By Melanie Haiken
Standing outside the thick soundproofed door of a locked psych ward, the thought occurs to me: nothing I've learned in 20 years as a parent has prepared me for this moment. A nurse whose stern demeanor is belied by her kind, weary eyes leads me down the silent hallway. Does she — with her years of experience — know who will make it out of here, and who won't?
As I pass other patients, the statistics I’ve obsessed over take form before my eyes. Some of these girls will leave healthier, eager to get back to their lives, greeted by the hugs of happy family members. The majority will relapse at least once. Others face a lifelong struggle. About one fifth will die from complications related to this disease. Will that wraithlike girl staring sightlessly at the TV make it out of here? Will that young woman, striding frenetically up and down the hall in an attempt to burn the calories she’s been required to consume, relapse? What about my beautiful girl, hunched under a blanket on the visiting room couch?
She stands to give me a hug, and I ask about the flannel pajama bottoms she’s wearing. “Yeah,” she says with a wry smile, pulling out the waist to show me how loose they are, “They’re a present from Aunt Claire, but they made me take the drawstring out so they don’t fit.” She makes a face with a shadow of her usual irreverence: “Suicide risk. As if we didn’t know a million ways to do that already.” For a moment, I catch a glimpse of the old Melia — the girl I call Beans because she's "full of beans;" the girl we tease for being a "monkey" because of her rubber face, her wiggliness, her inability to be serious for long. Then the wan, blank-eyed girl who replaced her is back.
It all started with an email. Writing to a classmate she was trying to befriend, Melia — then 15 and a sophomore in high school — confessed to a secret: anorexia and bulimia that had being going on for more than a year. Melia also said she was being physically abused, that I was locking her in a closet.
I wasn't allowed to see the original email. Instead, I learned about it from the school psychologist, who called and summarized the contents in vague terms to protect the classmate’s identity. Then she told me to expect another call — from Child Protective Services. The revelations were beyond stunning. The girl the therapist described bore so little resemblance to the daughter I thought I knew that I spent the next few days wondering if Melia’s friend might have made the whole thing up. Could this really be my girl?
Melia was the kind of child people noticed, in all the best ways. "Melia is such a great kid," teachers would say, seeking me out on back-to-school nights to describe her brilliant writing, her leadership skills, her insightful comments in group discussions. She was singled out as the "most outstanding student" (female; a boy was chosen too) in her 250-person 8th grade class. She won lead roles in plays, played saxophone in a jazz combo, earned admission to a prestigious summer science program at U.C. Santa Cruz.
But Melia also had social issues. Emotionally young for her age, she started having problems fitting in when she hit middle school, when the other girls discovered boys and clothes and stopped talking about books and playing “pretend" games. Six weeks into her freshman year of high school, she begged to transfer to a magnet school because of ostracism by other girls. When that school closed due to lack of funding, she had to transfer again. By the spring of sophomore year she seemed to be adjusting nicely; she had a best friend and a few ancillary pals, landed roles in school plays, went to sleepovers and even the occasional dance.
And yet here I was on the phone with the school psychologist, being told that my daughter had a serious psychiatric disorder, while Melia sobbed in the background. Along with anorexia and bulimia come lies and deceit; it’s part of Melia's disease, the psychologist explained, so it wasn't surprising that I'd suspected nothing, or that Melia made extreme accusations. "Having an eating disorder is like having a secret life," she said. She'd seen this scenario countless times: girls who starve themselves, binge and purge, or exercise compulsively — all disguised by a web of lies, excuses, and secrets as impenetrable as the layers of clothes they hide themselves under.
I made an appointment with the eating disorders program at Kaiser Permanente. When I told Melia, she was by turns angry, defensive, and distraught. She only stopped eating a few times, she said. She exaggerated to win the girl’s sympathy and when her friend didn't respond the way she'd hoped, she made up the child abuse to create more drama. (Even though Melia recanted her “locked in a closet” claim, I had to go through the embarrassment of a CPS investigation. It helped that our house doesn’t have any closets that lock. I will never forget the social worker’s parting words: “Don’t worry, your CPS file won’t stay open forever.”) Melia was sorry for all the trouble. If I just let it lie she wouldn't do it anymore… life would return to normal.
Instead, our life quickly became anything but normal. At the Kaiser intake appointment, Melia answered the therapist’s questions and the details came pouring out: bag lunches tossed, dinners missed because "I already ate at so-and-so's house." Signs I missed came flooding back, too. A camp counselor at Melia's summer science program calling because Melia missed dinner. (Her answer, which made sense at the time: she'd taken food back to her room to eat while she studied.) The Pop-Tart found in our front bushes. (The excuse: "It must have fallen out of my hands as I ran for the bus.") Deeper, more painful revelations followed: friendships that crashed and burned, loneliness and social rejections, self-esteem so low it verged on self-loathing. Finally, the revelation that she was cutting herself, a self-harming disorder that often goes hand in hand with anorexia and bulimia. (Why hadn’t I noticed she always wore long sleeves — even on hot days?)
Thus began our six-year journey into the backward world of eating disorders. Following a program known as the Maudsley Method, we began what's called the re-feeding period. The thinking is that self-starvation affects the brain as well as the body, and the child can't think clearly until she gets closer to a normal weight. Melia, naturally slender to begin with, had shot up to 5'8" yet weighed only 114 pounds when she entered treatment; she needed to weigh at least 125 pounds to reach a normal BMI.
Just as other parents were learning to let go, giving their teens more freedom, I had to keep a tighter watch on mine. Mealtimes were sullen and silent, as I alternately pleaded with and commanded Melia to finish her food, while she picked at her plate and made excuses for why she wouldn’t eat (“I don’t like pasta.” “I ate a big snack when I got home from school.” “You gave me more than anyone else.”)
After dinner, she wasn't allowed to use the bathroom for half an hour, and even then she had to keep the door cracked. I'll never forget the hollow mix of shame, fear, and disgust I felt listening at that door. Everything else was a battle, too. Melia hid in her room, lashing out at any interruption, and when coaxed out she was eerily aloof. It often seemed like she'd turned into an entirely different girl, her old sweetness and goofy humor replaced by cool distance and a hair-trigger temper. It was like her inner light had gone out.
"Picture the eating disorder like a demon sitting on Melia's shoulder; we call him ‘ED’," her therapist counseled. When she eats, ED criticizes her. When she goes all day without eating, ED cheers her on. That’s why eating disorders are so hard to fight. In therapy, "It's ED talking, not her," was a constant refrain. It helped a little — but not much.
Every day I faced questions from family and friends (those I felt comfortable enough to tell, which wasn't many) — "But what caused it? She's always been a stick. Why would she feel she needs to lose weight?" — typically followed by that person's opinion or insight about what went wrong: "It's the media — all those anorexic-looking models," was a common response. "It's because she's so bright and so hard on herself. I hear girls who are perfectionists get anorexia," was another. Others, intending to reassure, shared their own stories: "Actually, I went through an anorexic period, too, when I was young. I grew out of it and I bet she will too." But all that did was make me feel lonelier and less understood — this was no youthful phase, and Melia was certainly not going to be okay without a great deal of help.
At night I lay awake, enveloped by deep, soul-wrenching doubt, fear, and guilt. Was it my fault, or the fault of our bitter divorce? Was it because I write for women's magazines and have copies all over the house? Was it my own body image issues — offhand comments in the dressing room about looking fat in those jeans? I wish I knew. But as with everything else in the world of eating disorders, nothing is that simple.
One revelation sucked the breath out of me; a fact that, had I known, might have made a great deal of difference. In that very first Kaiser interview, as the psychiatrist ran methodically through a checklist of intake questions, one stopped me cold. Had Melia had behavioral problems — truancy, acting out? No. When did I first notice Melia losing weight? Never. She'd been a string bean as a child, and I'd simply failed to notice when she didn't fill out as much in adolescence as might have been expected. Has Melia had any problems in school? No. “Is there any history of alcoholism in your family?” I wanted to cry. Um, yes. Big time. I ran through the dreary details: my mother had been an alcoholic as long as I could remember; at the time, she was slowly dying from the physical effects of lifelong drinking. My ex-husband’s father, also an alcoholic, died of liver and pancreatic disease at 53. We knew of previous generations of alcoholics on my mother's side as well. Ah, came the reply, kids with eating disorders are more likely than the general population to come from families with a genetic predisposition to alcoholism and addiction. In fact, anorexia, bulimia, and binge eating disorder are considered addictive behaviors.
How had I not known this? We told both our daughters' pediatricians about our family history, discussed the need to be proactive about the genetic potential for addiction when they hit their teens. Yet in all my daughter’s 15 years, no one had ever mentioned a heightened risk of developing an eating disorder.
But even this crucial insight only revealed part of the story. There’s also a connection to other mental health issues like depression, anxiety, bipolar disorder, and obsessive-compulsive disorder, for which eating disorders can serve as a coping mechanism. In our case, anxiety disorders and depression run through both sides of the family tree; but who knew an eating disorder could mask such problems? Odd as it sounds, both restricting food and purging can have the physiological effect of boosting endorphins and the feel-good brain chemical serotonin. Once discovered, this boost serves as an addictive fix to soothe the fears, stresses, and rejections that haunt teenage life.
Fueled with new understanding, I relived moments that, had I known better, could have pulled back the curtain on Melia’s emotional life. Her second grade teacher saying Melia was a "delight," but that she'd seen Melia wandering sadly alone at recess, rebuffed by the other girls. "I think Melia's just a little too goofy and high-energy for them," she said. "Maybe you could help her tone it down a bit?" Ten-year-old Melia’s heartbreaking emails begging her father, who had disappeared from her life to travel around the world for a year, to come home; then her rage when he came back and acted like she had no right to be upset. The day Melia came home from seventh grade upset because she won a county-wide essay contest and her English teacher threw a class pizza party in her honor. “Why is that a bad thing?" I asked, bewildered. Because, she answered, "All the girls have a crush on him and now they're mad at me because they think he likes me best. They think I was showing off, but I wasn't, Mama! He sent the essays into the contest, not me, and I didn't even know he was going to give us pizza!" Along with her exuberance, Melia has always been sensitive and thin-skinned. Now I could see how over the years the barbs and wounds had left deeper and deeper scars.
Fifteen minutes early to our first group therapy appointment, I look up to see a girl we've known since preschool and her parents, old friends, sitting in Kaiser’s psychiatric waiting room. We all wave, look embarrassed, and quickly turn back to our magazines, avoiding the catch-up conversation we'd have under any other circumstance. What issue are they dealing with, I wonder: Addiction? Depression? And it hits me: they're wondering the same thing about us. That's the moment I realize we've entered another world — the world of families struggling with private issues not discussed at book clubs or PTA meetings.
Try as I might, I never found any common denominators among the families we got to know far too intimately in years of group therapy. Some parents were divorced, some happily married, some in relationships marred by tension and fury. Some families were poor, others rich. Some spoke English, others Spanish. Some mothers — or fathers — were stay-at-home parents, others worked in high-powered careers.
Nor could I make any generalizations about the girls (and a few boys: anorexia affects about 20 girls for every 1 boy) battling eating disorders. Some seemed, at least on the surface, almost absurdly well-adjusted. Some were academic powerhouses, fitting the anorexia stereotype of the extreme perfectionist; some couldn't care less about school. Others were out-and-out rebels, bedecked with piercings, tattoos, outlandish clothes and haircuts. Some, like my daughter, had few friends and struggled socially; others were entrenched in the “popular” crowd and had all the party invitations they could possibly want. The only commonality was that the eating disorder was a cry for help — evidence of desperation to be truly seen and heard. The therapy they received as part of eating disorders treatment helped them work through feelings that, if the eating disorder hadn't brought them to light, would likely have haunted them all their lives.
Daily heartbreaks and incidents dealing with “ED” collapse together in my mind, but one shadow loomed throughout: anger. Anger at myself: How had I missed the signs, now so clear, that Melia was in trouble? Anger at Melia's high school administrators for putting her in "home hospitalization" while she was in full-time outpatient treatment, but refusing her the extra time she needed to complete assignments, forcing her to fail and sacrifice a summer to remedial summer school. Anger at the therapists and doctors who tried one thing, then another, promising hope and progress that never came. Anger at the insurance company, which offered such limited options. Anger at other parents, who talked about their children's achievements with no clue what it felt like to watch your child self-destruct before your eyes. Anger at Melia's friends, who abandoned her when she got too "weird," when she wasn't fitting in. And anger at Melia — why can't you see how crazy this all is? Why can't you see what you're doing to yourself? Why can't you just EAT?
June of her senior year, Melia finally graduated from eating disorders treatment. Triumphant, we sat in the same room we’d sat in hundreds of times before; Melia, her father, sister, and I, her therapists, and all the teens and family members of the various support groups. We all cried. She left with a paper certifying her recovery. I told anyone who would listen about the benefits of dialectical behavior therapy, about her wonderful therapist, who attended Melia’s final school play on her own time, about the importance antidepressants played in treating her underlying anxiety and depression.
Accepted into her first-choice college, Melia set off for a new life in Portland, Oregon at the end of summer. I was terrified to let her go, ferociously protective of her recovery. But her senior year had been a great success, her weight was normal, she had a boyfriend and plenty of friends — all was good.
But not for long. Homesickness, social anxiety, and school stress triggered repeated trips to the hospital during Melia's first year of college. She fainted from dehydration and electrolyte imbalance caused by repeated purging. Her RA took the knives from her room because she started cutting again. Melia managed to hold on through her freshman year. Once again, she spent the summer in intensive outpatient treatment. But a few months into sophomore year, she was sent home, deemed "a risk to self and others."
That was when the hole fully opened under my daughter's feet, and Melia fell all the way down. With all her friends away at college, Melia sat on the couch watching TV reruns between sessions at her outpatient treatment, which she was now repeating for the third time. One night, after confessing to her therapist that treatment wasn't working, she drove home, cut herself, then drove herself to the emergency room, where she was held on a 5150 suicide watch and hospitalized.
Now I was walking the halls of my worst nightmare, watching the fears that had haunted me ever since that first call from the school psychologist come true: Melia required hospitalization. Just a month past her 18th birthday and considered an adult, Melia was housed in a ward with women who screamed through the night with paranoid delusions or sat in the halls catatonic with depression.
It was terrifying, but it was also the turning point. Finally, our insurance company approved inpatient treatment at Herrick Hospital, one of the most respected eating disorder treatment programs in northern California. At Herrick, Melia spent three weeks in round-the-clock care, then two more weeks in a full-time day program, and several months in follow-up treatment. She missed a full year of school.
Is there a happy ending to this story? I wish I could offer a neatly wrapped package, but that’s not how eating disorders work. When Melia graduated from her first eating disorders treatment program, I truly believed she was cured. Now I know better. Like a sober alcoholic, Melia will live forever with the possibility of a relapse. There may well be more late-night calls, more 5150s, more days spent sitting in a circle of chairs, with tissues passed. In this, my experience with my mother's alcoholism, and her many failed attempts at recovery, comes in handy; the serenity prayer is once again taped to my mirror.
Last fall, Melia learned that a girl in her treatment program at Herrick had died. Over Facebook, Melia and the other young women and men from Herrick shared their sorrow, their terror, their gratitude for being alive. Reading those comments, my heart tore with empathy for the parents and their loss. Five years ago, I couldn't have fathomed their experience. Now, having been just partway down that same road, I treasure every twist and curve we still have to travel.
But that's just one way of looking at it. Another way is to look at where we are today and honor the past that brought us here. Melia wouldn't be as insightful, brave — or shine so brightly — if it weren't for what she's been through. This summer, Melia’s improv teacher commended her powerful intuition, self-awareness, and finely tuned ability to read the signals of others. When Melia repeated the comments to me, we burst out laughing: "Little does he know," she said, "where I learned all that."
Now a junior at Humboldt State University, Melia is studying psychology and plans to work with troubled teens. Recently, when a family friend reached out to say her daughter was cutting and showing signs of anorexia, Melia didn't hesitate to shoot off a text. Within hours the girl agreed to talk. Later, telling me about their conversation, Melia said, "It was easy to know what to say, because I remember exactly what it was like when I was in that place. But you know what also felt really good? I realized I'm not in that place anymore."