Brave Girl Eating_ A Family's Struggle With Anorexia Part 10

"You left," she says when I reappear. "Where'd you go?"

"I had to get something. I'm back now."

Kitty picks up her fork and resumes eating, turning the pages of her book with an apparent lack of concern. We say no more about it. But the next day I re-create the experiment. At breakfast I dish up her oatmeal, wait for her to stir in brown sugar and whole milk. After the first few bites I get up and begin rummaging in a cabinet, my back to Kitty for a few seconds. When I turn around, I see that she has indeed stopped eating. I give her an oblivious smile. "How're you doing?" I ask cheerfully, and she starts eating again.

Later that day, I pick Kitty up at school for an appointment with Dr. Newbie. After she climbs into the front seat, I hand her a protein bar. "You'll have to eat your snack in the car today," I say.

She tears open the paper wrapper and takes a bite as I pull into traffic. She chews for a second, swallows, and says, "You're watching me, right? I can't eat if you're not watching. You can see me out of the corner of your eye, right?"

"Yep," I say, my eyes firmly on the road. "I see every bite you take."

Over the next few days Kitty asks again and again whether we're watching, and I know what she's really asking: You're making me eat this, right? I don't have any choice here. Do I? You're making me eat this, right? I don't have any choice here. Do I? She needs us to take the responsibility for her eating because the compulsion to She needs us to take the responsibility for her eating because the compulsion to not not eat is still so powerful. eat is still so powerful.

Which is why, I realize, more traditional treatments are not just ineffective-they're cruel. It's cruel to insist that a child in the throes of anorexia "take responsibility" for eating, and absurd to suggest, as many therapists and treatment programs do, that unless a person with anorexia "chooses" to eat, she can't recover. Kitty's reactions make sense to me now. What wouldn't make sense would be to turn my back on her. To have her life hinge on her doing something she cannot do.

Because I believe this with all my heart: Kitty cannot choose to eat. Kitty cannot choose to eat. Not yet. The time will come when she'll have to do that, of course, when she'll have to maintain her weight and her health herself. And when that time does come, I think we'll know. She'll tell us, just as she's telling us now that she's not ready to go it alone. Just as she told us when she was ready to go away to camp, stay home alone, stay up a half hour later. All along she's been telling us, through words and action, what she needs in order to grow and become more independent. All we have to do is listen. Not yet. The time will come when she'll have to do that, of course, when she'll have to maintain her weight and her health herself. And when that time does come, I think we'll know. She'll tell us, just as she's telling us now that she's not ready to go it alone. Just as she told us when she was ready to go away to camp, stay home alone, stay up a half hour later. All along she's been telling us, through words and action, what she needs in order to grow and become more independent. All we have to do is listen.

Kitty's spirits have improved as her weight has inched up. And I've learned I can occasionally head off the demon by refusing to acknowledge it. On Halloween night, for instance, Kitty asks if she needs a snack. She hasn't collected or eaten any candy. I say yes, she needs to eat two ice cream sandwiches. "Do I really need two?" she asks. "My stomach hurts." I hear the beginning of an edge in her voice. as her weight has inched up. And I've learned I can occasionally head off the demon by refusing to acknowledge it. On Halloween night, for instance, Kitty asks if she needs a snack. She hasn't collected or eaten any candy. I say yes, she needs to eat two ice cream sandwiches. "Do I really need two?" she asks. "My stomach hurts." I hear the beginning of an edge in her voice.

"Yep, that's what you need," I say matter-of-factly, and turn away deliberately to talk to Emma. Kitty eats the ice cream sandwiches, and the moment pa.s.ses.

This strategy doesn't always work. A few nights later Kitty erupts into a sudden rage when I bring out her bedtime snack. The plate flies across the room and breaks, a shower of yellow shards. When I jump up to get the broom and dustpan, she bolts out the front door, yelling, "I'm going to run away!" Jamie finds her down the block, on her bike in the dark, and half carries her back to the house, bike helmet and all.

I feel blindsided and stupid, shocked all over again. It's been a few weeks since we've seen the demon, and already I'm forgetting its claws and fangs, its flicking tongue. How quickly the face of anorexia came to seem normal to us, and now I see that the opposite is true too: on a superficial level, at least, we're slipping back into something resembling ordinary life. Not our old life, which was more fragmented, less organized, more spontaneous. The new normal includes shopping, cooking, and supervising three meals and two snacks a day for Kitty. It includes more time spent as a family, sitting at the table or in the living room, driving to doctors' appointments, playing board games, talking before bed. It has its pleasures, this new life. Kitty taking Emma trick or treating, for example-that's something she wouldn't have been willing to do last year, or able to do six months ago. Last year, of course, Kitty was hanging with her own friends; next year, I hope, she'll be doing that again.

I'm puzzled by the fact that the demon is still so close to the surface. When Kitty doesn't get quite enough to eat, or when she goes more than a couple of hours during the day without eating, her mood plummets predictably. But she's nowhere near as thin as she was three months ago; in fact, her weight is now within a normal range for her height. That is, someone her height who had never had anorexia might be healthy at this weight, though clearly, Kitty has a ways to go. She's been eating three thousand to thirty-five hundred calories a day for weeks now, but both her physical and emotional well-being are still intensely frangible. She has no equilibrium point; she swings from feeling good to falling apart with frightening fluidity.

When we started refeeding Kitty, Jamie and I told each other and her that food was her medicine, that it would cure her, body and mind. I still believe that. But I thought we'd see change more quickly. Before we began, Kitty ate very little, but she was chipper, competent, tireless. She practiced three hours a day at the gym, and, as we later discovered, spent hours at night in her room on conditioning exercises. I understand now that hyperactivity is a hallmark of anorexia; back then, I thought Kitty's stamina meant that she was was getting enough food. Some people need less sleep than others; I wondered if some people need less food. getting enough food. Some people need less sleep than others; I wondered if some people need less food.

I can see now how my own att.i.tudes toward food and eating blinded me to reality. I am the miser who expects his dog to not just survive but thrive on little or no food, only in my case it's not cheapness that informs this skewed perspective but my own ambivalence about food. I can't remember a time when I didn't feel conflicted about eating. The message I've gotten all my life, from a variety of sources, is that food is dangerous. Enjoying Enjoying food is dangerous, because it might lead to eating too much, and the goal is to eat as little as possible and still survive. Because the worst thing you can be in this culture is fat. food is dangerous, because it might lead to eating too much, and the goal is to eat as little as possible and still survive. Because the worst thing you can be in this culture is fat.

Like every parent, I want to save my children from pain and suffering, especially the pain and suffering I've experienced. So when Kitty announced she would eat no more desserts, I thought Good for her Good for her instead of instead of What's going on? What's going on?

I go back to Ancel Keys's Minnesota Experiment, this time focusing on what happened to the volunteers toward the end of the study, after twelve weeks of refeeding-about where we are now with Kitty. The volunteers still struggled with stomach pains and constipation, exhaustion and swelling. They ate vast quant.i.ties of food-five or six thousand calories a day-but most continued to feel tired and weak. "We were rather surprised," wrote Keys, "at the slow rate of overall recovery, including recovery in the psychological aspects."*

Researchers interviewed the men one more time, eight months after they'd started refeeding. Most had gained back all the weight lost and were more or less back to normal. Keys commented that both psychological and physical recovery from starvation "required many months of unlimited good diet."

I feel a little better knowing that the volunteers recovered-eventually. That the punishment starvation inflicts on a human being, body and mind, can be overcome in time. More time than I'd like, maybe, but it can happen. It will happen.

Meanwhile, because of Kitty's continuing stomach pain, Dr. Beth schedules her for an endoscopy and a colonoscopy, to make sure there's no underlying disease. The worst part about the test is that Kitty has to fast for about thirty hours. Dr. Beth agrees that the fasting is unfortunate, but says we have to make sure there's nothing else going on. "I had a nineteen-year-old patient with stomach pain once who turned out to have colon cancer," she tells me. "Not that I think Kitty has cancer. But we need to rule it out."

The tests are scheduled for a Monday, so Kitty doesn't have to fast on a schoolday. Not that she would mind. She says she likes the way fasting makes her feel: clean and light and virtuous. She says she hasn't felt hungry in many months, since long before the diagnosis. As Sunday wears on, her mood improves; mine deteriorates. After everything we've been through, I can hardly bear to watch her not eat. It feels wrong on every level.

The next morning, the nurses let me hold her hand as they insert the IV and start the anesthesia. "You know," she murmurs sleepily, "it's going to be hard for me to say I'm hungry when we get home."

I hear what she's saying under the words: I will be hungry. I am hungry. Please feed me. Please take care of me. I will be hungry. I am hungry. Please feed me. Please take care of me.

I smile. "No problem," I say. By the time they wheel her out of the waiting room, she's asleep. And thankfully, the tests show no cancer, no Crohn's disease. Nothing to worry about. I never thought I'd be grateful that my daughter "only" has anorexia.

When we get home I make Kitty a coffee milk shake, put on a Harry Potter movie, and sit beside her on the couch as she drinks. At her weigh-in later that week, she's down a pound-not surprising, given the long fast, but still upsetting. Her progress has been meandering-up two pounds, down one, stay the same for two weeks, up a quarter. It's taken three months for her to gain fourteen pounds, but five of those came in the first three weeks. So she's basically gained three pounds a month. At our appointment later that week, Dr. Beth says she'd rather have Kitty gain the weight slowly; she says we shouldn't worry, things are moving in the right direction. We have to be patient but steady, keep doing what we're doing.

"Well, I hate what you're doing," Kitty interrupts her. She folds her arms. "I don't want want to gain weight," she says. to gain weight," she says.

I glance at Dr. Beth, who after all spends most of her professional life dealing with adolescents. Her face is watchful, nothing more. "I know," she says to Kitty, then turns to me and asks, "Any questions?"

I do have questions, actually, but I already know they have no answers. How do we tell the difference between anorexia and, say, ordinary teenage behaviors? The full-fledged demon is unmistakable. But what about moments like these, which we see with increasing regularity? Maybe they're like the rumblings of a dormant volcano that's about to erupt again. Or maybe they represent emotional progress. I've noticed how anorexia and the refeeding process sent Kitty back to infancy in many ways. As she recovers, she seems to be moving forward, recapitulating the developmental stages of childhood. Right now it feels like she's. .h.i.t age two.

I remember Kitty in the hospital, too weak to sit up, let alone resist, and take this stubborn crankiness as a good sign. Maybe we can teach Kitty to stick up for herself, stop worrying about pleasing others and figure out what makes her happy. Maybe, in an odd way, anorexia's giving us all a second chance. And what parent hasn't wished for a do-over somewhere along the line?

Over the next few weeks, Kitty's weight gain stalls, and her mood continues to deteriorate. Dr. Beth suggests cutting out dairy to see if that helps with the stomachaches. The trouble is, it's awfully hard to get in enough calories without the daily milk shake, the lasagna, the macaroni and cheese. And it feels like the very act of restricting anything-even for medical reasons-reinforces the anorexia. weeks, Kitty's weight gain stalls, and her mood continues to deteriorate. Dr. Beth suggests cutting out dairy to see if that helps with the stomachaches. The trouble is, it's awfully hard to get in enough calories without the daily milk shake, the lasagna, the macaroni and cheese. And it feels like the very act of restricting anything-even for medical reasons-reinforces the anorexia.

I realize how much ground Kitty's lost one afternoon in mid-November, when she appears in the kitchen to ask what she's having for her bedtime snack, six hours from now. "Why do I need to eat anything for snack?" wheedles Not-Kitty. "I ate so much today already. I feel really fat. I think I'll skip dinner and snack tonight."

Standing at the sink, wrist-deep in soapy water, I say nothing. That's the best way to deal with the demon.

"I won't eat," persists Not-Kitty. "You can't make me."

No, I can't, I think. I can't physically put food in her mouth, make her chew and swallow. I wouldn't do that even if I could. I think. I can't physically put food in her mouth, make her chew and swallow. I wouldn't do that even if I could.

"No school until you eat," I say, not turning around.

"I don't care," says Not-Kitty. This shocks me as much as anything. Part of her goal of going to Columbia and then to law school has been not missing any school-and, of course, excelling at it.

It would be best to say nothing. Best not to argue with the demon. But I open my mouth and out come words I haven't planned on saying: "You'll never get to be a lawyer if you die from anorexia."

I think this is the first time I've mentioned the idea of dying from anorexia to Kitty. No, I know it's the first time, because I've been careful to stay positive and hopeful. She's She's said the word a few times, as in "I'm going to die if I have to eat one more bite!" And of course there was the night she said at the dinner table that she wanted to go to sleep and never wake up. But this feels different. Something about the juxtaposition of the illness with Kitty's hopes for the future strikes home, for her as well as for me. said the word a few times, as in "I'm going to die if I have to eat one more bite!" And of course there was the night she said at the dinner table that she wanted to go to sleep and never wake up. But this feels different. Something about the juxtaposition of the illness with Kitty's hopes for the future strikes home, for her as well as for me.

For the rest of the day, Kitty eats. Quietly. Unhappily. More slowly than usual. But she eats, afternoon snack, dinner, and bedtime snack. And no more is said, for the moment, about not going to school.

The next afternoon is, if anything, worse. The demon takes over at the lunch table and the rest of the day is a disaster. Trying to figure out why, I sit down and calculate calories-something I've stopped doing, thinking we had the hang of it. I write down as much as I can remember of her recent meals, ingredients and quant.i.ties, and realize, in horror, that for the last week, she's been taking in fewer calories than I thought-more like twenty-five hundred a day than three thousand. I can't believe we let this happen. No wonder she's been antsy and anxious; twenty-five hundred calories is nowhere near enough for her right now.

Then another thought strikes me: I wonder if she's grown? Or is growing? At her next weigh-in I ask the nurse to measure her, and sure enough, Kitty's nearly an inch taller. Now the whole picture begins to make sense: just as Kitty's body began to need more calories, for growing, we inadvertently cut back. Those two processes, plus the physiological and psychological effects of restricting, combined to strengthen the demon within her.

Ms. Susan agrees. She says restricting-even the tiniest amount-quickly takes on a life of its own for someone with anorexia. Starvation over a period of time creates actual neural pathways in the brain. And now even the most minor echo of starvation-a slight reduction in calories, nowhere near the danger zone-reactivates those pathways, brings back the emotions and obsessions of true starvation. The reason lies in the brain's malleability-what researchers are beginning to refer to as its neuroplasticity. Psychiatrist Norman Doidge, author of the book The Brain That Changes Itself, The Brain That Changes Itself, compares the brain to a snow-covered sledding hill. Because snow is soft and easily shaped, the first time you sled down the hill, your sled carves a path. Each time you go down after that, your sled tends to run along the same path, digging it deeper and making it harder to steer your sled elsewhere. It's the softness of the snow, ironically, that creates a rigid, well-defined pathway. Doidge argues that it's the same with the brain: the brain's very flexibility, its ability to create new neural pathways, also makes those pathways hard to break away from. Each time Kitty restricts, no matter how slightly, it's as if she's sledding down that hill again, wearing the old groove ever deeper in the snow. compares the brain to a snow-covered sledding hill. Because snow is soft and easily shaped, the first time you sled down the hill, your sled carves a path. Each time you go down after that, your sled tends to run along the same path, digging it deeper and making it harder to steer your sled elsewhere. It's the softness of the snow, ironically, that creates a rigid, well-defined pathway. Doidge argues that it's the same with the brain: the brain's very flexibility, its ability to create new neural pathways, also makes those pathways hard to break away from. Each time Kitty restricts, no matter how slightly, it's as if she's sledding down that hill again, wearing the old groove ever deeper in the snow.

Neuroplasticity doesn't cause eating disorders, of course; it's just part of what makes them so tough to overcome. In Kitty's case, I suspect a confluence of events last spring pushed her into full-blown anorexia: a growth spurt, restricting, and a prep.u.b.ertal hormonal s.h.i.+ft. And it's going to take time, and many thousands of calories, to reverse.

In any case, I know what we have to do, and I know, now, that we can do it. We push Kitty's calories back up to three thousand a day. I buy a big bottle of Maalox and start making milk shakes again. We pull out the Ensure Plus from the bas.e.m.e.nt. We carry on.

By Thanksgiving week, Kitty's gained two more pounds. She's calmer, though still fragile, still quick to fall apart. Dr. Beth wonders if Kitty could use some individual therapy right now. I think it's a good idea. Of course we've used up all our mental health benefits. But the amazing Ms. Susan calls our insurer and extracts extra "transitional" funding, enough to cover about six weeks of individual therapy. All I have to do, she says, is call Melanie, our behavioral health "consultant," and make nice.

I very nearly don't manage that, because the first thing Melanie says when I call is "You've used up all your benefits," making it sound like I'm the gra.s.shopper from Aesop's Fables, blithely romping through summer, failing to prepare for the winter ahead. Her att.i.tude reminds me of the last last round of health-care debates, when the buzzword was round of health-care debates, when the buzzword was choice, choice, as in "Make wise choices about how to spend your health-care dollars." Whatever the h.e.l.l as in "Make wise choices about how to spend your health-care dollars." Whatever the h.e.l.l that's that's supposed to mean. Should we supposed to mean. Should we choose choose not to treat Kitty's anorexia because, gosh, we'd use up too many health-care dollars? Or should we choose instead to not have Emma's broken arm set? Or maybe we're supposed to choose not to get sick or hurt at all. not to treat Kitty's anorexia because, gosh, we'd use up too many health-care dollars? Or should we choose instead to not have Emma's broken arm set? Or maybe we're supposed to choose not to get sick or hurt at all.

I know I shouldn't argue with Melanie. I know she is the gate-keeper and I need to have a good relations.h.i.+p with her. "If my daughter had diabetes, you wouldn't just cut off the benefits part-way through her treatment," I say.

"Your employer chooses the plan," she says. "It's not our fault if your employer buys a health plan that doesn't cover this."

True enough. But I work for a small company that doesn't have to give me any any health insurance. I'm lucky to have this plan-and I didn't get any choice about it. Jamie and I work hard, pay our bills on time, and pay plenty for our insurance, such as it is. Our daughter is sick, with an illness neither she nor we caused, an illness that requires care. An illness with a high mortality rate. An illness that could take her sanity and her life. health insurance. I'm lucky to have this plan-and I didn't get any choice about it. Jamie and I work hard, pay our bills on time, and pay plenty for our insurance, such as it is. Our daughter is sick, with an illness neither she nor we caused, an illness that requires care. An illness with a high mortality rate. An illness that could take her sanity and her life.

What we need is help. What we get is the message that we're unreasonable, freeloaders or criminals, or worse: negligent parents who are to blame-and therefore must pay the price-for our daughter's illness.

In the end, despite my argumentative comments, we are granted six more weeks of therapy with Ms. Susan. It won't be enough. It won't even be close to enough. But it's the best offer we're going to get from the insurance company. We'll take it. But I refuse to be grateful.

chapter nine

Crusts and Crumbs

Hunger is a country we enter every day, like a commuter across a friendly border.

-SHARMAN A APT R RUSSELL, Hunger: An Unnatural History Hunger: An Unnatural History

Years ago, when I was pregnant with Emma, I had to decide whether to have amniocentesis. I was old enough that there was a fair risk of Down syndrome and other chromosomal abnormalities, but I was pretty sure I wouldn't have an abortion, no matter what I learned about the child I was carrying. I wasn't keen on the idea of the test, which in itself can cause miscarriage. But my obstetrician encouraged me to have it. was pregnant with Emma, I had to decide whether to have amniocentesis. I was old enough that there was a fair risk of Down syndrome and other chromosomal abnormalities, but I was pretty sure I wouldn't have an abortion, no matter what I learned about the child I was carrying. I wasn't keen on the idea of the test, which in itself can cause miscarriage. But my obstetrician encouraged me to have it.

"It gives you time," she said. "Time to let go of the fantasy of the perfect child. You have to grieve the child you're not going to have before you can embrace the one you are having."

I had the amnio, which was normal. And I've thought of her a.n.a.logy often these last few months. Jamie and I have had to let go of a certain image of Kitty in order to focus on how she is right now. I think about parents whose children have cystic fibrosis, spina bifida, sickle cell anemia, any of the thousands of ailments that will never get better and will never go away, that make a child's life painful, one way or another, and may ultimately end it. We're lucky, really; Kitty has a chance to make it through, to come out whole on the other side.

But that doesn't make things any easier. The obstetrician was right; this is a process of grieving and letting go, acknowledging that the fantasy not only isn't happening right now but will never happen. Intellectually, I get it; emotionally, I'm lagging way behind.

I can see, now, that I've been going through Elizabeth Kubler-Ross's famous stages of grief. Denial: Denial: then, when I thought Kitty couldn't have anorexia because she hadn't lost a lot of weight, when I tried to talk the doctor out of transferring her to the ICU; and now, when I believe (because I want to) that Kitty's fine and that we can slack off on watching, observing, recalculating. then, when I thought Kitty couldn't have anorexia because she hadn't lost a lot of weight, when I tried to talk the doctor out of transferring her to the ICU; and now, when I believe (because I want to) that Kitty's fine and that we can slack off on watching, observing, recalculating. Anger: Anger: breaking a stack of dishes on the kitchen floor; pulling out clumps of my own hair, as I've done more than once; yelling, when I know it's not her fault, when I know that she's in pain. breaking a stack of dishes on the kitchen floor; pulling out clumps of my own hair, as I've done more than once; yelling, when I know it's not her fault, when I know that she's in pain. Bargaining: Bargaining: If I give up my life, stop seeing friends, do nothing but shop and cook and sit with her, she'll be all right. If I give up my life, stop seeing friends, do nothing but shop and cook and sit with her, she'll be all right. Depression: Depression: not sleeping; crying a lot; feelings of despair, guilt, hopelessness. not sleeping; crying a lot; feelings of despair, guilt, hopelessness. Acceptance: Acceptance: nope; I'm not accepting this; not yet; maybe not ever. nope; I'm not accepting this; not yet; maybe not ever.

Two days before Thanksgiving, Kitty comes home from Ms. Susan's lunch group distraught. She tells me she's figured out what "the problem" is. "I'm doing this for you, not for myself," she says. Kitty comes home from Ms. Susan's lunch group distraught. She tells me she's figured out what "the problem" is. "I'm doing this for you, not for myself," she says.

"Doing what? Going to lunch group?"

"No," she says irritably. "Eating. I'm eating what you tell me to. So I'm doing it for you, not for me."

Slowly the story emerges. She's pretty much the only one in the group whose family is doing FBT; many of the other girls have been in and out of hospitals and residential treatment centers for years. But all Kitty can see is that they're somehow "doing better" than she is. "They seem like they're so much more insightful than I am, Mom," she says.

Ms. Susan warned me that compet.i.tiveness can be a problem in eating-disorders groups. I'm beginning to see what she meant.

"So what are you saying, Kitty?" I ask her. "You want want to go away?" to go away?"

In fact, that is what she's saying. I can't help but wonder if this has something to do with her weigh-in today. She weighs more than she's ever weighed in her life by about ten pounds. In fact, she's only about four pounds under her target weight. Could this all be a ploy by the demon, a last-ditch attempt to claw its way back?

"Kitty, you're doing so well right now," I begin. "It seems to me that we'd be going backward to send you away now. We've got momentum going. Why would you want to throw that away?"

"I knew you'd think it was just the eating disorder talking!" she cries. "But it's not!" She pauses, then says, "Maybe I would lose a little weight at first if I went away. But I'd make so much emotional progress!"

We are talking to the demon, and it's scary, because on one level what Kitty says makes perfect sense. She is a people pleaser, eager to do what other people want her to do. But real emotional insight and growth typically comes after after physical recovery. That's how FBT is structured, and for good reason. Starving doesn't make you more insightful; it just makes you sicker. The demon is so very clever, taking a little bit of truth and twisting it into a lie. Right now, Kitty physical recovery. That's how FBT is structured, and for good reason. Starving doesn't make you more insightful; it just makes you sicker. The demon is so very clever, taking a little bit of truth and twisting it into a lie. Right now, Kitty does does have to do what we want her to, at least when it comes to eating. There will be plenty of time for her to become more independent later, when she's recovered. have to do what we want her to, at least when it comes to eating. There will be plenty of time for her to become more independent later, when she's recovered.

When Kitty realizes that we're not going to send her away, she switches gears. If we're not going to send her to a treatment center, maybe we can support her emotional growth here at home.

"We've been trying to do that all along," I say carefully. "What do you have in mind?"

What she has in mind, it turns out, is to skip our traditional Thanksgiving celebration with friends, stay home, and eat dinner-alone-with another girl from the lunch group, Sh.e.l.ly, who's just been released from the hospital.

I stare at Kitty. I want to say, Where the h.e.l.l did this come from? Where the h.e.l.l did this come from? Except I know where it came from-the demon, that's where. The demon, who wants Kitty on the outside looking in. The demon, who will take every chance we give it to starve our daughter. Except I know where it came from-the demon, that's where. The demon, who wants Kitty on the outside looking in. The demon, who will take every chance we give it to starve our daughter.

I get that this is a tough holiday for anyone struggling with an eating disorder. All the more reason to spend it with the people who love you, who care about you, who want you to get through it and get over it. And I get that teenagers crave autonomy. But starving at home with another anorexic for Thanksgiving? That's the illness speaking. Not my daughter.

Anorexia wants Kitty to be as separate as possible from us, because we are its enemy. Anorexia wants Kitty to be isolated, with only the company of others who are ill, so that it can continue to sink its claws and teeth into her. I look my daughter in the eye and say, "Sorry, but you have to come with us to Thanksgiving dinner." She storms off, crying, and after a while Jamie goes in to sit with her, to try to calm her so she can eat the rest of her food and go to bed.

She's grumpy with us for the next few days, worrying about Thanksgiving. The day itself, at the home of our close friends Harry and Lisa, goes smoothly. Kitty sits next to me at the table and eats what I serve her-turkey and cranberry sauce and roast potatoes, bread and b.u.t.ter, pumpkin pie. After dinner she wants to go home. I tell her we're not quite ready, that she can take her book upstairs to a quiet room if she wants to get away from the hubbub of nine children, six adults, and several dogs. But instead of going upstairs, she follows me around the house, standing so close to me that I can feel her breath on the back of my neck. I try to draw her into the conversation, but she stays quiet. I try to ignore her, but I can feel her silent pressure bearing down, and it irritates me. At one point I tell her she's standing way too close, and could she please go sit on the couch? When I turn back to the conversation, she takes hold of my upper arm and pinches, hard.

"Ow!" I cry, and look at her. Not-Kitty looks back at me through a studiously neutral mask.

"I'm sorry," she says. "I didn't mean to do that."

I rub my arm and stare into my daughter's face. Kitty didn't mean to do that. The demon did.

We go home.

The next week, Jamie and I accompany Kitty into the session with Ms. Susan. It's time for a family check-in. In traditional FBT, Emma would come to the session too. But Emma begs not to go, and I don't have the heart to force her. and I accompany Kitty into the session with Ms. Susan. It's time for a family check-in. In traditional FBT, Emma would come to the session too. But Emma begs not to go, and I don't have the heart to force her.

Kitty is eloquent on the subject of wanting to take control of her eating once more. She tells Ms. Susan what she's told us: that she feels her recovery won't count somehow unless she does it herself and not us, that she wants to go away to a treatment center, that she wants us to back off.

Ms. Susan turns to us. "Are you ready to give Kitty back control over her eating?" She barely gets the words out when both Jamie and I say no, she's nowhere near ready. Susan turns back to Kitty.

"Your parents say you're not ready," she says. "You're still under your target weight. I think if you want some control back we should talk about very small steps, and make sure they're working before we move on to anything more."

Together she and Kitty come up with an idea for a first step in that direction: Kitty might eat lunch at school once a week instead of coming home. "Could you arrange to eat with someone specific?" asks Susan. "What about the guys?" Kitty's been spending time with a couple of guy friends, Martin and Garth. I find it interesting that as she recovers she chooses to hang with them more than with female friends. Neither Jamie nor I picks up any s.e.xual tension; it's more camaraderie, doing things together. Friends.h.i.+ps among girls at this age tend to focus on talking about feelings and emotional interactions and, increasingly, boyfriends. Kitty's avoiding those kinds of conversations right now. She's not really in a place where she wants to spill her guts to other people, and I can't blame her. Plus, there's the added bonus of how much high school guys eat.

We agree that Kitty can try eating lunch at school once a week with Martin and Garth. "Or I could eat with Sh.e.l.ly," she says.

"If Sh.e.l.ly even eats lunch," says Ms. Susan conversationally.

"Eat with the guys," I say firmly.