Community, in any case, is the last thing on Kitty’s mind. Truly, I think she’s grateful to have homework, glad to have something else to think about, even if it is algebra. Maybe because it’s algebra, which is completely unconnected with anorexia. What makes school hard for her is what she used to love most about it: the friendships. She obsesses over what people think of her and is convinced they’re judging her because she has anorexia. I tell her no one blames her, that people understand she’s ill, that they feel empathy and compassion. I wish I believed that. I’m sure her closest friends do feel for her. But I’m also sure she is being judged, and harshly, by plenty of others. I know we’re all being judged, and found wanting, by some of the people who smile and cluck sympathetically in the grocery store, in the neighborhood, at the office or school. I know it hurts Kitty, because I know how much it hurts me, and Jamie, and even Emma.
We all have our reasons for staying close to home.
Kitty objects strenuously to the Sunday plan, and I nearly say never mind. But I feel as though that would be giving in to the anorexia, validating on some level her worries about—about what? I’m not really sure. So we load up our picnic, tie the kayaks onto the roof of the car, and go.
Lunch at the park takes more than an hour; Kitty dawdles and picks at her sandwich, insists she can’t eat the chips, tries to refuse the chocolate milk. I wonder again if this is a mistake. But we’re only five minutes from home; we can always leave if we have to.
Once we actually get into the kayaks, though—Jamie and Emma in a rented double, Kitty and I each in our own—it’s as if some switch gets flipped and Kitty is her old self, smiling, enthusiastic, even cracking a joke about my less-than-stellar steering skills. We paddle in loose formation under a watercolor-blue sky, waving at other boats, watching a muskrat swim away from our wake. Emma, too, seems more relaxed than usual. For the first time in months I remember the ways we all fit together. We share a sense of humor. We are a family.
Which is why it’s such a shock to see the demon emerge the very second Kitty steps out of the kayak. “I’m so fat,” she starts. “I’m horrible and no one loves me. Why doesn’t anyone love me?” When I try to calm her down, she accuses me of speaking harshly. She tells me I’m not listening to her feelings. The monotonous ranting of the demon goes on and on. Emma puts her hands over her ears, and Jamie walks her toward the car, dragging two of the kayaks with them. I give up talking to Kitty and just stay with her, on an isolated bench, until she winds down.
We walk up to the playground, and I give Kitty and Emma each a protein bar. We’ve learned the hard way that she has to eat something, even a small snack, every two hours or so; she’s gained eight or nine pounds, but her body still has no reserves. We feed her as often as you’d feed an infant.
I’m expecting resistance, but Kitty opens the wrapper and begins to eat. She takes tiny bites and chews each one with infinite care, the way she eats everything now. But at least she’s eating.
Jamie looks at me quizzically—What happened?—and I shake my head: Tell you later. Emma finishes her snack and runs over to the swings. Kitty stands up abruptly and starts toward the garbage can.
“What are you doing?” I call.
“I’m done!” she answers, not turning around. “I’m throwing away the wrapper.”
“Please come here,” I say, raising my voice so she’ll hear me. I don’t know why I want her to come back. I just do.
She turns, reluctantly, and walks toward me, one hand closed behind her back. “Show me,” I say, and even so, I’m shocked when she uncurls her fist and reveals half the protein bar, uneaten.
My daughter is fourteen years old and this is the first time I know of that she’s tried to deceive me. I feel like I’m watching the scene from a great distance as it happens to someone else. Kitty’s always been the good-girl type, afraid to break the rules or get into trouble. I know she’s lied before; every kid does. But this feels different. This isn’t Kitty.
She sits down beside me on the bench, folds back the paper, and begins to eat again. She keeps her eyes cast down and her face empty. What is she feeling? Is she angry or embarrassed, frustrated or defiant? She looks like a sleepwalker—blank, quiet, driven by some force deep within her.
For the first time it occurs to me that my daughter will be permanently changed by this—this thing inside her, this twisted creature that shrieks and writhes and spits poison into her blood and bone and mind. And that, in fact, each one of us will be changed, Jamie and Emma and I. Our family will never be the same. Even if Kitty gets well—and at this moment that seems a distant possibility—things will never go back to the way they were.
Of course this is always true, in every family, all the time. Children are walking palimpsests, continuously evolving, and as parents we change along with them, accommodating and responding to who they are in the process of becoming. Part of the pleasure and reward of parenting is watching the alchemy of childhood, seeing our offspring transform themselves from generic infancy into gloriously individual adulthood. And part of our necessary sorrow as parents is having to accept the kinds of change we fear for our children.
That night in bed, I say to Jamie, “Maybe we’ve hit the bottom now, and there’s nowhere to go but up?”
“Maybe,” he says.
We are, of course, wrong again.
The next morning Kitty comes down to breakfast with her hair in pigtails, a style I haven’t seen her wear in years. She dawdles at breakfast, stirring her bowl of granola and yogurt for twenty minutes, until I say, “You’re going to be late for school.”
“I’m not going,” she says.
“Why not?”
“Everyone there thinks I’m a freak who got fat over the summer. They won’t stop looking at me.”
“Who’s looking at you?” I ask.
“Everyone,” she says impatiently, and I wonder if this is normal teenage impatience or eating-disordered impatience. I hate the fact that I wonder about this. This is another legacy of anorexia: the need to question, analyze, worry every interaction like a dog with a bone. When all I want is to be like we used to be, Kitty and I, easy with and on each other.
I tell her I think she should go and at least try to stick it out. I tell her it’s only two morning subjects, and if she starts missing classes this early in the year, it will be hard to catch up, and that will feel even more stressful. I tell her (though I doubt she can take this in) that it’s important for her to stay involved with the world as much as she can. I know that if we let her stay home today, she’ll want to do it again tomorrow and the next day.
My words seem to have no effect. So I coax her up from the table after she’s eaten. “Come on, I’ll walk you,” I say.
I have to practically drag her out the door, into the steamy late summer air. I figure once we’re outside, her aversion to public scenes will make things easier. But this morning Kitty doesn’t seem to mind making a scene. She wrenches her arm out of my grasp and balks like a horse who’s come up against a jump too high. “Why are you torturing me?” she shouts, standing in front of our next-door neighbor’s house. “Why don’t you understand that I can’t go to school this morning?”
I speak in a low, soothing tone. “Come on, Kitty, you know you have to go,” I say and try to somehow urge her down the street without actually touching her.
She glares. “Why are you doing this to me?” she shouts, her voice rising to an actual scream on the last word. I consider taking her back inside—how can she possibly go to school like this? But my gut tells me that to back down now would be to let the demon win. I’m not letting this illness take one more thing from Kitty if I can help it. She’s suffering now, I know, but her whole life is at stake. We can’t go backward, even for a second.
And so I take hold of her arm again, firmly, and try to move her down the block, one step at a time. Two doors down from our house she sits down abruptly on the sidewalk, her short black skirt flipping up for a moment a
round her waist. I’m sure the neighbors are watching, not that I care; I’m not easily embarrassed. But Kitty is, and she would care, if she could process anything but the anxiety and terror overwhelming her.
By the time we get to the school she’s fifteen minutes late, which normally would freak her out; today I’m not sure she even notices. Clearly she can’t go to her first class. Last week, we met with the school psychologist, Mr. R., an earnest young man who told Kitty she was welcome in his office anytime, even in the middle of a class. Now I tell her I think she should go to Mr. R.’s office.
She whirls toward me with a look of pure rage, her pigtails bouncing incongruously. “The minute you leave I’m going to the bathroom to make myself throw up!” she yells.
Inside my head a voice is shouting No! No! No! I’ve read enough to know that up to 30 percent of people with anorexia cross over into bulimia, and that purging complicates recovery even more. It’s the last thing Kitty needs.
What should I do? Take her home? Follow her to class and keep her out of the bathroom all morning? I’m paralyzed. Kitty makes the decision for me. Standing in the empty hallway, she says, “Fine, I’ll go to Mr. R.’s office!” Then she’s running down the hall away from me, her backpack slapping against her shoulders. She rounds the corner and disappears. I have no idea which way Mr. R.’s office is, so I don’t know if she’s heading there or not. I stand there, irresolute. Eventually I walk home.
I spend the rest of the morning cleaning, unable to concentrate on anything else, picturing Kitty in the girls’ bathroom at school, a finger down her throat, or running out the door, away from school. Running away from us. In a school of several thousand, no one would notice she was gone.
I finally unclench my jaw when I hear the front door open at the usual time. Kitty seems calmer than when I left her at school. But within minutes the demon is raging again. My heart aches for her, but I have to know.
“Did you throw up today?” I ask, interrupting the flow.
She glares. “That’s all you care about, what I eat and whether I throw up!” she shouts. “You don’t care how I feel!”
I do care about her feelings, of course I do. But what I really care about is getting her well as fast as possible. Getting her through this nightmare.
I hate the demon. I fantasize about strangling it with my bare hands, squeezing until its forked tongue protrudes. But I can’t picture that without also picturing my hands around my daughter’s neck, because the demon wears her face and speaks with her voice.
Kitty cries until she falls asleep at one o’clock in the afternoon. Clearly she’s not going back to school today. When she wakes up an hour later, she’s a bit calmer. I sit with her as she drinks her milk shake, and eventually I ask, again, whether she threw up.
The look she gives me now is weary. “I tried,” she confesses. “I wanted to. I went into the bathroom and stuck my finger down my throat. But I couldn’t do it.”
I’m not religious, but I send a prayer toward the ceiling. Thank you, whoever and whatever. Thank you for watching over my daughter.
One of the strangest things about this whole year is that despite all the trauma and drama, I have a hard time remembering that Kitty’s ill. When she smiles or makes a joke, when I see a bit of the old Kitty, it’s as if I suddenly mistrust the events of the last few months. Things can’t be that bad. Can they? I’m a pessimist, the first to leap to the worst possible scenario; my lack of sunny positivity is a family joke. Yet these days I often find myself wondering whether we’re making a big deal out of nothing. It’s not denial; three months ago I was in denial. I know without question now that Kitty has anorexia, that her life was and still is in danger. And yet every time the demon emerges I’m surprised. I thought we were past all that. It’s as if my own thinking has been compromised by Kitty’s illness. As if I’ve caught a touch of anorexia myself.
If I look beyond what I want to see, I can easily chart the rise and fall of Kitty’s distress. It jumps when she’s stressed—like now, starting ninth grade in a new school—and when we hold the line around eating. It’s as if the illness is a wild animal, snarling, backing slowly into a corner. Its outbursts are a sign of resistance. We didn’t see the demon until we started refeeding her. In a way, it’s a measure of our effectiveness.
For instance, the night after Kitty tries to make herself vomit at school is a bad one. We get dinner into her, and a bite or two of the bedtime snack, but then we give up. Jamie stays in her room, holding on to her, keeping her safe as she rages and cries, while I put Emma to bed.
Emma’s room is dark and quiet, with two closed doors between her and Kitty’s radiating misery. Yet I know Emma is hyperconscious of the drama playing out across the hall. I sit beside her on the bed, as I’ve done every night since she was a toddler. This is our talking time, in the dark, just the two of us. I want to help her process what’s happening, but I don’t want to make everything revolve around Kitty. So I try to follow her lead.
Tonight she wants to talk about the anorexia. “Is Kitty going to get better?” she asks.
“Yes,” I promise, hoping it’s true.
“Are you taking care of her?”
Will you take care of me? That’s what I hear in Emma’s anxious question. “Always and forever,” I say.
We sit quietly for a few minutes. Then Emma says, “I can see the anorexia in my mind. It’s like a cartoon person, but it’s not funny.”
“No,” I say. “It’s not funny.”
“It’s wearing all black and has spiky hair.”
“Blond hair, like Kitty?”
“No, dark hair,” she says. And suddenly I can picture it too, faceless. A walking black hole that sucks everything into its open, aching mouth. Including a lot of Emma’s life.
My only consolation is that maybe watching Kitty go through this will somehow inoculate Emma against the possibility of an eating disorder. Craig Johnson, who directs the eating disorders unit at Laureate Psychiatric Hospital in Tulsa, Oklahoma, says that having a family member with anorexia nervosa makes a child twelve times more likely to develop it herself. In relative terms, the risk is still small, since only about 1 percent of girls and women develop the disease. But any extra risk is too much for me. I’ve heard of families with two anorexic daughters; a mother named Mary Ellen Clausen, who lives in central New York, started a nonprofit called Ophelia’s Place after both of her daughters struggled with anorexia. I can’t imagine what she’s gone through—what their whole family has gone through. Then again, before anorexia, I could never have imagined what Kitty’s going through now.
Back then, I wouldn’t have thought it important to understand the inner reality of an eating disorder. People suffer in so many ways—it’s not possible to get them all. Anorexia, I would have said, is one of many illnesses, and thank God it hasn’t happened to my family.
I don’t feel that way anymore, of course, because it has happened to my family. But self-interest is only part of the urge I feel to make people get it, give them a taste of what it’s like to have anorexia. Only a small subset of the population is biologically predisposed to have an eating disorder. But we’re all vulnerable in some way. I’ve had panic disorder for as long as I can remember, and the experience has shaped me profoundly. I’ve watched friends struggle with depression, bipolar disorder, anxiety disorder—the kinds of illnesses we all think happen only to other people. Advocates for mental health parity say that for every piece of parity legislation that’s been introduced, there’s a legislator with a spouse, a family member, or a close friend who struggles with some form of mental illness. We don’t get it until it gets us. But one way or another, it gets us all.
The next day, I take Kitty for her weekly weigh-in. Dr. Beth schedules us as her last appointment of the day, and she often stays to talk with us long past closing time. As usual, Kitty’s anxiety rises as the afternoon wears on. Getting weighed for her is a no-win situation. The demon wants her to lose weight, or at least n
ot gain; the part of her that’s separate from the anorexia wants to gain weight, both because she wants to please us and because she wants to get better. “I want my life back,” is how she puts it. “I have no life now.” If she doesn’t gain weight, she suffers our disappointment, and her own. If she does, she suffers a cascade of anorexic thoughts and feelings, the wrath of the demon.
At the office, the nurse hands Kitty a cup and ushers her into the bathroom for the usual ritual. Then comes the moment of truth, when Kitty steps onto the scale, her back to the machinery, and waits for the nurse to nudge the metal weights into perfect alignment. I try to keep my face blank, though Kitty says she can always tell by looking at me whether she’s gained or not.
Today the scale shows neither gain nor loss. My heart sinks, even though I know that metabolism is complicated and weight gain is not a linear process. But I need to feel like Kitty’s moving forward, even at a glacial pace. Plus, some days I’m overwhelmed by the feeling of being way out here on our own. It’s not just that no one is telling us exactly what to do, that we’re more or less feeling our way through the dark and scary forest; we’re actually going against the conventional wisdom. If we’d taken the accepted route, Kitty would be an inpatient now at a hospital an hour away. Instinct tells me that that wouldn’t help her, that in fact it would harm her. But Jamie and I don’t know what the hell we’re doing. I’m not a doctor. What if my judgment is compromised? What if I’m just wrong?
Dr. Beth comes in with her usual smile. Tucking a strand of blond hair behind one ear, she looks over Kitty’s chart and reassures me that by every objective measure, Kitty is improving. Her heart rate’s up into the 70s; her pulse and blood pressure are good. Despite today’s stagnant scale reading, Kitty has gained fourteen pounds in the last seven weeks.
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