Brave Girl Eating_ A Family's Struggle With Anorexia Part 7

To me this feels awfully contrived. Primitive people observed lightning and thunder and came up with a story to explain them: the G.o.ds were angry. They looked for intention and meaning in the world around them because that's what humans do; our brains seek to make order out of chaos, narrative out of random occurrences. Theories like Bruch's are equally unscientific; they conflate correlation-things that happen at the same time-with causation. It's true that eating disorders often start at adolescence, but we could come up with a dozen theories that "explain" that correlation-say, eating disorders are physiologically triggered by hormones. It's just as likely as the ambivalent-about-growing-up theory, to my mind.

Guisinger's theory seeks meaning in the illness too, but her conclusions seem more genuinely aligned with reality-though it's a reality that no longer literally applies.

At the end of the day, of course, no one knows what causes anorexia, and no one is likely to know for a long time, if ever, which is yet another reason why family-based treatment appeals to me: in the clamor of competing theories and hypotheses, the Maudsley approach says simply, "We don't need to know in order to treat the illness." FBT emphasizes recovery over etiology, results over theories. Human lives over intellectual jousting.

As a journalist, I want to know what's behind this deadly disease, what makes young women and men starve themselves, what are the causes and risk factors. I follow the research, collecting scientific articles the way some people collect baseball cards. I go to conferences, look up medical terminology, try to teach myself the essentials of anatomy so I can understand what the insula does, why tryptophan is important, how ketosis works. I read and reread descriptions of metabolism and appet.i.te, hunger and satiety. My curiosity is piqued by the mystery that is anorexia.

As a mother, I care about only one thing: my daughter. The dead look in her eyes makes me feel dead inside. What drives me is the terror that she will never come back. That her life will be a wasteland without landmarks or topography. That Kitty's face, more known to me than my own, will harden and set into the mask of Not-Kitty, and that when I look into her eyes years from now I'll see the demon looking back.

Or worse: I'll see nothing, because she'll be gone.

One night I sit at the computer and explore a Web site called somethingfishy, which is dedicated to people with eating disorders. I read some of the threads in the chat room for families and feel ill at the despair and hopelessness expressed there. But the most disturbing part of the site is a page of memorials to people who have died from eating disorders. I scroll through screen after screen of candles, each marked with a name, a date, a fragment of a story: Christy Henrich, died July 26, 1994, from anorexia. Number 2 gymnast in the USA in 1989.Jane, died December 26, 1995, from anorexia and bulimia; she is survived by her husband, Andy, and their 14-month-old son.This is in prayer to light a candle for Baby Angella Hope, born September 17, died December 2, 1996. She is the result of a practicing bulimic.Heidi Guenther, age 22. Died of a sudden fatal heart attack on June 30, 1997, in California on her way to Disneyland.Deborah Simone Fradin. Debbie died from anorexia nervosa after battling this disease with every fiber in her being for 18 years. The disease ravaged her body, but not her gentle soul.

Candle after candle. Name after name. Story after story. She struggled with this disease for a year, for five years, for twenty-five years. Bright shining girls who should be giggling with friends in the halls of high schools and colleges, studying Latin and microbiology and dance. Girls who should have been walking through fields of light and dark, who instead fell into shadow. They died of heart attacks in bathrooms, in beds, in hospital rooms. They died at home, at school, alone. They died with their parents crying over them, their friends confused. They died before they had a chance to live, because once the demon moves in they're not really living. I know. Believe me, I know.

Tears stream down my face, tears I haven't been able to shed for my own bright shining daughter because I haven't been able to face the fact that she might have died this summer. She still might die. I hope she's on the road to recovery, that she'll have to walk this particular stretch only once. But the numbers are against her. The statistics say she'll come back this way again and again, her body getting weaker and more adapted to starvation until it comes to feel natural and right to her, until her very cells learn the pattern and shape and feeling of constant gnawing hunger. Until that skull face in the mirror looks like her face. Until it is is her face. Until it has obliterated her real face not only in her own eyes but in ours. her face. Until it has obliterated her real face not only in her own eyes but in ours.

And that's when my fury rises. Between our reality-where Kitty's life hangs in the balance-and the theories about why why she is sick and she is sick and how how to help her lies an enormous chasm. I have no idea how to get across it. I don't even know if it's possible. And all the research is no help. It exists only on paper, tidy and two-dimensional, disconnected from the messy, dangerous, three-dimensional world we're trapped in. to help her lies an enormous chasm. I have no idea how to get across it. I don't even know if it's possible. And all the research is no help. It exists only on paper, tidy and two-dimensional, disconnected from the messy, dangerous, three-dimensional world we're trapped in.

Every paper I read, every doctor I talk to, seems to have a different explanation for and approach to anorexia. No wonder the field has such a lousy track record. A higher percentage of people with anorexia die than people with schizophrenia or bipolar disorder or depression or any other mental illness. Of those who survive, only half truly recover.

You'd think numbers like these would inspire a little more soul-searching among the professionals. You'd be wrong.

A heart surgeon who used outmoded techniques would be barred from the operating room. Yet eating-disorders therapists cleave to theories from sixty years ago as if they represented the most up-to-date thinking, and they defend their beliefs with the self-righteous vigor of zealots. Maybe this is because so many of the people who treat eating disorders had (or still have) the illness themselves. On one hand, this gives them great empathy. On the other, it weds them to a particular narrative-their own personal story line. For instance, if they recovered by finding G.o.d-which isn't that unusual; one of the biggest residential treatment chains, Remuda Ranch, offers a twelve-step, Bible-based approach-they'll push their patients in that direction. If, as is all too common, they themselves still struggle with disordered eating, they're likely to believe, and to communicate to their patients, that full recovery is impossible, that anorexia is an illness you have to manage for the rest of your life. They will, however inadvertently, convey a sense of hopelessness and resignation based on nothing but their own experience.

What I want is what's commonplace in every other area of medicine: best practice. Evidence-based treatment, based on the most up-to-date research and clinical practice. It doesn't seem a lot to ask, to advise patients out of knowledge rather than belief. That's what doctors do, isn't it?

Not in the world of eating disorders. Not yet.

When Kitty was four or five, she went through a fairy-tale phase. Every night Jamie and I read her parables about good and evil, usually featuring a young girl in mortal danger who, in the end, lives happily ever after. So I know how fairy tales work. Events unfold according to a formula known or intuited in advance. They have a predictable story line, complete with warnings and foretellings, symbols and metaphors that make them both universal and compelling. Which, now that I think about it, might be why Kitty loved them so much. She's always been the kind of child who likes rules, who needs to know not just what to do and how to do it but what not to do and how to stay out of trouble.

If our story were a fairy tale, there would be a magic needle, a bridge rising out of the mist, a talking fish that would whisper instructions in my ear about how to trick our way across that chasm. And we would would cross that chasm. We would overcome all obstacles, real and supernatural, and make our way to safety. cross that chasm. We would overcome all obstacles, real and supernatural, and make our way to safety.

One of Kitty's favorite childhood books was a gorgeously ill.u.s.trated retelling of the Russian firebird myth. The main characters are a dim but handsome young prince named Dmitri and his wise talking horse. Together they face dangers, pa.s.s through trials by fire and water, and pit their wits against the machinations of an evil king. Each time they face a seemingly insurmountable obstacle, Dmitri runs crying to the horse, wringing his hands, sure that he'll fail. And each time the horse says, "The trouble is not now. The trouble is still to come," and then tells Dmitri what to do. Those phrases-The trouble is not now. The trouble is still to come-become a refrain in the book, and over time they've become a kind of family motto for us, a joke we tell each other to remind ourselves that we can handle it, whatever it it is. is.

Toward the end of the book, Dmitri must leap three times into a cauldron of boiling water without getting scalded or drowned. When he runs to the horse, anxious about this final test, the horse replies, "The trouble is now." It comes as a shock because you've been lulled by the rea.s.suring leitmotif: The trouble is not now. The trouble is still to come The trouble is not now. The trouble is still to come. Of course, thanks to the horse's quick thinking, Dmitri pa.s.ses unscathed through the boiling water, vanquishing the evil king and winning the hand of the woman he loves. Happily ever after for everyone, including the horse.

I want someone to tell us not only what to do and how to do it but that we can can do it. I want to live inside a fairy tale, where good triumphs over evil and love overpowers greed, envy, resentment, and fear. Because the one thing I know for sure is that the trouble is now. The water is boiling, the demon is laughing, the young woman's life is in mortal danger. do it. I want to live inside a fairy tale, where good triumphs over evil and love overpowers greed, envy, resentment, and fear. Because the one thing I know for sure is that the trouble is now. The water is boiling, the demon is laughing, the young woman's life is in mortal danger.

If I can't have a talking horse, I at least want a guide, someone who's traveled this road and knows how to make it across the chasm. Who will talk us through the scary parts. The trouble is now and the trouble is still to come. And I don't know if we'll be all right.

chapter six

September

Through all my growing up, and through all my marriage and through all the tough times, I was always trying to measure up, or trying to be somebody else. And all of a sudden you said, "I just love you. I don't need you to be well. It doesn't matter."

-BETSY H HALL, who has struggled with anorexia and bulimia for much of her life, quoted in a film made by her daughter, Hope Hall

To mark the end of the first week of school-a week that's gone pretty well for both Kitty and Emma-Jamie and I make plans for Sunday afternoon. We'll take our kayaks to a nearby lake and paddle around, then hang out in the park onsh.o.r.e. Our last family outing was the opera in the park concert back in July. The night Kitty ended up in the hospital. of the first week of school-a week that's gone pretty well for both Kitty and Emma-Jamie and I make plans for Sunday afternoon. We'll take our kayaks to a nearby lake and paddle around, then hang out in the park onsh.o.r.e. Our last family outing was the opera in the park concert back in July. The night Kitty ended up in the hospital.

We've avoided going out since then because Kitty has needed to stay close to home. Eating is beginning to seem easier, but the prospect of eating a meal in front of other people still sends her into a panic. And I've come to realize just how much socializing is based around eating. Every party and backyard get-together includes food, and even when the focus isn't a meal-say, a graduation party, even a neighborhood meeting-food is almost always on the table, literally and metaphorically. I think of Shan Guisinger's comment about how social pressure facilitated eating in primitive societies and wonder if the urge to share food is an instinct coded into human DNA because it helps us build community.

Community, in any case, is the last thing on Kitty's mind. Truly, I think she's grateful to have homework, glad to have something else to think about, even if it is algebra. Maybe because because it's algebra, which is completely unconnected with anorexia. What makes school hard for her is what she used to love most about it: the friendships. She obsesses over what people think of her and is convinced they're judging her because she has anorexia. I tell her no one blames her, that people understand she's ill, that they feel empathy and compa.s.sion. I wish I believed that. I'm sure her closest friends do feel for her. But I'm also sure she is being judged, and harshly, by plenty of others. I know we're all being judged, and found wanting, by some of the people who smile and cluck sympathetically in the grocery store, in the neighborhood, at the office or school. I know it hurts Kitty, because I know how much it hurts me, and Jamie, and even Emma. it's algebra, which is completely unconnected with anorexia. What makes school hard for her is what she used to love most about it: the friendships. She obsesses over what people think of her and is convinced they're judging her because she has anorexia. I tell her no one blames her, that people understand she's ill, that they feel empathy and compa.s.sion. I wish I believed that. I'm sure her closest friends do feel for her. But I'm also sure she is being judged, and harshly, by plenty of others. I know we're all being judged, and found wanting, by some of the people who smile and cluck sympathetically in the grocery store, in the neighborhood, at the office or school. I know it hurts Kitty, because I know how much it hurts me, and Jamie, and even Emma.

We all have our reasons for staying close to home.

Kitty objects strenuously to the Sunday plan, and I nearly say never mind. But I feel as though that would be giving in to the anorexia, validating on some level her worries about-about what? I'm not really sure. So we load up our picnic, tie the kayaks onto the roof of the car, and go.

Lunch at the park takes more than an hour; Kitty dawdles and picks at her sandwich, insists she can't eat the chips, tries to refuse the chocolate milk. I wonder again if this is a mistake. But we're only five minutes from home; we can always leave if we have to.

Once we actually get into the kayaks, though-Jamie and Emma in a rented double, Kitty and I each in our own-it's as if some switch gets flipped and Kitty is her old self, smiling, enthusiastic, even cracking a joke about my less-than-stellar steering skills. We paddle in loose formation under a watercolor-blue sky, waving at other boats, watching a muskrat swim away from our wake. Emma, too, seems more relaxed than usual. For the first time in months I remember the ways we all fit together. We share a sense of humor. We are a family.

Which is why it's such a shock to see the demon emerge the very second Kitty steps out of the kayak. "I'm so fat," she starts. "I'm horrible and no one loves me. Why doesn't anyone love me?" When I try to calm her down, she accuses me of speaking harshly. She tells me I'm not listening to her feelings. The monotonous ranting of the demon goes on and on. Emma puts her hands over her ears, and Jamie walks her toward the car, dragging two of the kayaks with them. I give up talking to Kitty and just stay with her, on an isolated bench, until she winds down.

We walk up to the playground, and I give Kitty and Emma each a protein bar. We've learned the hard way that she has to eat something, even a small snack, every two hours or so; she's gained eight or nine pounds, but her body still has no reserves. We feed her as often as you'd feed an infant.

I'm expecting resistance, but Kitty opens the wrapper and begins to eat. She takes tiny bites and chews each one with infinite care, the way she eats everything now. But at least she's eating.

Jamie looks at me quizzically-What happened?-and I shake my head: Tell you later. Tell you later. Emma finishes her snack and runs over to the swings. Kitty stands up abruptly and starts toward the garbage can. Emma finishes her snack and runs over to the swings. Kitty stands up abruptly and starts toward the garbage can.

"What are you doing?" I call.

"I'm done!" she answers, not turning around. "I'm throwing away the wrapper."

"Please come here," I say, raising my voice so she'll hear me. I don't know why I want her to come back. I just do.

She turns, reluctantly, and walks toward me, one hand closed behind her back. "Show me," I say, and even so, I'm shocked when she uncurls her fist and reveals half the protein bar, uneaten.

My daughter is fourteen years old and this is the first time I know of that she's tried to deceive me. I feel like I'm watching the scene from a great distance as it happens to someone else. Kitty's always been the good-girl type, afraid to break the rules or get into trouble. I know she's lied before; every kid does. But this feels different. This isn't Kitty.

She sits down beside me on the bench, folds back the paper, and begins to eat again. She keeps her eyes cast down and her face empty. What is she feeling? Is she angry or embarra.s.sed, frustrated or defiant? She looks like a sleepwalker-blank, quiet, driven by some force deep within her.

For the first time it occurs to me that my daughter will be permanently changed by this-this thing inside her, this twisted creature that shrieks and writhes and spits poison into her blood and bone and mind. And that, in fact, each one of us will be changed, Jamie and Emma and I. Our family will never be the same. Even if Kitty gets well-and at this moment that seems a distant possibility-things will never go back to the way they were.

Of course this is always true, in every family, all the time. Children are walking palimpsests, continuously evolving, and as parents we change along with them, accommodating and responding to who they are in the process of becoming. Part of the pleasure and reward of parenting is watching the alchemy of childhood, seeing our offspring transform themselves from generic infancy into gloriously individual adulthood. And part of our necessary sorrow as parents is having to accept the kinds of change we fear for our children.

That night in bed, I say to Jamie, "Maybe we've hit the bottom now, and there's nowhere to go but up?"

"Maybe," he says.

We are, of course, wrong again.

The next morning Kitty comes down to breakfast with her hair in pigtails, a style I haven't seen her wear in years. She dawdles at breakfast, stirring her bowl of granola and yogurt for twenty minutes, until I say, "You're going to be late for school."

"I'm not going," she says.

"Why not?"

"Everyone there thinks I'm a freak who got fat over the summer. They won't stop looking at me."

"Who's looking at you?" I ask.

"Everyone," she says impatiently, and I wonder if this is normal teenage impatience or eating-disordered impatience. I hate the fact that I wonder about this. This is another legacy of anorexia: the need to question, a.n.a.lyze, worry every interaction like a dog with a bone. When all I want is to be like we used to be, Kitty and I, easy with and on each other.

I tell her I think she should go and at least try to stick it out. I tell her it's only two morning subjects, and if she starts missing cla.s.ses this early in the year, it will be hard to catch up, and that will feel even more stressful. I tell her (though I doubt she can take this in) that it's important for her to stay involved with the world as much as she can. I know that if we let her stay home today, she'll want to do it again tomorrow and the next day.

My words seem to have no effect. So I coax her up from the table after she's eaten. "Come on, I'll walk you," I say.

I have to practically drag her out the door, into the steamy late summer air. I figure once we're outside, her aversion to public scenes will make things easier. But this morning Kitty doesn't seem to mind making a scene. She wrenches her arm out of my grasp and balks like a horse who's come up against a jump too high. "Why are you torturing me?" she shouts, standing in front of our next-door neighbor's house. "Why don't you understand that I can't go to school this morning?"

I speak in a low, soothing tone. "Come on, Kitty, you know you have to go," I say and try to somehow urge her down the street without actually touching her.

She glares. "Why are you doing this to me?" she shouts, her voice rising to an actual scream on the last word. I consider taking her back inside-how can she possibly go to school like this? But my gut tells me that to back down now would be to let the demon win. I'm not letting this illness take one more thing from Kitty if I can help it. She's suffering now, I know, but her whole life is at stake. We can't go backward, even for a second.

And so I take hold of her arm again, firmly, and try to move her down the block, one step at a time. Two doors down from our house she sits down abruptly on the sidewalk, her short black skirt flipping up for a moment around her waist. I'm sure the neighbors are watching, not that I care; I'm not easily embarra.s.sed. But Kitty is, and she would care, if she could process anything but the anxiety and terror overwhelming her.

By the time we get to the school she's fifteen minutes late, which normally would freak her out; today I'm not sure she even notices. Clearly she can't go to her first cla.s.s. Last week, we met with the school psychologist, Mr. R., an earnest young man who told Kitty she was welcome in his office anytime, even in the middle of a cla.s.s. Now I tell her I think she should go to Mr. R.'s office.

She whirls toward me with a look of pure rage, her pigtails bouncing incongruously. "The minute you leave I'm going to the bathroom to make myself throw up!" she yells.

Inside my head a voice is shouting No! No! No! No! No! No! I've read enough to know that up to 30 percent of people with anorexia cross over into bulimia, and that purging complicates recovery even more. It's the last thing Kitty needs. I've read enough to know that up to 30 percent of people with anorexia cross over into bulimia, and that purging complicates recovery even more. It's the last thing Kitty needs.

What should I do? Take her home? Follow her to cla.s.s and keep her out of the bathroom all morning? I'm paralyzed. Kitty makes the decision for me. Standing in the empty hallway, she says, "Fine, I'll go to Mr. R.'s office!" Then she's running down the hall away from me, her backpack slapping against her shoulders. She rounds the corner and disappears. I have no idea which way Mr. R.'s office is, so I don't know if she's heading there or not. I stand there, irresolute. Eventually I walk home.

I spend the rest of the morning cleaning, unable to concentrate on anything else, picturing Kitty in the girls' bathroom at school, a finger down her throat, or running out the door, away from school. Running away from us. In a school of several thousand, no one would notice she was gone.

I finally unclench my jaw when I hear the front door open at the usual time. Kitty seems calmer than when I left her at school. But within minutes the demon is raging again. My heart aches for her, but I have to know.

"Did you throw up today?" I ask, interrupting the flow.

She glares. "That's all you care about, what I eat and whether I throw up!" she shouts. "You don't care how I feel!"

I do care about her feelings, of course I do. But what I really care about is getting her well as fast as possible. Getting her through this nightmare.

I hate the demon. I fantasize about strangling it with my bare hands, squeezing until its forked tongue protrudes. But I can't picture that without also picturing my hands around my daughter's neck, because the demon wears her face and speaks with her voice.

Kitty cries until she falls asleep at one o'clock in the afternoon. Clearly she's not going back to school today. When she wakes up an hour later, she's a bit calmer. I sit with her as she drinks her milk shake, and eventually I ask, again, whether she threw up.

The look she gives me now is weary. "I tried," she confesses. "I wanted to. I went into the bathroom and stuck my finger down my throat. But I couldn't do it."

I'm not religious, but I send a prayer toward the ceiling. Thank you, whoever and whatever. Thank you for watching over my daughter. Thank you, whoever and whatever. Thank you for watching over my daughter.

One of the strangest things about this whole year is that despite all the trauma and drama, I have a hard time remembering that Kitty's ill. When she smiles or makes a joke, when I see a bit of the old Kitty, it's as if I suddenly mistrust the events of the last few months. things about this whole year is that despite all the trauma and drama, I have a hard time remembering that Kitty's ill. When she smiles or makes a joke, when I see a bit of the old Kitty, it's as if I suddenly mistrust the events of the last few months. Things can't be that bad Things can't be that bad. Can they? Can they? I'm a pessimist, the first to leap to the worst possible scenario; my lack of sunny positivity is a family joke. Yet these days I often find myself wondering whether we're making a big deal out of nothing. It's not denial; three months ago I was in denial. I know without question now that Kitty has anorexia, that her life was and still is in danger. And yet every time the demon emerges I'm surprised. I'm a pessimist, the first to leap to the worst possible scenario; my lack of sunny positivity is a family joke. Yet these days I often find myself wondering whether we're making a big deal out of nothing. It's not denial; three months ago I was in denial. I know without question now that Kitty has anorexia, that her life was and still is in danger. And yet every time the demon emerges I'm surprised. I thought we were past all that. I thought we were past all that. It's as if my own thinking has been compromised by Kitty's illness. As if I've caught a touch of anorexia myself. It's as if my own thinking has been compromised by Kitty's illness. As if I've caught a touch of anorexia myself.

If I look beyond what I want to see, I can easily chart the rise and fall of Kitty's distress. It jumps when she's stressed-like now, starting ninth grade in a new school-and when we hold the line around eating. It's as if the illness is a wild animal, snarling, backing slowly into a corner. Its outbursts are a sign of resistance. We didn't see the demon until we started refeeding her. In a way, it's a measure of our effectiveness.

For instance, the night after Kitty tries to make herself vomit at school is a bad one. We get dinner into her, and a bite or two of the bedtime snack, but then we give up. Jamie stays in her room, holding on to her, keeping her safe as she rages and cries, while I put Emma to bed.

Emma's room is dark and quiet, with two closed doors between her and Kitty's radiating misery. Yet I know Emma is hyperconscious of the drama playing out across the hall. I sit beside her on the bed, as I've done every night since she was a toddler. This is our talking time, in the dark, just the two of us. I want to help her process what's happening, but I don't want to make everything revolve around Kitty. So I try to follow her lead.

Tonight she wants to talk about the anorexia. "Is Kitty going to get better?" she asks.

"Yes," I promise, hoping it's true.

"Are you taking care of her?"

Will you take care of me? That's what I hear in Emma's anxious question. "Always and forever," I say. That's what I hear in Emma's anxious question. "Always and forever," I say.

We sit quietly for a few minutes. Then Emma says, "I can see the anorexia in my mind. It's like a cartoon person, but it's not funny."

"No," I say. "It's not funny."

"It's wearing all black and has spiky hair."

"Blond hair, like Kitty?"

"No, dark hair," she says. And suddenly I can picture it too, faceless. A walking black hole that sucks everything into its open, aching mouth. Including a lot of Emma's life.

My only consolation is that maybe watching Kitty go through this will somehow inoculate Emma against the possibility of an eating disorder. Craig Johnson, who directs the eating disorders unit at Laureate Psychiatric Hospital in Tulsa, Oklahoma, says that having a family member with anorexia nervosa makes a child twelve times more likely to develop it herself. In relative terms, the risk is still small, since only about 1 percent of girls and women develop the disease. But any extra risk is too much for me. I've heard of families with two anorexic daughters; a mother named Mary Ellen Clausen, who lives in central New York, started a nonprofit called Ophelia's Place after both of her daughters struggled with anorexia. I can't imagine what she's gone through-what their whole family has gone through. Then again, before anorexia, I could never have imagined what Kitty's going through now.

Back then, I wouldn't have thought it important to understand the inner reality of an eating disorder. People suffer in so many ways-it's not possible to get them all. Anorexia, I would have said, is one of many illnesses, and thank G.o.d it hasn't happened to my family.

I don't feel that way anymore, of course, because it has has happened to my family. But self-interest is only part of the urge I feel to make people get it, give them a taste of what it's like to have anorexia. Only a small subset of the population is biologically predisposed to have an eating disorder. But we're all vulnerable in some way. I've had panic disorder for as long as I can remember, and the experience has shaped me profoundly. I've watched friends struggle with depression, bipolar disorder, anxiety disorder-the kinds of illnesses we all think happen only to other people. Advocates for mental health parity say that for every piece of parity legislation that's been introduced, there's a legislator with a spouse, a family member, or a close friend who struggles with some form of mental illness. We don't get it until it gets us. But one way or another, it gets us all. happened to my family. But self-interest is only part of the urge I feel to make people get it, give them a taste of what it's like to have anorexia. Only a small subset of the population is biologically predisposed to have an eating disorder. But we're all vulnerable in some way. I've had panic disorder for as long as I can remember, and the experience has shaped me profoundly. I've watched friends struggle with depression, bipolar disorder, anxiety disorder-the kinds of illnesses we all think happen only to other people. Advocates for mental health parity say that for every piece of parity legislation that's been introduced, there's a legislator with a spouse, a family member, or a close friend who struggles with some form of mental illness. We don't get it until it gets us. But one way or another, it gets us all.

The next day, I take Kitty for her weekly weigh-in. Dr. Beth schedules us as her last appointment of the day, and she often stays to talk with us long past closing time. As usual, Kitty's anxiety rises as the afternoon wears on. Getting weighed for her is a no-win situation. The demon wants her to lose weight, or at least not gain; the part of her that's separate from the anorexia wants to gain weight, both because she wants to please us and because she wants to get better. "I want my life back," is how she puts it. "I have no life now." If she doesn't gain weight, she suffers our disappointment, and her own. If she does, she suffers a cascade of anorexic thoughts and feelings, the wrath of the demon.

At the office, the nurse hands Kitty a cup and ushers her into the bathroom for the usual ritual. Then comes the moment of truth, when Kitty steps onto the scale, her back to the machinery, and waits for the nurse to nudge the metal weights into perfect alignment. I try to keep my face blank, though Kitty says she can always tell by looking at me whether she's gained or not.

Today the scale shows neither gain nor loss. My heart sinks, even though I know that metabolism is complicated and weight gain is not a linear process. But I need to feel like Kitty's moving forward, even at a glacial pace. Plus, some days I'm overwhelmed by the feeling of being way out here on our own. It's not just that no one is telling us exactly what to do, that we're more or less feeling our way through the dark and scary forest; we're actually going against the conventional wisdom. If we'd taken the accepted route, Kitty would be an inpatient now at a hospital an hour away. Instinct tells me that that wouldn't help her, that in fact it would harm her. But Jamie and I don't know what the h.e.l.l we're doing. I'm not a doctor. What if my judgment is compromised? What if I'm just wrong?

Dr. Beth comes in with her usual smile. Tucking a strand of blond hair behind one ear, she looks over Kitty's chart and rea.s.sures me that by every objective measure, Kitty is improving. Her heart rate's up into the 70s; her pulse and blood pressure are good. Despite today's stagnant scale reading, Kitty has gained fourteen pounds in the last seven weeks.

We talk about Kitty's increasing anxiety, some of which is likely a by-product of refeeding. The psychiatrist b.u.mped up Kitty's dose of fluoxetine a few weeks ago, because she was feeling more anxious, and now Dr. Beth wonders if the meds are part of the problem. "Try cutting back to the previous dose," she suggests-good advice that I suspect would never have come from the psychiatrist. In fact, as I later learn, study after study shows that antidepressants like fluoxetine don't help people with anorexia. Which doesn't stop psychiatrists from prescribing them.