Listen to the MPR show with Katharine Loeb

The host of the show did a fantastic job--one of the best interviews I've heard or participated in on the subject.

Here's a link to the show.

Talk to me live tomorrow!

I'll be doing a live call-in show tomorrow, Friday, December 29th, 2006, on "Midmorning," hosted by Kerri Miller and produced by Minnesota Public Radio. The other guest on the program will be Dr. Katharine Loeb, assistant professor of psychiatry at Mt. Sinai School of Medicine in New York, and an avid supporter of the Maudsley approach. We'll be discussing anorexia research and treatments, and I'm looking forward to our conversation.

The show airs at 9 a.m. central time. You should be able to catch it online at http://news.mpr.org/programs/midmorning/. Call in with your questions at 651-290-1592.

Talk to you tomorrow!

Is Anorexia Cultural?

That's the $64,000 question. Folks in Brazil are wondering why so many women are dying of anorexia there. Is there something about the culture that is suddenly contributing to a surge of cases? Is the media reporting on anorexia more? What's going on?

More and more, researchers see a genetic component to anorexia and other eating disorders, including chromosomal abnormalities. A 2006 study that looked at anorexia and twins found that genetics accounted for more than half the cases of anorexia, suggesting that people are born with a susceptibility to anorexia and then get triggered during the vulnerable time of adolescence and young adulthood.

Makes sense to me. If culture were the sole culprit, anorexia would be far more prevalent than it is.

Brazil is a country where many people don't have enough to eat; anorexia is typically a disease of "starvation in the midst of abundance." Maybe the rise in prevalence--if there is one--is a symptom of widening gap between the very rich and the rest of the country in Brazil. Maybe it's a sign that the Brazilian economy is improving.

Whatever the statistical explanation, I know one thing for sure: Young women (and men) in Brazil and elsewhere don't have to die. Anorexia can be cured, especially if it's treated early, in adolescence. It's not a cultural metaphor; it's a disease with a tragic trajectory that inflicts a great deal of suffering on anorexics and their families.

Changing the culture, one heart and mind at a time

Last night a friend told me that since my daughter Kitty's illness, her daughter had become very outspoken on the subject of anorexia. She said that whenever other teenage girls joked about it, she "set them straight"--a commendable act of friendship.

But what really made me want to stand up and cheer was when she told me about the day her daughter--Kitty's friend--came home and headed straight for the refrigerator. Apparently someone had told Kitty's friend she looked like she'd lost some weight. "I can fix that," she said, reaching for the whipped cream.

Here's what blows my mind about that: In a culture where all of us are so conditioned to think that thin is always good (and thinner is always better), it's hard to go against the stream. We parents of anorexics are shoved right up against this cognitive dissonance when we re-feed our ill children. It took the gut-wrenching experience of watching my child nearly starve herself to death to open my eyes and change my reflexive thin=good, fat=bad mentality. But Kitty's friend, who is still in high school, is a much quicker study than I am. She's learned from Kitty's nightmare and is already applying the lesson in her own life.

Her insight and perspective give me hope that although change seems to come slowly, it does come, one heart and mind at a time.

Hand-On Parenting Gets a Rave

This morning's story in the New York Times titled "Parenting as Therapy for Child's Mental Disorders" is yet another acknowledgment by both the media and the medical community that sometimes parents can make all the difference for their children.

The article references how kids with ADD and other types of mental health issues often respond well to parents' efforts to modify their interactions with the world through changing their behavior. Writer Benedict Carey quotes one parent as saying, “If you are willing to take on the responsibility of extra parenting, you can make a big difference.”

This will sound familiar to anyone who's used the Maudsley approach to refeeding an anorexic. Kids with ADD often are prescribed Ritalin or other stimulants to "fix" their behavior; there's no such magic pill for anorexia. Maybe it's a good thing.

Just one more reason for parents to follow their instincts when it comes to what their children need.

Our Bodies, Our Ideas of Our Bodies

I was fascinated to read in Women's Wear Daily that fashionistas are now having some models' photos retouched to make them look heavier. In the wake of the Madrid revolt, where models with BMIs under 18 were not allowed to walk the runway, this seems like more of a good thing. And I definitely applaud the demystification of anorexia chic.

There's certainly nothing chic about anorexia, as I have reason to know all too well.

Still, I can't help feeling like this misses the point on a number of levels. If these models are so thin that readers of Allure don't want to look at them, then they need food and professional help, not an airbrushed photo. The problem isn't in our perception--it's in their realities.

The current politically correct (and highly ironic) focus on too-thin models is just one more manifestation of our compulsion to make our bodies conform to a culturally defined weight, look, shape, or style. That, right there, is the problem--and it isn't going to be fixed with an airbrush, any more than it's going to be fixed with the next great diet or exercise regime.

The human body comes with a marvelous ability to regulate its own appetites. Then we muck it all up with our ideas of what it should look like.

In the ideal world, all kids would be raised to eat when they're hungry and stop eating when they're not hungry, just as wise woman and nutritionist Ellyn Satter writes in her books. We would learn from an early age to value our connection with our hunger and feelings of fullness.

Though we don't, alas, live in the ideal world, we can still nurture our own interior connection with our bodies, our hunger, and ourselves. We can begin to accept the fact that bodies come in all shapes and sizes, that while one person might be healthy at size 4, another might be just fine at size 16. We can learn to value health over faddish or slavish notions of appearance.

I'll lift a fork to that.

And another Leaden Fork award goes to . . .

economist Susan Lee, whose December 4 commentary on public radio's Marketplace show began like this: "How much you weighed used to be a private matter. If you wanted to look like a tub of lard, that was pretty much your business. But now fat is a public issue."

And included this line later on: "Why else would people be willing to pay extra to make sure that no kid looks like a tub of lard?"

Tub of lard? Is this how we really want to describe a child or adult who's overweight? Since when does this level of judgment belong in an economist's commentary on public radio?

I haven't heard anyone use that kind of language since 7th grade. Maybe 6th. Susan, in case you aren't aware of this, words are powerful. There's no call for that kind of demeaning, demoralizing, judgmental language from anyone in the media.

Read Lee's whole commentary here. Then tell the folks at Marketplace what you think of her choice of words here.

The Leaden Fork Award

When our family started dealing with anorexia, one of the first things that happened was that we became highly sensitized to questions of weight and body image. And folks, once you tune in to what people are saying--about their own weight and bodies, about yours, about other people's--you'll be astonished and appalled.

The media, of course, is a huge offender. Several exposures recently have inspired me to highlight some of the most egregious offenders with a special Leaden Fork Award (kinda the opposite of Laura Collins' Golden Fork--for more on Laura Collins see her fabulous site).

My first Leaden Fork Award goes to the well-intentioned but way-off-base folks at braincake, a site meant to be all about empowering girls. (Thanks to Gale Petersen for bringing this to my attention.) The flash intro to their site shows the words "If I could change the world," and follows it with various wishes, apparently in the words of girls themselves. One of those wishes is: "If I could change the world, I'd . . . reengineer chocolate to have negative calorie. The more I ate, the skinnier I'd get!"

Congratulations, braincake! Your Leaden Fork award is well-deserved for the way you've bought in to the myth that when it comes to girls, thinner is always better. You've trivialized girls' dreams and wishes. And you've blithely ignored the very real and very destructive problem of eating disorders.

Want to be part of changing the world? Send the misguided folks at braincake an e-mail and tell them you want them to change their intro, pronto. The address is braincake@carnegiesciencecenter.org. Tell 'em I sent you.

Got any candidates for the Leaden Fork award? Send them my way at hnbrown@tds.net.

In Memoriam: Vivian Langan, 1927-2006

My mother-in-law died last week. Aside from being a wonderful person in so many of the ways that count, she taught me to eat. I wanted to take a moment to remember and celebrate her for this.

I grew up in a household of dieting women. I think I understood that certain foods were good and certain foods were bad from the time I was one; in fact, one of my mother's favorite photos of me as a child shows me at about 16 months sneaking cookies from a tin in a kitchen cabinet. Hilarious, huh? In my family, the nicest thing you could possibly say to anyone is "You've lost weight!" Our family meals veered between the good stuff and Weight Watchers diet food, including possibly the worst "food" ever manufactured, diet chocolate mint soda.

My mother-in-law was thin. Not stick thin, not too thin, but thin in a healthy way. She was an athlete from before the days of Title IX, member of a curling team that won the national championships in the 1960s, tennis player, runner, and overall physically active person. And she loved both to cook and to eat.

At first her cooking appalled me. Real butter? We might all drop dead from eating that. Or at least gain 50 pounds. In my family quantity trumped quality any day.

But gradually I came to understand, from watching her cook and eat, that when you eat good food, real food, it's satisfying in a way that carrot sticks and artificial sweetener can never manage. That you don't need 20 cookies when they're made with real butter and chocolate; one or two suffices.

From my mother in law I began learning how to listen to my body's appetite and hunger, and satisfy it. I began the long process of learning to care for myself through eating, while stepping around the traps of obsession and guilt.

So as I mourn her passing, as I begin the long missing of her, I also want to celebrate her in this as well as so many other ways. Vivian, wherever you are, I'm raising a forkful of shrimp salad to you. Made with Hellman's mayonnaise, not the fake-o stuff, and served on good crackers. This one's for you.

Are We All Calorie Phobic?

What is it about calories that freaks everyone out?

In one of the recent radio interviews I've given about anorexia and refeeding, I was struck by what a big deal the interviewer made about the number of calories required for a recovering anorexic to gain and then maintain weight. She just couldn't get over the number I mentioned in the NYT Magazine article--between 3,000 and 5,000 calories per day--and made a point of interjecting with what she considered the "normal" number of calories required by a teenage girl.

It reminded me of that old Lenny Bruce routine about the word c***sucker, where first the prosecutor and then the judge kept saying the word over and over: "Your Honor, he said c***sucker!" "He really said c***sucker?" "Yes, your honor, he said c***sucker!" And so on.

I had the same feeling about this: as if talking about so many calories (let alone eating them) was somehow disgraceful or shocking or obscene. I think this is part of what makes it challenging for anorexics in this country to recover--that in this culture we are so phobic about calories that we can't bear to feed someone that much, even when they so clearly require it for recovery.

Myself, I'd much rather see a recovering anorexic eat a few too many calories (and what is "too many" in this context?) than not enough. Anyone who's lived with the firsthand experience of anorexia should be far more phobic about "not enough" than about "too much."

Update on Kitty

For everyone who has so lovingly asked about Kitty and how she's doing:

She's doing really well. She was apprehensive about the New York Times article coming out, nervous that people would say things to her in school. And they did say things, but they were pretty much all supportive. And I think that's helped her feel empowered.

She's busy with real life now, not trapped by what I think of as the red shoes of anorexia--which make you dance and dance even when you're so exhausted you just want to fall over.

The goal of Maudsley treatment is to get an anorexic back to normal adolescent development. She's there. At least for now. Which is all we can really know or ask for at the moment.

Thanks, all, for your messages of caring and support for her. I know they touched her.

Why talk About Anorexia?

Last Sunday I published a first-person account of our family’s year-long efforts to refeed our 14-year-old anorexic daughter. Since then I’ve been taken to task in the blogosphere for publishing the personal and often harrowing essay.

I was accused of violating my daughter's privacy, of writing something that would haunt her for the rest of her life; every boyfriend and potential boss, goes the accusation, will now know intimate details of her life. How could I, or any parent, reveal such details? Maybe, she suggested, I was getting back at my daughter in a passive-aggressive way for the hell she'd put us through last year.

I considered the criticism honestly and thoughtfully. And I want to explain why I did what I did. Not just for me, because I'm just one mother telling one story. I want to explain this for all the mothers and fathers out there whose children struggle with mental illness, whether it's anorexia or schizophrenia or dyslexia or ADD or bipolar disorder or an as-yet unnamed malady that affects their child's brain, mind, thinking, and behavior.

What all of these have in common is that they come with a deep and abiding sense of shame and stigma. Every parent knows the feeling; it’s a question of degree. When you see or the world tells you that there's something wrong with your child, and that it's possibly, even probably, your fault, your instinct is to cover it up, hide it, put a lid on it and a hood over its face. Don't talk about it. Don't ask about it. Just accept the verdict and do the best you can.

But I believe with all my heart that if we are quiet about our children's illnesses, if we act as though there is something shameful about them, if we slink around and hang our heads and speak in hushed whispers about the agonies our children are going through, then we are not doing our job as parents. If we put Privacy with a capital P above the real true needs of not just our children but everyone's children, then we are failing them and we are failing the greater community that we inhabit.

As one eating disorders expert told me, "The reason there's not more research on anorexia is that there's no strong advocacy group pushing for it. Look at the autism parents—look what they've accomplished by putting it out there."

When we say yes to shame and stigma, we consign our children to years of suffering a kind of torture we can only imagine—we don’t want to imagine. We doom them to live terrible half-lives and to die of starvation or exposure or by their own hand. We send them to hell with our pious words and our respect for their Privacy.

I will not do this.

I wrote the article with the permission of my daughter. It is true that she was ambivalent about it. She worried about losing her privacy and feeling exposed. But she overcame those fears because she wanted to help others who were going through what she'd gone through. She wanted to save other lives. She is a generous and good and brave person, my daughter, much braver than anyone else can truly ever know. She was willing to put principle and habit and fear aside for the chance of participating in what we call tikkun olam, repair of the world, the opportunity to heal some small portion of the tear at the heart of the world. Her recovery is in large measure her own doing—with our support and love.

I call that heroism. And I honor it by telling her story and the story of thousands of others like her.

As long as the forces of shame and stigma and conformity press us to shut up, sit down, be embarrassed, we and our children will continue to suffer and, yes, to die, in silence and misery.

I call that stupid.

Love as Part of Recovery from Anorexia

I've been completely overwhelmed by the outpouring of emails I've received since my New York Times Magazine article appeared yesterday ("One Spoonful at a Time," www.nytimes.com). Wow. It's an incredible feeling to be so connected with so many people who have shared the same awful and misunderstood experience.

I want to share one of those emails with you, because it moved me so much. The author has given me permission to excerpt it here. The notion that a parent or other close relation's love and caring are a vital part of recovery from anorexia feels absolutely true to our family's experience.

I'd love to hear what other people think about this.

--Harriet


Hi, Ms. Brown,
I’ve just read “One Spoonful at a Time,” your article in the NY Times about refeeding your daughter, and her long recovery from anorexia nervosa. As a teenager—also 14—I was anorectic, and the memory of the first milkshake my mother asked me to drink is still vivid, a full-body memory. I’m writing as a former sufferer of anorexia nervosa to provide a kind of confirmation of the wisdom of the Maudsley approach, which my parents had never heard of, but which mirrors their approach to helping me escape the grip of the “demon” you describe so well in your article.

Over the years, I’ve tried to figure out just how I escaped anorexia. Two things stand out, and I was amazed to find both addressed very clearly in your article. First, I was simply exhausted by what you’ve called the anorexia demon—the obsessive thoughts about food, about how fat I was, about how undisciplined and grotesque I would be if I gave in and allowed myself to gain weight. I ran three to four miles a day just to keep that demon at bay. I was never as open with my parents as your daughter has apparently been with you, but if I had been, I’d have said precisely the things that you report in your article. I knew what was going through my mind would seem absurd if I revealed it, so I kept it to myself, sometimes completely convinced that I alone knew how true it all was, sometimes not so sure, but always, always fatigued by it.

More importantly, I was deeply affected by my mother’s sense of urgency about my need to eat. Your description of the frustration, fear, and anxiety you’ve experienced as you’ve tried to help your daughter recover is very familiar—I’m sorry to say that my mother went through something very similar with me. The full-body memory I mentioned above is not so much of drinking the milkshake, but of the experience of taking it from my mother’s hands, her presence, her watchfulness, all of which were, in comparison to my masochistic inner voice, so gentle and nonjudgmental. Her concern, and the patient but steel-willed lovingness that went into each milkshake, did the demon in. If you’re ever tempted to believe that your daughter isn’t aware of and grateful for all you and her father have done and continue to do to help her, please think again. I’m not sure how else to put it. And now, over 20 years later, it’s easier for me to admit that on some level what I really needed most was for someone to show that she cared that much, and that her caring was stronger than my self-hatred. I’m not sure why—my parents were always loving people—but maybe it’s just that, once self-imposed starvation really sets in, an opposite and greater-than-equal reaction from a firm, compassionate outside force is required to overcome it. Showing your daughter that you care, that you’re concerned--so much so that you’re not going to back down until she’s regained her health and vitality--is what makes the difference. If that’s the core of the Maudsley approach, I’m sure further tests will continue to reveal its effectiveness.

The Maudsley Approach to Anorexia

Last year my husband and I spent most of a year refeeding our older daughter, who was diagnosed with anorexia. I wrote an essay about our experiences, which will be published in the New York Times Magazine tomorrow, 11/26/06.

The approach we used is called the Maudsley approach. It was developed at the Maudsley Hospital in London in the 1980s, and is very successful at helping teens with anorexia (though I know of families who have used it to help young adults in their 20s too) recover. It's not easy, but then nothing about this disease is easy, especially for the person who suffers from it.

If you're interested in finding out more about the Maudsley approach, visit www.maudsleyparents.org, a website run by parent volunteers. There's a lot of great information on the site, including a basic introduction to Maudsley and a couple of personal stories from families who have used it. There's also a link to an online parents forum, which has been invaluable to me and my family as we have gone through this experience.

Another great site is www.eatingwithyouranorexic.com, which is run by Laura Collins. Collins wrote a book about how her family helped their daughter recover through Maudsley; I recommend it highly. Her book of the same name is available on Amazon.

I've begun to do some coaching and guidance for families who are going through this re-feeding process. If you're interested in finding out more about coaching, or just want to get in touch for whatever reason, please e-mail me at hnbrown@tds.net.

Anorexia Study Volunteers Wanted

It seems appropriate on Thanksgiving Day to post about anorexia, a disease that's all about starvation in the face of plenty.

One of the most astonishing facts about the disease is that there's been very little research done on how to cure it. As in almost no studies. As in, anyone can call themselves an eating disorders therapist, and offer his or her own concoction of treatments, with predictable resuls.

If you've seen the movie THIN, you know what I mean.

There's only one way to make sure that compassionate, practical, and good treatments are developed--and that's with well-designed, controlled studies.

If you're a parent reading this because your daughter or son (yes, boys get anorexia too) is anorexic, you have the chance to enroll your child in one of the biggest studies that's ever been done on anorexia. It's being run by researchers at the University of Chicago, academic home of Dr. Daniel Le Grange, one of the leading practitioners of the Maudsley approach. The five-year study compares the Maudsley approach with another treatment approach. It's designed for teens ages 12 to 18 and their families, and involves either 24 or 32 treatment sessions over a year, with follow-ups down the road.

Treatment is FREE if your family is in the study. Of course you have to live within driving distance of Chicago.

For more info on the study, see http://psychiatry.uchicago.edu/research/volunteers/anorexia.html, or call 773-834-5677, or email anorexia@yoda.bsd.uchicago.edu.

I know it's hard for parents to make the choice to enroll a child in a study. I know you don't want your child to be a guinea pig. The great thing about this study is no matter which half your child gets randomized into, parents and families are involved with the treatment--which is a huge and important difference from most other treatments out there right now. To my mind that's crucial. I wouldn't post about the study if that weren't true.

I also like the fact that treatment is free if you're in the study. God knows most health insurers don't cover much (if any) treatment for anorexia. Ours certainly didn't. If you live in a state without mental health parity (as we do), you'll be stuck footing most of the treatment bills because insurers seem to consider treatments to be a frivolous luxury. They seem to think kids can somehow think themselves out of anorexia without all that expensive treatment.

If you're a parent of a child with anorexia, my heart goes out to you. You're not alone.

News Flash: Anorexia Is a Brain Disease, Says NIMH

The press release below will hardly be news to those of us who have had personal experience with anorexia. But to the rest of the world, it's a news flash, all right.

And to families who are struggling to get sleazy insurers to cover the cost of their children's life-saving treatment, this could make all the difference. Note to insurers: All the recent research on eating disorders shows a strong genetic and biological component to the disease. The suffering of those with anorexia is real and based in biology. Pay up--or have the suffering and deaths of children on your corporate conscience.
_____
NIMH Director States Anorexia is a "Brain Disease"
Today NEDA released a letter received from Thomas R. Insel, MD, Director of the National Institute of Mental Health. Dr. Insel wrote the letter in response to a request made by participants at the 2006 NEDA Conference. The landmark statement issued in the letter that anorexia is a “brain disease” may well help thousands of families struggling with insurance companies to pay for their loved one’s treatment. For details or to link to today’s NY Times article, visit: http://www.NationalEatingDisorders.org. Please thank Dr. Insel for taking the time to assist us in our efforts to improve access to quality treatment! He can be reached c/o nimhinfo@nih.gov.

Wise Words from Fair Wisconsin

This speech was posted by Fair Wisconsin, the group leading the charge to defeat the so-called marriage amendment.

Wise words, though I'm still ashamed of living here.


------

My friends, tonight we came up short in our struggle.

So many of you gave everything you had.

You pounded the pavements.

You emptied your wallets.

You forced yourselves to go up to the doors of strangers and ask them how they feel about something many of them had never discussed so openly before.

Many of you came out to more people than you wanted to because you knew telling your personal story was one of the best ways to change people’s minds.

Some of you have been giving this your all for almost three entire years. And many of us have made many personal sacrifices to make this campaign a top priority.

What I am most proud of most of all is how all of us dared to hope.

And we must not lose this hope and we cannot ignore what we have accomplished.

Because despite the results I still believe in a fair Wisconsin. I refuse to stop believing.

This debate was forced on us at a time and a place not of our choosing.

This fight against the amendment was never just about what happened today. All of us committed to a long-term struggle for equality and fairness for everyone. We cannot give up on Wisconsin, and there’s good reason not to.

We know for certain that many of the same people who voted for this amendment today are the very same people who will support equality for gay families within the next 5 or 10 years. That change might not have been on the timeline forced on us by our opponents, but we cannot ignore the fact that we have laid the foundation for long-term change in Wisconsin. Because of our work, more people in this state than ever before understand that gay families exist in this state and discrimination hurts them.

We may not have won the election, but there were so many victories along the way. We achieved many things that have drastically altered attitudes about gay people, gay families, and the way we do politics around this issue. We transformed a “gay rights” issue and made it a Wisconsin issue.

Our accomplishments are not in vain.

Two and a half years ago, it was unfathomable to most people, including myself, that we could wage a strong fight against the ban.

People said we couldn’t raise enough money. But we raised over $5 million from over 12,000 people to help us communicate with the people of this state.

People said we couldn’t recruit the volunteers necessary, but over 10,000 of you exploded that myth from day one.

They said elected leaders wouldn’t stand with us, and if they did, voters would reject them. But our leaders challenged that notion in fact, leaders like Gov. Doyle never wavered in his opposition to the amendment whether at a UAW rally or editorial board meetings in Baraboo.

Again and again, we proved the cynics wrong.

I know we have changed something fundamental because I saw it unfold in our offices every week of this campaign.

When I saw a standing-room only crowd of Fair Wisconsin supporters sitting in a church basement in Wausau back in March, I knew we were making change.

When I saw an ironworker stop by our office to take literature back to his local labor union because they had taken a position against the amendment, I knew we were making change.

When I saw clergy in their collars in Appleton explaining why the teachings of Jesus compel them to speak out, I knew were making change.

When I saw business leaders move from expressing private concerns to issuing press releases, I knew we were making change.

We set a high bar for ourselves and met it. This changed our campaign but it also changed the way people view gay families and gay issues in this state.

We transformed this so-called wedge issue into an issue that united Wisconsinites of all backrounds. We have made equality and fairness for gay Wisconsinites something that is embraced by many organizations, leaders, and average citizens.

Thank you to the thousands of gay and lesbian people who did not ask for this fight, who did not want to become poster children. You chose to interrupt your lives so that one day our children will know a world without discrimination.

You bravely stepped up to put your lives on display.

Thank you to all of you who like me aren’t gay but made this issue your own. Thousands of you refused to stand by silently while your friends, families, and citizens we will never meet were attacked with this amendment.

Together, all of us stood shoulder to shoulder—grandmothers, farmers, ministers, school teachers, and many, many more of us from all walks of life.

And although we didn’t win we ran a historic effort that changed Wisconsin.

Ashamed to Live in Wisconsin

Love, Food, and Money

Tonight I am ashamed to live in the state of Wisconsin.

We've joined the ranks of states that have now written into their constitutions prejudice. We've institutionalized discrimination--not just made it legal but mandatory.

It's a sad, sad day for Wisconsin, which has a long and rich history of progressivism, of valuing all people equally.

Our so-called marriage amendment may have passed, but they can't make us believe it. They can't make us believe that people who are gay deserve fewer rights than the rest of the population. We'll fight this. We'll overturn this amendment.

Next time.

The Madrid Models Controversy

I applaud the designers in Madrid who banded together to insist that every model in the Fashion Week show had a BMI of at least 18. As theater, it was a highly effective device. As a way to call attention to eating disorders, it succeeded. The blogosphere is now abuzz about stick-insect models and irresponsible designers.

But those of us who have had personal experience with anorexia know that the controversy over runway models is something of a red herring. Yes, the media has power and influence; yes, images of cadaverous models in the pages of magazines, on billboards, and TV make for unhealthy role models. But fashion doesn’t cause anorexia, any more than critical mothers cause schizophrenia or food coloring causes AIDS.

Not many 10 and 12-year-olds are catching the latest runway show or reading Vogue. But they are walking the hallways of school, where—at least if their school is like my younger daughter’s middle school—they will see exhortations to lose weight. They take dance and gymnastics and cross-country, where their teachers and coaches will praise the “line” of a thinner girl’s body, the need to shed pounds to gain speed.

Most important, they’re in the backseat of the car, listening to their mothers and other adult women talk about how fat their thighs are and their latest diet. From the time most girls are old enough to feed themselves, they’ve listened to the women in their lives obsess about food and dieting. They’ve learned that there are good foods and bad foods, that it’s important to deny yourself, that there’s something shameful about the enjoyment of food. They’ve learned that hating your body is not only acceptable, it’s de rigueur, that physical self-loathing is a rite of passage among American women.

They’ve also heard the compliments that their mothers and older sisters get on a daily basis. They understand at a tender age that there is no more welcome or powerful phrase among women than “You look so thin!”

None of these things in and of themselves cause eating disorders, of course, any more than emaciated models do. But the everyday role models in a girl’s life exert a much more powerful influence than models on a runway in Spain. And that kind of influence can be part of how an eating disorder develops: A young teenager goes on a diet or gets sick; she loses a little weight, and the compliments come pouring in. She feels good about herself, so she loses a little more weight; maybe she runs a few more miles a day, does more sit-ups and push-ups. If she’s unlucky enough to be one of the 1 percent or so of adolescent girls who are genetically and psychologically susceptible to an eating disorder, she will find that the weight loss takes on a life of its own. It quickly becomes a compulsion, not a choice; it morphs into an obsession, something over which she has no control. It becomes full-blown anorexia, which stems not from cultural ideas of beauty but from the physiological, psychological, and emotional effects of starvation. It becomes a terrible disease that will cost her, on average, five to seven years of her life—if she recovers.

Recently my 11-year-old daughter got into an argument with a friend her age over being skinny. The friend (who, like most girls their age, is just starting to develop) often skips breakfast and lunch; her mother diets, and the family never eats pasta or potatoes. Now the friend was explaining to my daughter that being skinny was something to aspire to. My daughter, who is neither overweight nor skinny, replied, “I’d rather be too fat than too skinny.” Her friend insisted, “Thin is good. The thinner, the better!”

That night, as my daughter reported this conversation to me, she cried with frustration. She had good reason to feel upset; for the last year her brave, smart, funny, wonderful older sister has been struggling with the physical and mental hell of anorexia. Though we tried to shield our younger daughter, she, like us, had endured the hospital visits, tormented meals, suicide threats, crying bouts, and other symptoms of self-starvation. It was an awful year, but her older sister was now, finally, well into recovery.

I told my 11-year-old she’d said the right things. That it would take more than a comment or two to change her friend’s opinions. The Spanish designers have made a good beginning—now the rest is up to all of us.

Calling All Mr. Wrong Stories!

Mr. Wrong: he's the tug behind your navel, the guy who lights you up like a Roman candle, the danger you can’t resist. At some point in her life, just about every woman encounters one—or many.

He’s the fellow who lives on a houseboat (seasick sex, anyone?), the guy who can’t sweat. The one who’s thrown out of a restaurant because of the hideous orange coat that makes him look homeless or deranged (or both). The med student who says, at least once a day, “My body is my temple.” The banker who insists on eating kimchi before making love. The classical guitarist with inch-long fingernails on one hand. The guy with the banana-shaped penis (it hurts!). The man who thinks bathing once a week is enough (it’s not). The one who can’t get it up and the one who won’t go down. The married man who’s been having affairs for 25 years and says his wife doesn’t know. Right.

And those are just the ones I’ve run into.

These and other sordid guys inspired me to put together a collection of essays on the subject of, as my daughter calls it, "poopy boyfriends." The book is called--what else?--MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE (Ballantine), and features essays from the likes of Jane Smiley, Marge Piercy, Audrey Niffennegger, Alicia Erian, Ann Hood, Whitney Otto, Roxana Robinson, and others about *their* poopy boyfriends and husbands.

But enough about them--I want to hear from ordinary women (and men) about their poopy boyfriends. Who was the worst boyfriend you ever had, and why? Here's a chance to tell your story. Tell a good one and I'll send you a T-shirt made from the book cover later this summer.

Yours in solidarity,
Harriet Brown
www.harrietbrown.com