Brave Girl Eating_A Family's Struggle with Anorexia

chapter nine

Crusts and Crumbs

Hunger is a country we enter every day, like a commuter across a friendly border.
—SHARMAN APT RUSSELL, Hunger: An Unnatural History
Years ago, when I was pregnant with Emma, I had to decide whether to have amniocentesis. I was old enough that there was a fair risk of Down syndrome and other chromosomal abnormalities, but I was pretty sure I wouldn’t have an abortion, no matter what I learned about the child I was carrying. I wasn’t keen on the idea of the test, which in itself can cause miscarriage. But my obstetrician encouraged me to have it.
“It gives you time,” she said. “Time to let go of the fantasy of the perfect child. You have to grieve the child you’re not going to have before you can embrace the one you are having.”
I had the amnio, which was normal. And I’ve thought of her analogy often these last few months. Jamie and I have had to let go of a certain image of Kitty in order to focus on how she is right now. I think about parents whose children have cystic fibrosis, spina bifida, sickle cell anemia, any of the thousands of ailments that will never get better and will never go away, that make a child’s life painful, one way or another, and may ultimately end it. We’re lucky, really; Kitty has a chance to make it through, to come out whole on the other side.
But that doesn’t make things any easier. The obstetrician was right; this is a process of grieving and letting go, acknowledging that the fantasy not only isn’t happening right now but will never happen. Intellectually, I get it; emotionally, I’m lagging way behind.
I can see, now, that I’ve been going through Elizabeth Kübler-Ross’s famous stages of grief. Denial: then, when I thought Kitty couldn’t have anorexia because she hadn’t lost a lot of weight, when I tried to talk the doctor out of transferring her to the ICU; and now, when I believe (because I want to) that Kitty’s fine and that we can slack off on watching, observing, recalculating. Anger: breaking a stack of dishes on the kitchen floor; pulling out clumps of my own hair, as I’ve done more than once; yelling, when I know it’s not her fault, when I know that she’s in pain. Bargaining: If I give up my life, stop seeing friends, do nothing but shop and cook and sit with her, she’ll be all right. Depression: not sleeping; crying a lot; feelings of despair, guilt, hopelessness. Acceptance: nope; I’m not accepting this; not yet; maybe not ever.


Two days before Thanksgiving, Kitty comes home from Ms. Susan’s lunch group distraught. She tells me she’s figured out what “the problem” is. “I’m doing this for you, not for myself,” she says.
“Doing what? Going to lunch group?”
“No,” she says irritably. “Eating. I’m eating what you tell me to. So I’m doing it for you, not for me.”
Slowly the story emerges. She’s pretty much the only one in the group whose family is doing FBT; many of the other girls have been in and out of hospitals and residential treatment centers for years. But all Kitty can see is that they’re somehow “doing better” than she is. “They seem like they’re so much more insightful than I am, Mom,” she says.
Ms. Susan warned me that competitiveness can be a problem in eating-disorders groups. I’m beginning to see what she meant.
“So what are you saying, Kitty?” I ask her. “You want to go away?”
In fact, that is what she’s saying. I can’t help but wonder if this has something to do with her weigh-in today. She weighs more than she’s ever weighed in her life by about ten pounds. In fact, she’s only about four pounds under her target weight. Could this all be a ploy by the demon, a last-ditch attempt to claw its way back?
“Kitty, you’re doing so well right now,” I begin. “It seems to me that we’d be going backward to send you away now. We’ve got momentum going. Why would you want to throw that away?”
“I knew you’d think it was just the eating disorder talking!” she cries. “But it’s not!” She pauses, then says, “Maybe I would lose a little weight at first if I went away. But I’d make so much emotional progress!”
We are talking to the demon, and it’s scary, because on one level what Kitty says makes perfect sense. She is a people pleaser, eager to do what other people want her to do. But real emotional insight and growth typically comes after physical recovery. That’s how FBT is structured, and for good reason. Starving doesn’t make you more insightful; it just makes you sicker. The demon is so very clever, taking a little bit of truth and twisting it into a lie. Right now, Kitty does have to do what we want her to, at least when it comes to eating. There will be plenty of time for her to become more independent later, when she’s recovered.
When Kitty realizes that we’re not going to send her away, she switches gears. If we’re not going to send her to a treatment center, maybe we can support her emotional growth here at home.
“We’ve been trying to do that all along,” I say carefully. “What do you have in mind?”
What she has in mind, it turns out, is to skip our traditional Thanksgiving celebration with friends, stay home, and eat dinner—alone—with another girl from the lunch group, Shelly, who’s just been released from the hospital.
I stare at Kitty. I want to say, Where the hell did this come from? Except I know where it came from—the demon, that’s where. The demon, who wants Kitty on the outside looking in. The demon, who will take every chance we give it to starve our daughter.
I get that this is a tough holiday for anyone struggling with an eating disorder. All the more reason to spend it with the people who love you, who care about you, who want you to get through it and get over it. And I get that teenagers crave autonomy. But starving at home with another anorexic for Thanksgiving? That’s the illness speaking. Not my daughter.
Anorexia wants Kitty to be as separate as possible from us, because we are its enemy. Anorexia wants Kitty to be isolated, with only the company of others who are ill, so that it can continue to sink its claws and teeth into her. I look my daughter in the eye and say, “Sorry, but you have to come with us to Thanksgiving dinner.” She storms off, crying, and after a while Jamie goes in to sit with her, to try to calm her so she can eat the rest of her food and go to bed.
She’s grumpy with us for the next few days, worrying about Thanksgiving. The day itself, at the home of our close friends Harry and Lisa, goes smoothly. Kitty sits next to me at the table and eats what I serve her—turkey and cranberry sauce and roast potatoes, bread and butter, pumpkin pie. After dinner she wants to go home. I tell her we’re not quite ready, that she can take her book upstairs to a quiet room if she wants to get away from the hubbub of nine children, six adults, and several dogs. But instead of going upstairs, she follows me around the house, standing so close to me that I can feel her breath on the back of my neck. I try to draw her into the conversation, but she stays quiet. I try to ignore her, but I can feel her silent pressure bearing down, and it irritates me. At one point I tell her she’s standing way too close, and could she please go sit on the couch? When I turn back to the conversation, she takes hold of my upper arm and pinches, hard.
“Ow!” I cry, and look at her. Not-Kitty looks back at me through a studiously neutral mask.
“I’m sorry,” she says. “I didn’t mean to do that.”
I rub my arm and stare into my daughter’s face. Kitty didn’t mean to do that. The demon did.
We go home.


The next week, Jamie and I accompany Kitty into the session with Ms. Susan. It’s time for a family check-in. In traditional FBT, Emma would come to the session too. But Emma begs not to go, and I don’t have the heart to force her.
Kitty is eloquent on the subject of wanting to take control of her eating once more. She tells Ms. Susan what she’s told us: that she feels her recovery won’t count somehow unless she does it herself and not us, that she wants to go away to a treatment center, that she wants us to back off.
Ms. Susan turns to us. “Are you ready to give Kitty back control over her eating?” She barely gets the words out when both Jamie and I say no, she’s nowhere near ready. Susan turns back to Kitty.
“Your parents say you’re not ready,” she says. “You’re still under your target weight. I think if you want some control back we should talk about very small steps, and make sure they’re working before we move on to anything more.”
Together she and Kitty come up with an idea for a first step in that direction: Kitty might eat lunch at school once a week instead of coming home. “Could you arrange to eat with someone specific?” asks Susan. “What about the guys?” Kitty’s been spending time with a couple of guy friends, Martin and Garth. I find it interesting that as she recovers she chooses to hang with them more than with female friends. Neither Jamie nor I picks up any sexual tension; it’s more camaraderie, doing things together. Friendships among girls at this age tend to focus on talking about feelings and emotional interactions and, increasingly, boyfriends. Kitty’s avoiding those kinds of conversations right now. She’s not really in a place where she wants to spill her guts to other people, and I can’t blame her. Plus, there’s the added bonus of how much high school guys eat.
We agree that Kitty can try eating lunch at school once a week with Martin and Garth. “Or I could eat with Shelly,” she says.
“If Shelly even eats lunch,” says Ms. Susan conversationally.
“Eat with the guys,” I say firmly.
Then Jamie, who tends to be quiet in therapy sessions, starts to talk. As the fall has progressed, I’ve been spending more time at work, and he’s been in the trenches with Kitty. He’s the one who makes the peanut butter and honey sandwiches at lunch; he makes the daily milk shake, and sits with her as she drinks it. Now he brings up something that’s been troubling him for weeks: Kitty’s tendency to leave food on her plate. Sometimes it’s sandwich crusts; sometimes, though, she crumbles food and spreads it around on the plate.
“It upsets me when you do that,” he says, and Kitty immediately bursts into tears, burying her face in one of Ms. Susan’s overstuffed pillows. “It would be a lot easier for me to say nothing,” he continues. “But I’m trying to take care of you, and I need to bring up the difficult things.”
I am moved, as I have been so often this fall, by his willingness to not just show up but stand up for our daughter. It’s hard to say these things to Kitty right now. It’s hard to watch her fall apart. I think it’s especially hard for him, because he comes from a family of enablers and avoiders. He’s the kind of man who doesn’t seek out conflict. Our roles here have flipped; I’m usually the confrontational one, always up for challenging the status quo. But I find it so painful to articulate what I’m seeing these days that I’ve retreated into silence more and more. Kitty’s lucky to have him for a parent, though she may not feel that way right now, or for the foreseeable future. About either of us.
The day after our session, Kitty seems much calmer, more relaxed. After school she works on a jigsaw puzzle with Emma and me, though she says she doesn’t like puzzles. She’s nicer to me, giving me a spontaneous hug in the kitchen as I make tea. Most of all, she’s clearly making an effort to eat more of what’s on her plate. We measure her progress in crusts and crumbs, and keep going.


December is busy, as usual. There are school concerts and neighborhood potlucks and holiday parties, and every one of them involves food. This year we attend as few as possible: Emma’s violin concert, my office holiday party. Kitty hits a couple of rough patches: finals are looming, and Ms. Susan thinks some of Kitty’s anxiety comes from the pressure she puts on herself to not just do well in school but do perfectly. On her advice we pull Kitty out of school two weeks before the end of the semester and have her guidance counselor let her teachers know she will not take finals for medical reasons. Immediately Kitty seems more relaxed, better able to eat.
“People with eating disorders don’t tend to do well with stress,” Ms. Susan reminds us for the hundredth time.
No. Well. Neither do their families, at the moment.
The second rough patch has to do with sleep—or rather, the lack of it. Kitty’s had insomnia on and off since last spring. The psychiatrist has tried a variety of medications, none of which have helped. In early December, Dr. Newbie prescribes Ambien. It’s not particularly helpful; Kitty falls asleep fast but still wakes up several times during the night. And she’s groggy in the morning, even though I’m giving her only half a dose.
After a couple of days on Ambien, Kitty’s still not sleeping well. She complains of anxiety, says she can’t concentrate or read. One evening she starts to hallucinate, rolling her eyes, backing away from some invisible threat. I don’t give her an Ambien that night. The next day I call a friend who’s a psychiatrist, who tells me that Ambien can cause paranoia and a psychosis-like state, especially in children. Why didn’t the psychiatrist mention that when she prescribed it? Or the pharmacist, when we filled it? Someone should have told us to watch out for a reaction like this. Shouldn’t they have?
I toss the Ambien. Better living through chemistry isn’t the answer here. Alas.
Our days take on a semblance of normality, one that includes the regular, predictable landmarks of three meals and two snacks a day. But by mid-December, Kitty’s weight hasn’t budged; after nearly five months of refeeding, she’s still ten pounds below her target, in part because she continues to grow.
I’ve spent time recently on a couple of online forums for families with eating-disordered children—one that focuses on the Maudsley approach, and another, bigger site that’s more general. It’s a relief to know we’re not alone, that other families are doing what we’re doing, and succeeding at it. But it seems like other people’s children gain weight much faster than Kitty.
I realize how much like an anorexic I sound—competitiveness is a hallmark of the illness. The truth is, I want this to be over. For fourteen years my daughter has been a daily part of my life, and I miss her. I miss the small moments most. Occasionally we’d walk arm in arm to the grocery store or park, our legs moving in sync, and Kitty would give a little skip so we’d be off beat with each other—her right leg moving with my left leg. I’d skip again to put us back in sync, and then back and forth we’d go, hopping and adjusting until finally we were standing on one spot jerking and hopping and laughing so hard we couldn’t breathe.
I miss her clear-eyed way of looking at the world. It’s funny: before Kitty was born, my biggest fear about becoming a parent was having another person in the house, seeing everything I did. I felt abashed at the thought of a child who would see me at my worst, most disheveled, crankiest. I worried that this baby would grow up to be a child who judged me harshly. Who held my heart in her two hands and found it unlovable. But all my self-consciousness and worry fell away once she was born, because she wasn’t a faceless watcher, she was Kitty, who was known and loved and loving. Parents and children are hardwired to love each other. But I liked Kitty. I like her.
And I want her back. I want her healthy and well so we can keep getting to know each other. So we can think about other things, travel and plan and be spontaneous in ways we can’t right now. And I don’t understand why it’s taking so long for her to gain weight.
Though I do, really. Her goal weight has gone up since August because she’s grown, and I think there’s more to come. So we’re aiming at a moving target. And she’s become more physically active over the last month or two, with Dr. Beth’s encouragement. She’s started taking a weekly class in Israeli dance. And she’s spending more time with the guys.
One December afternoon, Martin rings the doorbell to see if Kitty wants to hang out. She’s working on a milk shake, and I offer to make him one. “Thanks!” he says enthusiastically.
He doesn’t say, “Oh, I really shouldn’t, I’m too fat.” He doesn’t say, “My butt’s too big already!” He doesn’t say, “Do you have any frozen yogurt instead?” He sucks up the milk shake in under two minutes, then turns to Kitty.
“Yo, hurry up with your ten-million-calorie milk shake!” he says.
I hold my breath, waiting for Kitty to snap or fall apart. Instead she giggles, finishes the last of the shake, and jumps off the couch. “I’m ready,” she says, and off they go. And that’s it. Not that they don’t talk, she and the guys—they just talk about different things. And they do things. They take apart bikes and ride them. They play foursquare in the street outside our house. They do homework together. They go to the movies.
We couldn’t have arranged anything better if we’d tried. Which comforts me, and reminds me that I’m not in charge, thank goodness, of every aspect of my daughter’s life. That she’s a resilient, savvy kid who’s good at finding what she needs a lot of the time.
We still have to be vigilant. Her irrationality about food is matched by her hyperactivity. She’ll push herself way beyond the comfort zone physically and then pay the price. One evening, right after dinner, Jamie takes her rock climbing, an activity they’ve done together since Kitty was four. She comes home a mess, refusing the bedtime snack, rocking back and forth on the sofa, literally wringing her hands.
“Kitty, I love you,” I tell her, holding a pumpkin chocolate chip muffin on a plate. “And I expect you to eat this snack.”
She turns her face away from the plate and keeps rocking. “You don’t understand,” she chokes out. “You don’t understand how hard it is.” And then: “Please love me no matter what!”
“Of course I do,” I say. But something has tripped the switch again. I think back over what she ate today, and realize that dinner—fish, broccoli, squash with butter and brown sugar—wasn’t especially high-calorie. It was a good meal, a nutritious meal; but maybe Kitty’s metabolism is so sensitive right now that we need to match every “extra” outgo of calories with an equal intake. Or, clearly, more; she’s been stuck at the same weight for six weeks now.
A few nights later, we replay the same scene. It’s not the demon, exactly—more like its shadow falling over Kitty. She sits at the table, refusing to eat, and I sit with her, trying to project patient firmness. “Part of me wants to eat, but part of me doesn’t!” she says. I’m impressed that she can articulate this so clearly; if only saying it out loud made that shadow disappear.
For my part, I’ve learned to stay on-message, as politicians say. No matter how articulate Kitty is, it’s best for me to keep on reiterating the basic truths. So now I remind her, for the hundredth time, “Food is your medicine. You just have to eat.”
“I can’t, I can’t,” she says, sobbing.
“You can,” I tell her. “You’ll feel better.”
Later that night I sit beside her as she falls asleep, looking at the glow-in-the-dark stars on her bedroom ceiling. And as I lie there it’s as if a movie starts to play on the dark screen of my mind. I see Kitty in the ICU, her eyes closed, her arms limp at her sides. I see the long, snakelike tube sliding up her nose, disappearing into her body. I see a faceless nurse, her body radiating anger and irritation, unable to tell the difference between my daughter and the disease. I touch the skin on Kitty’s back, which is smooth and warm, flesh over bone; but I feel the ridge of her shoulder blade, sharp enough to cause a bruise. I see her sticklike arms and legs, her shrunken features. I shake my head, put my fingers in my ears, chant silently: No no no.
What’s that corny expression? “Do you curse the darkness or light a candle?” I’m groping for the candle, but I can’t find the matches, and my hands are shaking so badly that no matter how many times I try, I can’t strike a spark. I’m hoping that the act of groping itself will somehow bring on the light.
That’s how I feel right now. Other times, I feel sure we’re on the right track, that Kitty will be OK. And still other times, the knowledge and reality of what she’s going through takes up every bit of space inside my body. The pain of it washes through me like blood, flares when I breathe. My skin feels tender and hot and bruised; my brain feels swollen and slow. Those times I literally want to jump out of my body. Like Kitty, I want someone to make it stop.
And Emma does too. Emma, who calls me from school the next day, sobbing, saying she can’t stop thinking that we’re all at home, dead, and she’s supposed to save us and can’t. Ten-year-old Emma, who feels powerless and overwhelmed and scared just as we do. Who cries at the dinner table later, saying she’s not hungry, she can’t eat.
A shaft of pure ice lodges in my chest when I hear this. Anorexia’s heritability—meaning how much of it is caused by genetics rather than environment—is hard to pinpoint. The ongoing Genetics of Anorexia Collaborative Study, sponsored by the National Institute of Mental Health, is creating a repository of genetic information about people with eating disorders and their families. “We now know that [eating disorders] occur when there is a perfect storm of events that include genetic vulnerability and a culture that is promoting thinness through dieting and exercise,” says Craig Johnson, director of the Eating Disorders Program at Laureate Psychiatric Hospital in Tulsa, Oklahoma, and one of the study’s principal investigators.*
Emma is clearly at risk. Her sister has anorexia; her great-aunt, my mother’s sister, had bulimia for many years. Anxiety, perfectionism, and eating disorders overlap and coexist in ways that aren’t yet clear but are undeniable.
Knowing all this, I wish there was a way to prevent her from falling down the rabbit hole. We can’t change her biology; all we can do is wait and watch for signs of trouble. At least now we know what to do if we see them. At least now we know we not only can do something—we have to.


New Year’s has never been one of my favorite holidays. The collective frenzy of self-criticism, the communal fantasies of starting over (this time for real) with whatever it is we wish we were doing differently—none of it appeals to me. As a friend once said, “We do exactly what we want to do.” Yeah. When it comes to behavior, talk is more or less irrelevant; it’s what we actually do that matters.
I will admit, though, that I can’t wait for this year to officially end. I know time is an artificial construct and nothing will change when the clock hands hit midnight. Still, this year I need the feeling of a new beginning, even if it’s an illusion. I need to believe that next year will be a better year for us, that it will contain the tipping point I’ve been waiting for, the moment when we glimpse the demon’s back, retreating, when the fog clears from Kitty’s eyes and everything goes back to normal.
Alas, this is magical thinking, and I know it. Life isn’t a play, with a predictable arc, clear moments of conflict and resolution. Life is muddled and disorderly, proceeding in fits and starts. There’s nothing linear about it.
I think by now we’ve at least seen all of the demon’s tricks, but, as usual, I’m wrong. On New Year’s Day, Kitty struggles with lunch and cries so hard afterward that she throws up. She begs us to believe that she didn’t do it on purpose, that it was, as she says, “an accident.” She says she’s sorry she violated our trust, which suggests that there was an element of intention.
But I don’t know what to believe. Kitty sobs herself to sleep, napping for an hour or so; when she wakes up I give her an Ensure Plus, to make up some of the lunch calories, and she drinks it without complaint. Later that afternoon, she eats cookies and milk for her snack, then announces that she’s going to the bathroom upstairs; do I want her to not flush the toilet after? Because this is so uncharacteristic I say, yes, don’t flush the toilet. She comes out of the bathroom saying, “I’m sorry, I didn’t mean to, I don’t know why I did,” and I run for the bathroom, bracing myself for the worst. I look into the toilet and see not vomit but an unidentifiable object, floating in the water.
“I’ve never done it before, I don’t know why I did,” Kitty cries outside the bathroom door. Eventually she tells me she’d spit the last bite of cookie into the toilet. My knees go shaky with relief. “Now you won’t trust me,” she sobs. “How can I win back your trust?”
“I trust you,” I say (which is not a lie: it’s the anorexia I don’t trust). But I’m on my guard. And a few days later, it happens again. Kitty has come to work with me, for something to do during winter break. We eat lunch together—chicken salad, potato chips, milk, and, for her, a Hershey’s bar. When she gets up to throw away her garbage, I have a feeling, like the feeling I had the day in the park, and I say, “Give it to me.”
She hands it over wordlessly, pulling the napkin off the top of the pile to reveal half the chocolate bar, which she proceeds to eat without fuss. Afterward, she says, “I don’t know why I did that.”
“I know why,” I tell her.
She says, “Because you always know.”
I say, “Yes, and you want me to know. You want to make sure I’m paying attention, that I’m watching and taking it all in. You want to make sure I’m taking care of you.”
She stares at me for a long minute. The look on her face is one of relief.
That night, as I’m making her bedtime snack of two pieces of buttered toast with cinnamon sugar sprinkled on top, she asks if both pieces need cinnamon sugar.
“No, but they both need butter,” I say. “Do you want to butter them yourself?”
“No, you do it,” she says, but as soon as I’ve buttered both pieces she says, with despair in her voice, “Oh God, I should have done it myself, I had a chance to get away with eating much less.”
“You know I would have been watching,” I tell her firmly. “You wouldn’t have gotten away with anything.”
I hand her the plate and we sit down on the couch. She looks up at me. “I love you Mommy,” she says. “You always know just what to say.”
And that’s the last of the demon’s tests. For a while.


It’s coincidence, really, that just after New Year’s I set out to buy a calorie counter. Kitty’s weight has been stalled for nearly seven weeks; obviously we need more information. I’m unprepared for the embarrassment I feel, walking into a bookstore and asking for the calorie counters. I’m sure the bookseller thinks I’m embarking on a New Year’s diet. I want to say, “It’s not for me, honest! It’s for someone who needs to gain weight!”
Instead, I slink upstairs to the nutrition section, where I stand in shock, gaping at shelf after shelf of diet books. There are at least a hundred different diet books here, and their names range from the pathetic to the absurd: The Prayer Diet. The Coconut Diet. The Paleo Diet (raw meat? really?). The Slowdown Diet, the Fat Flush Diet, the 3-Apples-a-Day Diet. The After-40 Diet. The Starch Blocker Diet. The Big Flavor Diet. The Real Age Diet (mine would be around seventy-five by now, I fear). The Soy Zone Diet, The Acid-Alkaline Balance Diet, the Super Foods Diet. The Potatoes, Not Prozac Diet. The Warrior Diet. The Uncle Sam Diet (hot dogs, hamburgers, apple pie?). The 5-Day Miracle Diet.
Losing weight has become our national obsession, our holy grail. I watch part of a talk show one afternoon at the health club, without sound. The segment covers new diet drugs, and the on-screen graphic shows a three-dimensional model of the brain with lots of animated capital A’s swarming toward one particular spot in the brain and being magically repelled. The drug purportedly brings about weight loss by chemically suppressing appetite. Judging by the looks on the hosts’ faces, this is excellent news.
The cultural assumption seems to be that there’s something wrong with wanting to eat. Appetite is something to be fended off, with willpower or chemically. We’re locked in a war with our own hunger, which is the primal force that sustains us. Of course the talk shows and magazines aim mainly at women, who make up the vast majority of those with weight issues. We’re socialized to fear our appetites, whether they’re for food or sex or power. We’re taught from birth to make ourselves small and dainty, to not take up room. Can this kind of acculturation cause anorexia? I don’t think so. Can it trigger someone who’s vulnerable? No doubt about it.


Kitty’s anxiety waxes and wanes over the first week or two of the new year. She’s much more relaxed before school starts, and we briefly consider homeschooling her for the rest of the year.
But homeschooling would be so isolating. Jamie thinks it’s good for her to go to school and see people, and I have to agree. Though social interactions are fraught for Kitty right now, they’re also, sometimes, energizing. Ms. Susan asks her one day to think back to an earlier time, a time in her life before anorexia, and remember what made her happy then.
“Other people,” Kitty says promptly, and it’s true. It’s always been true. Even as a toddler, when other kids her age would play next to each other, not connecting, Kitty wanted to interact.
Some social situations aren’t so good for her, though. Like Ms. Susan’s eating group. Lately, Kitty’s been coming home from group upset; a few times she’s balked at eating a snack or dinner afterward. The last straw is the night Kitty comes home from the group, refuses her bedtime snack, and cries for an hour: she’s the fattest girl in the group, she’s the only one who’s doing it this way, why can’t she be like everyone else. She says again that she wants to go to an inpatient program, it would be so much easier if we weren’t involved with this; we make everything so much harder.
Kitty is the only teen in the group whose family is doing FBT; the other girls (and they are all girls) are struggling to eat on their own. I wonder how many of their families have been told that’s the only way to do it. I wonder how many have been scared off by one of the main criticisms of family-based treatment—the idea that most families can’t handle it, that you have to be a very special family to pull it off. I don’t think so. Our family is as flawed and dysfunctional as the next. We make a lot of mistakes. We get mad, we get sad, we get frustrated. If we can help Kitty through anorexia, other families can do that for their children too.
“Sometimes parents are just too afraid to actually challenge and disrupt the behaviors at the level they need to, and to do so consistently,” says James Lock, professor of child psychiatry and pediatrics and director of the eating-disorders program at Stanford University. “Sometimes the parents’ relationships may interfere with their ability to work together to do this. Sometimes other mental illnesses like severe OCD or depression can interfere. Sometimes there are other needy children in the family, so it’s difficult to focus on this issue. There may be people whose parenting style is such that they just can’t do it. It wouldn’t sit with their way of being a parent.”
I can see that last idea reflected in our own family. For me, some of the hardest moments this year have come while we watched Kitty’s illness unfold. FBT appealed to me because it’s all about doing something, which fits with my parenting style. James Lock believes most families have the capacity and the impetus to do FBT. “It’s really not rocket science,” he says. “Families just have to accept that it’s going to be hard. There’s going to be a lot of push-back. They’ll be on, 24/7, until the behavior is disrupted.”
He’s right, of course. But I wonder what he or any other doctor imagines goes on at home in between therapy sessions. I wonder if they can have any idea of how hard it really is.
In any case, our path at the moment is clear. I call Ms. Susan and tell her that Kitty will be taking a break from the lunch group, though she’ll keep doing individual sessions. Maybe she’ll go back to the group at some point. Or maybe, by the time she can see clearly again, she won’t need to.
Without the overt triggers of the group, Kitty’s eating goes a bit more smoothly. But there’s still drama to spare at our house. One day in mid-January, when Jamie has a job and I have to go to work and Emma goes to a friend’s house, Kitty stays home alone for part of the afternoon. Her anxiety spikes, and she spends much of the evening in tears, which prompts Emma to make a rare outburst. “I’m sick of you always crying!” she shouts at her sister. “All you do is cry!”
Kitty immediately goes into paroxysms of apology. She makes a halfhearted attempt to run away, fumbling with the front door until Jamie leads her gently upstairs. I feel furious at Emma because I know that it will take hours to calm Kitty down again. I make Emma apologize, which she does, sullenly, and then runs to her room and bangs the door shut.
I sit at the kitchen table, tears of self-pity stinging my eyes. So much of the time now I feel like a bad parent to one or both of my daughters. I’m more or less checked out at work, doing just what’s necessary; I’m lucky my boss is understanding. I’m sick of shopping and planning meals and cooking. I’m sick of thinking about food all the time. I’ve become obsessive about food myself, always checking calorie counts, always calculating in my head: Is this enough? How can I get more calories into this? I’m sick of it all. If I never cooked another meal, I’d be quite happy.
The truth is, I’m wrung out. Used up. Exhausted. I don’t know if I can hang on until Kitty’s better. How long will it be? We’re only five months into this—many families spend years fighting the demon. I don’t know that I have it in me. I really don’t.
I sit at the kitchen table, where we spend so much of our time now. I’ve run my finger over every nick and dent in its chrome rim, memorized the patterns of black and white dots on its Formica surface. I’ve scraped oatmeal and ice cream, fried onions, bits of lettuce—every kind of food imaginable—from the space where the two halves of the table don’t quite meet. I sit there for an hour, until Jamie wordlessly turns out the kitchen light, helps me out of the chair, and guides me up the stairs to bed.
When this is all over, I’m putting this table out on the curb. Let some other family use it. We’re getting a new one.


And it’s only two or three days later—can that be true?—that we have a really good day, a stellar day, the best we’ve had in eight months. Kitty comes to work with me, and we spend a peaceful morning sitting side by side, each of us engrossed in her own task. Eating her pumpkin chocolate chip muffin after lunch, she asks, “Did you do something different with the recipe this time? It tastes much better than usual.”
I want to leap onto my desk and do a little dance because Kitty isn’t worrying about what’s in the muffin; she’s enjoying it. She likes it! It tastes good to her! She still insists that she never feels hungry, that she hasn’t felt hunger since sometime last spring. But this must be a first step. Eating as a sensual experience. Eating as pleasure. Not only that: what’s different about these muffins is that I made them with butter instead of oil—an entire stick of butter, a fact I judge it best not to share with Kitty right now, because that would trigger her guilt and anxiety over eating. She doesn’t need to know.
Critics of FBT would disagree with me here. They’d say I’m being dishonest, that I’m lying to my daughter. That I’m sneaking butter into her food, violating her trust, destroying any chance of an authentic relationship with her.
But I’m not lying to her, or sneaking anything; I’m taking care of her nutritional needs as I see them, which is precisely what she needs from me and what I’ve promised her. Most people don’t know what’s in the food they eat. I don’t give Kitty a list of ingredients for everything I make because (a) she doesn’t need to know, and (b) it would derail her eating, which in turn would (c) impede her recovery. Besides, it’s Not-Kitty who freaks out at the thought of eating butter. And I don’t owe Not-Kitty, or the demon, a thing.
Don’t ask, don’t tell. And don’t confuse what we’re doing now for pathology, or for a permanent arrangement. Right now, my job is to know what Kitty needs and provide it; her job is to eat what I put in front of her. If she recovers—when she recovers—we’ll renegotiate.
That night, when Emma asks for her favorite bedtime snack, Kitty says, “Can I have toast with jelly too? That sounds good.” She’d eaten enough earlier in the day, so I make toast with jelly for both of them, and they eat it together at the table, giggling and licking strawberry jam off their fingers.
Later, as I sit on the edge of Emma’s bed to say goodnight, she says, “Kitty had a good day, didn’t she? When I heard her say she wanted toast with jelly, it made me feel really good.” She closes her eyes, settles herself, then says sleepily, “I know tomorrow might not be a good day, but today was. That’s still really good.”
As usual, Emma nails it. It’s so easy to focus on the anguish and misery; it’s harder, somehow, to acknowledge the positive, maybe for fear of jinxing it, bringing the nightmare back down on our heads. The nightmare will come back; we’ll have plenty of opportunities for endurance. But today was a good day. Today was a good day.
“Yes,” I tell Emma. “Yes, that’s still really good.”