Purge

by Nicole Johns

  Thin/Fat Spectrogram

  I rush, slightly sweaty, to the Psychodrama room after working out under Douglas’s watchful eye. Psychodrama Therapist Rachel is asking the residents how they feel today, and if there is anything in particular they’d like to do a psychodrama about. Everyone stares at the floor, and Rachel asks us all to stand up and organize ourselves into a straight line from thinnest to not thinnest. We stare at each other in horrified disbelief but do as we are told, and all hell breaks loose.

  Eliza and I know we are the two not-thinnest residents, so we go to one end of the line, where we are challenged by Sandra and Danielle, who try to shove us out of their way with their sticklike arms. Both of them have a desperate gleam in their eyes. Laura places herself smack in the middle of the line. All of this happens in silence. Once we have arranged ourselves (for the most part) in a line, Rachel begins asking questions.

  “Nicole and Eliza, how do you feel being the not thinnest in the group?”

  “Strangely enough, I’m okay with it,” I say, while secretly horrified.

  “Yeah, I’m okay with it too,” says Eliza.

  Sandra and Danielle start shoving each other again.

  “Sandra, do you really believe you are one of the not thinnest here?” asks Rachel.

  “Yes. I should be at the front of the line.”

  “Nicole, do you think Sandra should be at the front of the line?”

  “No. She’s drastically underweight, while I am within my weight range.”

  “Can you see what Nicole is saying, Sandra?” asks Rachel.

  “No.”

  This is the trouble with eating disorders: We all think we’re the not-thinnest one in the room, and that we should be ashamed. Our distorted vision seldom lets us see the truth.

  Body Image and Comparing

  Sandra and Danielle are sitting on my bed while I search through my drawers for a shirt to wear. This is one of the days when I change clothes upward of ten times because nothing looks right. I walk to my closet in hopes of finding something there. Nothing. I stand in front of my closet in jeans and my bra, exasperated.

  “You have a model-like torso,” says Sandra.

  “What?”

  “Your breasts are the perfect size and you have a defined waist.”

  I realize that Sandra and Danielle have been evaluating my body, ranking my parts against their own. I grab a shirt from my closet, not caring that it doesn’t fit like it used to. I don’t want Sandra and Danielle, neither of whom tops one hundred pounds, staring at my bare stomach anymore.

  One day during Group Therapy, RC Allison hits on a source of my negative body image. I have just stated for the sixth time that day that I hate my body, hate looking in the mirror, and just want to hide in pajama pants and my Penn State sweatshirt for the rest of my life.

  “Nicole, have you been comparing yourself to other residents?” asks RC Allison.

  “Yes, every woman compares herself to others; it’s not something anyone can help,” I argue.

  “I think you should try to remind yourself this is not an average group of women,” says Allison.

  She’s right. I hate admitting that I am jealous of the anorexic girls, with knees they click together to hear the sound of bone hitting bone. I am jealous of how they have reduced their bodies to the bare essentials, how they are a lesson in symmetry and angles. My own body is all flesh and curves, thighs rubbing together, breasts bouncing, and hips that run into objects. Allison has sensed my misery. The anorexics stare at me with overly large eyes and the pinched faces of the starving.

  Laura and Holly tell me that I’m beautiful, that I don’t need to lose any weight. I suspect they are lying to me. It will take a long time for me to realize that the anorexic body is a symbol of sickness, and not something I should aspire to have. It will take even longer for me to learn to accept my own body for its unique planes and curves.

  Sex and the City

  “What are you doing ? It’s 4:00 AM.”

  “I have insomnia.”

  “I’m watching Sex and the City if you want to join me.”

  RC Shannon works third shift when Natalie is on vacation. No one wants to spend time with Natalie when they can’t sleep, but I like Shannon, so I stumble down the hall to the dayroom, where I find her wrapped in a resident’s blanket, watching Sex and the City. I curl up on the sofa and watch two episodes until I’m pleasantly drowsy, then head back to my room.

  I savor the unit’s quietness. No one is having a breakdown, refusing snack, having flashbacks, or screaming about weight gain.

  It is August, three weeks before I discharge. I am sitting outside in a lawn chair, waiting for RC Julia to bring the van around for an outing. Everyone else is inside. The air is heavy with the scent of blooming flowers and the wetness of dew. The moment lasts until RC Marie pokes her head out the door and jokingly tells me to go back inside. I tell her how much I am enjoying the quiet, and she leaves me to enjoy it before the rest of the residents come out.

  Julia doing My Makeup

  Danielle is knitting at the back table and no one is watching the Olympics, even though the television is blaring the results of the women’s fifty-meter freestyle, when I come back from pass with $60 worth of Clinique makeup. I met up with Sandra at the Mayfair Mall, where she helped me pick out my very first eyeshadow duo, eyeliner, and undereye concealer stick.

  My mother once told me that I could be a pretty girl if I just did something with my hair and started wearing makeup. So I cut off a foot of my hair and highlighted it, then bought some makeup because, secretly, I want to be a pretty girl.

  RC Julia has promised that she will do my makeup for me before I discharge from the EDC. There is a no-physical-contact rule at the EDC, which means staff is not supposed to touch the residents. Julia’s offer to do my makeup violates that rule, so we both know she will have to do my makeover on a night when the floor is quiet.

  Except for Danielle, all of the residents are napping. Julia agrees to do my makeup in the dayroom, before everyone wakes up. We take all of it out to the table where Danielle is knitting, and Julia paws through the various foundations, blushes, and lip glosses I now own while we talk about her recent camping trip. RC Julia is less than a year older than I am. I often wonder if we would have been friends if our paths had crossed outside of the EDC.

  She starts with moisturizer, smoothing it onto my face in a circular motion. Next, she applies liquid foundation, and after that she brushes blush up my cheekbones. There is something soothing about the gentle, methodical way she applies my makeup. While she works on my eyes, I examine her face. I notice that her eyeliner is crooked and her eyes are a clear blue. Intimacy usually bothers me—normally I would feel exposed, sitting in front of Julia without any makeup. She can see all my flaws: my large pores, the black-heads that tend to dot the bridge of my nose, the patch of acne on my chin, my crooked front tooth, the fuzz on my upper lip. I do not think about any of this, though. I trust Julia. This kind and intimate gesture warms something within me.

  Julia wants to apply my lipstick in the bathroom because the light is better there, so I perch on the counter while she concentrates on coloring my lips a rich plum. Afterward she turns me around to look in the mirror, and I want to cry. Who is this reflected woman with sultry green eyes and full lips? My impulse is to hug Julia, to thank her for making me feel so beautiful. But I don’t. I remember the no-physical-contact rule and merely say thanks. We both stand in the bathroom for a minute, peering into the mirror.

  Master Treatment Plan

  8/13/04

  DANGER/SAFETY ISSUES

  High risk of relapse

  Continues eating disorder behavior

  UNMET GOALS

  To remain abstinent from bingeing, purging, overexercising, and

  weighing self at YMCA

  COMPLIANCE WITH TREATMENT

  Patient is moderately compliant.

  TENTATIVE DISCHARGE PLANS/DISPOSITION


  Discharge 8/19/04. Resident plans to fly back to Pennsylvania and

  stay with a friend or in a hotel for a week and then drive back with

  a friend to Minnesota with her car. Treatment team for aftercare

  is being arranged. Resident is continuing to decide if she wants to

  begin school right away, or take a semester off. If she takes a semester

  off, resident plans to find a full-time job.

  Therapeutic Exercise:

  GETTING READY TO LET GO

  When is enough enough? I don’t know. The health problems, the lost time, and the loss of myself should be enough, but it’s not. I’ve made progress, I’ve talked, I’ve been working on my issues, but I haven’t let go. I don’t know how to let go of so many things in my life, including the eating disorder. I don’t know why I’m not living my life to the fullest. Maybe I don’t know how.

  Something is missing, but I don’t know what. Maybe it’s that I feel I don’t deserve to live life to the fullest, whatever that means. I don’t think it’s that I’m scared. Sometimes I don’t think I’m a very good person. I feel guilty, and I hate myself. I feel like I deserve this eating disorder and the pain it brings with it. My eating disorder and school go hand in hand. I’m scared to go back to school without my eating disorder, because I’m afraid I won’t be such a good student without it. I like the physical release of purging. I don’t know how to deal with feelings, and I don’t want to deal with feelings. I don’t know what it will take for me to let go. If I knew, I wouldn’t be here. I’m not ready to let go.

  Part of me is ready to let go, but the other part isn’t. I want to want to let go.

  Spontaneous Solo Outings

  At first I don’t understand why everyone wants to sneak out to their car and drive to the gas station for coffee when staff is busy. I find this behavior immature and adolescent. Then, after my second month of limited opportunities to have caffeine and unsupervised time, I begin to understand.

  Sandra and I stay behind during a Barnes & Noble outing so that we can sneak out. We are supposed to be working on discharge planning. Sandra sneaks out to her station wagon, and I pretend to go on my solo walk around the hospital grounds. I jump into her station wagon and duck until we are off hospital property.

  The back seat of Sandra’s car is filled with candy wrappers and half-filled bottles of Diet Coke, and a peculiar odor is wafting through the air. I think back to a Group Therapy session when Sandra confessed that she binged and purged in her car, discarding half-eaten food, wrappers, and containers filled with vomit in the back seat. I begin to breathe through my mouth and I pull my legs up to my chest, rather than placing my feet on the floor.

  Sandra drives slowly, not paying attention to the road. A minivan almost collides with us at an intersection. I yell at Sandra to speed up—we have to be back before anyone notices we are gone—but she keeps dawdling and talking about how green the fields are in Wisconsin.

  At the gas station, I make a beeline for a twenty-ounce bottle of Diet Code Red Mountain Dew because I crave the manic anxiety that caffeine induces. Sandra samples different flavors of coffee and experiments with flavored creamers. I yell at her to hurry up. Back at the EDC, I slip in and no one notices, even though I am so hyper I can barely sit through Group Therapy.

  That night, Elise and I head to the gas station. Instead of sneaking out, we make a dash for her car, sprinting across the lawn, which is slippery from the torrential downpour of a recent thunderstorm. Elise screeches out of the parking lot and swerves onto the road. Her driving is the opposite of Sandra’s: She speeds down the wet roads, going sixty when the speed limit is thirty, pulling out in front of cars, and making left turns on red.

  I have never felt so free in my life.

  Instinctively, I know Elise is a reckless driver and my life is probably in danger, but I believe I am in charge of myself, and the wind is cool and fresh on my face and I feel alive.

  A Surreal Moment

  It is ten o’clock on a Thursday night in August, less than a week before I discharge, and I am sitting in the office with RC Erica and RC Marie. My new obsession is the game Scattergories. Therapist Elaine challenges me to play it a few times, to see if I can play without getting too competitive (her suggestion stems from a half-court volleyball game during which I knocked RC Allison over in my attempt to spike the ball). I want to play Scattergories all the time, and RC Marie jokes that it’s all I talk about. Erica and Marie finish their charting early and are up for a game or two. Then Elise comes in and wants to play after she hooks up her feeding tube, and so does Danielle.

  Sandra comes back from pass loaded with bags of clothes she shoplifted from the mall; she will confess her thievery later that night. She also wants to play. All six of us sit in the office; the residents are on the floor in their pajamas, and Erica and Marie sit at the computer desks. We talk and laugh, and I think I’m content for the first time in a long time. Earlier in the evening, RC Marie told me that she could see my personality emerging as my eating disorder receded. She told me it was so good to hear me laugh, and to see me smile genuinely. I will miss RC Marie, and her stories about working at Planned Parenthood and the trials of raising two small children.

  The feeding pumps are making a rhythmic, soothing noise; Marie is singing some song about all the states in the nation that no one is really listening to; Sandra is waving her arms triumphantly; and RC Erica is trying to give Elise her evening meds. I am laughing at the ridiculousness around me.

  I want to pinch myself to see if I’ve dreamed the last three months.

  Therapeutic Exercice:

  THREE STAGES OF RECOVERY

  RECOVERY: I’m living my life fully and not focusing on or distracting myself with eating disorder behaviors. I own my life and recovery. I’m attending my outpatient appointments and actively striving for recovery. I’m enjoying my life and realizing that each new day is a fresh start. I’m using my support system and not isolating myself. I am honest with myself and others. I am not engaging in eating disorder activities, but if I slip, I realize I can move on. I am following my meal plan and expressing my feelings. I will take time out for myself every day and combat my perfectionist tendencies. I will remember to breathe and take care of myself, and remember how far I’ve come.

  IN-BETWEEN: Some days I am more recovery-oriented than others, but I will stay focused and ask for help on hard days. I will realize recovery is not an overnight process. The following behaviors are indicative of this stage: weighing myself, skipping appointments, not talking, purging sporadically, skipping meals, overexercising, bingeing, losing weight, feeling overwhelmed and out of control. I will seek out extra support and talk more. I won’t keep secrets, I will reexamine the motives for my behaviors, I will challenge my thinking, and I will journal. I will also seek further treatment if appropriate. I will realize this is a hard time, and I will not give up on myself.

  RELAPSE: I have relapsed, but I will keep working, asking for help, and believing in myself. I will seek more intensive treatment. These behaviors indicate relapse: purging every day, weighing myself multiple times a day, taking diet pills, abusing caffeine, fasting, restricting, overexercising, isolating, dropping below my weight range, fainting, worsening health problems from not taking care of myself, feeling like there is no way out, and going through the motions of my life. If I find myself in full relapse, I will be honest with my treatment team and support system. I will consider a higher level of care. I will get labs drawn regularly. I will talk and not keep everything inside. I will accept and evaluate how I ended up in a relapse.

  Skinny-Dipping

  Holly has never skinny-dipped before, so we decide to meet up on pass and search the numerous local lakes for a secluded spot where we can forgo swimsuits. Residents are strictly forbidden to meet up with each other on pass, but Holly and I never heed that rule. I leave my rental car in the Stone Creek Coffee Shop parking lot, and she picks me up. Most of the time, we drive to
a suburb of Milwaukee and get large Caramel Coolers at Caribou Coffee. Sometimes we drive into Milwaukee and get coffee at Alterra, a coffee shop near the shore of Lake Michigan.

  We also eat meals together while on pass, which is perhaps the biggest rule that we break. Often when residents meet up with each other on pass, it is for the purpose of bingeing and purging together. Holly and I never do that. We talk each other into eating and out of purging after a filling meal. When we both discharge and move back to the Twin Cities, Holly will invite me over for dinner and invite me out to eat when I am in the midst of restricting and relapsing.

  I will sit with her after eating and distract her from purging, and I will talk her out of stopping at Perkins and bingeing.

  On the last Saturday before Holly discharges, we meet up as usual. We drive with the windows of her Mazda down as we drink quarts of Diet Coke and listen to the Dixie Chicks on the stereo. Our plan is to drive the isolated country roads around the hospital and search for the perfect spot to skinny-dip. We have not anticipated finding the numerous private property and no trespassing signs we encounter. We decide to alter our plan and head to Lake Labelle, a local lake with a beach and docks.