Brave Girl Eating_A Family's Struggle with Anorexia

chapter eight

Watching Kitty

I keep both eyes on my man. The basket hasn’t moved on me yet.
—JULIUS ERVING
In some ways, Halloween is the perfect holiday for anorexia: it’s about collecting candy but not necessarily eating it. After the ritual acquiring of the candy, the traditional counting, organizing, and trading of the candy are an obsessive’s dream come true: arranging seventy-five or a hundred candy bars and bags in concentric semicircles, their cellophane wrappers festive against the dark wood of the living room floor. Long before anorexia, Kitty and her friends would set out their candy according to their own mysterious hierarchies. They would line up the Snickers bars, the Milky Ways, the Oh Henry!s and Baby Ruths, the Skittles and packages of jelly beans, the little red boxes of raisins (always at the bottom of the heap). They’d pick them up, put them down, rearrange them, square them into neat rows. They’d bargain with one another, swapping the rejects for their favorites. Then they’d eat one or two and dump the rest back into a pillowcase or bag, to be stored in a kitchen cabinet, picked through over the next few months, and finally, a month before next Halloween, tossed out.
I wish Kitty wanted to go trick or treating, but I’m not surprised that she doesn’t. I am surprised when she throws herself into putting a costume together with Emma, who wants to be Anne Boleyn. The girls spend all afternoon in Kitty’s room with the door closed, improvising from the dress-up box, and emerge before dinner laughing and excited, with Emma in a long green cape and flowing white gown, her hazel eyes lined with dark pencil, her lips a glowing red. Her whole face shining with the pleasure of having her big sister pay attention to her.
And I’m even more surprised when Kitty announces that she wants to take Emma around. The three of us go out, leaving Jamie behind to hand out candy. Kitty walks behind Emma, holding up her trailing cape, encouraging her to tackle another block, and another. When we spot a couple of her friends, Kitty runs across the street to talk to them. “Why don’t you walk around with them?” I ask. “Emma and I will be all right on our own.”
“But I want to stay with you!” says Kitty, looping her arm through Emma’s. This isn’t the clinginess of anxiety or terror; it’s the pleasure of being with people you love. We cover the last block arm in arm, like Dorothy et al. in The Wizard of Oz, and I feel a wave of gratitude. An hour from now Kitty might be sobbing on the couch, or the demon might be raging through our house. Or the rest of the night could be just as magical as this.
Anorexia is teaching me to live in the moment. When the moment is awful, as so many moments have been over the last months, I can’t imagine how we’re going to survive it. When the moment is sweet, like this one, there’s nowhere else I’d rather be.
When we get home, Kitty asks if she can take over candy duty. I hear her at the door, talking to the children who ring our bell. “You must be Madeline!” she cries to a small girl from down the street. “What a great costume!” This is the Kitty we’ve known for fourteen years—outgoing, sparkling, kind. I haven’t realized until now how much I’ve missed this side of Kitty, the part of her that’s so good at reaching beyond the borders of her self.
Later, she sits on the floor with Emma and inspects each piece of candy with her, turning it over in her hand, setting it neatly into its appointed spot. She’s tender with Emma, and attentive. The two girls lean their heads together—one blond and curly, one dark and straight. Kitty pulls her curls up into a ponytail and whispers in her sister’s ear. Emma bursts out laughing, her face open and vulnerable. Despite everything that’s happened, she trusts her sister, a fact that astonishes and humbles me.
That night, tucked into bed, Emma says, “I like my hair, my body, and my feet.”
“Good,” I say. “Because you’re perfect just the way you are.”
“But what if I had feetalimia?” she continues. “What if I thought my feet were too fat, and I cut off all the circulation to them, on purpose?”
I look at her in the light from the hallway. Eyeliner smudges each cheek, like the dark half-circles football players draw under their eyes. I worry about Emma, who doesn’t say nearly as much as she feels.
“What if you did?” I say. “What do you think?”
She slides one leg out from under her blue-and-green biscuit quilt and considers it, turning it this way and that, looking at her pale toes, the slight swell of her calf muscle. Finally she says, “I think that would be ridiculous.”
“Me, too,” I say. I tuck her leg back under the quilt, smooth the fabric under her chin, kiss the spot on her forehead where her hairline dips into a heart shape. Emma has always had this knack of holding a mirror up to reality, showing us her own quirky, frank take on whatever’s going on. She’s only ten, an age when children are still literal thinkers and trauma can overwhelm their psyches. Plus, I haven’t forgotten that Emma’s more vulnerable to developing an eating disorder herself. So I’m not just amused by her analogy; I’m relieved. She gets it, and maybe that will keep her safe on both fronts.
Of course, I thought Kitty would be safe because she’d written a research paper on eating disorders, because she knew so much about them. Now I wonder if knowing can actually trigger anorexia in kids who are susceptible.
Keep Emma safe, I think—to myself, to the universe, to anyone who’s listening.


From the beginning of this refeeding process, Jamie and I have been watching Kitty, day and night. We watch every bite she puts in her mouth and every bite she doesn’t. We watch her in the bathroom after meals—that is, we require that the door be partly open if she uses the bathroom, and one of us hovers nearby, listening. We watch to make sure she eats, she drinks, she doesn’t hurt herself. We check on her to make sure she’s not exercising at 2:00 A.M. We watch because we’ve learned the hard way that the demon will exploit any moment of inattention or trust, like that day in the park when Kitty tried to throw away part of her protein bar. I’d guess there have been other moments we’ve missed.
On the whole, Kitty accepts our watching. On some level she seems to realize she’s not capable of making good decisions, at least when it comes to food and eating. On some level, she still trusts us. Not just trusts us but relies on us to keep her safe.
One of the biggest criticisms of the Maudsley approach is that no teenager would willingly give up so much autonomy (or should be asked to), especially to her parents. And if you believe that anorexia is a choice, the last resort of a growing child who’s been denied self-determination, then I can see how the refeeding process might seem like a further violation of a child’s independence.
But I think this perspective fundamentally misunderstands the nature of anorexia. When I observe Kitty at the table I don’t see a child who’s expressing herself, who’s exerting control over her environment. I see a child who’s the prisoner of compulsions she doesn’t understand—that no one understands—and that she can’t control. I see a terrified hostage yearning for rescue. And there’s no cavalry on the way. Only us.
If I need persuading (which I don’t), the gradual shift that starts at the end of October—about three months into refeeding—convinces me we’re on the right track. As eating has become easier for Kitty, Jamie and I have backed off a little in our scrutiny. If I’m sitting with her at the table, I might get up and stir something on the stove, leaving Kitty at the table for five or ten seconds. I’m still in the room with her, just not at the table. But one afternoon during snack, when I get up to get the newspaper from the living room, Kitty puts down her fork.
“You left,” she says when I reappear. “Where’d you go?”
“I had to get something. I’m back now.”
Kitty picks up her fork and resumes eating, turning the pages of her book with an apparent lack of concern. We say no more about it. But the next day I re-create the experiment. At breakfast I dish up her oatmeal, wait for her to stir in brown sugar and whole milk. After the first few bites I get up and begin rummaging in a cabinet, my back to Kitty for a few seconds. When I turn around, I see that she has indeed stopped eating. I give her an oblivious smile. “How’re you doing?” I ask cheerfully, and she starts eating again.
Later that day, I pick Kitty up at school for an appointment with Dr. Newbie. After she climbs into the front seat, I hand her a protein bar. “You’ll have to eat your snack in the car today,” I say.
She tears open the paper wrapper and takes a bite as I pull into traffic. She chews for a second, swallows, and says, “You’re watching me, right? I can’t eat if you’re not watching. You can see me out of the corner of your eye, right?”
“Yep,” I say, my eyes firmly on the road. “I see every bite you take.”
Over the next few days Kitty asks again and again whether we’re watching, and I know what she’s really asking: You’re making me eat this, right? I don’t have any choice here. Do I? She needs us to take the responsibility for her eating because the compulsion to not eat is still so powerful.
Which is why, I realize, more traditional treatments are not just ineffective—they’re cruel. It’s cruel to insist that a child in the throes of anorexia “take responsibility” for eating, and absurd to suggest, as many therapists and treatment programs do, that unless a person with anorexia “chooses” to eat, she can’t recover. Kitty’s reactions make sense to me now. What wouldn’t make sense would be to turn my back on her. To have her life hinge on her doing something she cannot do.
Because I believe this with all my heart: Kitty cannot choose to eat. Not yet. The time will come when she’ll have to do that, of course, when she’ll have to maintain her weight and her health herself. And when that time does come, I think we’ll know. She’ll tell us, just as she’s telling us now that she’s not ready to go it alone. Just as she told us when she was ready to go away to camp, stay home alone, stay up a half hour later. All along she’s been telling us, through words and action, what she needs in order to grow and become more independent. All we have to do is listen.


Kitty’s spirits have improved as her weight has inched up. And I’ve learned I can occasionally head off the demon by refusing to acknowledge it. On Halloween night, for instance, Kitty asks if she needs a snack. She hasn’t collected or eaten any candy. I say yes, she needs to eat two ice cream sandwiches. “Do I really need two?” she asks. “My stomach hurts.” I hear the beginning of an edge in her voice.
“Yep, that’s what you need,” I say matter-of-factly, and turn away deliberately to talk to Emma. Kitty eats the ice cream sandwiches, and the moment passes.
This strategy doesn’t always work. A few nights later Kitty erupts into a sudden rage when I bring out her bedtime snack. The plate flies across the room and breaks, a shower of yellow shards. When I jump up to get the broom and dustpan, she bolts out the front door, yelling, “I’m going to run away!” Jamie finds her down the block, on her bike in the dark, and half carries her back to the house, bike helmet and all.
I feel blindsided and stupid, shocked all over again. It’s been a few weeks since we’ve seen the demon, and already I’m forgetting its claws and fangs, its flicking tongue. How quickly the face of anorexia came to seem normal to us, and now I see that the opposite is true too: on a superficial level, at least, we’re slipping back into something resembling ordinary life. Not our old life, which was more fragmented, less organized, more spontaneous. The new normal includes shopping, cooking, and supervising three meals and two snacks a day for Kitty. It includes more time spent as a family, sitting at the table or in the living room, driving to doctors’ appointments, playing board games, talking before bed. It has its pleasures, this new life. Kitty taking Emma trick or treating, for example—that’s something she wouldn’t have been willing to do last year, or able to do six months ago. Last year, of course, Kitty was hanging with her own friends; next year, I hope, she’ll be doing that again.
I’m puzzled by the fact that the demon is still so close to the surface. When Kitty doesn’t get quite enough to eat, or when she goes more than a couple of hours during the day without eating, her mood plummets predictably. But she’s nowhere near as thin as she was three months ago; in fact, her weight is now within a normal range for her height. That is, someone her height who had never had anorexia might be healthy at this weight, though clearly, Kitty has a ways to go. She’s been eating three thousand to thirty-five hundred calories a day for weeks now, but both her physical and emotional well-being are still intensely frangible. She has no equilibrium point; she swings from feeling good to falling apart with frightening fluidity.
When we started refeeding Kitty, Jamie and I told each other and her that food was her medicine, that it would cure her, body and mind. I still believe that. But I thought we’d see change more quickly. Before we began, Kitty ate very little, but she was chipper, competent, tireless. She practiced three hours a day at the gym, and, as we later discovered, spent hours at night in her room on conditioning exercises. I understand now that hyperactivity is a hallmark of anorexia; back then, I thought Kitty’s stamina meant that she was getting enough food. Some people need less sleep than others; I wondered if some people need less food.
I can see now how my own attitudes toward food and eating blinded me to reality. I am the miser who expects his dog to not just survive but thrive on little or no food, only in my case it’s not cheapness that informs this skewed perspective but my own ambivalence about food. I can’t remember a time when I didn’t feel conflicted about eating. The message I’ve gotten all my life, from a variety of sources, is that food is dangerous. Enjoying food is dangerous, because it might lead to eating too much, and the goal is to eat as little as possible and still survive. Because the worst thing you can be in this culture is fat.
Like every parent, I want to save my children from pain and suffering, especially the pain and suffering I’ve experienced. So when Kitty announced she would eat no more desserts, I thought Good for her instead of What’s going on?
I go back to Ancel Keys’s Minnesota Experiment, this time focusing on what happened to the volunteers toward the end of the study, after twelve weeks of refeeding—about where we are now with Kitty. The volunteers still struggled with stomach pains and constipation, exhaustion and swelling. They ate vast quantities of food—five or six thousand calories a day—but most continued to feel tired and weak. “We were rather surprised,” wrote Keys, “at the slow rate of overall recovery, including recovery in the psychological aspects.”*
Researchers interviewed the men one more time, eight months after they’d started refeeding. Most had gained back all the weight lost and were more or less back to normal. Keys commented that both psychological and physical recovery from starvation “required many months of unlimited good diet.”?
I feel a little better knowing that the volunteers recovered—eventually. That the punishment starvation inflicts on a human being, body and mind, can be overcome in time. More time than I’d like, maybe, but it can happen. It will happen.
Meanwhile, because of Kitty’s continuing stomach pain, Dr. Beth schedules her for an endoscopy and a colonoscopy, to make sure there’s no underlying disease. The worst part about the test is that Kitty has to fast for about thirty hours. Dr. Beth agrees that the fasting is unfortunate, but says we have to make sure there’s nothing else going on. “I had a nineteen-year-old patient with stomach pain once who turned out to have colon cancer,” she tells me. “Not that I think Kitty has cancer. But we need to rule it out.”
The tests are scheduled for a Monday, so Kitty doesn’t have to fast on a schoolday. Not that she would mind. She says she likes the way fasting makes her feel: clean and light and virtuous. She says she hasn’t felt hungry in many months, since long before the diagnosis. As Sunday wears on, her mood improves; mine deteriorates. After everything we’ve been through, I can hardly bear to watch her not eat. It feels wrong on every level.
The next morning, the nurses let me hold her hand as they insert the IV and start the anesthesia. “You know,” she murmurs sleepily, “it’s going to be hard for me to say I’m hungry when we get home.”
I hear what she’s saying under the words: I will be hungry. I am hungry. Please feed me. Please take care of me.
I smile. “No problem,” I say. By the time they wheel her out of the waiting room, she’s asleep. And thankfully, the tests show no cancer, no Crohn’s disease. Nothing to worry about. I never thought I’d be grateful that my daughter “only” has anorexia.
When we get home I make Kitty a coffee milk shake, put on a Harry Potter movie, and sit beside her on the couch as she drinks. At her weigh-in later that week, she’s down a pound—not surprising, given the long fast, but still upsetting. Her progress has been meandering—up two pounds, down one, stay the same for two weeks, up a quarter. It’s taken three months for her to gain fourteen pounds, but five of those came in the first three weeks. So she’s basically gained three pounds a month. At our appointment later that week, Dr. Beth says she’d rather have Kitty gain the weight slowly; she says we shouldn’t worry, things are moving in the right direction. We have to be patient but steady, keep doing what we’re doing.
“Well, I hate what you’re doing,” Kitty interrupts her. She folds her arms. “I don’t want to gain weight,” she says.
I glance at Dr. Beth, who after all spends most of her professional life dealing with adolescents. Her face is watchful, nothing more. “I know,” she says to Kitty, then turns to me and asks, “Any questions?”
I do have questions, actually, but I already know they have no answers. How do we tell the difference between anorexia and, say, ordinary teenage behaviors? The full-fledged demon is unmistakable. But what about moments like these, which we see with increasing regularity? Maybe they’re like the rumblings of a dormant volcano that’s about to erupt again. Or maybe they represent emotional progress. I’ve noticed how anorexia and the refeeding process sent Kitty back to infancy in many ways. As she recovers, she seems to be moving forward, recapitulating the developmental stages of childhood. Right now it feels like she’s hit age two.
I remember Kitty in the hospital, too weak to sit up, let alone resist, and take this stubborn crankiness as a good sign. Maybe we can teach Kitty to stick up for herself, stop worrying about pleasing others and figure out what makes her happy. Maybe, in an odd way, anorexia’s giving us all a second chance. And what parent hasn’t wished for a do-over somewhere along the line?


Over the next few weeks, Kitty’s weight gain stalls, and her mood continues to deteriorate. Dr. Beth suggests cutting out dairy to see if that helps with the stomachaches. The trouble is, it’s awfully hard to get in enough calories without the daily milk shake, the lasagna, the macaroni and cheese. And it feels like the very act of restricting anything—even for medical reasons—reinforces the anorexia.
I realize how much ground Kitty’s lost one afternoon in mid-November, when she appears in the kitchen to ask what she’s having for her bedtime snack, six hours from now. “Why do I need to eat anything for snack?” wheedles Not-Kitty. “I ate so much today already. I feel really fat. I think I’ll skip dinner and snack tonight.”
Standing at the sink, wrist-deep in soapy water, I say nothing. That’s the best way to deal with the demon.
“I won’t eat,” persists Not-Kitty. “You can’t make me.”
No, I can’t, I think. I can’t physically put food in her mouth, make her chew and swallow. I wouldn’t do that even if I could.
“No school until you eat,” I say, not turning around.
“I don’t care,” says Not-Kitty. This shocks me as much as anything. Part of her goal of going to Columbia and then to law school has been not missing any school—and, of course, excelling at it.
It would be best to say nothing. Best not to argue with the demon. But I open my mouth and out come words I haven’t planned on saying: “You’ll never get to be a lawyer if you die from anorexia.”
I think this is the first time I’ve mentioned the idea of dying from anorexia to Kitty. No, I know it’s the first time, because I’ve been careful to stay positive and hopeful. She’s said the word a few times, as in “I’m going to die if I have to eat one more bite!” And of course there was the night she said at the dinner table that she wanted to go to sleep and never wake up. But this feels different. Something about the juxtaposition of the illness with Kitty’s hopes for the future strikes home, for her as well as for me.
For the rest of the day, Kitty eats. Quietly. Unhappily. More slowly than usual. But she eats, afternoon snack, dinner, and bedtime snack. And no more is said, for the moment, about not going to school.
The next afternoon is, if anything, worse. The demon takes over at the lunch table and the rest of the day is a disaster. Trying to figure out why, I sit down and calculate calories—something I’ve stopped doing, thinking we had the hang of it. I write down as much as I can remember of her recent meals, ingredients and quantities, and realize, in horror, that for the last week, she’s been taking in fewer calories than I thought—more like twenty-five hundred a day than three thousand. I can’t believe we let this happen. No wonder she’s been antsy and anxious; twenty-five hundred calories is nowhere near enough for her right now.
Then another thought strikes me: I wonder if she’s grown? Or is growing? At her next weigh-in I ask the nurse to measure her, and sure enough, Kitty’s nearly an inch taller. Now the whole picture begins to make sense: just as Kitty’s body began to need more calories, for growing, we inadvertently cut back. Those two processes, plus the physiological and psychological effects of restricting, combined to strengthen the demon within her.
Ms. Susan agrees. She says restricting—even the tiniest amount—quickly takes on a life of its own for someone with anorexia. Starvation over a period of time creates actual neural pathways in the brain. And now even the most minor echo of starvation—a slight reduction in calories, nowhere near the danger zone—reactivates those pathways, brings back the emotions and obsessions of true starvation. The reason lies in the brain’s malleability—what researchers are beginning to refer to as its neuroplasticity. Psychiatrist Norman Doidge, author of the book The Brain That Changes Itself, compares the brain to a snow-covered sledding hill. Because snow is soft and easily shaped, the first time you sled down the hill, your sled carves a path. Each time you go down after that, your sled tends to run along the same path, digging it deeper and making it harder to steer your sled elsewhere. It’s the softness of the snow, ironically, that creates a rigid, well-defined pathway. Doidge argues that it’s the same with the brain: the brain’s very flexibility, its ability to create new neural pathways, also makes those pathways hard to break away from. Each time Kitty restricts, no matter how slightly, it’s as if she’s sledding down that hill again, wearing the old groove ever deeper in the snow.
Neuroplasticity doesn’t cause eating disorders, of course; it’s just part of what makes them so tough to overcome. In Kitty’s case, I suspect a confluence of events last spring pushed her into full-blown anorexia: a growth spurt, restricting, and a prepubertal hormonal shift. And it’s going to take time, and many thousands of calories, to reverse.
In any case, I know what we have to do, and I know, now, that we can do it. We push Kitty’s calories back up to three thousand a day. I buy a big bottle of Maalox and start making milk shakes again. We pull out the Ensure Plus from the basement. We carry on.
By Thanksgiving week, Kitty’s gained two more pounds. She’s calmer, though still fragile, still quick to fall apart. Dr. Beth wonders if Kitty could use some individual therapy right now. I think it’s a good idea. Of course we’ve used up all our mental health benefits. But the amazing Ms. Susan calls our insurer and extracts extra “transitional” funding, enough to cover about six weeks of individual therapy. All I have to do, she says, is call Melanie, our behavioral health “consultant,” and make nice.
I very nearly don’t manage that, because the first thing Melanie says when I call is “You’ve used up all your benefits,” making it sound like I’m the grasshopper from Aesop’s Fables, blithely romping through summer, failing to prepare for the winter ahead. Her attitude reminds me of the last round of health-care debates, when the buzzword was choice, as in “Make wise choices about how to spend your health-care dollars.” Whatever the hell that’s supposed to mean. Should we choose not to treat Kitty’s anorexia because, gosh, we’d use up too many health-care dollars? Or should we choose instead to not have Emma’s broken arm set? Or maybe we’re supposed to choose not to get sick or hurt at all.
I know I shouldn’t argue with Melanie. I know she is the gate-keeper and I need to have a good relationship with her. “If my daughter had diabetes, you wouldn’t just cut off the benefits part-way through her treatment,” I say.
“Your employer chooses the plan,” she says. “It’s not our fault if your employer buys a health plan that doesn’t cover this.”
True enough. But I work for a small company that doesn’t have to give me any health insurance. I’m lucky to have this plan—and I didn’t get any choice about it. Jamie and I work hard, pay our bills on time, and pay plenty for our insurance, such as it is. Our daughter is sick, with an illness neither she nor we caused, an illness that requires care. An illness with a high mortality rate. An illness that could take her sanity and her life.
What we need is help. What we get is the message that we’re unreasonable, freeloaders or criminals, or worse: negligent parents who are to blame—and therefore must pay the price—for our daughter’s illness.
In the end, despite my argumentative comments, we are granted six more weeks of therapy with Ms. Susan. It won’t be enough. It won’t even be close to enough. But it’s the best offer we’re going to get from the insurance company. We’ll take it. But I refuse to be grateful.