Brave Girl Eating_ A Family's Struggle With Anorexia Part 2

I tried to forget that I'd felt that way about seeing Dr. Beth, too.

That night and every night after for a long time, I went to sleep thinking of the sharp angle of Kitty's elbows, the shape of her bones under skin. I saw against my closed eyelids her hollow face, her enormous eyes, the unnatural point of her chin. I could not bear to see these things. I could not stop seeing them.

In the meantime, our health insurance refused to accept a diagnosis of anorexia from Dr. Beth because, as the "consultant" told us, only a psychiatrist can diagnose a mental illness, and anorexia nervosa is listed in the DSM-IV, DSM-IV, the bible of mental illnesses. Once more I started on a seemingly endless round of phone calls. The only psychiatrist who could see us within six months- the bible of mental illnesses. Once more I started on a seemingly endless round of phone calls. The only psychiatrist who could see us within six months-six months-was a psychiatric fellow in her last year of training whom I'll call Dr. Newbie, who had an opening the following week.

Our first visit was not auspicious. Kitty stayed curled in a fetal position, her head in my lap, while Dr. Newbie asked question after question. Her diagnosis, after forty-five minutes, was depression and eating disorder not specified, commonly known as ED-NOS. She prescribed fluoxetine (the generic form of Prozac) and weekly visits, both of which we dutifully began, neither of which seemed to help. Dr. Newbie was kind but more or less clueless; she spent most of our sessions telling Kitty she had to eat, which we were already doing at home. The fluoxetine gave Kitty headaches and upset her stomach, making it even harder, she said, to eat.

Worse, what I didn't understand then was that our mental health coverage was limited to $1,800 a year. Seeing Dr. Newbie, it turned out, cost us $200 a pop, using up our precious benefits on an exercise in futility.

Nothing seemed to help Kitty's anxiety and guilt around eating. Though we rarely cook red meat, one night I made lamb; Kitty's lab reports showed that she was anemic, and lamb is rich in iron. After an hour of cajoling, arguing, and yelling, she choked down two bites of meat. Afterward she ran into the backyard and curled up in the gra.s.s, where Jamie and I could see and hear her through the kitchen window. "Oh my G.o.d," she cried, arms wrapped around herself, rocking in the gra.s.s. "That must have had three hundred calories in it! Oh G.o.d!" We sat at the table and listened to our daughter's agony, and did not know what to do.

I hoped the therapist would help. On the day of our first appointment in mid-July, she came out to the waiting room and said h.e.l.lo in a high-pitched, syrupy chirp that immediately set my teeth on edge. The old Kitty, a precocious observer of human nature, would have rolled her eyes at me. The new, withdrawn Kitty didn't even blink.

Dr. V. tried to get Kitty to come in alone, but I was done with staying in the waiting room. So in we went, to Dr. V.'s blandly beige office, where she commenced interrogating Kitty in the same gooey tones. I didn't care how idiotic or patronizing she sounded, as long as she could tell us what to do and how to do it. If she'd come up with a workable plan, I would gladly have given her all our disposable income for the next ten years. If I'd trusted her, even a little, we would have been in her office twice a week. Alas, no plan was forthcoming, and trust was not an option after Dr. V. informed me that anorexia "isn't about the food" and was typically caused by "the mother's unresolved conflicts."

"Now, Mom, don't be the food police!" she admonished me as she ushered us out of the office. I wanted to bite her head off. How in the world could Dr. V. be considered an expert on adolescents when she talked to Kitty as if she were two years old? She hadn't a clue how to relate to a teenager.

"What did you think?" I asked Kitty in the car. She shrugged apathetically, but I thought I caught the tiniest hint of something-amus.e.m.e.nt? sarcasm?-in her dulled gaze. It cheered me immensely, which I needed when I imagined coming back to Dr. V.'s office week after week, offering up our family's dysfunctional moments as Kitty grew thinner and weaker and paler. Dr. V., it was clear, was not going to save Kitty. But if she couldn't do it, who could?

That night, Emma ran away from home. She didn't go far-only to the end of the block-and she was easy to find, because she stood on the street corner and screamed, "I have the stupidest, most lousy parents in the world!"

Man, was I jealous. I wanted to stand on the corner and cuss someone out too. I just didn't know who.

In the second week of July, the weather turned even steamier, with three-digit temperatures nearly every day. One of those days was our city's annual opera in the park concert, which we went to every year, eating a picnic dinner on a blanket in the gra.s.s. of July, the weather turned even steamier, with three-digit temperatures nearly every day. One of those days was our city's annual opera in the park concert, which we went to every year, eating a picnic dinner on a blanket in the gra.s.s.

Kitty spent that entire afternoon in our sweltering kitchen, frying chicken and making carrot cake, the oven and range going full blast. The room was like a sauna, but she wore a long-sleeved gray sweats.h.i.+rt over a T-s.h.i.+rt, heavy jeans, fuzzy socks-and still she did not sweat. Nor would she drink, even when I followed her around with a gla.s.s of ice water, begging her to take a sip. "For G.o.d's sake, it's a hundred degrees in here," I said.

"I'm not thirsty."

"Promise me you'll at least eat some of what you're cooking," I said, my voice raised in frustration.

Kitty looked at me calmly. "Of course I will," she said.

Of course she didn't, not really. She peeled every speck of fried coating from a drumstick and picked at the meat. She produced a small bag of red grapes and ate three, turning down the carrot cake, the potato salad, the apple juice. "My stomach hurts," she said. "I'm not hungry."

I got angry. Furious, actually. Furious enough to turn my back on Kitty in her sweats.h.i.+rt, zipped up to the neck. I sat at the opposite end of the blanket, denying her contact, avoiding her icy hands, her now nearly constant need for physical rea.s.surance. Fine, Fine, I'd thought. I'd thought. OK. You want to starve yourself to death? Go right ahead. OK. You want to starve yourself to death? Go right ahead.

The chicken and carrot cake were, no doubt, delicious. I don't know, because none of us ate a bite. I went to bed angry, feeling like things were about as bad as they could get.

And that's when Kitty came to me in the dark, her hand on her chest, her voice full of fear.

I can see from the look on the nurse's face that the news is not good. She ushers us back to the emergency room cubicle, where an earnest young doctor shakes my hand and opens Kitty's chart. He seems to be a long way off, his voice tinny and low as he explains there's a problem with Kitty's EKG. The electrical impulses that initiate each heartbeat are coming from the wrong part of her heart, a sign that her body is stressed. She's also dehydrated, and her heart rate is too low, only thirty-five beats per minute. The number penetrates the gray fog that's descending over my whole body. Kitty's heart rate has dropped since our visit with Dr. Beth two weeks earlier. This isn't good. the look on the nurse's face that the news is not good. She ushers us back to the emergency room cubicle, where an earnest young doctor shakes my hand and opens Kitty's chart. He seems to be a long way off, his voice tinny and low as he explains there's a problem with Kitty's EKG. The electrical impulses that initiate each heartbeat are coming from the wrong part of her heart, a sign that her body is stressed. She's also dehydrated, and her heart rate is too low, only thirty-five beats per minute. The number penetrates the gray fog that's descending over my whole body. Kitty's heart rate has dropped since our visit with Dr. Beth two weeks earlier. This isn't good.

"I'm going to admit her," says the doctor. He rubs his eyes as he speaks, as if the very sight of us makes him weary. I suppress the urge to apologize, barely, but it persists as I fill out the paperwork, as we wait for a bed to open upstairs, Kitty s.h.i.+vering in my arms now, fear s.h.i.+ning from her huge brown eyes.

By the time we're ushered upstairs to the pediatrics ward, the sun is rising, lightening the pale green walls, the hospital bed, the chair beside it. A nurse opens the door, taking us in with a professional flick of her eyes-Kitty, curled in a ball on the bed, her eyes closed; me pacing, my hair uncombed, my eyes red, literally wringing my hands. She sets to work, helping Kitty into a hospital gown and into bed, talking to her in a soothing voice as she inserts the IV line that will help rehydrate my daughter. Normally Kitty would put up a fuss; needles are the one thing she's scared of. But this morning she lies listlessly in bed, eyes closed. She's asleep by the time the line is in.

The nurse tidies up and leaves, the hospital door closing soundlessly behind her. I sit in the chair beside Kitty's bed and watch clear liquid drip into her arm. Her face is chalk-white; her jaw is clenched in sleep. I take one of her freezing hands between mine and hold it, trying to warm her with my own heat.

There's relief in being in the hospital, after the weeks of going it on our own. It's cool and clean, and, best of all, someone else is in charge. My job is to sit at Kitty's bedside and talk to the endless parade of residents and interns, who want to hear her history over and over: How tall is she, how much does she weigh, when did you notice a change in her eating, when did she lose weight? I tell them she lost only a couple of pounds. I tell them she was fine until two months ago. I tell them our family is not dysfunctional, that we are reasonably happy, that Kitty has never been abused.

Actually I don't tell them that. I want them to believe it, but I see that they don't. I watch their young, transparent faces as they make notes in Kitty's chart, notes I am not allowed to read but that no doubt say things like Mother in denial Mother in denial. I don't care. I'll accept any judgment they want to offer, if they will make my daughter well.

I don't get it yet. I still think someone can make my daughter well. That this is a process that will take days, that there's some incantation that will reverse the damage, turn back the clock, remove the curse, and that, like Sleeping Beauty, Kitty will open her eyes and be magically healed.

If only.

After twenty-four hours with the IV, Kitty is rehydrated, but her heart rate is still too low. She's too dizzy to sit up by herself; it takes two of us to help her to the bathroom. She hates the hospital meals, and I don't blame her. The kitchen sends up mountains of steamed broccoli, little cups of Jell-O, bowls of consomme, all of it unappetizing, none of it with enough calories to sustain a caterpillar.

Although she's not on call, Dr. Beth turns up at the hospital that first day, a Sunday, and spends hours talking to the doctors on the ward and sitting with Jamie and me. She is our lifeline, our reminder of the world of sanity and light. And so, late the next afternoon, when the resident tells me that Kitty's heart rate isn't coming up and he wants to transfer her to the ICU, it's Dr. Beth I call in a panic. As the nurses wheel Kitty's bed to the ICU, I trot along beside them, arguing. Isn't this a bit extreme? Aren't we overreacting just a little? Can't we give her more time? She's a reasonable girl. She's going to come around, I know it. The ICU is for people who are really, really sick, isn't it? My daughter's not that sick.

But of course, she is.

Jamie arrives in time to hear the doctor in charge of the ICU tell the nurse, "Get an NG tube."

"A what what?" I say.

The doc looks up, his eyes impatient. "A feeding tube," he says, drawing the word out as if he thinks I can't hear him. And maybe I can't. "It goes up her nose and into her stomach," he adds briskly. "We'll feed her that way if she won't eat."

"No, Mommy!" cries Kitty from the bed. "Not the tube! I want to be able to taste my food!"

It is a moment of the highest imaginable absurdity. I want to say, "But you're not eating anything now!" Later, I understand her reaction. The need to eat is hardwired into our brains and bodies. Anorexia can keep a person from eating, but it can't turn aside that primal force. Hunger denied expresses itself in other ways-in Kitty's case, in the compulsion to taste and savor every shred of food she consumed.

I bargain with the doctor. "Give her an hour," I beg. "If she eats something in an hour she doesn't need the tube."

The doctor raises an eyebrow. Clearly, he thinks I'm a deluded and interfering mother. Clearly, he doesn't believe Kitty will eat. But reluctantly he agrees that if she downs a whole protein milk shake in the next thirty minutes, and then then eats a plate of spaghetti an hour later, he will hold off on the tube. For tonight. eats a plate of spaghetti an hour later, he will hold off on the tube. For tonight.

The ICU nurse, who is the kindest person I have ever met, brings a chocolate protein milk shake and a straw. She helps Kitty sit up, arranges the pillows behind her, pulls a tray over, and puts the milk shake on it. Kitty reaches for the milk shake, holds it in one hand, lifts the straw to her lips. She's crying silently now, tears slipping over the sharp cliffs of her cheekbones. Her hands tremble. Her whole body trembles. For five minutes, ten minutes, fifteen minutes she sits, holding the milk shake and crying, while Jamie and I murmur encouragingly.

I have fed this child from the moment she was born. I have fed her not just with food but with love. The thought of a nurse, even this one, pus.h.i.+ng a bolus into her stomach through a tube makes me want to vomit. I try to arrange my face into a neutral expression. I try to be ready for the sight of the rubber tube threaded up my daughter's nose and down her throat.

But Kitty eats. One shaky, terrified bite at a time, crying steadily, she consumes the shake. Between bites she talks out loud to herself. She seems beyond caring that we can hear, or maybe she's so deep in her own nightmare that she doesn't know we're here. "Come on, Kitty, you can do it," she says. "You don't want to go back to that scary place." Jamie and I are crying now too, as we understand for the first time exactly how courageous our daughter is. Each time she lifts the spoon to her lips, her whole body shaking, she is jumping out of a plane at thirty thousand feet. Without a parachute.

Thirty minutes later exactly, Kitty finishes the milk shake. And an hour later she eats the plate of spaghetti, one agonized bite at a time. The nurses praise her extravagantly, rubbing her hands, her back. It's more than Kitty's eaten in days. Afterward she falls asleep. Jamie goes home to collect Emma from the friends who have been taking care of her. I sit in a chair beside Kitty's bed, exhausted but unable to sleep. Every time I start to nod off, Kitty's sunken, terrified eyes rise up before me. Seeing the shape of her ulna revealed against the white hospital sheet feels strangely p.o.r.nographic, like seeing part of someone's brain pulsing and exposed. It's a reminder of my daughter's vulnerability, and it feels unbearable, because there is nothing I can do to protect her from the thing that is eating away at her. And how ironic-she's being eaten alive, literally, by the fear of eating.

There is no privacy in the ICU; a gla.s.s wall separates us from the rest of the unit. I see the nurses filling out charts at the station, doctors hurrying back and forth. I see other parents with bloodshot eyes and ravaged faces. As night falls I sit, and I watch, and I wait for whatever will come next.

chapter two

Home Again, Home Again

Hunger is experienced not just in abdominal ache but as a heaviness in the limbs, a yearning in the mouth.

-DREW L LEDER, The Absent Body The Absent Body

Five days later, Kitty is discharged from the hospital. I'm anxious about bringing her home, because as awful as the hospital has been, at least we weren't alone with the anorexia there. It wasn't just Jamie and me at the kitchen table, locked in mortal combat with our starving daughter. Kitty's eating about a thousand calories a day now-not much, nowhere near enough, but probably twice as much as she was eating before the hospital. What will happen now that we're going home again? is discharged from the hospital. I'm anxious about bringing her home, because as awful as the hospital has been, at least we weren't alone with the anorexia there. It wasn't just Jamie and me at the kitchen table, locked in mortal combat with our starving daughter. Kitty's eating about a thousand calories a day now-not much, nowhere near enough, but probably twice as much as she was eating before the hospital. What will happen now that we're going home again?

On our way home we stop for groceries, the first of the nearly daily shopping runs we'll make over the next year. Kitty rests in the car with Jamie while I blow through the store at top speed. Just last week I wished I could shop without Kitty's intrusive presence. Be careful what you wish for. Be careful what you wish for.

As I steer the cart through the produce section, I'm reminded in a curious way of what it feels like to begin a diet: the special preparatory shopping trip, the sense of hopefulness undercut with past experiences of failure. The sense of wiping the slate clean. The feeling that this time, things will be different.

Will they, though? I want to believe Kitty's hospitalization will change things, though I don't, yet, understand how. I can't see my way from where we've been to where we need to go. And I'm a person who needs to be able to see the path ahead, to see what I'm up against and what I have to do, no matter how tough. Right now, not only is there no clear path, there's no suggestion of one-just a seemingly infinite slog through the darkness that has swallowed up our daughter.

If she was ill with something else-if she had diabetes, or pneumonia, or strep-her doctors would prescribe medicine, bed rest, fluids, and we would give her all those things. But this-this is like battling a many-headed monster in the dark. It's like fighting darkness itself, a darkness that is inside my daughter, that's somehow part of her. To fight it it feels like fighting feels like fighting her her.

Dr. Beth has explained to us that we need to increase Kitty's calories by about three hundred every couple of days. And that's why I'm here, to prepare for the battles that are coming. I rip up my shopping list and any concept of a budget and speed-walk down the aisles, piling the cart with cookies, Muenster cheese, alfredo sauce, ranch dressing, b.u.t.tery crackers, ice cream, potato chips, candy bars-all the foods Kitty used to love. Before anorexia, I didn't buy much processed, packaged food. I was a conscientious and health-conscious mother in twenty-first-century America, where we all understand the words healthy food healthy food to mean to mean low-fat, low-calorie food, and not too much of it low-fat, low-calorie food, and not too much of it. Standing in front of the Pepperidge Farm display now, I have the sense that the world as I know it is tipping, elongating, growing as strange as an image in a funhouse mirror. I grab an armful of Milanos and keep going.

At the far end of the store I stop at the shelves of high-protein and high-calorie supplements, which Kitty drank in the hospital with every meal. I tried one once; they taste nasty, a revolting c.o.c.ktail of chemicals and artificial flavors. But each Ensure Plus packs 350 calories, more than a quarter of Kitty's daily requirement right now, and Kitty has perfected a way to drink it: she holds her nose and pours it down in less than five seconds. I load the cart with chocolate-flavored Ensure Plus and move on.

Kitty's asleep in the backseat when we get home. As a toddler, the only way we could get her to nap was to drive her around until her eyes slid shut and her head drooped. Then we'd carry her into the house, car seat and all, tiptoeing so as not to wake her. Now Jamie unbuckles her seat belt, scoops her into his arms, and carries her upstairs to her room. He looks at me, and I know what he's thinking: it's been years since he could lift her this easily.

I call the friends who are keeping Emma today to let them know we're home and to talk to Emma, who says she's been invited for dinner and wants to stay. Over the last few weeks, she's found ways to avoid all of us as much as possible, and I don't blame her. Emma's world has been turned upside down. She's watched her sister suffer and starve and her parents morph from reasonably functional adults into obsessed, irritable wrecks. I wonder if we should send her to stay with my sister for a while, to get her out of the house. Not yet, I think. If things get really bad. Then I laugh to myself. How much worse can they get?

I tell Emma of course, we'll pick her up later, and then I take my time putting away the groceries. I stow the Ensure in the bas.e.m.e.nt pantry, tucking the small square bottles behind cans of chick-peas and lentil soup. Their sell-by dates read two years from now. Where, I wonder, will Kitty be then? Where will we all be?

On our first posthospital appointment with Dr. Beth, three days after Kitty comes home, she's still shaky and dizzy, but at least she can walk now, leaning on one of our shoulders. The nurse has her pee into a container in the bathroom and put on two hospital gowns, and then weighs her, standing her backward so she doesn't see her weight. appointment with Dr. Beth, three days after Kitty comes home, she's still shaky and dizzy, but at least she can walk now, leaning on one of our shoulders. The nurse has her pee into a container in the bathroom and put on two hospital gowns, and then weighs her, standing her backward so she doesn't see her weight.

Dr. Beth is gentle with Kitty when she comes in, taking her vitals, talking to her in the kind of low, soothing voice you might use with a frightened animal. After the exam, as Kitty is dressing, I ask the doctor what we should do next.

"I've never had a patient this sick before," she says, and I feel a now-familiar frisson of guilt run up my spine. Dr. Beth tells us that other families send their children to hospital inpatient units or residential clinics. The nearest clinic is at Rogers Memorial Hospital, an hour away. Lots of teens from our town wind up there, she says. On the plus side, Kitty would probably gain weight there. She'd be in competent hands. We'd have a breather, a break from the relentless drama and terror of anorexia.

On the other hand, says Dr. Beth, Kitty might learn to be a better anorexic at Rogers. I don't understand what she means.

"Right now, Kitty's being fairly straightforward with you," she explains. "But kids teach each other all the tricks in places like Rogers."

What tricks, I want to know. Dr. Beth ticks them off on her fingers: Water loading, the practice of guzzling dangerous amounts of water before a weigh-in. (That's why Kitty's urine is a.n.a.lyzed before weigh-in, to make sure it's not too diluted.) Sewing weights in their underwear. Making pessaries out of coins. Stuffing food in their cheeks at the table and then spitting it into a napkin when no one's looking.

I try to keep my face blank, but inside my head a voice is screaming No! No!

Not my daughter. Not Kitty, whose face, until recently, I could read like my own. Who can't bear the feeling of having done something wrong. Whose sense of right and wrong has always been overdeveloped-for years Jamie and I have been trying to break her of the habit of apologizing fifty times a day. Who still, until recently, left me little notes saying "I love you, Mommy." That Kitty would never do the things Dr. Beth describes. If we send her to Rogers, will that Kitty vanish forever?

Dr. Beth goes on. There are residential clinics all over the country; there's a place in Utah that's supposed to be very good, if you can get in.

Utah? Jamie and I look at each other. We don't know anything about eating disorders, but we know that Kitty needs us. And we need to be with her. She panics when we're out of her sight for more than a minute, and, at the moment, so do we. How can we send her to Utah? How can we send her anywhere?

"What if it's her best chance for recovery?" asks Dr. Beth.

That's the million-dollar question: What will give Kitty the best shot at recovery? Is a faraway clinic her only only chance? Are we irresponsible to want to keep her close? chance? Are we irresponsible to want to keep her close?

I'm a journalist; my usual coping mechanism is to gather information. I'd begun reading up on anorexia, and the statistics terrify me: A third of all anorexics stay sick forever. A third to about a half will truly recover. The rest stay on the brink of illness, living diminished lives: they have trouble keeping friends and holding down jobs; they cycle in and out of hospitals. They spend years on the outside looking in, unable to live fully or wholly.

That's not what I want for my daughter.

And there's no consensus on what true recovery means. Everything I read suggests that anorexia, like alcoholism or drug addiction, is a disease with no real cure, a disease you have to "manage," one day at a time, for the rest of your life. Once an anorexic, always an anorexic.

I refuse to believe that.

But I don't know what to to believe. I can't read the dozens of books and articles piling up on my desk. They paint such bleak portraits: Anorexics are dying for attention; their parents neglect their true needs, so they take drastic measures to get what they need. Or: Anorexics are dying for control; their parents are so dominating that controlling what they eat (or don't) is the only way they can express their normal adolescent need for autonomy. Or: Anorexics are conflicted about growing up and becoming s.e.xually mature, so they try to keep themselves small and childlike by starving. Choose A, B, or C-the message is the same: anorexics (and their families) are seriously f.u.c.ked up. believe. I can't read the dozens of books and articles piling up on my desk. They paint such bleak portraits: Anorexics are dying for attention; their parents neglect their true needs, so they take drastic measures to get what they need. Or: Anorexics are dying for control; their parents are so dominating that controlling what they eat (or don't) is the only way they can express their normal adolescent need for autonomy. Or: Anorexics are conflicted about growing up and becoming s.e.xually mature, so they try to keep themselves small and childlike by starving. Choose A, B, or C-the message is the same: anorexics (and their families) are seriously f.u.c.ked up.

Maybe I'm in denial, but our family doesn't seem particularly pathological. We've got our issues, like all families. I've had panic disorder since I was a child, which I manage through therapy and medication; Jamie grew up in an alcoholic family where emotional self-expression was not encouraged. We bicker sometimes. We're grumpy sometimes. We're far from perfect. Still, I don't recognize us or Kitty in the literature. Each time I read another chapter, another article, I feel worse, not better. Reading has become another exercise in self-flagellation, and I don't need any more of that, thank you very much.

And so I stop reading, and Jamie and I move through the hours in a stupor of barely suppressed terror and confusion. We're back in the same boat we were in before Kitty was hospitalized, only now she's eating a little more. The hospital scared her. It scared all of us. But I can see that it won't be enough.

Dr. Beth calls the day after our appointment with an idea: she's talked to the head of a new adolescent psychiatric hospital in town, and although the hospital doesn't treat eating disorders per se, the director has agreed to what's called a partial hospitalization. Kitty can spend eight hours a day at the hospital, going to cla.s.ses and group and individual therapy, but come home at night. It might be a good compromise.

The next afternoon, I help her into the car and we drive across town to see the hospital for ourselves. A storm breaks as we pull in, complete with thunder and lightning and pea-size hail, which pelts us on our dash from the parking lot to the building-a fitting demonstration of Sturm und Drang.

The receptionist buzzes open the front door; every door in the hospital, it turns out, is kept locked. We wait in a growing puddle for the therapist who will take us around. Dr. N. is young and friendly, greeting the teenagers we see as we walk slowly through the building. Most are oddly dressed-bathrobes over blue jeans, hair unbrushed, eyes dazed or combative or both. Kitty squeezes my hand and I squeeze back.

Dr. N. leads us to a small conference room for the intake interview. Kitty, she tells us, will come to the hospital at nine each morning and stay until five. She'll have individual and group therapy; the group will comprise other teens struggling with illnesses like depression and bipolar disorder. Kitty can also attend the hospital's "school." "Like right now," she says, turning to my daughter, "the eighth graders are learning about volcanoes and building birdhouses. You can sit in on a cla.s.s if you'd like."

Kitty physically recoils, and for the first time in weeks I feel like laughing. One of her long-standing complaints about school has always been the slow pace and endless busywork, especially in middle school. Spending the rest of the summer building birdhouses and learning about volcanoes is about the last thing she'd want to do.

Besides, the other kids here are really really messed up. Kitty's not like that. messed up. Kitty's not like that.

But isn't she? Isn't she, in some profound way, like the other teenagers, with their disoriented eyes and odd behaviors? Yes and no. Eating disorders affect a person's thinking and cognitive abilities, but only around certain subjects. Kitty can rattle off a quadratic equation, speak eloquently about World War II, play a violin solo. Her intelligence is unaffected by anorexia-until the subject of food or eating or body image comes up; then she'll eat two bites of turkey and spend an hour sobbing because she's eaten so much and she's going to get fat. When this happens, as it does every time she eats, I want to say, "Don't you get it? You need to eat or you'll die."

I'm only just starting to understand that she really doesn't doesn't get it. That her perceptions are genuinely out of whack. Much later, another therapist describes anorexia to me as a kind of "encapsulated psychosis": someone with anorexia suffers under a set of delusions just as powerful as the delusions of a schizophrenic-but only when it comes to food, eating, and body image. get it. That her perceptions are genuinely out of whack. Much later, another therapist describes anorexia to me as a kind of "encapsulated psychosis": someone with anorexia suffers under a set of delusions just as powerful as the delusions of a schizophrenic-but only when it comes to food, eating, and body image.

Dr. Walter Kaye, director of the Eating Disorders Program at the University of CaliforniaSan Diego and one of the leading researchers on the biology of eating disorders, once found a way to make this dissonance clear to his students. He invited two anorexic women to cla.s.s and asked one of them to describe how much she weighed and how she looked. The woman said that she weighed seventy pounds and that she looked fat. Then he asked her to describe the other woman. "She said, 'She looks terrible; she's so thin; she looks like she's going to die,'" Kaye tells me. "And I said, 'But look, you're seventy pounds and she's seventy pounds and you're the same height. How do you put this together saying you're too fat and she's too thin?' And she just looked at me and said, 'I don't know, but I feel too fat.'"*

That's how Kitty feels too.

Dr. N., meanwhile, is talking about rules. There seem to be a lot of them, especially with regard to eating. Kitty will eat breakfast and lunch here, so we all have to know, for instance, that no long sleeves are allowed at the table. "Sometimes they hide food there," she says matter-of-factly.

They? I think. There aren't any other eating-disordered children here. Who is she talking about? I think. There aren't any other eating-disordered children here. Who is she talking about?

"No clothes with drawstrings," continues Dr. N., ticking off points on her fingers. She eyes my daughter's shoulder-length hair. "She'll have to cut her hair or pull it back." So they can't hide food in their bangs? So they can't hide food in their bangs? I wonder. I wonder.