Anorexia Nervosa and Recovery

A Hunger for Meaning

Ellen Cole, Esther D Rothblum, Karly Way Schramm

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317823544
• Edition: 1
• Topic: Medicina
• Subtopic: Nutrición, dietética y bariatría

Through the voices of twenty-one women, Karen Way presents the most objective, complete, and compassionate picture of what anorexia nervosa is about and, more importantly, of the complex individual variables and obstacles in the journey to recovery. From the premise that anorexia nervosa is an addiction--an obsession controlling all aspects of an individual's life--and that complete recovery is possible by finding meaning in life, this enlightening book contrasts sharply to other books written on the subject by clinicians and theorists which merely speculate on the nature and etiology of anorexia nervosa. Anorexia Nervosa and Recovery lets the reader hear the personal struggles of women who have fought this powerful disease. They describe how anorexia controlled their lives and how, once they overcame their obsessions with food, weight, and thinness, they were able to lead fulfilling lives. This illuminating book encourages and inspires women who are in the throes of anorexia nervosa. They will recognize the emptiness in the voices and the descriptions of daily life. Therapists and clinicians who treat anorexic women will find intriguing chapters on events which trigger anorexia and what anorexics will do to maintain their strategies for coping. Concerned friends and family and others interested in understanding this controlling disease will be enlightened from this important and helpful book.

Chapter 1

Emptiness

Chelsey answered the door in a white tank top and shorts, struggling to restrain Ginger, her golden retriever, by the collar. As I followed her inside, she apologized profusely for her house “being a mess.” I could barely hear what she was saying, but it was immaculate.

Chelsey began struggling with anorexia nervosa two years before, when she was 25. She was a working professional with a graduate degree; married, no children. She described her family background as middle class and traditional – her father worked in sales; her mother was a housewife. The middle daughter of three, Chelsey portrayed herself as “a rebel” in Catholic school, although with time, she settled down, worked hard, and earned her undergraduate and graduate degrees at a local university.

She was very petite – just over five feet tall. Over the phone, she told me she was recovering from anorexia nervosa, but to me, she still looked extremely thin.

I tried to subtly ask Chelsey her current weight. She told me it was 77 pounds. I must have instinctively winced because she quickly assured me, “It’s not that low.”

She searched my face briefly for a nod or other expression of agreement and immediately added, “I eat really often. I just don’t eat meals. Like I’ll have two crackers for breakfast – crackers and tea – saltines or something. For lunch, I usually get a salad. And I have my diet dressing. Or I’ll bring my own tuna fish with diet mayonnaise and oat bran or something. So I don’t really eat meals, but I’ll eat a lot between meals. Not anything bad – just crackers or something.”

When Chelsey said “crackers,” she meant two saltines, 10 calories each. “I keep track of everything I eat and drink every day,” she remarked with a tinge of pride in her voice. “I’ve been keeping track of calories for almost two years. Every day. I never miss a day. And I know by heart what [calories] everything has. It’s real easy to do now.

“Vegetables are great!” Chelsey added brightly. “They hardly have any calories. And seafood is pretty safe. But I don’t eat red meat. I eat a lot of chicken. Grilled or something safe. But I never fry it, or like, put sauce on it. As long as it’s skinless and grilled, it’s safe. I haven’t had anything fried in a long time. Well, I have had french fries. Like on the weekend. But fried chicken or … I don’t eat hamburgers. I eat very little bread because I see bread as a waste of calories. They’re so many! What else … anything in a cream sauce. I haven’t had a cream sauce in two years. I eat chocolate though. I used to eat 500 calories a day during the week, and if I wanted something chocolate, I’d eat 200 calories the rest of the day so I could have something with chocolate in it for the 300.”

To most people, it’s mind-boggling that a person could be so engrossed in food, yet only consume 500 calories a day. Most people do not understand how in the world a person could survive on so few calories day after day after day, and not pass out or double over from the constant gnawing pain in the pit of their stomach.

Chelsey would assure you it’s easy. “After a while, you really don’t know when you’re hungry and when you’re full anymore,” she remarked. “I’d always heard that, and I thought, like a few years ago, ‘Well how do people not know when they’re hungry?’ But I really feel that now. I could eat at any time – I’d love to – but I really don’t know what hungry means because … I’ll get dizzy, I’ll get headaches, my stomach will be burning, but I don’t see that as hunger. I see that as … something else. I know that I’m empty because I haven’t eaten. I just don’t perceive that as hunger. I think of it more as emptiness, and that feels good, to be clean and pure. And then when you put food into you, you’re ruining it. It’s going backwards, going in the wrong direction.”

In Chelsey’s mind, not eating was purifying. To her, starving – fasting – conveyed the underlying symbolism of asceticism. It certainly was not simply dieting for the sake of dieting – nor “dieting gone haywire” – but pursuing the ultimate state of thinness to feel cleaner and more pure – a better, more perfect person.

When I talked with Chelsey, vigilantly guarding against fat was the most important thing in her life. She clung to it desperately. That’s why she went to such great lengths to prevent the horrible predicament of “becoming fat.”

“If I have a bad day, or retain too much water, I might, like, go over,” Chelsey said, as a point of illustration, “so I have to be a little under, just in case. Or if I’m going on vacation, then I have to lose three pounds before, so I can even out, so I can eat while I’m away. But then I still can’t. I still go crazy worrying about everything anyway.”

Chelsey wasn’t always like this. “I never used to be a perfectionist,” she admitted, “but that came with this. In fact, in high school, I didn’t do that well. I was pretty rebellious as a teenager. I was in trouble a lot. And I think that’s part of this, too, that I didn’t like who I was then, so I’m trying to go back and make up for it. Now I have to be totally perfect at everything. Now I am a perfectionist in a lot of ways. If I do something, it has to be perfect or it really bothers me.

“Sometimes I’ll torture myself,” Chelsey continued, “especially if I feel like I have to punish myself. I’ll walk through a bakery and I won’t let myself get anything. It’s like, smell it, and then walk out. Or I’ll walk down the candy aisle and look at all the things I want. Like if I screw up something, then I don’t like myself and I’ll punish myself – make myself walk up the candy aisle and not be able to get anything.”

Consequently, along with the underlying symbolism of thinness meaning purity, cleanliness, and goodness, to Chelsey, denying herself food also served as a form of punishment – discipline – for “screwing something up,” for bad behavior. Tempting herself in the way she described could be a way of “torturing” herself – to see how strong she was, mind over body. Sometimes she’d just be angry. That’s why she’d do it; that’s why she’d want to punish herself.

For instance, if people would tell her she looked “good,” Chelsey starved herself even more strenuously in order to punish herself because she wasn’t thin enough. “When people say you look good,” she explained, “it’s like they want you to look fat. If they say, ‘Oh you look good,’ then I think, ‘Well, I must be getting fat.’ I don’t want to look good to them because that means that I’m not too thin anymore.”

On the surface, it may not make a whole lot of sense, yet, the anorexic hates herself so intensely that she’ll twist every situation – subjectively distort it – just to make sure she’ll always end up losing, always failing. In her mind, she’s not good enough to win. She’s not worthy. Once entrenched in this framework, she’s convinced she never will be.

Chelsey said she compares herself to everyone. “If I see someone who’s obviously thinner than me, I get real mad,” she confessed. “If I go out to dinner, and I’m feeling okay because I know I’m thin, and then someone walks in who’s really skinny, I just don’t want to eat. It ruins my whole night.

“I look at everybody now,” she continued, giving me a quick once-over. “I’m always asking my husband, ‘Is she thinner than me?’ It drives him crazy. He’ll say, ‘I’m not even going to answer that.’ But I really have trouble with being able to tell, I think.”

“Most of the people I know, I weigh less than, so it doesn’t matter what they weigh, as long as I weigh less,” Chelsey remarked with a slight laugh. “I felt really good when I could go into the preteen department and get my shorts. I thought that was great! Because I was in there with all these 12-year-olds and I felt like one of them, you know? I thought, ‘This is really weird. I’m 27, why do I want to be 12?’”

Chelsey confessed that her husband had a hard time dealing with her anorexia. “He doesn’t really understand that much,” she said. “A few months ago, when my doctor wanted to put me in the hospital – I really didn’t think it was necessary – my husband jumped on that bandwagon and he kept talking about it – I think because he didn’t know how else to deal with it. Until about six months ago, he never really said anything about it. And then all of a sudden, it became a big issue. I don’t know why. And he started on me about what I was eating – ‘Well you can’t have that, that’s not enough for dinner! You have to eat more or you’re going to go to the hospital!’ And he was constantly asking me what I weighed. He got to be a real nag about it,” she concluded with a laugh. “He’s gotten a little better, because I told him that it makes it more difficult to pressure me. But it was really annoying for a while.” Not to mention, pointless. At this stage, there’s really nothing he – or anyone – can do to change Chelsey’s mind.

When I spoke with Chelsey, losing weight was the only thing that really mattered – that meant anything to her. And to give that up, to lose that, she was convinced, would be like losing a part of herself. “If I don’t focus on that, then what else,…” she trailed off. “I have a really busy life – it’s not like I have nothing to do – but it seems like it’s the most gratifying. And if I don’t focus on that, what am I going to focus on that will give me this much gratification?”

When I met Jenny, she had just come in from a run. She struck me as a friendly, happy-go-lucky college kid, or so it seemed.

At 19, Jenny had been slipping in and out of anorexia for four years. She had never been hospitalized. “I was right on the border, but they said no,” she told me. “Three more pounds and I would have been. And that would have been awful! They intravenously feed you, and you don’t know what they’re feeding you…” she trailed off.

I soon realized that that was the scariest thing to Jenny about anorexia nervosa – being hospitalized and having any semblance of control she thought she had taken away from her. Once we started talking, I began to suspect that she rather liked being anorexic. Even though she told me over the phone she was recovering, I had my doubts that she really wanted to. In fact, her energies seemed to be very much invested in staying right on the border, at 5’3” and 95 pounds. Not quite low enough to be hospitalized, yet just low enough for others to notice the problem and treat her for it.

“I see a therapist once a week,” Jenny said flatly. “My parents are always asking me, ‘Would you like to see her twice a week? Is any of this helping?’”

“It really isn’t,” she admitted with a sly grin. “My parents talked with my therapist last Christmas and she suggested I start seeing a nutritionist, someone who would tell me what to eat.”

“So … I started going to a nutritionist,” Jenny remarked smiling. “I see her about once a month and she just weighs me. I don’t use any scales. I hate numbers. I’m not getting obsessed with numbers again because when I started my last diet, I was dropping a pound a day, and I’d get depressed. I don’t deal with numbers. I just go by the way I look and feel and how my clothes fit, that kind of stuff. And so I get weighed in and she gives me an exchange diet, something like Weight Watchers, except I’m supposed to eat 12 milks and 13 meats and so many fats. I like that, because then I can eat what I want, when I want it.”

“But you know,” she confessed, “I like skim milk. I’m not going to drink whole milk with more calories and stuff like that. But she’s really nice and she specializes in people with eating disorders. Like everybody who sees these psychiatrists gets sent to her.”

“She’s gotten me up to 2,500 calories a day,” Jenny added. “I used to be at 2,100, but now that I’ve been hovering around 89, 90, she’s given me a boost. I told her, ‘I’m sorry, but I do not find time in the day to consume 2,500 calories. I’d have to get up at 3 o’clock in the morning and go to bed at 1 o’clock at the end of the day in order to eat that many calories.’ And she said, ‘Well how about six mini-meals?’ Well, I’m in classes with 13 people and if I’m going to pull out all of this food and say something like, ‘I’m hypoglycemic; I have to eat it,’ it’s just embarrassing. I find it embarrassing. I find it embarrassing to always be eating. Maybe it is a carrot stick, maybe it is nonfat yogurt, but I’m eating, and people are watching me, and I feel uncomfortable.”

“Now I work every day,” Jenny added, “and I work in an office that’s real open and the refrigerator is there, and every time you go there, everything jingles and jangles. People see you, people hear you, you know? And okay, it would be different if I weighed 400 pounds and I was going to the refrigerator every 13 minutes. But I can’t block that out of my head. I still think people are watching me every single time I go, so … I do not find enough time in the day, and I tell her that.

“She [nutritionist] has me keeping a food diary, so I write down everything I eat every day, and the portions. But I always overestimate,” Jenny confessed with a grin. “I just want a little bit! A little bit is fine with me. I don’t want a big gob of cheese, I just want a little bit. If I eat a gob, I’m going to get sick, and I’m going to get a lot of cholesterol and calories.”

Jenny’s powerful resistance to weight gain was abundantly clear. “I haven’t put on weight in over a year,” she admitted. “I don’t know what’s there, what’s holding me back and why I just can’t get over. They say a normal weight for me is 110-115, and when I think about when I weighed 115 pounds in 10th grade, I was fat. You know, maybe if I had gone to the gym and toned it up, it would have looked better, but when I think about that number, I just can’t. I refuse! And I’ve got to get over that. I mean, 115, I’ll probably look good, I’ll have a chest, the guys will be running, that’ll be great, you know? But right now, I look at myself and I say I’m skinny. I look at myself and I’m fragile, but I get so much feedback from other people, ‘Oh, you’re just small, you’re not skinny.’”

Being judged as “on the borderline” seemed to bother Jenny a little bit. It made her angry when people didn’t believe she was anorexic, no matter how hard she tried to convince them. “I just got this new roommate in January, and I didn’t tell her until last month that I went home every Thursday to see a psychiatrist, and she said, ‘You have an eating disorder? I just thought you were really small. You look fine to me.’

“There are so many mixed messages,” Jenny continued. “I’m trying to get through this, and then there’s this whole society that’s on a diet, and I’m fighting them because I’m eating all of this food and everyone else is like, ‘Well, I’ll just have this and this cracker.’ My roommate, she’s a maniac. She rides a stationary bike about 20 miles a day. She’s always walking around doing something. She’s got to be standing because she’s burning more calories standing up than sitting down. And I have to live with this!”

By contrast, Jenny felt her own exercise routine was quite reasonable. “I don’t racewalk like an idiot,” she assured me. “I just walk fast. Because running hurts my knees and my ankles and I just don’t like that jarring, because there’s lots of curbs around here. But I can do about five miles an hour – that’s about a mile every 12 minutes – and I move. I move. I want to feel my heart pounding, I want to feel like I’ve gotten a workout.”

“I’m totally addicted to exercise. I can’t stop,” she confessed. “I always feel that everybody’s better than me and so I have to be better. I was just talking to my psychiatrist about the exercise, and I said, ‘They say three times a week, 20 minutes is fine, that will keep you physically fit. But I’m sorry, I’ve got to be better than everybody. I’m going to do an hour a day. I don’t care. That’s good for me.’”

“When you get so obsessed with it,” Jenny concluded, “spending a hundred dollars every three months on Nike Airs doesn’t matter. As long as you’re skinny. As long as you’re getting your exercise. I don’t know, exercise didn’t seem that important when I was in high school. But now, it’s really important.”

Jenny revealed that she’s not comparing herself with anyone else, but to an...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Introduction
• Chapter 1: Emptiness
• Chapter 2: Society’s Girl
• Chapter 3: Families
• Chapter 4: Onset
• Chapter 5: Chronicity
• Chapter 6: Choices
• Chapter 7: Changes
• Chapter 8: Meaning
• Reference Notes
• Resources
• Index