Dying to be Thin
She sips her coffee through a straw so she doesn't have to pause to tilt back her head. Darlene, a 58 year-old woman weighing 60 pounds, is out for her morning walk and can't afford to waste a moment of this daily, six-hour, 20-mile exercise ritual. Later, Darlene does 500 sit-ups and 3600 leg lifts while watching the Food Channel. "I like to watch the food on T.V. because it looks good to me, even though I won't eat it," she confessed on an episode of The Dr. Phil Show that aired in March. For the past year, Darlene has been living on a handful of bran cereal and two cups of popcorn a day. Diagnosed with anorexia nervosa 11 years ago, doctors say she's now at "death weight."
DIAGNOSIS OF DISORDER
A bizarre and rare illness first described by a British physician in 1868, anorexia nervosa--a dangerous eating disorder--a is now prevalent in the developed world. Media portrayal of ultra-thin models as a standard of beauty to which many aspire has led to a view of anorexia as more fashionable than shocking. Thinness has come to represent attractiveness, personal success, power, and self-control, giving rise to what some term "The Cult of Bodily Perfection."
Contrary to that viewpoint, eating disorders involve serious disturbances in eating behaviour, usually in the form of extreme and unhealthy reduction of food intake or severe overeating. They are real and treatable medical illnesses in which certain patterns of behaviour spiral out of control.
Anorexia nervosa, characterized by refusal to maintain normal body weight and an intense fear of gaining weight, affects up to 3.7% of females in their lifetimes and is the third most common chronic illness for young females (after obesity and asthma). Anorexics have distorted body image, believing they are fat even when dangerously thin.
Bulimia nervosa is another dangerous eating disorder, affecting up to 4.2% of North American females. Bulimics binge on large amounts of food in short periods of time and then purge to get rid of unwanted calories. This purging can take the form of diuretic or laxative misuse, vomiting, or excessive exercise. Bulimics usually maintain a normal weight, but may fear gaining weight and be extremely dissatisfied with their bodies.
Alarmingly, a 2001 study revealed significant symptoms of eating disorders in 27% of Canadian girls aged 12 to 18. There are many more who don't meet the diagnostic criteria for full-blown anorexia or bulimia, but live on the edge of disorder.
Study results released by Health Canada in 2003 indicate the ratio of males to females with full-syndrome eating disorders is approximately 1 to 5. While eating disorders commonly develop between 14 and 25 years of age, they are increasingly seen in children as young as 4 years of age and in women in their 60s.
Eating disorders pose immediate health risks as well as long-term consequences. The death rate associated with anorexia is more than 12 times higher than the overall death rate among young women in the general population. Although sufferers are usually secretive and resistant to treatment, treatment is essential to recovery.
CAUSES: A PLETHORA OF POSSIBILITIES
You may ask what causes a person to fall into the grip of such self-destructive behaviour. Many theories exist about the causes, and it has become clear that biological, psychological, and social factors all play a role in the susceptibility to, and development of eating disorders. Some evidence suggests a genetic pre-disposition to anorexia, while other research points to hormonal disturbances and to an imbalance of certain brain chemicals that regulate mood and appetite.
Family dynamics are one factor in the constellation of possible contributing causes. Children are at greater risk for developing eating disorders when raised in chaotic environments or by parents who are overprotective, overly strict, disengaged, perfectionistic, or even dissatisfied with their own weight and constantly dieting.
Certain careers--dancing, modelling, and acting--and participation in sports where weight is critical to performance can increase the risk as well. Among female athletes, the prevalence of eating disorders is reported to be between 15% and 62%.
Living in a culture where self-worth is equated with impossible standards of slimness and beauty also makes individuals prone to disordered eating behaviours. Society's "ideal" body size for a woman has decreased over the last few decades, ever-widening the gap between the average woman's actual size and the size she thinks she should be. Studies reveal that even children are not immune to poor body image. Forty-two percent of 1st to 3rd grade girls want to be thinner, and 46% of 9 to 11 year-olds are "sometimes" or "very often" on diets, as are 82% of their families.
Dieting is one of the strongest predictors of eating disorders, reinforcing the sense that something is wrong with the body. Ninety-five percent of dieters regain their lost weight within one to five years. Eating disorders sometimes occur as a reaction to the sense of futility created by failed diets.
Most often however, eating disorders have very little to do with food. Starvation, purging, and even binge eating are outward expressions of how the disordered person feels about herself. Low self-esteem, and feelings of helplessness and inadequacy, are characteristic of people with eating disorders. For some, starvation is punishment for not being "good enough." One young woman explained, "My mission was to shrink, to implode almost."
TRAPS AND TRIGGERS
Eating disorders often occur alongside other psychological problems such as depression, perfectionism, obsessive-compulsive disorder, anxiety disorder, and post-traumatic stress disorder. In people vulnerable to eating disorders, the illness is often triggered by an event, or series of events, causing trauma.
Triggers can be as subtle as teasing or as devastating as rape, the death of a loved one, or the break-up of a family through divorce. Even seemingly positive transitions like graduating from school, starting college, or taking a new job can cause some to feel an overwhelming lack of control that can lead to disordered eating. But the disorder eventually ends up controlling them…as it did me.
MY OWN JOURNEY
I could sense the frustration in the young doctor's stern voice. "You look like a prisoner in a Nazi death camp! You're starving, Sharon. You have to start eating." Dr. Fenton* had been assigned to my case while doing her residency in psychiatry. I was one of her first anorexic patients.
Later that day her supervising doctor ordered bed rest. With a blood pressure reading of 68/40, just standing erect caused my heart to race and my head to spin; yet I believed the doctors were over-reacting. I can't be starving; I don't even get hungry anymore, I argued to myself as I pulled the blankets over my thin, shivering frame and drifted off to sleep.
I developed the eating disorder anorexia nervosa two months into my first hospitalisation for major clinical depression. One of the symptoms of depression is a change in appetite; mine vanished. I was no longer interested in eating and began to look quite thin. Having grown up believing I was fat, it pleased me to be losing weight so easily. This is the one good thing to come out of this miserable experience, I thought.
I believed I could control my weight-loss, and planned to return to eating normally once I was thin enough. But anorexics live in a world where normal is not possible, lies become truth, and reality is ignored. This is a place where flesh is fat and bone is beautiful. There is no such thing as "thin enough." Giving in to physical needs is weakness; wasting and withering are signs of strength.
My anorexia was partially a response to living an existence that always seemed frighteningly beyond my control. With my depression, life had become completely unmanageable. My body became my kingdom, the only thing I could rule. The treasures of the land were hollow cheeks and stick legs. My crown was made of bones.
Although I was a believer in Christ and I knew God loved me, I had always sensed that I was, in some way, flawed, sub-standard, inferior. I desperately tried to hide this "truth" from others. By carefully controlling my behaviour, my performance, and even my emotions, I believed I might be able to influence what others thought about me.
I worked very hard and managed to make people believe that I was a bright, talented, decent person. The more praise I received, the better I felt about myself. I began gauging my value by my achievements and deeds.
I burned out at the age of twenty-six. Exhausted, I no longer had the energy to do anything. I couldn't concentrate on the simplest of tasks and lost interest in all the activities I had previously enjoyed. I withdrew from others, just wanting to be alone, quiet, and still. I had everything to live for--a loving husband and two beautiful daughters--but began to long for death. I felt like a failure as a mother and a wife.
My first admission to the psychiatric ward came just days after my youngest daughter's first birthday. As the door to the unit closed behind me I thought, What's someone like me doing in a place like this? I felt defeated and confused. My days of achieving had ended; my greatest accomplishments became getting showered and dressed in the morning.
My need to succeed at something, and my lifelong dissatisfaction with my body, made me vulnerable to anorexia nervosa. The quest for thinness became my new focus in life, something to fill the void left by depression, and I worked hard at it. My thoughts became consumed with calories, weight, and ways to avoid eating. As I reached weight-loss goals I'd set for myself, I was still dissatisfied with my appearance. "Just five more pounds," became my mantra.
The illness progressed and I became increasingly weak. While someone else cared for my children, I slept--eighteen hours a day.
Eventually, I grew weary of this battle. I longed for a normal life and knew that my first step would have to be to give up the quest for "thin enough." I resolved to start eating healthy meals again, but soon discovered that it wouldn't be easy.
I always felt terribly guilty, defeated, and angry with myself after I ate. One evening, after finishing a meal, I was leaving the hospital dining room when I heard a hideous voice inside my head. Full of loathing, it screamed, "You fat pig! Why did you eat that? You've ruined everything!" I'd never heard anything like it before; it was very frightening.
The harder I worked to get well, the more vocal the hateful being became. I felt like two people in one body, one who wanted to live and another who wanted me dead. I realised that I was no longer in control. Someone--or something--had seized my throne and it appeared that I was now at his mercy. Each day I became weaker. I tried to eat, but often was too tired to even chew. My doctor knew I was struggling, but I never told her about the enemy in my head.
The afternoon I found myself looking through my closet for something to wear to my own funeral, I realized that I would not live much longer as an anorexic. I was ready for death, but was not willing to leave a legacy of pain and torment behind for my husband and children. I knew that I had to live for them.
After three years of battling my psychiatrist, I resigned myself to trusting her, to tell me how much to weigh and what to eat--no matter what the voices shrieked. It was this decision to dismiss the voices that allowed me to overcome the eating disorder, although I was still depressed.
While six more years crept by, I tried everything the doctor ordered, hoping that each new treatment or medication would be the one that would set me free. But the depression would always sink its claws deeper into my soul, drawing me back into the darkness.
As my husband parented our children, I focused on trying to stay alive. My absence due to many hospitalisations was difficult for my family. One day, my eldest daughter, Lauren, asked, "When will you be coming home forever?" After nine years, 20 medications, 80 weeks of hospitalisation, and more than 100 electro-convulsive treatments, I realized that if I was ever going to find a cure for my illness, I had to look elsewhere. While home from the hospital, I began to see a Christian counsellor.
WORDS OF HOPE
Berys was unlike any counsellor or therapist I had ever spoken to. "I don't have all the answers," she said, "but the Lord does." Together, through prayer, we invited Him into the counselling process. Berys also taught me how to study God's Word and listen for His voice. The words He spoke changed the direction of my life.
The angry, condemning voice in my head was replaced by God's loving, tender one, speaking softly to my wounded soul. As I listened, I came to understand that the roots of my depression reached to the core of my spirit and my entire life had been based on a lie.
I had worked so hard to hide my inferiority, but I was not the worthless person I'd always believed I was! I was the handiwork of the Creator of the universe, made in God's image. It was not a number on a scale that determined my value. My achievements did not matter. My genetic makeup or who I was didn't determine my worth--whose I was did. I was a beloved child of the King!
I read words that told me that God had a plan for my life, a future full of hope. He said that if I put my whole heart into searching for Him I'd find Him…and He would bring me back from captivity (see Jeremiah 29:13,14). God fulfilled His promise. Within three months of my initial meeting with Berys, the depression was gone. I never had another electro-convulsive treatment. I no longer needed medication, or the care of a psychiatrist. And I never returned to the psychiatric ward. Lauren's wish was granted: her mother came home "forever." Eight years have passed--and 15 since my battle with the eating disorder--and I remain free from both depression and anorexia nervosa.
After a lifetime of looking for fulfillment and value in all the wrong places, a quest that almost killed me, God transformed me and turned my life around. Finding my true identity was the key that unlocked the heavy door to the dungeon I had been imprisoned in for nearly a decade. I learned that peace and contentment cannot be found in work or wealth, or even weight…
CHALLENGING THE STATUS QUO
God can heal the deep wounds and fears that provide rich soil for the growth of depression and eating disorders--but how much better if we work towards prevention. We can take the first step by challenging our cultural standards of worth and beauty and renouncing the lie that our value is based on what we can achieve, how much we can acquire, and what we look like. The truth is, there is no image that's worth dying for!
For more information on eating disorders, visit the following websites:
National Eating Disorder Information Centre
National Eating Disorders Association
National Institute of Mental Health
* Name changed
© 2007 Sharon L. Fawcett