Anorexia and target weights

Doctors do a lousy job, overall, at setting target weights for people recovering from anorexia. Most set them way too low, so the patient never reaches or stays at a weight high enough to heal from prolonged malnutrition, and relapses.

Now a new study published in the International Journal of Eating Disorders suggests a different measure of recovery: resumption of menstruation.

As nearly any pediatrician or parent can tell you, this is a bad idea. Really bad idea. Some girls never lose their periods no matter how much weight they lose. Some get them back while they're still significantly underweight. Getting your period back while you're in recovery is a good sign, but it's no litmus test of health.

In fact there is no single measure of restored health. Some clinics use body composition analysis, which takes into account not just a person's weight or BMI but also the percentage of lean and fat tissue in the body.

I think the best measure is mental health, and parents are well-placed to judge it. They know what their child was like before anorexia, and they know when their child is "back." I've heard countless stories of teens who reach the weight the doctor sets and still aren't better, or who get their periods back despite still being in the grip of anorexic delusions and obsessions.

When I saw my daughter's anxiety around food and eating was pretty much gone, I knew she was close to full recovery. Don't settle for anything less.

And the winners are . . .

You all could be making tons of money as high-paid marketing shills for Big Pharma. But I'm glad you're not.

And the winners of the Taranabant marketing slogan contest are:

Letitshine's "Taranabant: Because food is bad." Because, you know, that's what people really really think, deep down.

bigmovesbabe's "Taranabant: Because nothing tastes as good as anxiety feels." For its social satire of That Other Tagline.

And finally, littlem's "Taranabant: Rimonabant Duzn't Wurk On Fattiez, So We Tryz Agen" just because I think it's hilarious. And oh so true.

I'll award more prizes if you keep the entries coming. Meanwhile, congratulations to our 3 lucky winners. Send me your address and T-shirt size and I'll send you a prize. :-)

Would you rather be fat or have a mood disorder? Win a prize!

Because those are your two choices, if you listen to the hype around the latest in the slew of anti-obesity sweepstakes entrants, known generically as taranabant. Amid the hysterical buzz that's been making the rounds online, we're now beginning to see mention of "psychiatric side effects." This Scientific American article describes side effects as "nausea, vomiting, and moodiness," and goes on to explain that taranabant is what's known as a cannabinoid antagonist, meaning it blocks the receptors in the brain that are activated by cannabis sativa, or pot. So instead of giving you the munchies, this drug takes away appetite; instead of calming, it "activates," or makes people irritable and anxious.

But wait--I have a better idea. And you can win a prize! Keep reading.

Can me say first how much I hate the photo and headline that ran with this story, too? The head was "New Diet Drug in the Battle of the Bulge," and it ran with this image.

My interpretation of the phrase "battle of the bulge" is people who want to lose 10 or 20 or 30 pounds—who want to be in the lower end of their setpoint range rather than the higher end. This is hardly what even the medical profession would label "obesity." I suppose this image is better than the one that ran with a report on a site called Dogflu.ca., which I'm not going to reproduce here because it's so exploitative.

I think we need an anti-anti-obesity drug marketing campaign, and drugs like this give us the perfect material. We could start by resurrecting the old "This is your brain on drugs" ad campaign. See the fun that's possible?

Let's have a little friendly competition, in fact. You write a clever tagline to go with this new drug, and I'll send a prize to a couple of lucky winners. Ready, set, go.

Why we need to talk about food

Over at Laura Collins' blog there's a compelling debate raging about treatment for eating disorders. It started with a link to a Student Doctor Network discussion about Maudsley (also known as family-based treatment).

The forum link is a peek into the minds of some medical/psych students who dismiss Maudsley treatment as something that might work only for "the very tame cases" (has anyone out there ever seen a "very tame case" of anorexia?). Students who know nothing about it say confidently that they would "never recommend it."

I would think that given the truly abysmal rates of recovery from eating disorders, medical professionals would be thrilled to learn about a treatment with positive results and an excellent track record. I've got a couple of suggestions for where to start: With this useful Q&A on Maudsley and this article about the University of Chicago's Daniel Le Grange.

And in answer to a comment made on the Student Doctor Network, I love what Dr. Le Grange says at the end of the article: "How can you not talk about food when your daughter is starving?"

Pop quiz

What's the first thing that pops into your head when you think about eating disorders? Or see someone who's clearly struggling with anorexia or bulimia?

A. "What a selfish brat--why doesn't she get a life?"

B. "What a dreadful illness this is--I know how much she's suffering"?

The answer most likely depends on what you know--or think you know--about eating disorders.

If you think they're emotional responses to trauma or lifestyle choices, you probably answered A. If think they're physiological diseases that are no fault of the patient and can't be chosen (or unchosen), you probably chose B. And you'd be correct.

As Cynthia Bulik, professor of eating disorders and psychiatry at University of North Carolina, put it, "“There is a lot of false information about anorexia nervosa disseminated in pop culture. This study suggests that even a nugget of accurate biological information can influence how health care professionals perceive the illness."

And not just doctors and nurses but real people, too, according to the experiment Bulik is commenting on. Attitudinal change comes hard, but it does happen. Read and rejoice.

Body image/sexuality 101--for teens

Here at Feed Me!, I get a lot of books sent to me by publishers and authors who want some blogosphere buzz. I write only about the ones that really move me--negatively or otherwise--because life's just too short to bother with the rest.

Body Drama by Nancy Amanda Redd is the most recent submission that's come my way, and I thought it would be perfect to try out on my two teenage daughters. They're a tough audience, as most teens are these days, quick to spot the phony tone and the overly chirpy (and uninformative) information. This book is, as it trumpets, designed for "Real girls, real bodies, real issues, real answers," and its cover features tasteful images of 5 teenage girls in their underwear, along with the tagline "Shape * Skin * Down there * Boobs * Hair & Nails."

I like the book a lot, for its joyful photos of bodies of all shapes and sizes, for its common-sense, practical advice, and for its willingness to take on some tough questions and provide elegant, useful answers. One of my favorite pages shows photographs of 24 different vulvas of all shapes and sizes. "When I study the different vulvas, I see elements of my own here and there, and realize that no one's exactly the same" writes Redd, a former Miss America contestant and Harvard grad. "I also have been able to release a lot of the embarrassment I always carried around about my own vag. I hope that these pages will do the same for you."

But what would my daughters think?

I brought the book down to the living room one afternoon and put it on a table. Within 10 minutes both girls had picked it up--a promising beginning. The 16-year-old dismissed it by saying, "I know all that already." But I noticed she kept going back to it, picking it up, paging through it. The younger one didn't want to pick it up, so I wound up asking her to take a look. She read it cover to cover and told me later, "That book was pretty good."

Bottom line: If you've got teenage or preteen daughters, you might want to buy this book and leave it lying around. At the very least they'll see that not everyone looks like Paris Hilton (thank God).

Why Immanuel Kant was right

A letter in today's issue of the British Medical Journal warns that the obesity epidemic in the U.K. is so bad that action must be taken now; no more studies or research, says the letter writer. Do something now!

What does she think should be done? It's a question of infrastructure, she writes; we need to build more bike lanes and sidewalks and remove the physical obstacles to biking, walking, and swimming.

That sounds like a great idea to me. I live in a city famous for being bike-friendly. I bike to and from work when the temperature is above freezing (round trip: 6.5 miles) and walk the rest of the time, and I love it.

But I haven't lost any weight doing it, and I don't expect to. That's not why I do it. I bike and walk because I love the feeling of getting somewhere under my own steam--always have; I walked to and from high school, 2 miles each way, even though there was a bus I could have taken. My brain works better when I'm in motion, so I get a lot of my best ideas while I'm walking or biking. And the efficient part of me likes combining daily exercise with basic transportation--killing two birds with one stone.

The trouble comes when we pose such social changes as means to an end, ways to drop pounds, rather than an end unto itself. The philosopher Immanuel Kant spoke to this kind of mistake in his writings. In his view, all means to an end have a merely conditional worth because they are valuable only for achieving something else. In order to have value, something must be worth doing for its own sake.

Bingo! Let's build bike lanes and hiking paths and public swimming pools because we think there's intrinsic benefit in people biking, cycling, and swimming. Conflating weight loss with these activities just muddies the waters. What will letter writers propose when said improvements don't result in massive weight loss? I shudder to think.

How to get naked on national TV

My older daughter has been bugging me to take a look at Lifetime's new show, How to Look Good Naked, and last night I finally did. The idea is that any woman can look good naked if she Loves Her Body. It stars Carson Kressley, one of the Fab Five from the Queer Eye for the Straight Guy show of a few years back, and (in each episode) a woman who is unhappy with her body. Like all reality shows, it's based on the premise of quick transformation, only in this case it's not through diet, overexercising, or self-hatred.

In this show, the path to loving your body does include some high-end clothes, a proper bra fitting, and spa time. But it also pays at least lip service to the idea of taking a good look at your body and learning to love what you see, regardless of how you do or don't conform to cultural beauty norms. It's an appealing premise, though I do have to wonder why women require the services of a gay man to appreciate our boobs, thighs, and butts.

Carson Kressley is, as my daughter says, adorable, and much of the dramatic tension of the show comes from the cognitive dissonance of watching a perfectly toned, tweezed, and tucked-in gay man not flinch at the sight of a fat woman in underwear. And the whole show takes on the unfortunate feeling of a scavenger hunt at the end, when Kressley persuades the somewhat-transformed woman to pose naked for the camera. It feels a bit like a frat dare of epic proportions, and I couldn't help wanting the woman to say "No way!"

But even dressed up in TV sham and tinsel, the show has a little nut of true feeling at its core. When Layla, the subject of the first show, talks about how her mother put her on a diet for the first time at age 12, she wipes away tears—who can't relate to that? When she's asked to place herself in a lineup of women in their underwear, arranged by hip size, she vastly overrates the size of her own hips--and who can't relate to that? It's a clever way to illustrate the concept of how differently we look to others and to ourselves. Mostly, the pleasure that shines on her face when she looks at herself in the mirror at the end of the show, coiffed, well-dressed, and most important closer to accepting her body and herself--that's a genuine moment, no matter how fake the trappings.

Of course, the rest of us have to get there without the help of Carson Kressley or thousand-dollar outfits or highlights. We have to look in the mirror and find a way to say, "I'm beautiful just the way I am." Maybe this show will inspire us to at least give it a try.

I'm going upstairs to do that right now.

New Year's greetings, of sorts

My daughter sent me this piece, which ran in our local paper on New Year's Day, along with an email asking, "Isn't this appalling?"

Tha's my 12-year-old daughter, who apparently understands more about the world than the fancy-schmancy newspaper editors around here.

Yeah.

Of course, what do you expect from a column called "The Skinny"?

Please read this first-hand account

sent to me by a mom, describing her daughter's recent experiences in an upscale residential facility for eating disorders:

". . . If my daughter cries in the facility, she is restrained in a punishment chair. If a girl regurgitates food at the table, she has to eat it again. The nurses tell my daughter to try to swallow her vomit at the table so she won't get the punishment chair. Over the past four days, my daughter's typical meal has consisted of two veggie burgers on buttered rolls, three cups (!!!) of canned vegetables, two cups of milk, two bananas, six TBS of peanut butter, and a granola bar, all of which must be consumed within 20 minutes. All food is served stone cold because the pediatric unit has no kitchen. We are allowed one visit per day, during which she cries to come home. . . ."

This is why I'm such a strong believer in family-based treatment (the Maudsley approach). Those of us who have been through the nightmare of anorexia know that you have to be tougher than the eating disorder to help your child survive. You have to allow no loopholes for the disease to continue its insidious mind-twisting.

But you do not have to punish the child. Someone with anorexia is already suffering torments beyond what we can truly imagine. The very concept of a punishment chair makes me feel ill. Eating stone-cold food? Being punished for crying? Who wouldn't cry, trapped in the hell of anorexia? Serving massive amounts of fruits and vegetables during re-feeding? You need the smallest volume possible of food during re-feeding, partly because the digestive system can't handle so much volume and partly because fat is a crucial part of the recovery process. Quality, not just quantity, is important, and the brain and body need fats and protein to begin to heal.

Imagine being ill with cancer and being punished for throwing up after each round of chemotherapy.

Treatment for an eating disorder should never look like medieval torture. There are other ways and options. Even in cases where a child requires an NG tube, treatment can be done with love and kindness and not punitively.

Resolve

Fillyjonk over at Shapely Prose has a great post on New Year's resolutions. Check it out.

This year, I resolve to:

Make progress toward learning to love my body the way it is, not the way I wish it were.

Finish my second anthology.

Sell the guitar I bought last year, and which I've played twice. Take voice lessons instead.

Do something surprising every day. OK, every week.

How about you?

The portable Love-Your-Body Pledge

Thanks to my pal Mary Ketarkus Brown for making the I Love My Body! pledge pretty and portable. Use it as a bookmark, tape it to the inside of your cabinet door or mirror, hand it out on street corners. Say it out loud to yourself once a day. Try to mean it.

Then spread the word.

In loco parentis

Colleges should stand in loco parentis to their students, but when it comes to eating disorders and psychiatric illnesses, they rarely do.

So three cheers for this Cornell University custodian, who went above and beyond the call of duty to get help when she suspected that a student had bulimia.

We've got a long way to go, though. What if the student had refused treatment? Would the college call her parents? Probably not in this current privacy-oriented climate.

Well, it's a start.

Unspeakable

is what this is. Truly. I cannot speak of it. Children being harmed, mutilated, possibly killed, all because they're considered overweight. As one of the so-called surgeons involved says, “I am very pleased that youngsters will soon be offered gastric banding. Of course this will only be in extreme cases when everything has been tried and the child just cannot lose weight...."

And why exactly does a child need to lose weight so badly that s/he must be mutilated? Where does the urgency come from, the pressing need? And just how in the world can a child give informed consent for such an operation?

I don't know which is more sickening, the fat hatred that inspires such vile acts or the profit motive that no doubt encourages these surgeries. Or the thought that someday parents who refuse such surgeries on behalf of their children may be censured or have their children removed from their care.

Where are the yellow stars?

I'm going to throw up now.


Thanks to Sandy Szwarc for posting on this. I think. I'll be having nightmares. . . .

Meaning and metaphor

Laura Collins over at Eating With Your Anorexic posted an interesting entry today, on a topic that's close to both my heart and my obsessions. Writing about our tendency to ascribe meaning to experience after the fact, she points out some of the "meanings" that have been ascribed to eating disorders over the centuries, from piety to family pathology to cultural norms around thinness. Her point is that eating disorders neither represent nor are caused by any of these hindsight insights, and simply are biological diseases.

It's a point I can agree with. Only I find that I keep wanting to add, "But there's more!"

As a poet and a journalist, I know both sides of the dichotomy. I've written here about growing up with panic disorder, and have alluded to the levels of meaning I assigned to my anxiety over the years. I've been through more than my share of therapy for anxiety, and have often gained insight from dreams, journaling, and exploring the metaphors and allusions that come with this disorder. Writing for me became a redemptive act very early on. Even in my teens I was aware that I wanted to make meaning out of suffering. If an important poem grew out of many nights of insomnia and philosophy, existential terror and affliction, well, maybe it was all worth it. And if not, I'd still created something beautiful—or at least meaningful—out of my pain. I'd made something out of, well, not nothing, but nothing useful.

The journalist part of me understands the concepts of neurotransmitters, genetics, and brain chemistry. I've had ample evidence of my panic disorder as a biological disease, often triggered by hormonal shifts and other physiological upheavals.

But. Still. I don't think that makes the poems, the metaphors, or the insights less important or meaningful. In fact they are deeply meaningful to me and, I hope, to others.

But. Still. Years of insight-based therapy have not changed the panic attacks or anxiety in any appreciable way.

So what does it all mean? Is retrospective insight always a chimera? Should we discount it altogether and stick to the facts, ma'am, just the facts?

I think when it comes to treatments for eating disorders and other psychiatric illnesses, the answer is yes. If I dream, as I once did, that my grandmother is trying to pierce my ears with a blunt knitting needle, and causing a lot of pain in the process, I don't believe this is a clue to the roots of my panic attacks.

But I'd hate to give up the relentless and quintessentially human quest for meaning and metaphor. That's the fertile terrain of all art and much spiritual and emotional growth.

All of which is a very long-winded way to say that I think what's needed here is a separation of church and state. When it comes to causes and treatments of eating disorders and other illnesses, I'm with the scientists; give me DNA and anatomy and chemistry. But when it comes to being alive and human, I need meaning and mystery and the indirect but often achingly apt language of symbol and metaphor. We need it.

And another Leaden Fork award goes to

all the folks involved with this incredibly tasteless book.


How to Get Fat is one of a series of so-called "self hurt" books. We know they're supposed to be funny because of the Dick-and-Jane-style illustrations. Other titles in the series include How to Get Into Debt, How to Drive Like a Maniac, and How to Traumatize Your Children. Now there's a knee-slapper. They're all published by an outfit called Knock Knock, which describes itself this way:

We are Knock Knock, a semi-spanking-new design company with aspirations to greatness. We concoct, manufacture, and distribute witty objects of cosmopolitan panache. . . . Our customers comprise the impish, the dapper, the droll, the young-at-heart—those who feel misunderstood by Santa-inflected wrapping paper and maudlin gilded greeting-card sentiments that rhyme. . . . Knock Knock seeks to integrate art and commerce—creating original, authentic, noncynical products that support themselves in the marketplace so that we don’t have to deal with “clients.”. . . Rather than a product category, material, or target market, Knock Knock’s unifying force is a sensibility. Also, we read a lot.

I'm all for poking fun at ourselves, but this one just doesn't seem funny. The humor here derives from the usual assumption that being thin is a choice and that any idiot would certainly choose it. It's really nothing more than a po-mo diet book.

Should you feel like weighing in on this book, you can contact the publisher at info@knockknock.biz or call (800) 656-5662.

Passing the Roar

A couple of days ago, writer/blogger Lisa Romeo gave me a "roar" (thanks, Lisa!) with a directive to do two things: list three things I think are crucial to powerful writing, and "roar" at a few of my favorite and fearless writers.

My three requirements for powerful writing:
Move the story forward. Good writing, like life, doesn't stay still. It's gotta move. Don't linger. Keep going.

Less is more. I'm a poet, so I learned early on that shorter is almost always better--punchier, sharper, more vivid. Compress, compress, compress.

Sound and fury. Powerful writing lives in the ear as well as on the page. Read it out loud to yourself. The sound of the words carries part of the meaning and effect.

Now, on to the roaring part. I'm going to tag a few bloggers, since this is, after all, a blog.

Kate Harding. Kate's blog, Shapely Prose, wins the I-wish-I'd-written-that award. Kate's prose is lucid, compelling, and as much fun to read as it is to write. She's a fat activist, feminista, and all-around fascinating writer. Fearless? Ya mon. Go read her. You won't be sorry.

Sandy Szwarc. Sandy's blog, Junkfood Science, takes on all manner of sacred cows, from Big Pharma to Big Science and more. If you've ever read a news article that scared you--"Obesity is contagious," for instance--check it out on Sandy's site. She's blown open a lot of b.s.

Rachel over at The F Word. It's the internet age, so I don't even know Rachel's last name. But I do know that her trifecta of obsessions--food, fat, and feminism--makes for some powerful writing. We don't always agree, but I'm always interested in what Rachel has to say.

Laura Collins. The author of Eating With your Anorexic is one of the feistiest writers/activists I know. Her book, and her online parent forum, have saved many lives. She's not afraid to take on the powers that be.

Caroline Leavitt. One of the best essayists I know. And I'm not just saying that because she's got pieces in both my first and second anthologies, either. Caroline has a gift for writing personal narratives that hit home for others.

I could probably keep going. Maybe I'll do installment 2 tomorrow.

Keep Santa fat and feed the hungry

I have a feeling I've come to this story late here in the fatosphere . . . but no matter. Better late than never. Thanks to littlem for sending me the link to this awesome site.

Sign the petition there to Keep Santa Fat, and the keepers of the site will donate a pound of food to America's Second Harvest.

While you're at it, make your own donation. I hate to think of anyone going hungry, at this time of year or any other.

Et tu, Santa?

I don't know about you, but I'd like to take this guy's red suit away.

He's a Scottish dime store Santa who refuses to pad his middle with a pillow because he thinks it makes children think it's OK to be overweight.

No, indeed. We wouldn't want the little children to grow up loving their bodies or anything.

I say we vote him off the island.

Against blogging

I've often wondered if blogging gets in the way of my writing, if the sometimes obsessive world of the internet mucks up the quiet place I require to be creative in. So I was very interested to read Doris Lessing's Nobel Prize acceptance speech, which got very little play here in the U.S. Lessing has always been one of my favorite writers, and this speech--like so many of the Nobel acceptance speeches--gives real food for thought.

What do you think?


A hunger for books
Doris Lessing


I am standing in a doorway looking through clouds of blowing dust to where I am told there is still uncut forest. Yesterday I drove through miles of stumps, and charred remains of fires where, in 1956, there was the most wonderful forest I have ever seen, all now destroyed. People have to eat. They have to get fuel for fires.

This is north-west Zimbabwe early in the 80s, and I am visiting a friend who was a teacher in a school in London. He is here "to help Africa", as we put it. He is a gently idealistic soul and what he found in this school shocked him into a depression, from which it was hard to recover. This school is like every other built after Independence. It consists of four large brick rooms side by side, put straight into the dust, one two three four, with a half room at one end, which is the library. In these classrooms are blackboards, but my friend keeps the chalks in his pocket, as otherwise they would be stolen. There is no atlas or globe in the school, no textbooks, no exercise books or Biros. In the library there are no books of the kind the pupils would like to read, but only tomes from American universities, hard even to lift, rejects from white libraries, detective stories, or titles like Weekend in Paris and Felicity Finds Love.

There is a goat trying to find sustenance in some aged grass. The headmaster has embezzled the school funds and is suspended. My friend doesn't have any money because everyone, pupils and teachers, borrow from him when he is paid and will probably never pay it back. The pupils range from six to 26, because some who did not get schooling as children are here to make it up. Some pupils walk many miles every morning, rain or shine and across rivers. They cannot do homework because there is no electricity in the villages, and you can't study easily by the light of a burning log. The girls have to fetch water and cook before they set off for school and when they get back.

As I sit with my friend in his room, people shyly drop in, and everyone begs for books. "Please send us books when you get back to London," one man says. "They taught us to read but we have no books." Everybody I met, everyone, begged for books.

I was there some days. The dust blew. The pumps had broken and the women were having to fetch water from the river. Another idealistic teacher from England was rather ill after seeing what this "school" was like.

On the last day they slaughtered the goat. They cut it into bits and cooked it in a great tin. This was the much anticipated end-of-term feast: boiled goat and porridge. I drove away while it was still going on, back through the charred remains and stumps of the forest.

I do not think many of the pupils of this school will get prizes.

The next day I am to give a talk at a school in North London, a very good school. It is a school for boys, with beautiful buildings and gardens. The children here have a visit from some well-known person every week: these may be fathers, relatives, even mothers of the pupils; a visit from a celebrity is not unusual for them.

As I talk to them, the school in the blowing dust of north-west Zimbabwe is in my mind, and I look at the mildly expectant English faces in front of me and try to tell them about what I have seen in the last week. Classrooms without books, without textbooks, or an atlas, or even a map pinned to a wall. A school where the teachers beg to be sent books to tell them how to teach, they being only 18 or 19 themselves. I tell these English boys how everybody begs for books: "Please send us books." But there are no images in their minds to match what I am telling them: of a school standing in dust clouds, where water is short, and where the end-of-term treat is a just-killed goat cooked in a great pot.

Is it really so impossible for these privileged students to imagine such bare poverty?

I do my best. They are polite.

I'm sure that some of them will one day win prizes.

Then the talk is over. Afterwards I ask the teachers how the library is, and if the pupils read. In this privileged school, I hear what I always hear when I go to such schools and even universities. "You know how it is," one of the teachers says. "A lot of the boys have never read at all, and the library is only half used."

Yes, indeed we do know how it is. All of us.

We are in a fragmenting culture, where our certainties of even a few decades ago are questioned and where it is common for young men and women, who have had years of education, to know nothing of the world, to have read nothing, knowing only some speciality or other, for instance, computers.

What has happened to us is an amazing invention - computers and the internet and TV. It is a revolution. This is not the first revolution the human race has dealt with. The printing revolution, which did not take place in a matter of a few decades, but took much longer, transformed our minds and ways of thinking. A foolhardy lot, we accepted it all, as we always do, never asked: "What is going to happen to us now, with this invention of print?" In the same way, we never thought to ask, "How will our lives, our way of thinking, be changed by the internet, which has seduced a whole generation with its inanities so that even quite reasonable people will confess that, once they are hooked, it is hard to cut free, and they may find a whole day has passed in blogging etc?"

Very recently, anyone even mildly educated would respect learning, education and our great store of literature. Of course we all know that when this happy state was with us, people would pretend to read, would pretend respect for learning. But it is on record that working men and women longed for books, evidenced by the founding of working-men's libraries, institutes, and the colleges of the 18th and 19th centuries. Reading, books, used to be part of a general education. Older people, talking to young ones, must understand just how much of an education reading was, because the young ones know so much less.

We all know this sad story. But we do not know the end of it. We think of the old adage, "Reading maketh a full man" - reading makes a woman and a man full of information, of history, of all kinds of knowledge.

Not long ago, a friend in Zimbabwe told me about a village where the people had not eaten for three days, but they were still talking about books and how to get them, about education.

I belong to an organisation which started out with the intention of getting books into the villages. There was a group of people who in another connection had travelled Zimbabwe at its grassroots. They told me that the villages, unlike what is reported, are full of intelligent people, teachers retired, teachers on leave, children on holidays, old people. I myself paid for a little survey to discover what people in Zimbabwe wanted to read, and found the results were the same as those of a Swedish survey I had not known about. People want to read the same kind of books that people in Europe want to read - novels of all kinds, science fiction, poetry, detective stories, plays, and do-it-yourself books, like how to open a bank account. All of Shakespeare too. A problem with finding books for villagers is that they don't know what is available, so a set book, like The Mayor of Casterbridge, becomes popular simply because it just happens to be there. Animal Farm, for obvious reasons, is the most popular of all novels.

Our organisation was helped from the very start by Norway, and then by Sweden. Without this kind of support our supplies of books would have dried up. We got books from wherever we could. Remember, a good paperback from England costs a month's wages in Zimbabwe: that was before Mugabe's reign of terror. Now, with inflation, it would cost several years' wages. But having taken a box of books out to a village - and remember there is a terrible shortage of petrol - I can tell you that the box was greeted with tears. The library may be a plank on bricks under a tree. And within a week there will be literacy classes - people who can read teaching those who can't, citizenship classes - and in one remote village, since there were no novels written in the Tonga language, a couple of lads sat down to write novels in Tonga. There are six or so main languages in Zimbabwe and there are novels in all of them: violent, incestuous, full of crime and murder.

It is said that a people gets the government it deserves, but I do not think it is true of Zimbabwe. And we must remember that this respect and hunger for books comes, not from Mugabe's regime, but from the one before it, the whites. It is an astonishing phenomenon, this hunger for books, and it can be seen everywhere from Kenya down to the Cape of Good Hope.

This links up improbably with a fact: I was brought up in what was virtually a mud hut, thatched. This kind of house has been built always, everywhere where there are reeds or grass, suitable mud, poles for walls - Saxon England, for example. The one I was brought up in had four rooms, one beside another, and it was full of books. Not only did my parents take books from England to Africa, but my mother ordered books by post from England for her children. Books arrived in great brown paper parcels, and they were the joy of my young life. A mud hut, but full of books.

Even today I get letters from people living in a village that might not have electricity or running water, just like our family in our elongated mud hut. "I shall be a writer too," they say, "because I've the same kind of house you were in."

But here is the difficulty. Writing, writers, do not come out of houses without books.

I have been looking at the speeches by some of the recent Nobel prizewinners. Take last year's winner, the magnificent Orhan Pamuk. He said his father had 500 books. His talent did not come out of the air, he was connected with the great tradition. Take VS Naipaul. He mentions that the Indian Vedas were close behind the memory of his family. His father encouraged him to write, and when he got to England he would visit the British Library. So he was close to the great tradition. Let us take John Coetzee. He was not only close to the great tradition, he was the tradition: he taught literature in Cape Town. And how sorry I am that I was never in one of his classes; taught by that wonderfully brave, bold mind. In order to write, in order to make literature, there must be a close connection with libraries, books, the tradition.

I have a friend from Zimbabwe, a black writer. He taught himself to read from the labels on jam jars, the labels on preserved fruit cans. He was brought up in an area I have driven through, an area for rural blacks. The earth is grit and gravel, there are low sparse bushes. The huts are poor, nothing like the well-cared-for huts of the better off. There was a school, but like the one I have described. He found a discarded children's encyclopaedia on a rubbish heap and taught himself from that.

On Independence in 1980 there was a group of good writers in Zimbabwe, truly a nest of singing birds. They were bred in old Southern Rhodesia, under the whites - the mission schools, the better schools. Writers are not made in Zimbabwe, not easily, not under Mugabe.

All the writers travelled a difficult road to literacy, let alone to becoming writers. I would say learning to read from the printed labels on jam jars and discarded encyclopaedias was not uncommon. And we are talking about people hungering for standards of education beyond them, living in huts with many children - an overworked mother, a fight for food and clothing.

Yet despite these difficulties, writers came into being. And we should also remember that this was Zimbabwe, conquered less than 100 years before. The grandparents of these people might have been storytellers working in the oral tradition. In one or two generations, the transition was made from these stories remembered and passed on, to print, to books.

Books were literally wrested from rubbish heaps and the detritus of the white man's world. But a sheaf of paper is one thing, a published book quite another. I have had several accounts sent to me of the publishing scene in Africa. Even in more privileged places like North Africa, to talk of a publishing scene is a dream of possibilities.

Here I am talking about books never written, writers who could not make it because the publishers are not there. Voices unheard. It is not possible to estimate this great waste of talent, of potential. But even before that stage of a book's creation which demands a publisher, an advance, encouragement, there is something else lacking.

Writers are often asked: "How do you write? With a word processor? an electric typewriter? a quill? longhand?" But the essential question is: "Have you found a space, that empty space, which should surround you when you write? Into that space, which is like a form of listening, of attention, will come the words, the words your characters will speak, ideas - inspiration." If a writer cannot find this space, then poems and stories may be stillborn. When writers talk to each other, what they discuss is always to do with this imaginative space, this other time. "Have you found it? Are you holding it fast?"

Let us now jump to an apparently very different scene. We are in London, one of the big cities. There is a new writer. We cynically enquire: "Is she good-looking?" If this is a man: "Charismatic? Handsome?" We joke, but it is not a joke.

This new find is acclaimed, possibly given a lot of money. The buzzing of hype begins in their poor ears. They are feted, lauded, whisked about the world. Us old ones, who have seen it all, are sorry for this neophyte, who has no idea of what is really happening. He, she, is flattered, pleased. But ask in a year's time what he or she is thinking: "This is the worst thing that could have happened to me."

Some much-publicised new writers haven't written again, or haven't written what they wanted to, meant to. And we, the old ones, want to whisper into those innocent ears: "Have you still got your space? Your soul, your own and necessary place where your own voices may speak to you, you alone, where you may dream. Oh, hold on to it, don't let it go."

My mind is full of splendid memories of Africa that I can revive and look at whenever I want. How about those sunsets, gold and purple and orange, spreading across the sky at evening? How about butterflies and moths and bees on the aromatic bushes of the Kalahari? Or, sitting on the pale grassy banks of the Zambesi, the water dark and glossy, with all the birds of Africa darting about? Yes, elephants, giraffes, lions and the rest, there were plenty of those, but how about the sky at night, still unpolluted, black and wonderful, full of restless stars?

There are other memories too. A young African man, 18 perhaps, in tears, standing in what he hopes will be his "library". A visiting American, seeing that his library had no books, had sent a crate of them. The young man had taken each one out, reverently, and wrapped them in plastic. "But," we say, "these books were sent to be read, surely?" "No," he replies, "they will get dirty, and where will I get any more?"

I have seen a teacher in a school where there were no textbooks, not even a chalk for the blackboard. He taught his class of six- to 18-year-olds by moving stones in the dust, chanting: "Two times two is ... " and so on. I have seen a girl - perhaps not more than 20, also lacking textbooks, exercise books, biros - teach the ABC by scratching the letters in the dirt with a stick, while the sun beat down and the dust swirled.

I would like you to imagine yourselves somewhere in Southern Africa, standing in an Indian store, in a poor area, in a time of bad drought. There is a line of people, mostly women, with every kind of container for water. This store gets a bowser of precious water every afternoon from the town, and here the people wait.

The Indian is standing with the heels of his hands pressed down on the counter, and he is watching a black woman, who is bending over a wadge of paper that looks as if it has been torn out of a book. She is reading Anna Karenina. She is reading slowly, mouthing the words. It looks a difficult book. This is a young woman with two little children clutching at her legs. She is pregnant. The Indian is distressed, because the young woman's headscarf, which should be white, is yellow with dust. Dust lies between her breasts and on her arms. This man is distressed because of the lines of people, all thirsty, but he doesn't have enough water for them. He is angry because he knows there are people dying out there, beyond the dust clouds.

This man is curious. He says to the young woman: "What are you reading?"

"It is about Russia," says the girl.

"Do you know where Russia is?" He hardly knows himself.

The young woman looks straight at him, full of dignity, though her eyes are red from dust. "I was best in the class. My teacher said I was best."

The young woman resumes her reading: she wants to get to the end of the paragraph.

The Indian looks at the two little children and reaches for some Fanta, but the mother says: "Fanta makes them thirsty."

The Indian knows he shouldn't do this, but he reaches down to a great plastic container beside him, behind the counter, and pours out two plastic mugs of water, which he hands to the children. He watches while the girl looks at her children drinking, her mouth moving. He gives her a mug of water. It hurts him to see her drinking it, so painfully thirsty is she.

Now she hands over to him a plastic water container, which he fills. The young woman and the children watch him closely so that he doesn't spill any.

She is bending again over the book. She reads slowly but the paragraph fascinates her and she reads it again.

"Varenka, with her white kerchief over her black hair, surrounded by the children and gaily and good-humouredly busy with them, and at the same time visibly excited at the possibility of an offer of marriage from a man she cared for, Varenka looked very attractive. Koznyshev walked by her side and kept casting admiring glances at her. Looking at her, he recalled all the delightful things he had heard from her lips, all the good he knew about her, and became more and more conscious that the feeling he had for her was something rare, something he had felt but once before, long, long ago, in his early youth. The joy of being near her increased step by step, and at last reached such a point that, as he put a huge birch mushroom with a slender stalk and up-curling top into her basket, he looked into her eyes and, noting the flush of glad and frightened agitation that suffused her face, he was confused himself, and in silence gave her a smile that said too much."

This lump of print is lying on the counter, together with some old copies of magazines, some pages of newspapers, girls in bikinis.

It is time for her to leave the haven of the Indian store, and set off back along the four miles to her village. Outside, the lines of waiting women clamour and complain. But still the Indian lingers. He knows what it will cost this girl, going back home with the two clinging children. He would give her the piece of prose that so fascinates her, but he cannot really believe this splinter of a girl with her great belly can really understand it.

Why is perhaps a third of Anna Karenina stuck here on this counter in a remote Indian store? It is like this.

A certain high official, United Nations, as it happens, bought a copy of this novel in the bookshop when he set out on his journeys to cross several oceans and seas. On the plane, settled in his business-class seat, he tore the book into three parts. He looked around at his fellow passengers as he did this, knowing he would see looks of shock, curiosity, but some of amusement. When he was settled, his seatbelt tight, he said aloud to whomever could hear: "I always do this when I've a long trip. You don't want to have to hold up some heavy great book." The novel was a paperback, but, true, it is a long book. This man was used to people listening when he spoke. When people looked his way, curiously or not, he confided in them. "No, it is really the only way to travel."

When he reached the end of a section of the book, he called the airhostess, and sent it back to his secretary, who was travelling in the cheaper seats. This caused much interest, condemnation, certainly curiosity, every time a section of the great Russian novel arrived, mutilated, but readable, in the back part of the plane.

Meanwhile, down in the Indian store, the young woman is holding on to the counter, her little children clinging to her skirts. She wears jeans, since she is a modern woman, but over them she has put on the heavy woollen skirt, part of traditional garb of her people: her children can easily cling on to it, the thick folds.

She sends a thankful look at the Indian, who she knows likes her and is sorry for her, and she steps out into the blowing clouds. The children have gone past crying, and their throats are full of dust anyway.

This is hard, oh yes, it is hard, this stepping, one foot after another, through the dust that lays in soft deceiving mounds under her feet. Hard, hard - but she is used to hardship, is she not? Her mind is on the story she has been reading. She is thinking: "She is just like me, in her white headscarf, and she is looking after children, too. I could be her, that Russian girl. And the man there, he loves her and will ask her to marry him. (She has not finished more than that one paragraph). Yes, and a man will come for me, and take me away from all this, take me and the children, yes, he will love me and look after me."

She thinks. My teacher said there was a library there, bigger than the supermarket, a big building, and it is full of books. The young woman is smiling as she moves on, the dust blowing in her face. I am clever, she thinks. Teacher said I am clever. The cleverest in the school. My children will be clever, like me. I will take them to the library, the place full of books, and they will go to school, and they will be teachers - my teacher told me I could be a teacher. They will live far from here, earning money. They will live near the big library and enjoy a good life.

You may ask how that piece of the Russian novel ever ended up on that counter in the Indian store?

It would make a pretty story. Perhaps someone will tell it.

On goes that poor girl, held upright by thoughts of the water she would give her children once home, and drink a little herself. On she goes, through the dreaded dusts of an African drought.

We are a jaded lot, we in our world - our threatened world. We are good for irony and even cynicism. Some words and ideas we hardly use, so worn out have they become. But we may want to restore some words that have lost their potency.

We have a treasure-house of literature, going back to the Egyptians, the Greeks, the Romans. It is all there, this wealth of literature, to be discovered again and again by whoever is lucky enough to come up on it. Suppose it did not exist. How impoverished, how empty we would be.

We have a bequest of stories, tales from the old storytellers, some of whose names we know, but some not. The storytellers go back and back, to a clearing in the forest where a great fire burns, and the old shamans dance and sing, for our heritage of stories began in fire, magic, the spirit world. And that is where it is held, today.

Ask any modern storyteller and they will say there is always a moment when they are touched with fire, with what we like to call inspiration, and this goes back and back to the beginning of our race, to fire and ice and the great winds that shaped us and our world.

The storyteller is deep inside everyone of us. The story-maker is always with us. Let us suppose our world is attacked by war, by the horrors that we all of us easily imagine. Let us suppose floods wash through our cities, the seas rise . . . but the storyteller will be there, for it is our imaginations which shape us, keep us, create us - for good and for ill. It is our stories that will recreate us, when we are torn, hurt, even destroyed. It is the storyteller, the dream-maker, the myth-maker, that is our phoenix, that represents us at our best, and at our most creative.

That poor girl trudging through the dust, dreaming of an education for her children, do we think that we are better than she is - we, stuffed full of food, our cupboards full of clothes, stifling in our superfluities?

I think it is that girl and the women who were talking about books and an education when they had not eaten for three days, that may yet define us.