Unraveling The Riddle of Anorexia
It's time to change the way we talk about anorexia and eating disorders
I was in my first year of graduate school when I checked myself into the psychiatric ward for my eating disorder. I called treatment centers across the country, but in the end I chose a psychiatric hospital in New York City because I didn’t have insurance and they offered treatment for free. They claimed their program was “old school,” meaning they stressed behavior modification. At this point, anorexic on and off for more than twenty years, I figured I didn’t have much time to fool around. I knew I needed to be in a place where I would be forced to change my behavior.
When I signed myself into the hospital, I was told I’d be in for a month. This was the typical protocol. I wasn’t as “bad” as everyone else, or at least that's what I thought. I wasn’t terribly underweight. At 5’4” and 105 pounds, my weight was low but not as bad as it had been. (My lowest weight was in the low 80’s). Other girls on the unit were skeletal. I thought I’d figure it out pretty quickly and leave before the month ended. Instead, they kept me the entire summer.
Would Anne still be alive if she’d been told that she would always have anorexia?
The way the program works--the way most eating disorder rehabs work--is that the doctors have as their main goal "refeeding" the patients. So my main and only objective on the unit was to gain weight. This meant we were shepherded four times a day into the “dining hall,” a room with long tables where all the eating disorder girls sat, elbow to elbow, eating. We didn’t choose what to eat, we just ate it. Meals were usually what I would have termed “binges” before I entered the hospital. For example: a plate of mashed potatoes, steak, oily peas and corn, a chunk of white bread with butter and a huge slab of cake. We were timed and had thirty minutes to eat everything. If, for whatever reason, we were unable to eat everything on our plates within the thirty minute time frame, we lost our privileges. This meant staying one day in our dorm room alone. In addition, it also meant guzzling down Ensure shakes to make up for the missing calories. It didn’t take long for us to realize that in order to leave, we just needed to gain the weight. So we ate the food, drank the shakes, and gained the weight knowing just as soon as we were set free, we’d start our diets all over again.
Anorexia nervosa is in the DSM. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is a classification of mental disorders published by the American Psychiatric Association. I have a friend diagnosed with schizoaffective disorder, a mental disorder. He has been hospitalized for his mental illness and sees a doctor on a regular basis who administers meds to him. He has learned about his illness and, as a result, has centered his life around his limitations. He knows what he can and cannot do. He has a job, friends, and lives a relatively “normal” life in New York City. The only reason he can live a productive, fulfilling life and not spend the rest of his life in and out of psychiatric hospitals is that he accepts his illness.
The same thing is true for any mental illness. Temple Grandin, the incredibly prolific writer, inventor and activist has flourished despite the fact that she also has high functioning Autism. Autism is also classified in the DSM as a mental disorder.
So here’s the muddle: if anorexia is also a mental illness, then why are we treated as if we are choosing to have it?
With CBT (cognitive behavioral therapy) I have learned to stop practicing certain detrimental behaviors. I no longer starve myself, I no longer binge. I don’t use laxatives or diet pills. For the most part, I have a full, rich life. I am a published writer, a wife, and I teach at colleges. All of this--my life--is far more important than getting to the gym, going for a run, calculating my daily caloric intake. In many ways, I have changed.
But inside, at my core, I will always be anorexic. Just as I will always be an alcoholic. Though my desire to drink has been removed, it can return at any time. In order to live a normal life, I need to attend meetings, help others, and stay in fit spiritual condition. If I do these things, I have a reasonable chance of living a relatively normal life. But I will never be “normal.” I’ll never not be alcoholic.
With anorexia, though, we are expected to be “cured;” to no longer be anorexic. We are told we must change, gain weight, and somehow become “normal.” But I was never “normal.” When you take away the eating and weight obsession, what you get is something that looks an awful lot like alcoholism, a disease of the mind.
If eating disorders are a mental illness, then the best way to help sufferers is not to tell them they have to change who they are, but to help them accept that they have an illness, and to help them orchestrate a full, rich life around it, just like recovery from alcohol and drug addiction.
Anne, a girl on the eating disorder ward with me, grew up in hospitals and rehabs. She spent her childhood inside locked wards. One month after finally being set free, Anne hung herself. Even now, I wonder if she would be alive today if this idea hadn’t been burned into her consciousness: the idea that in order to get better, to survive, she needed to somehow miraculously rid herself of her eating disorder.
Would Anne still be alive if she’d been told that she would always have anorexia? And that, though there are limitations inherent to her illness, with help she could learn how to survive? That, in fact, she might thrive? I wish Anne were here now, so I could tell her this. I could show her my life as evidence. But of course I can’t. Anne’s dead.
But it’s not too late to begin to change the way we talk about anorexia and eating disorders. Treating them the way we treat alcoholism is a start. But especially important is the fact that once one is anorexic, she will never not be. The idea that with rehab or by gaining weight or by reading self help books, an anorexic can somehow overcome her eating disorder is delusional. And, more importantly, its fatal.