At the Y

She was there again this morning, in the vigorous Zumba class I take most Sunday mornings. I love this class because it's fun--exercising to blaring Latin music, following an instructor who shows rather than teaches the moves. I also love it because there's such a wide variety of ages and body types represented, from the hunched-over 70-something woman to 10-year-olds with their mothers. The women in the class--and we are women, although men are welcome--range from thin to fat. Each of us moves to the best of her ability. There are good dancers and bad dancers in the class, and it's all OK.

There are plenty of thin women in the class, but the woman who turned up this morning--second time I've seen her in class--is far thinner than anyone else. Her close-fitting black leggings reveal the shape of her femurs where they meet her jutting hipbones. Her arms look like they might snap at any moment. Her face has a look I've come to recognize, a driven look that also conveys flatness, a certain kind of despair.

You can't tell whether someone has an eating disorder from looking. But I'd bet a year's salary that this woman has anorexia.

Last time she turned up in the class, I went out to the front desk afterward and asked if the Y had a policy about people with eating disorders or whose health was compromised in other ways taking vigorous exercise classes. Shockingly, they do not. I explained my concerns to the woman at the desk, saying I was afraid this ill woman might collapse in class. Or worse. I hoped I wouldn't see her again.

But there she was this morning. In a sweltering room, she wore leggings and a sweatshirt zipped to her chin. I watched her exercise in the mirror; she didn't know most of the steps, being new to the class, but she threw herself into the dancing with determined force. She was burning calories. I couldn't tell if she was having fun. Most women in the class smile through much of it, but this woman's expression never changed.

I'd thought at lot about her since the last time I saw her in class, and decided I would try to talk to her after class, befriend her, get to know her. Only this time, like last time, she ducked out of class before the end. I glimpsed her on one of the elliptical machines on my way out, and wondered how many hours a day she spents at the Y.

I was struck recently by a quote in this film, made by documentary filmmaker Hope Hall about her mother, who's struggled with anorexia and bulimia for many years. The film includes a voiceover phone call between Hope and her mother, where her mother says, "Through all my growing up, through all my marriage, I was always trying to measure up, trying to be somebody else. And all of a sudden, you said, 'I just love you. I don't need you to be well.'"

I think about the woman at the Y, and am torn by what I wish for her. I hope she people in her life who just love her. But I also wish that she, and everyone with an eating disorder, had people in their lives who could help them get well. Who could help them out of the private hell of anorexia and bulimia and into a life filled with something besides starving and binging and suffering.

I hope the woman does not come back to class, because, selfishly, I am uncomfortable seeing her there. In her gaunt face I see the face of my daughter, Kitty, at her sickest. I imagine Kitty at age 40, living this kind of hell, and I feel sick.

I wish I knew what I could do to help.

Ransom me

NYU's "Ransom Notes" ad campaign has taken a lot of heat in the form of bad press lately.

In case you've been in Tahiti for the last few weeks, these ads are written in the form of mock ransom notes from children with a range of psychiatric disorders, from autism to anorexia. The premise is that these illnesses "kidnap" kids, and that treatment "rescues" them.

And guess what? I think this is BLOODY BRILLIANT. I had panic disorder--undiagnosed and untreated--for my entire childhood, and this is exactly how it felt even to me at the time. I wish someone had noticed my distress and rescued me. And as the parent of a teen with anorexia, I appreciate the sentiment here--that parents need to wake up and do something.

I get the counterarguments, especially as they come from parents in the autism advocacy movement. And I'm just as cynical as the average reader (maybe more so) about the drug company lobbies. There's money to be made in peddling medications, and kids are a big market.

But none of this holds a candle to the absolute life-shattering despair of living with an untreated psychiatric illness. Of feeling like you're going mad and no one is noticing. Of the fallout of years and years of feeling so alone and helpless.

I often wonder how my life might be different had someone helped me with panic disorder when I was a child. I suspect I'd be a very different person today. And while those who know and love me might say, "We wouldn't want that!"--I'd take it in a heartbeat.

Sometimes a strong message is what's needed. I think BBDO, the agency that created this campaign, got it right.

"Mom, I'm too fat!"

These are the words to strike terror into a mother's heart, especially if you've ever dealt with anorexia or bulimia in your house. Every child or teen with an eating disorder says these words at one time or another. They reflect the delusion at the heart of an eating disorder, the distorted perceptions of her/his own body and the anguish caused by those distortions.

I heard them many times in the year my older daughter was sick with anorexia. But this time, this weekend, they were uttered by my younger daughter.

My younger daughter sat with us at the table during the year and a half of re-feeding. She lived through the horror and terror of it all with us. We tried to protect her from the worst of it, but she certainly experienced firsthand the nightmare of living with an eating disorder. This may contribute to the reality that as the sibling of a child with anorexia, she's 8 times more likely to have it than other kids her age.

And we've talked about it. Boy, have we talked. We've talked about unrealistic body images and the media. We've talked about food-as-fuel. We've talked about bodies-come-in-all-shapes-and-sizes. We've talked about health-at-every-size.

I thought we'd talked our way through the dangerous parts and onto the solid shores of reason and understanding.

But the trouble is, as my younger daughter informed me, I just don't understand. I don't understand what it's like to be in 7th grade and be a girl. I don't understand what it's like to be a year or two behind when it comes to puberty, to still have a child's body, a child's shape, in a world full of budding young women.

"They look like this, Mom," she cried one night this weekend, sucking in her stomach to show me. Whereas my younger daughter still has the round shape of a child. She's younger than everyone else in her class, shorter, and clearly going through puberty later.

I don't think other kids are making fun of her for her childish figure. I think this is a case of institutionalized self-loathing. But I don't know for sure. I do know that seventh grade girls diet. A lot. And that they talk about their diets. And they talk, as young women (and some young men) do, about how fat they are.

They talk about how fat their butts and thighs and stomachs are. I know these kids; I've chaperoned them on field trips and come into their classrooms for years. They are not fat. They are not the headless fat children whose photos you see accompanying every media scare on the subject of childhood obesity. They look no different from kids of my generation, except that maybe they're a little taller.

Even if they were fat, of course, it would make no difference.

These children are bombarded with media images of super-thin women and men, and so that body type and paradigm comes to look very normal to them. They watch a lot of TV and movies and they learn to see themselves as sexualized from an early age.

They're bombarded at school with hysterical warnings about body fat and obesity and unhealthy eating. They are forced to watch Supersize Me. They are weighed and their BMIs calculated, in front of other children. Their body fat is "measured" (however inaccurately) with calipers, all in front of other children. They are taught that there's good food and bad food, that some foods are unhealthy, that some bodies are unacceptable. They're taught that you can never strive hard enough to be thin, to exercise, to avoid certain foods.

Some of them develop eating disorders. Maybe they would anyway; there's no way to know. We do know that some kids come hard-wired to be susceptible to an e.d., and that those disorders can then be triggered by environment and other factors. So maybe if they grew up in a culture that wasn't obsessed by issues of weight and body size and shape, they would pass through the dangerous time of adolescence without ever developing an e.d. If they grew up in a culture where it was OK to be who you are--fat or thin, intellectual or street-savvy, funny or serious--they would come out of adolescence loving themselves, not hating who they are.

Maybe this is all wishful, deluded thinking on my part.

I do know that those words my younger daughter said struck pure terror into my heart. That we will be talking about this from every direction I can think of over the next few months and years. That I'll be watching her like a hawk for the first inklings of an eating disorder, watching with terror a lump in my throat, with the memories of my older daughter still fresh, and with the determination to do whatever it takes to save her if she is in fact in danger.

But my god, how I wish I didn't have to. It occurs to me for pretty much the first time how different this would feel is the culture supported me rather than fought me. But in this culture and time, to advocate for, as Ellyn Satter says, a "joyful, comptent relationship with food," is to swim against the current, to fight the mainstream, to be perceived in many ways and places as a nutcase, a fruitcake, a mom-with-an-agenda in the worst possible sense of the word.

I've developed a thick skin. I don't care what the powers that be think. I care only about my children, and other people's children. But it's so easy to buy in to the culture's sick obsession. So easy, in a certain way, to turn to my younger daughter and say, "You do have a little tummy, dear--why don't we go on a diet? Together?" To unwittingly set her up for either a lifetime of physical self-loathing or disordered eating, or the hell of a full-blown eating disorder.

Not today. Not my daughter.

Media misunderstandings

I suppose I should be glad that my local newspaper is covering eating disorders in this article on a 41-year-old woman with bulimia.

But you know, it's hard to feel encouraged when you read lines like this:

Thanksgiving, challenging for anyone on a diet, is particularly problematic for people with eating disorders, whose troubles with food generally stem from deep psychological issues, therapists say.

There's a whole lotta sloppy thinking and reporting packed into that one paragraph. For one thing, it conflates "anyone on a diet" with "people with eating disorders," as if an eating disorder was the same phenomenon as a diet, only taken to an extreme.

And of course the line about "deep psychological issues" is just the same old b.s. we've been hearing since Hilde Bruch started writing about anorexia.

We know a hell of a lot more about these diseases now than Bruch did. We know they're biological illnesses. We know that genetics plays a huge role. And we know that you don't need "psychological issues" to develop anorexia or bulimia.

SOmeone who's lived with an e.d. for 20-some years may well have "deep psychological issues" with food. But it's a chicken and egg thing. The illness comes first, the "issues" come later.

The article goes on to describe how the woman with bulimia has been hospitalized seven times (six times at Rogers Memorial) for her eating disorder and still struggles with it. The tone smacks of prurience--"She actually might get up from the Thanksgiving table and vomit!"--and the continued conflation of eating disorders and dieting leads to comments like "Therapists encourage people with eating disorders — and anyone with more routine concerns about overeating on Thanksgiving — to plan ahead. Consider what items might be served and decide how much of each you'll eat."

Um, that sounds exactly like eating disorder talk to me.

Anorexia as metaphor

Recently I've read seveal memoirs about being anorexic, or books by doctors about eating disorders, that emphasize the metaphoric context of anorexia and bulimia. They talk about anorexics craving emptiness and hunger, the politics of appetite, the power trip of self-starvation.

I can see that for those who suffer from anorexia for a long time--more than a year? more than two?--the natural human tendency to assign meaning and metaphor to biological reality kicks in. When you live with something for a long time, it becomes part of your self-image, a key element in how you see yourself.

Such writers tend to make an important and to my mind unsupported leap, though. They generalize backward from their own situation, years down the line with anorexia, and conclude that the metaphor is what causes girls and boys to become anorexicv. This is the classic pitfall in anorexia treatment, the conventional wisdom espoused by doctors and therapists. And it's wrong.

It's important for parents and therapists and doctors to not get sucked in to the persuasive world of the anorexia metaphor. To remember that the vast majority of anorecxics become sick accidentally, from a diet that takes on a life of its own, an illness, a natural propensity for losing weight that gets pushed too far in some way and takes over a child's physial and psychological life.

To buy in to the notion of anorexia as metaphor is, frankly, to fall under its sway. I think this is one reason why, as Daniel Le Grange told me, even doctors and therapists sometimes make bad decisions about anorexia. "It's as if the anorexia affects the thinking processes of those around the sufferer," he told me.

I think the mechanism he was talking about is metaphor. And that's why I think it's absolutely vital that we de-metaphorize anorexia. We can best help our children--and other people's children--by taking anorexia's power away, both literally and metaphorically. By remembering that anorexia is a biological disease and that its symptoms and consequences are larely the result of starvation. And that the first line of treatment for it is not psychological but physiological: food.

There is time later, after a child is weight restored and mentally restored, to discuss the metaphors of eating disorders, if they apply. But it's a dangerous trap to fall into that conversation right away.