I remember those feelings. The waiting, waiting, waiting, and then, in my case, not a whole lot happened. One day in the college dorm, a girl I thought was a friend said after we’d changed into our swimsuits: “Where were you when they passed out the waists?” I will never forgive her, whatever her name was.
As Stirpe-Gill says, a lot of children hear the anxiety from their parents: “I was so bad today. I had dessert!”
Young people get the message from parents and other adults, that it’s what’s on the outside that is important. Their inner hungers get shoved aside in desperation to look a certain way and they develop an insatiable desire to match an imagined standard. But what is the hunger really about? Attention from parents and teachers, yes, but at the core, what’s important is to have a life that means something to you.
As kids can see, most of the adults are hungry, too. We may look like we have it all together, but most of us just figure out how to make do with our limited talents. That’s the big secret kids have to learn, and adults have to remind ourselves.
Stirpe-Gill also helped us by talking calmly to Lisa on the phone, during a time when we were all falling apart.
lisa: I know that we did have what Mom remembers to be a lengthy conversation on the phone before any treatment plans had been decided for me. But I was in such a state of extreme anxiety and doubt that I felt capable of having a real conversation with anyone. Louise asked about my eating disorder and my mental state, including what became a frequent inquiry: “Are you depressed?” I can’t recall many of my answers. I’m sure I told her that I did in fact feel depressed, but I wasn’t sure if I was actually clinically depressed. I had become so against antidepressants that I didn’t want to think about needing them again. I told her that I felt I wasn’t doing anything in my life right and had let everyone down. She said, “Gosh, Lisa, you are so critical of yourself. Why is that?”
The Student Health Director
sheila: I heard about Alejandro Martinez from a friend at Stanford University. As director of the student health center, he was the guy to help me understand why college is such an incubator for eating disorders. It was for Lisa at UC Santa Cruz. At super-elite colleges like Stanford, especially, students have achieved the dream of American children and parents everywhere. Their tickets in life would appear to be punched, with a superior education and connections. What could they possibly be hungry for?
Martinez started by admitting that student health professionals pretty much missed eating disorders until the mid-1980s. There were isolated cases of anorexia, which is easier to catch. A resident assistant in the dorm may notice a student’s severe weight loss or isolation. But bulimics are often social and look normal. Before eating disorders became widely known on campus, the other way college officials were alerted was when students needed medical clearance to participate in a sport or activity.
Most students are extremely reluctant to get help. They’ve gotten to college through tremendous drive, and they’ve been praised for being outstanding, but in college everyone is exceptional. Control and perfectionism may have helped get them there. Who better than a perfectionist to take the societal ideal of thinness and achieve it better than anyone else?
What I hadn’t thought of is that college is such a breeding ground for eating disorders because it’s a very large community of people the same age. As Martinez explained, “There are lots of places to make comparisons. And they have pressure in almost every dimension of their lives. In high school, someone’s watching over them. In college, they’re in a group that’s watching them and they’re watching each other.”
Or it could be a casual, overheard comment, like, “I need to lose five pounds.” You look at the speaker and think, as Martinez says, “Hmm, maybe I ought to be losing a few pounds myself.”
And then, “I just wanted to lose a few pounds and it became a waterfall that I couldn’t stop.”
The Dietitian
sheila: When Lisa slipped badly down that waterfall, her senior year in high school, she found dietitian Karen Astrachan to be helpful. I had gone to Lisa’s initial appointment and been impressed with Astrachan’s straightforward approach.
In researching this book, I returned to Astrachan’s office to see what was new in the street-level treatment of eating disorders.
Astrachan played intercollegiate tennis and became interested in how food fuels the body. She was introduced to eating disorders by observing other female tennis players. “I developed a comfort level because I saw it in the bathrooms,” she says.
Why are sports so often the trigger? I wanted to know. It seemed to me that athletes needed all the energy they could get. Later, I met an Olympic downhill skier who said she and her teammates all used eating disorders to keep off body fat, the better to fly down the mountain, despite being extremely cold. Coaches encouraged this. In sports like gymnastics and ice-skating, the same aerodynamics apply. Astrachan had a patient who wanted to be an ice-dancer, but was too heavy for the lifts and flips, and eventually picked another sport. Ski jumping is a high-risk sport for anorexia, for both men and women. The extra problem for boys and men is that they don’t have a key physical clue—the lack of menstruation—telling them something is very wrong. Again, it’s usually up to the parents to notice.
Like Stirpe-Gill, Astrachan was seeing younger patients. A ten-year-old exercise bulimic wanted to spend time with her father, a busy Stanford doctor, so she went to the gym with him. This made me think about all the young children I’ve been seeing at the Y. Not only on school holidays, but on regular weekdays. What are they doing inside with a bunch of adults, strapped to heavy equipment, monitoring their calories? I wondered why they weren’t outside playing baseball or soccer. Then again, a person with eating disorders can turn any activity against herself.
lisa: I did ballet and gymnastics in my younger years but preferred the intensity of kicking a ball across a soccer field. In soccer, the focus is more on strength and endurance. With twelve years of soccer, muscle sculpted my legs, and even when I had lost a great amount of weight, my legs were never thin. When I was seeing Karen, I mentioned my distaste for my “soccer legs.” She explained how everyone has a set-point weight, where her body is most comfortable, and while I might desire a certain weight, it may not be where my body can function. We talked about how I could always find a reason to hate my body or feel bad about not having a thin frame and skinny legs. And then she asked, “If you didn’t like your ears, what could you do about it?” I hadn’t heard of anyone having plastic surgery on her ears, so she had a good point, and she had many others throughout our sessions.
The High School Teacher
sheila: I met Linder Dermon years ago, when our kids were on a swim team and our job was to stand over the pool for hours with stopwatches. Our children also went to the same elementary school. In addition to teaching English at the high school, Dermon was the elementary school’s resource specialist, the friendly face in the Cottage, where kids went for help with learning difficulties like ADHD. My kids didn’t have those difficulties, so I had to wait several years to get the benefit of her gentle wisdom.
Kids in Dermon’s and my generation used to “go out and play.” We would knock on the neighbors’ door and say, “Can Jill come out and play?” Whatever the game, parents never lined up on the sidewalks to cheer. That was good, but in my town, being a good student was a mark of weirdness. I remember an older, blond, sophisticated neighborhood girl snarling, “You like to read?”
For kids these days, reading too often can be just another place to keep score. It’s about standardized test scores, not learning and certainly not pleasure. All of this starts at birth, when the month is crucial. As Dermon has noticed, “If your kid has a June birthday, you keep them back, so they’ll have an edge later.” She explained the rules of the game to me, an average parent who wants her children to be above average. As a resource specialist, Dermon sometimes sees what the trade calls “the genius disabled.” If chil
dren aren’t doing well in class, they must have learning disabilities.
Right up there with grades, sports, and honors, how you look is a matter of competition. Being thin becomes another area to keep score.
Dermon personally gets the weight issue, and is realistic. As she told me over dinner in a Thai restaurant: “I’ve been on a million diets. I’m not sure we can prevent it as parents. It would be nice to catch it earlier, but a lot happens in secret.”
What does one do with the feeling that he doesn’t measure up? Some kids are promiscuous, others get into substance abuse, others diet.
Dermon remembers Lisa being a panelist at a community meeting about stress, in which she spoke up for being average. “If there’s any good news, it’s that girls have become much more forthcoming.”
lisa: At my elementary school, everyone knew and adored Linder. She ran a reading and writing program out of a portable building called the Cottage. Even though students of the Cottage had learning disabilities, mainly dyslexia, I wished I could go there because of Linder. Later I did get to experience Linder’s amazing warmth and fabulous teaching skills, when I took her Film Literature class in high school. It was when I was suffering from anorexia, though, and my focus was very shaky. When I confided in Linder, she reminded me of a time, just the previous year, when I showed amazing courage. I got invited to be on a public panel with a few other students, two teachers, and a guest speaker about stress in high school, especially for people who didn’t get all the awards and attention. Talking with Linder helped me remember that, somewhere, I still had that strength and honesty.
The Psychoanalyst
sheila: Even less than dealing with the police did we ever expect to consult a psychoanalyst. If we hadn’t played tennis with one, and through her meet other psychoanalysts, we would have sailed merrily along assuming the breed was pretty much extinct. Last seen, psychoanalysts were being lampooned in Woody Allen movies. My view swept in the couch, the self-indulgent rehashing of childhood traumas, and the expense. Whatever would Sigmund Freud know about eating disorders?
In the hospital, Lisa had seen several nutritionists and a psychologist specializing in eating disorders, but nobody was getting through. In desperation, I took my tennis friend’s referral to an analyst who specializes in eating disorders.
lisa: The woman I’ll call Dr. Cohen approached therapy as none of my former psychologists had. From our initial meeting I felt immediately comfortable. She didn’t judge me, even though I could barely talk and Mom or Dad had to sit with me because I shook so much. After getting out of the hospital I was beyond timid. Everything seemed too bright and moved so quickly, I just wanted to hide. But with Dr. Cohen, I felt I could slowly come out of my shell and try to understand what happened to me in the hospital. On our first meeting she said hi to me in such a sweet, soft, and soothing voice. Her manner was never critical or too aggressive. She knew I was incredibly fragile and let me go as slowly as I needed. I lay on her couch, just staring blankly at her. As I recall our conversation began like this:
“Hi, Lisa. I’m Dr. Cohen.”
“Hi.” I spoke in the pitch of a painfully shy young child.
“How do you feel?”
“Bad.”
“Yeah? Is there anything else?” Still, she remained soft and soothing.
“Sad . . .” My voice trailed off.
“Why do you feel sad, Lisa?”
“Because of the hospital,” I said, looking up at the ceiling. I couldn’t think of anything else to say, as if my mind allowed me only a few words at a time.
“What made you so sad in the hospital?”
I felt so small lying on her couch, like I had truly shrunk into a child again. It wasn’t so much that I felt skinny but actually short and little.
Our first few sessions went exactly like this. I needed time to open up and be in the world a bit. She and my parents agreed that for a while I needed to see her every day and she was determined to pull me out of my dissociated state. She knew she could uncover the old Lisa by digging into my past, especially having me go back and try to detail my breakdown in May. Every day she was there for me, even when I freaked out after two days in the halfway house and ended up back in the locked ward. She came to visit me and promised to get me out of there. She told me I did not belong in a hospital and I needed to be out in the world with people who loved me.
For once, I had a medical professional telling me I was, in fact, not crazy and did not need a lockdown and did not need the medication, and she wanted to listen to me and she actually understood me. When I thought I hadn’t made any sense, she told Dad we were making progress. When I became trapped in bingeing cycles, she tried to make sense of it, at first explaining my tiny body needed the calories and then, when I had been gaining weight, tried to devalue food. In her office I felt safe and comforted to have someone who “got me.” I no longer felt misunderstood and forgotten.
Dr. Cohen promised to help me get back to my normal self, and after months of intense therapy I regained a great deal. I was able to tap into my emotions. I stopped feeling so numb and disconnected from my environment. Early on, I described to her how I felt like a cardboard cutout, with no insides. I didn’t think I really existed, like I told the police when I called 911, that I wasn’t a person. I truly believe she made me a person again.
I still talk to Dr. Cohen three nights a week, at least. I put my complete trust in her. She knows when I’m withholding feelings or information, even if we’re having a phone session. Dr. Cohen told me never to pretend with her and that it was okay to be sad or have trouble and to bring all of my emotions to her. So I did and I still do, and I often find our sessions too short.
sixteen
Ten Things We Learned About Eating Disorders
I spend a lot of time at the Y. The more stress, the more rowing. One Saturday afternoon, a tired, gray-haired man settled a disabled teenager onto a treadmill, showing her what to hold on to and what buttons to push. He looked like he could’ve been her grandfather, but he was probably her father. The strain of caring for her may have put years on his face. While going through my strength-training routine, I spun out a colorful fable about his family, what they were living with, how it made our plight seem trivial. I felt sad for this family and yet, incredibly, a little envious. Their pain had an obvious cause, a severe physical disability. Of course this heroic man looked exhausted. Ned and I were slackers in comparison.
Parents with seriously ill children often follow an unwritten handbook of public decorum—of question and response. Mostly we act as if life is normal but we walk around with our guts clenched, fearing the next phone call, tuned to the “fight” setting of the fight-or-flight instinct. On the phone and in person, we feel out our contacts for their capacity to hear a complicated, worrisome story that may not change and has no visible end.
Sometimes, instead of “Fine” in response to “How are you?” I start talking. The news isn’t easily packaged. Soon I get lost and stumble around for an appropriate way out, embarrassed that I haven’t thought to ask anything about them. But sometimes I don’t want to hear their news, good or bad.
We gauge how helpful people really can be right then, by how much work it will be for us to fill them in and deal with their reactions. “Fine” is often the best conversational tool. Many people want to be helpful, but we don’t know what to have them do. Then the burden is on them, the would-be helpers, and we all feel bad. They are like workers at a soup kitchen that gets slammed by enthusiastic volunteers at Christmastime. The volunteers end up standing around with nothing to do or trying to socialize with needy people who may be embarrassed to be there.
We go to events about our child’s illness. They can be like mental health trade shows, where you cruise the booths and pick up pens with organizations’ names on them, maybe find another doctor or treatment to try. At the September 2007 kickoff event of the Eating Disorders Resource Center in San Jose, there was a wine and cheese reception fo
llowed by experts giving talks and panel discussions. Melissa and Don Nielsen, founders of the well-respected National Eating Disorders Association, spoke movingly about their daughter’s fourteen-year battle with anorexia. “She took pride in being the Queen of Anorexia,” Don said. Exactly! Ned and I thought. Lisa acted that way, too. This was between Lisa’s two worst episodes. We didn’t know she would soon take pride in regarding herself as the worst patient Stanford Hospital ever had. Don Nielsen continued, as if speaking directly to the Himmels, “Each hospital made her worse, and we tried dozens. Everything we did was wrong.”
Bingo again. Maybe every parent in the auditorium felt this way. Eating disorder parents, like the patients themselves, can get to thinking that if the sun doesn’t come up, it’s their fault. The encouraging news was that Nielsens’ daughter got her life back. She is now married, has two children, and works as a therapist. What they finally did that wasn’t wrong, but that actually worked, was to give their daughter an ultimatum: Go in for long-term care or get no contact from us, and no support.
The first time Lisa seemed to have recovered, when she was a sophomore in college, people would often ask, “What helped?” We didn’t know, except that around the time Lisa turned twenty, something clicked and she decided she wanted her life back. We latched onto the UCLA experience as a turning point. When she refused to go to that treatment program, we were paying her tuition and supporting her in every way, but we didn’t say, like the Nielsens, “Go in for long-term care or we can’t help you anymore.” We didn’t say, “Get better or go to UCLA.” She just decided, “It’s a locked facility.
Hungry Page 25
