On BreadApr 10, 2017 12:12PM ● By Lisa Knopp
Over a decade before Karen Carpenter’s death from anorexia nervosa, the event that awakened many Americans to the dangers of eating disorders, I had never heard of the condition. Apparently, neither had the pediatrician who examined me when I was my thinnest and most unhealthy. He simply told my mother that I needed to eat more, which eventually, I did. When I was 25 and left my family, friends, and hometown for a demanding job in a big faraway city where I knew no one, my malady returned in a less dangerous though more tenacious form. In spite of intensive psychotherapy, this bout of my malady didn’t start abating until three years after it started with the birth of my son.
Most perplexing to me was that when I was deep into middle age, a professor at a state university, the author of five award-winning books, the mother of an adult son and daughter, a homeowner, a church member, and a supporter of various worthy causes, my malady returned. Then, my weight dropped to a number on the scale that I hadn’t seen since middle school, as I whittled down my list of permissible foods until it fit on my thumbnail. Because of age-related changes in my bodymind, the departure of my grown children, and the loss of other significant people in my life, I was heartbroken and anxious. Just as when I was 15 and 25, I tightly restricted what and how much I ate as a way of keeping myself safe from what threatened me. But I couldn’t see what I was doing, much less link it to the two other times when eating too little had been so easy and gratifying. In fact, I didn’t know that I was sick again until my 20-year-old daughter told me that if I didn’t eat more, I was going to die. My blindness to my situation still astonishes and baffles me.
I didn’t want to write the story of an illness that many judge to be a character flaw, a moral failing, nothing but a silly, overzealous diet, or a childish attempt to get attention. I didn’t want to write a story in which I had to admit that I had a condition that usually strikes teenagers and young women. I didn’t want to write a story that would require me to re-enter, through memory and imagination, the dark periods of my life when eating less than my body needed seemed like a logical, fitting response to adversity. I didn’t want to write a story that was an illness narrative and, so, presents a version of the self that isn’t sound or fully functioning.
And yet, I felt compelled to write this story. In “On Keeping a Notebook,” Joan Didion advises us “to keep on nodding terms with the people we used to be, whether we find them attractive company or not.” If we don’t, they might “turn up unannounced and surprise us, come hammering on the mind's door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends. We forget all too soon the things we thought we could never forget.” What I had forgotten was the woman in me who sometimes found self-starvation and the taking up of as little space as possible so alluring.
To write the story of my malady, I had to educate myself about eating disorders and disordered eating. Eating disorders—anorexia nervosa, bulimia nervosa, binge-eating disorder—are clinically defined and diagnosed, according to criteria set forth by the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders. Less well-known to most people is “disordered eating,” which Lauren Reba-Harrelson and the co-authors of a 2009 study define as “unhealthy or maladaptive eating behaviors, such as restricting, binging, purging, or use of other compensatory behaviors, without meeting criteria for an eating disorder.” “Other compensatory behaviors” include the use of laxatives, diuretics, stimulants, or excessive exercise to counteract the calories one has consumed.
I went into my research believing that eating disorders and disordered eating are caused primarily by unhealthy family dynamics and the message from the fashion, entertainment, beauty, and diet industries that nothing you are and nothing you’ve achieved matter as much as being thin. Now I know that those are but the easiest explanations and that they trivialize a complex problem. Aimee Liu, the author of Gaining: The Truth About Life After Eating Disorders, compares an eating disorder to a gun: “Genes shape the gun, environment loads it, and stress pulls the trigger.” This felt true to me, so I went to work researching the genetic, environmental, and psychological aspects of eating disorders. From the studies I read by geneticists and neuroscientists, I learned that those with eating disorders and disordered eating can’t trust their brains to tell them the truth about when and when not to eat.
Several studies, for instance, have investigated variations on the gene for serotonin among the eating-disordered, since when people with anorexia severely restrict their caloric intake, their abnormally high levels of serotonin drop, and they report feeling calmer and less anxious; when those with bulimia increase their caloric intake, their low serotonin levels rise, and they report feeling happier. Another study found that those with bulimia and anorexia have an altered response in the insula, a part of the brain involved in appetite regulation, when given tastes of sugar, which means that they don’t accurately perceive signals about their hunger or satiety. Yet another study suggests that increased activity in the dorsal striatum leads to “maladaptive food choices” among restrictors, meaning that they actually prefer the plain rice cake over the Asian pear and smoked gouda panini.
From my reading in psychology, I learned that certain family structures and personality types were more likely to “load the gun” than others. Hilde Bruch, a psychoanalyst and pioneering researcher on eating disorders, studied the connection between disturbed interactions between a child and a domineering or detached mother and the development of anorexia, while psychiatrist Salvador Minuchin studied how “psychosomatic families,” especially those that are “enmeshed,” contribute to the genesis of eating disorders. For a 2004 study, Walter H. Kaye, the director of the Eating Disorders Center for Treatment and Research at the University of California-San Diego, administered standardized tests for anxiety, perfectionism, obsessionality, and eating disorders among individuals with anorexia, bulimia, and both disorders, as well as a control group. He found that 66 percent of the members of the three eating-disordered groups had “one or more lifetime anxiety disorders,” 41 percent had obsessive-compulsive disorder, and 20 percent had a social phobia. The majority of the eating-disordered study participants reported that the onset of their anxiety disorder, obsessive-compulsive disorder, or social phobia had occurred during childhood, before the symptoms of their eating disorder manifested. Even those who had recovered from an eating disorder and were symptom-free “still tended to be anxious, perfectionistic and harm-avoidant.”
I explored various cultural factors that “load the gun.” Feminist theorists, such as Susie Orbach, Naomi Wolfe, and Susan Bordo, see anorexia as rebellion against or an over-conformity with Western notions of feminine beauty and power. Historians and medievalists weighed the similarities and differences between contemporary anorexia and the prolonged fasting of religious women in Europe in the late Middle Ages who sought worldly power and a deeper union with God through their austerities. Accounts by and about hunger strikers, whether the imprisoned members of the Irish Republican Army, the American suffragette movement, or those being held at the Guantanamo Bay detention camp, present their fasts as the ultimate political statement and protest.
Clearly, eating disorders and disordered eating are due to a messy tangle of genetic and biochemical factors, family dynamics, individual psychology, and a wide range of cultural influences. Also clear to me is that my story isn’t unique. Experts say that about 10 percent of those with eating disorders are older women. But, says Dr. Cynthia Bulik, the director of the Center of Excellence for Eating Disorders at the University of North Carolina, the percentage is surely higher since most older women with eating disorders disguise or misread their symptoms as being due to a health condition or changes associated with aging, and so they aren’t included in the number of reported cases. In a 2012 study, Danielle Gagne and her research team found that women over 50 are engaged in unhealthy eating behaviors and thinking to the same extent that adolescents are. Most experts that I’ve read see a link between loss, grief, and depression as triggering the onset or return of an eating disorder in women who are middle-aged or older.
The loss and grief triggered by an empty nest, the death or relocation of several others who mattered to me, and an awareness of my own aging caused me to start restricting my diet again in 2011. But of all the factors that loaded the gun, two presented the most daunting challenges to my recovery. The values of hyper-consumerism was one. In “Hunger,” the Canadian writer and human rights activist Maggie Helwig says that it’s no accident that the widespread appearance of eating disorders in the 1960s and the epidemic of the 1970s coincided with the unprecedented growth of the consumer society, which places supreme value on one’s ability to buy goods and services. Helwig, who almost died from anorexia when she was young, observes that by the end of the 1960s, our material consumption had become “very nearly uncontrollable,” resulting in “what is possibly the most emotionally depleted society in history, where the only ‘satisfactions’ seem to be the imaginary ones, the material buy-offs.” Anorexia, then, is the “nightmare of consumerism” played out in the female body. “It is these women,” writes Helwig, “who live through every implication of our consumption and our hunger and our guilt and ambiguity and our awful need for something real to fill us … We have too much; and it is poison.” By not eating, the anorexic tells us that she’d rather be skeletally thin than ingest something that isn’t real or substantial. By not eating, the anorexic causes a cessation in ovulation and menstruation, rendering herself literally unproductive. By not eating, the anorexic refuses to be consumed by the act of consumption. Such self-denial in a culture of plenty is an audacious, radically countercultural act and statement. I extend Helwig’s metaphor to include binge-eating disorder (rapid, uncontrolled consumption with no “compensatory behaviors”) and bulimia (a refusal to complete the act of consumption by hurling out what one has just taken in) as responses to unrestrained consumerism.
The things, services, and diversions that money can buy can’t fill a hungry heart or lessen the pain one feels from a lack of meaning or purpose. Ironically, or perhaps fittingly, what we’re truly hungry for can’t be bought. And what I was craving when my malady returned for the third time were a renewed sense of purpose and deep nourishing relationships to “replace” those that I’d lost.
This was easier said than done. The rise of consumerist culture has been accompanied by a decline in the number of close relationships among Americans of all ages. Instead of visiting and confiding in each other, we spend more and more of our time working and, in our leisure time, gazing at screens. Consequently, finding others with the time and desire for new friendships was challenging and at times, disheartening. But with prayer and persistence, I eventually found people who share my values and who enjoy my company as much as I enjoy theirs.
The other factor that made recovery during the third bout of my malady so challenging was that in my early 50s, I had become acutely aware of the effects of ageism. Because the master narrative our culture imparts about aging is that late midlife and beyond is a time of inexorable decline, marked by deterioration, powerlessness, dependency, irrelevance, and obsolescence, it is the fear of aging and even more, of ageism, that is the inciting force that triggers disordered eating in some women. I didn’t want to think about aging—my aging—and I certainly didn’t want to write about it. Yet, address it I must. In a 2011 study, a team of Australian researchers found that a group of women ages 30 to 60 with disordered eating who participated in just eight weeks of cognitive behavioral therapy focused on “midlife themes” were still doing better in terms of “body image, disordered eating, and risk factors” at the follow-up six months later than a control group that had not had the opportunity to explore these themes in a therapeutic setting. To counter the effects of ageism in my life, I now collect resistance narratives from women, role models, really, who live their later years with passion and purpose and on their own terms—Jane Goodall, Maria Lassnig, Gloria Steinem, Helen Mirren, Isabel Allende, and others, both famous and not.
Although I was reluctant to write this story, I did find pleasure in crafting Bread. And the act of writing was filled with many moments of self-revelation and one grand epiphany: that there are aspects of my malady that are within my control (how I respond to ageist, hyper-consumerist, and patriarchal values) and some that are not (genetics and brain chemistry: my hard-wiring). Now, I know what I can fight and what I must gracefully accept.
When people asked me what I was working on as I was writing Bread, I reluctantly told them about the story that I didn’t want to write. I found that most were not only interested, but they wanted to tell me their stories about being in the grip of something beyond their control that lead them to eat too much or too little, about feeling shamed or misunderstood because of this, about the familial tensions or social costs or the ill physical effects that resulted from their unhealthy relationship with food and self. Some told triumphant stories about the residential treatment, the counseling, the spiritual practice, the religious conversion, or the supportive loved ones that saved them. But some were in the thick of it. Many were grateful to be given a name—disordered eating—for what they were experiencing and to know that this could afflict anyone of any age and circumstance.
Many were grateful to learn that the reasons they were stuffing or starving were more complex and nuanced than their having played with Barbie dolls as children or having conflicted relationships with their mothers.
The deep story I’ve heard in each of these testimonies concerns the tellers’ hunger for wholeness and fullness. Now, I encourage those who tell me their stories to ask themselves a difficult question—What am I truly hungry for? —and then answer it with courage and honesty. I’m hungry for companionship. I’m hungry for solitude. I’m hungry for reconciliation. I’m hungry for meaningful work. I’m hungry for less busyness or the opportunity to paint or dance or fight for social justice. Then, I urge them to bring that source of nourishment and sustenance into their lives. Some women thanked me for writing Bread before they’d even read it.
When I consider how frankly confessional my story is and how controversial some will find my interpretations of the research, I squirm and second-guess myself. But then I remember that I am safer from relapse because I understand what I can and can’t control and because I’m far less likely to forget, as Didion says, “the things [I] thought [I] could never forget.” And, too, I feel full knowing that people are finding self-knowledge, nourishment, hope, and strength in the story that I didn’t want to tell.
Lisa Knopp, Ph.D., is a professor at the University of Nebraska at Omaha’s English Department. Her recent book, Bread: A Memoir of Hunger, was published by the University of Missouri Press in 2016. Visit lisaknopp.com for more information.
This article was printed in the March/April 2017 edition of 60 Plus.