Hungry

by Sheila Himmel

  I don’t like the director. I’d have to miss school. I’m not going.” A few months later, she got a job, met her boyfriend, moved into a new house, and was engaged in her classes.

  Our Lisa was back! Why mess with success? For a while we insisted that she continue in psychotherapy, but she hadn’t made a good connection with either therapist in Santa Cruz, was blowing off appointments, and didn’t want to try another one. Professionals call a phase like this a “flight to health,” meaning the patient hasn’t dealt with underlying issues or followed a treatment plan, but just wants to fly away and try to have a normal life. We were worn out, and naively hoped that acting healthy could become being healthy. It was a false start, but Lisa did have almost three manageable years before crashing again.

  In the end, what helps? Here are ten things Ned and I learned we needed to deal effectively with Lisa’s eating disorders: 1. One professional who really relates your child. For Lisa, a psychoanalyst who specializes in eating disorders turned out to be the one. We were as surprised as anyone, but right from the start, when Lisa was trembling from medications and barely spoke, Dr. Cohen conveyed understanding and hope. And soon we saw progress. It’s been very bumpy, but Lisa has pretty much traded in the protective rigidity of anorexia and the oblivion of bulimia for a real life. That is a huge success.As we discussed in the previous chapter, experts on eating disorders run the gamut of credentials and degrees, including pediatricians, psychologists, psychiatrists, nurses, and nutritionists. In addition, their theories and practices range from dialectical behavior therapy, based on a concept that everything is composed of opposites, to structural family therapy, focusing on how family members communicate and solve problems. What matters is that the expert listens in a way that makes your child feel heard and talks in a way your child understands. You’ll know it when you see it. Most important, this person should be someone both you and your child trust. The ED industry is only too willing to take your money. Progress is so slow and full of setbacks, parents have to wonder if even the most highly regarded experts know what they’re doing.

  But first, you have to get your child to go. Teenagers tend to resist any kind of help, and with young adults you may have zero leverage legally. If your child is over eighteen and refuses treatment, you can withdraw support and force the issue, knowing that the risk is finding them on the street or dead. (A recommended book on the subject of when to force treatment is Xavier Amador’s I Am Not Sick and I Don’t Need Help! Vida Press, 2007.)

  2. Your village. Our nephew and his wife camped at our house. When we were away and Lisa was hospitalized, our sisters flew in and organized the troops, which included my mother, my aunt, and our cousins in the Bay Area, Chicago, and Portland. Friends, neighbors, and colleagues circled the wagons.There may be an overload of advice. Often it is best to say thank you and be on your way. It’s great that your hairdresser’s son had success with Abilify for bipolar disorder, but that may not be relevant to your situation. Remember that they are only trying to help. Other friends and family will make you dinner, force you to go to a movie, hold you together. They may also be the best source of referrals—we found Lisa’s doctor through a friend—and backup—when Lisa ran away, a friend helped us find her.

  A family support group may also help, but it needs to have a skilled leader, more like a teacher than a physician. Stressed parents and siblings easily go off topic, dominate the discussion, or hold back when they need help the most. A good facilitator makes sure group members get what they need, whether it’s a resource, referral, or empathy.

  3. Books about other subjects. Whatever gives you comfort, read it again and keep it close. During Lisa’s runaway month, someone gave me Jumpha Lahiri’s collection of short stories, Unaccustomed Earth. Lahiri writes about being the adult child of aging parents. The stories resonated for me, in a completely different situation with adult children. I read this book of stories twice.I also returned to The Runaway Bunny, one of Lisa’s favorite books as a child. It is the flip side of author Margaret Wise Brown and illustrator Clement Hurd’s hypnotically calming Good Night Moon. When the little bunny comes up with ever-more fanciful plans to run away from home, his mother doesn’t panic or get angry, but keeps saying, basically, Raise the ante all you want, I’ll be there for you. “If you become a sailboat and sail away,” said his mother, “I will become the wind and blow you where I want you to go.” All of this, “Because you are my little bunny.” These lines soothed me, helped me cling to a belief that whatever was tormenting Lisa, whatever her hungers, Lisa still carried this feeling.

  Of course, we also read books about eating disorders.

  4. Exercise. No thinking, just doing. It’s hard to ruminate while rowing. Find an exercise that gets your heart going, or at least gets your mind off its disaster movie. Some people swear by Bikram yoga, an hour and a half of sweating that, like rowing, includes your whole body and pretty much excludes thought.Since Lisa became anorexic in high school, my exercise regimen has ramped up, from the treadmill to the elliptical trainer, weight-training, and rowing. At the worst times, I felt if I could just lift the same weights as yesterday, or even add a little, I could handle whatever trial was coming next. I loved the feeling of warmth in my muscles and my Michelle Obama arms. As a collateral benefit, our nearby YMCA is the place where we find out all the neighborhood news.

  5. Laughter. Science has shown that humor helps patients relieve stress and heal. The same is true for caregivers and families, but if you’ve just spent an hour weeping into a pillow, good luck getting up and finding something clever. I often felt our situation was too precarious for laughter. Movies and TV shows that once seemed funny did not do the trick anymore, and often made me feel worse. As in, “I used to laugh at that dreck? How pathetic. Nothing else makes me laugh, either. I have completely lost my sense of humor.”It wasn’t true, exactly. I found other dreck to make me laugh, including flings with Desperate Housewives and What Not to Wear. Also, I am married to someone who makes me laugh.

  6. Work—paid or volunteer. The tendency to obsess about your child’s illness is overwhelming; work is a great diversion. It was easy to lose myself in a story or momentarily forget my troubles as I discovered a new food or restaurant. I also appreciated the time I was able to participate in the outside world—a world beyond illness. During Lisa’s first descent into anorexia, I kept reviewing restaurants and writing about food for the Mercury News. Four years later, when she crashed again, the media world had darkened. But I had taken early retirement from a newspaper I loved and was able to devote more time to Lisa. We were fortunate to have health insurance from Ned’s work, so I was able to write this book and pick up freelance assignments.I volunteer at a local elementary school twice a week, in a program for English-language learners. Not only does it give me something to do besides worry endlessly about Lisa, if not the economy, I get to help somebody in a concrete way. One year, my third-grade student started in September at a 2.3 reading level (equivalent to the third month of second grade) and in June scored at 4.6. He did the best out of the program’s ninety students. At some point during that year, I could see the joy of reading clicked with him. Even when I felt like a failure in my relationship with my daughter, working with these kids gave me a sense of purpose and accomplishment.

  7. Early intervention. I recently met a woman who did intervene early, and I admired and envied her. She happened to be talking on the phone to a friend one day as her fifteen-year-old daughter measured out portions of food. The daughter had become a vegetarian, and then started measuring portions to the nth degree, which the woman mentioned in an “isn’t this funny” kind of way. Her friend said no, this could be serious, take her to the doctor right now. The pediatrician recommended a nutritionist that the girl saw, often unwillingly, for a year. She never developed an eating disorder.Unfortunately, we had no such aha moment with Lisa. Ned and I didn’t recognize the problem until it was full-blown. Even then I’m not sure we would have found the righ
t help. Were we oblivious? In denial? Maybe, but it isn’t easy to decipher the difference between actionable behavior and the normal hormonal hit-and-run of puberty and adolescence.

  Your child was walking around the house singing yesterday, but slamming doors and moping around today? Does that mean she’s bipolar? Are moodiness and monosyllabic answers signs of an underlying problem, or typical of teenagers? You can come barging in, and the effect is too much too soon, or you can hang back, keep a watchful eye, and do too little too late. As NEDA’s Don Nielsen said, you often feel like everything you do is wrong. It is better to jump in, ask questions, and offer help—and risk overreacting and alienating your child—than to risk a downward spiral into severe depression or severe eating disorder. It would be great if parents could always spot the warning signs and save the child, sparing everyone a lot of agony in the moment and years later when we mull over our many mistakes. Ned and I do occasionally rewind that movie, but not so much anymore. It’s useless. Don’t do it. You love your child and you got help as soon as you were able.

  8. Getting out of bed. I sometimes wake up and study the way the pillow forms a canyon landscape with the sheet and blanket, or how the quilted blue comforter looks like a calm ocean. I could lie there and study linen shapes all day, or doze a little longer, and maybe some problem will have gotten better without me. But I know I have to get up and do something, if only to stand around and worry until I get to sit down or go back to bed. Otherwise how will I ever know about the improvement?

  9. Vacations and trips. Take them. Lisa still resents that Ned and I went to Europe when she was clearly very sick. We still second-guess that decision. But I don’t know what we would have done to change the outcome had we been there. Would she not have ended up in the hospital, where at least she was safe? Impossible to know, but what I do know is that our canceling the trip would have made Lisa feel guilty and given her another incident to prove what a bad person she was. In this book, we focused on that trip, and the weekend that forced a choice between her high school prom and my James Beard award, because they highlight our most exquisite moments of torture. This may leave the impression that Ned and I were constantly jetting off to Europe and New York, leaving a desperately ill daughter to fend for herself. Well, no. Every time we went anywhere, we assembled a multifaceted contingency plan and spent hours with Lisa on the phone in transit and at our destination. At home, we canceled events at the last minute if Lisa seemed fragile. Now I think we did that too much. Lisa needed to grow, and we needed to recharge. The unrelenting pressure a child’s illness places on parents physically and emotionally is tremendous. Sometimes all you can do is take a recess, so that everyone gets some fresh air. You do have to take care of yourself in order to take of your child.

  10. Eating well. Bodies are nourished and sustained by good, healthy food. We have to eat, and eating is fun in all kinds of ways, as I have learned in my life with Ned. Lisa and I disagree about how much my job and our food-centric family life contributed to her eating disorders. I suspect a bit of defensiveness and guilt on my part (and Ned’s), and a bit of immaturity and the need to blame on Lisa’s part. But we are gradually loosening up our fighting stances. We can even enjoy eating together again.

  These are ten things that worked for Ned and me. You may find others to add to the list. Somewhere in the thicket of emotional needs and cultural pressures, we all hack our way through. Lisa has a list of her own.

  lisa: I still have issues with food and my weight and I probably always will, although there are days when the idea of an eating disorder seems something foreign and horrible from my past. Other days, I have to meditate into a comfortable, nurturing quiet to avoid purging. I can’t help calculating the caloric contents of nearly every food. I control my portions reasonably, but I don’t use measuring cups. I examine food labels and nutrition facts, and the words “fat free” still send a shiver of excitement through my veins, but I also read the benefits of heart-healthy monounsaturated fats found in my consistent supply of olive oil, avocados, and peanut butter. I can better understand what my body needs and wants and the joy in learning how to balance and incorporate all the food groups in moderation. I’ve come to enjoy and appreciate the relieving effects of a glass of wine—good wine—with dinner, or to unwind at a bar after work with friends without obsessing about calories.

  Many people, mothers mainly, ask me how they can help with their daughter’s or son’s fear of food. The questions make me sad and worried that I’m going to disappoint them. These diseases vary so much. Among my friends with anorexia and bulimia, we all played by our own schedules and rules. I’ll do my best with what I do know:1. Watch those transition years, from middle school to high school, and especially from high school to college. If your child is struggling, encourage her to take time off and get healthy. College won’t make issues go away.

  2. If you’re worried about a friend, sibling, or child, it’s okay to say something. Don’t accuse, but do express concern. Often the ED individual takes silence as an insult. A reality check may be just what they need to realize they have an issue.

  3. Be careful with what you say about someone’s appearance. Say, “It’s great to see you!” instead of “You look great!” which young girls often take the wrong way. I know I did. Hear it often enough and you think your outer shell is all that matters.

  4. Go out to eat, but avoid buffets. One evening I was watching the TV show Intervention (which should be called How to Be a Better Addict) featuring a bulimic woman named Selena. Her sweet husband, Neil, wanted to take her out for dinner after work, but he picked an all-you-can-eat pizza buffet. Intervention then filmed Selena, up close, heaping piles of pasta, pizza, salad with creamy ranch dressing, baked potatoes, soup, ice cream, and finally cinnamon rolls onto her little plate. She kept going back, while Neil sat there helplessly. They had driven separate cars to the restaurant, so that while he was paying the check Selena rushed home in plenty of time to purge. She didn’t use the toilet, which he would have noticed. Her system was to throw up into zippered plastic bags she kept in her closet and take them out to the trash when he wasn’t looking. A young bulimic could’ve gotten a few tips from watching Intervention, but it did demonstrate the hazards of buffets.Many in recovery find it easier to just eat alone for a while, because we take any comment about our meal choice the wrong way.

  Of course, eating alone can backfire. I’ve had my own Selena scenes, alone in Fresh Choice. I had a system, too. I took my plate and began with greens, healthy enough, and then started piling on the forbidden items like bacon bits, ranch dressing, and croutons. I got a real drink instead of a diet soda and my money’s worth from the restaurant’s soup, salad, pizza, baked potato and bread sections. I especially loaded up on cheesy bread, fried chicken wings, and spaghetti sauce (the juicy-smooth quality of the sauce made it easier to purge the rest). It was like a trance. While I didn’t feel my stomach at all, I knew exactly what I was doing: bingeing and purging. In order to get a good purge, though, I had to hit up the ice cream machine, swirl out the vanilla and chocolate soft serve, and top with caramel sauce, chocolate sauce, and Oreo chunks. I ate this faster than a kid with birthday cake and then dashed to the bathroom. It didn’t take long to see the evidence of my binge before my eyes, to see the baked potato and sourdough roll, the chicken and dumpling soup, and the entire salad bar. I spent $8.99 to continue my disease. Still, my meal wasn’t complete until I went to the nearby donut shop where I bought two donuts, or an apple fritter and a glazed twist, then ate them and threw them up, too.

  At the time, I was working at a reading program for mostly Spanish-speaking kids. I spent each lunch hour bingeing, ending with donuts in the car. Then, I’d go back to work, head straight to the bathroom, jam my fingers down my throat, wipe up vomit here and there, and keep jamming my fingers down until I got all the food out. Back in the classroom, I helped a child distinguish words with a soft g from those with a hard g. I was posing as a good person, as a tut
or and mentor to kids. All they wanted was my help for an hour, but I still needed to satisfy my sickness.

  5. Don’t talk about food during meals. Very difficult, I know, but there is nothing more uncomfortable than discussions of last week’s fried chicken bucket and mashed potatoes while a recovering or hopeful recovering anorexic and/or bulimic sits hesitantly picking at her chicken and potatoes with a side salad, trying so desperately not to engage in an ED behavior. Don’t bring up body image, weight, the pretty girl you used to play tennis with, or anything to do with eating disorders. My parents often did this, and asked me over dinner if I’d thrown up that day. A hard shot of embarrassment paralyzed everything. How do I answer that? If it’s a yes, how will they feel? If no, will they believe me?

  6. Consider modifying the foods you keep in the house, at least temporarily. Maybe ask the person with the disorder for a detailed list of binge trigger foods. I know it can be hard not to have ice cream around the house, but buy it and it may not even last a day. Don’t fool yourself into thinking that writing your name on whatever you buy will make an impression on a bulimic. I ate one roommate’s entire ice cream carton and bag of chips and didn’t bother replacing them. I figured she was stupid for buying this kind of food, knowing I was bulimic, and for doing nothing about it. She could have called my parents, asked me about it, done something to show concern. As with drug addicts, with ED it doesn’t matter who you trample on to get your fix because if you don’t get it you will explode. I couldn’t have ice cream in the house, because all too easily I would start eating it right out of the carton, and even when I tried scooping smaller amounts into a bowl for portion control, all of a sudden it would be gone and I’d be bending over the toilet, puking it all out.Baked goods, chips, salty crackers, and frozen or fried foods couldn’t be in the house. Dad would sometimes buy baked goods and try to hide them in the freezer, but during a binge I would scoured the shelves for treats and would always find them. I’d stick to cereals like Special K that aren’t all that interesting to binge on. At my worst, though, I could pretty much binge on anything: a whole block of cheese or a loaf of bread with a stick of butter. Now that’s pretty hard to purge. Bread turns to clumps in your stomach and almost hurts to get out, but I never quit until I was sure. I have, at times, baked cookies or cake not intending to binge and purge them but ending up having a little, and then a little more, and then more until I had no choice—in my mind—but to purge. Once, as a peace offering to my parents after we had gotten into a huge fight, I baked a cake from scratch and spelled out “I’m sorry” on the frosting with chocolate and butterscotch chips. My parents never saw it. I tried a little corner piece, just as a taste, but then the surge of adrenaline passed through my body and a little turned into more, which became me taking a fork and diving right in.