Monday, June 27, 2011

Dispatches From Anorexic Hell

"Maybe maybe maybe," Marya Hornbacher writes, exhausting a list of things that could have gone differently in her life. Maybe if her parents weren’t so distant. Maybe if she had gotten professional help earlier. Maybe then she wouldn't have struggled so terribly with anorexia and bulimia. "But all this is moot. Sometimes things just go awry." That statement is as close to an epiphany that Marya ever gets in her memoir Wasted. There is no easy explanation for why she spent years of her life in anorexic and bulimic hell. Instead of offering answers, Hornbacher tells stories and asks questions. And even though there’s no real resolution at the end of this strikingly tragic and beautiful memoir, Marya’s words have a powerful and haunting effect.

Eating disorders, Marya points out, citing a wide array of medical and psychiatric data and studies, are frequently symptomatic of other mental illnesses. But sometimes perfectly healthy people develop debilitating eating disorders. Of course, the nature of eating disorders is such that they lead to other mental health complications: depression, anxiety, mania, paranoia, insomnia. It’s a cycle of disorder. Marya is not arrogant enough to claim she can pinpoint the exact cause of her eating disorder. She tries to point to plausible explanations, but refrains from black and white answers, which gives this memoir a kind of novel-like feel to it.

Still, there are some obvious factors that contributed to her chaotic disease. Family is a huge one. She doesn't hate her parents or blame them for screwing her up, which is refreshing. Instead, she's brutally candid about her upbringing. Her parents "were perhaps less than ideal candidates for parenthood." I think it's safe to say that's a fitting description to all parents. It’s obvious to the reader here that fear of food and an unhealthy obsession with food in her parents contributed to her eating disorder. Her mother, who herself was bulimic and has always had disordered eating behavior, tells Marya: "You didn't pick up anything. You just came this way." Basically, her messed up family tells her it's all nature, no nurture. And it's clear from evidence that much about anorexic and bulimic behavior is in fact learned, not innate. Still, Marya rightfully places the weight of her own decisions on her own shoulders: "Let it be noted here that it is decidedly not their 'fault.' If someone tells you to jump off a bridge, you don't have to jump."

This book isn’t just about food or the lack thereof. It’s also a tour through the dark corners of insanity. Marya totally loses her mind for a good part of her life. She doesn’t sleep, goes days without eating, ends up binging and purging until she passes out. She gets pregnant and solves the problem by purposefully falling down some stairs. "Flush the red matter away. No tears." That’s just one of many examples of her life gone awry. Large portions of this book are clearly hard to read. It’s not easy reading of someone killing themselves slowly over the course of many years.

Of course, she ends up in more than one hospital. When she finds herself in a treatment center, she writes: "I was light years away from understanding my Issues." And she proves this to be true in the years after she gets out of treatment. She systematically starves herself again, knowing full well what it is doing to her body. It is only after her stint in the hospital that the severity of her masochism is fully realized. This woman hates herself so intensely that it’s incredible she’s alive. It seems Marya's truly in love with her eating disorder, in love with destroying her body any way she can. She squelches real love from her family and her friends, and turns all her love and attention to brutalizing herself. It's absolutely terrifying, but it's also oddly resonant. It’s like Marya is reminding us that somewhere deep inside all of us is the ability to inflict terrible harm upon ourselves. Sometimes, our desire for death can equal or surpass our desire for life.

Marya spends much of the book speaking about the learned aspect of eating disorders. Disordered behavior can be learned, through parents, through media images, cultural mores. Many people with eating disorders have larger mental health issues, it just so happens that they translated into an eating disorder. At least that's Hornbacher's take. And, I've got to say, I tend to believe her, not totally, but enough. There’s also some interesting discussion about how eating disorders tend to fall on the middle and upper classes with far higher frequency. Mayra herself enjoys significant class privilege. She quotes a psychologist’s study that found thinness has become, “an ideal symbolizing self-discipline, control, sexual liberation, assertiveness, competitiveness, and affiliation with a higher socio-economic class.”

This is part of a larger discussion of how society views eating disorders. And it’s amazing and atrocious to read about, for example, a school boy telling his anorexic girlfriend she needed to lose weight while she's literally starving to death. That our society produces males like this is disturbing.

She points to eating disorders as social diseases, problems that are encouraged by mass media and modern American culture. "We lived in a larger world where there is also a sense of hunger and a sense of lack. We can call it loss of religion, loss of the nuclear family, loss of community, but whatever it is, it has created a deep and insatiable hunger in our collective unconscious." I understand the hunger she's trying to convey. I don't necessarily equate the innate sense of hunger in the human consciousness to the lack of anything in particular. I view that insatiable hunger as a natural byproduct of human consciousness. We're always trying to find perfection, and when it never comes, there's a sense of loss. This hunger is based on a loss of something that was never possible to attain in the first place. In Marya’s case this “perfection” was a sixty-pound, shriveled, skeletal woman.

It was impossible to read this book without having flashbacks to my own disordered history. In 2008 I nearly died from malnutrition and ended up in a psychiatric ward for people with eating disorders, which I chronicle in my novel Broken Bones. I was diagnosed with anorexia nervosa and a slew of other problems. Going into this book, I knew it would be a tough read. Still, I couldn’t have prepared myself for how deeply this book shook me.

It was like reliving a nightmare. It was as if some of these words had been written about my experience. I could relate so much to her story. For example, when you feel your body is worthless, it doesn't take long for you to believe that life itself is worthless. Suicide becomes a more and more attractive option the further you go. Marya grows lanugo, or, as she calls it, “fur.” And that's not too much of a stretch. It really does look like baby kitten fur, or a peach with overgrown fuzz. This is the body’s way of keeping warm when it reaches the brink of death from malnutrition. The way malnutrition spawns manic episodes is described in terrifying detail. I remember having manic episodes, and it was always shocking how bad things got so quickly.

After nearly killing myself through anorexic behavior, spending a month in a treatment center, reading many books on the subject and writing one myself, I still came across things in this book that I’d never heard before. For example, people with anorexia commonly die of broken hips. It makes sense. Brittle bones break easily, and an anorexic's body simply does not have the materials needed to heal itself. A trip or fall can put their weakened body into a quick death spiral.

On pain, she writes: "In truth, you like the pain. You like it because you believe you deserve it, and the fact that you're putting yourself through pain means you are doing what you, by all rights, ought to do." What begins as disordered behavior quickly  if not immediately  turns into masochism. Pain is the body reminding the mind that it exists. She also liked the attention that being sick brought. "You are so sick. When people say this they turn their heads, you've won your little game. You have proven your thesis that no-body-love-me-every-body-hates me, guess-I'll just eat worms. You get to sink back into your hospital bed, shrieking with righteous indignation. See? you get to say. I knew you'd give up on me. I knew you'd leave." She makes it clear that her eating disorder wasn’t as much an experiment with the limits of the body as it was a suicide pact with her own mind. “I was trying to die, in a curious, casual sort of way.” It was her only way of coping. "My only means of self-regulation was self-destruction."

Like so many women I met in the psychiatric ward for people with eating disorders, Marya grew to love the protective environment of a hospital facility. She loved being sick and cared for, and in the unit she could be sick and cared for. Her compulsive, disordered behavior was minimized in the unit, not because Marya tried to kick her habits, but because she simply couldn't harm herself as effectively when she was in the hospital. She tried, as did all the girls I met in the ward. They tried to puke when no one was looking. They tried to cut themselves. But someone always found out. Marya's health improved in the unit, but her mind was still set on self-destruction, proof that treatment can only do so much. Once an anorexic or bulimic person steps out the doors, it’s up to them to survive or die.

Marya does a terrifyingly good job at recounting the horrors of life in an eating disorder treatment center. This is where the book rings most true to me. I was in such a facility: locked doors, plexiglass windows, no mirrors, no sharp objects. It's pretty scary to wake up and know you're stuck, and Marya is definitely stuck. And she's blunt about her decision to "get well." It only came about because she was forced to get well.

What haunts me is the big hole at the end of this book: the complete lack of resolution. There is no come-to-Jesus moment. There is no epiphany. In the end, Marya marches on with her life, balancing precariously between “normalcy” and relapse. Fortunately, she has stayed on the healthy side of the cliff in recent years, enough to write an incredible and moving book.

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