It was bizarre to watch someone, who only months earlier had regularly sat at the table eating normally, enjoying conversation, suddenly slip away to her room whenever there was a family meal on the table, taking her own tiny portions of a very small list of acceptable (non-caloric) foods to her room.
The closest thing I can compare it to is a drug or drinking habit. We saw the paraphernalia of self-abuse -- the little plates, the empty bags of frozen corn, the wrapper for a bunch of celery, the empty can of fat-free tomato sauce. What we didn't see was anything substantial being consumed.
But with treatment, my daughter was back to a marginally healthy 120 pounds six weeks after she walked off that plane. She got a part-time job and began taking a couple of college courses as a general studies student. She was in therapy, seeing a psychologist who specialized in anorexia and bulimia. Things seemed to be improving. She even made arrangements to transfer to another college closer to home for the fall term. As my daughter approached a healthier weight, I started being able to sleep again and to be able to concentrate on my work.
But over the summer we could see that things were not resolved. Our daughter was still eating like a dieter, though she was managing, with careful monitoring, to maintain her weight at between 120 and 125 pounds. But she was morose much of the time, rarely seemed enthusiastic about anything, and kept talking about being nervous about things she had never before worried about, like how she'd do in her courses in the fall. Any comment from us about her eating habits would lead to accusations that we didn't trust her, or complaints that we were making her feel that she was a "disease," not a person.
Still, if she hadn't yet reached an understanding as to why she had fallen into this problem, we felt confident that she at least had a grip on her disorder, that she knew how to control her impulse to starve herself.
We were cautiously optimistic when we sent her off to school again this past fall. Her therapist agreed that she was much improved. He felt she needed to get off on her own again so that she could gain the sense of being an adult, in charge of her own life.
This time, however, we vowed to stay in close touch with her. She was only a few hours' drive away, and we decided we'd make frequent visits -- at least once a month.
She promised to make regular use of the school's health services, which we'd been assured included a resident psychiatrist, several staff psychologists, and a nutritionist, all of whom specialized in eating disorders (an epidemic at American colleges, we were told by school officials). In addition, she agreed to get weighed weekly at the heath services office.
After a few weeks, reports from our daughter were basically good, but she said she was "having trouble" getting an appointment with the psychologist. All the available hours, it seemed, conflicted with her course schedule. She was eating, she assured us, but she didn't tell us her weight. I see now that we should have known better at that point than to trust her to take care of herself. (As we have subsequently learned, anorexia, like drug addiction, involves a good deal of deception.)
Four weeks into the semester, she called one evening. Her boyfriend had insisted that she tell us to come get her immediately. When I leapt into the car the next morning, I didn't know quite what to expect. What I found was worse than I could have imagined: a skeletal girl of just 90 pounds who could barely lift anything to help me move her out of her dorm room.
"How could you have done this to yourself?" I asked on the ride home. "Why didn't you go to the health service for help?" Obviously frightened at what had happened to her, she said, "I kept thinking I could fix it before going to see them. I was afraid that they'd send me home if they saw how much weight I'd lost. I was afraid you'd be angry at me."
Why hadn't she eaten for the five weeks she had been away? "Everything was just so stressful," she answered vaguely. She had been doing well in her classes and liked her work-study job. I did notice, however, that she didn't seem to have any friends she needed to say goodbye to as she moved out.
We've learned over this terrible year what many others who have endured this hell learned before us: That anorexia is not usually about being thin; it's about control. Contrary to a commonly held belief among the dwindling number of Americans who have not been touched by the disease, young people who fall into the grip of anorexia (15 percent of anorexics die of the ailment) are not, for the most part, trying to look like some magazine icon; they're trying to assert some control over a life that they feel is not really theirs. In our daughter's case, it seems she was reacting to a situation of being in a society -- school -- not of her own choosing. At least part of her not eating may simply have been a way of avoiding having to be in a social situation -- a student cafeteria -- that she found uncomfortable.
There is often an element of depression in anorexia, and also, as in our daughter's case, of obsessive-compulsive behavior. There was the apparent inability to get enthusiastic about anything. And there were the lists she made. She would plan every detail of her day on paper.
It was back to the hospital for my daughter, this time as an in-patient. She was clearly suffering from bone loss and, worse, was putting her heart and other vital organs at risk. It was urgent that she gain back some weight, and quickly.