mouth, make her chew and swallow. I wouldn’t do that even if I could.
“No school until you eat,” I say, not turning around.
“I don’t care,” says Not-Kitty. This shocks me as much as anything. Part of her goal of going to Columbia and then to law school has been not missing any school—and, of course, excelling at it.
It would be best to say nothing. Best not to argue with the demon. But I open my mouth and out come words I haven’t planned on saying: “You’ll never get to be a lawyer if you die from anorexia.”
I think this is the first time I’ve mentioned the idea of dying from anorexia to Kitty. No, I know it’s the first time, because I’ve been careful to stay positive and hopeful. She’s said the word a few times, as in “I’m going to die if I have to eat one more bite!” And of course there was the night she said at the dinner table that she wanted to go to sleep and never wake up. But this feels different. Something about the juxtaposition of the illness with Kitty’s hopes for the future strikes home, for her as well as for me.
For the rest of the day, Kitty eats. Quietly. Unhappily. More slowly than usual. But she eats, afternoon snack, dinner, and bedtime snack. And no more is said, for the moment, about not going to school.
The next afternoon is, if anything, worse. The demon takes over at the lunch table and the rest of the day is a disaster. Trying to figure out why, I sit down and calculate calories—something I’ve stopped doing, thinking we had the hang of it. I write down as much as I can remember of her recent meals, ingredients and quantities, and realize, in horror, that for the last week, she’s been taking in fewer calories than I thought—more like twenty-five hundred a day than three thousand. I can’t believe we let this happen. No wonder she’s been antsy and anxious; twenty-five hundred calories is nowhere near enough for her right now.
Then another thought strikes me: I wonder if she’s grown? Or is growing? At her next weigh-in I ask the nurse to measure her, and sure enough, Kitty’s nearly an inch taller. Now the whole picture begins to make sense: just as Kitty’s body began to need more calories, for growing, we inadvertently cut back. Those two processes, plus the physiological and psychological effects of restricting, combined to strengthen the demon within her.
Ms. Susan agrees. She says restricting—even the tiniest amount—quickly takes on a life of its own for someone with anorexia. Starvation over a period of time creates actual neural pathways in the brain. And now even the most minor echo of starvation—a slight reduction in calories, nowhere near the danger zone—reactivates those pathways, brings back the emotions and obsessions of true starvation. The reason lies in the brain’s malleability—what researchers are beginning to refer to as its neuroplasticity. Psychiatrist Norman Doidge, author of the book The Brain That Changes Itself, compares the brain to a snow-covered sledding hill. Because snow is soft and easily shaped, the first time you sled down the hill, your sled carves a path. Each time you go down after that, your sled tends to run along the same path, digging it deeper and making it harder to steer your sled elsewhere. It’s the softness of the snow, ironically, that creates a rigid, well-defined pathway. Doidge argues that it’s the same with the brain: the brain’s very flexibility, its ability to create new neural pathways, also makes those pathways hard to break away from. Each time Kitty restricts, no matter how slightly, it’s as if she’s sledding down that hill again, wearing the old groove ever deeper in the snow.
Neuroplasticity doesn’t cause eating disorders, of course; it’s just part of what makes them so tough to overcome. In Kitty’s case, I suspect a confluence of events last spring pushed her into full-blown anorexia: a growth spurt, restricting, and a prepubertal hormonal shift. And it’s going to take time, and many thousands of calories, to reverse.
In any case, I know what we have to do, and I know, now, that we can do it. We push Kitty’s calories back up to three thousand a day. I buy a big bottle of Maalox and start making milk shakes again. We pull out the Ensure Plus from the basement. We carry on.
By Thanksgiving week, Kitty’s gained two more pounds. She’s calmer, though