still on her growth curve. She didn’t fall off it until she lost five pounds, last April or May. And Kitty now, having gained twenty-five pounds, weighs far more than she ever did, and still has five or six pounds to go. For her it’s less a question of weight restoration than it is a question of weight correction.
Carolyn Hodges, a nutritionist and director of the Sol Stone Center in Elmira, New York, suggests that each person has a kind of magic number, a weight that signals true recovery for her. “Below that body weight, the thought process is very obsessive,” she explains. “I’ve seen this in several patients. Above that weight, they are much less obsessive; one to two pounds below, they will be very obsessive.”
We’ve noticed this with Kitty. And it’s not all about weight gain, especially for teenagers. There have been times over the last nine months when the number on the scale has stayed the same but Kitty’s grown taller, putting her further from her target weight. Every time, her mood has deteriorated and she’s seemed sicker again.
Another measure of recovery often suggested for women is menstruation. When body fat drops below a certain level, menstrual cycles stop. The problem is, this happens at a different point in the process for everyone. One teen may lose her period at 90 percent of her goal weight, while another may continue to have it even at 75 percent. Some women with anorexia never stop menstruating.
Maybe I’m deluding myself, but I have a sense that I’ll know when Kitty is really well again. I probably am deluding myself, because even the experts don’t seem to have a good grip on who is and isn’t recovered. This has ramifications not only for the patients themselves but for the ongoing research, much of which compares people who are actively ill with recovered anorexics. Often, the criterion for recovery is “being weight restored for a year.” But it all depends on what you mean by weight restored, doesn’t it? Who’s measuring, at what age, and how much growth has taken place? Pediatricians and doctors seem inclined to lowball weight. They’re often all too willing to settle for keeping a kid on the edge of normal; I suspect this is because everyone’s so obsessed with obesity in children these days. Doctors, especially, have internalized the notion of “thinner is better.” Whereas I think for a child like Kitty, having an “extra” five pounds is insurance against relapse.
Physically she looks healthy and strong, if still on the thin side. She’s developed more of a womanly shape. Her hair, which fell out in clumps all last summer and fall, is now shiny and long. Her eyes sparkle, her face is nicely full; she’s alive again.
She still says she feels no physical hunger; she says she can’t remember the last time she felt hungry. It’s been well over a year. Does she truly feel no hunger, or does she just not connect the physical feelings with the idea of appetite? I think of people with brain injuries, who, if given a math problem, say they don’t know how to solve it even as their hand writes the correct answer; they’ve suffered some crucial disconnect between speech and motor movements. I wonder if it’s that way for Kitty, if malnutrition has broken the connections between body and mind, and, if so, if they will ever be healed. I wonder if Kitty will ever feel hunger again, ever feel comfortable with her own appetite, or if eating will forever remain a necessary but unpleasant chore.
Emotionally she’s still volatile, still prone to anxiety attacks about everything from homework to friends to how she looks. But she smiles more these days; she laughs. After months of ignoring the three-year-old across the street, Joe, she now makes a fuss when she sees him. One day in early May she tells me she feels happy some of the time now—a huge improvement over ten months ago.
She’s come along in other ways as well. She sees Ms. Susan by herself, and she seems a little more open, more willing to talk about the eating disorder. One day she says she’s trying to keep the eating disorder in check by not “talking e.d.” Two months ago, she didn’t have the self-awareness to make a comment like that.
By mid-May she’s eating her afternoon snack alone in her room every day, at her request. Once a day, at least, she seems able to marshal her inner