And I’m proud of her: she managed. Not ideally by any means; she’s a long way from being able to take care of herself. But the fact that she wanted to go, and went, despite the difficulties, feels positive.
Ms. Susan thinks so anyway. “As I’ve told you many times, I think people with eating disorders should make their lives as stress-free as possible,” she tells us at Kitty’s next session. “On the other hand, there’s a lot to be gained from learning to cope with stress and anxiety, from coming away from the experience of being bored and anxious and learning to manage those feelings.”
Dr. Beth agrees. For months she’s encouraged Kitty to spend time with friends, join a club, hang on to as much real life as possible. Now she tells me, “I think Kitty’s going to be in that one-third who make a complete recovery and just go on with their lives.”
She smiles as she says this. All year we’ve been drawing on Dr. Beth’s steady encouragement. These words, coming from her, mean more than any dry pronouncement or study. She doesn’t know the future, of course; no one does. But she does know Kitty, and she knows us. And I know she wouldn’t lie.
I’ve described the demon in great detail to Dr. Beth because I want her to understand what Kitty’s going through. And she seems to, as much as anyone can: she’s never been punitive or angry; she’s maintained her empathy for Kitty, spent many hours talking with her, reassuring her, cheering her up.
But I also want Dr. Beth to know what refeeding entails because I know she has other patients with anorexia; in fact, I’ve talked with other parents, at her request, explaining FBT and encouraging them to look into it. And when those families try FBT, I want Dr. Beth and other pediatricians to prepare them for what they might encounter along the way. I’ve heard stories about kids who bang their heads on the wall until they break their own noses and black their eyes. Who leap out of moving cars or jump from second-story windows. Who kick and pinch and bite their parents—behaviors so completely foreign to their ordinary personalities that their parents panic, understandably, lose faith in themselves, believe their children are too sick to stay home. Behaviors that come from the damage starvation wreaks on the body.
But if parents know what’s within the realm of possibility, they can prepare themselves, mentally and physically, do a better job of keeping their children safe. That’s where pediatricians come in: they can reassure families who go through this that, yes, these behaviors are part of the recovery process, they will go away; your child’s not crazy in any permanent or overarching way.
Pediatricians are nearly always the first doctors to mention the word anorexia to a family. They’re the ones who describe the disease, who sketch out treatment, who refer families to shrinks and therapists and nutritionists. I don’t understand why insurance companies insist that only psychiatrists can diagnose and treat eating disorders; pediatricians are the ones who have relationships with parents and kids. The pediatrician is like the first-base coach, keeping up a steady stream of chatter and reassurance, whereas a shrink is like the designated hitter, brought in late in the game to knock a home run over the fence.
I know who I’m going to trust.
Pediatricians are best positioned to help a family. The trouble is, they get little to no training in how to treat eating disorders. Unless they’re unusually motivated and responsive, like Dr. Beth, they know only what they were taught in medical school, which often consists of Hilde Bruch and not much else. When a child is as sick as Kitty was last summer, pediatricians usually recommend sending her away for residential treatment at a for-profit chain like Remuda Ranch or Renfrew, or to an eating-disorders center like Sheppard Pratt in Baltimore.
Places like Renfrew and Remuda boast sky-high recovery rates—but those are short-term rates, often measured on the day they leave. Kids usually do gain weight at residential centers, but they rarely gain enough; typically they’re sent home when they reach 90 percent of “ideal body weight.” Which is about where Kitty is now. So I know that 90 percent of ideal body weight does not constitute recovery. It’s an improvement; it’s medically stable. But it’s too low to promote true psychological healing. The demon is still very much in the picture at 90 percent. When teens leave