE WRECK,”
BY ADRIENNE RICH
I have used Adrienne Rich’s poem “Diving into the Wreck” as a metaphor to describe the process of writing this book, as well as my recovery from an eating disorder. I have had to dive into the wreck of my journals, my medical and psychiatric records, the minds of those who accompanied me during my three months of treatment, and my own mind in order to find my way back to the scene and accurately record my experience. I chose to write about the three months I spent in residential treatment for Eating Disorder Not Otherwise Specified (EDNOS) because there is a dearth of well-written, timely, and accurate literature about eating disorder treatment.
Numerous psychological studies have been published regarding the success rates of various methods of treating eating disorders. While such studies are integral to healthcare professionals’ understanding of how to better treat eating-disordered individuals, they do not tell the story of the individual who struggles with an eating disorder, or her treatment experience.1 Although a recent explosion of self-help books addresses the topic of eating disorders, these books often offer dubious advice and are poorly written.
Another genre of eating disorder books exists: a cross between the traditional self-help book and the memoir. In these books, the narrator is “saved ” by a treatment provider or God, or a combination of both. These books give the reader the impression that an eating disorder is just a diet gone wrong, and that it can be cured if the individual finds the right support group, the right religion, or the right therapist.
Unfortunately, it is not that simple. Eating disorders are complex pathologies—they do not stem from a single source, they have no simple resolution, and they are seldom cured. Treatment can help an individual lessen her symptoms (restricting, purging, and so on) and obtain a better quality of life. However, treatment does not cure an eating disorder. What the general public does not realize is that the eating-disordered individual struggles and needs continued support after leaving treatment, and that, to some extent, she will struggle with eating disorder urges after treatment, even if she doesn’t act on them. The happily ever after ending of many of the eating disorder books on the market today is a myth.
One of my main goals in writing this book is to reveal that despite having spent three months in treatment, I am not cured, and neither are the majority of patients. I wanted to write an honest, detailed narrative about my experience in treatment and the effect it had on my life. I wanted to show the reader that there is no happily ever after, but that there is hope. Most of the current eating disorder literature glosses over the ugly parts of living with and attempting to recover from an eating disorder. I chose specifically to describe what it is like to purge, what it is like to abuse diet pills and starve myself. The readers deserve to know the truth, rather than have it sugar-coated. For this reason, I also included a number of primary documents from my stint in treatment. Along with aiding the structure of my book, these documents detail my treatment experience and offer the reader a clearer idea of the treatment process.
Most of the literature about eating disorders written by treatment providers and individuals who have battled an eating disorder creates the unrealistic expectation that the reader’s eating disorder will be cured after one round of treatment, after a few therapy sessions, or after the eating-disordered individual reaches a healthy weight or stops purging. The reality of eating disorder treatment is that the relapse rate is astronomical. According to the Cleveland Clinic, up to 50 percent of bulimics relapse six months after treatment, and the relapse rate for anorexia is even higher.2
We as readers are living in the age of the memoir. Memoirs, especially those dealing with subjects previously deemed taboo by society, are selling well. Eating disorders have not gone undocumented in this era.
The preeminent eating disorder memoir is Wasted, by Marya Hornbacher. As a senior in college, I checked out Wasted from the library and read the book in one day, as I was riveted by Hornbacher’s description of her battle(s) with anorexia and bulimia. At the time, I was in the throes of purging anorexia—my goal was to eat less than seven hundred calories a day; I purged if I exceeded my self-imposed limit, in an effort to lose weight and gain control over something in my life: my body.
It is worth noting that Wasted has a cult following of eating-disordered individuals. While I was in treatment, several women attempted to smuggle Wasted into the treatment facility, but the staff confiscated their dog-eared copies of the book. These women considered Wasted their eating disorder bible; they gleaned tips from it and used it to trigger their own eating disorder behaviors.
The cover of Wasted was what first caught my attention. The paperback edition of the book showcases a thin Hornba
cher on its front cover. To non-eating-disordered women, this visual of the author and what she has done to her body may serve as a warning. But all I saw was that she was thin.
As a reader, I searched for firsthand accounts of what life in a treatment center is like, and was left unsatisfied. As I progressed through treatment, I learned that I was not the only one without a clear idea of what eating disorder treatment entails. Well-meaning friends thought it was like summer camp, while others thought I’d be spending time on lockdown with psychotic individuals. The reality of the treatment experience (or at least my treatment experience) was quite different from what most people imagine. My hope is that this book dispels the myths about eating disorder treatment that are circulating.
Another myth I hope to dispel is that anyone who is not emaciated cannot have an eating disorder. At 137 pounds, in the midst of consuming diet-pill cocktails, starving, and purging, I was hospitalized for fainting, a concussion, electrolyte imbalances, and three different kinds of heart-rhythm irregularities. My eating disorder behavior had wreaked havoc on my body. Not until after treatment did I learn the sum total of the damage I had done, but for a long time I refused to believe I had a problem because I was not underweight.
In treatment, I met overweight and normal-weight bulimics with an array of medical problems—including heart irregularities, eroded esophageal tracts, bowel problems, osteopenia, and osteoporosis—at the age of twenty. A person does not have to be underweight to suffer the medical consequences (not to mention the emotional pain) of an eating disorder. An eating-disordered individual should not have to weigh fifty-two pounds to be taken seriously.
In conclusion, I wrote this book to inform the public, counteract the myths surrounding eating disorders and treatment, and provide eating-disordered individuals with hope.
1 While most eating disorder patients are female, it should be noted that increasing numbers of males are seeking treatment for eating disorders.
2 .http://wwwclevelandclinicmeded.com
Diagnosis
Eating Disorder Not Otherwise Specified
(EDNOS),
characterized by restricting and purging.
Selected Journal Entries
(2001—2004)
12/10/01: I made myself sick and it felt really good. I liked it.
I’m one sick fuck.
12/21/01: 143 lbs. I feel disgusting. I look disgusting.
I need to lose at least 10 lbs.
6/13/02: 139 lbs. Bulimia is back. I’ve started taking
diet pills with ephedra.
6/29/02: I threw up my birthday dinner.
7/3/02: I threw up every day last week.
7/7/02: Threw up uncooked brownie mix. That was sick.
9/24/02: I’ve developed heart problems from bulimia and diet pills.
10/11/02: 144 lbs. Reading Marya Hornbacher’s Wasted.
10/19/02: Dizziness and chest pain when I purged.
10/27/02: I feel myself slowly slipping into anorexia. I’m in the
interim. No pills, less purging. A gradual changeover.
I’m remembering my summer of compulsive running. I’m
remembering my blood pressure bottoming out at boarding
school because I wasn’t eating. Exhaustion. Dizziness.
Running around jacketless in winter so I would burn more
calories. My body has lost its integrity. Binged at Perkins,
and then threw it all up.
1/11/03: 135 lbs. Therapist claims I’m emaciated. Wants me to
watch a Lifetime movie.
2/28/03: 130 lbs. I’m focused on my plunge into bulimia and
anorexia. It’s been a hellish past few months in that respect.
My hair is falling out, my nails are a mess, I’m dizzy and
on the verge of passing out a lot. I look like shit, except I’m
thinner, and everyone notices and the compliments keep
rolling in the more I drop. I need the muscle spasms and
irregular heartbeat to stop.
4/17/03: 141 lbs. I have wasted a year of my life. The year that
held so much promise in the beginning. All the time I
spent counting calories and purging has been a waste.
I haven’t purged in a month. Not worrying about food
gives me so much time. I can eat dinner with my friends.
Eating disorders are a subtle suicide, and I am choosing
to live.
4/29/03: I slipped. I binged and purged.
9/13/03: Started taking diet pills again. Feel so gross. Some things
never change.
9/21/03: 150 lbs. That’s three-quarters of the way to 200. Fatness. I’m
going to take diet pills and stay under 1,000 calories a day.
1/31/04: 138 lbs. The only time I’m hungry is when I wake up in the
morning. Then I eat, take a Metabolife, and have energy,
but not hunger. I know this is completely ridiculous, but
if I can just get down to 100 lbs., then I can start over and
do everything right. I see this as getting to the essentials,
the basics. Looking in the mirror today, I noticed I looked
thinner. It was nice. At 138, I don’t look too bad, and
at 128, I’d look even better. It’s been so easy lately with
these pills, having three classes and one section to teach.
Starving=happy, binge/purge=unhappy. I’m finally starting
to figure it out.
2/4/04: I am in too deep now. Half the time I feel like I don’t have
anything the matter with me because it’s not physically evident
. Then I feel guilty about eating. I just don’t know. I’m
ashamed because I’m too old for this. I am scared that I’m
never going to get better. Worse, I’m scared I’ll stay in the
exact same place. . . . Mirrors lie. There are fat mirrors and
skinny mirrors; which ones are right? Now I know I’m happier
, because not eating=control. And I hide the disorders
so well. I’m a pro. No one needs to know. My guilty secret.
It’s my Incredible Shrinking Woman act. I want to shrink
into oblivion. Get to the bare bones, the essentials. I throw
up my emotions. My grief, my secrets. I starve away into
nothingness, flatness.
2/11/04: I feel like I’m going to pass out. I’m eating two candy bars.
I feel like I’m losing my mind. This is madness. Since I’ve
eaten these candy bars, I’m only allowed salad tonight. I
have my life all together, except for this. Maybe I should
purge these candy bars. Now I want a muffin. I just want to
go to bed, but I can’t sleep anymore.
3/28/04: Sometimes I hate what I’ve reduced my life to.
4/4/04: I feel like I’m dying.
Euphemisms
Making yourself sick purging, yakking, scarf and barf, self induced vomiting, engaging in bulimic symptoms. Starving, restrict ing, fasting compulsive exercising, engaging in anorexic symptoms. None of these terms adequately describe the frenzy of an eating disorder. An eating disorder, to most people, is anorexia or bulimia. But, there is an island between anorexia and bulimia, a no-man’s-land that borrows from both diagnoses. This island is Eating Disorder Not Otherwise Specified (EDNOS).1
An eating disorder is driving to a gas station in the midst of a blizzard and writing a bad check to buy dozens of stale doughnuts because they are being sold at the day-old discount price and you are ravenous because you have been starving yourself, again. Your car gets stuck in the middle of an intersection, your tires churn up wet snow, you’re going nowhere as you cram doughnuts into your mouth, sugar circling your lips and chin, granules of sticky sugar on the steering wheel, and you don’t care that there is oncoming traffic, the light is about to change, and the tires
are spinning. All you care about is making it back to the apartment before your roommate gets off work, in time to stick the index finger of your right hand down your inflamed throat so that doughnut pieces will heave their way up your esophagus and plummet into the toilet bowl.
Back at the apartment, your right hand is slick with saliva, mucus, and chunks of wet doughnut. Your eyes water and tears roll down your face and land in the toilet bowl, mixing with the doughnut remains. There is a splash-back effect as the doughnut pieces hit the water. Toilet water splashes your face but you don’t care, because all you can think of are calories, fat grams, did I get it all out? Then you strip down, running your hands over the contour of your hips; you search for rib bones and shoulder blades, and you grab the loose skin of your abdomen in disgust.
An eating disorder is bingeing on a salad with fat-free dressing in the student union, running up three flights of stairs to a seldom-used bathroom, and pausing to look in the mirror before going into a stall. Eyes are ringed with circles, lips are chapped, there’s a scar on your right knuckle from where your teeth scrape when you shove your fingers down your throat. You are pale. You retch away, the acidic salad dressing burning your throat and mouth; wilted brown lettuce coated with a sheen of bile glides back up your blistered throat.
Ten minutes before seminar starts, you race to Starbucks, buy a large black coffee, dump three Equals into it, and walk to class, wondering, When is my body going to give out? It’s negative ten degrees outside, goddamn Minnesota, but you are oblivious, coat unbuttoned, scarf trailing off your shoulder. The hand holding your coffee shakes. In the bathroom of the English building you gulp down two Dexatrims with your coffee, sitting through seminar in a glazed stupor, anxious and paranoid, voice wavering, neck and face turning a splotchy red if you attempt to contribute to the class discussion.