Updated: Nov 13, 2020
It’s not like me to begin an interview by talking about myself. Typically, these interviews are a welcome and deliberate break from total self-absorption. When I began talking to Sarah, however, she brought out a different part of me. Almost immediately, she asked the questions. What were my motivations for interviewing her? Have I been easily triggered in talking to other people with eating disorders? Are there any things she should or shouldn’t say for the sake of my own recovery?
This is someone who knows the mind of a disordered eater.
Talking to Sarah reminds me that I am a beginner. I knew it would feel different to talk to someone who identifies as “fully recovered”; I just didn’t know how different.
If you are one of the many who identifies as “half-recovered,” or “recovering,” I wonder if you raised your eyebrows at the phrase “fully recovered.” I know I did. But here’s a spoiler: By the end of my interview with Sarah, I believe her. She is fully recovered - which means that I can be, too.
Unlike many of my interviewees, Sarah's eating disorder started as a conscious choice. Thanks to ED awareness campaigns, she always new that anorexia was an option. She picked up starvation the way more rebellious kids might pick up a drink or a drug after a helpful briefing from the DARE program.
“Alcohol was out," she says. "At dinner, I considered cutting. By the time I was taking my shower that night, I had picked starvation instead. Less messy. More practical.”
At the time, it was this simple. In retrospect, Sarah can see that she was looking for a tangible way to express and even call attention to her own pain. In a brand new public high school, she felt isolated, irrelevant - lost in the shuffle. Her community felt shallow, fleeting, occasionally nonexistent.
Relatively quickly, Sarah dropped to a dangerously low weight. ”It felt like a game,” she says, “And I wanted to be the best at it.” Sarah didn’t go online for “thinspiration” or visit the notorious pro-ana or pro-mia websites. Rather, she picked up the Diagnostic and Statistical Manual (DSM) and followed it to a tee. If she lost her period and her BMI dropped below 18.5, she was doing it right. It said so right in the book.
After about seven months of purposeful and calculated starvation (counting, weighing, measuring), a switch flipped. Starving herself had ceased to become a choice. Like an alcoholic, Sara could no longer choose to stop.
This scared Sarah, and she went to her mom for help. She clarifies now that her mother's dismissive response had more to do with ignorance than apathy.
Sarah’s doctor, too, was a stranger to the true nature of the disease. After glancing at her low weight, he asked, “Are you eating?”
“Oh yes!” said Sarah enthusiastically. “I love food.”
Most anorexics love food. But that was enough for him.
Sarah’s aunt was the only person who recognized that something was wrong. “My parents saw what they wanted to see,” said Sarah. In contrast, her aunt saw what was plain before her eyes. She took one look at Sarah and pulled her parents aside. “Sara needs help.”
Reluctantly, her parents appointed Sarah a therapist and nutritionist. Both professionals promptly refused to treat her: Outpatient care was laughably inadequate, and Sarah needed to be hospitalized. Sarah’s parents promptly denied this - our daughter can’t be that sick - but the professionals were adamant.
Sarah’s parents weren’t the only ones in denial. Sarah, too, was shocked. “It was like I had been flirting with death,” she says, “Only to find out we were in a serious relationship.”
At first, Sarah didn’t feel sick enough to go inpatient. They’ll laugh me out of treatment, she worried - the worst-case scenario for someone who began the game with the intention to win. As it happened, she didn't win, per se, but she did fit right in. The group in treatment was ostensibly diverse, with all genders, races, and gradations of privilege represented. In practice, however, all their stories sounded the same. “The whole point was to be different,” says Sarah. Only upon entering treatment did she realize how common it really was to make a life goal of being thin.
I am always eager to know what people learn in treatment. As it turns out, the focus of adolescent treatment for anorexia is much more on weight restoration than it is on unlearning thought patterns or challenging cultural dogma. “I had liver failure, I was losing bone density, my heart was leaking,” said Sarah. These were urgent problems, and all of them were addresses simply by eating.
With refeeding, Sarah regained her cognitive capacity. She was almost instantly able to make better choices. She left treatment firm in her resolve to never go back.
That's it? I thought. Or maybe I asked outright. "Was that really all there was to it?"
Looking back, Sarah knows her treatment was only partially effective and her resolve at the end was somewhat naive. “I still had food rules when I was discharged,” she admits. “I didn’t realize how many unresolved issues there still were."
Two years later, I met Sarah. I was attracted to her boldness, her sense of humor, her intelligence, and her Christian perspective. The latter part felt like home in a school that was intimidatingly secular. We also bonded in part over our "half-recovery"; I was gradually replacing disordered eating with alcohol abuse, and Sarah quietly maintained food rules, an inflexible eating schedule, and a weight lower than her natural set point. Neither one of us were beacons of health, but we also weren't in crisis. Many disordered eaters stay in half-recovery indefinitely.
In her freshman year of college, Sarah was sexually assaulted by a local youth pastor. In the aftermath, she became even more disconnected from her body. She had more pain to express, and was in many ways working with the same limited tools she had at 15.
That's it? Again, I have to know. "Was there any more to it?"
"Yes," she says. But it came later.
In the year following graduation, Sarah moved to Rwanda to teach. Although she didn’t move with the intention of losing weight, she realized upon arrival that doing so would be easy, almost unavoidable. Although there was enough food to go around, Sarah couldn't cram her caloric needs into two mealtimes per day. As she shrank, so too went her ability to challenge her latent eating disorder. Once in Rwanda, she stumbled across a scale and was met with a low number. Her disorder stirred: Why not?
Of course, her relapse didn’t occur in a vacuum. In Rwanda, Sarah faced tremendous pressure and little support. Things came to a head when she was met with an unwanted advance from the owner of the school at which she taught. When she denied his advances, he was furious.
The owner of the school had a key to her bedroom. That night as she lay in bed, Sarah began having severe chest pain. The physical stress of not eating combined with the psychological stress of feeling so profoundly unsafe wreaked havoc on her mind and body.
There was only one cardiologist in Rwanda, and he was not prepared to identify eating disorders or treat their symptoms. Within a week, Sarah was on the plane home. “Heart issues,” she told anyone who asked.
Sarah arrived home with a plan. As an adult, she was fully responsible for her own recovery. “All I have to do is eat!" She sat herself down in front of a burger and fries, and gave herself an ultimatum: “If I can eat this all by myself, then I don’t have to go inpatient again."
She couldn’t do it. She couldn't do it, even though it would cost her thousands of dollars to go inpatient. “You could’ve held a gun to the head of a family member, and I still wouldn’t eat,” said Sarah.
I’m reminded again of alcoholics. Knowing full well that they will lose everything, they still pick up a drink.
Having failed her own ultimatum, Sarah checked herself into inpatient at 24 years old. Her experience there was “discouraging in the best way.” She saw old women whose families had long since given up on ever seeing them well. She saw people who had sacrificed their entire lives to preserve their disease. When she heard her own thoughts reflected in their words, the insanity was clear. Is that what I sound like?
Of course, Sarah didn’t actually reason her way out of her disease. That's not how it works. From my perspective, awareness of insanity is more a symptom of recovery than it is a cause. You know you're getting better when it starts mattering to make sense.
One part of inpatient treatment involved hosting a discussion panel for parents and family members of disordered eaters. One father asked the panel, “Why do you want to look so small? It's not even attractive.”
When Sarah shares this story, her Texan side comes out. Around 80% of those in treatment had survived a sexual assault. “Ain’t nobody here looking for sexual attention,” she laughs. Far from it: Many of them were looking to disappear.
It wasn't until inpatient treatment that Sarah began to connect the dots between her assault by the pastor and the maintenance of her eating disorder. The relationship here is complex, and I hesitate to even try to describe it. My impression is that it has to do with wanting both to disappear from the world and to dissociate from oneself. Sarah both resented her body and felt as if it wasn't hers to resent. Recovery was about taking the reigns on one's experience: I am sick enough to be here, my pain is important, and I matter more than the game I've been playing. My experience counts.
The man at the panel was not the only one who asked the wrong question. When Sarah shared her experience of assault with friends in college, people's reactions ranged from boring, albeit nonjudgmental platitudes to overtly hurtful and blaming questions.
The therapist in me is compelled to ask: Has anyone ever responded in a helpful way? Has it ever felt genuinely cathartic to tell your story?”
Yes - once. When she told her now-husband about the assault, he suggested that they drive from Texas to Arkansas to report it, both to the authorities and to the church where the youth pastor still worked. “At first, I didn’t want to go,” says Sarah. She feared she'd hear the same, stupid questions, the ones that implied it was her fault. She was afraid her story wouldn't count, that it wasn’t "bad enough.”
Based on the way in which both the church and the authorities received the news, this would appear to have been true.
“There’s no real evidence,” said the police.
“We’ll keep him on staff,” said the church.
And yet: Sarah had done her part. She filed a report before the statute of limitations was up. Perhaps if more reports are filed against this man, her story will be harder to ignore. For the time being, she at least acknowledged her own experience: the assault counted. It was bad enough.
Sarah hasn’t experienced an eating-disordered thought in five years. Her husband has never seen her sick. “You know the part in the Bible, where Paul repeatedly asks Jesus to remove a thorn from his flesh, and all three times Jesus says ‘no?’ Well, it’s like I asked for it to be removed, and Jesus said ‘yes.’ I don't know why, but he did."
In Texas, it’s a crime to pick bluebonnets - though it's more of a running joke than a serious offense. Sarah jokes that, these days, she'd feel more guilty for picking a bluebonnet than for gorging herself on dessert. It simply doesn’t matter anymore - and Sarah is clearer than ever on what does matter.
In recovery, Sarah is more capable than ever of hearing and responding to God's plan for her. She is able to show up for her family in a way that wasn't possible even in half-recovery. And speaking of family: For the last several years, Sarah has been trying to start her own. It has been harder than expected, and requires of Sarah a degree of connection, acceptance, and gratitude for her body that is wholly incompatible with disordered eating.
From the ages of 15-24, Sarah's body was a worry, her appetite a nuisance, and her successful disregard of both was a sign of success. Although Sarah notes that she'd be recovered from her disorder regardless of whether she was carrying a child, she is now more motivated than ever to take care of herself, to maintain a healthy weight, to listen to her appetite, and to cherish - rather than fight - her own embodiment.