Brave Girl Eating_ A Family's Struggle With Anorexia Part 3

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 b.l.o.o.d.y 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. 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 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 la la la so I don't have to see or hear them. I want to run to the car without looking back. 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 soph.o.m.ore 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, surrept.i.tiously, 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 b.u.mmer 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 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. 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. 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 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. 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 p.i.s.ses 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 G.o.d'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.

Cla.s.sifying eating disorders as mental illnesses piles even more stigma and judgment onto sufferers. This categorization shifts a.s.sumptions 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.

Semantics? Maybe. But the words we use to think and talk about the world often shape the way we see it-literally. I decide right here, standing in front of my closet, that I will never refer to or think of Kitty as mentally ill. She has an eating disorder. She, Kitty, the whole person. The eating disorder is a small part of her. It doesn't define her, even now.

One afternoon about five days after Kitty comes home from the ICU, I'm sitting on the end of her bed, holding a frozen protein shake, the kind she ate in the hospital. Kitty sits propped up on pillows, crying. "Come on, Kitty," I say encouragingly, moving the spoonful of chocolate shake closer to her. I want her to take the spoon and feed herself, but so far she hasn't. In the last half hour I've managed to get three spoonfuls into her mouth. The shake has long since melted; chocolate now stains the front of my pants and Kitty's blanket. My hands aren't all that steady these days. days after Kitty comes home from the ICU, I'm sitting on the end of her bed, holding a frozen protein shake, the kind she ate in the hospital. Kitty sits propped up on pillows, crying. "Come on, Kitty," I say encouragingly, moving the spoonful of chocolate shake closer to her. I want her to take the spoon and feed herself, but so far she hasn't. In the last half hour I've managed to get three spoonfuls into her mouth. The shake has long since melted; chocolate now stains the front of my pants and Kitty's blanket. My hands aren't all that steady these days.

I'm waiting for Kitty to be able to eat, but she says she can't eat, she can't drink. She says her throat is closing, she's a horrible person, she's going to get fat, she's the worst person in the world. She says she's never felt this way before. "What way?" I ask, still holding the spoon.

Kitty's hand shoots out, knocking the spoon to the floor. "I'm sorry!" she cries. "I can't help it! It's pressing on me!"

"What? What's pressing on you?"

But she's done with words, she's curled up on her pillow, sobbing, as the milk shake melts in its paper cup. I sit on the end of her bed, stroking her foot, waiting for the tears to pa.s.s.

I've spent so much time over the last few weeks waiting. Waiting for Kitty to have her IV changed. To cry herself to sleep. To finish chewing, with exquisite slowness, an infinitesimal bite of bread or egg or tomato. Waiting for that tiniest of bites to pa.s.s between her lips, down her throat, into her stomach. For the calories in that bite-two? five? fifteen?-to seep into her bloodstream, to circulate through her body and into her brain. To make her better. I'm so tired, I'd love to curl up on the end of her bed and sleep myself. But then where would we be? Still right here, with Kitty starving.

I force myself to sit up, let a little edge slip into my tone. "Kitty," I say firmly, "you have to drink this milk shake. The doctor said so. Come on now, sit up. I'll get you a straw. It's melted anyway."

Amazingly, Kitty sits up. She lifts her tear-streaked face toward me and I nearly drop the spoon. I know my daughter's face far better than I know my own. I've stared at it, examined it, admired it, loved it for fourteen years. I know every look in her repertoire, every expression. But I've never seen this face before. Her eyes have gone blank; her mouth turns downward in almost a caricature of a pout. Her tongue pokes out, and for a second I think she's sticking it out at me. Then I realize with horror that it's flicking like a snake's forked tongue.

Then she opens her mouth, and her voice, too, is unrecognizable. She speaks in a singsongy, little-girl tone, high and strange and chillingly conversational, the creepy voice of the witch in a fairy tale. "I'm a pig," she says, not to me, exactly; it's almost like she's talking to herself. "I'm a fat pig and I'm going to puke. I'm going to puke up everything because I'm such a pig."

I can't say anything because my teeth are chattering. The hairs on the back of my neck stand up as the words pour from Kitty's mouth. No, not from Kitty's mouth, because this is not Kitty. It's not my daughter who looks out of those dead eyes, who rocks on the bed, her bone-arms wrapped around her flat chest, who says the same words over and over as if her brain was reduced to a single thought. Somehow I'm up and off the bed, calling for Jamie, and then the two of us listen in horror and incomprehension as Not-Kitty spews a sickening litany of poisonous, despairing threats.

I don't know how long it goes on. A long time. I pray that Emma, in the next room, stays asleep. Over and over Jamie or I put our arms around Not-Kitty. We speak quietly in her ear, we shout, trying to break the hypnotic trance, trying to get her to see us, hear us. But it's as if we're talking to a ghost. No matter what we do, Not-Kitty keeps rocking and talking, her tongue flicking in and out.

Hours later, her eyes close suddenly and she doesn't so much go to sleep as fall out of the world. The veins in her neck stand out, as if even exhausted and unconscious she's straining against something. That's how it seems to us: as if the Kitty we know is being held hostage by-what, exactly? We don't know.

We creep out of the room without speaking, taking the long-melted milk shake with us. We lie together in bed, trembling. Was I wrong about Kitty? Is she, in fact, deranged, possessed, mentally ill beyond our ability to help her? The next time she opens her eyes, who will we find: our daughter, or the demon who now seems to possess her?

In the morning, unbelievably, Kitty is back to her normal self, or rather back to the version of normal we're getting all too used to. She eats breakfast without complaint and goes off to work with Jamie. I'm too rattled to go in to the office. Thank G.o.d for a boss who understands about families, because I need this job. Kitty is back to her normal self, or rather back to the version of normal we're getting all too used to. She eats breakfast without complaint and goes off to work with Jamie. I'm too rattled to go in to the office. Thank G.o.d for a boss who understands about families, because I need this job. We We need this job, not just for the salary but because it supplies our health insurance. Such as it is. need this job, not just for the salary but because it supplies our health insurance. Such as it is.

That night, Emma's theater camp gives a performance of Midsummer Night's Dream Midsummer Night's Dream. Kitty doesn't want to attend, but we insist. We're trying to maintain some vestige of normal family life, especially for Emma, who stood with us at her sister's bedside in the ICU. Who sits at the dinner table, hearing the poisonous words that pour from her sister's mouth. Whose life has already been profoundly altered by anorexia.

Jamie takes Emma to the theater early, and Kitty and I arrange to meet them there. In the car on the way over, Kitty tells me she feels funny again-dizzy, tight in the chest, floaty. It's been another hundred-degree day, suffocatingly humid; we're all feeling a little ill. In her fragile state, Kitty's probably dehydrated and overheated.

I could turn the car around and take her home, but I know how disappointed Emma would be. And suddenly I'm angry-no, enraged enraged-at the idea of upsetting Emma. She's important too, d.a.m.n it, and I'm not going to let her down. I pull in to the parking lot, grab Kitty's hand, and half-pull her into the building, where I jam change into a vending machine. "Drink this," I say, handing her a twenty-ounce bottle of fruit punch.

"I'm not thirsty-" she begins, but I interrupt her.

"This is not negotiable," I say, my voice tight. "You will drink this, all of it, and then we will go inside. And if we need to go back to the hospital, we'll do it after the play is over."

Kitty's mouth opens in surprise and hurt. Tears spring into her eyes and roll down her cheeks. Remorse p.r.i.c.kles in my chest; I ignore it. "Drink," I say. She drinks, all of it, as we stand outside the theater, watching families stream in, laughing and talking, going about their lives on an ordinary summer night.

By the time Kitty finishes, my anger has dissipated, leaving me both appalled at my behavior and encouraged by its results. I take the empty bottle from Kitty's shaking hand and put my arm around her shoulder. "You did good," I tell her. I put two fingers on the artery in her neck, the way the nurses in the hospital taught me, and take her pulse: forty-one beats per minute. We'll call the doctor. But not until after Emma's show.

In the auditorium, I wind up sitting next to an old friend, Lisa. Kitty took dance cla.s.ses with her at ages four and five. I wonder if Lisa knows what's going on with Kitty. We haven't kept it a secret, but we also haven't broadcast the news. I'm grateful when the lights dim and the show begins, and I can sit in the dark, my face hidden, and focus on something other than anorexia for an hour.

The show is a success, and Emma, a fairy swathed in bright gauzy scarves, has a moment in the spotlight playing the harp. She's been taking lessons for six months, and it's thrilling to see her absorbed in the music. And a relief to hear her pull it off without a wrong note. Jamie snaps photo after photo from the audience. At the end of the show, as the cast take their bows, Kitty and I slip away; Jamie will wait for Emma and bring her home, where we'll celebrate her stage debut.

Before that, though, I call the pediatrician's office and find that Dr. Beth, bless her, has left instructions for just this scenario. I ply Kitty with Propel and ice cream and rub her back until she falls asleep. When Emma and Jamie get home, the three of us eat chocolate ice cream and giggle at Emma's backstage stories. For a little while we are a family again, though we each feel Kitty's absence.

Later, as Jamie sleeps beside me, I think about what I learned tonight. The last three months have been one long and painful lesson in inadequacy-our inadequacy in the face of our daughter's mortal danger. Tonight, out of fury and despair, I stood up to the eating disorder and won, at least for a moment. Tonight I learned that I'm not helpless. We're We're not helpless. not helpless.

chapter three

There Will Be Cake

Studies indicate that...dramatic calorie restriction can result in an impairment of competence.... Investigators have noted that patients, often with no previous history of psychiatric disorder, may manifest megalomaniac and persecutory delusions, auditory hallucinations, somatisation, dissociation, suicidality, and confusion.

-D.M.T. FESSLER, "The Implications of Starvation Induced Psychological Changes for the Ethical Treatment of Hunger Strikers," Journal of Medical Ethics Journal of Medical Ethics

The last day of July is Emma's tenth birthday. Kitty's been talking about it for a week now-not because she's excited to celebrate her sister's birthday but because she knows there will be cake. She bargains with us: if she doesn't have to eat a piece of cake, she'll eat an ear of corn, an extra slice of bread. July is Emma's tenth birthday. Kitty's been talking about it for a week now-not because she's excited to celebrate her sister's birthday but because she knows there will be cake. She bargains with us: if she doesn't have to eat a piece of cake, she'll eat an ear of corn, an extra slice of bread.

But underneath the drumbeat of Kitty's anxiety, Jamie and I both hear another note, a whisper of longing that surprises me, then horrifies me because because it surprises me. In just a few months, I've grown used to the idea that Kitty fears and hates food, that she doesn't like to eat. I have, without meaning to, changed the way I think about her and eating. it surprises me. In just a few months, I've grown used to the idea that Kitty fears and hates food, that she doesn't like to eat. I have, without meaning to, changed the way I think about her and eating. Of course she doesn't want cake. Of course she doesn't want b.u.t.ter on her bread, or cheese in her sauce, or any food with more than fifty calories. Of course she doesn't want cake. Of course she doesn't want b.u.t.ter on her bread, or cheese in her sauce, or any food with more than fifty calories. I'm already thinking about Kitty's fears as if they're perfectly understandable, if not rational-like Emma's picky-eater aversion to chili. Some of my reaction is an instinct to avoid conflict, a strategy I can no longer afford; we've been forced into conflict, like it or not. Some, I see now, is a kind of insidious accommodation. I, too, am a "good girl" personality, given to internalizing rules and playing by them. I'm already thinking about Kitty's fears as if they're perfectly understandable, if not rational-like Emma's picky-eater aversion to chili. Some of my reaction is an instinct to avoid conflict, a strategy I can no longer afford; we've been forced into conflict, like it or not. Some, I see now, is a kind of insidious accommodation. I, too, am a "good girl" personality, given to internalizing rules and playing by them.

Suddenly I can see how the very human propensity to make order out of chaos, to come to terms with change, to adjust, can inadvertently enable an eating disorder. Kitty's been sick for only a few months, but already it's as if I've forgotten who she is without the anorexia. Of course she doesn't want cake. Of course she doesn't want cake. Months from now, Dr. Daniel le Grange will tell me, "There's something about anorexia that makes parents and clinicians think in different ways than they would have. I don't know what it is about this illness that gets us to think, Months from now, Dr. Daniel le Grange will tell me, "There's something about anorexia that makes parents and clinicians think in different ways than they would have. I don't know what it is about this illness that gets us to think, It's not such a bad illness It's not such a bad illness."

I wonder if our twenty-first-century ambivalence about food is to blame. I can't think of a single woman friend who has never dieted, never deprived herself of food in the name of something bigger than appet.i.te-health or fashion or s.e.xual attractiveness. And where do we draw the line between anorexic food restriction and other kinds of restricting? We live in a culture where many of us feel shame over eating anything but grilled chicken, lettuce, and fat-free dressing. A friend once told me she wished she could sc.r.a.pe the taste buds off her tongue, so she didn't have to choose between the pleasures of eating and being thin. I'm guessing she's not the only one who feels this way.

When I look at the rich dark chocolate cake, I feel not only Kitty's fear and shame and longing but my own. Kitty wants to eat the cake and and she's afraid of it. In a fundamental way, I know how she feels. Doctors harangue us about eating too much and being too fat. TV, movies, and magazines present stick-thin women as attractive, and after a while, we begin to buy in to that image. We reinforce it in casual conversations in the grocery store, on the phone, at our children's schools, at restaurants, walking around the neighborhood: she's afraid of it. In a fundamental way, I know how she feels. Doctors harangue us about eating too much and being too fat. TV, movies, and magazines present stick-thin women as attractive, and after a while, we begin to buy in to that image. We reinforce it in casual conversations in the grocery store, on the phone, at our children's schools, at restaurants, walking around the neighborhood: I'm so bad-I ate a piece of cake I'm so bad-I ate a piece of cake. Or I'm such a pig! I'm such a pig! Or Or Look at these thighs. It's a wonder I don't break the chair. Look at these thighs. It's a wonder I don't break the chair.

Food as an object of fear and loathing is a strangely seductive idea. Which reminds me of a Yiddish folk tale I heard as a child, about a miser, a miserable old coot who kept a dog to protect the gold coins hidden under his mattress. Being a miser, he was always looking for ways to spend less. One day he had a brilliant idea for how to save money; each week, he would feed his dog a little less than the week before, so the dog would get used to eating less, bit by bit. He did just that. Each week the dog became weaker and hungrier. Eventually the miser stopped feeding the dog altogether, and not too long afterward, the dog keeled over, dead. And the miser lamented: Just when I'd trained him to live on nothing at all, he had to up and die on me! Just when I'd trained him to live on nothing at all, he had to up and die on me!

I realize how deeply we as a culture have fallen for the notion that food is a regrettable necessity. As if the ideal, the holy grail we are all working toward, is to do without food altogether-and as if we not only should but could attain this state, were we good enough, determined enough, strong enough. As if that's what we should want.

So I tell Kitty no bargain; she has to eat a piece of cake. We all all have to eat a piece of cake. Still, I'm shocked when she does, spending half an hour over a small slice of dense chocolate ganache. Afterward she weeps in my arms. "That was scary, Mommy!" she cries. have to eat a piece of cake. Still, I'm shocked when she does, spending half an hour over a small slice of dense chocolate ganache. Afterward she weeps in my arms. "That was scary, Mommy!" she cries.

When Kitty was four, she scrambled onto the back of an enormous quarter horse for a walk around an indoor ring. When the horse reared, she held on without a sign of panic. I asked later if she'd been scared. "Not really," she said. "Can I ride again?"

This is the child who is now terrified by a slice of chocolate cake.

Later that night I prowl the house, unable to sleep. I pad into Kitty's room and lean over her bed, wanting to see her face relaxed even a little, free of the shadow that haunts it when she's awake. She stirs at my approach, rolls her head from side to side, and says clearly, "Make it go away." Her eyes are squeezed tight, her mouth drawn down in a rictus of pain. Physical pain? Emotional pain? I have no way to know.

Make it go away. The shadow is always with her now, even in sleep. The shadow is always with her now, even in sleep.

The next day, I decide to run errands before heading to work. For the last month and a half, everyday life in our house has pretty much stopped; the only trips we've taken lately have been to the grocery store and the doctor's office. Emma needs new shoes and a haircut, but she says she doesn't want to go out with me this morning. "I need some time to myself," she says, blowing the bangs out of her eyes. I know what she means: time in the house without Kitty (who's at work with Jamie), or the endless discussions about food that seem to take up every waking moment these days. I kiss the top of her head and lock the door behind me. decide to run errands before heading to work. For the last month and a half, everyday life in our house has pretty much stopped; the only trips we've taken lately have been to the grocery store and the doctor's office. Emma needs new shoes and a haircut, but she says she doesn't want to go out with me this morning. "I need some time to myself," she says, blowing the bangs out of her eyes. I know what she means: time in the house without Kitty (who's at work with Jamie), or the endless discussions about food that seem to take up every waking moment these days. I kiss the top of her head and lock the door behind me.

At the library, I pay for a stack of long-overdue books, then force myself over to the new books section-not that I have the time or the energy to read. But I always cruise the new books at the library, and right now I'm hanging on to any shred of life as it used to be. As I stand unseeing in front of the New Nonfiction shelf, one t.i.tle jumps out at me: a book called Eating with Your Anorexic Eating with Your Anorexic, by Laura Collins.