Book Giveaway: 100 Questions & Answers About Anorexia Nervosa

Dr. Sari Shepphird is one of my favorite "experts." Shepphird, a clinical psychologist from Los Angeles who specializes in treating eating disorders, has a new book out, 100 Questions & Answers About Anorexia Nervosa. The book tackles the complex and confusing subject of eating disorders by posing and answering questions like "Are athletes at greater risk for developing anorexia and eating disorders" and "How do I know if I have a healthy body image?" The book is written for people with anorexia, their friends and families. I admire its clear, practical approach, and think it will be of great help to many.

And I've got a copy to give away! If you'd like to enter the drawing for a free copy of Dr. Shepphird's new book, leave a comment on this post telling me why you're interested in reading it. I'll draw names at random next Monday, March 29.

Good luck!

A troll among many trolls

I don't normally bother with trolls, but this one sent me an email to my work address that is so vile, I have to share it here with all of you.

Barry, I suspect you are what I think of as a self-loather. Maybe you were once fat. Maybe you're fat now. Maybe you're deathly afraid you will be fat in the future.

Personally, I love how you toss aside research in favor of your own baseless and warped opinions. That Barry, he sure knows better than those high-falutin' doctors who actually research this stuff!

Since you think shame is a good health-care strategy, I'll take your idea a step further and see if shame is a good strategy for curing haters like you. Probably not, alas.

I hope my readers will respond to you in the same spirit in which you wrote to me.



I was mystified and angered by your article in the Times today. Are you actually arguing that obesity is a healthy lifestyle? Are you really saying that fat people have no control over their food intake and amount of exercise? Eating too much is nothing to be proud of, just as drinking too much alcohol is nothing to celebrate. You are lying to yourself if you think you are not shoving far too many calories into your mouth. You're fat because you can't control yourself--it's that simple.

The reason we stigmatize obesity is because it really is a choice, unlike skin color, ethnicity and the religion you were raised in. Obesity is a signal to others that this fat person is living an important part of his/her life totally out of control. It signals a lack of self-discipline and a warped sense of self-worth. Your position on this means means you're proud of your lack of control about how much, and what, you eat. It's delusional to be proud and pleased that you are out of breath when you climb stairs, that you are heading for a horrible old age--if you live that long, that making love to your partner is a problem instead of a happy event, and that you can't perform simple tasks from properly wiping your ass on the toilet to picking up an earring you've dropped.

Delusional: For example, you state that the emotional stress of the prejudice against fat people causes the health issues that result from obesity. That is not science, that is nonsense. We know stress can be a contributing factor to poor health, but you're trying to blame others for the conditions you create by eating too much. Reminds me of alcoholics saying they drink too much because of all the pressure on them to stop drinking.

On the one hand you blame doctors for relating to obese people differently than normal weight folks because, as you say, doctors believe fat patients won't follow orders, won't show up for appointments etc. Then later in your article you say fat people don't show up for doctor appointments because they feel bad about themselves and worry about how doctors will relate to them. Doctors know from experience that fat people miss appointments and can't or won't take care of their own health. Of course they relate differently to people like you who disdain main stream medical advice.

When Lincoln University tried to help fat kids get well and avoid incipient heart and other diseases, you condemn them for their efforts. What you fail to understand is that your stance actually kills people by making gluttony and self abuse through food a good choice, a choice to be proud of. What you are doing diminishes the real harm of prejudice which punishes innocent people for the color of their skin or their ethnicity--things they can't and should not want to change.

But obesity is a lifestyle choice, like smoking and alcoholism, a self-destructive lifestyle choice that harms the people who choose to follow that course. Anyone can get thinner and improve their overall health. It is not easy but rarely are the important life choices easy. That doesn't make your choice a virtue. It is difficult to diet and exercise on a regular basis and change your attitude about stuffing as much food as you can into your face. We've all heard the reasons people live your way, and none of them are good, abuse as a child, the comfort derived from eating lots of fatty creamy things, the hit of sugar, the bad habits of a deprived upbringing blah blah blah. We rightfully despise drunks who abuse themselves and others, ruin careers and the lives of those who love them. Similarly obese people are wearing a big sign that says "it's all about me and screw you who object to my overeating, it's costs to society, it's bad example to young people, it's strong signal that I'm out of control. I do it because it feels good and I'm proud of that." This is called selfish and irresponsible--nothing to be proud of.

Think about the damage your article has done. Making a virtue out of a lifestyle that any scientist, medical person or just plain educated folks know is harmful. Shame on you.
Barry XXXX
NY

PLEASE NOTE: THIS THREAD IS NOW CLOSED.

The stigma of obesity

I'm delighted that the New York Times has run this piece, even though they cut the fabulous Marilyn Wann from my final draft.

Let me know what you think. And if you're feeling brave, venture on over to the New York Times' blog discussion of it. It's a stunning example of how deeply ingrained fat stigma is in our culture. Sheesh.

And a big welcome to Jezzies who land here. Love the photo of Gabby that ran with the post today.

Protest in D.C. today

If you're in Washington, D.C., today, check out this protest against the insurance industry. Activists plan to "arrest" health insurance execs who are there for a meeting, and hold a rally afterward.

The idea behind the event, according to Gerald McEntee, president of the American Federation of State, County, and Municipal Employees (AFSCME), is "to expose the high crimes and misdemeanors perpetuated by the insurance industry time after time and year after year, and we are totally sick of it. We're going to crash their party and put an end to its injustice."

I'm with you in spirit!

The U.K. tackles body image issues

Kudos to the Royal College of Psychiatrists across the pond for taking on the thorny issue of media and body image in a powerful way.

The U.K. group just issued a statement admonishing the media for their damaging portrayal of eating disorders. That's good, and it goes along with similar statements made recently by several U. S. groups. Raising awareness on both sides of the pond--excellent work.

The RCC's gone a step further, though, calling for a "new editorial code" that would end the promotion of the unattainable thin ideal in the media. This is a bold step, and I'm going to be following developments closely on this subject.

The RCC identified three main areas of concern (and I'm quoting here from its press release, as you can no doubt tell from the Anglicized spelling):

Visual imagery: Preteen or underweight models are used by the media and advertising companies to promote a thin body ideal, and airbrushing and digital enhancement is widely used to portray physical perfection that is unattainable in real life.

Unbalanced articles : Many magazine articles give advice on dieting without giving information about the long-term effectiveness of diets and the dangers of extreme dieting. ‘Body critical’ articles also target celebrities for being overweight, underweight or physically imperfect, which normalises body criticism and can make people dissatisfied with their own bodies.

Inaccurate portrayal of eating disorders: Many articles ‘glamorise’ weight loss and portray eating disorders as mild disorders or personal weaknesses, rather than serious mental illnesses requiring specialist treatment.

I'm expecting cries of First Amendment foul on this side of the pond. It raises an interesting dilemma for me, as both a magazine journalist (and professor of magazine journalism) and an eating disorders advocate. Is censorship ever a good idea? How about self-censorship, which I think is what the British shrinks are suggesting?

My journalism colleagues will no doubt want to throw me off the island for saying this, but I'm all for some kind of self-censorship in this case. No journalistic standards will be violated if, for instance, magazines ran images of beautiful 20-year-old American models instead of emaciated Russian preteens with preternaturally pouty lips. In fact, I could argue that in the best possible tradition of journalism, magazines have a responsibility to tell both sides of the story: Instead of blaring the trumpets of weight loss at any cost, how about stories that encourage women to accept and love themselves as they are? I'm not even gonna mention the kind of cognitive dissonance that comes from Photoshopping the hell out of Kelly Clarkson on the cover and then running a feature quoting her as saying she loves her body the way it is and doesn't feel the need to diet herself into oblivion. I'm not even going to mention the magazine that did this (cough, rhymes with elf).

When I pitched a story on self-acceptance and body image recently to a magazine that shall not be named (cough, rhymes with wealth), I was told by my editor, rather sadly, that it would never fly.

Maybe when pigs grow wings.

**Thanks to one of my students, Courtney Egleston, for posting this story originally on the Newhouse magazine feed.

Jezebel investigates MeMe Roth!

Check out this awesome post by Jenna over at Jezebel, who as far as I can tell is the only journalist who's actually bothered to investigate Roth's pseudo (cough fake) credentials for her ridiculous one-woman anti-obesity campaign.

As a professor of journalism and writer for mainstream media outlets, I'd love to know why no one else has even questioned Roth's patently false claims and unsupported stance. How about Nightline, which pitted Roth and a chick named Kim Bensen against Marianne Kirby and Crystal Renn in this "faceoff" questioning "Is it OK to be fat?"

I can't help but think this is a) an example of how sloppy some journalists are getting, and b) a function of the widespread fatphobia washing through the culture.

Either way, kudos to Jezebel for doing some actual reporting. And, of course, presenting that reportage with the requisite levels of snark and sarcasm.

The Woman at the Y, part 4

She was back again. The woman at the Y. I thought I was ready. I'd talked to myself about it. I'd told myself, It's her business, it's her life, I don't know her story, and anyway, there's nothing I can do. So when she took up a position right toward the back of the room this morning, I made myself look away from her in the mirror. I did OK.

But five minutes later, I looked at the mirror and she had somehow moved up in the class. She was now directly behind me, close enough to once more see the shape of her thigh bones through her pants, see the strained and straining look on her face. When the song ended I moved across the room, to a spot where I couldn't easily see her. I thought I was doing OK.

And she took off her shirt.

Understand, this is not a class where people take off their shirts or exercise in their sports bras. I've never seen anyone else do that. Not that there's anything offensive about the idea of working out in a sports bra; it's just not the culture of this particular class. So her action would have been startling no matter who she was or what she looked like.

Now everyone could see the shape of every rib, count the knobs of her spine, consider the impossibly small diameter of her waist.

I fled. I ran out of the room clutching my water bottle and sat in the bathroom of the Y and cried.

I'm sure at this point that she knows that her presence disturbs me. As a friend later said, it's as if she's a specter, haunting me. As if I needed haunting. As if I needed reminding of everything anorexia has taken from the people I love and care about.

I won't be going back to that class.

Comments have been disabled on this blog post only.

Why Dick Cavett needs a muzzle. Or maybe a gag.

I used to like Dick Cavett. Of all the talk show hosts, he was the one known for his erudition, his intellectual streak. Johnny was the funny one, but Dick was the insightful interviewer, the one who came up with the best questions, whose show made you think.

I haven't been a fan of Dick's in a while, ever since he wrote this truly obnoxious blog post on obesity. Cavett's not the only painfully thin celebrity to weigh in (ha ha) on the subject, and he won't be the last. But his blog post seemed especially egregious to me, maybe because he wasn't responding to a current event, or an interviewer's question. He was just flying his fatphobic flag, loud and proud. By using words "heavily larded," "a herd of heifers," "the size of the Hindenburg," and other choice descriptors, Cavett showed off not only his vocabulary but his jejune perspective. (No, Dick, you're not the only one who knows fancy words.)

I thought I was over Dick Cavett. I really did. It's hard to stay pissed off at a washed-up ex-talk-show-host who's got nothing better to do than vilify people based on their appearance. Then he ticked me off all over again with a quote in this week's New Yorker magazine, in a piece by Ben McGrath on an odd little throwback of a recruitment video recently released by Yale.

McGrath quotes various Yale alums on the pros and cons of the video. Their comments are informative and amusing. That is, until we get to Cavett, who says, "“I wonder if it really was made in America, because there are no fatties.”

Really, Dick? That's your reaction? That the video features "no fatties"? What does that have to do with the subject at hand?

It seems that Cavett just can't put a lid on it; he's got to inject a little fatphobia into every conversation in print. Mercifully, there aren't too many of those, because, after all, he hasn't actually done anything worth mentioning in about 25 years. Maybe he's trying to line himself up a reality show. Maybe he wants to replace Howard Stern. Or maybe he's so obsessed with the subject of fat people that he literally can't help himself.

In which case, Dick, let me give you a few words of advice: Shut up already. You may have a high IQ, but your comments illustrate your ignorance, your prejudice, and your inherent lack of decency and kindness.

Come to think of it, maybe Rush Limbaugh has a co-host spot. Dick Cavett would be perfect for the job.

Ditching the concept of "refusal"

The editors of the venerable Diagnostic and Statistical Manual of Mental Disorders, otherwise known as DSM, have just released proposed revisions for the fifth edition of the book, due out in 2013. And WOO-HOO! They've taken out the word refusal in their criteria for anorexia nervosa.

That word has always bugged the crap out of me. It embodies everything I've come to dislike and distrust about conventional eating disorders treatment. It assumes that the person with anorexia is making a choice--a conscious choice--to not eat. It reinforces Hilde Bruch's characterization of anorexia and the people who suffer from it and the whole psychodynamic theory of AN--a theory that has absolutely no basis in scientific evidence or fact. A theory that has kept ED treatment in the 18th century, in my opinion, and condemned sufferers to years of ineffective treatment and torment.

So three cheers to the editors. I hope their proposed revisions make the final cut.

NEDA Walk in San Diego

You don't have to be in San Diego to support the first annual San Diego NEDA walk, which will be held on February 21. The walk is being hosted by the University of California San Diego's Eating Disorders Program--the same folks who run a five-day intensive outpatient program for families getting started with family-based treatment for anorexia or bulimia.

Sign up online to sponsor one or more walkers on UCSD's team, which includes Walter Kaye, Roxanne Rockwell, and Bridget Whitlow. Go, team!

A word about civility

Hey folks--

It should be clear by now that I'm not going to post comments that are rude, spiteful, mean, or abusive. I make an effort to be positive and constructive in my posts and when I respond to comments. I hold you to the same standards, or I won't be allowing your comments.

We don't have to agree. We do have to have a civil dialogue.

Frankly, my college writing students are far better at the whole constructive criticism thing than some of my anonymous commenters.

And you know what? It's hurtful. And hurt just breeds hurt.

So please, do yourself a favor, and either grow up or go comment on someone else's blog.

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.

NAAFA takes on Michelle Obama's crusade against childhood obesity

I wouldn't normally repost a press release. But this one from the National Association to Advance Fat Acceptance is so well-researched and concisely effective that I can't resist.

Repeat after me, everyone: Shame is not a health-care strategy.

Enjoy.

NAAFA Challenges the First Lady

For Immediate Release
January 29, 2010

Oakland, CA – First Lady Michele Obama has recently announced her intention to focus on childhood obesity prevention. NAAFA encourages the First Lady to consider all the research before taking action and supporting any program that may do more harm than good.

Mrs. Obama, please explore and consider the following:

• When important figures such as parents, teachers and peers in children's social environment endorse a preference for thinness and place an importance on weight control, this can contribute to body dissatisfaction, dieting, low self-esteem and weight bias among children and adolescents (Davison & Birch, 2001; Davison & Birch, 2004; Dohnt & Tiggemann, 2006; Smolak, Levine, & Schermer, 1999).

• The stigmatization of large children has increased by 40% over the last 30 years (Latner & Stunkard, 2003).

• Many drugs presently being prescribed to children cause weight gain. There was a 40 fold increase in bi-polar diagnoses in children between 1994 and 2003. 90.6% of youth received a psychotropic medication during bipolar disorder visits. For many, mood stabilizers, antipsychotics, and antidepressants were also prescribed. (Arch Gen Psychiatr,. 2007)

• Prescribing dieting is, in effect, prescribing weight cycling, and many people will be fatter in the long run (Mann, 2007).

• Weight-control practices among young people reliably predict greater weight gain, regardless of baseline weight, than that of adolescents who do not engage in such practices (Neumark-Sztainer et al., 2006).

• Based on results from a population-based, longitudinal study with 2,500 teens, Neumark-Sztainer and colleagues at the University of Minnesota (2006) concluded that to prevent obesity and eating disorders, the focus needs to be on health much more than weight. The more weight per se is talked about, the more likely teens are to adopt dangerous dieting behaviors.

• A 2006 study from UCLA suggests our media and cultural obsession with achieving a certain weight does little or no good and may actually undermine motivation to adopt exercise and other healthy lifestyle habits.

• The National Center for Health Statistics, part of the Centers for Disease Control and Prevention indicated in 2008 that childhood obesity has leveled off.

NAAFA urges the First Lady to:

• Partner with us and our many resources in the scientific and healthcare communities to examine this issue. Fat children are already the targets of merciless bullying. NAAFA urges Mrs. Obama not to support any programs that would create a pervasive bias against fat children.

• Consider Guidelines for Childhood Obesity Prevention Programs found at: http://www.aedweb.org/media/Guidelines.cfm Childhood School Plans at http://www.healthyweight.net/schools.htm and Guidelines for Children at http://www.healthyweight.net/children.htm

• Support the Health at Every Size (HAES) tenets which state that healthy habits are good for EVERYONE, no matter what their size. Eat healthy, nutritious foods and enjoy occasional treats. Pay attention to your natural hunger and satiety cues. Move your body in ways that feel good rather than exercise focused solely on weight loss.

"Obesity has a strong genetic component that is expressed in environments that foster sedentary activity and eating an energy dense diet", stated Joanne Ikeda, Nutritionist Emeritus, University of California Berkeley, "Therefore, we encourage First Lady Michelle Obama to promote environmental changes in school settings that support enjoyable physical activity and consumption of a wide variety of nutritious, appetizing foods."

This issue is about the critical need to create environments in which children and adolescents do not feel shame or guilt about their bodies but, rather, are motivated to enjoy healthful eating and active living habits regardless of their body size or shape.

Founded in 1969, NAAFA is a non-profit human rights organization dedicated to improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through public education, advocacy, and member support.

On the web:
http://www.naafa.org

News flash: A little "extra" weight can be a good thing

Especially if you're over 70, say researchers at the Western Australian Center for Health and Aging.

A recent study shows that normal-weight and obese patients over 70 had slightly higher levels of mortality than those whose BMIs put them into the overweight category--BMIs of 25 to 29.

In an article in the Journal of the American Geriatrics Society, the researchers said, "These results lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people."

Makes sense to me--that "extra weight" is what Ellyn Satter describes as "nutritional resources." Food is fuel, folks. Your body needs food not just to power itself but to fuel resilience, especially as we get older.

Now I want to see them study this same notion in 60-year-olds. I'm curious about what the results might show.

Chicago conference! April 26!

If you're in the Chicago vicinity (or even if you're not), please join Maudsley Parents for a day-long conference featuring some of the smartest and most articulate researchers in the field of eating disorders.

Our speakers include Dr. Walter Kaye, director of the University of California San Diego's Eating Disorders Program, and Dr. Daniel Le Grange, director of the University of Chicago's Eating Disorders Program. They're two of my all-time favorite experts, and they'll have some exciting new research results to share. We'll also have a panel of parents who will share their experiences using Family-Based Treatment (FBT) to help their children recover from eating disorders.

Register here before Feb. 28 and the fee is only $40. After March 1, the fee is $50.

I'll be there--I hope to see you!

The decade's worst photoshopping, and it's all done on women

The first decade of the 21st century was apparently the decade of Photoshop. Here, Newsweek magazine takes us through some of the decade's most egregious Photoshopping as applied to women's bodies.

We know this kind of overzealous retouching happens, of course, but seeing it drives home the point: When it comes to women's bodies, our culture is seriously fucked up.

Because really, who is the Photoshopping for? Do men really prefer women who look like praying mantises to women with, well, normal proportions? Or is it women who judge one another (and ourselves) so harshly that we demand an unattainable beauty ideal for ourselves, damn it?

Well, neither. You know who loves images like this? Advertisers. Media advertisers. They're the ones trafficking in fantasies. And what is an unattainable beauty idea if not a fantasy?

So how can we respond? We can boycott the offending advertisers. We can consciously look at slideshows like this, reminding ourselves that the images on the left are not any less beautiful than the ones on the right that have been retouched. Au contraire--in pretty much every case I find the unretouched image far more powerful and moving than the ridiculously overdone fantasy on the right.


**Thanks to Christen Brandt for finding the slideshow!

Let's hear it for Gabby Sidibe's designer

. . . who has the guts to articulate, in an interview with the Washington Post, the sad truth about the fashion business: It exists not to serve women but to use them. As Megan Carpentier over at Jezebel writes, "If a designer wants to design a pair of formal, satin shorts with pleats and pockets because for some godforsaken reason he thinks that's cool, then he's got to find a rail-thin model to wear it, or else his design is going to look as ugly and unflattering as it actually is. If he wants to design clothes for women to wear, then he might actually be forced to take into account the women who will be wearing them."

And thanks to Carpentier for pointing out some of the cognitive dissonance in the story. Which is unsurprising. We as a society are so screwed up on the subjects of weight and health, it's a wonder we don't all burst into tears every time we walk into a clothing store.

OT: RIP Kate McGarrigle

Why I believe in fat activism

Scene: Meeting of my university's diversity committee (of which I am a member), where we have been planning a day-long diversity workshop for our faculty. Much conversation over who will be resistant to such a workshop, who is resistant to the idea of diversity in education in general. Much conversation in general over issues of cultural competence, etc.

The conversation turns to the current crisis in Haiti.

Professor Y: Some of the coverage on this has been unbelievably racist.

General agreement around the table.

Professor Z: Pat Robertson is talking about those "colored" people making a pact with the devil. And Rush Limbaugh, too. It's unbelievably offensive.

Professor X: Yeah, especially for a fat white guy like him!

Beat.

Me: Did you say "fat white guy"?

Professor X: (to his credit) I just caught myself.

Cut.

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.