But instead, she says slowly, “In some ways that would be easier.” As soon as she says this her eyes cloud, she claps one hand over her mouth, and she begins to cry.
“What is it?” I ask, but I already know. She’ll pay dearly for saying this, my brave and honest daughter. She’ll suffer guilt and terror at the hands of the demon inside her for even this small defiance. I’m her mother; I’m supposed to be able to protect her. Instead, I have to make it all worse, at least for now.
I remember a picture book we used to read when Kitty was small that described a family who ran into obstacle after obstacle—a swamp, a bear, a mountain—on their way to a picnic. Each time, they tried silly tactics to avoid the obstacles, and each time they succeeded by confronting rather than evading them. Kitty and I used to chant the refrain together each time: “We can’t go over it. We can’t go under it. Oh, no, we have to go through it!”
It’s the same with anorexia. We can’t go under it, we can’t go over it. Oh, no. We have to go through it.
The week after we start our higher-calorie regime, Kitty gains three pounds. I feel like dancing around the doctor’s office, but I keep my face neutral. I stay in character as The Mother.
“I did good, right?” asks Kitty anxiously. “Did I do good?”
What do I say? It depends who’s asking, Kitty or Not-Kitty. My daughter or the disease. Either way, my answer could provoke a meltdown. My instinct is to speak to my daughter, and deal with the demon if it shows up.
“Good,” I say calmly. “You did really good.”
I see the conflict in Kitty’s eyes, guilt and relief and fear swirling together, and wait for one of them to win out. “OK,” she says eventually. We move on.
For weeks now we’ve lived in a kind of bubble. We’ve seen few friends, kept no social engagements. I’ve barely gone to the office; I’ve done the essentials of my job at home, late at night, after Kitty and Emma are asleep. I’m usually too anxious to sleep, anyway. Our lives have narrowed to a few basic activities: shop, cook, eat, clean up, watch movies, do it all again. We’re lucky, if you can call it that, that it’s summer, when schedules are more forgiving. But school will be starting in two weeks. Fifth grade for Emma, and ninth for Kitty. If she goes.
That’s the question: Should she start high school? Some of the answer depends on what happens in the next few weeks. Right now, Kitty stays close to home, literally and metaphorically. Can she handle the emotional demands of high school, or would it be cruel to send her? Would it be crueler to keep her home, setting her back in a way that will feel humiliating? Then there are the practical considerations, like the logistics of lunch and snack, which have to be eaten with one of us.
From the time Kitty was a toddler, she’s been an intensely social person, always wanting playdates, always up for going places and seeing people. She’s the kind of person who’s reenergized by hanging out with friends. This year, though, she doesn’t want to see her friends and she doesn’t want to go to school. I know a lot of her anxiety is a by-product of both the anorexia and the refeeding process. But I can’t help wonder if on some level she’s always felt anxious about school, and just never told us. Does the illness give voice to feelings that have been hidden to her, or does everything get mixed up in its chop and churn?
Ms. Susan says it’s not helpful to get tangled up in this kind of thinking. She says people in recovery from an eating disorder do best when they limit the stress they’re under, and I believe her. On the other hand, to keep Kitty out of school entirely would create a different level of stress for her. She’d feel like a failure, a freak, a weirdo. And, to be honest, it would be good for all of us—including my relationship with my staff and my boss, who have been immensely patient—to have her out of the house for a few hours a day.
One late August afternoon Kitty sits in front of a milk shake and weeps with anxiety. This is her talking, the real her in her own voice, not the creepy distorted voice of the demon. And yet—and yet she’s irrational. She stares at me, her face full of worry, and says, “I don’t want to go to high school and have everyone look at me and say, ‘Look at Kitty, she got so fat over the summer!’”
“You’re not fat!” I say, but I might as well be speaking in tongues, because she can’t hear or understand.
“I’m so fat, everyone will be talking about me,” she insists.
I don’t want to tell her the truth: that kids will talk, but not about how fat she is. God. They’ll be gossiping and speculating about the fact that she has an eating disorder. They will comment on how she looks, but it will be about how thin she is. And yes, some of them will say and do stupid, insensitive things. Not that teenagers have a corner on the insensitivity market—some of our acquaintances have made some appallingly hurtful comments.
Like the acquaintance I run into at the food co-op, who had us to dinner early last spring, before we realized Kitty was sick. Now she leans across the sweet corn and says, in a voice dripping with concern, “How is Kitty?”
I don’t know why it rubs me the wrong way. She means well, I tell myself. “She’s doing all right,” I say, and then, to shut down the conversation, “Thanks for asking.”
She leans in closer. “You know, I could have told you she had anorexia,” she confides.
What I want to say is “Then why didn’t you?” Instead I grit my teeth and say, “How so?”
She smooths her glossy hair. “I noticed the way she cut all her food into tiny pieces and pushed it around her plate,” she says, her voice low and intimate. She gives me a look of concern and adds, “She didn’t eat a thing. Didn’t you notice?”
Now I feel like slapping her. No, punching her in the mouth. No, garroting her. Anything to make her stop talking. “I have to go,” I say, leaving my basket on the floor. I manage to get out the door and into my car, where my rage quickly evaporates, leaving an acid bath of shame. Of course people know exactly what’s going on. And of course they blame us. Hell, I blame us. We’re Kitty’s parents; we’re supposed to be in charge. We’re supposed to protect her.
What I didn’t realize was that they would blame Kitty, too. That they would see her behavior as willful and manipulative. That they would ascribe to her a kind of devious intention, not just now but always. That they would recast her whole life in the light of anorexia, and judge her harshly for it. So while Kitty’s completely deluded on one level, her emotional radar is working. She’s right to be self-conscious; she’s right to feel judged. Just not for being fat.
Later that night, for the first time in weeks, Kitty will not eat her bedtime snack. Jamie’s reading to Emma downstairs while I sit with Kitty in her room. Her snack tonight is four pieces of toast, with butter and cinnamon sugar on them—a nursery meal, one that both my daughters have loved since they were small. Kitty takes one tiny bite and spits it out, and the demon is back, with its infantile, singsong voice and vicious words.
I’ve learned by now that there’s no point in arguing. Words seem irrelevant, so much more fuel for the self-loathing and despair. Usually the demon runs down eventually, but not tonight. Not-Kitty rants on and on, possessed by a manic energy, pacing, practically leaping around her room. I take hold of her shoulders, both to comfort her and to stop her frantic motion. The toast lands on the floor, and I don’t want to leave her to make another batch.
“Come on, Kitty, you can do this,” I encourage, but she gives no sign of hearing me. Jamie opens the bedroom door, holding a bottle of Ensure, bless him. “OK, you don’t have to eat tonight,” I tell her. “Just drink this.”
She knocks the bottle out of my hand, spraying its sticky contents all over herself, me, and the floor, and begins hitting herself in the head with her closed fist.
Jamie grabs for her wrists. “Kitty! Stop it!” I shout. My words are tiny feathers in a blizzard of hail. I plead. I threaten. I tell her if she doesn’t eat or drink the Ensure we’ll take her back to the hospital for the feeding tube. She flails and shrieks, and even though I’m right up in her
face I don’t think she can hear me.
Jamie wraps his arms around her and pulls her down to the bed, trying to keep her from hurting herself. I phone Dr. Beth and Ms. Susan. Neither of them is on call. I call Dr. Newbie and leave a message with her service. She’s not on call either, but another psychiatrist calls back and suggests, just for tonight, letting the snack go and giving her one of the sedatives Dr. Newbie prescribed. I’m afraid Kitty won’t take it, but she does, and we sit with her as her sobs subside and the demon’s voice falters and trails away. She falls asleep in Jamie’s arms. Together we pull down the sheets and lift her into bed, clothes and all, turn out the light and tiptoe out of the room.
Now I know what “just in case” meant.
Emma is standing in the hall, her face blank and unreadable. I put my arm around her shoulders and take her to her room, sit with her while she undresses, brushes her teeth, gets ready for bed—all the ordinary moments in a ten-year-old’s evening ritual. Yet this night is anything but ordinary. The demon has upped the ante, or so it feels to me. We’re in a different place now, the country of mental illness, and it scares the hell out of me. I don’t know how we got here and I don’t know how to get home and I don’t want to be here. I don’t want any of us to be here. What if this refeeding process doesn’t work? What if Kitty wakes up tomorrow and it’s more of the same, if she won’t eat and won’t eat? I’ve heard of girls tethered to feeding tubes for months and girls who rip out feeding tubes. I’ve heard of girls dying, their hearts giving out in their sleep, just like that, and I can’t help imagining Kitty dead in her bed, the sharp point of her chin, her sunken eyes closed, the demon getting the last word.
I don’t know if we can save her. Tonight I don’t know anything.
Emma takes off her glasses, turns out the light, and climbs into bed, snuggling into her blue-and-green quilt as she does every night, until only her thick dark hair is visible. I lie down beside her, ducking to avoid the top bunk. “I hate the anorexia,” she says. I expect tears, but instead there’s an edge to her voice.
“Me too,” I say. “How much do you hate it?”
Part of our bedtime ritual has been a kind of call-and-response: How much do you love me? More than bread loves salt. This inversion of the usual question makes Emma giggle. “Come on, how much do you hate it?” I ask.
“I’d like to poison it,” she answers. “No, wait. Stab it in the heart!”
“That sounds sufficiently evil,” I say. “Maybe we could put a noose around its neck and hang it.”
“I’ve got it,” she says. “Burn it to death!”
She starts to laugh, and I smile too. Then she says, “I want to put anorexia in the blender, grind it up, and feed it to the cats!” And suddenly we’re both roaring with laughter, rolling around on the bed, breathing in great gulps. “The blender!” she says hysterically, and we’re both off again.
“But the poor cats,” I say at last. “They don’t deserve it either.”
“They can’t catch it!” Emma announces triumphantly.
“So it’s just like cat food for them?” I ask. “Crunch crunch, yum yum?”
We’re off again, laughing in the face of the worst thing that’s ever happened to our family.
I hate the fact that Emma, too, has to deal with this illness. Mealtimes have gotten a little easier, but they’re still tense and often explosive. Jamie and I are preoccupied with taking care of Kitty. I wish there was somewhere I could send Emma for a week or two, just to get out of the house. I feel guilty for putting her through this.
Not long ago, another mother told me about a conversation with her younger son, when she told him she was sorry he had to go through his sister’s anorexia too, sorry that mealtimes had become so painful for the whole family.
“And you know what he said?” she told me. “He said, ‘Mom, the worst part was before.’ I said, ‘Before what?’ And he said, ‘Before you started helping her eat, when we were all pretending.’”
That story comforts me now. Maybe Emma will benefit by seeing Jamie and me tackle Kitty’s illness. Maybe in the long run she’ll feel safer because she’ll know that no matter what happens, we’ll take it on. That we’d do our best to protect her, too.
I shuffle downstairs to turn out the lights and find Jamie lying on the living room couch. For the first time in months, we’re awake and both of our children are asleep. I nudge him over and lie down beside him, and we don’t say a word. We don’t confer about logistics: who’s shopping where, what’s for snack or dinner, who’s taking Kitty to the doctor or psychiatrist. We don’t go over how this happened, when it happened, why we didn’t see it coming and stop it. We don’t talk about hard it is to walk around feeling so raw, to take in Kitty’s terror and rage, to stay present for Emma.
We’ve done all that, and no doubt will do a lot more of it, though it’s usually me who needs to talk things out, perseverate, go over and over events and feelings and worries about the future. But not tonight. Tonight I lie beside my husband, feel the warmth of him through his clothes and my own. Kitty is built like him, long and angular, muscled but not obviously so—more Clark Kent than Superman.
I look into my husband’s face. His eyes are tired; his face is lined. He needs a haircut. But he is still handsome to me. Eighteen years ago I had the great good fortune to marry a man who believes in showing up. He might not always know what to do. He might not always have the words to describe how he feels. But no matter how awkward or terrible the situation, no matter how bad things get with Kitty, he will be there. I don’t have to do this alone.
At the moment, I can’t imagine anything more romantic.
By the end of the week, we have worked out a plan, along with Ms. Susan: Kitty will start high school, going part-time, at least for the fall semester. I worry that the school will give us a hard time about asking for accommodations—this school district, like many others, makes a practice of saying no to parents—but Ms. Susan suggests we use the words medical necessity in talking about what Kitty needs. Sure enough, when I put it that way, Kitty’s guidance counselor, Mr. C., becomes extremely helpful. He arranges for Kitty to attend the first and last two periods of the day. In between she’ll come home to eat lunch with one of us; we live three blocks from school, which makes this schedule workable. In theory, anyway.
I hope classes and friends will distract Kitty from the misery of recovery. I hope the stress of performing academically—a stress she puts on herself; we’ve told her many times the world won’t come to an end if she gets a B—won’t prove too much for her. Kitty wants to go to school because she wants desperately to be “normal.” She hates being sick, hates us thinking of her as sick. Most of all, she can’t stand the idea that people will pity her, because she can’t bear the idea that she messed up, that she made mistakes or is in any way less than perfect.
“Everyone makes mistakes,” I tell her. “We’re supposed to mess up. We learn and grow by trial and error. That’s part of what makes us human.”
Kitty shakes her head. “I’m supposed to be smarter than this,” she says. “I’m supposed to be able to figure things out without screwing up.”
I try another tactic. “You’ve seen me make mistakes, right?” She shakes her head. “Come on,” I say. “I screw up all the time. Remember the bread I made without salt? Disgusting. Remember how I used to get lost in the car when we first moved here? I told you we were having ‘adventures,’ but really I was trying to find our way home.”
I’m hoping for at least the hint of a smile; instead, Kitty frowns. “That’s different,” she says.
“Why?” I ask. “Because it’s me and not you?”
She nods, slowly.
“So you think you’re supposed to be better than everyone else in the world?” I ask, smiling so she knows I’m making a joke. Clearly I am no comedian, because she hears my words as criticism and stalks off.
The answer is yes, she really does believe she’s supposed to be perfect in a supe
rhuman way. I wonder if somehow we’ve given her the impression that we expect perfection. I don’t think so. But what if I’m wrong?
I’m not usually defensive about my parenting. I know I make plenty of mistakes. Like missing the early signs of anorexia—that was a mistake I wish like hell I’d avoided. And I know other people, including my children, make mistakes. It’s part of being human. I think Jamie and I have given them the message that we love them the way they are.
So why does Kitty hold herself to such an unrealistic, inhuman standard—yet not expect that from other people too? This emotional blind spot feels analogous to her perceptual blind spot about her body: when she looks in the mirror, she sees rolls of fat rather than ribs and hollows. Yet she sees other people’s bodies accurately.
Neurologists talk about interoceptive information, data that flows from the body into a part of the brain called the insula—things like taste, touch, temperature, and other visceral sensations. The insula helps transform this physiological input into both self-awareness and emotions. For instance, if you eat something that tastes bitter, you might feel disgust or aversion; the chemical stimulus of bitterness becomes the emotional and physical response of disgust in the insula. According to Walter Kaye, anorexia symptoms like distorted body image might be related to glitches in the body’s interoceptive system.
Maybe someday information like that will lead to better treatments for anorexia. In the meantime, we’re stuck with slogging through this, one meal—sometimes one spoonful—at a time.
On the first day of ninth grade, I plan to meet Kitty in Mr. C.’s office and eat lunch with her there, because it’s a short day and there’s not enough time for her to walk home and eat. When I wake her that morning, the first thing she says is, “I don’t want to go! I want to stay home with you!” But she gets dressed in the new clothes we bought last week—a silver T-shirt and plain dark jeans—which I insisted on buying a size larger than necessary; even so, the jeans, which came from a children’s store, look painfully tiny. She spends ten long minutes straightening her hair, so now it hangs to her shoulders in a clean blond sheet. Most important, she eats breakfast with Jamie while I walk Emma to her school. By the time I get back, Kitty is losing her nerve; she takes one look at me and her face starts to crumple. I’m afraid she’s going to fall apart in a big way. But miracle of miracles, the phone rings; it’s a friend asking if she’d like a ride to school.
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