Health

Hey you all.
I’m not sure how rigidly computer access will be restricted while I’m in treatment, so I wanted to post before I leave. I think a good thing to post now would be my goals because then I can look back and see if I have fulfilled them. I also think these goals are worthy of anyone’s efforts, regardless of whether or not you have any eating problems.
TOP TEN GOALS (in no particular order)
1. Follow the program without trying to compromise with ED; i.e., during menu planning, instead of counting calories, pick what you’d most enjoy.
2. Form friendships with other girls and look beyond competition regarding shape and size or who is the thinnest.
3. To be HAPPY about reaching a healthy weight! That’s the toughest one.
4. Leave prepared to eat in a carefree, non-restrictive way, including “fun foods” (desserts, soda, etc.–basically everything I won’t eat now).
5. Leave with a mindset in which eating, exercising, wardrobe, and talk of food or dieting are not major sources of anxiety or obesession.
6. Fully committ myself to recovery by taking any desires to lose weight, starve, purge, or other ED thoughts with not even a grain of sand (or is it a grain of salt? What’s the expression?)
7. Stay in touch with at least a few close friends.
8. Become a less obsessive and anxious person in general and be less judgmental and nagative toward myself; improve confidence and self-esteem.
9. Alright, this sounds kind of heavy, but to become more spiritually attuned. I’ve noticed that this naturally goes with recovery. When I’m not so consumed with weight and food I can reflect on what really matters to me in life and who I am in the context of the world. I have also noticed that once I have a more positive aura I am more creative and more able to connect with other people.
10. What should my last goal be? I think ultimately to change the wiring in my brain my replacing self-harming and mean thoughts with loving and encouraging ones. This way, instead of getting myself down for eating a “fun food,” I can actually feel good about it. Also, if I change the way I percieve my own thoughts and feelings I can start to feel hunger again, and then I won’t have to follow a meal plan or obsess about servings because I will know what I need to eat.
That’s all for now. Wish me luck.

I have been debating for days over what to write. I started writing something, but today I am aware that, ironically, my eating disorder has kept me from writing about eating disorders. It is a complete distraction and emotional drainer. I am disappointed in myself for having gone backward and feel like I am letting down all of you who have supported me, but all I can write about right now is my personal story.
A few weeks ago I was getting ready for my school’s senior brunch when my mom came into my room with a tear in her eye. I was not expecting it. She simply said, “That dress used to fit you. Now it’s barely hanging on you. I think you should take that to heart.” Of course, I denied that I was the least bit underweight. Then my dad confronted me about how he had seen me restricting foods, especially high-fat foods and carbohydrates, and knew that I had been coming up with any excuse possible to go on a long walk. They were very upset that after going so far after day treatment I had ended up here again. I became overwhelmed as I, relieved by the weight I had lost and convinced that my stomach stuck out, heard my parents say they were taking control of my eating again and watched them plop a blueberry scone on my plate, which I had picked out at the store to appease my mom but hadn’t eaten. I was terrified that all the work I spent losing the weight would be for nothing, even though the logical side of me knew all along that it wouldn’t get me anywhere positive. I also dreaded the feeling I get when I gain weight—the feeling of being worthless, fat, and ugly. It’s something I have tried to get past over and over again. People say I have always been on the thin side but all I see is my impossibly large stomach and it makes me cry and have panic attacks and lose my sanity. I am such a mess.
My visit to the nutritionist that week confirmed I had lost weight. I had two weeks to meet my weight goal, or I would have to go back into a day or residential treatment. My therapist came up with a contract I would have to follow in order to stay home this summer and go to college in the fall. The idea of eating foods other than vegetables, chicken, and low fat yogurt shocked my addled, malnourished mind. I also felt very depressed because of the situation I had gotten my family and myself into. I realized my eating disorder had made me into someone I disliked; someone who cared more about how she measured up on the scale than how she came off to other people. I had gone to the prom several days before, and despite meeting my goal of losing five pounds, I felt unsatisfied and empty. Looking skinny in my dress seemed like the best part of the night. And that is sad. I also won five awards when I graduated, but I knew that the perfectionism and competitiveness that had caused me to excel academically would ultimately lead to my destruction if I didn’t act soon.
I lay on the steaming bricks on my backyard, staring at the roses, remembering how beautiful they once looked through eyes without eating disorder lenses. My obsession with losing weight had consumed me so much that little else mattered. I was thinking about food so constantly that I couldn’t take the time to just relax and enjoy life or celebrate my accomplishments. I was never happy because I was never thin enough. I looked up at the sky and for once enjoyed the peace of just being outside in nature and becoming part of its calming silence and stillness. “This is summer,” the rational voice inside of me said. “It’s supposed to be fun and carefree. Now you’re only miserable. What are you doing with your life?” That voice had not surfaced in a very long time.
Later that night, still sulking in my misery and defeat, I practiced driving with my dad. The strength inside of me knew I had to act now to regain my life, no matter what Ed was telling me. Despite Ed’s screams and protests, as we got into town, I asked my dad if he had any money. “I want to get an ice cream cone at Baskin Robbins,” I said with tears streaming down my face. “It’s the last thing in the world I want to do right now, but I have to keep pushing forward.” That was probably the hardest thing for me to do at that moment, but at the same time there was a sense of relief, a feeling that I could trust myself to salvage my own life. And you know what? Eating that ice cream cone outweighed all my academic awards put together. It was my proudest, most difficult accomplishment by far.
Once I started acting with my goals of getting a summer job, seeing my friends, going to college, and regaining my happiness in mind, things got easier. Over the next few days, an ice cream cone gave way to a brownie, a blondie, strawberry shortcake, and other foods I wouldn’t have dreamed of eating. I felt very scared of gaining weight, but I also felt free. Anorexia was not controlling my mind and or my actions. I was.
Unfortunately, I can’t say that’s the end of the story. Despite the level of determination I had, it wasn’t enough to get me through the week and gain any appreciable amount of weight. In fact, when my nutritionist visit showed the little progress I had made, I completely freaked out and vowed to lose weight. The torment I felt was unspeakable. I felt like a failure, a slob. I would be fat. “How could you give up like that, Suzy?!?” Ed screamed. “You have no discipline! You are a failure in life! Are you just going to throw away your opportunity to be thin? I worked so had for you, and this is how you repay me? Look how much your stomach sticks out. And you have such a big butt. You’re worthless. I hate you.”
I should have told Ed right then and there that if I had a big butt, he could kiss it. But “should” does not always equal “did.” In fact, before my two-week mark was up, it became very clear to all of us that I would need the support of a residential program. The truth is that I was barely managing to stay medically safe with my parents breathing over my shoulder, telling me when and what to eat. How could I survive college without the necessary tools?
On the one hand, I realize what I really need to do is to summon the determination I had when I ate that ice cream cone, grit my teeth, and do what I have to do. On the other hand, I also know I am too weak to handle the depressed and anxious feelings that come with this task without extra support. If I were able to kick off this eating disorder, I would have done it years ago. But here I was, going around in circles, convincing myself I could fight it and then slipping back into old patterns.
The differences between treatment at home and treatment in a residential facility are the following: 1) As an inpatient, you are constantly around people who understand your struggle and support you. At Renfrew in Philadelphia, the facility I am going to, each day is filled up with different types of group therapy. I agree with their philosophy that we can heal through positive relationships—with others, with ourselves, with food. 2) Having parents as meal coaches adds a lot of emotional baggage for the whole family. My parents grow emotionally exhausted, and mealtime becomes a power struggle. They grow extremely frustrated on the battlefield of the kitchen table. 3) Closer monitoring and more accurate measurement of weight, food intake, bathroom visits, exercise, use of pills and other weight-control methods, other medical conditions, and emotional state. 4) The earliest form of treatment of anorexia nervosa was to have the patient literally go on a vacation away from her family to regain her health. An inpatient facility mimics this approach; it clears out all commitments and has the patient spend a month—or however long she is there—completely focused on getting better. It also, as I said earlier, eliminates the emotional baggage related to family life that may contribute to eating problems.
I know it will be hard to be at Renfrew and to gain weight. But I also want to come out free of this burden that keeps me up at night and sucks the life out of every day. I want to lower the volume on the voice in my head that chants, from the moment I wake up to the second I fall asleep and then throughout my dreams, “You’re too fat. You need to lose weight. Do whatever it takes. Lie. Trick Mom and Dad. You must be thinner. If you disobey me you will never be good enough.” My psychiatrist says this is a good choice for me because I am not able to do this on my own, but I am motivated to recover.
If you have an eating disorder, it will tell you that it will make you happy and in control. It may live up to this promise for a while, but trust me—after several years, it will only have screwed up your life. I remember there used to be so much joy on camp visiting day. I would be ecstatic and energetic and overjoyed to see my parents. We would go out for the best meals and walk around and enjoy one another’s company. Yesterday, my dad reminding me of last year’s visiting day. My starving and purging had left me fuzzy-headed, irritable, and depressed, and all I could think of was how “fat” I had become. In turn, it just made my family depressed to see that, not only had I lost weight, but I was also clearly following a restrictive diet and obsessed with controlling my food intake. All of our thoughts were so consumed with these ugly truths that we didn’t enjoy the day one bit. My size was so far to the forefront of my mind that my family’s visit didn’t mean anything to me. I put on a smile to show everyone else, but I wasn’t fooling my own heart: I had become cold and indifferent.
This is why I am so desperate to get better. It will be such a waste if somebody with my talents and abilities has to spend her life consumed with an eating disorder—and I’m not being conceited; that’s true for anybody. It will make you feel good temporarily, but ultimately, you have to ask yourself, “Do I like the person I have become, and do I like the life I’m living?” Then, you have to realize that, regardless of your situation, you don’t have to live in a way that doesn’t make you happy. You have the choice, and you can act on it, whatever that means to you. Ed is like those mean girls in junior high: his words only have an impact on you if you let them. Don’t give him that power. If you’re like me and you already have given it to him, strive to take it back and regain your life–whatever it takes.

I’m glad that I have gotten a lot of great feedback from my blogs. Thanks to everyone who contributed. I was especially stricken by what someone named Breanne wrote as a response to my most recent blog. She wrote, “I think that these problems with people is mostly to get attention. Why else would they stave themselves or binge after eating. If they truly wanted to lose weight they could work out and do it the healthy way, but they take it to the extreme and think it is the only way out. Then they get put in the hospital. Girls these days are pressured a lot to look good but there are other ways of going about ‘losing weight’ if that’s all they want.”

I can only tell my story, but what I do know is that nobody in my situation asked for her eating disorder. It’s extremely important to understand that an eating disorder is a disease, not a choice. A crucial part in anyone’s recovery is to separate one’s own thoughts from eating disorder thoughts. Even those who are so brainwashed by Ed that they go on pro-ana/mia websites do not, in their heart of hearts, want to have eating disorders. We all have more profound dreams and goals for the future. Trust me–if I could magically get rid of my body dysmorphia, addiction to food withholding, low self-esteem, health problems, and the tremendous effect my illness has had on my family, I would give them up in a heartbeat—no questions asked! My friend describes it perfectly: “Its not cool and its not fun.” She adds, “Its embarrassing, and it makes college life very difficult. I can remember everyone else having so much fun in the dining hall, and I’d sit there with my black coffee and apple, barely able to bring myself to speak or chew. “ As you can see, having an eating disorder is a complete burden (I mentioned before that people who have to deal with eating disorders have a shockingly high suicide rate). It’s not an issue of vanity. It’s far worse and more serious than being selfish or shallow. I can’t tell you what exactly causes an eating disorder, but I do know that people who develop them later realize that they use them as coping mechanisms—in other words, it’s not actually about food.

As the individual becomes more entrenched in her eating disorder, her ability to resist it worsens because of its devastating physical affects. Many anorexics get to a point at which they just cannot get themselves to eat, no matter how much they want to save their lives. The girl I quoted above confessed to me that she wishes she were at a healthy weight so that she was strong enough to kick off her anorexia rather than let it back her into a corner. She has so much anxiety about eating and not exercising that she cannot normalize her behaviors on her own.

I too have experienced a period of panic in which Ed’s voice is so loud I feel utterly powerless in standing up to him. I want to say, “Go away, Ed! I don’t need you!” but I am too weak; if you want to use the kicking analogy, my leg is not powerful enough to knock Ed down. This is especially true for anorexics who are malnourished, and therefore too weak, physically and emotionally, to fight back.

As Breanne points out, if people with eating disorders simply wanted to lose weight, they would not go to such extremes as described above. The truth is that eating disorders are about so much more than weight. They reflect different issues for different people. Most have histories of depression or anxiety. Many feel that they are not “good enough” and use weight loss to compensate for their low self-esteem. Some are neglected by their parents and latch onto their eating disorders once they realize how much attention it brings them. But no one wakes up one day and thinks, “I don’t think I’m good enough, so I’m going to become anorexic,” or “I wish I had more attention so I think I’ll be bulimic now.” I mean, think about it—there are MUCH, MUCH better ways to get attention!! I have been through an eating disorder, so I can attest to how torturous it is for the person inflicted. Nobody would willingly put themselves through so much torment.

First of all, having an eating disorder means giving up your freedom. Ed doesn’t only take over your mealtimes—he fills every single part of your life with nonstop chatter about how much you eat or how fat you are. This was not the result I had in mind when I began to diet! I can’t remember a family vacation that I actually enjoyed in years because I had so much anxiety about the next meal. I want so, so badly to be able to eat and enjoy food like all my friends do and to actually respond to hunger instead of starving. The moment I move toward the food, though, my anxiety overwhelms me, and it’s so hard to get myself to stop restricting, even though I want to. The times I do succeed, I usually go through withdrawal, which makes my pain so unbearable that I can’t deal with the cessation of my eating disorder behaviors. It’s not fun.

Second of all, it messes with your mind. The eating disorder’s ultimate goal, as my psychiatrist says, is to kill you, and it will go to any lengths to deceive you into thinking it is your friend. Imagine being unable to think with a logical part of your brain. That’s what it is like. Trying to tell an eating disordered individual he or she is not fat or doesn’t need to restrict, binge, or purge, is like telling a paranoid he is not being followed, or telling someone with OCD that she doesn’t have to wash her hands compulsively. It’s a mental illness, not something you can control or wish away. People often say anorexics try to be in control, but their disease controls them, and that’s true. Most recovering anorexics want to eat normally, but the anorexia deceives you and says things like, “If you eat that cookie it will hinder your recovery because you could develop binge eating disorder,” or “That’s a normal, healthy portion size” (when it’s actually too small) or “Just because you’re trying to gain weight doesn’t mean you should eat fatty, sugary, or salty foods. They will damage your health.” Until I learned otherwise, these were the guidelines I went by because I didn’t recognize this voice as ED—I thought these were healthy thoughts, and that following them was in my best interest if I wanted to recover. When I first was diagnosed, I 100% wanted to recover, but sometimes I displayed old behaviors because Ed was disguising himself as a healthy voice instructing me to become healthier.

Third, it’s an addiction—like an addiction to drugs or tobacco. I remember when I first stopped making myself throw up because my psychiatrist informed me that purging makes people gain, not lose, weight (if you purge, try stopping now because not only does it screw with your body, it also slows down your metabolism—I lost weight when I stopped). The first few weeks were hell as I went through withdrawal. Because of the way an anorexic has conditioned herself to respond to certain behaviors, activities like purging release endorphins and provide a sense of comfort. Even though it is slowly destroying your body, your mind grows very dependent on it to stay sane. When I stopped, I experienced such magnified depression, anxiety, and body dysmorphia that I became suicidal. I certainly didn’t ask for that. The truth was that the more I purged, the louder Ed’s voice got. He told me that if I didn’t throw up, I would gain weight. After every meal, he screamed at me, saying that I would become a big fat pig. I certainly did not choose that either. It’s not cool.

Breanne, you are right—people with eating disorders do not simply want to lose weight; they have a variety of psychological complications that lead them to struggle with food. But they do not choose their eating disorders. Or, in the rare case that somebody actually aspires to have an eating disorder, he or she is not actually aware of what an eating disorder is and the pain it entails. These people only see the glamour, which is nonexistent once you have to drop your activities and schoolwork and end up in a hospital. I just want everyone to know that people with eating disorders do not find their thoughts and behaviors fun or cool—they find them painful, oppressive, and burdensome. And for those of you who envy people who achieve extreme weight loss, you would probably think otherwise if you had been at the table with me watching stick-thin girls with tears in their eyes as they lift forks up to their mouths in a desperate struggle to force themselves to do what is necessary to keep them alive and off of a feeding tube. These experiences are neither fun nor cool.

As the years have gone by, the diagnosis of eating disorders has gotten more and more complicated because new ones keep popping up. There are still the three basics: anorexia nervosa, bulimia nervosa, and binge eating, but the most common diagnosis is EDNOS (Eating Disorder Not Otherwise Specified). This can be somebody who practices abnormal eating behaviors that are not in the diagnosis of any of the other three conditions, or somebody who has some but not all symptoms of anorexia, bulimia, or binge eating. Although some people who diet in unhealthy ways may overlap with eating disordered individuals in symptoms, such as restricting and then binging or false belief that one is overweight, they do not necessarily have eating disorders—this is often referred to as “disordered eating.” In the following list I will further explain each condition.

Anorexia Nervosa

In order to meet the diagnosis for this disease, one must exhibit: Refusal to maintain a weight over 85% of recommended body weight; intense fear of becoming fat or gaining weight; distorted view of body shape and size; loss of menstrual cycle for at least 3 consecutive months. There are two types: the restricting type, including those who lose weight simply by restricting food intake, and the binging/purging type, consisting of people who display the characteristics of anorexia and also either binge or engage in “purging” activities like vomiting, use of laxatives, or excessive exercising. Although it is very common for anorexics to induce vomiting in order to get rid of food they have consumed, this is different and separate from bulimia (for bulimia diagnosis, see below).

It should also be noted that while restriction of certain types of food, severe restriction of food, excessive exercise, drastic weight loss, excessive exercise, eating and dieting rituals, preoccupation with and distress over body weight and shape to the point of withdrawal from other activities are very common characteristics of anorexics, one does not have to display either of these to be diagnosed with the disease (the only characteristics required are those listed above).

I emphasized this because I was surprised to learn that fasting was not necessarily a characteristic of anorexia. I learned this when I told my psychiatrist I didn’t think I was ever anorexic because I rarely skipped meals. He informed me that the amount of food eaten is not part of the diagnostic criteria. One of his patients, in fact, had the same seemingly harmless ritual each day: a bagel for breakfast, a 6-inch sub for lunch, and pizza for dinner. Given her body type and physical activity, this was not enough to maintain her weight, and she met all the criteria for anorexia.

Anorexia has an extremely extensive history, although there is much debate about when the official disease anorexia nervosa originated. During the Middle Ages, there was a condition called anorexia mirabilis in which a girl or woman, such as Catherine of Sienna, claimed that their ability to go without eating was an indication of divine privilege and spiritual power. This phenomenon lasted through the 19^th century, until people stopped believing in the religious implications of this behavior, and furthermore, scientists proved that although these women severely restricted their food intake, they did not survive entirely on God’s divine love as they had claimed. The term anorexia nervosa was coined in the early 20^th century when doctors noticed anorexia (which means lack of appetite) linked to no other condition, such as digestive problems or mental illness. Those with this new disease severely restricted their food take solely because they experienced discomfort around food. Since then, there has been a growth in diagnosed anorexics, especially in the past few decades, almost one quarter of whom are male, which defies the stereotype that eating disorders are “girls’ diseases.”

Treatment includes giving parents total control over the child’s meals and insisting that they must eat or else be hospitalized (known as the Maudsley Method), taking in a high calorie diet, nutritional counseling, cognitive behavioral therapy (a fancy term for therapy), psychiatric counseling if needed, and in severe cases, hospitalization and/or tube feeding. Even so, about one tenth of anorexics die because of complications related to anorexia nervosa or suicide, which attests to how difficult it is to live with this disease.

Bulimia Nervosa

Bulimia is characterized by consumption of an abnormally large amount of food in a short period of time followed by some purging activity, such as self-induced vomiting, use of laxatives, diuretics, enemas, excessive exercise (often known as “exercise bulimia”), or fasting. These individuals evaluate themselves largely based on their body weight and size.

Bulimics are different from anorexics in that, although many anorexics exhibit binging and/or purging behavior, this behavior occurs more recurrently in bulimics. Bulimics often restrict food intake like anorexics do but then shortly follow these dieting periods with a binge-purge episode. Anorexia and bulimia each inflict 1-4% of the population.

Bulimic practices also date back many years. In ancient Rome, there was even a room called the vomitorium in feast halls. It was common practice for guests to eat huge amounts of food and then vomit it out before their next course (if you think I’m making this up, google it). It was also a regular ritual for members of this society to eat copious amounts of food one night and then fast for several days.

Although I am not a bulimic, I can attest that purging behaviors bulimics and some anorexics engage in are as ugly as they sound.

Treatment is similar to that of anorexia nervosa. In severe cases, the individual is taken to a hospital, where he/she is re-hydrated and given supervised meals. Some facilities monitor showers and bathroom visits; others simply force patients to wait a certain period of time after meals before using the bathroom. The Maudsley Method described earlier also applies to bulimic cases. Usually, parents’ normalizing their children’s eating and eliminating dieting rituals decreases the desire to binge and purge. Although bulimia is not as deadly or as noticeable as anorexia (bulimics are usually at normal weights), it brings about severe health complications that can lead to death.

Binge Eating Disorder

The most common of clinical eating disorders, binge eating disorder is characterized by consumption of excessive amounts of food in short periods of time and a feeling of being out of control of one’s eating. Again, many individuals with other disorders exhibit behaviors associated with Binge Eating Disorder, but not as frequently and usually combined with other behaviors. The binge eating is often overweight and often has low self-esteem and uses food to cope with emotional problems. Clearly, this disease has significant medical consequences because it can bring on obesity and the complications that arise because of it. I should emphasize, though, that any eating disorder has, in addition to medical consequences, severe psychological ones like obsession with food, inability to concentrate, body dysmorphia, intense self-loathing, and social withdrawal.

Binge eating disorder in children can also be treated with the Maudsley approach. Normalizing eating often decreases the desire to binge. Many binge eaters work through their problems on their own through therapy, seeing dieticians, and exercising and decreasing food intake in order to lose weight. Others don’t. Some go too far the other way and become anorexic or bulimic.

Parents should know that, although they may be concerned about their children’s weight, giving them restricted access to food and pushing “healthy” foods while prohibiting “junk” foods is actually harmful, not helpful. This approach does not decrease a child’s desire to eat “unhealthy” foods. Furthermore, it makes these foods something they turn to for emotional reasons because it is “special” or “prohibited” and because of this can lead to binge eating disorder (or any other disorder).

Eating Disorder Not Otherwise Specified (EDNOS)

Although not specified in the DSM (Diagnostic and Statistic Manual), EDNOS is the most common eating disorder and requires treatment just like the other ones. Some EDNOS patients have begun developing anorexia or bulimia, or have some symptoms, but do not fit all the criteria. Some fit certain criteria from each of the three main eating disorders but do not fit one exactly. Others display entirely different symptoms from a classical anorexic, bulimic, or binge eater. For example, some habitually chew food and then secretively spit it out. One girl I was in treatment with had significant trouble eating solid food because she was afraid of choking, although ingesting high-calorie liquids, soup, or other “less dangerous” foods like ice cream did not faze her. Often, an EDNOS patient is one who has partially recovered from an eating disorder but still meets some criteria. For example, I have restored most of my lost weight and regained my period, but still struggle with the desire to go back to my old behaviors and exhibit the other diagnostic criteria for anorexia (intense fear of becoming fat or gaining weight; distorted view of body shape and size).

Eating disorders are varied and complex, and it is important not to get too caught up in the specific diagnosis and instead focus on treatment. Whatever the physical consequences, all these disorders have severe mental and emotional ones. If one catches the eating disorder while it is first developing and still in the EDNOS stage, this is an advantage, but the person still must undergo one or several of the types of the treatment listed in order to halt the eating disorder before it entirely consumes his or her life (if it hasn’t already).

Despite the length of this article, there is much left unsaid, but this should provide you with a few basic ideas.

A girl recently wondered out loud what people did in an inpatient or day-long program for anorexia or bulimia. I thought for a long time about how I would describe the whole experience to someone. It was the most educational and intense three weeks of my life, and this is what it is.

It’s difficult, and it’s rewarding. It’s depressing, and it’s elating. It’s smiling, and it’s frowning. It’s looking in the hospital window and hating your stomach for being so huge, but also occasionally believing that you wouldn’t be here if overweight were your problem. It’s struggles and tears, staring down at your plate unable to believe you can eat all that. It’s staring down a seemingly bottomless bottle of Ensure and picturing your head on the body of a pig. It’s sometimes sneaking to the bathroom to throw up your meal after saying you have to “call your parents” or something, but it’s usually hanging in there and staying still and knowing you were strong enough to keep the food in your stomach, as uncomfortable as it seems. It’s feeling a comforting, uplifting rush of nutrients to your brain after you get some fat in your diet after months of fat-free living.

If you work hard enough, it’s usually also horrible, nasty fights with your parents (pretty much as bad as it gets if you’re me). It’s ignorant psychiatrists and annoying nurses who misdiagnose you and try to put you on unnecessary medication and baby you to the point that you really just want to smack on of them right in the middle of her snaggle tooth—but instead you just vent to the other people in the program because most likely they feel the same way.

At the same time, it’s intelligent, respectful, and wise staff who will come in just to give you advice about spending time in nature and reading and self-soothing techniques and believing in yourself, and even read you Dr. Seuss’s “Oh the places you’ll go.” It’s therapists who point out flaws in yourself that you haven’t seen before. It’s friends who support you in ways only possible when people can read one another’s minds. It’s patients who finish one another’s sentences. It’s girls who collectively agree that they will gain ten pounds after eating a cookie and then laugh out loud at their ludicrous but real consensus.

It’s having to tell your teachers and friends why you are missing so much school. It’s being so behind in chemistry that you have to go to extra help every day for two weeks to catch up. It’s returning to your small school and knowing that everybody knows where you were, but then seeing their smiling and welcoming faces.

It is watching eleven-year-olds with eating phobias that they cannot understand, that nobody can really understand, and feeling sorry for them at first but then just simply growing tired of the ones who constantly complain because you all are going through the same thing and you have to try to keep your cool.

It is when your eyes fill up with tears as the girl across from you in therapy talks about her dream to become a pediatrician, or her experience at the art school she had to drop out of, or her vision of herself as a cat who falls out of a tree and gets back on her feet. It is praying that your friends will keep their balance, or at least land on their feet after they fall.

It is watching your weight increase and feeling helpless, knowing that whatever you lose you’ll just have to gain back. It is crying but it is also laughing. It is the time you peed in the cup and put on your hospital gown to get weighed and then heard there was a fire drill and had to wait in the day room in your hospital gown holding your cup of pee for half an hour while watching ABC News until it was declared “safe” to resume your activities.

It’s having to deal with girls who are thinner than you, and not wanting to go back after your first day when another patient makes the comment, “You don’t look very underweight.”

It is witnessing at least one person completely lose it every Wednesday, the dreaded “pizza day.” It is watching your friend surreptitiously throw cheese on the floor and wishing she could be as rational and sane at meal times as she is the rest of the time.

It is watching You, Me, and Dupree or doing “music therapy” (there’s another funny story attached to that . . .) or drawing in your sketchbook with the other patients during breaks. It is helping a younger girl with her chemistry homework at ten o’clock every morning and feeling really good when she says, “I finally get it.” It is drawing a picture of Miley Cyrus of another younger girl and watching her pride as she hangs it in her room.

It is going home and venting to your parents about how gross you feel after eating ice cream, or perhaps how strong you feel, all depending on your mood. It is petting your cat for comfort and trying to concentrate on his serene and mesmerizing purring and not your own thoughts.

It is being discharged and having the other girls hug you and say they don’t want you to leave. It is not wanting to leave yourself, but also knowing you need to get back into the real world. It is ultimately recognizing that you don’t want to be stuck in the shadows of this disorder, and that there is no shame in moving on. It is actually wanting the emotional and physical comfort and strength that your new, proper eating regimen brings you. It is feeling fat and looking around and knowing you’re not the only one, but also realizing that if you let this thought define your actions, you are being weak, not strong. It is learning that it doesn’t take discipline to give into a disorder; it doesn’t make you a failure to succumb to the temptations of food. Instead, you are strong for doing what you think you cannot do; disciplined for being able to regain your health.

It is finally understanding that if you keep your old ways and old goals, you have entered into a contest you can’t win. It is observing that there are no “best anorexics” except those who are dead, and that even those who get so thin they die don’t feel successful. It is being able to say that the glimmering prize of total control and happiness awaiting you at the end of a never-ending marathon of obsessing, restricting, exercising, and purging is a mirage. It is acknowledging that, in this one case, the only way to win is to quit the race. The only way to say “yes” to yourself is to say “no” to this disorder. The only way to get ahead is to walk straight out. It is wanting to deal with your actual problems; wanting happiness that is lasting, accomplishments that are meaningful, and relationships that are real. It is rejecting denial and fear. It is being proud to keep on fighting the good fight.