Wednesday, February 27, 2008

Anorexia: a portrait


WARNING: THIS POST MAY BE TRIGGERING.




You’re standing in a bakery. Not just any bakery—-let's say it's the best bakery in Paris. It’s warm, and the room is full of so many wonderful smells: cinnamon rolls, sourdough bread, pain au chocolate. Flaky Napoleons decorated with real gold leaf, the chocolate custard oozing from between flaky layers. Gateau, petits fours, elephant ears, all of them buttery and sweet and warm.

And you’re hungry. Not just a little hungry, not just wanting to eat. You’re starving. Your hunger is a hurricane blowing through you like a thousand fists, battering your insides. It’s a tiger clawing you, its claws sharpening on your insides. As you stand in front of the glass cases filled with beautiful pastries and cakes and breads, the tiger swipes at you again and again. Your stomach clenches and contracts. You swallow again and again.

More than anything you want what’s in those glass cases. You want to sink your teeth into one of those pastries, let almond filling ooze from the corners of your mouth, lick raspberry jam from your lips. You want to bite into an ├ęclair, taste the rich custard, hold the chocolate against your tongue until it fills your mouth with sweetness. You know just how good everything would taste because you’ve been dreaming about it, night and day, for months. Other people come in and out of the bakery, buying white paper bags full of warm cakes. Other people reach into those bags, break off a piece of croissant, pop it into their mouths. But not you. Never you.

Because you are not allowed to eat. Though your stomach grinds against your backbone and your cheeks are hollow, though that familiar wind howls inside you all day long, you cannot eat. When you do, when you manage half of a fat-free yogurt, a pretzel, two grapes, the voice in your head starts up again. It hisses in your ear—how weak you are, how stupid and lazy and gluttonous. It shouts at you all day long: You’re a fat pig. You’re disgusting. You don’t deserve to eat. You don’t deserve to live. You don’t remember when that voice began. You can’t remember a time when it wasn’t inside you, always watching, making you suffer. The voice takes you inside your worst nightmare, to the scariest place you’ve ever been, a place you’d do anything to stay out of. So you don’t eat, even though food is all you think about, all that matters. Even though all day long, wherever you are—doing homework, sitting with friends, trying to sleep—part of you is standing in this bakery, watching, smelling, longing to eat, paralyzed with fear.

And you can’t leave the bakery, either. You have to stand here, breathing in those buttery, delicious smells, the voice growling softly in your ear. You have to stand here, longing for the pastries, terrified and alone. You have to stand in this bakery, shivering now, getting colder and colder and more alone while the rest of the world goes on, full of light and laughter and good things to eat.

You wish someone else could sweep into the bakery, cry, “Here you are!,” hand you a warm roll straight from the oven, and protect you while you take that first bite, the buttery taste of relief. You wish there was someone, anyone, who could shout down the voice, who could keep you safe. But there isn’t. There will be no rolls for you, no pastries, no feeling of relief and safety. There’s only the voice and its torments, and you, more alone than you’ve ever been. You, growing smaller and thinner and frailer. You can't bear the suffering. You want to die.

This is what it feels like to have anorexia.

41 comments:

samsi77 said...

Harriet, what a vivid, accurate account. As I was reading this and especially towards the end I could not help but think, this is what anorexia feels like when you don't have a team supporting and facilitating Maudsley based treatment. I visualize Maudsley based treatment as a parent entering into the bakery telling this individual "don't worry, we are going to do this together, food is medicine, your body needs to eat, I understand that you are experiencing so many emotions and yet need to ask you to trust me" and then the parent procures the baked good and they begin the process of re-feeding. Since this is a visualization I chose to leave out the adolescents response lol. Without Maudsley the young sufferer is left in the bakery, drooling, in agony without need. There is hope and help and we know that recovery is possible!

cq said...

Harriet,

I am interested to know who wrote that?

cq x

carrie said...

Harriet-

Couldn't have said it better myself- and I've tried! :)

Stephanie-

That is exactly what it feels like to have someone help you eat. Having a parent/carer/really cool therapist acknowledge that this really really sucks, it's not going to be fun, but we will get through this is the most important part.

hotsauce said...

... man ...

... this reminds me of me circa 2004. there was a bakery in my neighborhood that had amazing pastries. i would go there periodically with some work, order a coffee, and sit at a table directly facing the bakery case, which sounds like the one you describe. i would never order anything if it was a for-here order, ever (my pastry purchases there were strictly run-in-go-home). but i would sit and do some work, although the entire experience was clouded with my brain going "strongstrongstrongstrongdon'tneedanythinggoodgoodgood..." i remember one time i was seated next to a woman who appeared to be doing the same willpower exercise, because she was "reading" but kept glancing up at the bakery case. finally she got up and shuffled to the counter with her wallet and pointed silently at a brownie and paid with her head hung down and left. i recognized then how pathetic it was (both her and me, i mean), but at the same time i felt triumphant because *I* had succeeded while SHE had not.

... sad, i know. i'm not proud of it. just happy that i'm not like that anymore.

Anonymous said...

I think dieting feels like this too. Perhaps it's not as extreme, but it's close.

Anonymous said...

thanks for giving me a little insight into what my daughter feels; I am trying to separate the claw from my wonderful, witty child. Victory, this morning she ate french toast and no screaming! hurrah! We are just starting this journey and every bit of insight helps.

orodemniades said...

This is one of the saddest food related things I've ever read.

Harriet said...

cq,

I wrote it. It's the opening to a presentation I'm giving next week to public health nurses-in-training on the subject of anorexia. It's the opening (I think) of a book I'm writing about our family's experience. The next line after the end of this is "I"ve never had anorexia," and goes on to say this is what I saw in my daughter when she was ill.

I am hoping this doesn't offend anyone. I just think people need to know what it's really like, not some media depiction. I want it to be powerful, but not offensive.

thenewthirteen said...

Reading this made me realize that, much as I want to think it didn't "count" because I wasn't thin, that there were times my ever disordered eating really was an eating disorder.

Good luck on your presentation...I think this is something people need to hear!

Anonymous said...

Please put a trigger warning on this for people who do have eating disorders.

This was extremely triggering. :(

Tari said...

Harriet, this is really well-written and moving; this kind of thing helps me (not having much exposure to EDs personally) get an idea of how hard it must be to overcome from the inside. Thanks so much for sharing.

Anonymous said...

It is not offensive, it is very powerful and you know what? sometimes the truth does offend. It will make alot of people think.

Anonymous said...

Wow Harriet-what a powerfully written article.It really gives you some insight as to what these poor people go through.It will make a wonderful book when the rest is written.

Di

mary said...

Just reading this makes me want to meddle, to reach out to that stranger when I've seen them struggling but knew not what to say. One young woman bought a vintage mixer from me and went on and on about how she was a pastry chef. I wanted to let her know she had to fight this and get help that knew that food was the medicine she needed. I wondered if she ever tried her own pastries or if she knew that her disease had become visible.
Another young woman was thin as a rail and I noticed that her grocery cart contained nothing but cat food. Yes, her cat deserved to eat, but not her.
Another time it was a young mom with several children with her as she was filling her cart with produce from the vegetable section, quite proud no doubt of her healthy selections. Her children did look well cared for with the hi-pro glow but who was feeding this young mom? She looked quite thin and my radar told me she was one of the people suffering from this horrible disease.
I am aware that there are many who struggle and have hidden it well. Their dirty little secret is exactly what you spoke of. They don't feel worthy and the bastard ED never shuts up. If he dared to step up in front of us mom's we'd nail him but good. Oh yes, we would.
This is a very well written piece Harriet. It's just that I want to meddle. Reach out and help somehow. Wish we could all break a nice warm loaf of freshly baked bread with butter and help begin the fight back to health.
thank you, you touched many of us today.

Chanda (aka Bea) said...

I found your blog through a recommendation by Maggie over at okay, fine, dammit, and Im so glad I did. This is wonderful, heartbreaking stuff. Im struggling with my own issues on the other end of the eating disorder spectrum, and as I read this piece I was struck by how similar the voices and the hunger are regardless of which end you find yourself. It's not a perspective I ever considered. Thank you. (I've put you on my blog roll, I hope you don't mind).

Emily said...

Just so you know, this is *not* what all anorexia feels like. I have had the wonderful wonderful fun of drug induced anorexia, and it is different from anorexia nervosa. And my anorexia was different from my brother's, and his was different from that of another ADD person we knew.

I wanted to eat. But I just wouldn't feel hunger. If I tried to force myself to eat when I didn't feel hungry, I couldn't eat much. The food didn't taste good.

Even if I did feel hunger, food would smell bad to me. I could usually manage to force down a Snickers bar or two a day. The odds of me eating much else were... pretty low. Milk maybe. Things that I normally loved just were not something I could make myself eat. Not even carrots.

(I just looked up the nutritional information and I can *see* why I dropped so much weight... I was probably getting 600-800 calories a day and I needed 2000.)

It was all ok with my doctor tho. Thin is good, right? My parents were great and insisted I not have the drugs when they realized what was happening.

cq said...

Harriet,

I'm impressed. (I thought maybe you had edited something of Kitty's - in a sense you have). It is rare to see writing about experiencing anorexia that maps powerfully to what I went through. Of the memoirs I have read only one got to the core of what I went through and had me thinking "that's it". I think that this piece joins it.

I checked your "about me" bit and was not surprised that you are a journalist. The author of the memoirs I mention above was a journalist too.

I think that you are perceptive (and I know from reading your article that you are close to Kitty) as well as an excellent writer, that is what makes the piece.

I wish you all the best for your presentation. I think that this will make an attention-grabbing opening.

cq x

Harriet said...

Emily,
That sounds awful. You have my sympathies. I'm glad you're off the meds.

cq,
Thank you for your words. My hope is to translate a bit of the reality of anorexia to those who have no experience with it, so they know what it's like, or what it can be like. I value your opinion and appreciate your comments.

chanda,
Feel free to add me to your blogroll! I look forward to checking out your blog too.

mary,
keep on meddling. like samsi77 said at the top of this comments thread, it's the meddlers among us who can sweep into the bakery, bring warmth and light and a piece of buttered bread to the person who is suffering so. I'm all for butting in when it's something like that.

Maggie said...

Spot on, Harriet. Bravo.

littlem said...

Whoa.

Damn.

What is this an excerpt from?

Harriet said...

littlem,

it's an excerpt from the book proposal i'm working on. and the beginning of a presentation i'm making next week on anorexia.

Kitten said...

This was a really excellent description of just the whole battle of it all. I've linked you on my post about my own little struggle with disordered eating, I hope you don't mind.

Anonymous said...

Once upon a time, I was a definite Maudsley skeptic. The more I read your blog (and others, but to be honest, yours especially) the more I see the kindness and the brilliance of the approach. I don't know what causes EDs--no one does, nor do I think we'll ever have a clear-cut answer other than some combination of genes, perhaps prenatal environment, temperament, psychosocial stress of some kind, dieting, etc. Perhaps there are some families where difficulties or inadequacies--which EVERYONE has--were the ingredients that interacted with genetic tendency to produce an ED. Perhaps in some this is not true. But the beauty of Maudsley lies in its compassion, I think. NO ONE is blamed--not the parents, not the sufferer. Parents, even if they've made mistakes (which ALL parents do--and which therefore are in and of themselves NOT responsible for EDs) are empowered to change if they need to and, more importantly, to help. Sufferers are not presented with a nearly impossible task and then told they "don't want recovery" or "need to own their recovery" or some other horseshit when they fail. Neither parent nor child is asked to hit bottom or watch; the family is kept intact while the disease is excised. Like anything, it's probably not perfect and won't necessarily work for everyone; it's also far more complicated in adults. But I think the principle behind it--that nutrition is not an option, and that asking an ED sufferer to take charge of it is cruel--is something ALL treatment could and should adopt.

Anyway. I know that this is kind of off topic, but this piece brought home to me that you really GET what it's like to have an ED because you where THERE for and with your daughter. The concept of the person who sweeps into the bakery is absolutely beautiful.

I hope this becomes a book, because I think you have a perspective that is much needed.

Thank you.

Jen said...

This makes my heart ache for everyone who has felt this way. It also makes me desperately, desperately happy and grateful that my MAJOR body hatred in the past never manifested itself this way--I would deprive myself, and then realize, what the hell am I doing?! I'm HONGRY!

My heart goes out to all of you who have felt this way.

Thank you for this, Harriet--it's haunting and moving.

Harriet said...

"But the beauty of Maudsley lies in its compassion, I think. NO ONE is blamed--not the parents, not the sufferer."

That's exactly it, anonymous. I think so much suffering would be avoided if all treatment was compassionate and not cruel--and so much of current treatment *is* cruelty dressed up as autonomy or empowerment.

Thank *you* for understanding, and for being open-minded.

kitten, i'm glad for the link and look forward to reading your blog.

kate said...

Okay, I have a question: If we think intervening is good, maybe even if the person we see struggling with eating is a stranger, how are we supposed to approach it? I ask because I had an experience about ten years ago where I know I did the wrong thing, and it's bothered me ever since, and I still have no idea what I should have done differently.

What happened was, I had a college classmate who clearly had an ED and also an exercise problem (exercise addiction? I don't know what it's called), and was so thin she was practically translucent. This girl had actually been kicked off the college XC team because she ran *too much* (and probably because of her low weight, too). I saw her in the dining hall one day, and she had a plate piled high with green peppers and mushrooms and nothing else.

So I said something to the effect that I hoped that wasn't all she was eating. I couldn't not. And she brushed it off, but I know what she thought inside was "Of COURSE it's all I'm eating, because otherwise I'd be a fat pig like you!"

So my question is, for those of us who are substantially beyond any weight considered "acceptable" by most of society, how do we try to help without triggering even *more* fear that any lapse in "willpower" will make the person as horribly fat as we are?

AnnieMcPhee said...

We had a neighbor who was clearly anorexic - scary-skeletal - who jogged incessantly through the neighborhood. I would have liked to help but she was a complete stranger and it would have amounted to stopping the car, getting out, and getting up in her grill. I don't know what I could have done. :( At least when it's someone we know and love, we can interfere without wondering if we shouldn't.

Katy said...

I don't know, Kate--I'm not necessarily sure that's what she would have been thinking. I have a memory of being basically out of my mind with starvation and going into Walgreens to run a quick errand and then, since I had a little extra time, wandering over to the candy aisle to do exactly what Harriet described here and indulge in a little vicarious eating--stare at the food, imagine the food, not eat the food. While I stood there, another guy came in. He was well over six feet tall and fat and he grabbed a few bags of candy and left. I remember standing there feeling unbelievably jealous and saying to myself, "yeah, okay, if I was that big I'd DIE, but at least he gets to EAT. I would rather be that big and get to EAT." If he had said something to me? I would've brushed it off--I brushed off everything EVERYBODY said to me at that point, fat or thin. I don't think I really evaluated anyone's advice based on their weight, quite frankly. Maybe I'm alone in that, but I was/am much more afraid of my own body's size than anyone else's. I'm not sure I can say how one SHOULD approach a situation like that, but I think deep down there is something reassuring about ANYONE telling you you should eat when you are clearly starving out of your mind.

AnnieMcPhee said...

One of the saddest stories I ever watched about anorexia was a promising little girl singer (Lena Zavaroni) whose bio is on youtube. (I was a fan of her since my own childhood.) Her anorexia took on a form I haven't read about elsewhere - she would go through mountains of food - more food than her family could fathom. But when they would go to her, they'd find she was chewing it up and spitting it all out into buckets. No vomiting, just no swallowing. So she'd get to "eat" and taste - just never ever be satisfied. So who knows what goes through their minds - different for everyone I suspect. At any rate, a Maudsley approach *was* helping her, but her mind was so far gone from being starved for so long that she talked the doctors into a highly dangerous surgery (emaciated as she was) that ended up killing her.

Her father, too, had some success with his own Maudsley approach, but it was her aunt and uncle who were literally feeding her back to health. But the neurological effects were horrific by that point, and she was sure they were by then unrelated to her anorexia - after all, wasn't she back up towards 90 lbs? :(

Sarah said...

Emily, everybody is different. Harriet offered a powerful perspective. You don't have to dismiss it because it doesn't jive with your life experiences.

Harriet said...

Kate,
Don't blame yourself. Nothing you *said* to your classmate at that point could have made a difference. She was literally unable to hear you or take in the truth of your words. Someone with anorexia is in the grip of a very powerful delusion; some have described it as a psychosis, but only around food--i.e. the person is rational about eveything else. The thing to do in that case would have been to contact her family. And of course colleges do not support that because of confidentiality laws. I don't know why it's OK to call the family if the student has pneumonia but not if she has anorexia or bulimia--more of the double standard we have around eating disorders and mental health stuff.

Anyway, it takes the family, or someone in a family-type position to the sufferer (sometimes nurses in a hospital), to take on the job of re-feeding. A casual comment isn't going to change anything.

Gemma said...

Harriet,

I mentioned this over on 'Shapely Prose' and someone suggested I comment here, so I figured "why not?". :)

I think this is a very powerful and poignant piece. But, as an anorexia survivor, I couldn't relate to it at all.

That's not a criticism, mind. It never ceases to amaze me how we can have so much in common as sufferers of a disease, and yet our experiences are so unique and individual. I think that's one of the important things you learn during recovery; that you won't heal at the same pace or in the same way as others, and that you don't need to constantly compare yourself to others, either (which was a big problem for me).

To give an alternative perspective, hunger was never an issue for me. I stopped being hungry very early on. If I'd been standing in that bakery, I would have felt sick and physically assaulted by the calories and food. I would have felt under attack, repulsed, horrified, furious, vulnerable, and frightened.

I stopped eating in public at my worst point. I refused to go shopping for food with my mother (I was a child/teenager during my anorexic years). I got to the point where I couldn't swallow solid food and would have panic attacks if I had to put anything in my mouth around other people. Even drinks became a problem if strangers were around.

Was I ever hungry? Not that I can remember. Was I afraid all the time? Pretty much. Was I assaulted with the voices you mention? Yes, but they were a cheer-leading squad. Every time I found a new way to hide or avoid food, they praised me. Every time I noticed another visible rib, they told me what a great job I was doing. But they always reminded to push further and harder.

Whatever our experiences with EDs, I think it's so important to discuss them. To face the fear that so many of us carry around with us and be brave enough to risk being vulnerable. If people recognise themselves in our words then we've accomplished something.

Thank you for writing this piece.

Harriet said...

Gemma,

Thank YOU for sharing your personal experience. I appreciate hearing about it. Like you, my daughter felt no hunger while she was anorexic, and all through the re-feeding process. It took nearly a year of eating, and being nearly completely weight restored, for her to begin to feel hunger again. I think for some people that disconnect happens more easily. But I still think the person is deeply and powerfully hungry, even though they don't experience hunger. My daughter, for instance, became obsessed with cooking while she was sick, which is so common, and reflects a kind of deflection of the deep hunger underlying starvation.

I am so sorry you had to go through this, and so glad you are better. Those of us without eating disorders can't really know what it's like, but we can honor your bravery and acknowledge your vulnerability. Which of course we do share in many other ways.

Gemma said...

Harriet,

Thank you. It's taken me a long time to feel healed from my experiences. Although I 'officially' overcome anorexia years ago, it's taken until quite recently to recognise that I was still eating in a disordered and unhealthy manner.

Your comment about hunger interests me. My obsession with food centred around total avoidance, but perhaps one could say that I hungered for control? A big part of my disorder was the sense of iron control I felt whenever I avoided another meal; whenever I went another day without eating. I suppose I was hungry, just never for food.

I'm sorry to hear about your daughter, and I hope she is in recovery now. It must be very hard to watch someone you love go through this disease. I was very lucky to have a supportive family help me through it. I refused their help for a long time (also part of the disease) but now I realise just how lucky I was, and still am.

All the best!

Anonymous said...

I too had an eating disorder many years ago. I think that people with EDs are very adept at convincing themselves that they aren't hungry. Perhaps it's easier to cope with feelings of anger, revulsion, fear, disgust, etc. on a daily basis than it is to cope with hunger. But I think the hunger is always there.

kate said...

Yeah, I get that it isn't my place to say anything that will change someone's whole life if I'm just a casual acquaintance. I get that it wasn't my responsibility, or within my ability, to really help my classmate through her problems. I just want to know, what does one say that is helpful rather than harmful? I feel like the common theme here has been that people feel praised (by other people, but mostly by their own internal voices) for their disordered eating, or scolded for not eating disorderedly *enough*, and it seems like an offhand comment from a stranger or near-stranger has the potential to play into that.

For instance, if someone were to see an anorexic person staring at food but not eating that and interpret that as "willpower", and therefore a good thing, that would be...unhelpful. Telling someone "Wow, I'm impressed that you can stop yourself from eating that, i wish I were that good" would clearly be harmful.

So I'd be more inclined to encourage eating, but then I worry, does the fact that I'm fat make me the wrong person to do that? I don't want to do more harm than good, is all. I can readily believe that anorexic people (like everyone else) are more obsessed with their own problems than with mine, so maybe it wouldn't matter, but it seems like a better idea to try to actually find out rather than assuming about something I luckily know nothing about, thereby risking doing harm.

Anonymous said...

Kate, I can really relate to your uncertainty and your questions. In 1990, about 11 years after my final hospitalization for AN, I saw a woman who had been in the hospital at the same time as me, when we both were in our late teens. At the time I saw the woman, I was pregnant with my first child; the woman was exceedingly thin, obviously still suffering. She was at a restaurant (as a customer) and was scrubbing a table, I guess to get it "clean" before she sat down to eat or not eat. I really wanted to greet her but I didn't know what to say. We seemed so far apart from each other. A few weeks later, she died. I learned that she had had a heart attack in her apartment. I was crushed. I still think that I should have said something to her. But I still don't know what I should have or could have said.

DaniJo said...

As I read this I have the same thought I always have, that even tho I've experienced this it means less because I never acheived that state of thin. I lost my hair, strength, health, had horrible heart palpitation episodes, panic attack and spent my days revelling in the feel of hunger knawing its way out thru my stomach and chest...but I was never thin so my pain should be less. sad but true that this is what I think deep inside. As for some of the comments regarding treatment/confronting/helping, strangers can tell me all day long that its ok to eat but I wish my family, my parents those closest to me would say it and mean it. I've never thought of it before but reading here made me realize that THAT would make a huge difference to me. not likely to happen, but its a nice fantasy.

Anonymous said...

This is wonderfully written, and it is exactly how it feels to be anorexic. It's so hard to ask for help. Oh how I loathe this disease...

sso said...

This is quite a realistic account of my experiences. I'd also like to add that the kind of pain and indecision you described so vividly often applies to ANY food at all, not just foods an anorexic might view as "bad." On bad days, you might find me frozen in the grocery store, silently and furiously contemplating the merits of an apple. Sometimes the pain gives way to anger, as I see other shoppers easily placing items in their cart. Why can they have food, but I can't?

Anonymous said...

I don't think Maudsley would have worked on me. I stopped exhibiting anorexic behaviour on my own, and never got below a 16 on the B.M.I. chart.

This was because I wasn't obsessed so much with being thin as with a weird set of morals in which food was morally bad, and because I was a bad person, I had to starve to make up for it. This rule, weirdly enough, did not apply to other people, because other people are good people, so they can eat. Being thin was like, an indication of how much self control I had, not really a goal per se.

I've been diagnosed with a form of autophobia relating to being embodied, where bodily functions such as aging, eating, and using the loo (but funnily enough not drinking or sleeping) are wholly disgusting to me.

I honestly don't think I'll ever be mentally rehabilitated, but at least I've mostly got into the habit of eating.