An Excerpt from Hungry: A Mother and Daughter Fight Anorexia

LISA'S BLOOD GLUCOSE DIARY: BINGED. One-half chocolate banana. One-third vegan apple nut pastry. Pita chips (about 10—12).

SHEILA'S WORKDAY: Taste-testing french fries at seven restaurants.

On a postcard-perfect June afternoon, green hills going gold, I am driving around Silicon Valley to sample french fries. It is my job. In another universe, my daughter, Lisa, records each bite she takes in her Blood Glucose Diary, a booklet from her nutritionist. She is frantic about veering from anorexia to binge eating. We don't understand each other at all.

As the restaurant critic of the San Jose Mercury News, I had noticed french fries popping up on high-end menus, many more than the three instances needed to call it a trend. Was it merely another cheap thrill that posh restaurants could overcharge for, or were these frites really that much better than at McDonald's? After all, no less an authority than James Beard, the dear leader of foodies everywhere, had approved of McDonald's fries.

Food reporting's serious aspects concern safety, fraud, and consumer protection, but this story was just fun. It was also an escape. While I was out judging America's favorite vegetable for flavor, texture, and price, my daughter was home, starving herself.

Lisa spent much of her nineteenth year in her room, like a child being punished. Her struggles with anorexia and bulimia had become apparent two years earlier, in 2001, starting with an interest in diet, nutrition, and exercise that was healthful before going very wrong.

Lisa grew up with a lusty appreciation of food. My husband, Ned, is an excellent cook. When we get together with friends, it's in a kitchen or a restaurant. Our vacations are food pilgrimages. Food to us is home, health, family, fantasy, entertainment, education, and employment. Heart disease in the family, yes. Anorexia, never. And bulimia? What was that?

We had experienced none of the common triggers often associated with eating disorders: divorce, death, job loss, sexual abuse. As for the anorexic family stereotype—domineering mother, distant father, perfectionist daughter—um, no. We come closer to the opposite—quietly supportive mother, loving father who cries easily, creatively disorganized daughter. We forced the kids to visit distant relatives and to write thank-you notes, but when they tired of piano lessons and soccer we didn't argue about jeopardizing Ivy League prospects.

After a very bad senior year in high school, Lisa got well enough to go to college in the fall of 2003. There she soon relapsed, but came out of it and had three pretty good years before crashing in an even worse way, just shy of graduation. As we write this book, Lisa is twenty-four, coming back to life, and again we all have hope.

But the past seven years brought police cars and emergency rooms into our life, and phrases like "seventy-two-hour hold" and "danger to yourself or others" into our everyday conversation.

As a newspaper writer and editor, I used to love irony. It made for the best stories, especially when they involved an apple falling far from the tree, or at least a little oddly. For example, "Liberal, Matriarchal Family Spawns Pro-Life Leader" and "Anti-Gay Vice President's Lesbian Daughter Says . . ." What fun when it's someone else! How to explain the intergenerational drama? Too often, the shortcut answer was to blame the mother. "She's so controlling." "She's too lax." "She's distant." "She works too much." "She's always home, interfering in everyone's life." When we need someone to pin to the wall, Domineering Mom is so convenient. I have to admit I did it, too, although I was just as quick to blame the Distant Dad in those deliciously ironic situations. As in "Publishing Heiress Patty Hearst Robs Bank." Extrapolating, I wasn't the only one picturing a love-deprived child of privilege, rattling around the mansion, hungry for the family feeling she was to find, briefly, as a soldier in the Symbionese Liberation Army.

I didn't love irony when it happened to me: Food writer, in the public eye, has an anorexic daughter. Our life was like a movie in which the audience understands what's going on but the main characters are clueless. And I certainly didn't appreciate the armchair psychologists, real and imagined, pointing the finger at me as the cause of my daughter's ED (the catchall term for eating disorders). Our family went into triage mode, trying to help Lisa.

The upside of irony, when it happens to you, is that you have to learn something. Perhaps there's a loosening of attitude. I'm doing a lot less tut-tutting these days, and more tapping into a well of compassion, even for myself and my missteps in our family drama.

Hungry traces our fall from grace as a healthy middle-class family and follows our tightrope walk back to a tenuous perch. In many chapters, Lisa and I write alternating sections, so that families can see eating disorders from both the child's and the parent's point of view. In some chapters, we stop and look at the larger picture of craziness around food.

At first, Ned and I kept Lisa's illness to ourselves and very few friends. All we knew about eating disorders was that if they didn't strike in early adolescence you didn't have to worry, and that turned out to be wrong. Our daughter was older, preparing to leave home for college, when her symptoms first became severe. When she started acting strangely around food Ned and I thought, "This must be stress, it couldn't be anorexia. That would've shown up already." Many denials and common misconceptions later, my editors at the San Jose Mercury News asked me to consider writing a story about our experience with ED.

A few months went by, and Lisa seemed to be getting better. We agreed to share what we'd learned. The story would bring a shameful subject out into the open and, who knew, maybe putting Lisa's improvement in print would make it stick. It happened to be Pearl Harbor Remembrance Day, the Sunday in 2003 that the Mercury News published our dueling first-person account as the front-page centerpiece, with photographs of Lisa as a smiling six-year-old holding a soccer ball, a pudgy fourteen-year-old, a stick figure at nineteen.

Reader response was overwhelming and heartbreaking. Desperate families appreciated knowing they weren't alone. Like them, we had discovered that eating disorders are moving targets. Just when we thought we'd learned the rules and found the right strategy, the whole game would pack up and move to a new field. We'd been studying anorexia and the test was on binge eating. We had to learn to say, "Okay, that didn't help. Now we have to try something else."

"Something else" was at times a new medication, a therapist specializing in eating disorders, a nutritionist, another medication, a different therapist—all of which helped for a while and then didn't—and an eating disorders treatment center, which was a disaster.

"Looks like you've thrown everything at this," said one hospital doctor. I think he was trying to sympathize with our desperation, but all Ned and I heard was, "Look what you've done to this child." And when we went the route he recommended, it was a different kind of disaster. The lessons of the past several years never presented themselves in an obvious way.

When Lisa was diagnosed with anorexia, I picked up book after book, but none of them gave me what I needed: a sympathetic, articulate expert or parent who not only had been through this hell but also was insightful about food in our culture. This book is our effort to be that resource. Yes, eating disorders function like addictions, but no, you can't just say no to food. At work, at home, on the street, America is a twenty-four-hour buffet. We're never more than steps away from an endless stream of gastronomic options screaming: "Eat me!" Even gas stations have mini-marts serving groceries and hot food. (Pay no attention to the noxious fumes around the pumps.) No wonder we all flail around, from the eating disordered to the healthiest among us. Food overload makes me almost long for the rigid olden days of my youth, when families sat down for three meals a day, or at least dinner on weeknights, at specified times and places. In my parents' house, it looked like this:

3:30 p.m. After-school snack

4 p.m. Kitchen closed

6:30 p.m. Dinner

7 p.m. Do dishes; kitchen closed

When certain guests came over, we brought food into the living room, but never our bedrooms. Grocery stores sold the raw materials to make a meal at home, not hot meals to go. Restaurants were for special occasions. There wasn't a lot of room for individual expression, but the day had structure and families had control.

Now, over forty percent of American adults eat out on a typical day and nearly fifty percent of the family food budget goes to food eaten out or pre-prepared, as cooking is considered a time-consuming craft. Economic necessity may give a boost to home cooking, but it will be a whole new world if we get reacquainted with the dinner table and regularly sit down to meals together, without iPhones, laptops, or Tvs.

Revered cookbook author and teacher Marion Cunningham lamented the loss of the family meal in 1998, when only thirty percent of the population cooked at home, even with skyrocketing interest in kitchen appliances. (Perhaps those were for the caterer.) "Home cooking in America has always been considered menial drudgery," Cunningham told the Los Angeles Times. This despite all the food shows on TV and sales of celebrity cookbooks. In defense of the family meal, Cunningham wrote cookbooks for children and for adults who didn't know what to do with their saucepans or spatulas.

We like to watch, like Chance the gardener, the Peter Sellers character in the 1979 movie Being There, the man who never went anywhere. Everything he knew, he learned from television. On the bright side, a person like Chance could learn to cook from Julia Child, who took to television and books to simplify French home cooking for Americans, knowing "our readers wouldn't have mortars and pestles for pounding lobster shells." (And if the readers didn't, the TV audience certainly didn't.) Now many of us have the mortars and pestles, but they're heavy and inconveniently stuffed way back in a kitchen cabinet because who has time, and who can afford lobster?

Burdened by beatific Norman Rockwell visions of the family meal, we have developed a negativity about eating at home that is shared even by organizations that know better, the ones pushing healthy food habits. Weight Watchers ("Stop Dieting. Start Living.") acknowledges the difficulty of cooking for a family night after night, particularly for the person on a diet, because home is where we know we should comply with whatever diet we've adopted at the time. Restaurants are where we go for a little fun, to treat ourselves, not to control our consumption.

Let's do the math: Food adds so much to our lives that we can lose track of the grand total. We love the feelings food arouses—the sensuality, the comfort of old favorites, the thrill of discovering new treats, the entertainment value of food—just not those pesky calories. We don't want to bother with meal planning and preparation, but we care more than ever about what we eat and how we look. This doesn't compute, except perhaps for those mythical gods with such a "fast metabolism" that they can eat anything and never gain an ounce. They are like students who always ace the exam and claim to "never study." For lesser mortals, passing tests and eating healthfully both take effort. We exist on a continuum of difficulty. Who doesn't have some kind of food addiction? It may be fleeting, like the woman who downs a box of Wheat Thins while sitting in freeway traffic the day before Thanksgiving (me). It may be deadly serious, like the teenager who obsessively counts every calorie as an enemy (Lisa).

Eating disorders fester in an individual's biological and psychological makeup, but we all live in a society that prizes thinness for women above all other qualities. Meanwhile, food gets in your face all the time, the elephant in the room. Project Runway and Top Chef battle it out for your desires. Want to look like a supermodel (or date one), or do you want to cook and eat like a great chef?

The national panic about obesity provides more grist for obsession. Maybe you didn't feel fat, just a touch overweight, before the U.S. Centers for Disease Control and Prevention revised the height/ weight tables, and now your weight is considered morbidly obese. Are you going to exercise more and eat less, or just fuss more about food and appearance? Obsession is what food addiction is all about, and the accompanying compulsion to eat or starve yourself in order to soothe emotional pain, avoid scary feelings, or perhaps narrow your thighs or reach your "ideal body weight." Eating disorders are diagnosable food addictions.

If you're not hungry now, you will be soon, and then you'll have decisions to make. For serious food addicts these decisions take up most of the day. If your addiction is to drugs and alcohol, it is difficult but possible to learn to live without them. But you can't abstain from food. For people with eating disorders, the object of their addiction is in their faces every day, next to media images of impossibly skinny celebrities.

A few stars are finally admitting to eating disorders, but girls still want to look like them—thin hangers for designer dresses. Some centers of the fashion industry have been scared into setting standards. After the deaths of two anorexic models, the fashion shows in Madrid and Milan agreed to ban models whose body mass index falls below what the World Health Organization considers healthy.

In the United States, the Council of Fashion Designers of America recognized the problem and formed a committee, which recommended "awareness and education, not policing." Meanwhile, tabloid magazines and websites run galleries of shame, with big yellow arrows noting problem areas in legs and butts, and photo contests like "Guess the Celebrity Cellulite! Can you tell the star by her dimples?"

Models, actors, and athletes set the pace, but at least one in every one hundred female adolescents in the United States is starving herself. Two-thirds of women students could be diagnosed with eating disorders at some point during college. College dormitories have their vomitoriums, where, everyone knows, a resident or two regularly throws up.

ED patients jump all over the demographic landscape, from children as young as six to women in their eighties, to men and boys. Ten million women and one million men have eating disorders, and twenty-five million people struggle with binge eating, the latest wrinkle in the obesity epidemic.

In times of famine, only the rich were fat. Now that anyone can look like Henry VIII—and too many people do—he's gone out of fashion. The most self-accepting among us still despair of our own spare tires.

This scourge hits our children at their most vulnerable. When I was a miserable teenager, my main focus of personal failure was having curly brown hair in a blond surfer-girl culture. But I could look forward to college, where a single standard of beauty wouldn't snuff out all the rest, brains would matter, and the population would be more diverse. We had Barbie, but compared with what came before and after, we lucked out in the sixties and seventies, when there were lots of really bad ways to look. My mother's generation and Lisa's generation have a tougher time with the One-Look-Fits-All dictators.

The Eating Disorder Referral and Information website gets over 3,200 visits a day—and that's only one of dozens of such websites. Anorexia and bulimia are so virulent that even with professional care, forty percent of patients never recover.

Then there are the rest of us, who occasionally diet but are always aware of our weight, and it's always too high. Psychology Today found that eighty-nine percent of women want to lose weight. But this statistic is even more stunning: Twenty-four percent of women would sacrifice three years of life to lose weight. Refusing food is a time-honored form of protest, whether you're a child objecting to broccoli or Mahatma Gandhi fighting British colonial rule of India. What's new is the relentless beat that skinny is best (ever more so with big breasts, like the classic Barbie figure) and the common acceptance of that inhuman ideal. We worship deprivation and disdain gluttony as sinful and repellant. Better by far to be hungry. Girls earn bragging rights based on how little they eat, as do women who are old enough to know better. They share tips for reaching the promised land of Size Zero and even better, Size Double Zero.

Pro-anorexia websites are waiting to share ever-more effective techniques of starvation with teenage girls, who love to hang out in digital space. (A recent posting: "I am aiming for 500 cals a day, and I am not exceeding 800. Under any circumstances. FRESH START!")

When Lisa was trawling for "thinspiration," as the pro-anorexia websites call it, I was out reviewing restaurants. People often ask, "How did you keep working?" The real question is, "How could you keep working? Your child might be dying!" I asked myself that question many times a day. But being by Lisa's side didn't seem to help, either. She just kept getting worse. Lisa often called my cell phone when I was driving to a restaurant, and sometimes she would say, "I can't do this anymore." By "this" she meant life.

Meanwhile I had the job of my dreams. Besides reviewing restaurants and answering readers' questions, I wrote news and feature stories. It made national news when I found that a prominent local Italian restaurant was substituting pork for veal, a fraud that caused Muslims and Jews to eat forbidden foods. The more I focused on the details of food safety and marketing, the more passionately readers responded. Everybody eats. My predecessor had to quit this job for his health, but lucky me, I have the metabolism for it. I tacked this quote from the great food writer M.F.K. Fisher to my cubicle wall: "First, let's eat," and I followed that commandment.

Also, I had to keep working because we needed my salary. Health insurance covered little of Lisa's care. We finally found a psychologist Lisa connected with, and she's made tremendous progress. Again we have hope, but her treatment has cost $30,000 a year. It comes out of money we had saved for Lisa's education and future.

Faced with a disease of uncertain origin and wildly conflicting experts, I flew into information-gathering like a frantic bird, collecting sticks and leaves to patch the nest. Quick, let's try this treatment or that doctor. When your child is sick, that's all that matters. You feel paralyzed at times, you can't face another day, but you keep going. My job just made the going a little trickier.

People who meet me as a food writer invariably say, "But you're skinny!" It may be my greatest accomplishment ("She ate a ton and never got fat"). But even at my thinnest postcollege depressive self, a knife blade in skinny jeans, I never lost track of the two or three pounds that would have flattened an imaginary bulge in my stomach.

As a food writer and middle-aged woman, I have rounded up a bit. (When I started reviewing restaurants, it was: "But you're so skinny!" Mostly I don't hear "so" anymore.) I exercise a lot, and I kick myself for all the mental energy I put into my weight and body parts I'd like to trade in, when I could be caring about something important. How did my body issues and my job as a food writer contribute to my daughter's anorexia? Lisa and I retreat to our own corners on this one. She sees a lot to blame on me, my job, our family's food obsession. And you know, so do I. But I wonder how much can be attributed to my career choice, my personality, or just being Mom. Hungry is not about piling on the blame. There's a lot more at work. Like mothers and daughters everywhere, when Lisa and I build up muscles of self-righteous anger and hurt, it's hard to break through. Our book is about the hungers that put us back in the ring.