Brave Girl Eating

by Harriet Brown

  The receptionist buzzes open the front door; every door in the hospital, it turns out, is kept locked. We wait in a growing puddle for the therapist who will take us around. Dr. N. is young and friendly, greeting the teenagers we see as we walk slowly through the building. Most are oddly dressed—bathrobes over blue jeans, hair unbrushed, eyes dazed or combative or both. Kitty squeezes my hand and I squeeze back.

  Dr. N. leads us to a small conference room for the intake interview. Kitty, she tells us, will come to the hospital at nine each morning and stay until five. She’ll have individual and group therapy; the group will comprise other teens struggling with illnesses like depression and bipolar disorder. Kitty can also attend the hospital’s “school.” “Like right now,” she says, turning to my daughter, “the eighth graders are learning about volcanoes and building birdhouses. You can sit in on a class if you’d like.”

  Kitty physically recoils, and for the first time in weeks I feel like laughing. One of her long-standing complaints about school has always been the slow pace and endless busywork, especially in middle school. Spending the rest of the summer building birdhouses and learning about volcanoes is about the last thing she’d want to do.

  Besides, the other kids here are really messed up. Kitty’s not like that.

  But isn’t she? Isn’t she, in some profound way, like the other teenagers, with their disoriented eyes and odd behaviors? Yes and no. Eating disorders affect a person’s thinking and cognitive abilities, but only around certain subjects. Kitty can rattle off a quadratic equation, speak eloquently about World War II, play a violin solo. Her intelligence is unaffected by anorexia—until the subject of food or eating or body image comes up; then she’ll eat two bites of turkey and spend an hour sobbing because she’s eaten so much and she’s going to get fat. When this happens, as it does every time she eats, I want to say, “Don’t you get it? You need to eat or you’ll die.”

  I’m only just starting to understand that she really doesn’t get it. That her perceptions are genuinely out of whack. Much later, another therapist describes anorexia to me as a kind of “encapsulated psychosis”: someone with anorexia suffers under a set of delusions just as powerful as the delusions of a schizophrenic—but only when it comes to food, eating, and body image.

  Dr. Walter Kaye, director of the Eating Disorders Program at the University of California–San Diego and one of the leading researchers on the biology of eating disorders, once found a way to make this dissonance clear to his students. He invited two anorexic women to class and asked one of them to describe how much she weighed and how she looked. The woman said that she weighed seventy pounds and that she looked fat. Then he asked her to describe the other woman. “She said, ‘She looks terrible; she’s so thin; she looks like she’s going to die,’” Kaye tells me. “And I said, ‘But look, you’re seventy pounds and she’s seventy pounds and you’re the same height. How do you put this together saying you’re too fat and she’s too thin?’ And she just looked at me and said, ‘I don’t know, but I feel too fat.’”*

  That’s how Kitty feels too.

  Dr. N., meanwhile, is talking about rules. There seem to be a lot of them, especially with regard to eating. Kitty will eat breakfast and lunch here, so we all have to know, for instance, that no long sleeves are allowed at the table. “Sometimes they hide food there,” she says matter-of-factly.

  They? I think. There aren’t any other eating-disordered children here. Who is she talking about?

  “No clothes with drawstrings,” continues Dr. N., ticking off points on her fingers. She eyes my daughter’s shoulder-length hair. “She’ll have to cut her hair or pull it back.” So they can’t hide food in their bangs? I wonder.

  Dr. N. goes on: “You’ll open your mouth after every bite so we can make sure you’re not stuffing food into your cheeks. No bathroom for an hour after each meal. Oh, and you get thirty minutes to eat. If you don’t finish, you’ll drink Ensures to make up the calories.”

  A clap of sudden thunder shakes the window; lightning cracks across the steel-gray sky. If this were a horror movie (and it’s starting to feel like one), the next flash of lightning would reveal the therapist’s bloody fangs. Or maybe the door would swing open to reveal Nurse Ratched in a starched white cap, syringe at the ready.

  I’m not the only one feeling the melodrama. When Dr. N. steps out of the room for a minute, locking the door behind her—locking us in, or locking others out?—Kitty grabs my arm. “Don’t make me go here,” she begs.

  The therapist returns with a folder full of paperwork, which I toss into a trashcan on our way out.

  When Kitty was a baby, Jamie and I both freelanced—him in photography, me in writing and editing. For most of Kitty’s first year, she went to work with one of us. She was popular at magazines and photo studios all over New York City. I became adept at typing and marking proofs with one hand while nursing her with the other. Jamie mastered the front carrier and entered the often-lonely world of hands-on fatherhood. Our parenting strategy—born out of both necessity and the instinct to keep her close—worked when she was an infant.

  We’re hoping it works now.

  In some ways, our lives now feel similar to those early parenting days. Jamie and I divide and conquer, one of us taking Kitty and the other handling Emma, which means we rarely have the time or energy for a sustained adult conversation. We both have the same sense of heightened experience, trauma waiting around every corner, the same sense of helplessness and ignorance. Kitty cries nearly nonstop. Her tears turn to rage whenever we confront her with food. Our cajoling moves more quickly now through explaining and pleading and into yelling—for all the good it does. Arguing with Kitty about food is like debating someone in a foreign language: no matter what we say and how we say it, she seems not to understand. She refuses to eat more than the bare minimum she ate in the hospital, and sometimes not even that. Stony or tearful, her opposition remains steady. She will not eat and she will not eat.

  Daytimes are a bit easier than nights, especially when Kitty comes to work with me. My office has a door, and I use it, telling my colleagues that Kitty isn’t feeling well. I feel a sense of distance from them, as if I’m standing at the edge of a precipice, watching the world as I know it fall away. I need to be near Kitty as much as she needs to be near me. She eats the lunches I pack, watching DVDs on a laptop behind my closed office door as I try and mostly fail to work.

  By calling everyone I know and following every lead, I’ve found another therapist, Ms. Susan, whom we all like. Ms. Susan is a clinical specialist in psychiatric mental health nursing—a nurse psychotherapist, as she puts it. Her office, in a business park ten minutes from our house, is small and friendly, with soft lighting, candles, and a comfortable couch big enough for Kitty to stretch out on, her head in my lap. After our disastrous meeting with Dr. V., I feel a certain amount of anxiety about therapy, but Ms. Susan speaks in a low, musical voice, makes eye contact with Kitty, and speaks to me easily. Her calm feels contagious.

  In our first session, she asks Kitty what anorexia feels like to her, and Kitty actually responds. “It’s like a voice in my head,” she whispers. She’s lying on the couch next to me, her head in my lap, so it’s hard to hear her words.

  Ms. Susan doesn’t press her, just says, “Lots of people describe it that way, like a voice in their heads that can get pretty scary. That will get quieter and eventually go away as you recover.”

  I can feel Kitty’s relief as much as my own. Ms. Susan, too, thinks Kitty can recover.

  Ms. Susan tells us Kitty will improve with time and food. She also says that she runs a twice-weekly lunch group with a group of young women who are recovering from a variety of eating disorders. Kitty lifts her head from my lap and asks, “Can I go?” It’s the first sign of interest she’s shown in weeks.

  Ms. Susan smiles, and her whole face lights up. “We meet on Tuesdays and Fridays,” she says. After the session, she sends Kitty out to the waiting room so we can
talk for a minute. “I’ve seen a lot of teenagers with eating disorders,” she says. “Your daughter is unusually open. It’s rare for someone this age and who’s this sick to have any insight about the illness.”

  Really? I think. Kitty doesn’t seem terribly open to me. But over time I come to realize that Ms. Susan is right. Most teens with anorexia turn away from their families, a process that’s encouraged by most therapists and treatment providers. Kitty turns toward us, and toward the people she trusts—Dr. Beth and Ms. Susan. Which doesn’t mean that her recovery is easier than others’ recoveries, or that the voice is somehow less powerful in Kitty’s mind. But it does mean that she accepts our help on a fundamental level.

  I hope this will carry us through the worst times and help us repair our family once the anorexia has gone. I can’t stand the idea that we might ruin our relationship with Kitty in the process of helping her recover. But I accept the risk. It’s better than the alternatives, way better.

  I thank Ms. Susan for the encouraging words and arrange to bring Kitty to the next lunch group. We leave with a few weeks of appointments set up.

  These days of keeping Kitty close represent an oddly peaceful interlude in the surreal world we now inhabit, Jamie and Emma and I and this new Kitty, with her pointed chin and enormous eyes and will of iron. I try to remember my daughter as she was just a few months before, dancing through the house, laughing and affectionate, talking on the phone or going out with friends. Already this new Kitty, gaunt and tense and slow-moving, seems normal. Human beings can adapt to anything, from infinite riches to the horrors of Auschwitz. I don’t want to adapt to the way things are now. I want to scream, howl, tear the hair from my head in mourning and rage at what’s happening to my daughter. I can hardly muster the energy to cry.

  A few days after Kitty comes home from the ICU, a neighbor drags me to a support group meeting she’s read about, for friends and families of people with eating disorders. In the hospital meeting room we find no other parents, only two young women in recovery from eating disorders themselves. I don’t want to talk to them; I want to avert my eyes, put my fingers in my ears, and chant la la la so I don’t have to see or hear them. I want to run to the car without looking back.

  But that would hurt their feelings. They’re here to help us, after all. And so we stay and talk to Abby, a lank-haired college sophomore whose smile does not reach her tired eyes, and Sarah, a high school senior who fingers the end of her curling ponytail. I glance across the table, trying to see, surreptitiously, how thin they are: Abby is skinny, too skinny, but not as thin as Kitty. Sarah wears a bulky sweatshirt and pants, so it’s impossible to see what her body looks like.

  Sarah tells us she’s been dealing with anorexia for four years. She’s just come home after several months in a hospital eating-disorders unit, where she landed, she tells us with disarming frankness, because she tried to kill herself. “Actually, I tried a couple times,” she says, lounging in the plastic chair.

  I sit beside my neighbor, nearly mute with fear, imagining my daughter with this air of weariness and quiet despair. My daughter trying to kill herself. My daughter succeeding.

  I turn to Sarah; I can’t bear the look of exhaustion in Abby’s eyes. “What’s it really like?” I ask. “What does it feel like?”

  Sarah swings one foot, considering. “It’s like having an angel sitting on one shoulder and a devil on the other shoulder,” she says earnestly. “And it’s like they’re fighting all day long.” Her foot goes back and forth hypnotically under the table. “And it gets so bad I can’t concentrate on anything else, you know? It’s like I’m watching a movie, only I’m in the movie too. The angel says, ‘Eat this chicken, you know you should!’ and the devil says ‘Don’t eat it, you’re already gross and fat and disgusting.’ Honestly, I don’t remember very much from when it was really bad. Just that feeling.” She twirls a strand of hair around one finger and grins, and suddenly she’s an ordinary teenager with a dimple. She might be talking about a bad date or a bummer of a math test.

  My neighbor and I walk out the revolving door an hour later. I feel like all the words have been drained out of me. The night air is humid and thick and seems to press on my chest, making it hard to breathe.

  I never talk about the evening again. But I think about it often, imagining the angel and the devil on Kitty’s shoulders. Kitty’s head twisting from side to side as if she’s watching a tennis match, her shriveled body jerking as if she’s in the grip of something electric. I try to feel what she’s feeling, my own head twitching, my mind jagged and disconnected, and wonder if I’m getting a glimmer of what she’s going through—not just what we can see from the outside, which looks nightmarish, but her inner experience. I can hardly bear it: my firstborn, the child of my heart, suffering like this.

  I have to bear it, though, because she has to bear it. More than anything I want to make it better. That’s been my role and Jamie’s role for fourteen years—to make it better for Kitty, whether “it” was a skinned knee or hurt feelings. And we’ve always been able to. Until now.

  Later that night I lie awake for hours thinking about Kitty in the ICU, hooked up to monitors and wires. How did this happen to our daughter? What have we done, and how can we undo it? No, that’s not right. What have I done? Because my husband has no issues with food. He eats when he’s hungry and stops when he’s full. He’s never counted a calorie in his life, and, as far as I can tell, he doesn’t care how much he or anyone else weighs.

  I, on the other hand, grew up in a household obsessed with food and weight. I went on my first diet at fifteen, the first of many where I would lose, and then gain back, the same twenty-five or thirty pounds. Maybe Kitty’s fear of fat is really a fear of being like me? Maybe if I were thinner, she wouldn’t have to be so thin?

  Or maybe it’s my own obsession with food and being thin that’s infected her. I’ve tried, I’ve really tried, to be a good role model for Kitty and Emma. I’ve tried never to make disparaging comments about my own body (or anyone else’s). I’ve tried not to say things like “I feel fat!” I’ve tried, but I know I’ve slipped up. I know I’ve failed. And maybe my own ambivalence about my body lies at the root of Kitty’s illness.

  Or maybe that’s an unbelievably egocentric perspective. Maybe Kitty’s illness has nothing to do with me.

  To be honest, I’m not sure which scenario I prefer. If she’s sick because I screwed up, maybe I can do better, and she’ll get better. But if Kitty’s anorexia has nothing to do with me, then I’m powerless to fix it.

  Of course, maybe I’m powerless anyway, regardless of what’s caused Kitty’s illness. And maybe that’s exactly what I cannot bear.

  The week after Kitty comes home from the ICU, I buy every book I can find about anorexia, mostly first-person accounts. I read only a few pages of each before stuffing them into the back of my closet. Despite the bright covers, the implied triumphs, the books radiate despair. Or maybe that’s what I’m seeing now, because of Kitty. The young women (and they are all written by women) are dealing with so much more than anorexia: abusive or neglectful grown-ups, hostile peers, drugs, alcohol, cutting, thoughts of suicide.

  I can’t believe that’s where Kitty is heading, or maybe already is. OK, she’s sick; she’s very sick. She spent two days in the ICU, where she might have died. I’ve been slow on the uptake, but I get it now. I’ve been watching her behave in baffling ways—self-destructively, counterintuitively, without logic or reason.

  But Kitty’s not like the teens we saw at the psychiatric hospital and she’s not like the authors of those books. She wasn’t troubled or oppositional or defiant as a child. She doesn’t smoke or drink or cut herself.

  I know how Kitty reacts to pain and to pleasure. I know her ups and her downs, what pisses her off and what lifts her up. I often know what she’s thinking; we’ve always been able to read each other. We still can, most of the time.

  I don’t think I’m kidding myself about these things
. I don’t think I’m one of those mothers who believes she’s close with her child when actually the child loathes her.

  On the subjects of food and eating and fat, Kitty’s delusional. Obviously. On every other subject, though, she’s the same girl she’s always been, sharp-witted, insightful, quick. She’s a perfectionist, yes; an overachiever, definitely. But she isn’t crazy, for God’s sake. She has an illness, like diabetes or pneumonia or meningitis. With the right treatment—if only we can figure out what that is—she’ll get better. She isn’t losing her mind. She isn’t standing at the top of a slippery slope of self-destructive behaviors.

  These are the conclusions I draw from observing Kitty. To me they seem reasonable; given the history of eating-disorders treatment, though, they’re downright revolutionary. Back in the 1600s, people thought you could catch a mental illness by touching someone who had one. We haven’t come very far from that idea. We treat people with mental illnesses like lepers, stepping over them in the street when their disorders lead to homelessness, poverty, drug addiction; we shun them when they turn out to be people we know. A few psychiatric disorders have lost a little of that stigma—for example, people talk more openly now about depression and bipolar disorder. But with few exceptions we still don’t want to hear about the most severe cases of depression, or about the inner lives of people with schizophrenia or personality disorders. Once the label is slapped on, you enter a world made nightmarish not just by whatever disorder you’ve got but by the stress of being marginalized in a society that fears and loathes any hint of mental differences.

  Classifying eating disorders as mental illnesses piles even more stigma and judgment onto sufferers. This categorization shifts assumptions around cause and treatment from the realm of the physical to the psychological. And it paints someone like Kitty all one color—the color of mental illness; whereas I see her as a complex person whose thinking and behaviors are distorted in certain crucial areas, but whose mental processes are working fine in others.