Brave Girl Eating

by Harriet Brown

  What she says is just right: “That would not be a good idea for you, Kitty.”

  “But all my friends will fast, and I’ll feel awful if I don’t,” says Kitty. “How about if I just eat lightly?”

  “Nope,” says Dr. Beth. Thank God.

  In the end, the nagging sense of unease I have about Kitty’s target weight is resolved in the best possible way: she begins to grow. By the end of September she’s half an inch taller, which means her target weight goes up too. For the moment, anyway, we’re back to straightforward refeeding. Spare no calories. Full steam ahead.

  { chapter seven }

  In Which We Take On the Insurance Company, and Lose

  It wasn’t simply that I chose not to eat; I was forbidden to. Even thinking about forbidden foods brought punishment. How dare you, this voice inside me would say. You greedy pig.

  —ANONYMOUS ANOREXIA SUFFERER, quoted in an online “thinspiration” video

  Every family deals with anorexia in its own way, just as each family deals with—well—everything in its own way. One of the long-standing arguments for the screwed-up-psychodynamics theory is that by the time families get to treatment with an anorexic teen, they tend to look rather similar: resistant child, angry/worried/overwrought parents. Lots of tension, especially around meals. Lots of frustration expressed on all sides, especially around meals and eating. Lots of criticism, also related to food and eating.

  But this homogeneity is superficial. There’s no better way to see what a family’s really made of than to go through the process of refeeding. Anorexia and its horrors can highlight every little crack in the mirror of a family’s self-image; it can also take a hammer and smash the whole thing to bits.

  In their 1994 book Helping Families Cope with Mental Illness, psychiatrist Harriet P. Lefley and professor of social work Mona Wasow write:

  Families [struggling with mental illness]…must deal with disrupted household routines; time investments in negotiating the mental health, housing, social security, and sometimes the criminal justice systems; impaired relations with an unsympathetic outside world; financial burdens; psychological and career impact on other household members, and difficulties in finding alternatives to hospitalization…. Families must learn to cope both with the patient’s behavior and with their own reactions; to balance the patient’s needs against those of other family members; to perceive when expectations are too high and too low; and to know how and when to set limits. They must deal with unwarranted guilt feelings, learn to handle their anger, tolerate the suffering of people they love.*

  I cringe at the label mental illness. Yet there’s truth here. Janet Treasure, a psychiatrist at the Maudsley Hospital in London who specializes in treating eating disorders, says that caring for a child with anorexia is just as stressful as caring for a child with schizophrenia or other serious psychiatric disorders.

  I believe it. Taking care of Kitty has been the hardest thing our family has ever gone through. Harder than both girls’ colicky infancies. Harder than my bout with postpartum depression after Emma was born. Harder than surviving the ups and downs of the freelance world, or the week Emma spent in the hospital with Kawasaki disease.

  It’s harder because the range of emotions is so much greater, and because the literal exigencies of this process are so complex. There’s the denial at the start, followed by dawning comprehension, shock, and horror. There’s shame and self-blame, guilt and doubt. There’s anger and frustration. And then there’s the sheer exhaustion, physical and emotional, of battling a force you can’t physically touch and don’t understand.

  I know families who put a child into residential care because they need a break, and I don’t think badly of them for it. “For a year and a half, anorexia consumed our whole family,” one mother tells me. “We had a bit of breathing room when she was away. Time to think.” I can’t imagine sending Kitty away and being able to relax. But I also can’t imagine dealing with the demon every day for a year and a half.

  And then again, the fallout isn’t entirely negative. There’s a growing movement toward involving families more in the mental health treatment for their children, whether they’re dealing with bipolar disorder, eating disorders, depression, or autism. The days of experts “fixing” a child—or attempting to “fix” the child—are over. This isn’t to say that families should go it alone without professional help. But part of the pleasure as well as the burden of being a parent is engaging with your kids, no matter what’s going on with them. Caring for Kitty now—despite the demon—feels more satisfying than watching her starve and not being able to do anything about it.

  The events of the last few months have taught me a lot about our family’s strengths and weaknesses. On the plus side, we’ve practiced attachment parenting from the start, and both Kitty and Emma seem to trust us. In times of trouble, they tend to turn toward the family rather than away. We know them, and each other, pretty well. We’re a communicative family, and I think we do OK at expressing feelings and listening to one another. That was one of Hilde Bruch’s critiques of “anorexigenic” families, families that produce (in her view) children who must resort to anorexia in order to express themselves. Bruch believed that families like ours shut down their children’s true feelings and engender a kind of intimacy based on falseness and superficiality.

  I’m ready to take the blame for anything I’ve done that might remotely have harmed either of my daughters. But on this point, I think Bruch was wrong. Both Kitty and Emma have been enthusiastically telling us how they feel and what they think from the time they learned to talk. For the most part, we’ve been listening. Not perfectly or all the time, but consistently and enough. More than many parents.

  I sound defensive, I know. Like so many of my generation, I grew up in a household where children were supposed to be seen and not heard. My parents brushed off my feelings, telling me that if I just stopped thinking, everything would be all right. Maybe they didn’t know what else to do; maybe that’s what their parents had said to them. But I grew up determined to listen to my children, even if I didn’t want to hear what they said.

  Another of our family strengths is the fact that Jamie and I have very different temperaments. I’m quick—sometimes too quick—to take action and rush to conclusions; he’s a think-about-it-from-all-angles kind of guy. I’m loquacious; he’s more reserved. I like to—need to—talk things through, while he’s more private. He processes situations slowly; I tend to leap first, ask questions later. I’m empathetic, sometimes overly so, while he maintains more of an emotional distance. At times these differences have proved problematic for us as a couple. But they’ve made us more resilient and resourceful parents.

  For instance, when we started this process of refeeding Kitty—only seven weeks ago?—I researched anorexia, came up with the plan to do family-based treatment, got things rolling. Jamie was slower to come to terms with what was happening. He got frustrated and angry more often than I did. “Why can’t she just eat?” he would ask me in the privacy of our room. “I just can’t understand this disease.” I didn’t understand it either, but I didn’t need to. I was focused on the next step, and the next. What did we have to do today? Tomorrow?

  Now, however, we’ve switched roles. I’m the one who often loses patience first, who paces or frets when the demon emerges. I’m restless, always in motion; I clean and tidy obsessively and still have too much anxious energy at the end of the day. Jamie can sit with Kitty indefinitely as she weeps or rages. He’s the calm and steady presence these days. On one of Kitty’s bad nights not long ago, Jamie took her upstairs while I stood in the middle of the kitchen, overcome. I picked up a dirty plate, to load it into the dishwasher, and instead hurled it at the floor, where it smashed in a satisfying spray. It was so satisfying, in fact, that I broke three more. The only thing that stopped me was remembering that Kitty needs big plates. She’d freak out if I served her food on small plates, because it would look like she was eating so much more.
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  Jamie would never have broken plates on the kitchen floor.

  On the other hand, he’s less assertive about what and how much Kitty eats. He’s hesitant to push for more and often holds back instead of actually dishing out the food and requiring her to eat. The concept of counting calories in either direction is strange to him; that and his natural reticence make him hesitant to plunge in.

  If Kitty gets well, all the struggles and suffering will have had a purpose, and the hardest thing we’ve ever done will also become the most important and most satisfying thing. And if Kitty doesn’t get well?

  I can’t, I really can’t imagine that.

  One morning in early October, when I collect the mail, I see an envelope from Kitty’s school. I open it absently, thinking it’s a progress report. Instead, Kitty’s school picture stares up at me, taken the day she registered for school, nearly two months ago. It’s shocking to come face-to-face once more with her huge, shadowed eyes, the exhaustion and despair written on her gaunt face. I slide the photo back into its envelope and bury it at the bottom of a dresser drawer. This is one school photo that’s not going up on top of the piano.

  But I’m also encouraged by this glimpse of how much progress Kitty’s made in the last six weeks, progress it’s hard to see on a day-to-day basis. Before anorexia, I tended to think about time in chunks—this week, this month, this season. This day. Now time has telescoped down into the intervals between Kitty’s meals and snacks. Each takes on its own character and rituals. Midmorning snack, for instance, which these days often comprises several slices of toast with cream cheese. Kitty arranges them on a large plate and methodically cuts them into squares with a knife and fork. She spears them, one at a time, and slowly chews them. It takes her twenty minutes to consume three slices of toast. Which feels like a long time when I’m sitting at the table with her, buttering my own toast (I’ve learned the best way to keep her eating is to eat along with her), but which is only half the time it took her to eat the same snack two weeks ago.

  Progress. I’ll take it.

  Each day has its rhythms, too. Eating seems easiest early in the day for Kitty, both physically and mentally. As the afternoon wears on she complains of stomachaches, indigestion. She bargains and pleads. The demon is far more apt to make an appearance between, say, five o’clock and bedtime than earlier in the day.

  She’s particularly resistant to the daily milk shake, asking why she can’t have a smoothie instead. “Peaches and yogurt sounds delicious,” she says, and I’m tempted, because it’s such a pleasure to hear her say that any kind of food sounds delicious. But a peach smoothie is three hundred calories, tops, while a Häagen-Dazs milk shake is about a thousand. Kitty swears it’s not the calories; she just prefers the taste of a smoothie, honest.

  We tell her no, sorry, milk shakes are a must. I ask Dr. Beth to “prescribe” a daily milk shake, and that helps. A little.

  For many kids, the descent into anorexia begins with restrictions that could be reasonable. Vegetarianism, for instance. I was a vegetarian for fifteen years; I’m certainly not wedded to the idea of eating meat. But I’ve heard too many stories about teens who go meatless (and often vegan) right as they’re developing an eating disorder. Coincidence? I doubt it.

  I’m convinced that Kitty’s preference for smoothies over milk shakes comes from the anorexia, not from her natural tastes. But when, exactly, did the shift begin? I think again of the sixth-grade “wellness” class that inspired her to cut out desserts. I bet other kids in that class cut back on sugar for a day or two, but Kitty’s probably the only one who stuck to her resolution for weeks and weeks. Was that the beginning?

  Years ago, Walter Kaye discovered lower-than-normal levels of the neuropeptide galanin in the brains of people who’d recovered from anorexia. Galanin is a kind of amino acid made by the brain, and its role is to stimulate an appetite for fat. Low levels of galanin likely lead to an aversion to eating fat. I wonder how long the subjects in his study had been recovered. Six months? A year? Ten years? I wonder if levels of galanin ever recover. Or is it possible that people who go on to develop anorexia make less galanin in their brains from the start?

  Will Kitty’s tastes change back, once she’s recovered? Will she ever dig in to a plate of sesame chicken with the same innocent pleasure? Will the eating disorder rob her of her original appetites? Or is that loss part of growing up in this culture—acquiring guilt and anxiety over every bite we put into our mouths? So many women eat the way Kitty does, avoiding fat and calories; do they do it out of a wish to be thin, or true preference?

  A few years ago, researchers identified a fat receptor protein known as CD36, found on the surface of human cells and throughout the body, including on the surface of the tongue. Recent research done by Nada Abumrad, a professor of medicine at Washington University School of Medicine in St. Louis, suggests that some people may naturally have higher levels of CD36, which may lead to a taste (and even a craving) for fat. Maybe people like Kitty who develop anorexia are born with lower levels of CD36. Maybe the disease process of anorexia alters levels of these fat receptors. Or maybe anorexia masks Kitty’s true tastes.

  Whatever the cause, what I want to know is simple: Will she ever again eat the way she used to?

  As October proceeds, Kitty goes to school most days, if not eagerly then at least willingly. She spends part of her sessions alone with Ms. Susan. She seems livelier, more interested in the rest of the world. She still complains about stomach pain every time she eats. But she does eat everything we put in front of her.

  One day she comes home from school with news: one of her friends is joining the school gymnastics team, and she wants to join too.

  I love seeing her excited about something. One of anorexia’s most devastating consequences is isolation. But gymnastics? Everything in me says no. Gymnastics was part of how Kitty got where she is now—the emphasis on form and line and how she looked in a leotard. The hours of strenuous practice. The constantly sprained ankles and pulled tendons. The stress of competing in meets.

  And something more: my sense that the coaches, however pleasant, however good with the girls, saw them as gymnasts rather than children and teens. What I mean is that they saw them as interchangeable elements of the team rather than as whole people. There wasn’t much warmth, despite the fact that most of the girls, including Kitty, spent ten or fifteen hours a week at the gym, spent years training, practicing, and competing.

  All last spring, as Kitty began to slide, her coaches never raised the issue of an eating disorder, not to her and not to us. When I called the head coach to tell her that Kitty was in the ICU, I asked if she’d ever known a gymnast with an eating disorder before.

  “Of course,” she said. “Unfortunately, it’s fairly common.”

  “Did you know Kitty had a problem?”

  The coach said cautiously, “I’m not surprised.”

  “Why didn’t you say anything to us?”

  Did they think we’d dismiss their concerns, get defensive? Did they worry that we’d pull Kitty off the team? Or maybe they didn’t consider it a big deal. Maybe eating disorders are so common in gymnastics, they’re not even worth discussing.

  I really wanted to know. But the coach said nothing. “She won’t be coming back,” I said, and hung up.

  “Just say you’ll consider the high school team,” begs Kitty now. That night Jamie and I talk it over, going around and around. My gut tells me it would be a mistake to say yes. She’s still way too thin, and emotionally fragile. We haven’t seen as much of the demon in the last ten days or so, but we have seen a lot of tears and anxiety. Jamie argues that maybe gymnastics will motivate her to recover. Plus, it’s hard for him to say no to something she cares about so passionately. It’s hard for me, too; I don’t want to be the killjoy. Maybe I’m overreacting. Maybe I’m letting my own fear get in the way of her recovery. Or maybe the emperor truly has no clothes.

  Eventually we come to a compromise: the hi
gh school season doesn’t start for another month. We’ll let Kitty go to the gym once or twice a week to practice with her friend, as long as she keeps gaining weight. And we’ll ask Ms. Susan what she thinks of the idea.

  Over the next few days, Kitty’s anxiety becomes palpable. At dinner one night, the demon digs in its heels over a plate of chicken Parmesan. Not-Kitty pushes the plate away so it skids into the middle of the table, chicken and buttered noodles flying everywhere. “Why are you doing this to me?” she shouts, her voice rising to an eerie scream, dripping with rage and self-loathing. The demon’s voice is relentless and reptilian, its vocabulary poorly developed but effective. I’ve heard this voice in my own head, though it’s more like me talking to myself—a mean version of me, sometimes a downright cruel me, but still me. Whereas the demon in Kitty seems so other, so different from her.

  This concept may not be as bizarre as it sounds. More than thirty years ago, psychologist Julian Jaynes suggested that consciousness is a function of neuroanatomy—specifically, of the corpus callosum, the fibrous band that connects the right and left hemispheres of the brain.* His theory was that thousands of years earlier, before the two halves of the brain evolved a connection, they functioned independently. He pointed to the many biblical and literary references to earlier peoples hearing voices or seeing visions, which they interpreted as messages or visitations from God or the gods. In fact, Jaynes believed, they were communications from the other side of the brain.