My stepsister Marcia and I share an occasional lust for high grease
breakfast foods, and over pancakes and eggs recently, she told me something
interesting. Marcia’s daughter, Drennan, was with us — a wily, emphatic
little girl who, at 4 years old, is young enough that one can still
spell words in her presence and elude — just — the clamp of her
curiosity. S-E-X is a big one, of course. Marcia is careful to spell out
the name of her ex-husband, Drennan’s father, when speaking of him with
anything but the warmest affection. I was surprised, though, when Marcia
mentioned that she’d been on a D-I-E-T.
“Why did you spell it?” I asked.
“Oh, I don’t even want her thinking about all that,” Marcia said.
We both looked at Drennan, who was smacking her lips over fried eggs and
hash browns. I didn’t have to ask what Marcia meant by “all that.” We are
both 35, members of the vanguard generation of disordered eaters.
When Marcia and I were children, no one had heard of anorexia; I first
encountered the term at 13, in 1975, in a magazine article about a
girl who had emaciated herself for reasons no one understood. I remember
her picture: somber, willowy, standing on a bathroom scale, her shoulder
blades jutting out like wings. I looked at her and felt my whole being
compress into a single strand of longing. I wanted that. Anorexia. And I
got it, not in so dire a way that I was hospitalized with feeding tubes –
or even close. But at 14, when I began losing weight precipitously, I
inculcated myself into the cult of food consciousness and its attendant
elations and despairs. I joined the ranks of girls and women whose
notebook margins are dappled with obscure sums — apple, 100; bagel, 200;
frozen yogurt, 150 — women for whom countless meals are fraught with the
tension of trying to eat less than anyone else, who keep a section of their
closets full of “skinny” clothes that radiate desire and reproach, who
cancel doctor appointments because they’re afraid of being weighed that
day, for whom “You look too thin” is perceived as a radiant compliment and
a growling stomach and a light head inspire feelings of triumph. These
rituals, and many others, were to circumscribe my thoughts and behavior for
the next 15 years.
It can be eerie, in light of our presumed uniqueness, to discover how
closely the experiences of one’s contemporaries parallel one’s own. I’ve
heard many women my age say, “I wanted to get anorexia,” or even, “I
learned how to make myself throw up,” as a prelude to prolonged and
desperate struggles with bulimia. Many of my friends at the University of
Pennsylvania were grappling with full-blown eating disorders; the rest were
wary and self-conscious about food. How could they not be? In the women’s
restrooms at the Wharton Business School, where I sometimes studied at
night, food containers often lay right next to toilets. Donut boxes,
Twinkie wrappers, ice cream containers — these remnants of desperation
frightened me the way nightmares do, grotesque distortions of things that
are, at bottom, deeply familiar. Here, eating no longer bore any relation
to nourishment or even to pleasure: It had been reduced to a brief
complication in the process of purgation, of emptying oneself.
My mother, who graduated from Vassar in 1959, finds these stories
incomprehensible. “We’d order in plates of French fries and hamburgers,
and we’d just eat it all and go to bed,” she says. “We were all a little
overweight by today’s standards, but I don’t remember that troubling me in
the least.” Marilyn Monroe was the beauty who floated in the minds of my
mother and her friends, voluptuous, pillowy. “The models in the fashion
magazines were skinny, but no one cared about them,” my mother says. “They
were anonymous.”
But attitudes toward food were the least of the differences between my
mother’s college years and my own. “There were certain people who planned
to have careers,” she says, “but the rest of us majored in English or
something, and the idea was that you would get married. I thought I’d
never have to earn a living. I’d be an even more ornamental accessory.”
This promise — that in exchange for being lovely and well educated, my
mother would be taken care of for life — was one of many the world failed
to keep. By 26, she found herself divorced with a 2-year-old
daughter. It was 1965. Women only five or six years younger than she were
studying at universities awash in demands from all quarters — for
equality, for opportunities — demands my mother had never thought to make.
The world that she and her Vassar friends had been groomed to inhabit had
vanished from under their feet.
My fears of being overweight, which commenced when I was 9 or
10, have always been linked, in my mind, to my mother. She is a glamorous
woman with exquisite taste and a sumptuous wardrobe. Physically, I
resemble her to an almost uncanny degree; people have been doing
double takes at the sight of us for as long as I can remember. Perhaps
because she and my father were divorced before I was 3, my sense of my
mother and myself as a unit, a pair, an inseparable duo, feels ancient and
inviolable. When I was 5, we wore matching two-piece bathing suits.
I regarded my future stepfather as an unwelcome interloper in our
small, simple world. “He’s just coming over for a bite to eat,” my mother
would assure me, to which I would reply, “OK , one bite. And then make
him leave.” But they married when I was 4 and moved to San Francisco,
taking me far from my father, who was still in Chicago. He, too,
remarried, and as both families began having more children, I struggled,
alongside much of my generation, in the role of stepchild, so perilous in fairy
tales and in life. My unease made me cleave all the more to my mother –
the unit of us two was the only one in my life that still felt intact.
I was an average little girl, not skinny, not fat, with white blond
hair, an enormous grin and an unrelenting sweet tooth. I remember my
mother suggesting at some point that I hold in my stomach when I stood; not
only would this look better, she said, but it would strengthen my stomach
muscles so that pretty soon, my stomach would stay tucked in of its own
accord (I’m still waiting for that part). This missive from the world of
adults was something I took quite seriously: I was careful to hold in my
stomach.
“Something odd happened in the ’60s,” my mother recalls.
“Fashions became very childlike. The models all had these knobby legs and
patent leather shoes … women suddenly wanted to look like prepubescent
girls.” Considering that many consumers of fashion in the 1960′s were
women like my mother, bred to inhabit a world that was now in staggering
transformation, this yearning to return to puberty — to start over — seems
deeply reasonable. My mother was fashionable; she subscribed to Vogue and
Harper’s Bazaar, and she followed their leads — followed, too, the
ascension of those skinny, anonymous models from the status of clothes
hangers to that of stars. If feminine power in the ’50s was measured in
overt sexuality, the ability to attract a man (a man who would take care of
you for life), in the ’60s, a woman’s power became vested in her ability to
regulate her sexuality — most obviously with birth control, but also by
curbing the womanliness that would land her in the kitchen slinging pork
chops, as my mother’s had.
In the selfishness of childhood, I could not imagine my mother
doing anything but serving us, and she never implied that she would have
preferred to do otherwise. But I think I sensed her frustration. By the
time I was 12, her marriage to my stepfather was stretched tight over
fissures that would ultimately bring its collapse. He was gone a lot on
business; she cooked dinner for my brother and me every night (“Chicken
again?” we were forever whining) and did enough laundry to fill an airplane
hangar. Recently I asked my mother what she might have done if she hadn’t married so young (she returned to the workplace in her early 40s, and is now a successful art dealer) and she mentioned languages, diplomacy, Europe. I can’t blame her. As a
child, I felt a deep aversion for my mother’s life, and that aversion
filled me with guilt — and fear. I adored my mother. She was all I had.
A heightened consciousness of food first seized our household in
the early ’70s, when my mother read Adele Davis and banished Quisp and
Lucky Charms forever from our shelves. Hostess Ho Hos and Ding Dongs
yielded to Fruit Rolls and Tiger’s Milk Bars. My brother and I were fed
spoonfuls of cod liver oil each morning before we left for school; I spit
mine onto the garage floor, where it mingled nicely with the oil stains
(“It smells like fish in here,” my stepfather would muse, bewildered). And
this health consciousness was duly followed by a growing awareness of
weight. The flat green scale in my parents’ bedroom acquired Delphic
powers; it revealed whether you had been Good or Bad. My stepfather
transformed into a fanatical runner, and when the early antecedents of
aerobics came along (before Jane Fonda, who, incidentally, was a college
classmate of my mother’s), my mother embraced them with a fervor. My
parents would marvel at snapshots of themselves from the 60′s — look at
that double chin, that flabby stomach — as if some prior blindness, some
naive vulnerability in themselves had now been cast off.
I took my Fruit Rolls and Tiger’s Milk Bars to school and traded
them for Ho Hos and Twinkies, which I wolfed down like a refugee receiving
succor during wartime. And then I worried. My love of food, and of sweets
in particular, had begun to feel dangerous. I had absorbed the notion of
Good and Bad with regard to eating, and knew that I was Bad. And
perversely, the more entangled food became with virtue, or my lack thereof,
the more tenuous its connection to satisfying hunger, so that rather than
quelling my desire to eat, these ruminations made me crave food always,
whether I was hungry or not. By 13, I was eating a lot and it was starting
to show. Now, mingled with the general wretchedness of
adolescence was the specter of fatness, which loomed before me
terrifyingly, compounding my sense of powerlessness and unease in the
world.
I began to soothe myself with fantasies, visions in which I became
popular, irresistible, strong, like the models in my mother’s fashion
magazines (which I devoured), visions in which, above all, I was searingly,
mightily, unstoppably thin. The article on anorexia, intended as a
warning, functioned for me as a how-to manual. I remember the euphoria of
finding myself lighter on the bathroom scale, my sense of joyous and secret
achievement when the waistbands of my pants hung loose and my ribs became
distinct as fingers and people asked my favorite of all questions, “Have
you lost weight?” I felt as if I were finally coming into focus, hard and
sharp and light, released from the muffled padding of my sadness.
My sudden 14-year-old weight loss made my stepfather
apoplectic, but my mother wasn’t nearly as troubled by it — not as
troubled as she would have been, say, had I gained weight. Fat meant
sloppy, out of control, but thin meant sleek and powerful. She joined
my stepfather’s bullying efforts to make me eat, but on a tacit, subterranean
level, I believed that I sensed her approval, and luxuriated in it. Because
my mother herself was thin, and dieted, I felt a kinship with her, as if losing weight were an organic feature of the adult world she inhabited. At the same
time, in craving strength and power, I sought to leave behind the life my mother stood for — to enter the arena of the worldly, rather than the chicken basting and laundry folding. And I felt, in some buried way, that my mother wanted
that for me, too.
It is in the body of a true anorexic that the irony of equating
thinness with power becomes grotesquely obvious: shriveled, weak, married
to a project of self-erasure that often ends in death. But for those of us
who struggled with an undue consciousness of food and weight without
destroying ourselves, those of us for whom time and experience and whole
sections of our lives were measured in fatness and thinness, in Good and
Bad, for us, too, there are ironies. And the main one is this: Our route
to worldly power involved shrinking the world to match the dimensions of
our own small (but never small enough) bodies, and then dominating those. A
conspirator against us could not have planned it better.
How did it happen? For myself, I have an idea: As much as I longed
to triumph, to have adventures, to succeed in ways my mother had not, a
separate part of me was terrified to betray her. Without my mother, whom
did I have? What would I be? By mistaking my physical self for the world
and exerting my power over that, I could experience the sensations of
triumph while remaining essentially harmless: preoccupied, physically
weak, inhabiting a world more narrowly circumscribed, in these ways, than
my mother’s had been. When I think on those years, the waste of time is
what I most regret; all that thought and worry, those physical trials. I
could have learned Greek or Latin with that time. I could have built a
boat and sailed around the world. But these regrets are subsumed, finally,
by sheer relief at having been released from that tiny box of thought,
subtly, almost without my noticing, somewhere around the time I published a
novel. That was my first, tentative brush with the world beyond myself,
and it led me to imagine what real power might feel like.
An eating disorder is partly a disease of consciousness, of
perspective — hence its insidiousness, and also its contagion. Attitudes
toward food are taught and learned, but once food becomes entangled with
notions of good and evil, it can be nearly impossible to extricate. Nor
can one give it up altogether. Eating disorders have become part of our
culture, and they’ll multiply and reproduce with lives of their own. We
can’t take them back. But unlike our mothers, who were as blindsided by
their arrival as we, I and my generation know exactly what they are. I
don’t have children yet, but when Marcia spelled out D-I-E-T, I made myself
a promise: If I ever have a daughter, I’ll keep the cult of food
consciousness outside her range of vision for as long as I can, so that
when it finds her some other way, as it surely will, she won’t see me as
its silent advocate. And then I can help her fight it. I made that
promise as I watched Marcia’s little girl finish eating in peace.
In Nov. 1991, Merry Scheck admitted her 13-year-old daughter Christy to a psychiatric hospital near their San Diego Home. Once an honor student and gifted athlete, Christy had become suicidal, hiding razor blades and aspirin bottles in her room and telling her friends that life at home was unbearable. The Schecks were a close, religious family. Christy had always maintained healthy relationships with her parents, especially her father, Bob, who coached her sports teams and practiced pitching, throwing and hitting with his daughter every chance he could. But when Christy approached adolescence and her father decided she should no longer play in boys leagues, she was furious, and her behavior became irrational and self-destructive. On the advice of a family therapist, the Schecks checked their daughter into Southwood Psychiatric Hospital. Five months later, she hung herself while on suicide watch.
What the Schecks didn’t know when they admitted Christy to Southwood was that it was one of 70 psychiatric hospitals affiliated with National Medical Enterprises, a $4 billion player in the mental health business. In her new book, “A Wrongful Death: One Child’s Fatal Encounter with Public Health and Private Greed,” reporter León Bing interweaves the Scheck’s haunting personal story with a tale of corporate health care gone horribly awry. Chapter by chapter, the Scheck story unfolds, revealing a picture of a mental health system largely devoid of compassion and competence — and an institutional structure based primarily on profit, where patients with generous insurance policies receive expensive and lengthy hospital stays that often do more harm than good.
Salon recently spoke to Bing about trendy psychological theories, her own experience working at a psychiatric hospital and why, when it comes to health care, insurance is everything.
You worked as a “tech,” someone who ushers kids to and from therapy and chaperones at meals and activities, at a private psychiatric facility in Southern California similar to the one that Christy Scheck was in. Techs have the most contact with kids, but you write that in order to get hired you were interviewed briefly, given a cursory medical exam and two days later you were hired.
Yes, I worked for a facility that is no longer in operation, during the summer of 1985, but I only lasted for three months. I asked too many questions. At the time I was hired, I thought, this is easy enough, this is pretty fast. Techs were part-time, on-call workers, with no benefits, who could be paid almost a minimum wage. So, if you were able to understand directions, and provide answers that showed that you comprehended them, it seemed pretty clear that you’d get hired.
After I left the facility, I wrote a cover story about it for the L.A. Weekly that nearly broke their record for mail received. It seemed that every kid in the L.A. area who had been put in one of those places wrote in. So I kept that in the back of my mind and knew I wanted to write a book about it. And then as more and more atrocities came to the surface, I realized it was the time.
What atrocities?
There was a case in Texas in which a 14-year-old boy was picked up at his house and taken in handcuffs to a private psychiatric hospital for supposed drug abuse. He was kept for five days without being allowed to see or speak to his family; he tested negative for drugs and wasn’t even seen by a psychiatrist until two days after he got there. So a suit was brought against the hospital chain, Psychiatric Institutes of America (PIA), which also ran the hospital that Christy Scheck was placed in.
This book did not start out being about Christy Scheck.
In 1993 I began interviewing kids. One of them, Lynn Duff , was on Barbara Walters a couple of weeks ago talking about how she had been in effect kidnapped by her family and driven to Utah with a hood over her head to a facility there called Rivendell. Her mother put her there because Lynn had told her that she was gay. I interviewed Lynn at great length. She was going to be one of the chapters in the book; I was going to do different chapters on different kids. Then in 1994, I read an article that had to do with a settlement made by National Medical Enterprises (the corporate parent of PIA) to the Scheck family because of the death of their 13-year-old daughter at one of these facilities in a suburb of San Diego.
I called the Scheck’s attorney to ask if I could meet with them, and he said he didn’t think they wanted to talk to a member of the press — which I understood, of course, as a parent, if nothing else. But about a week later Merry Scheck called me. And what started out as a chapter on Christy Scheck ultimately overtook the book. I mean, I had talked with some kids who had riveting accounts, but this overshadowed all of them. Those kids were still alive. Christy was dead.
Did the stories that you heard from the kids you interviewed corroborate and round out what you learned from the Schecks?
I had interviewed all of those kids, and I had worked in one of those facilities. You know when something has a ring of truth, and when you have been there to witness it, well, there is not much problem believing it. And I am not a “believing” person by nature.
Were any of the kids you worked with — or interviewed — helped by the treatment they received in these hospitals?
If the kid gets lucky, they are helped. No matter what the bylaws of the facility are, if they are hooked up with the right shrink they are going to be helped. Or if the kid was open to being there, they might be helped. But unfortunately many of the kids I worked with were lied to by their parents, by their school counselors or by both. My question at staff meetings was, “How are these kids ever going to trust their parents or any authority figure again?”
How do they navigate the adult/authority world, once they get out?
It depends. Remember, they are being sent back to the exact same environment. Same people, same kind of happenings that put them there in the first place. I sat in on one parent-child meeting and it was amazing. The mother did nothing but shriek at the kid for the hour and justify the fact that she had read the girl’s diary and gone through her drawers.
You write about the tactics that these facilities use in order to play on parents’ fears. You call it the “what if” approach.
The ad copy for these hospitals will read something like “It could be growing pains, but what if it’s not?” or “The moods and the roach you found in the back of the car could just be typical teenage behavior, but what if it’s not?”
How can parents make sure they are not getting duped by good PR?
They have to ask questions like, What is the history of the parent company? Are the people at this facility compassionate? Have they sold out to trendy psychological theories? The Schecks clearly tried to make the right choice, and tragically they didn’t.
What are some examples of “trendy psychological theories”?
Examples of trendy theories are recovered memory syndrome and the anger reduction stuff, where a kid is held while insults and abuse are hurled at them. Naturally, the kid freaks out, but they are being held down. I once saw this on a PBS show, and my jaw was hanging. One common theory is that if you have an eating disorder, then you must have been sexually abused by your parents. I find all of these really frightening.
While hospitalized, Christy Scheck accused her father of sexual molestation, a charge that you write she fabricated as a way to become closer with the hospital staff.
She wanted to gain the approval of the staff, but she also wanted to one-up her peers. She made up stories about being in a gang, then that she was kidnapped and raped. When those didn’t create ripples either, she said she was molested. It was guaranteed to draw a collective gasp.
How did the counselors at the hospital facilitate Christy’s charade?
When Ed Dueñez, Christy’s high school guidance counselor, went to spend Thanksgiving with her at the facility three weeks after she was there, he realized something was seriously wrong. She was sitting at the table having dinner with three other kids and she began emulating their rap, their whole street attitude. Dueñez approached one of the counselors and said, “When are you going to confront her with her real life?” The counselors said, “We know what we’re doing.” Which is also what the Schecks got. Obviously they didn’t know what they were doing.
In the book, Merry and Bob Scheck admit that to this day, they don’t know what Christy’s treatment was. Why weren’t the Schecks more aggressive? Why didn’t they yank her out?
I must defend them here. Merry Scheck was on the phone constantly, she tried every way she could to get a handle on the kid’s treatment. She was not concerned with popularity for even an instant. But they had to be careful because the more they tried to get in contact, the more they were kept in the dark. Had there been front line people who were more in touch with the proper treatment, who at least knew what they were doing, who at least didn’t suddenly decide to believe everything the kid said in order “to give her her own credibility,” then I don’t think the Schecks would have been kept so much in the dark.
Still, they knew Christy wasn’t making much progress. Why not take her out?
Well, by the time this was starting to happen, their younger daughter had been taken from their home. (The Scheck’s other daughter, Molly, was taken away from them after the abuse charge was leveled against Bob Scheck.) Christy would then have been moved into a foster home with God knows what results. I know no one ever expected what happened to happen. They felt that at least their child was safe because she was being watched by professionals. They were not told that she had been put on a suicide watch. All of us, especially parents, can say, “How could they have been so passive?” But the fact is that they were blindfolded and hooded, and put into one of those Skinner boxes, as far as their child’s treatment.
Are there any laws that protect a parent’s right to know what is going on when they admit their child to a psychiatric hospital?
I wish I knew. That is a lapse in my own investigative journalism.
Christy Scheck had great insurance coverage because her father had been in the military. How long would she have stayed at Southwood if her coverage wasn’t so comprehensive?
She would have been out of there quickly because they would have wanted to make room for a big payer. I imagine her treatment would have been a bit different because her parents would not have been able to pay out-of-pocket. In the book there is an example of a Medicare patient, whom I called Amber, who ended up in a coma due to an overdose she suffered when she was moved out of the hospital. They moved her before her insurance was even up, to make room for a high payer.
Christy was placed on high doses of sedatives and psychiatric drugs, much higher than what is normally recommended for adolescents. Is it common practice to drug up the kids?
Apparently, it is pretty prevalent. And the charging, the capricious charges are just staggering. In this instance, Christy’s case was not isolated.
In the book you explain a phenomenon called “charting parties.”
Patient charts were in fact changed. At Southwood, pizza was brought in and charts were changed to reflect treatment that was probably not given, but was put down on the patients’ charts so it would be paid for. One memo was sent out saying, don’t say “bright affect,” which means good mood, say “manic episode.” That is an example of creative charting. When I was working at the psychiatric hospital, there were kids, little kids, who had been there for years and would be there as long as the insurance paid for it. They could be there until they were 18. It wasn’t just in California. It was pretty much all over the country.
Insurance companies were completely screwed by these private hospitals. Wasn’t there some kind of system of checks and balances?
Only when cases like the one in Texas began to show up, and state senators started forming panels, did this start bubbling up to the surface — and this wasn’t until the very late ’80s when hearings began.
What has happened to NME, the corporation the Scheck’s brought suit against?
In August, $100 million was paid to settle 700 claims filed by former psychiatric patients at NME hospitals. Most of these patients, at the time of their hospitalizations, were teenagers. Aside from that $100 million, doctors once affiliated with that psychiatric unit agreed to pay an extra $20 million in compensation to their former patients.
As a parent and someone who has done extensive research, what do you think a parent should do before admitting their child to a facility?
A parent must have a split-level view: knowing your child is in crisis, and yet keeping it together in order to thoroughly check out the facility. When a child is at a crisis point, tragically, understandably, most parents will hand over their child to people with at least what looks like some expertise and credentials. It does become a kind of crap shoot, or a slot machine in Vegas. Sometimes you come up with lemons or cherries, or sometimes it is just a blur of light and color, no payoff. At the worst level, it is what happened to Christy Scheck.
it’s one of the great American paradoxes. The more we snatch up diet books, ab busters and fen-phen, the fatter we get. Approximately one-third of adult Americans are overweight. Fatness — more politely known as obesity — results in hundreds of thousands of deaths each year from heart disease, high blood pressure, diabetes and cancer.
Last year, a spate of “fat acceptance” books made us feel a little better about our pear-shaped physiques. All of a sudden, anti-diet authors fed us the tasty news: You can be fit and fat.
Enter Michael Fumento. A medical journalist and self-proclaimed “debunker of faux fears” (his last book was “The Myth of Heterosexual AIDS”), Fumento is on a crusade. In his new book, “Fat of the Land: The Obesity Epidemic and How Overweight Americans Can Help Themselves” (Viking), he tells overweight Americans — “fat blobs on legs” — to get off their butts and stop using biology as an excuse for their corpulent shapes. Fumento himself has battled the bulge. Though he doesn’t reveal his weight, he admits he tried dozens of diet books; but only when he began research for his book did he lose the 25 pounds that had saddled him for years.
Salon recently talked to Fumento by phone from his Washington, D.C., office about Cheetos, genes and the myth of “fat acceptance.”
Why is it that the more we obsess about diets and perfect bodies, the more we put on weight?
It is quite bizarre, isn’t it? First of all, in American culture, obsession is practically the norm. Here we are buying all these billions of diet books and yet getting fatter by the year. The fat acceptance people say there is already a $30 billion diet industry and it doesn’t work. But that’s because most of it is quackery, with books that tell you things like “eat more, weigh less.” The big one right now is Barry Sears’ “The Zone,” which is just high fat, high protein, low carbos. It’s absolute nonsense. Most of that $30 billion is not only going down the drain, it is actually hurting.
How so?
Because what happens is this. You buy Susan Powter’s “Stop the Insanity.” But it doesn’t work. You buy “The Zone.” It doesn’t work. You buy Dr. Atkins’ book. It doesn’t work, so you buy another book that doesn’t work. You have now bought 15 books. Then along comes somebody from NAAFA (The National Association to Advance Fat Acceptance) and they say, guess what? Diets don’t work! It is impossible to lose weight! And you believe it because you have tried the 15 top-selling books.
But isn’t there some truth in that? Won’t fatness, like death and taxes, always be with us?
I’m not sure that we can eliminate obesity. Can we drop it by half? Yes, possibly. Can we at least stop it from increasing? I should like to think so. Yet in the last year, four books have come out that I know of, saying it’s OK to be fat!
You have a take-no-prisoners approach toward the overweight.
I want every single American out there who is obese to know exactly what they are doing to their bodies.
But what if someone is active, healthy, happy and large?
This happy stuff — I’m really skeptical about it. A few years ago I read an interview with Paul Simon which really hit me. He said, “Any short man who tells you that it doesn’t bother him to be short is lying to you.” Those who say, “I’m fat and happy,” I don’t believe it. I cite a study in my book where researchers talked to former obese people. They say stuff like, “I would rather go blind than be fat” and “I’d rather have both my legs cut off than be fat.” People don’t want to be fat.
You disagree with the fat acceptance books that say it’s possible to be fit and fat?
What do they mean when they say they fat and fit? To the medical establishment being fit means their cholesterol level is good, their triglyceride level is good, their blood pressure is not high and that they have a normal EKG. But there are all sorts of things going on inside that body that cannot be measured through any test that is yet available. For example, a study just came out that showed that women who are 44 pounds overweight have twice the risk of getting breast cancer. There is not a blood test that can look at a fat or thin person and say that something that you are doing to your body right now is going to give you breast cancer in 15 years. So they don’t know that they are fit. They can say that they feel fit, they go on nice, long walks every day and they don’t have high cholesterol. But the facts show that being obese is doing all sorts of nasty things to their body.
You write that “obese people are made, not hatched.” Haven’t medical researchers found there is an obesity gene and many people are born with the physical makeup of their parents?
The latest obesity gene study I have seen looked at black women, compared to white women. We know that black women in the United States on the whole are much fatter. Now, it was a tiny study — I think there were only 10 black women in the whole thing. In the study they found that the 10 black women did in fact burn 94 fewer calories a day than white women. So the people say, “Ah, there is your obesity.” Here is what nobody bothers to tell you: That white control group, the ones who are burning 94 more calories per day than the black women, were overall, and for their height, fatter than the black women. So what does this tell you? It says that while this 94 calories extra burn might be a little bit of a bonus, or the 94 calories might be a little bit of a drawback, it is not destiny. It is not eye color, it is not height, it is not hair color. It is a slight, very slight predisposition. It is the equivalent of three-quarters of a can of non-diet soda. It is a few minutes on a treadmill. It is walking the dog a couple of extra blocks. That’s all it is.
You cite examples of how Americans are actually becoming more tolerant of the obese and less tolerant of the thin. Yet it seems there is intense disdain towards the obese — and certainly more job discrimination.
Fat people are to some extent discriminated against. But I could say that every time I don’t get a job, it’s because I am 5-6. Because it is genetically ingrained into us to favor attractive looking people. All other things being equal, the attractive applicant, male or female, will tend to get the job over the less attractive person. You have problems even now with the laws protecting black people, and women and stuff. If we set up laws protecting people from “lookism,” that is going to be an absolute nightmare.
A few months ago, a 680-pound Richmond, Calif., teenager died due to complications from obesity. She was found lying in her own excrement and surrounded by pizza boxes. Her mother is being charged with neglect. What sort of responsibility do parents have to their obese kids?
It’s interesting the way the fat acceptance people reacted to this case. One of them said, “It’s not a crime to have a fat child.” In my mind it is a crime. Parents have different ways of influencing their kids. Kids live basically in a dictatorship while they are in their parents’ home. When a kid is really, grossly fat, that is the parent’s fault.
But a lot of overweight people blame their parents for their weight problems. They say, “My mother or my father controlled what I ate to the point where every time I was let out of their grasp, I would go and eat all the junk food I could, because I knew it wasn’t allowed in the house.” Don’t you think strong-arm tactics can backfire?
Yeah, they can. What I tell people in the book is when they get a craving they should go out and satisfy it right away. If you feel like getting a piece of cheesecake, go get it, get a small piece, eat a few bites, perhaps. Parents need to be the same way with their kids. If the kid really has a craving, take them out for ice cream, let them have a little bag of Cheetos. Just not the 16-ounce bag.
Let’s talk about that little bag of Cheetos. You talk a lot about portion size and how we grossly underestimate what we eat, because we are so accustomed to large portions. So that little bag of Cheetos isn’t going to satisfy most people.
It’s a matter of adapting to it. The two best bites of anything — be it Cheetos or chocolate or cheesecake — are the first bite and the last bite. The Europeans realize that much more than we do. They are much more sensual about their food; where we like it in quantity, they like it in quality. Europeans come here and are aghast at how big our food is. People need to be convinced that the small bag of Cheetos can, once you get used to it, end up providing as much pleasure, if not more so, than the large bag of Cheetos. It is a matter of paying attention to each and every Cheeto.
That sounds almost New Agey.
Look, we have a lot of trouble in this country with a notion called moderation. Nobody wants to say, look, here is an Oreo cookie. This Oreo cookie has lots of fat, lots of calories, so I better only eat one and enjoy every bite. No. Or they buy a packet of Snackwells, “fat-free” cookies and eat all 12. Since these Snackwells may each contain two-thirds the calories of one Oreo, they end up with a lot more calories, and end up fatter than ever.
How do you explain the flip side to our nation’s obesity epidemic — the high incidence of anorexia and bulimia?
I don’t buy the anorexia thing. Anorexia is not the result of somebody going overboard dieting. It is a psychological problem with deep roots. To anyone who accuses me of encouraging anorexia by saying you need to be thinner, I would say that by telling someone their hands are filthy and they ought to wash is encouraging obsessive-compulsive disorder. I am not telling people to lose weight until you die as a skeleton.
The new diet drugs, fen-phen and Redux, were all the rage, until it was found that they could cause lethal heart and lung abnormalities in some users. Do you advocate their use?
I talk about them in the book. As far as Redux goes, I simply panned it. There is no evidence that it is any better than anything else is. As far as fen-phen goes, it clearly works, there is no doubt about that. I did not have access to the latest studies at that time. Some of these are hyped anyway — these case studies are usually pretty worthless because they have no control. They are looking at hearts which already should be damaged because they are fat people’s hearts and they are saying, “Oh this person has a damaged heart and they use fen-phen.” But the question is, did the damage come from the drug use? That said, with all the stuff coming out on fen-phen, I’m more skeptical about it than ever. I am not a doctor, but I would only recommend it for people who are so extremely fat that it outweighs any risk from the fen-phen.
So, to sum up what you’re saying: Eat less, move more and don’t believe everything you read.
I am telling people that there is no magic, no miracles. You see these books, the 14-day diet book, the four-day miracle diet book, lose 30 pounds in 30 days. Once you have disabused yourself of the idea that there is magic — that you can take weight that you have put on over a period of 20 years and lose it in 20 days — once you have cut away the nonsense, all that is left is common sense and sensibility. Slightly reduce your calories each day and lose the weight that you gained over 20 years, but give yourself a couple of months to lose it. Don’t join a gym and work yourself like a dog only to quit the gym two weeks later. Join the gym and if an hour on an exercise bicycle bores you to tears, which it does me, do half an hour. Walk the dog a little farther. These are simple suggestions. But they are not simplistic, and unfortunately they are overridden by the massive amount of nonsense out there.
This is the story of how, at the age of 33, I learned to feed myself.
To begin with, here’s what I did until then: I ate, starved, binged,
purged, grew fat, grew thin, grew fat, grew thin, binged, purged, dieted,
was good, was bad, grew fat, grew thin, grew thinner.
I had been a lean, coltish girl, energetic, always hungry, always
eating, always thin. But I weighed 100 pounds at 13, 130 at l4. For the
next 10 years, I dieted. It is a long, dull story. I had lots of secrets
about me and my food and my body. It was very scary and obsessive, the way
it must feel for someone secretly and entirely illiterate.
In July 1977, when I was 23, my father was diagnosed with brain
cancer, and one week later, I discovered bulimia. I felt like I’d
discovered the secret life, and I learned how to do it more effectively by
reading articles in women’s magazines on how to stop doing it.
I barfed, but preferred laxatives. It was heaven. I lost weight.
All right, OK; there were tiny little problems, hardly worth
mentioning. I was scared all the time, full of self-loathing, and my heart
got funky. When you’ve lost too much water and electrolytes, your
muscular little heart cramps up; it races like a sewing machine.
I would try to be good, in the Puritanical sense, which meant denying
my appetites. Resisting temptation meant I was good — strong,
counter-animal. But the jungle drums would start beating again.
I looked fine on the outside, thin, cheerful, even successful, cute
as a barfy little button. But on the inside, I felt like Martin Sheen in
the Saigon hotel room at the beginning of “Apocalypse Now.” I went into a
long and very deep depression after seeing some photos of people on a
commune, working with their hands and primitive tools and work horses,
living outside the world. I saw Breughel scenes of them cutting wheat with
scythes, stomping grapes, lying under the sun, and I could see that they
were really tuned to Nature, to the seasons, to a direct sense of bounty,
where you plant something and cut it down or pick it and eat it, tasting
it, filling up. But I felt tuned in to heavy music. I felt like I had
the soul of a trapped rat.
Luckily I was still drinking at the time.
Then all of a sudden I wasn’t. I quit in 1986. I had all these sober
people helping me, and I told them almost every crime and secret I had,
because I believed what they said, that we are as sick as our secrets. But
I couldn’t tell anyone that I couldn’t stop binging and purging, being on a
diet, being good, getting thin, being bad, getting fat.
I remember hanging out with these people, letting their stories wash
over me, when all of a sudden the thing inside would tap me on the
shoulder and whisper, “OK, honey, let’s go.” And I’d cry out inwardly,
No! No! “Sorry,” it would say, “Time to go shopping.” And silently I’d
cry out, Please don’t make me go shopping! I’m not even hungry! “Shh shh,”
it would whisper. “Let’s go.”
I felt like God had saved me from drowning, but now I was going to get
kicked to death on the beach. It’s so much hipper to be a drunk than a
bulimic. Drunks are like bikers, or Lenny Bruce; bulimics are Cherry
Boone. The voice would say how sorry it was but then glance down at its
little watch, tap its foot and sigh, and I’d sigh loudly too, and get up,
and follow it to the store.
We’d buy the bad things, me and the voice — the chocolates, the
Cheetos, the Mexican food; and big boxes of laxatives. Dyno-Lax.
Finally, one day in l987, I called a woman named Rita Groszmann, who
was listed in the Yellow Pages as a specialist in eating disorders. I told
her what was going on, and that I had no money, and she said to come in
anyway, because she was afraid I was going to die. So I went in the next
day, and have not been bulimic since. That’s not the miracle, though.
The miracle is that I haven’t dieted, either.
I sat in her office and explained how I’d gotten started and that I
wasn’t ready to stop, but that I was getting ready to be ready to stop.
She said that was fine. I said that in fact I was going to go home that
very night and eat chocolates and Mexican food, and then purge. She said
fine. I said, “Don’t try to stop me.” She said, “OK.” I said, “There’s
nothing you can do to stop me, it’s just the way it is,” and we did this for
a half an hour or so, until she finally said, very gently, that she was not
going to try to take my bulimia away from me. That she in fact was never
going to take anything away from me, because I would try to get it back.
But she said that I had some choices.
They were ridiculous choices. She proposed some, and I thought, this is the angriest person I’ve ever met. I’ll give you a couple of
examples. If I was feeling lonely and overwhelmed and about to binge, I
could call someone up and ask them if they wanted to meet me for a movie.
“Yeah,” I said, “right.” Or here’s another good one: If I was feeling very
other, very sad and scared and overwhelmed, I could invite someone over for
a more or less regular meal, and then see if he or she felt like going for
a walk. It is only because I was raised to be Politeness Person that I did
not laugh at her. It was like someone detoxing off heroin, itching to shoot
up, being told to take up macrami. Something to do with those nervous
fingers!
She asked if I was willing to make one phone call after I ate and buy
a little time. I could always purge if I needed to, but she wanted me to
try calling one person, and see what happened. Now I’m not stupid. I knew
it was a trick.
But I was so scared and beaten up at that point that I agreed. I got
home, ate a more or less regular meal, called a friend, made contact, and
didn’t purge. The next day, I ate a light breakfast and lunch, and then a
huge dinner, rooting around the fridge and cupboards like a truffle pig;
but I called my younger brother. He came over. We went for a walk.
Several weeks later, during one of our sessions, Rita asked me what
I’d had for breakfast. “Cereal,” I said.
“And were you hungry when you ate?”
“What do you mean?” I asked.
“I mean, did you experience hunger, and then make breakfast?”
“I don’t really understand what you’re asking,” I said.
“Let me put it this way,” she said. “Why did you have breakfast?”
“Oh! I see,” I said. “I had breakfast because it was breakfast time.”
“But were you hungry?”
I stared at her a moment. “Is this like a trick question?” I asked.
“No,” she said. “I just want to know how you know it’s time to eat.”
“I know it’s time to eat because it’s meal time,” I said. “It’s
morning, so I eat breakfast, or it’s mid-day, so I eat lunch. And so on.”
To make a long story ever so slightly shorter, she finally asked me
what it felt like when I was hungry, and I could not answer. I asked her
to explain what it felt like when she was hungry, and she described a
sensation in her stomach of emptiness, an awareness of appetite.
So for the next week, my assignment was to notice what it felt like
when I was hungry. It was so strange. I was once again the world’s oldest
toddler. I walked around peering down, as if to look into my stomach, like
it was one of those old-fashioned washing machines where you can see the
soapy water swirling over your clothes. And I paid attention until I was
able to isolate this feeling in my stomach, a gritchy kind of emptiness, like
a rat was scratching at the door, wanting to be let in.
“Wonderful,” she said. And then gave me my next assignment: first,
to notice when I was hungry, and then — this blew my mind — to feed myself.
All of a sudden I was Helen Keller, after she breaks the code for
“water.” I felt lonely at first, but then I came upon a great line in one
of Geneen Roth’s books on eating, where she said that awareness was about
learning to keep yourself company. So I’d feel the scratchy emptiness in
my belly, and I’d mention to myself that I seemed hungry. And then I’d ask
myself, in a deeply maternal way, what I felt like eating.
“Well, actually, I feel like some Cheetos,” I might say. So I’d go
and buy some Cheetos, and put some in a bowl, and eat them. God! It was
so amazing. Then I’d check in with myself: “Do you want some more?” I’d
ask.
“No,” I’d say. “But don’t throw them out.”
I had been throwing food out, and wetting it in the sink, since I was
14; since I’d been on a diet. Every time I broke down and ate forbidden
foods, I threw out and wet what was uneaten, because of course each time I
was about to start over and be good again.
“I’m hungry,” I’d say to myself. “I’d like some frosting.”
“OK.”
“And some Cheetos.”
So I’d have some frosting and some Cheetos, for breakfast. I’d eat for
a while. Then I’d check in with myself, kindly: “More?”
“Not now,” I’d say. “But don’t wet them. I might want more later.”
I ate frosting and Cheetos for weeks. Also, cookies that a local
bakery made with M&M’s instead of chocolate chips. I’d buy half a dozen
and keep them on the kitchen counter. It was terrifying. It was like
knowing there were snakes in my kitchen. I’d eat a little, stop when I was
no longer hungry. “Want one more cookie?” I’d ask.
“No, thanks,” I’d say. “But I might want one later. Don’t wet them.”
I never wet another bag of cookies. One day I woke up and discovered
that I also felt like having some oranges, then rice, then sautied bell
peppers. Maybe also some days the random pound of M&M’s. But from then on
I was always able to at least keep whatever I ate down — or, rather, in my
case, up. I went from feeling like a Diane Arbus character, seen through
that lens of her self-contempt, to someone filmed by a friendly cousin,
someone who gently noted the concentration on my face as I washed a
colander of tiny new potatoes; each potato holy, each action tender.
Over
these years, my body has not gotten firmer. Just the opposite in fact.
But when I feel fattest and flabbiest and most repulsive, I try to remember
that gravity speaks; also, that no one needs that plastic body perfection
from women of age and substance. Also, that I do not live in my thighs
or in my droopy butt. I live in joy and motion and cover-ups. I live in
the nourishment of food and the sun and the warmth of the people who
love me.
I tell you, it feels like a small miracle, to have learned to
eat, to taste and love what slips down my throat, padding me, filling me
up, and it is the most radical thing I’ve ever done.
