September 18, 2006

On Anorexia

NOTE: I believe that I have true anorexia, which is defined as 'lack of appetite." It is "Anorexia nervosa," shortened in this posting to "anorexia," a psychiatric disorder, which is my subject tonight. I did suffer from anorexia (psychiatric) for 20 years in my very much younger years, so I know whereof I speak. Whether I "have it" now is something to be determined, though I frankly do not think so.

Many papers have been written and clinicians have discussed the illness called Anorexia nervosa over the years. My father, a physician himself, would sometimes see a young woman with anorexia in his practice of gastroenterology, and used to talk about anorexic young women as having “a love affair with the feeding tube.” In point of fact, all of those I met in the hospital the first time lived in stark horror of not gaining the required quarter of a pound a day and being tubefed as punishment. (And it was punishment, mark my words, there was no doubt in anyone’s mind on that unit but that tube feedings were intended as disciplinary measures). But “love affairs”-- that was how he and the shrinks talked of it, and thought worse, no doubt. Can you imagine what sort of mind sees these young women crying and protesting not to have a tube shoved down their noses and be forcibly fed Sustacal (in those days) poured too fast into their stomachs, and calls it a “love affair”?! It’s the same sort of mind that talks of manipulation by the young woman who doesn’t gain weight when she “ought to” in therapy. Why else would she be in therapy, but to gain weight, right? Buzzer - WRONG! These young women are in therapy 1) because their parents forced them to come, or 2) they came willingly because they are in pain, and maybe they wish they could eat normally, but usually they want to do so without gaining weight and when they start to gain, the panic sets in and the gain stops and perhaps even more is lost.

But they will tell you that themselves, and do, over and over: “I don’t want to gain weight!” How much more clear can they be? No one with anorexia would ever say, and still be anorexic, “I want to gain weight.” It’s a contradiction in terms. As soon as you want to gain weight, you are by definition no longer anorexic, not in the psychiatric sense. So they are asking these young women to somehow go to therapy for anorexia and NOT be anorexic. Then they call them manipulative and deceptive when they prove themselves anorexic after all, and do not want to gain weight, just as they have always protested.

They DO want to be out of pain, however, pain that has nothing to do with eating, food, or thinness, so they continue in therapy, not necessarily connecting it to having to want to gain weight. Why should they? Most people in therapy don’t have to want to gain weight as a prerequisite for entering therapy, all they have to do is be in pain and want to find a way out. So naturally, these young women think that this is all that is required of them too. They don’t know the therapist’s agenda is that they have agreed to gain weight, and to want to, by the very act of coming to see him or her!

So in short, I think all of it is bogus, and cruelty unalloyed. Any researcher or paper-writer who thinks these young women are manipulative and deceptive has never known what it’s like to starve yourself or the pain self-inflicted for the sake of thinness (ie to be like a model, that is to say, to be acceptable, to be good enough) and what’s more, doesn’t give a damn either. His ego has most likely been injured by an obstreperous anorexic young woman who “refused to succeed in therapy” that is, to gain weight in the time he allowed for it. Because of his ego-injury he is getting revenge by using his influence to describe all young women with anorexia as deceptive and manipulative and in love with the feeding tube. He may get his papers published and his name on some common symptom, but that still won’t make him correct. It just makes him what he is: an a—h—!

What about my own worry, that if the focus is on my weight that I’d never gain and might even lose more? Well, for me, this would be because the weighing made me too aware of the numbers, and it’s the numbers that I’m obsessed with, not being thin per se. I know I’m thin. I even know I am too thin. But the numbers tell me when I disappear into the woodwork “enough.” So if the number is focused on, I will focus on the number too, and in a way that I should not. I don’t want to know my weight in fact, because then I have to think about whether it is visible or invisible enough.

For younger women, those who claim to want to be as thin as the models they see on TV and so forth? Well, I think in some sense it is the therapist’s fault here too. I believe that these young women DO want to eat but the therapist’s focus on the weight and weighing them, and telling them how much better they are when they gain, only leads to failure. Why? Because INSIDE, even as they are gaining weight, they feel horrible. It is so crazy-making – telling someone they are better, when they feel so much worse – it’s enough to make someone commit suicide and I venture to say it probably has. Is it any wonder someone with anorexia might try to stay as thin as possible, her body reflecting her pain? This is not dishonesty, this is not manipulation, this is desperation and too many articles have been written by NON-sufferers who do not understand and are so very quick to label FEMALE anorexic patients “manipulative” while they would simply call a similar MALE patient “disturbed.”

I see this all the time. Females, to take another example using personality disorders, are labelled as Borderline; Males are called Antisocial. The behavior and symptoms are actually the same. But Borderline means the therapist finds the female a pain in the neck while Antisocial means they are afraid of the guy...Nothing more and NOTHING LESS. The difference is that they take the male seriously. As usual. The female is just dumped in the wastebasket.

But back to anorexia. Many have suggested that it stems from some painful memory or trauma from the past. It may or may not, but if it does, I’m pretty sure mine stemmed from this whole “bigger stronger twin” business, the way I was treated as if my feelings and needs were unimportant and that if I showed any I was merely “acting”, ie “Miss Sarah Bernhardt.” I don’t doubt this for a second as having deeply affected me, the relative lack of love and affection it led to, and my response, to become the stoic they said I was, which only produced less response from them in terms of love and affection, because I myself showed little.

The one time I did, hugging my mother each time she left to go out with my father in 7th grade, he told me I was too old for that kind of nonsense and to stop it at once! Naturally, I did. If Lynnie had needed to do that, well, I know the response would have been different. I still resent them today for the “Sarah Bernhardt” thing, because it haunts me almost every minute, causing extreme self-doubt in all that I do or think. Every medical test I take I expect to be told I’m just play-acting, that nothing is wrong, because that is what they said about every feeling I evinced, even when I was sick. But here’s the rub: If anorexia (that is, should my eating/weight problem meet those criteria, and I have some doubts that it does) is related to something in the past, how come knowing doesn’t solve the problem? Obviously something is wrong with the theory. But what I cannot say.

Posted by pamwagg at September 18, 2006 07:50 PM


Dear Pam,

I did a brief internet search on anorexia and here's what I found:

--15% below normal body weight. (How tall are you?)
--Use food and weight to deal with emotional problems.
--A sense of control and power feeling hunger and resisting it.
--Good students, perfectionists
--Dry skin, thinning hair, hairy, feel cold alot, may get sick often.
--Denial is common.
--Need for counseling, at least a year to work on changing the feeling that cause the eating problem.
--Low self-esteem/need for anti-depressants
-- "People with anorexia feel safe, secure and comfortable with their illness. Their biggest fear is gaining weight, and gaining weight is seen as loss of control."
--"Often they will develop strange eating habits such as refusing to eat in front of other people. Sometimes the individuals will prepare big meals for others while refusing to eat any of it."

Is it true for you that there is a feeling of safety and comfort in eating very little each day? Is eating seen as a dangerous or obscene activity? You wrote that anorexics do not want to gain weight, do you? I think you're in a good position because you know you have a problem with eating. Something is wrong and you are becoming emaciated. I think the focus should not be on your weight, but on your eating. Don't weigh yourself for a week and concentrate on increasing how much you eat each day. It sounds obvious, but, if you eat more, you won't have to worry about weighing less. Try eating only your favorite foods each day. Make it a ritual and not something you do on the sly. Put out a place mat, light a candle, sit down, feel grateful for the food and send out a prayer to those who don't have an option to eat or not eat, make it a meditation practice.

It seems to me that anorexia is about living with and adapting to a sense of deprivation. That's that continual almost subconscious feeling of hunger. You have been living with voices that hurt you and tell you to hurt yourself. To not eat is a way of hurting yourself and perhaps appeasing the voices at the same time. It's a slower death than setting yourself on fire, but it's still a shadow of death hovering around you. But I believe you can fight back. In fact just writing to us about this problem is a way of fighting back.
You deserve to be happy and eating should be a natural part of that happiness. I looked around for some support group message boards and found one that seems pretty active. The address is It's a members only forum, so it's pretty private.

I think you're probably right when you say that being the stoic twin as a child has contributed to your eating disorder. Again, the idea of deprivation as a child and certainly as a result of developing schizophrenia. Your illness has deprived you of many things, but now is the time to pamper yourself, now more than ever, now while you're doing better.

Posted by: Kate K. at September 19, 2006 02:29 PM

Your blog thoroughly covers all the ground we have covered together, both in writing and in speaking to each other. The problem is complex, the solution even more so. Your most provocative ending challenges the published papers of so many "experts", be they skilled and sincere or punative, as you have suggested. If indeed the solution to setting an anorexic free from her potentially distructive behavior is to identify the true cause of the pain she masks by making starving herself the culprit, why then, if the real cause is known , does the disturbing behavior continue in many cases? The answer is unique to the individual. Perhaps if the therapy was also let "out of the box" and was tailored to the individual and widely divergent needs of each person, a true and complete recovery could be made. As usual, your remarks give one much food for thought.(There I go again! I was not making a pun, just using a cliche', but I am so oblivious sometimes, I think I should just keep my mouth shut or perhaps discard my keyboard.) My words were meant to be taken seriously. One must forgive my neurologically impaired brain.
Congratulations on your well written blog, Admiringly, She who should remain nameless

Posted by: Paula Kirkpatrick at September 19, 2006 12:30 PM

Maybe the focus on anoxeria is taking the focus off schizophrenia. With your intelligence and medical background, have you ever taken a proactive stance on researching your own disorder? Gone "out of the box"?

Posted by: Pat at September 19, 2006 02:33 AM

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