“These days of keeping Kitty close represent an oddly peaceful interlude in the surreal world we now inhabit, Jamie and Emma and I and this new Kitty, with her pointed chin and enormous eyes and will of iron. I try to remember my daughter as she was just a few months before, dancing through the house, laughing and affectionate, talking on the phone or going out with friends. Already this new Kitty, gaunt and tense and slow-moving, seems normal. Human beings can adapt to anything, from infinite riches to the horrors of Auschwitz. I don’t want to adapt to the way things are now. I want to scream, howl, tear the hear from my head in mourning and rage at what’s happening to my daughter. I can hardly muster the energy to cry.”
Brave Girl Eating is Harriet Brown’s memoir of the year her family spent battling the demon that came to live in their house, the demon that attempted to kill their daughter ‘Kitty’, in the form of anorexia. When Harriet and her husband, Jamie, first began to worry about Kitty’s health, they hoped that her weight loss and obsession with food were somewhat normal teenage girl behaviors. All too soon, it became clear that there was something seriously wrong, that they needed to find a way to help their daughter.
Traditional treatment for anorexia is to treat the underlying causes first, the family dysfunctions, the girl’s (and increasingly, boy’s) psychological issues and fears with growing up, anxieties and perfectionist tendencies. Traditional treatment says that food is not the issue, control is the issue, and you only make things worse by trying to make your child eat. Harriet and Jamie started out following this traditional method, though it went against everything that felt right to them. They separated themselves from the recovery process, tried to allow her to cope with her issues and fears on her own. All the while, watching as she became worse and worse. And the more and more that Harriet read about the disease, the more she felt that her family was not represented in the typical psychological descriptions. Yes, they were a family in crisis. But because of the disease, not before it came and invaded their household. She was not hyper-controlling, her husband was not distant or critical. They were a close and loving family, supportive of Kitty and her younger sister, Emma. They started on this path, but felt increasingly helpless and frustrated, as they watched their outgoing, loving daughter withdraw into herself, ignore her friends, and appear to divorce herself from life. Kitty became obsessed with food, with cooking, with what was going to be served for dinner. But while she was interested, she would not eat. She continued to lose weight.
Then Harriet read a book, Eating with Your Anorexic, and she felt as though they had been thrown a lifeline. The book described the Maudsley Method of treatment, otherwise known as Family Based Therapy. The idea is that your child cannot think rationally about this issue until their bodies are pulled away from the brink of starvation. So you become agnostic about the cause of the problem, at least at first, and you feed your child. Easier said than done, and yet Harriet and Jamie found that if they stood up to the disease and fought with it, rather than pleading with her and trying not to make ‘food the issue’, their daughter was thankful for their help, and surprisingly, complied with their demands that she eat. Slowly, she recovered. They saw their pediatrician weekly, measuring her heart rate to make sure that she wasn’t in danger of having a heart attack. In fact, she was hospitalized once or twice with dangerously low heart rate, which can lead to a fatal heart attack. 20% of anorexics die. It is the most dangerous mental illness, killing far more children that bi-polar disorder, depression, or schizophrenia. 10% die from malnutrition, heart attacks, etc. Another 10% die from suicide, as the demon inside of them convinces them that they are weak, stupid, evil people for succumbing to their hunger and eating a few grapes, an apple. As time went by, they had to feed Kitty more and more calories. The starving body is a body with a metabolism completely out of whack, and when it first gets access to food, it puts it all towards restoring the reserves and internal organs that have been shrunken. Including the heart. The brain. So they were feeding her 3,000 calories a day, and she wasn’t exercising, and still, no weight gain. Very frustrating, very scary for them all.
But over time, they began to see their daughter come back from the edge. They had many awful fights with that demon, the ‘un-Kitty’ as they called it, who would look at them with her eyes, speak to them with her voice, and say cruel and painful things, anything, in an attempt to trick them into not forcing her to eat. Because as Kitty grew stronger, the demon grew weaker and weaker, and Kitty became more outgoing and fun loving, affectionate and laughing again. They had their daughter back.
Harriet tried her hardest to try to figure out what had brought this on, what could take her healthy daughter and bring her to the brink of death so quickly. Her search was ultimately unsatisfying, as there are many, many theories, and no real solutions. Her best guess seems to be that some people are susceptible to eating disorders, due to brain chemistry or heredity or both. And if you take those people, and present them with a ‘perfect storm’ of a society obsessed with thinness, calorie consumption, doctors who would be happier to see a patient 5 lbs underweight than to see one 5 lbs overweight, when the greatest fear anyone can think of is the ‘obesity epidemic’ and the coming onslaught of type 2 diabetes, then someone who is already susceptible might trigger themselves by something as simple as going on a diet, trying to lose 5 or 10 lbs, something most of us can do with no real problem (other than the frustration of losing 5, gaining 10). Someone this susceptible cannot lose weight without their brain chemistry, their metabolism, whatever, is triggered, and they find themselves on a hellish journey that only the very strong and brave can overcome. Kitty is indeed a brave girl, and with the support of her family, she fought the demon until it subsided. Though perhaps it still cowers in the corners of her brain, waiting for another opportunity to strike out.
I heard Dr. Brown (I’ve been calling her Harriet to personalize her, but she’s a professor of Journalism in New York) speak about her book, and the family’s battle with anorexia, on To The Best of our Knowledge, which is how I came to be familiar with the book. (You can listen to the podcast by following the link. There’s also a wonderful discussion of the joys of international adoption, which my friend Tracy might enjoy) It struck me that so much of the Maudlsey method of therapy is based on, or at least influenced by, the Minnesota Starvation Study, which my mom wrote about here and here. Her last two blog posts before she went into the hospital with her heart attack.
I would recommend this book to anyone interested in the physiology of metabolism, anyone who knows someone who might be going through a struggle with this horrific and ever more common disease. Dispel yourself of the outdated and somewhat cruel idea that anyone would choose anorexia. As Harriet Brown says, you don’t choose anorexia. It chooses you.