Bingeing and learning

Author Betsy Lerner explains why 20 years of therapy wasn't enough to save her from food addiction and manic-depression.

Published February 21, 2003 7:25PM (EST)

When she was a teenager, Betsy Lerner would whip up late-night meals after her parents went to bed: "I slathered a piece of bread with peanut butter, then drizzled it with frozen chocolate chips that my mother kept for baking, and toasted it until the chocolate made a shiny puddle on top ... Other times I'd cook up a whole pot of noodles and eat it with butter and cheese." If her parents woke up, Lerner would frantically carry the pot into the garage -- whatever she had to do to hide the evidence of her latest binge.

The bright and talented Lerner knew that "the real Betsy existed inside this overweight, miserable girl," but as she describes in her new book, "Food and Loathing: A Lament," it took rounds of therapy and years of desperation and misdiagnosis before she was able to control her eating and enjoy a stable life.

At age 15, 5-foot-2 and 170 pounds, Lerner started attending Overeaters Anonymous meetings. For five months or so, she would get down to her "fighting weight," only to rapidly pack the pounds back on again after furious cycles of secretive bingeing and terrible bouts of self-loathing. Then, at 16, Lerner was diagnosed with manic-depression and was prescribed what would turn out to be the wrong dose of lithium. She hated the medication -- it made her feel slow and she was scared the drug would change her "essential self" -- stopped taking it, and returned to O.A.

Years of lonely bingeing continued through college, as Lerner continued to seek relief from a peculiarly unsympathetic therapist named Dr. Mizner. When she was in her mid-20s and attending Columbia University's Master of Fine Arts program, Lerner found herself on a ledge overlooking the Henry Hudson Parkway in New York, contemplating ending her life. Her flirtation with suicide resulted in a six-month stay at a mental hospital.

When she returned to New York life, she became a successful book editor, got married, had a daughter. But it was only seven years ago, while in her mid-30s, that another therapist suggested she try lithium again. Only since then, Lerner says, has she truly felt that the weight of depression has lifted.

"Food and Loathing" reveals, with measured detail, humor and often pure rage, just how difficult it is for those suffering from addiction to address their own pain, and equally, how complicated it is for parents, doctors and friends to recognize the profundity of the victim's illness. Food addiction is like any other addiction -- Lerner's feverish passages on bingeing are painfully convincing of that; what's surprising is that it's an addiction that's strangely taboo.

Lerner, now 42 and a literary agent, spoke to Salon about the roots of her eating disorder, why Overeaters Anonymous didn't help her, and why, in the end, lithium was what she really needed to survive.

What was your goal with this book?

I wanted to make food addiction very real because I hadn't read about bingeing and being overweight. And I wanted to carve it into a good story so it wouldn't be boring.

When did you first start bingeing?

The dangerous bingeing started the first time I fell off of the O.A. wagon when I was 15. Up until then I really just overate.

Were you always aware that you were overeating?

I was aware that I was overweight. I didn't feel that I was eating in an out-of-control way. Everybody in my family was heavy. One of my sisters was asked by a reporter, "Did you know that Betsy was bingeing?" She replied, "Every meal in our family was a binge." The portions that we were eating were probably three times what we should have been eating.

You say in the book that your mother wasn't the type who would stop you from eating, and you seem grateful for that. But on the other hand, you sort of wished that she did stop you.

I felt that there was always a watchful eye that wanted me to control myself and to be thin. I wanted to please her and wanted her love. I knew when I lost weight that I felt a lot of positive reinforcement but it was all largely unspoken. She never did try to control me. But I still feel it to this day. If we go to a deli, she'll always order turkey on rye, dry. And if I order anything but that, I get a look. It's really subtle and she would swear to God she wasn't doing it and I would swear to God that I felt it.

It seems that one of the hard things to determine is whether you were depressed first and then started overeating, or if you became depressed over how you felt about your body and your eating habits.

Was it the chicken or the egg? I definitely had childhood depression, but I was also a very happy and successful kid. I was what my doctor would now call a mixed state. I could have very black moods and be quite a loner, but I could also be the center of attention and get A's and be really good at whatever activities I did. I felt I had to be really good at things and keep up those grades and all that.

Was that family pressure or did you grow up in one of those high-achieving towns?

It was a high-achieving town [Lerner grew up in the suburbs of New Haven, Conn.], for sure, but my mother would always say that she expected it of me because I could do it, not the other way around. And I enjoyed achieving. When I started to not achieve, toward the end of high school, I was very disappointed in myself.

When you would achieve something -- get a good grade, or get into college or when you got into Columbia's Master of Fine Arts program -- would that temporarily help you stay abstinent?

Actually, success would bring on a binge. For example, the worst one was after I won a prize at Columbia. That really set me off for weeks. I'd stop at a deli and usually I'd buy one or two things, maybe a bag of chips and some hostess cakes. I'd go from sugar to salt, salt to sugar, back and forth. I would eat whatever I bought for maybe six to eight blocks, or until I scouted another place and could buy more. There's something really scary about success, and bingeing and overeating tamping down those fears is part of why I must do it.

What did it feel like?

I felt like an alien. I felt invisible. I felt a little bit like a convict trying not to get caught, trying not to be recognized.

Is bingeing ever a reward?

Not really. I use it as an instrument of torture. Or it starts out that way -- to let off steam -- and next thing you know you're eating 10 times as much as you want and you're just hating yourself. The whole binge cycle -- it's not like alcohol or drugs -- is very fast and wears off quickly, but the recrimination lingers forever, as does the weight.

In the book, you describe a bingeing scene in which you felt you were endangering other people. You were a couple of years out of college and working as a camp counselor. You'd just binged and you had some of your campers in the car with you. You write: "In my addled state I pulled out from the Dunkin Donuts without looking carefully." You almost hit another car. What was happening to you then?

I remember that I was sweating and I thought, "This is really dangerous and this is a mistake and what am I doing?" At that point, too, I had been abstinent for five months. It was the first bite, it was the apple and I was going to leave paradise again.

And there's no pleasure in the moment?

No, the pleasure is that you're totally outside yourself. You've completely left yourself behind, which is the desire, I think, of all addicts. It's no longer me, it's this person who's on some kind of automatic pilot who can't stop what she's doing. That's what you're going for -- that feeling of obliteration. Disappearing yourself.

And when you were abstinent it was like a high?

Yes. If you were to chart my weight losses and weight gains, and my mood elevations and depressions, I would get depressed and gain weight in the fall and winter, lose weight and become elevated in the spring and summer. That's very classic for anyone who's bipolar. But I didn't know any of that then; I didn't take my moods or depression seriously. I just thought that because I felt good, and looked good, I was happy.

How did you keep your illness from your friends? There were points in the book when I wondered -- where are her friends?

I was leading a double life. My friends didn't know about O.A. but I had O.A. friends. In school, I didn't really make friends as much as go through them. I don't have a whole lot of college friends. I actually don't have any. I had two. One, I married, and the other recently fell out with me. I went through people. I did not attach. I only showed a certain facade of myself to most people.

I've always wondered why when someone has any sort of eating disorder, outsiders are hesitant to do something about it in the way they might if someone was a drug addict. What is it about food that's different or untouchable?

If you're morbidly obese, people say stuff. And if you're anorexic, people say stuff. And if you're in the vast middle, which most overweight people are -- you could have an eating disorder where you're just fighting with two pounds every day but you're obsessed -- it's very vexing. Food is not drugs or alcohol; it's socially acceptable, it's what we need to survive. It's a great taboo subject, really. Why is that so? Maybe because it's so personal. In our culture, looks are everything and yet you're never supposed to say anything about it. It's schizophrenic.

You were in Overeaters Anonymous for most of your teenage years, your college years and after. How do you feel about O.A. now?

It's not for me. For other people it's probably excellent and I've heard that the program is really different from when I was in it. But it took me years to think for myself, to be free of the slogans, to come back to myself. I lost my own power of judgment and thought. I was very much a devotee and a groupie of that program. The world cannot be answered by all O.A. program slogans and I really thought it could.

While in graduate school, you almost committed suicide, and then went to a mental institution.

I needed a lot of help breaking from the O.A. binge cycle mentality. I needed someone to take me seriously and they took me very seriously at the hospital. I needed to come out of an almost catatonic, suicidal depression and I had the time there to do that. What I learned in the hospital is that suicidal ideation, which is what they call it, is serious. It doesn't mean you're going to do it, but having those sorts of thoughts are part and parcel of depression. I didn't really want to destroy myself. I just didn't know how to live. I have an enormous life force and will to live, even though I still have very dark thoughts about life all the time. I know how to channel it now. And I'm medicated now.

You're on lithium?


Do you wish that they had put you on it from the get-go?

If one of my old therapists had medicated me with the correct dose of lithium or something else, I might have avoided the hospital. Prior to that, yes, I suffered a great deal and lost a lot of time. I'm not complaining because I've had an incredible life and I am who I am because of it, but maybe I might have been spared, and my family might have been spared, some of the effects of a really destabilizing depression.

Do you still struggle with food addiction?

Yes, it's not over. I always want to be thinner than whatever weight I am. I am always either eating better or not eating better -- I try to say that instead of diet or not diet. My binges don't last for more than two or three days now, whereas in the past they'd go on for weeks. I get scared sometimes. I still get elated or elevated, I still get depressed, but I'm in a really safe zone. I'm not thin, I'm not huge, I'm in the middle. It's all a lot better, but it's not over.

Can you sort it out now -- how much of your depression had to do with family dynamics/environment and how much did it have to do with a sense of self-loathing or chemistry?

It's hard to say because I've had 20 years of therapy, and obviously, I have a lot of self-awareness from that. But I think a much bigger issue is my chemistry. Now that I'm medicated, I can put all the therapy to use. In the past, no matter how much therapy I had, I kept on getting derailed. Since I've been on lithium for seven years, I haven't really had a bad day. I've had anxiety, but I've just been very stable. And I've been productive -- I've written two books.

You saw a lot of bad therapists, a Dr. Mizner in particular, who misdiagnosed you and made you feel like your depression was something you could control. It must be infuriating to think about all that lost time, to think you could have gotten help so much earlier.

Well, I understand now, working with the genius doctor that I'm working with, why I was misdiagnosed and why a lot of depressive people are. You only go to the doctor when you're depressed and they never see your elevated or manic side. It happens quite a lot. I'm only grateful that even when I got bad help that I was the kind of person that was always seeking help. And that at my midlife, I'm able to lead my life. I feel pretty lucky.

By Suzy Hansen

Suzy Hansen, a former editor at Salon, is an editor at the New York Observer.

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Eating Disorders