Brave Girl Eating_A Family's Struggle with Anorexia

chapter four

The Country of Mental Illness

If you’re going through hell, keep going.
—WINSTON CHURCHILL
Anorexia is possibly the most misunderstood illness in America today. It’s the punch line of a mean joke, a throwaway plot device in TV shows and movies about spoiled rich girls. Or else it’s a fantasy weight-loss strategy; how many times have you heard (or said yourself) “Gee, I wouldn’t mind a little anorexia”?
The symptoms of anorexia nervosa are detailed in the Diagnostic and Statistical Manual of Mental Disorders, known familiarly as DSM-IV, the so-called bible of psychiatric illnesses. And the first item on the list of diagnostic symptoms is “a refusal to maintain body weight at or above a minimally normal weight for age and height.” Notice the word refusal rather than inability. No wonder anorexia is so widely perceived as an illness of choice or lifestyle; the psychiatric profession defines it that way.*
In fact, the very name anorexia nervosa is ironic. The literal Latin translation is “nervous loss of appetite.” But people with anorexia don’t truly lose their appetites. They may be disconnected from the physiological sensation of hunger, but they are deeply, profoundly hungry. That’s why they draw out their meager meals for hours, savoring every scrap they allow themselves. It’s why they douse their food with mustard and salt and other condiments to sharpen the taste of what they’re eating. It’s why they read cookbooks like other people read pornography, why they plan elaborate menus they know they will not eat, why they stand longingly in front of bakery windows but never go inside.
Hunger is hardwired into us, physically and psychologically, and for good reasons. The drive for food must be insistent enough to propel us to seek it out three times a day. In twenty-first-century America, many of us have only to go to the kitchen, the grocery store, a restaurant to fill our bellies. But for most of the long story of human evolution, satisfying hunger has been a drawn-out and often perilous process.
Accounts of people with little or no appetites, who do not eat or have strong aversions to food, go back to at least the first century A.D., when the Roman physician Galen described people “who refuse food and do not take anything” and who “are called by the Greeks anorektous or asitous.” The Greek physician Alexander of Tralles, who practiced medicine in the sixth century, believed that anorexia developed from an imbalance of what classical philosophers called “humors” people with anorexia, in this view, had too many “cold humors” and needed herbs like cinnamon, pepper, and vinegar to restore balance and bring back appetite.
This perspective on anorexia persisted into the seventeenth century, when an English dictionary described it as “a queesinesse of stomack.” Lack of appetite, it was thought, must stem from physical disturbances—stomach problems, “humors,” and other bodily ailments. And in fact, a loss of appetite alone can be a symptom of all sorts of physical illnesses, from cancer to gallbladder problems.
In the Middle Ages, the culture around not eating shifted from physiology to spirituality. Religious women like Catherine of Siena, Beatrice of Nazareth, and Margaret of Cortona became known for fasting or eating almost nothing for years; some undoubtedly died from malnutrition. Their behavior was seen as a holy endeavor, a kind of reaching toward a state that transcended the body. Many of these women were later beatified by the church, and their starvation acquired a new name: anorexia mirabilis, a loss of appetite that was miraculously inspired. If they were good enough, holy enough, they were set free from the physical necessity of eating, lifted into an idealized state where food was irrelevant—or so the notion went.
Historians adamantly distinguish the self-starvation of these medieval women from later forms of anorexia. They argue that we don’t know enough about what inspired women in the Middle Ages to starve themselves and what kept them on that path. They say it would be naive to think that shared physical symptoms like an aversion to food, extreme thinness, and loss of menstruation derive from the same illness. They say that anorexia mirabilis and anorexia nervosa are two completely different disorders that originate in completely different ways.
To support this notion, medieval scholar Caroline Walker Bynum argues that fasting saints did much more than fast; they castigated themselves in all sorts of ways. Catherine of Siena, for instance, whipped and scalded herself and regularly slept on a bed of thorns.
I don’t buy it. The roads to anorexia mirabilis and anorexia nervosa may indeed start in different spots, and those spots may be defined in terms of the culture: in medieval times, young girls aspired to saintliness the way girls today aspire to thinness. But those roads quickly converge on the same highway to hell. Catherine of Siena, for instance, died at age thirty-three after years of subsisting on a daily handful of herbs; when forced to eat other food, she reportedly put twigs down her throat to make herself vomit it up.
Sounds like anorexia with a side of bulimia to me.
The difference in terminology underscores the idea of anorexia as a relatively new disease, an affliction of modern times. The first two medical descriptions of anorexia nervosa were published nearly simultaneously in 1873, one by a highly respected British doctor and one by a French neurologist. Sir William Withey Gull practiced medicine in London and was on close terms with Queen Victoria and the royal family. He spoke and wrote about an illness that affected mainly upper-class adolescent girls who suffered from diseased mental states and, as he put it, “perversion of the will.” Charles Lasègue was a neurologist in Paris when he described what he called l’anorexie hysterique as a “hysteria of the gastric center.”
Interestingly, their characterizations of the illness diverged from their recommended treatments. Gull believed that medicines were useless and that only food could cure the illness. He prescribed high-fat, high-protein meals, administered every two hours by a trained nurse, along with bed rest and a hot water bottle along the spine; he believed that the person who was ill needed someone outside herself to compel her to accept food. “The inclination of the patient must be in no way consulted,” he wrote. He thought a trained nurse was best because friends and family lacked the “moral authority” to insist that a young patient eat.
Lasègue’s treatment veered more toward the psychological. He was the first to suggest that anorexia stemmed from family conflicts over an adolescent girl’s transition to adulthood—a view that remains stubbornly entrenched today.
I think Gull had it right. When it comes to anorexia, food is medicine, and it’s a given that someone with anorexia will not willingly come to the table.
In her book Fasting Girls: The History of Anorexia Nervosa, Joan Jacobs Brumberg writes that Lasègue’s research “captured the unhappy rhythm of repeated offerings and refusals that signaled the breakdown of reciprocity between parents and their anorexic daughter. In this context anorexia nervosa can be seen for what it is: a striking dysfunction in the bourgeois family system.”
Like Hilde Bruch and so many other “experts” on anorexia, Brumberg mistakes effect for cause. Typically, by the time parents consult a doctor or therapist about a teen with anorexia, the family has become dysfunctional, no matter how competent it was to begin with. The pattern of insistence and resistance Brumberg describes is absolutely normal in the context of a child who is starving herself. Of course parents become edgy and upset, frantic to get their child to eat. And of course the child becomes terrified, hostile, and manipulative—anything to avoid eating.
But eating-disorders therapists don’t see a family before anorexia strikes. So they don’t know, they can’t know, the true rhythm and flow of a family’s previous life. Which means that they can’t establish cause and effect between family dynamics and eating disorders. There’s no way to predict who will develop an eating disorder, based on family dynamics or on any other criteria.
Somehow the medical and psychiatric professions have confused hindsight with understanding. There’s a saying in the scientific world: “Correlation does not equal causation.” Just because two things happen at the same time doesn’t mean that one causes the other. Maybe an unknown third variable causes them both. Maybe they coexist coincidentally. We know that anorexia changes family dynamics. But we don’t know whether those dynamics caused the anorexia in the first place.


Most years we take a vacation in August, but not this year. Just as well, because we’re not a beach family. Our vacations usually revolve around activities: kayaking in Lake Superior, skiing in the Porcupine Mountains, hiking in the Catskills. All of these would cost Kitty too many calories. Instead, we spend most of the month, when we’re not at work, watching movies and playing board games, which Kitty hates but Emma loves. Poor Emma, whose summer has been one big nonvacation. She’ll be glad to get back to school, I think.
In the second week of August, Jamie and I bump Kitty up to twenty-one hundred calories a day. For two days beforehand she frets and worries over the coming change, so much so that Dr. Newbie prescribes a mild antianxiety medication—just in case, she tells us. Just in case of what? I think as I pay for it at the pharmacy. In case things get any worse? I allow myself a small sardonic laugh. But even as I walk out, bag in hand, I know there’s nothing to laugh about. Things can always get worse.
With the increase in calories, meal planning becomes more of a challenge. Eating large volumes of food is stressful for Kitty physically as well as emotionally. We add in a midmorning snack, to spread out the calories, but still she complains of bloating and stomachaches—common side effects of refeeding. Starvation affects the entire body in ways both profound and minute, and it will take a while for her metabolism and digestion to normalize. I’m hoping to minimize the unpleasant gastric consequences by cutting back on fruits and veggies, which are hard to digest and which in any case don’t contain enough calories, and feeding her smaller amounts of calorie-dense foods.
I turn to my collection of cookbooks; leafing through them is an exercise in cognitive dissonance. Nearly every recipe seems to emphasize how low-fat and/or low-cal it is. Like Alice in Through the Looking-Glass, I have the curious sensation of looking through a mirror into an alternate universe. While the rest of America hunts for ways to cut down on calories, I’m searching desperately for ways to pack them in.
Frustrated, I go online and wind up on Web sites aimed at families of cancer and cystic fibrosis patients. I print out recipes for macaroni and cheese, chicken and peanut stew, lasagna made with ricotta and béchamel sauce, guacamole. Kitty’s still terrified of foods like these—creamy foods, sauces, and pasta. Foods with fat in them. Even if we wanted to, we couldn’t get enough calories into her by serving only “safe” foods—grilled chicken breast, steamed vegetables, plain whole wheat bread. And we don’t want to. On my single trip to a nutritionist, I learned that the brain is made up largely of fat. That both the brain and the body need fat—not just any old calories but the right kinds of calories—to begin the slow process of healing from starvation.
And it’s more than a physical thing. Instinct tells me that if we are ever to rout the demon completely, we’ll have to break all its rules, flout its proscriptions. We’ll have to tar and feather it and run it out of town. We can’t appear to collude or appease it in any way; we need to win this war visibly as well as tactically. We’re engaging in a kind of exposure therapy, slowly desensitizing Kitty to the things she fears. And there’s nothing she fears more right now than fat, whether it’s on her body or in her food.
One night, poking around online, I find a glimmer of evidence that we’re on the right track. I come across a 1967 study done by a grad student at Northwestern named Aryeh Routtenberg, who discovered, more or less by accident, that rats given access to food for only an hour a day became more physically active, running on their wheels for hours. After a few days the rats ate less and less and ran more and more. Most of them died within ten days, starving and running themselves to death.
I sit back in my desk chair. So many of Kitty’s behaviors are analogous to the rats’. If we didn’t stop her, she, too, would exercise more and more. She, too, would starve herself to death. This study doesn’t shed light on what triggers someone like Kitty into restricting her food in the first place. But it does lay out a pattern of effects that looks all too familiar. The rats’ refusal (or inability) to eat, their compulsive overexercising—even unto death—reflect a biological imperative. Their self-destructive behavior didn’t derive from psychological “issues” or screwed-up family dynamics; it was, as Routtenberg later discovered, a function of neuroanatomy.
The brain works on three main systems of neurotransmitters: serotonin, dopamine, and norepinephrine. These chemicals leap the synapses among the brain’s millions of neurons, creating and regulating processes that affect everything from movement to behavior to mood. Like the rest of the body, the brain exists in a complex and delicate balance; one little misfire can bring down a big chunk of the system. In this case, Routtenberg theorized, the rats’ limited access to food and unlimited access to the running wheel interfered with the brain’s dopamine system. Which makes sense, because among other things dopamine helps regulate physical movement (it’s connected with the basal ganglia, a cluster of nuclei involved with motor functions), motivation, and reward.
Just as interesting was a 1971 follow-up study done at the Medical College of Wisconsin by Joseph Barboriak and Arthur Wilson. They duplicated Routtenberg’s conditions, but divided rats into two groups. One group got the usual low-fat, high-carbohydrate laboratory chow; the other got a special high-fat mix with no carbohydrates. Both groups were fed the same total number of calories and, as in the earlier experiment, had access to the food for only an hour a day. The lab chow rats behaved just like the rats in the original study; they amped up their activity levels until they were running nearly all the time. Each rat lost about 20 percent of its body weight. At the end of the experiment, twelve out of fifteen had died.
The rats on the high-fat diet, by contrast, didn’t go into exercise overdrive. Their activity levels rose, but only a little, and they didn’t lose weight. Only one of the fifteen rats in the high-fat group died, and that one had increased its running more than most of the others.
So something about the higher-fat diet protected the rats from running and from starving themselves to death. Barboriak and Wilson didn’t speculate on cause and effect; they simply reported what happened. I want to know why, so I can keep Kitty safe from the same deadly cycle.
For now, I suppose, it’s enough to know that fat is an important part of the equation. Knowing will help me resist both the demon’s imprecations and Kitty’s fear of eating fat.* It’s so tempting to want to spare her suffering, to avoid some of the trauma. To feed her the foods she feels safest eating and hold off on the others until later. But I’m beginning to understand that there won’t be a later if we give in to Kitty’s terror, if we enable the demon in any way. There is no compromise possible. The stakes are too high and the process is too painful.
For instance: the next day I make one of our favorite meals, homemade pizza, which Kitty used to love. We’ve been keeping Kitty out of the kitchen during meal prep, but she sees the dough rising on the stove and falls apart instantly. “Oh my God, not pizza,” she cries. “I already feel so fat, Mommy. My thighs are jiggling. Please don’t make me eat it.” She is keening now, there’s no other word for it, crouching on the floor, rocking back and forth, arms wrapped around herself.
I feel like the worst parent in the universe. I am causing my child so much grief and fear and pain. My job is to protect her, not hurt her. I want to give up. I want to go back to the way things used to be, I think, before anorexia. B.A. Ha. We’re all getting an education in eating disorders. An education we don’t want and could live quite well without.
Then I think, If I feel this way, how must Kitty feel? I can take a walk, read a book, shut out the anorexia for a little while. But it’s inside her. She can’t get away, not for a second. And every minute she spends trapped with the demon must be hell. Pure hell. My child is going through hell. I could sink down right now onto the floor beside her. I could howl and cry and tear out handfuls of my hair. That’s what I feel like doing. But that would be self-indulgent. That would be abandoning my daughter.
In our family, as in all families, my husband and I have taken on certain roles. Jamie is the one who fixes things: the vacuum cleaner, the car, the computer, the broken chair. When someone gets a splinter, he’s the one who pulls out the hydrogen peroxide and tweezers. My role is to figure things out. I’m the one who makes the plans, who asks the questions (sometimes obsessively) about what it all means and what we should do. I’m the one who calls people and goes online and tears through the library looking for answers to whatever the problem.
The point is, Kitty needs both of us now. Jamie’s strengths and mine are complementary, and she needs every shred of power and steadiness and stubbornness we possess. No matter how much I feel like giving up, I can’t. Jamie can’t. There is no way we’re abandoning her. No way in hell is the demon going to win.
I slide down onto the floor beside her and put one hand on her back, to let her know I’m here. I sit beside her and I stay with her until she’s all cried out. Until Not-Kitty is gone, and Kitty is, for the moment, wholly herself.
Impulsively, I say, “This is really hard on you, isn’t it?”
Kitty hates the idea of anyone feeling sorry for her. Some of her biggest outbursts in these last few weeks have come in response to someone’s expression of sympathy, or empathy. I brace myself for her reaction.
But instead of stiffening in anger, Kitty simply turns her face toward mine. She’s always had beautiful eyes, my daughter, and they are still lovely, large and complex, the dark irises flecked with light. Now they look too big, out of proportion, like the oversized, pathos-filled eyes of puppies in flea-market paintings. I was raised to think thin is beautiful, that there’s no such thing as too thin. I will never again believe it.
Kitty leans her cheek into my hand, a rare moment of connection in our newly adversarial relationship. Once upon a time she trusted me. Once upon a time Jamie and I were not the enemies. Now the feel of her skin against my palm tells me what we have to do next. Each time we’ve raised her calorie intake, Kitty has suffered, her anxiety and terror flaring out of control. It’s as if we’re peeling away a Band-Aid, inch by agonizing inch. Wouldn’t it be kinder to rip it off in one go?
“What if we raised your calories to three thousand now, in one fell swoop?” I ask Kitty, bracing myself for panic, rage, the demon’s hissing.
But instead, she says slowly, “In some ways that would be easier.” As soon as she says this her eyes cloud, she claps one hand over her mouth, and she begins to cry.
“What is it?” I ask, but I already know. She’ll pay dearly for saying this, my brave and honest daughter. She’ll suffer guilt and terror at the hands of the demon inside her for even this small defiance. I’m her mother; I’m supposed to be able to protect her. Instead, I have to make it all worse, at least for now.
I remember a picture book we used to read when Kitty was small that described a family who ran into obstacle after obstacle—a swamp, a bear, a mountain—on their way to a picnic. Each time, they tried silly tactics to avoid the obstacles, and each time they succeeded by confronting rather than evading them. Kitty and I used to chant the refrain together each time: “We can’t go over it. We can’t go under it. Oh, no, we have to go through it!”
It’s the same with anorexia. We can’t go under it, we can’t go over it. Oh, no. We have to go through it.


The week after we start our higher-calorie regime, Kitty gains three pounds. I feel like dancing around the doctor’s office, but I keep my face neutral. I stay in character as The Mother.
“I did good, right?” asks Kitty anxiously. “Did I do good?”
What do I say? It depends who’s asking, Kitty or Not-Kitty. My daughter or the disease. Either way, my answer could provoke a meltdown. My instinct is to speak to my daughter, and deal with the demon if it shows up.
“Good,” I say calmly. “You did really good.”
I see the conflict in Kitty’s eyes, guilt and relief and fear swirling together, and wait for one of them to win out. “OK,” she says eventually. We move on.
For weeks now we’ve lived in a kind of bubble. We’ve seen few friends, kept no social engagements. I’ve barely gone to the office; I’ve done the essentials of my job at home, late at night, after Kitty and Emma are asleep. I’m usually too anxious to sleep, anyway. Our lives have narrowed to a few basic activities: shop, cook, eat, clean up, watch movies, do it all again. We’re lucky, if you can call it that, that it’s summer, when schedules are more forgiving. But school will be starting in two weeks. Fifth grade for Emma, and ninth for Kitty. If she goes.
That’s the question: Should she start high school? Some of the answer depends on what happens in the next few weeks. Right now, Kitty stays close to home, literally and metaphorically. Can she handle the emotional demands of high school, or would it be cruel to send her? Would it be crueler to keep her home, setting her back in a way that will feel humiliating? Then there are the practical considerations, like the logistics of lunch and snack, which have to be eaten with one of us.
From the time Kitty was a toddler, she’s been an intensely social person, always wanting playdates, always up for going places and seeing people. She’s the kind of person who’s reenergized by hanging out with friends. This year, though, she doesn’t want to see her friends and she doesn’t want to go to school. I know a lot of her anxiety is a by-product of both the anorexia and the refeeding process. But I can’t help wonder if on some level she’s always felt anxious about school, and just never told us. Does the illness give voice to feelings that have been hidden to her, or does everything get mixed up in its chop and churn?
Ms. Susan says it’s not helpful to get tangled up in this kind of thinking. She says people in recovery from an eating disorder do best when they limit the stress they’re under, and I believe her. On the other hand, to keep Kitty out of school entirely would create a different level of stress for her. She’d feel like a failure, a freak, a weirdo. And, to be honest, it would be good for all of us—including my relationship with my staff and my boss, who have been immensely patient—to have her out of the house for a few hours a day.
One late August afternoon Kitty sits in front of a milk shake and weeps with anxiety. This is her talking, the real her in her own voice, not the creepy distorted voice of the demon. And yet—and yet she’s irrational. She stares at me, her face full of worry, and says, “I don’t want to go to high school and have everyone look at me and say, ‘Look at Kitty, she got so fat over the summer!’”
“You’re not fat!” I say, but I might as well be speaking in tongues, because she can’t hear or understand.
“I’m so fat, everyone will be talking about me,” she insists.
I don’t want to tell her the truth: that kids will talk, but not about how fat she is. God. They’ll be gossiping and speculating about the fact that she has an eating disorder. They will comment on how she looks, but it will be about how thin she is. And yes, some of them will say and do stupid, insensitive things. Not that teenagers have a corner on the insensitivity market—some of our acquaintances have made some appallingly hurtful comments.
Like the acquaintance I run into at the food co-op, who had us to dinner early last spring, before we realized Kitty was sick. Now she leans across the sweet corn and says, in a voice dripping with concern, “How is Kitty?”
I don’t know why it rubs me the wrong way. She means well, I tell myself. “She’s doing all right,” I say, and then, to shut down the conversation, “Thanks for asking.”
She leans in closer. “You know, I could have told you she had anorexia,” she confides.
What I want to say is “Then why didn’t you?” Instead I grit my teeth and say, “How so?”
She smooths her glossy hair. “I noticed the way she cut all her food into tiny pieces and pushed it around her plate,” she says, her voice low and intimate. She gives me a look of concern and adds, “She didn’t eat a thing. Didn’t you notice?”
Now I feel like slapping her. No, punching her in the mouth. No, garroting her. Anything to make her stop talking. “I have to go,” I say, leaving my basket on the floor. I manage to get out the door and into my car, where my rage quickly evaporates, leaving an acid bath of shame. Of course people know exactly what’s going on. And of course they blame us. Hell, I blame us. We’re Kitty’s parents; we’re supposed to be in charge. We’re supposed to protect her.
What I didn’t realize was that they would blame Kitty, too. That they would see her behavior as willful and manipulative. That they would ascribe to her a kind of devious intention, not just now but always. That they would recast her whole life in the light of anorexia, and judge her harshly for it. So while Kitty’s completely deluded on one level, her emotional radar is working. She’s right to be self-conscious; she’s right to feel judged. Just not for being fat.
Later that night, for the first time in weeks, Kitty will not eat her bedtime snack. Jamie’s reading to Emma downstairs while I sit with Kitty in her room. Her snack tonight is four pieces of toast, with butter and cinnamon sugar on them—a nursery meal, one that both my daughters have loved since they were small. Kitty takes one tiny bite and spits it out, and the demon is back, with its infantile, singsong voice and vicious words.
I’ve learned by now that there’s no point in arguing. Words seem irrelevant, so much more fuel for the self-loathing and despair. Usually the demon runs down eventually, but not tonight. Not-Kitty rants on and on, possessed by a manic energy, pacing, practically leaping around her room. I take hold of her shoulders, both to comfort her and to stop her frantic motion. The toast lands on the floor, and I don’t want to leave her to make another batch.
“Come on, Kitty, you can do this,” I encourage, but she gives no sign of hearing me. Jamie opens the bedroom door, holding a bottle of Ensure, bless him. “OK, you don’t have to eat tonight,” I tell her. “Just drink this.”
She knocks the bottle out of my hand, spraying its sticky contents all over herself, me, and the floor, and begins hitting herself in the head with her closed fist.
Jamie grabs for her wrists. “Kitty! Stop it!” I shout. My words are tiny feathers in a blizzard of hail. I plead. I threaten. I tell her if she doesn’t eat or drink the Ensure we’ll take her back to the hospital for the feeding tube. She flails and shrieks, and even though I’m right up in her face I don’t think she can hear me.
Jamie wraps his arms around her and pulls her down to the bed, trying to keep her from hurting herself. I phone Dr. Beth and Ms. Susan. Neither of them is on call. I call Dr. Newbie and leave a message with her service. She’s not on call either, but another psychiatrist calls back and suggests, just for tonight, letting the snack go and giving her one of the sedatives Dr. Newbie prescribed. I’m afraid Kitty won’t take it, but she does, and we sit with her as her sobs subside and the demon’s voice falters and trails away. She falls asleep in Jamie’s arms. Together we pull down the sheets and lift her into bed, clothes and all, turn out the light and tiptoe out of the room.
Now I know what “just in case” meant.
Emma is standing in the hall, her face blank and unreadable. I put my arm around her shoulders and take her to her room, sit with her while she undresses, brushes her teeth, gets ready for bed—all the ordinary moments in a ten-year-old’s evening ritual. Yet this night is anything but ordinary. The demon has upped the ante, or so it feels to me. We’re in a different place now, the country of mental illness, and it scares the hell out of me. I don’t know how we got here and I don’t know how to get home and I don’t want to be here. I don’t want any of us to be here. What if this refeeding process doesn’t work? What if Kitty wakes up tomorrow and it’s more of the same, if she won’t eat and won’t eat? I’ve heard of girls tethered to feeding tubes for months and girls who rip out feeding tubes. I’ve heard of girls dying, their hearts giving out in their sleep, just like that, and I can’t help imagining Kitty dead in her bed, the sharp point of her chin, her sunken eyes closed, the demon getting the last word.
I don’t know if we can save her. Tonight I don’t know anything.
Emma takes off her glasses, turns out the light, and climbs into bed, snuggling into her blue-and-green quilt as she does every night, until only her thick dark hair is visible. I lie down beside her, ducking to avoid the top bunk. “I hate the anorexia,” she says. I expect tears, but instead there’s an edge to her voice.
“Me too,” I say. “How much do you hate it?”
Part of our bedtime ritual has been a kind of call-and-response: How much do you love me? More than bread loves salt. This inversion of the usual question makes Emma giggle. “Come on, how much do you hate it?” I ask.
“I’d like to poison it,” she answers. “No, wait. Stab it in the heart!”
“That sounds sufficiently evil,” I say. “Maybe we could put a noose around its neck and hang it.”
“I’ve got it,” she says. “Burn it to death!”
She starts to laugh, and I smile too. Then she says, “I want to put anorexia in the blender, grind it up, and feed it to the cats!” And suddenly we’re both roaring with laughter, rolling around on the bed, breathing in great gulps. “The blender!” she says hysterically, and we’re both off again.
“But the poor cats,” I say at last. “They don’t deserve it either.”
“They can’t catch it!” Emma announces triumphantly.
“So it’s just like cat food for them?” I ask. “Crunch crunch, yum yum?”
We’re off again, laughing in the face of the worst thing that’s ever happened to our family.
I hate the fact that Emma, too, has to deal with this illness. Mealtimes have gotten a little easier, but they’re still tense and often explosive. Jamie and I are preoccupied with taking care of Kitty. I wish there was somewhere I could send Emma for a week or two, just to get out of the house. I feel guilty for putting her through this.
Not long ago, another mother told me about a conversation with her younger son, when she told him she was sorry he had to go through his sister’s anorexia too, sorry that mealtimes had become so painful for the whole family.
“And you know what he said?” she told me. “He said, ‘Mom, the worst part was before.’ I said, ‘Before what?’ And he said, ‘Before you started helping her eat, when we were all pretending.’”
That story comforts me now. Maybe Emma will benefit by seeing Jamie and me tackle Kitty’s illness. Maybe in the long run she’ll feel safer because she’ll know that no matter what happens, we’ll take it on. That we’d do our best to protect her, too.
I shuffle downstairs to turn out the lights and find Jamie lying on the living room couch. For the first time in months, we’re awake and both of our children are asleep. I nudge him over and lie down beside him, and we don’t say a word. We don’t confer about logistics: who’s shopping where, what’s for snack or dinner, who’s taking Kitty to the doctor or psychiatrist. We don’t go over how this happened, when it happened, why we didn’t see it coming and stop it. We don’t talk about hard it is to walk around feeling so raw, to take in Kitty’s terror and rage, to stay present for Emma.
We’ve done all that, and no doubt will do a lot more of it, though it’s usually me who needs to talk things out, perseverate, go over and over events and feelings and worries about the future. But not tonight. Tonight I lie beside my husband, feel the warmth of him through his clothes and my own. Kitty is built like him, long and angular, muscled but not obviously so—more Clark Kent than Superman.
I look into my husband’s face. His eyes are tired; his face is lined. He needs a haircut. But he is still handsome to me. Eighteen years ago I had the great good fortune to marry a man who believes in showing up. He might not always know what to do. He might not always have the words to describe how he feels. But no matter how awkward or terrible the situation, no matter how bad things get with Kitty, he will be there. I don’t have to do this alone.
At the moment, I can’t imagine anything more romantic.


By the end of the week, we have worked out a plan, along with Ms. Susan: Kitty will start high school, going part-time, at least for the fall semester. I worry that the school will give us a hard time about asking for accommodations—this school district, like many others, makes a practice of saying no to parents—but Ms. Susan suggests we use the words medical necessity in talking about what Kitty needs. Sure enough, when I put it that way, Kitty’s guidance counselor, Mr. C., becomes extremely helpful. He arranges for Kitty to attend the first and last two periods of the day. In between she’ll come home to eat lunch with one of us; we live three blocks from school, which makes this schedule workable. In theory, anyway.
I hope classes and friends will distract Kitty from the misery of recovery. I hope the stress of performing academically—a stress she puts on herself; we’ve told her many times the world won’t come to an end if she gets a B—won’t prove too much for her. Kitty wants to go to school because she wants desperately to be “normal.” She hates being sick, hates us thinking of her as sick. Most of all, she can’t stand the idea that people will pity her, because she can’t bear the idea that she messed up, that she made mistakes or is in any way less than perfect.
“Everyone makes mistakes,” I tell her. “We’re supposed to mess up. We learn and grow by trial and error. That’s part of what makes us human.”
Kitty shakes her head. “I’m supposed to be smarter than this,” she says. “I’m supposed to be able to figure things out without screwing up.”
I try another tactic. “You’ve seen me make mistakes, right?” She shakes her head. “Come on,” I say. “I screw up all the time. Remember the bread I made without salt? Disgusting. Remember how I used to get lost in the car when we first moved here? I told you we were having ‘adventures,’ but really I was trying to find our way home.”
I’m hoping for at least the hint of a smile; instead, Kitty frowns. “That’s different,” she says.
“Why?” I ask. “Because it’s me and not you?”
She nods, slowly.
“So you think you’re supposed to be better than everyone else in the world?” I ask, smiling so she knows I’m making a joke. Clearly I am no comedian, because she hears my words as criticism and stalks off.
The answer is yes, she really does believe she’s supposed to be perfect in a superhuman way. I wonder if somehow we’ve given her the impression that we expect perfection. I don’t think so. But what if I’m wrong?
I’m not usually defensive about my parenting. I know I make plenty of mistakes. Like missing the early signs of anorexia—that was a mistake I wish like hell I’d avoided. And I know other people, including my children, make mistakes. It’s part of being human. I think Jamie and I have given them the message that we love them the way they are.
So why does Kitty hold herself to such an unrealistic, inhuman standard—yet not expect that from other people too? This emotional blind spot feels analogous to her perceptual blind spot about her body: when she looks in the mirror, she sees rolls of fat rather than ribs and hollows. Yet she sees other people’s bodies accurately.
Neurologists talk about interoceptive information, data that flows from the body into a part of the brain called the insula—things like taste, touch, temperature, and other visceral sensations. The insula helps transform this physiological input into both self-awareness and emotions. For instance, if you eat something that tastes bitter, you might feel disgust or aversion; the chemical stimulus of bitterness becomes the emotional and physical response of disgust in the insula. According to Walter Kaye, anorexia symptoms like distorted body image might be related to glitches in the body’s interoceptive system.
Maybe someday information like that will lead to better treatments for anorexia. In the meantime, we’re stuck with slogging through this, one meal—sometimes one spoonful—at a time.
On the first day of ninth grade, I plan to meet Kitty in Mr. C.’s office and eat lunch with her there, because it’s a short day and there’s not enough time for her to walk home and eat. When I wake her that morning, the first thing she says is, “I don’t want to go! I want to stay home with you!” But she gets dressed in the new clothes we bought last week—a silver T-shirt and plain dark jeans—which I insisted on buying a size larger than necessary; even so, the jeans, which came from a children’s store, look painfully tiny. She spends ten long minutes straightening her hair, so now it hangs to her shoulders in a clean blond sheet. Most important, she eats breakfast with Jamie while I walk Emma to her school. By the time I get back, Kitty is losing her nerve; she takes one look at me and her face starts to crumple. I’m afraid she’s going to fall apart in a big way. But miracle of miracles, the phone rings; it’s a friend asking if she’d like a ride to school.
“Oh, why not,” says Kitty with some of her old spirit, and two minutes later she’s out the door without time to worry or fret. It’s a miraculous exit for us, too, as we try to walk the line between acknowledging her anxiety and neediness on one hand and encouraging her glimmers of independence on the other.
Lunch goes all right, considering Kitty has only about twenty-five minutes in Mr. C.’s office to eat. And—another miracle—she tumbles in the door at the end of the day with three friends in tow, girls she’s known for years. She’s animated and laughing, as relaxed as I’ve seen her in months. It’s so good to see her like this, like her old self, I think as I make milk shakes for all of them.
Kitty even cracks a joke. “At our house, we know which ice creams have the most calories,” she says, catching my eye and grinning. It’s true; I’ve made a science out of packing as many calories as possible into everything Kitty eats, both to make it easier for her to get it all down and to speed up the very slow process of gaining weight.
The fact that she’s made a joke about food—about how much food she has to eat—makes me giddy with happiness. That’s my Kitty—funny, observant, alive to nuance and language.
Of course, the joke’s for me. Her friends prove sadly unable to understand it.
“We want to know which ice creams have the least calories!” says one.
“Yeah, because we have a problem over here!” says another, patting her flat stomach.
The third chimes in. “My thighs are enormous,” she says, glancing down at her legs, encased in narrow boot-cut jeans and looking absolutely ordinary.
Kitty, I notice, has gone silent.
I dither for a minute: stay out of the conversation, or jump in? I can’t keep quiet. “Wait a minute,” I say. “There’s nothing wrong with any of your thighs or butts. You’re all beautiful and healthy and strong. Thinking there’s something wrong with you—that’s the problem.”
I might as well be talking to myself. I’ve heard girls this age refer to fat-bashing as a bonding experience, and I can see that as a kind of process of establishing social hierarchy—like the submissive behaviors dogs engage in to find their place in the pack. Saying “I’m so fat!” can be a coded way of expressing social submission, or at least the urge to be accepted, to conform.
But I can’t believe these girls are joking about being too fat in front of someone who’s struggling with anorexia. Of course, they’re only fourteen years old, an age not exactly known for sensitivity to other people’s feelings. And, I remind myself, they have no idea of the hell Kitty’s going through. They know only that she’s been “sick” and is doing better now; a few know it’s anorexia, but some likely don’t. They probably envy her slenderness, though no one says that out loud.
I wonder what would happen if one of them said, “I like the way I look.” In today’s girl culture, would she lose status, become an outsider? Or might she start something positive? Teenagers are herd creatures; at this age, and in this society, it will take more than one voice of reason to start to turn things around.
At least they drink their milk shakes. Kitty, too.