Brave Girl Eating_ A Family's Struggle With Anorexia Part 1

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A Family's Struggle with Anorexia Brave Girl Eating Harriet Brown

Foreword

by Daniel le Grange, Ph.D.

Anorexia nervosa is a serious disorder with devastating psychological and physical consequences. Almost 75 out of every 100,000 people are diagnosed with anorexia nervosa. More specifically, 0.6 percent of adolescent girls are diagnosed with this illness. We have a tremendous challenge before us to determine serious disorder with devastating psychological and physical consequences. Almost 75 out of every 100,000 people are diagnosed with anorexia nervosa. More specifically, 0.6 percent of adolescent girls are diagnosed with this illness. We have a tremendous challenge before us to determine why why it is that young people develop this illness. While we wrestle with this vexing dilemma, however, a more urgent challenge is it is that young people develop this illness. While we wrestle with this vexing dilemma, however, a more urgent challenge is what what can be done to reverse anorexia and its array of devastating consequences. can be done to reverse anorexia and its array of devastating consequences.

Despite the crisis a.s.sociated with self-starvation, few treatments have been tested, and anorexia nervosa remains a confusing trial for sufferers, their parents, doctors, and researchers. One intervention that has received considerable clinical attention is family-based treatment (FBT). In FBT, parents aren't blamed for their child's illness; instead, they're viewed as a crucial resource in bringing about their child's recovery. They are encouraged to be in charge of their son/daughter's weight restoration while the therapist acknowledges the enormous difficulties of this task and supports the whole family. Once healthy weight has been restored, some of the developmental issues of adolescence are addressed in FBT.

Brave Girl Eating chronicles the Brown family's ordeal battling Kitty's anorexia nervosa-a remarkable journey that brings to life the almost unbearable struggle that both Kitty and her family endured. Anorexia nervosa brings about profound psychological as well as physiological changes in the sufferer. These changes are often so severe that it is common for parents not to recognize their offspring-to feel "This can't be my child." It is easy to see how perfectly competent, loving parents become bewildered and disorganized as they fail to understand this baffling illness. This confusion often makes them second-guess their natural instinct to reach out and help their child. As a consequence, they become immobilized in the face of the seemingly overwhelming power that anorexia has over their child and over them. The Browns' story is an uplifting drama as the parents' determination and perseverance, as well as Kitty's brave efforts, succeed in wresting Kitty away from the eating disorder. chronicles the Brown family's ordeal battling Kitty's anorexia nervosa-a remarkable journey that brings to life the almost unbearable struggle that both Kitty and her family endured. Anorexia nervosa brings about profound psychological as well as physiological changes in the sufferer. These changes are often so severe that it is common for parents not to recognize their offspring-to feel "This can't be my child." It is easy to see how perfectly competent, loving parents become bewildered and disorganized as they fail to understand this baffling illness. This confusion often makes them second-guess their natural instinct to reach out and help their child. As a consequence, they become immobilized in the face of the seemingly overwhelming power that anorexia has over their child and over them. The Browns' story is an uplifting drama as the parents' determination and perseverance, as well as Kitty's brave efforts, succeed in wresting Kitty away from the eating disorder.

Understanding and treating anorexia nervosa are daunting tasks. But one thing is certain: food is medicine, and recovery cannot come about unless healthy weight is restored. Put more bluntly, one has to eat in order to get better. Many obstacles block the road to recovery, and in Brave Girl Eating Brave Girl Eating the author describes some of these firsthand-for instance, the frustration experienced by both parents and teen when they get stuck in what we call "anorexic debates," where even the most rational adult can be convinced by (or give in to) the teen's insistence on the caloric "value" of a salad without a dressing. These debates demonstrate how malnutrition affects the mind and highlight the irrational power of the illness. As Brown points out, "The question isn't why but what: What do we do now?" the author describes some of these firsthand-for instance, the frustration experienced by both parents and teen when they get stuck in what we call "anorexic debates," where even the most rational adult can be convinced by (or give in to) the teen's insistence on the caloric "value" of a salad without a dressing. These debates demonstrate how malnutrition affects the mind and highlight the irrational power of the illness. As Brown points out, "The question isn't why but what: What do we do now?"

Brown also shares many of the important lessons she and her family learned throughout their ordeal. Most affirming of parents, and valuable from my perspective, is that families (parents) are not helpless-they just have to (re)gain their confidence. This, of course, is no easy task; in fact, it is perhaps one of the most difficult goals to achieve in battling anorexia nervosa. But with the support of the therapist, parents have to "stand up" and face this illness, with love and caring. Kitty's story demonstrates anorexia's awful power over the teen sufferer and over the desperate parents trying to rescue their child.

Brave Girl Eating highlights some commonly held misinformation about anorexia nervosa. By showing us Kitty's struggle, the author dispels the myth that anorexia nervosa is a choice. She equates it with other serious illnesses and disorders, and we are reminded that "anorexia chooses you!" Kitty's struggle educates all of us about the turmoil and guilt felt by both patient and parents. Confusion and denial are commonplace as the eating disorder challenges every family member, not just the teen. This book also speaks to the frustration and anguish felt by all parents who try to understand and do something when they suspect their child has an eating disorder. These feelings are exacerbated when parents have to scramble to find a specialist eating-disorders team as they navigate the health-insurance quagmire. highlights some commonly held misinformation about anorexia nervosa. By showing us Kitty's struggle, the author dispels the myth that anorexia nervosa is a choice. She equates it with other serious illnesses and disorders, and we are reminded that "anorexia chooses you!" Kitty's struggle educates all of us about the turmoil and guilt felt by both patient and parents. Confusion and denial are commonplace as the eating disorder challenges every family member, not just the teen. This book also speaks to the frustration and anguish felt by all parents who try to understand and do something when they suspect their child has an eating disorder. These feelings are exacerbated when parents have to scramble to find a specialist eating-disorders team as they navigate the health-insurance quagmire.

It is all too clear that everyone involved in this battle with anorexia nervosa requires support and guidance. While Kitty's family found ongoing support in their pediatrician and other professionals, they did not have access to a local FBT therapist and, instead, conducted the arduous task of weight restoration mostly by themselves. This absence of direct support and guidance no doubt complicated an already demanding task. I agree with the author that having hope is a great gift, having hope is a great gift, and this hope ushered them through many tough times. However, no family who struggles with this awful illness should have to do this on their own. and this hope ushered them through many tough times. However, no family who struggles with this awful illness should have to do this on their own.

Notwithstanding many obstacles along the way, Brown and her family have regained their footing, which is evidence of their resilience. Brown has since used her expertise as both a parent and writer to help empower other parents so that they may take center stage in the treatment of their children with eating disorders. Brave Girl Eating Brave Girl Eating serves as a reminder that parents are not to blame for their child's eating disorder; rather, they are a reliable resource in the recovery of their children. serves as a reminder that parents are not to blame for their child's eating disorder; rather, they are a reliable resource in the recovery of their children.

Daniel le Grange, Ph.D., is a professor of psychiatry and behavioral neuroscience and the director of the Eating Disorders Program at the University of Chicago.

Author's note

Impurities creep into every memoir for the simple reason that memory is fallible and you don't know, when you're living through an experience, that you'll someday be writing about it. (Even if you do know, walking around with a tape recorder doesn't play well in everyday life.) Then of course there's the question of perspective: two people can live through the same experience and remember it very differently-especially members of the same family. memoir for the simple reason that memory is fallible and you don't know, when you're living through an experience, that you'll someday be writing about it. (Even if you do know, walking around with a tape recorder doesn't play well in everyday life.) Then of course there's the question of perspective: two people can live through the same experience and remember it very differently-especially members of the same family.

Those issues become even more urgent when a memoir describes the lives of children, especially your own children, who are vulnerable in a variety of ways and who can't in any real sense give informed consent to being written about. It's one thing to expose your own life; it's quite another to expose the lives of your kids. As a longtime journalist and, now, a professor of journalism, I think a lot about what's ethical and what isn't. In this book, I considered the line between openness and exploitation. My intention here is to tell the truth as ethically and as compa.s.sionately as possible. To protect my children I've given them false names and disguised some of their physical and other characteristics.

Deciding to tell this story was a process for me and my family. We discussed it over a period of months, weighing the potential for good against the possibilities of harm. I give much credit to my daughter Kitty, who overcame her own preference for privacy out of a wish to help others. She's a brave and unusual young woman.

As for the vagaries of memory, I kept an extremely-one might even say obsessively-detailed journal during Kitty's illness, partly to keep track of her progress and treatment, and partly to keep myself from drowning in anxiety. In the journal I recorded many conversations more or less verbatim, and recapped others. The events I describe in this book are based on my recollections and on that journal. In a few instances I've conflated situations in order to compress the story line, but every conversation and event in this book is true and did happen as described, as far as I recollect.

People who are acutely ill with anorexia and bulimia often read a memoir like this as a guidebook for staying sick-as "thinspiration." For that reason, I have avoided mention of specific weights, numbers, and other details that might be interpreted as "pro-anorexia" or "pro-bulimia" material. It's my intention that this book never be used in that way.

What I Wish Everyone Knew.

Close your eyes. Imagine that you're standing in a bakery. Not just any bakery-the best bakery in Paris, its windows fogged, crowded with people who jostle for s.p.a.ce in front of its long gla.s.s cases. The room is fragrant and you can't take your eyes off the rows of cinnamon rolls and croissants, iced pet.i.ts fours, flaky napoleons and elephant ears. Every counter holds at least one basket of crusty baguettes, still warm from the oven. that you're standing in a bakery. Not just any bakery-the best bakery in Paris, its windows fogged, crowded with people who jostle for s.p.a.ce in front of its long gla.s.s cases. The room is fragrant and you can't take your eyes off the rows of cinnamon rolls and croissants, iced pet.i.ts fours, flaky napoleons and elephant ears. Every counter holds at least one basket of crusty baguettes, still warm from the oven.

And you're hungry. In fact, you're starving. Hunger is a tornado whirling in your chest, a bottomless vortex at your core. Hunger is a tiger sharpening its claws on your tender insides. You stand in front of the gla.s.s cases, trying to swallow, but your throat is dry and your stomach clenches and contracts.

You want more than anything to lick the side of an eclair, swirl the custard and chocolate against your tongue. You dream about biting off the end of a cruller, feeling the give of the spongy dough, the brief molecular friction of the glaze against your teeth, flooding your mouth with sweetness. The woman beside you reaches into a white paper bag, pulls out a hunk of sourdough roll. You see the little puff of steam that flares from its soft center, breathe in its warm yeasty smell. She pops it into her mouth and chews and you chew along with her. You can almost taste the bread she's eating. Almost.

But you can't, not really, because how long has it been since you've tasted bread? A month? A year? And though your stomach grinds against your backbone and your cheeks are hollow, though the tiger flays your belly, you can't eat. You want to, you have have to, but your fear is greater than your hunger. Because when you do-when you choke down a spoonful of plain yogurt, five pretzel sticks, a grape-that's when the voice in your head starts up, a whisper, a cajoling sigh: to, but your fear is greater than your hunger. Because when you do-when you choke down a spoonful of plain yogurt, five pretzel sticks, a grape-that's when the voice in your head starts up, a whisper, a cajoling sigh: You don't need to eat, you're strong, so strong. That's right. Good girl. You don't need to eat, you're strong, so strong. That's right. Good girl.

Soon the whisper is a hiss filling the center of your head: You don't deserve to eat. You're weak, unworthy. You are disgusting. You don't deserve to live. You don't deserve to eat. You're weak, unworthy. You are disgusting. You don't deserve to live. You, you, you. The voice is a drumbeat, a howl, a knife sunk in your gut, twisting. It knows what you're thinking. It knows everything you do. The more you try to block it out, the louder it becomes, until it's screaming in your ear: You, you, you. The voice is a drumbeat, a howl, a knife sunk in your gut, twisting. It knows what you're thinking. It knows everything you do. The more you try to block it out, the louder it becomes, until it's screaming in your ear: You're fat. You're a pig. You make everyone sick. No one loves you and no one ever will. You don't deserve to be loved. You've sinned and now you must be punished. You're fat. You're a pig. You make everyone sick. No one loves you and no one ever will. You don't deserve to be loved. You've sinned and now you must be punished.

So you don't eat, though food is all you think about. Though all day long, wherever you are-doing homework, sitting with friends, trying to sleep-part of you is standing in the bakery, mesmerized with hunger and with fear, the voice growling and rumbling. You have to stand there, your insides in shreds, empty of everything but your own longing. There will be no bread for you, no warm b.u.t.tery pastries. There's only the pitiless voice inside your head, high-pitched, insistent, insidious. There's only you, more alone than you've ever been. You, growing smaller and frailer. You, with nowhere else to go.

The voice is part of you now, your friend and your tormentor. You can't fight it and you don't want to. You're not so strong, after all. You can't take it and you can't get away. You don't deserve to live. You don't deserve to live. You want to die. You want to die.

This is what it feels like to have anorexia.

I've never had anorexia, but I've lived with it. I've observed it closely in someone I love: my oldest daughter, Kitty, who was fourteen when she got sick. I watched as the upbeat, affectionate, empathetic girl I knew became furious and irrational, withdrawn and depressed, obsessed with food but unable to eat. I saw her writhe in terror, heard her beg my husband and me for help, and then, in the same breath, shriek that we were trying to poison her, to make her fat, to kill her. I heard a voice I did not recognize come out of her mouth, saw her face changed beyond knowing. I held her in my arms and felt the arc of every rib, counted the bones in her elbows, saw her breastbone press out through the paper-thin skin of her chest. I felt her body shake and knew that whatever comfort I offered wasn't enough; it was nothing in the face of the thing that was stripping the flesh from her bones and the light from her eyes. but I've lived with it. I've observed it closely in someone I love: my oldest daughter, Kitty, who was fourteen when she got sick. I watched as the upbeat, affectionate, empathetic girl I knew became furious and irrational, withdrawn and depressed, obsessed with food but unable to eat. I saw her writhe in terror, heard her beg my husband and me for help, and then, in the same breath, shriek that we were trying to poison her, to make her fat, to kill her. I heard a voice I did not recognize come out of her mouth, saw her face changed beyond knowing. I held her in my arms and felt the arc of every rib, counted the bones in her elbows, saw her breastbone press out through the paper-thin skin of her chest. I felt her body shake and knew that whatever comfort I offered wasn't enough; it was nothing in the face of the thing that was stripping the flesh from her bones and the light from her eyes.

I had no idea anorexia was like that.

Before Kitty got sick, I thought eating disorders happened to other people's children. Not to my daughter, who was savvy and wise, strong and funny, the kind of kid who picked her way easily through the pitfalls of toxic middle-school friendships. She did fit the cla.s.sic profile: she was a perfectionist, fastidious about how she looked and dressed. She was hard on people sometimes, especially herself. She was athletic, a gymnast; her favorite event was the balance beam-fitting, I thought, for a child who so gracefully walked the line between childhood and adolescence.

But she would never have an eating disorder. She was way too smart for that.

Before my daughter got sick, I thought kids with anorexia or bulimia wanted attention, that they were screwed up and tuned out, bored or acting up or self-destructive. But my daughter was none of those things. She seemed cheerful and well adjusted; she had friends, interests, a pa.s.sion for new experiences. She wrote her sixth-grade research paper on eating disorders. She knew the dangers. She would never choose to have anorexia. She was safe.

I was wrong about many things, but I was right about that one thing: Kitty didn't didn't choose anorexia. Anorexia chose her. And it nearly killed her. choose anorexia. Anorexia chose her. And it nearly killed her.

At Kitty's lowest weight, her heart beat dangerously slowly; it could have stopped at any time. Between 10 and 20 percent of people with anorexia die from heart attacks, other complications, and suicide; the disease has the highest mortality rate of any mental illness. Or Kitty could have lost her life in a different way, lost it to the roller coaster of relapse and recovery, inpatient and outpatient, that eats up, on average, five to seven years. Or a lifetime: only half of all anorexics recover in the end. The other half endure lives of dysfunction and despair. Friends and families give up on them. Doctors dread treating them. They're left to stand in the bakery with the voice ringing in their ears, alone in every way that matters.

Kitty didn't choose anorexia. No one chooses anorexia, or bulimia, or any other eating disorder. Intelligence is no protection; many of the young women (and, increasingly, men) who develop anorexia are bright and curious and tuned in. Families are no protection, either, because anorexia strikes children from happy families and difficult ones, repressed families and families who talk ad nauseam about feelings. The families of anorexics do share certain traits, though: a history of eating disorders, or anxiety, or obsessive-compulsive disorder. Or all of the above.

I've never had anorexia, but I know it well. I see it on the street, in the gaunt and sunken face, the bony chest, the spindly arms of an emaciated woman. I've come to recognize the flat look of despair, the hopelessness that follows, inevitably, from years of starvation. I think: That could have been my daughter. That could have been my daughter. It wasn't. It's not. If I have anything to say about it, it won't be. It wasn't. It's not. If I have anything to say about it, it won't be.

This is our family's story. Kitty was diagnosed with anorexia in June 2005. In August of that year we began family-based treatment (FBT), also known as the Maudsley approach, to help her recover. That was the start of the hardest year of all of our lives. That year, I learned just how brave my daughter is. Five or six times a day, she sat at the table and faced down panic and guilt, terror and delusions and physical pain, and kept going. And she emerged on the other side. After months of being lost, she came back to us and to herself, and the world took on color and sound and meaning once more.

Between 3 and 6 percent of all teens deal with an eating disorder, whether it's anorexia, bulimia, binge eating disorder, or the all-too-common ED-NOS, or eating disorder not specified. Many more struggle with other devastating illnesses, both mental and physical: Schizophrenia. Bipolar disorder. Depression and anxiety. Autism. Cystic fibrosis. Cerebral palsy. Autoimmune disorders.

We have a long history, in this country and elsewhere in the Western world, of implicating families in their children's illnesses. As I write, the Academy for Eating Disorders has released a position paper-two years in the making-that acknowledges, among other things, that "family factors" may play some role in both causing and sustaining an eating disorder. But it goes on to say, "Current knowledge refutes the idea that [families] are either the exclusive or even the primary mechanisms that underlie risk. Thus, the AED stands firmly against any etiologic model of eating disorders in which family influences are seen as the primary cause of anorexia nervosa or bulimia nervosa, and condemns generalizing statements that imply families are to blame for their child's illness."

The AED's paper takes a step in the right direction-one that's already been taken when it comes to illnesses like schizophrenia and autism, where the biological underpinnings and mechanisms of the diseases are more widely accepted. We'll get there for eating disorders, too; it's just going to take awhile.

One of the hopeful signs is the slow rise of family-based treatment, which aligns parents with the teenager rather than separating them, as has been the norm. This sea change is not specific to eating disorders, but it's particularly encouraging in that context because of the hundred-plus-year history of blaming parents for anorexia and bulimia. As I write, the Children's Hospital in Westmead, Australia, has just opened two family units, so parents and siblings can stay at the hospital with a child undergoing treatment for anorexia. "It's very scary for an eight-or nine-year-old to be away from home and in hospital for weeks and weeks," says the director, Dr. Sloane Madden. "Treating the whole family as inpatients creates a much more friendly and private environment and is much more similar to what it will be like at home when they are discharged."

I believe we're in the midst of a cultural shift in how we see families across the board. Parents do have an enormous influence on their children, both good and bad. The experiences of childhood and adolescence can profoundly shape a person's life. But we're also more and more aware of the other forces that contribute, from genetics to biology to the influence of peers and the media. And we know, now, that even imperfect families-and aren't we all imperfect?-can effectively support a child through one of the most h.e.l.lish experiences of his or her life.

So this book is for the families whose children struggle not just with eating disorders but with depression, anxiety, schizophrenia, autism, bipolar disorder, and so many other illnesses that change the nature of a family's life forever. Know that you're not to blame, you're not alone, and you can make a difference in your child's life.

chapter one

Down the Rabbit Hole

Starvation affects the whole organism and its results may be described in the anatomical, biochemical, physiological, and psychological frames of reference.

-ANCEL K KEYS, from The Biology of Starvation The Biology of Starvation

My daughter Kitty stands by my bed. It's Sat.u.r.day night, close to midnight, and I'm trying-and failing-to fall asleep. Even in the dark, even before she speaks, I can tell Kitty's worried. I sit up, turn on the light, fumble for my gla.s.ses. Kitty's hand is on her chest. "Mommy?" she says, her voice rising in a way that instantly lifts the hairs on the back of my neck. "My heart feels funny." There's fear in her deep brown eyes, different from the anxiety I've been seeing since this nightmare started. A month ago? Two months ago? I can't remember a beginning, a discrete dividing line separating by my bed. It's Sat.u.r.day night, close to midnight, and I'm trying-and failing-to fall asleep. Even in the dark, even before she speaks, I can tell Kitty's worried. I sit up, turn on the light, fumble for my gla.s.ses. Kitty's hand is on her chest. "Mommy?" she says, her voice rising in a way that instantly lifts the hairs on the back of my neck. "My heart feels funny." There's fear in her deep brown eyes, different from the anxiety I've been seeing since this nightmare started. A month ago? Two months ago? I can't remember a beginning, a discrete dividing line separating before before from from after after. There's only now now. And now now is suddenly not good at all. is suddenly not good at all.

"Funny how?" I ask, wrapping my arm around her narrow back. I could lift her easily. I could run with her in my arms.

Kitty shakes her head. Closing her eyes, so huge in her gaunt face, she digs the point of her chin into my shoulder as I reach for the phone to call the pediatrician. I know, the way you know these things, that this is serious, that we will need more than soothing words tonight.

Dr. Beth, as I'll call her, phones back right away and tells me to get Kitty to the emergency room. She'll let them know we're coming, she says; she'll tell them about Kitty. About Kitty's anorexia, she means. I grab Kitty's sweatshirt, because she's freezing despite the 90-degree heat. I slip on shoes (a sandal and a sneaker, as I later discover), shake my husband, Jamie, awake. He wants to come to the hospital, but someone has to stay home with Emma, our sleeping ten-year-old. "Call me when you know something," he says, and I'm out the door, the car screeching through the rain-slicked streets of our small midwestern city.

Six months ago I barely knew what anorexia was. Six months ago my daughter Kitty seemed to have it all going for her: she was a straight-A student and a compet.i.tive gymnast; she loved friends, books, horses, and any kind of adventure, more or less in that order. One of her most noticeable traits, since toddlerhood, has been her reasonableness. I've seen this quality emerge in her again and again, even at times when I would have expected her to be unreasonable-at age two, being told we weren't going to buy a particular doll; at age five, tired from a long train ride. I've watched thought battle feelings in her for a long time, and reason has nearly always won out, a fact that has, over the years, concerned me at times: Aren't toddlers supposed supposed to be unreasonable? Don't kids have to go through the terrible twos, the unruly threes, the rebellious twelves? to be unreasonable? Don't kids have to go through the terrible twos, the unruly threes, the rebellious twelves?

Which is why Kitty's recent lack of reason when it comes to food and eating has been all the more puzzling. We've talked about it again and again: How her body needs fuel to keep going, especially since she's an athlete. How food is good for her, not something to be afraid of. How human beings are meant to eat everything in moderation. Including dessert.

Even now, I don't truly understand why Kitty can't pick up a fork and eat the way she used to, why she is suddenly obsessed with calories and getting fat. She's never been been fat; no one's ever made fun of her because of her weight. She has always loved to eat. In one of our favorite family stories, Kitty, age four, ordered a huge bowl of mussels in a restaurant one night and devoured them, licking the insides of the shiny dark sh.e.l.ls. The chef came out of the kitchen to see the child with the adult palate and sent out a bowl of chocolate ice cream in appreciation. Which Kitty finished. fat; no one's ever made fun of her because of her weight. She has always loved to eat. In one of our favorite family stories, Kitty, age four, ordered a huge bowl of mussels in a restaurant one night and devoured them, licking the insides of the shiny dark sh.e.l.ls. The chef came out of the kitchen to see the child with the adult palate and sent out a bowl of chocolate ice cream in appreciation. Which Kitty finished.

I still don't understand, but I'm beginning to know. To recognize the sick feeling in my stomach each time we sit down at the table and Kitty does not eat. I'm beginning to be able to predict how each meal will go: Jamie and I will take turns cajoling, pleading, ordering our daughter to eat, and she will turn aside everything we say with the skill of a fencer parrying a lunge. She will eat a few bites of lettuce, a handful of dry ramen noodles. She will count out six grapes and consume them with infinite slowness, peeling each one into strips and sucking it dry. She will pour her milk down the sink when she thinks we're not looking, allow herself only five sips of water.

And at the end of the meal, she will climb the stairs to her room and do a hundred extra sit-ups, penance for the sin of feeding herself even these sc.r.a.ps. Which would not keep a dog alive.

Which will not keep her her alive, either. alive, either.

Kitty sits next to me in the front seat, her lank blond hair sc.r.a.ped back in a ponytail, looking small and lost in the oversized sweatshirt that fit her six months ago. "I'm dizzy, Mommy," she murmurs. I keep one hand on the wheel, the other on her, as if I can keep her from floating away. My brain seems to divide as I drive, so that while part of me is watching the road, hitting the gas and brake, another part is thinking Don't die. Please don't die. Don't die. Please don't die.

The triage nurse is waiting when we hustle into the emergency room. She has my daughter on a gurney, sweatshirt off, hooked up to the EKG machine, within minutes. Kitty trembles in the hospital air-conditioning, goose b.u.mps rising along arms so thin they look like Popsicle sticks. She clutches my hand, the sharp bones of her fingers leaving bruises, as the nurse applies goo and deftly arranges the sensors across her chest.

"Don't leave me," she says, and I promise. They'll have to handcuff me to get me out of the room this time.

I'd left the room a few months earlier, at Kitty's fourteen-year-old checkup, trying to be a good mother, a wise mother, a nonhelicoptering mother. The truth is, I was worried about Kitty's weight. She'd always been on the small side, built lean. When she turned eleven, she'd gained a little weight as her body got ready to grow. It wasn't much, maybe five or six pounds, but Kitty was unhappy about it. That was the first time she talked about not liking how she looked, at least to us. Of course Jamie and I rea.s.sured her, reminding her that this was her body's way of getting ready to develop, that she'd be healthy and strong no matter what shape or size she was meant to be. a few months earlier, at Kitty's fourteen-year-old checkup, trying to be a good mother, a wise mother, a nonhelicoptering mother. The truth is, I was worried about Kitty's weight. She'd always been on the small side, built lean. When she turned eleven, she'd gained a little weight as her body got ready to grow. It wasn't much, maybe five or six pounds, but Kitty was unhappy about it. That was the first time she talked about not liking how she looked, at least to us. Of course Jamie and I rea.s.sured her, reminding her that this was her body's way of getting ready to develop, that she'd be healthy and strong no matter what shape or size she was meant to be.

She was in sixth grade at the time, the first year of middle school, and the emphasis in health cla.s.s, then as now, was on obesity. The sixth graders were weighed, their BMIs calculated, their fat measured with calipers. They learned about calories and nutrition, all from the cautionary perspective of too much too much rather than rather than not enough not enough. So it didn't surprise us when Kitty came home one day and announced that she was cutting out desserts because they weren't "healthy."

I thought it might be a good idea. I applauded her discipline and willpower. Like most women in America, I've had a conflicted relationship with food and eating. Like most women in my family, I'm short and plump and have a sweet tooth. And like most mothers of my generation, I was determined that my kids would be healthier than me. My children would breathe in no secondhand smoke; they would always wear seat belts and bike helmets and eat organic food as much as possible. I baked Kitty's first birthday cake myself, a homemade concoction of carrots and raisins, using applesauce instead of oil and a quarter of the sugar the recipe called for because I didn't want my baby getting a taste for the hard stuff. Our photos from the big day show a sagging Leaning-Tower-of-Pisa construction with barely enough icing to cover the 100 percent whole wheat dough. Very kindly, none of Kitty's grandparents criticized the cake. But n.o.body ate it, either. Not even the birthday girl. Not even me.

My views had evolved since then. All things in moderation, as Aristotle advised. Still, we probably ate too much sugar; less, in this case, might be more.

If I'd understood what was to come, I would have served dessert at every meal. I'd have bought an ice cream maker, taken up cake decorating. I'd have whipped up brownies and cookies every week. Every day. h.e.l.l-I might have opened my own bakery.

Kitty's worries about being fat seemed to dissipate by the end of sixth grade. She grew an inch and put on some muscle after joining a gymnastics team. But at her checkup that December, she weighed half a pound less than she had the year before, despite the fact that she was taller.

"Isn't she too thin?" I asked the pediatrician.

Dr. Beth is a small woman, short, with streaked blond hair and laugh lines at the corners of her eyes. She looked over my daughter's vitals and her chart. She soon had Kitty laughing and chatting about school and gymnastics and friends. While they talked, Dr. Beth plotted her growth on a chart and showed me that Kitty had gone from the 50th percentile in weight to about the 42nd-not a big drop, and probably, she explained, just a blip, a temporary dip in the curve. She'd dropped in percentile that way between ages nine and ten, though she hadn't actually lost any weight that time. Still, said Dr. Beth, this was probably within the range of normal adolescent growth.

"She's just naturally thin," she said. Then she asked me to leave the room so she and Kitty could talk privately. That, too, was a first, a sign of Kitty's growing autonomy. A sign that she had her own life now, and that as her mother, there were things I was no longer privy to.

But sitting in the waiting room, I felt more worried, not less, and I didn't know why. Was I being overprotective? I told myself the doctor knew best. I reminded myself to be proud of Kitty's maturity and good sense. Proud of myself and Jamie, for the hard work of raising her so far. If I felt a pang at the thought that our work was nearly done, that Kitty was growing up, well, that was my problem and my issue, wasn't it?

So why did I feel so uneasy?

Fast-forward four months, to April. Kitty was fourteen years old, with shiny blond hair that fell below her shoulders and dark eyes flecked with gold. She was, as she had been since birth, a compulsively curious person, physically and intellectually adventurous. Her goal was to be a lawyer, and she already knew where she wanted to go to law school: Columbia, because more than anything, she wanted to live in New York City. Which is why it was so much fun to take her to New York that spring, just the two of us. We stayed with friends, shopped, saw a play. And we ate: Indian dinners and sushi, bowls of pasta in alfredo sauce, creamy gelato-far better food than anything we could get back in the Midwest.

When I got the photos back the week after our trip, I thought Kitty looked taller. Or, possibly, a little thinner. In every picture, though, she was smiling broadly, one arm looped through mine. The image of happy confidence.

The triage nurse raises the strip of the paper and studies the zigzagging lines that hold the answer of what will happen next to Kitty. Then she busies herself tidying up the gurney. "Wait outside," she says briskly to both of us. "The doctor will come get you." the strip of the paper and studies the zigzagging lines that hold the answer of what will happen next to Kitty. Then she busies herself tidying up the gurney. "Wait outside," she says briskly to both of us. "The doctor will come get you."

I pull Kitty's shirt over her bony chest and b.u.t.ton it, slide her arms into her sweatshirt the way I did when she was a little girl, zip it all the way up again. It's not enough to keep her warm. I wrap my arm around her and she leans on me as we make our way back out to the waiting room. The TV's on, mounted high in one corner of the room, the sound off, and we turn our faces toward it, toward the light and normalcy it represents. The images on the screen might as well be scenes from a foreign film, like the filmstrips shown in grade-school social studies cla.s.ses, the kind of movies that establish firmly the otherness of the lives on-screen even as the script tries to make them seem just like us. Now we're the others, our lives unimaginably far from the brightly colored lives on-screen. Now we're the ones to be studied. Dissected. Pitied.

On Mother's Day-only two months ago, now-we planned a family bike ride. Emma had recently gotten good enough on a two-wheeler to keep up with the rest of us. And so we set out after lunch on a warm Sunday afternoon. Our route was an easy eight-mile ride; even with lots of water breaks, it shouldn't have taken more than two hours. But almost as soon as we hit the bike trail, half a mile from our house, Kitty began to cry. Not a few sniffles, either, but full-out hysterical sobbing. two months ago, now-we planned a family bike ride. Emma had recently gotten good enough on a two-wheeler to keep up with the rest of us. And so we set out after lunch on a warm Sunday afternoon. Our route was an easy eight-mile ride; even with lots of water breaks, it shouldn't have taken more than two hours. But almost as soon as we hit the bike trail, half a mile from our house, Kitty began to cry. Not a few sniffles, either, but full-out hysterical sobbing.

We stopped right away. "What happened?" I asked. She'd been fine at home, ten minutes earlier. "What's wrong?"

"I don't know!" she wailed. She wouldn't, or couldn't, tell Jamie or me what was wrong.

After twenty minutes of sitting by the side of the trail, Jamie asked, "Should we go home?"

"I don't want to ruin Mother's Day!" sobbed Kitty, getting back on her bike. Off we pedaled. Five minutes later, the same thing happened again. On and on Kitty wept, and we watched helplessly.

After an hour, we'd made it to a small concrete gazebo in the middle of a playground in a subdivision of McMansions. The gazebo offered the only shade in sight, and we huddled under its small roof, rubbing Kitty's back, trying to get her to drink (she insisted she wasn't thirsty), trying to figure out what had gone so suddenly and bewilderingly wrong. "I don't know," she said, over and over, as tears literally squirted from her eyes and down her cheeks. "I don't know! I'm sorry!"