IN AN AGE when most Americans struggle with overweight, it is hard to understand the epidemic of young women or men who are anorectic, as I was -- underweight by a choice that involved literally starving myself nearly to death.
Many people assume that anoerectics are all adolescents, and that somehow anorexia is connected with rebellion. People also assume that the anorectic just doesn't like to eat, doesn't eat much of the time, prefers diet or vegetarian foods such as cottage cheese or yogurt. Many also assume that the weight just falls off.
Any of these assumptions may be true of a particular sufferer, or none of them. One thing is certain, as I can attest: the weight is never lost without a lot of suffering.
Many anorectics love food and eating, and are as obsessed -- or even more obsessed -- with food than an obese person. Many binge and gain weight, which may or may not be lost. As a former anorectic, I am aware of the constant obsession with food, yet I was unable to let myself eat when I was starving. People around me -- my husband, relatives, friends -- watched me struggle through the problem, and were unable to understand my need to stay so thin.
Most people focus on the thinness itself, and not on the often-complex emotional problems masked by the disease. In the following "conversation" between the anorectic with the crazy habits that I used to be, and the friend -- the person I am striving to be now -- I try to explain what being anorectic is really like, and what the actual process of starving does to the body.
Friend: I just don't understand what this fear of gaining weight is all about. I mean, you've almost always been thin. And I've known you for 10 years now. What would be so tragic if you gained weight?
Anorectic: Well, there are real food fears, and there are fears that are more nebulous. When your weight drops really low, the body can't maintain its fluid and electrolytic balance, especially if you are not eating enough bulk, as few anorectics do. You may eat two or three cookies and find the next day you have gained a couple of pounds.
When I've been gaining weight I've panicked; I'm afraid that I'll never be able to stop gaining and will zoom up to 155 or 160 pounds.
You probably don't remember, but I've been that heavy. I'm afraid that I'll get stuck there and never be able to lose again.
On a more symbolic level, I think I was afraid that if I lost control over my weight, I would lose control over my other impulses. Impulsivity, in whatever form (drinking, gambling, suicidal impulses), is always bad.
Friend: You've always been an anxious, tense person. Come to think of it, you were a very tense cook, even though you are a gourmet cook. I remember all the wonderful meals at your house. How could you let those fears of food overwhelm you in your most enjoyable hobby? How do you get over them?
Anorectic: Well, for one thing, I found out that I didn't know anything about eating until I went to a nutritionist, who was recommended by the therapist I was seeing, who dealt in anorexia exclusively. She began to teach me how to eat, all over again, with all the basics. I get terrified when I go outside her guidelines. Yet I often crave to go outside those guidelines. I do go outside of them. Sometimes I gain a lot of weight, sometimes a little, sometimes none, if I have lamb instead of fish, or a taste of cheesecake. My body still isn't used to food and my metabolism is still low from years of binging and starving.
I didn't vomit. I could never get into that. But I would cook a wonderful gourmet meal and then, after I ate it, I wouldn't eat for three days.
Friend: Do you think you're learning?
Anorectic: It's very hard. When you're starving you think about what little bits of food you're going to let yourself eat all the time. Just like my sisters, thfe bulimics who go through repeated cycles of binge and vomit as many as five to 10 times a day, and the obese, I think about food all the time. I fill my empty time with thoughts of food and eating. I'm trying to learn to fill up my empty time with other thoughts, but it's really hard.
I used to have cravings for all those white fattening things like pasta, potatoes, rich cream sauces and whipped cream. A lot of people with eating disorders binge on junk. I don't eat junk. But I do crave exotic food, like Indonesian, Philippine, Chinese and, of course continental and nouvelle. If I want eggs benedict, I always have more of the eggs -- only the whites, the yolks are too high- calorie -- a tablespoon of hollandaise, no bacon and just half of the English muffin.
Friend: Are these fears the ones that got your started on all these weird little habits you have in regard to food?
Anorectic: Yes. I could tell you a million different things I do with food, still trying to protect myself. Even though I fail, I can't seem to stop these habits I've gotten started on.
I eat very, very slowly, and not because it's good for the body, but because I'm afraid of eating too much if I eat too fast. That's a leftover from when I was eating three 100-calorie meals a day. When I found out (via a basal metabolism test) that my metabolism would allow me to eat up to 1,000 calories per day, I was excited. After 300 a day, 1,000 seemed like a lot. Now 1,000 seems like very little.
I can have two cups of vegetables every day, so I concentrate on them. I have to have certain vegetables every week, so I tote them up every week: broccoli, cauliflower, spinach, artichokes, asparagus, beans and peas, all green. If one is missing at the end of the week, I panic. I like exotic vegetables, like arugula, escarole, endive, raddicchio; ocassionally I'll have eggplant or zucchini. I have to have mushrooms and tomatoes every day. If I have cheese with my vegetables, I can only have one ounce, so I save it for my last two bites.
All forbidden foods -- rich foods -- get left for the last two bites. My entire meal is divided into sections, so that each bite is "perfect" -- has a bite of every element of the dinner with it. For instance, one bite of broccoli, one taste of tomato, one bite of mushroom, etc., except for the last two bites, which, as I said, contain the rich foods.
Everything must be weighed and measured. For instance, bread is 80 calories an ounce, so that gets measured and toasted and put aside for the last two bites.
Friend: You let yourself have desserts?
Anorectic: I have to have my cake and ice cream. My nutritionist told me that cake has 30 calories per square inch. Angel food is best, because it has more protein and less fat than regular cake, since it's made of egg whites. I have low-calorie yogurt, or Weight Watchers ice cream. Or Tuscan yogurt.
I really have been obsessive about sweets. I used to have to have chocolate, cheese, nuts, bananas, red fruit, cake and ice cream every day for dessert. Very small amounts of each thing, so that it would fit into a tablespoon (except for the ice cream). I used to go to all these bakeries and buy slices of cake and throw it all away, except for the "best" square inch. Very wastful, I suppose, but I was crazy and had to have my cake.
I used to run all over New York, looking for the best gourmet carryouts, buying food, bringing it home, weighing and measuring it and throwing it away. I flushed it down the toilet, since I had no disposal. I couldn't trust myself to keep it around; I might go through the garbage and get it if I woke up in the middle of the night.
Friend: Isn't that more trouble than it's worth? Why don't you just gain some weight and then lose it later?
Anorectic: I'm afraid that I won't be able to cut back later in order to lose. I might get used to that amount of food and never be able to give it up. Also, the reality is that, from dieting too much, I've driven my metabolic rate down very low. If you drop your intakfe below 500 calories a day, the body, out of self-preservation, begins shutting down hormone systems so to be able to adapt to starvation-level food supply. You can't even think properly on less than 500 calories a day. The brain doesn't get enough food.
Friend: That's too much suffering for me. What's the point?
Anorectic: That'd a hard one. Filling the emptiness. I want to avoid filling up my emptiness with food. So I fill it with my pride in maintaining a too-thin body.
Friend: I've had a lot of moments of overeating to fill emptiness, but I never identified my "fat" self as my real identity. I mean, I've been overweight, so I understand filling up time with food, but I don't know that that's the same thing as having no identity.
Anorectic: I don't know. I had tried several careers, and they had all failed. And friends can't be with you all the time. Somehow thinness seems all you need. It's your selfhood. There comes a time when no feedback means anything like the feedback of the scale's dropping. It establishes you, even though you're never going to be a model or an actress. You become dedicated to a cause that seems sacred, in a perverted way. And of course, fear is still playing a part here. What will there be left if I give up my cause?
Friend: That's quite a cause! Does the dedication and fear keep you from remembering all that suffering from starvation?
Anorectic: I've heard many anorectics say that they don't remember it. But I remember very clearly how it felt to be starving to death. How weak I was, and faint, yet forcing myself to exercise. I remember being constantly nauseated and sick, my heart racing from all the caffeine I drank. I practically stopped sweating. Sometimes I just nodded off into a trance-like state. My vision was blurry and I couldn't concentrate to read.
I can remember waking up in the middle of the night, crying with hunger, yet I couldn't let myself eat because people don't eat in the middle of the night. I slept poorly. One time I woke up my husband at 2 a.m. begging him to take me out somewhere to eat. What place would be open at 2 a.m.? Finally I ate a soft- boiled egg, but found out that an egg doesn't satisfy hunger the way carbohydrates do.
Basically, at that point, all I could think about was my six bites of food, three times a day. I couldn't go back to that again.
Friend: Good! It sounds to me as though fear was one of your major problems -- fear of eating, fear of foods, fear of losing your identity. What's behind all the fears?
Anorectic: I don't know if the same things are true for all anorectics. But I know I was phobic about everything -- especially people. You know, you may be able to maintain control over yourself and your impulses, but you can't control other people. I was never even sure about myself because I often lost control over myself -- in the area of eating. When I did, I developed anxiety over losing impulse control in other areas of life -- like urges to binge on alcohol and suicidal urges. Anyway, the point is, even if I was unsure of myself, I surely was uneasy about other people.
Friend: Yes, but most people learn that they have no control over other things, especially other people. How could that fear become so important to you?
Anorectic: Yes, people may know that, but they really don't totally accept that. How often do you hear people gripe about the weather? How often do you see a driver griping about another driver? People get angry when they can't control other people or circumstances. An anorectic -- anyway, one like me -- just can't accept that she can't control other people, herself and circumstances.
Friend: What about the anger part of your hypothesis?
Anorectic: Just as a depressive can't accept that anger and turns it in on himself, an anorectic can't accept the anger and turns it in on herself. It's a symbol, just as all emotional illness is a metaphor.
Friend: Metaphor for fear and anger?
Anorectic: And helplessness! Everybody is helpless in some capacity, but some people feel it more than others. You know anorexia is also a metaphor for depression. Many anorectics become suicidally depressed when they gain weight because the metaphor of depression takes over.
Friend: Why the choice of anorexia as metaphor?
Anorectic: Why are alcoholics drawn to booze as a metaphor? Seriously, for everyone, I guess it's different. I guess I've always attached too much importance to food.
Friend: How would you feel if I started starving and playing with food?
Anorectic: I think I'd think you were crazy. I'd suggest that you get help. I mean, it's taken me two years, but the nutritionist I see has helped me. And, of course, so did my therapy at the Center for the Study of Anorexia and Bulimia in New York City. Everyone should know, as well, that not every therapist is equipped to deal with this problem. Only very specialized therapists and groups can handle the sensitive issues properly. It's a delicate line to follow. Obviously, the anorectic can't be allowed to starve, but she must be able to maintain her integrity over herself and her body.