Sunday, January 31, 2010

The Woman at the Y, Part 3

She was there again, the woman who comes to the Y sometimes. The woman who is so painfully thin I can see the shape of her femurs through several layers of clothes. The woman whose gaze is inward, whose face has the haunted look I recognize.

This time I tried to engage her before class--to reach out. I said hello. She looked at me and turned away. I haven't seen her talk to anyone, so maybe this wasn't surprising.

Usually she stays at the back of the class, but not today. Today she took a spot front and center, right behind the instructor and in front of the mirror. The harder the workout got, the more broadly she smiled at herself in the mirror. The more she smiled, the more sick I felt.

In the end I had to leave. I grabbed my coat in the middle of a song and ran out of the room, into a bathroom, where I cried and cried. I can't celebrate the joy of moving to music I love when I'm looking at her and imagining how many calories she's burning, how little she eats. When I know that she looks in the mirror and sees something completely different from what I see.

I don't know what to do, truly.

23 comments:

mariposai said...

That's really sad. I find it difficult to see people like that due to memories they evoke in me.

I don't think there is much you can do other than be a friendly face...then when/if she wants to reach out to someone, she knows you are there...

Sarah x

Amy said...

I'm with Mariposai. And, I think we recognize in each other people who will understand, people we can talk to, even if we're not sure until we open our mouths. Sending you hugs of the virtual variety.

Cathy (UK) said...

I used be one of those women - until 5 years ago. I would get up at 5 am to be at the gym when it opened at 6 am. My BMI was < 14. Every day I did the same, exhaustive workout in exactly the same way. People stared at me, but I wasn't going to let anyone stop me. I was frightened to stop. The gym staff let me continue to drive my body to the point of having palpitations. Eventually I had a heart attack.

Unlike your suggestion I saw exactly what everyone else saw in the mirror - an emaciated women who looked in need of a good meal. I didn't exercise exhaustively because I thought I was too fat, or because I feared I might get too fat if I didn't exercise. It was because my brain wouldn't allow me to rest. I had a long history of compulsive behaviours, and without those behaviours I felt I couldn't cope with life. My behaviours had nothing to do with body image.

After my heart attack I had a 'wake-up' call. I had two choice: (1) try to continue my crazy exercise rituals and have a major heart attack that kills me - or - (2) Quit, seek help, gain weight, learn to manage my compulsive/ritualistic behaviours.

Fortunately I did the latter. The anxiety I felt from not doing my daily exercise rituals crippled me emotionally. However, with time the anxiety did die down. I gained > 30 pounds and I will never set foot in a gym again.

I made a video on my YouTube channel about exercise risk in EDs that you may find interesting/helpful.

I understand your concern Harriet.

Toby Wollin said...

Reading this, all I can think about is Kafka's The Hunger Artist.

Eating Alone said...

This might not be realistic but maybe you could ask the instructor to advertise an eating disorder group meating before a class. Or ask the gym if they wouldn't mind putting up a few Neda posters for National Eating Disorders Awareness week. It's worth a shot and doesn't cost a lot.

Also you might want to check out http://www.realgirlsreallife.com/index.php I a saw just like the last 5 minutes of an episode and it's kind of cool About promoting healthy exercise and feelings about yourself.

The_Timekeeper said...

I know that this isn't the case, but when you talk about the woman and the situation, it's almost if you're the only one who *sees* her ... sees that something is wrong. As if she, herself, doesn't realize.

This sense of panic ... "why isn't anyone doing something? Someone do something! I feel helpless and traumatized by a grief that's more gripping than I even realized until a stranger in a Zumba class sends me to my emotional knees and to the locker room in tears!"

But *everyone* knows. Everyone sees. *She* knows. I have been hospitalized with anorexia too many times, and I have *never* met an emaciated patient who didn't know she had an illness and was remarkably underweight. There remain distortions about degree and whether it feels like enough of a problem to seek help for. But a pamphlet or a speech or some policy isn't going to save her or fix her or probably tell her anything she doesn't already know.

It's a great fantasy that a stranger could come in on a white horse, wearing a white hat, bearing a book or special words, a kind smile ... That you could say or do just the right thing that would help ... that would make all the difference.

That would make you feel less powerless.

There's nothing to do but take care of yourself, love your daughter, honor your own traumatic feelings that this woman triggers, and advocate for policies you wish were in place.

Georgia said...

The way you talk about this woman comes across as a bit of a FA double standard. As a commenter in an earlier post stated-- you can't just assume she has an eating disorder because she's thin. What I've learned from FA is that I can never look at ANYONE and assume "This person is obviously X weight because of Y and Z activities and behaviors", let alone would I put so much energy in to someone else's appearance (I would never go to a bathroom and cry for someone who is "obese" enjoying a huge meal at a restaurant under the idea that said person is destroying his/her health). Your justification earlier for her most likely having an eating disorder was (and I'm paraphrasing here) the blank look on her face as she exercised, how drained she seemed by herself in the back. Now she's BEAMING as she enjoys moving her body at the front of the class and you still suggest that the gym intervene. That is just as ridiculous as an idea proposed a long time ago in one of the southern states to ban people who are above a certain BMI from eating at some restaurants. I understand that you have only the best intentions for this woman but I beg you, don't stop doing what you love (like leaving a group fitness class you enjoy so much) because of something you assume, because for all you know, you could be wasting your energy on a perfectly healthy woman. It may be called "fat acceptance" but the underlying principal is accepting people for the weight (ANY weight) they choose to be.

Wow, sorry for the long rant, but being judged for my weight is an issue close to my heart. You don't have to publish this, but it felt good to write.

Harriet said...

Georgia,

I've explained in earlier posts my response to this woman. She is not healthy. I support the notion that people come in all shapes and sizes, from the slender to the larger size. Believe me, this woman is not slender. She's not just thin. There is no normal body size where you can see the shape of someone's thigh bones. Think about it.

Could she have, say, cancer and not an eating disorder? Yes. It's possible. But then I think she'd have a lot less energy. People with anorexia become hyperactive, often exercising for many hours a day while taking in only 500 calories--a feat that should not be possible and yet is.

You're welcome to be skeptical. But with all due respect, you don't sound like you have a lot of experience with anorexia. Unfortunately, I do.

Whether I'm right or wrong, I find it hard to see someone that ill. Because she is ill with something. To me all the signs point to anorexia. I'm not the only one who's noticed her and thinks so, either.

Georgia said...

My question is, though, do you have any more reason to attempt to intervene with her life than in the opposite situation? If you saw someone eating McDonald's who was, say, so heavy that there is absolutely no natural way they could be like that without extensive overeating, would it be YOUR job to go up to them, give them a kind smile and say "have you considered checking yourself into a clinic for the obese? Here, let me throw that cheeseburger away for you. Let me HELP you."

No, that would be an invasion of privacy and they would probably tell you to mind your own business.

It's not illegal to be fat and it's not illegal to be skinny--regardless of health. I'll bet no one who has commented here is this woman's doctor. Your only job is to enjoy the Zumba class and focus on the people who actually WANT your help or raise money for eating disorder organizations that are close to your heart.

Harriet said...

Timekeeper,

I am well aware that a pamphlet isn't going to fix anything. Or a policy, or a comment from an instructor, or whatever.

Georgia,

Not all fat people overeat. Fact. Not all fat people are unhealthy. Fact. Anorexia has the highest mortality rate of any so-called mental illness. Fact.

Your analogy does not hold.

It's not illegal to step over a homeless person in the street, either. But that doesn't make it right.

Meowser said...

I can't help thinking about the Carpenters' authorized biography here. Karen had her ED long before there was a lot of awareness about it (although I remembered reading about anorexia in teen magazines in the late '70s, I had no idea it pertained to Karen until she died), and responded to people (including her brother) commenting on her plummeting weight by digging in even harder and getting sicker. She did seem to make some progress with intensive therapy towards the end, but by that time she'd already abused her body badly enough with thyroid pills (!) and laxatives and ipecac and starvation and gods know what else, that it was too late.

It's a hard thing to know that you can't save someone. But you can't, especially not another adult you're not close to. Karen Carpenter knew in her sober moments that she was ill, but it took her work, which she loved more than anything, being disrupted before she would agree to treatment. This woman probably knows, too, and knows what could happen to her. It doesn't necessarily change anything.

And while I'm sure you're better than most people at recognizing people with AN when you see them, there is an outside chance that this is not AN but some kind of metabolic disorder or even a drug problem of some kind. (A naturally very slender person would probably be at a steady state, not getting progressively thinner.) Also, cancer patients are frequently given stimulants to help them deal with fatigue. This is why the Y probably can't legally intervene unless there's some kind of direct sequelae to her participating in the class, e.g. she passes out or something, because they just don't know what her deal is.

Anonymous said...

having had many friends with EDs, and having one myself, i can understand your concern and heartbreak, but i have to agree that you can never really 'know' when someone is sick in that way.
it sounds silly, bc lots of women with that disease start to look a certain way after awhile, but ascribing to the idea that you can tell when someone's in trouble-and wanting to help them when they may not want your help-is dangerous.

i've been approached by people before who thought they knew i was 'sick' because i am fat, and would make comments they thought would help me, and instead i was just super offended and hurt. so, i totally get where you're coming from, but it can be a slippery slope, if you get what i'm saying.

The_Timekeeper said...

Harriet ... The pamphlet comment was referring to other posters' suggestions that the Y make information available ... or the class teacher make some sort of tangible informational gesture.

My main point for you was one of compassion for the acuity with which you identify with this woman and wanting to do something.

As far as the comments that suggest the woman may have some other affliction or circumstance ... I think it's pretty improbable and preposterous. I'm sure you're right about the woman ... just enmeshed so far as the sense of powerlessness you express and the actual reality of any potential intervention.

I'm not trying to be contrary or pick a "fight." I just wonder if you even realize the degree to which this is affecting you ... and whether that isn't the area for action and introspection. It's terrifying to confront such critical illness that hits so close to home.

Harriet said...

Thank you all. You've given me an idea for the next big story I want to write.

wriggles said...

The attempt at equivalency between anorexia and fatness, however extreme, then conflating that with compulsive eating is bogus.

I had CED for a number of years-brought on by my constant weight loss attempts- and what I was eating was not reflected in my weight, even though I was fat.

So no, there may not be a point where you can be sure that someone is eating as much as their weight.

Metabolic variance.

Anorexia nervosa is not a body type, it is never benign, it is a very serious and life threatening condition. It can and does kill.

It can never be classed with mere fatness, nor is fatness in itself an eating disorder.

Yes we need to be careful of violating people's privacy, but can't people tell the difference between HB's feelings about this woman-right or wrong- and telling someone to throw away the cheeseburger?

There is no double standard here whatsoever. As HB's experience and comittment comes into play.

Can any of those who abuse fat people claim similar knowledge and understanding?

We all depend, as the man wrote, on the kindness of strangers. We are the beneficiaries of numerous considered interventions of others. I find the idea that we are supposed to just watch people die to spare mutual discomfort in case we are wrong, to be a misunderstanding of what fat people are protesting about.

Not in my name.

Yes there are times when you have to recongise and come to terms with your own impotence, but that's the point, can she be saved by some kind of intervention?

I'd want to be saved if there was still a window of opportunity, I'm sure we all would because that's why many of us are still alive, because somebody gave a damn.

Right or wrong HB, your heart is in the right place.

Harriet said...

Thank you, Wriggles. This is an important conversation and I appreciate your voice in it.

Believe me, I am well versed in my own impotence. Thankfully, I have also had the opportunity to feel empowered. I am not under the misapprehension that I can save the world, folks. I'm more interested in why our culture insists that it's wrong to want to "save" people at all. Why we value personal autonomy over connection, whether that connection is misguided or spot on.

And as Wriggles points out, the conflating of anorexia with obesity is just plain wrong.

JennyRose said...

Thanks for distinguishing obesity from anorexia. They are not opposite ends of the same disease. Anorexics need weight restoration, the obese do not. I have seen this used as an argument to tell the obese that they cannot be recovered until they have lost, er I mean restored their weight.

It is heartbreaking to see someone in that condition. It is hard to see a woman who has given up so much of her life to the disease.

I don't think our culture always says it is wrong to save people. People try to save the overweight all the time. Think of how many women try to save the men in their lives. There are mixed messages as you are hearing now. We value personal independence very highly in the US and that seems to be what is happening here. It is the flip side of the "up from your own bootstraps" point of view. Not everyone can do this. Sadly, not everyone can be helped either. I think you are right to care and I found your argument about stepping over a homeless person compelling.

I can see how hard it is for you to witness this and commend you for your compassion for a person who is most likely very sick.

the fat nutritionist said...

It is demonstrably true that being extremely, extremely fat does not carry the same mortality risk as being extremely, extremely thin.

If you look at the distribution of body weights among the population, you will understand this.

There do exist extremely fat people at the far right end of the curve. But there don't exist any thin people at the corresponding far left of the curve, past a certain point.

Because, while people can at least SURVIVE at very high weights, no adults can even exist at the inversely low weights.

People with lots of experience with eating disorders are also pretty good at identifying people who have them, or at least, people who are emaciated (for whatever reason) to the point of severe risk.

Of course we should not judge people's health by their appearance. But it is disingenuous to conflate the health risks of emaciation with the health risks of fatness, or to suggest that someone expressing concern for a person who is demonstrably unwell is doing them harm.

Harriet said...

Excellent points, fatnutritionist and JennyRose. Thanks for contributing to the discussion.

sayhealth said...

I just wanted to add that there are some very recent studies that show that ed-nos and bulimia nervosa have mortality rates equal to that of anorexia nervosa. ALL eating disorders are dangerous and need to be taken seriously. Harriet, obviously you are taking this seriously. That comment was not aimed at you; I just think the community as a whole needs to recognize that all eating disorders are deadly, especially in lieu of this new evidence.

That said, no. You probably can't save this woman. You definitely can't save her if she's not interested in being saved. You CAN offer her consistency, and I do think you can reach out to her, for example, perhaps through a note. I do think you would need to be VERY careful with your wording, how you approach her, etc., because it would be all too easy to alienate her as well. Living with an eating disorder is an alienating and often shame-inducing experience, so tread lightly.

Also, I think gyms should have information about local eating disorder treatment options as a matter of course. No, a pamphlet alone won't save anyone, but there's no reason the information should be readily available for loved ones, concerned friends, people who may be ready for treatment, etc.

Karen Karlsen said...

Wow, that is so sad! Don't let it wreck your class though; you need to enjoy the dance and how good your body feels doing it. That's your right!

IrishUp said...

(((((((Harriet))))))).

In addition to the great posts by JennyRose and thefatnutritionist (big fan wave!) and others, there is the fact that if Harriet is right (which I do not doubt) we are talking about someone who is not able to act in her own best interests. Recent papers by Walter Kaye & Ian Frampton each point to the fact that AN, and EDs more largely, are disorders of executive function. Frankly, we do a piss-poor job of supporting adults with executive function deficits in the US. The value we attach to autonomy tends to spill over into "What's wrong with you? Pull yerself together!" territory.

What a cruel cultural message to send to people whose brains function in such a way that they CAN'T do that! And on the flip side, how cruelly it traps those of us who want to help. Each are shunted to a place where healthy action is impossible. (I love this from Mia Mingus re the myth of independence http://leavingevidence.wordpress.com/2010/01/22/interdependency-exerpts-from-several-talks/.)

Well, Harriet, perhaps the actions you can take, as have been suggested, are to talk to the instructor, or maybe the manager, about what your concerns are. It may not have occurred to them this woman could go into arrest in one of their classes. At least, letting them know there is someone who may well be too ill to take a class might help this woman a little.

Anonymous said...

There are a couple of women like this at my Equinox gym on the Upper East Side. One of them always manages to pick the treadmill in my sight line. She looks so sick, like a skeleton, and she always strips down to tight running pants and a sports bra - clearly she cannot see how bad she looks, and it's horrible to see. I've been there (not as extreme) and it makes me want to talk to her, but I suspect that would be very unwelcome. It's difficult. Honestly, I find myself wishing the gym would talk to her.