RESTRICTED: Dying to Be Thin

AIVA, 16, from Atlanta

“Too skinny just doesn’t work … but I [still] wish my stomach was flatter. I think a lot of people, like, wish the same thing.”

After spending 18 months, starting in 2004, with women undergoing therapy for eating disorders at the Coconut Creek, Fla., branch of the respected Renfrew Center, photojournalist Lauren Greenfield, 40, knew one thing: The patients weren’t simply dieters who had gone too far. “Eating disorders are a serious mental illness,” she says. “They function as coping mechanisms, like drugs or alcohol, to numb intolerable emotional pain.”

At Renfrew, a 40-bed facility where the tab can be $1,500 a day (part of which is usually covered by insurance), Greenfield and her cameras documented the rounds of therapy—individual, group, art, dance and family sessions—along with weigh-ins, room checks and closely monitored meals. Her subjects had limited freedom; staffers made sure that they weren’t hoarding or discarding food or prescription drugs and that they followed strict rules (those with a history of “cutting,” or slashing themselves superficially, were watched especially closely).

On Nov. 14 HBO will air Thin, the documentary that Greenfield directed about Renfrew (for more information: http://www.thindocumentary.com). Excerpted here, the companion volume illustrates the viciousness of eating disorders. Striking millions of women in the U.S., anorexia and bulimia can lead to osteoporosis and heart damage; up to 10 percent of anorexia patients die. Do celebrities influence patients like those at Renfrew? Idealization of skinny celebs “doesn’t cause eating disorders,” says David Herzog, M.D., an eating disorders expert at Harvard Medical School, but “it surely fuels the mind-set” of victims. The good news, he says: “With comprehensive treatment, most patients improve, and many recover.”

As Thin illustrates, the most difficult part of the healing process is often trying to separate patients—even very sick ones—from the self-destructive behaviors they’ve embraced for so long. In the words of Alisa, 30, “Anorexia is my best friend.”

BRITTANY, 15, from Cape Coral, Fla.,

Followed mom Ann Marie’s example

I started going through puberty and thought getting breasts and hips was gaining weight, and I wanted to do anything to get rid of it. Once I started dieting, I couldn’t stop. The purging started when I was 15. My mom didn’t know what to do because she has an eating disorder also. All my life my mom has been a weird eater. We would buy bags of candy and chew it and spit it out. We didn’t think of it as a problem.

My mom told me about bingeing and purging, so I tried it. I went on the Internet for a list of what symptoms occur when you’re anorexic, to make sure I had every one. I told my mom, “I’m not perfect yet.” She told me, “The perfect anorexic is dead.”

When I got here I weighed 97. My heart rate was down to 36 and I was practically dead. My mom recently told me that she was completely jealous and that she was going to starve herself until she got down to my weight. That’s how sick the disease is.

UPDATE

In treatment for 11 weeks in 2004, Brittany is now living with her dad and “using a lot of her eating disorder behaviors,” says mom Ann Marie. “She’s obsessing about her weight.” Divorced since 2000 and sharing custody of Brittany, Ann Marie admits that she still struggles with her own eating disorder. Visiting at Renfrew, she says, she realized how consuming the illness is: “I would look at my daughter, starving to death and in pain, and it would not influence me one iota to stop my own behaviors.”

A DAY IN THE LIFE:

THE RENFREW EXPERIENCE INCLUDES INTENSE BONDING (SARAH IS COMFORTED BY EMILY, ABOVE LEFT, AND LACY), FOOD DIARIES (ONE PATIENT’S ATTEMPT TO STAY UNDER 300 CALORIES A DAY, LEFT) AND FIELD TRIPS (BELOW FROM LEFT: MELISSA, LOGAN AND MARY CONTEMPLATE DESSERT ON A SUPERVISED RESTAURANT VISIT TO HELP THEM CONQUER FEAR OF EATING IN PUBLIC).

CARA, 31, from Batavia, Ill.

“Being here with adolescents … that’s what I want my body to be too.”

The thoughts started around fifth grade. I remember praying that my stomach would go away. My brother, who’s older, started getting involved in steroids and having rages. He would kick me in the ribs, make mooing noises, or just say how fat and ugly I was.

In my freshman year of high school, a senior asked me out. When we began kissing, I felt so disgusted with my body. In about two months I dropped 60 lbs. By that point, my brother was in and out of rehab, so my parents didn’t say a lot. All I was allowing myself to eat was half a plum or half a piece of toast. As I was losing more weight, I knew how unattractive I would be to men. The eating disorder kept me safe. Now I’ve lost jobs because I was so sick I couldn’t work. Over the years, I wanted to change, but I felt addicted. I came to the point where I just wanted to die. But if I died, there would be nothing good to say about me. The only thing I’ve done with my entire life is change my body.

UPDATE

Back in Batavia since January and working at the local library, Cara (who arrived at Renfrew at 73 lbs. and left at 110) says she feels she’s finally “going in the right direction.” Recognizing that “being in treatment is the easy part,” she has joined a support group. It’s back in real life, she says, “when the real work begins.”

CHERYL, 35, from Kansas City, Mo.

“Karen Carpenter was my superstar.”

When I was 5, I was molested. Different people would touch me. It was this one person who touched me when I was 12 that made me start throwing up. I felt ashamed. The only thing that comforted me when I ate was to get rid of it fast.

I married my husband at 18. He’s a minister, and he loves me. When I was pregnant, I didn’t throw up. But after each of my [four] children was born, I would go right back to throwing up, 12 to 15 times a day. My husband checked me into a hospital. I had a black therapist, and the first words out of her mouth were, “Why do you want to be thin? Black women are supposed to be shapely.” You would be surprised how many black women purge but are too ashamed to get help.

I used to love seeing skinny women on TV and comparing their bodies to mine. I went down to 85 lbs. My eating disorder made me feel nothing could ever happen to me. It made me feel like Superwoman.

UPDATE

“If it wasn’t for Renfrew, I would be dead,” says Cheryl. She has mostly maintained the healthy weight she had achieved when she left in January, but she doesn’t feel cured. “Just because you are walking around healthy,” she says, “you might be starving inside.” In the last few weeks her symptoms have recurred. She has lost 6 lbs.

JENNIFER, 28, from Miami, gets a “body-check” during daily weigh-ins. Residents with a history of self-harm are regularly examined for new bruises or cuts.

SHELLY, 25, from Salt Lake City

“When I came to Renfrew I was so gone I didn’t know what a normal meal looked like.”

I had a tube in my nose for five years. It’s kind of embarrassing to have [that] and go to school and to work. I was getting formula through it. I was supposed to get three cans of 500 calories a night, but I’d only do one and run it really slowly. My dad was like, “My child can’t have a tube in her nose,” so he took me to the doctor. I woke up with a tube in my stomach. When I first got it in, I was like, This is easy access to my stomach. I could just flex my muscles in a certain way and stuff would come out. It was a good feeling, ’cause I didn’t have to throw up. Getting it removed was hard because it had become a part of me: One girl was saying that getting a tube is a status symbol that you are really anorexic.

I am a registered nurse. I like psychiatric nursing because I feel like I really fit in with the patients. I’ve had 10 hospitalizations. I felt like an idiot every time. Being stuck in a place with a bunch of anorexics, you want to do something and not get caught just to have that satisfaction. Give each other drugs, smoke in bathrooms, hide food. One girl purposely spilled half her food on the table—and there went 50 calories. I’ve gained a lot of weight [this time]. All I do is sit, eat and sleep. I just want to turn off the lights when I take a shower. In my head, I’m conflicted. I love the eating disorder so much and I hate it so much. [But] I don’t want to be in another treatment center somewhere in a year. I want to work, I want to have a family. I have so many things I want in life, and I can’t do them with an eating disorder.

UPDATE

Released from Renfrew at 103 lbs.—up from 84—last November, Shelly soon destabilized. Wrestling with an impulse to kill herself, she underwent electroshock therapy for depression before marrying her longtime boyfriend on July 15. “I was suicidal and stuff,” she says, “but I made it through.” After the honeymoon, “tired and weak from not eating,” she was hospitalized for two days. Working as a nurse once more, she has a feeding tube in her nose again and is down to 88 lbs. Of her time at Renfrew, she says, “I know all the things I’m supposed to do. I just don’t apply it.”