Eating Disorders: A Multi-Discipline Approach to the Kate Moss "Wispy Waif " Syndrome

by Dr. Catherine Sagan

Two evidently frightened sophomores sat on the edge of their counselor's couch. "Dr. Guberman, you've GOT to get in there right away! It's really bad. Jenna is throwing up like crazy."

Walking briskly towards the girls' bathroom with Marcia and Allison in tow, the Director of Guidance, Lois Guberman, wondered why the two had summoned her and not the school nurse. When she heard the tearful comment of one of the youngsters alongside her, the counselor quickened her steps.

"She's been doing it... a lot lately. We didn't want to 'narc' on Jenna, but she's killing herself."

Lois pushed aside the gray metal bathroom door just across the corridor from her office in time to see Jenna, pale and wan, emerging from the stall wiping her mouth. Glancing at Jenna's hands, the counselor recognized the telltale bite marks and small scars on the young girl's knuckles.

"Jenna, open your mouth. Let me see . . ." The young girl backed away.

"Come on, Jenna. I'm not going to hurt you. It'll just take a minute."

Slowly the terrified girl complied. The counselor sighed. There was no escaping the evidence of repeated regurgitation: the red raw gum tissue and discolored teeth.

"Jenna, we need to talk. Come on back to the office. What's your next class? …Biology? Don't worry. I'll send a note to Mr. Blake telling him you're with me. It's all right, girls. You did the right thing letting me know. Jenna and I are going to have a little chat. Hold all my calls, Angie."

Quietly Dr. Guberman closed the door of the office and took the sobbing girl into her arms.

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Later that week the Director of Guidance raised her concerns at a previously scheduled meeting with me in my role as English Department chair. On the agenda: curriculum planning for seniors during the period of late May into early June---that post-prom/ pre-graduation "flat line" time...when bodies are present but minds are elsewhere.

"Cathy, we need to do something more-- different from what we usually do in health classes. Maybe both of our departments -- English and Guidance---can do something to deal with this rising epidemic of eating disorders among our students. I'm finding out about too many youngsters lately--mostly girls...but even an occasional guy--binging and later purging in secret...or starving themselves to the point of absurdity! In the last three years the numbers are more than a bit scary. And my colleagues at our annual conference said this phenomenon is happening all over. No income groups are escaping--inner city or suburbs.

"Do you think you could find a piece of literature--something short…accessible--that we could discuss in a one or two English class periods and somehow raise the sensitivity of our seniors before they head out to college and the job market? A short workshop would at least be a place to start! We have that "down" time at the end of the year we're always trying to do something creative with. Why don't we try to get a short unit launched this year for seniors?

Then… when we have more time to plan in future years, we could look for ways to integrate the program into the rest of the high school curriculum…possibly embed the unit into self-esteem programs already in place in our health classes."

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The Eating Disorders Program at North Salem began that simply...with just the germ of an idea: to link the Guidance and English departments for a brief, one/two day, inter-disciplinary workshop in the last weeks of senior year. But before the week was out the word spread among our close-knit faculty, and within a few more days a more fully developed program evolved utilizing the expertise of colleagues from a number of other departments.

At the lunch table in our small school district--the site of so many serendipitous curriculum planning sessions--one of the phys ed teachers, Neil Broderick, overheard the English chairperson and the librarian, Rocco Staino, discussing our search for a short story that might work for our eating disorders workshop. Quizzing the two about our still embryonic plans, Neil suggested incorporating a session on inherited body types that dramatically affect an individual's "ideal" weight and overall appearance. He recommended starting the unit with a "hook": slides depicting traditional African tribal practices --extensive tattooing, elongation of the neck with rings, enlargement of lips--to spur dialogue on how diverse cultures define "beauty."

Before long, one of the high school art teachers, Dennis Szymanski, stopped by to ask if he could be part of our evolving Eating Disorders program. Piggy-backing on Neil's contribution, Dennis suggested that we focus on society's changing perceptions of beauty, starting with primitive cave drawings of the Earth Mother and the Egyptian fertility goddesses...progressing to the classic Greco-Roman ideal, then segueing to the changing figures of the Middle Ages (images ranging from elongated austerity to rotund fertility).

Later slides in the series included demurely clothed figures of Victorian prudery, emaciated images of the Flapper era, voluptuous "pin-ups" of the World War II period, and ended with contemporary ads showing contemporary models in all their wistful gauntness (the Kate Moss "wispy waif" look). In addition, Dennis suggested including in his presentation evolving societal perceptions of what we now term anorexia and bulimia---starting with the medieval view of anorexia (viewed as miraculous evidence of divine intervention (survival without food))...moving on to Freud's focus on the sexual roots of such behavior...and concluding with our contemporary linkage of eating disorders to both genetic and societal causes.

The final piece of our three to four day program fell into place when our then school nurse Carol Farnsworth (deceased) was conscripted to provide the seniors with basic background information: a working vocabulary, warning signs, psychological profiles, treatments and effective programs dealing with the devastating physical and emotional effects of eating disorders on victims and their families, Carol also recommended addressing some of the less horrific, "silent" eating disorders that plague an astonishingly large number of Americans, most notably our national obsession with sporadic bingeing and "yo-yo" dieting.

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Although pieces of the unit were eventually transferred into freshman and sophomore years in 1998 to make room for a mandated "school-to-career" internship program during the last quarter of senior year, the senior year Eating Disorders program enjoyed a successful tenure at North Salem between 1994 and 1998. During those four years we measured our success by the lively discussions in our classrooms as well as by the animated spillover "talk" in the cafeteria---albeit woven into the inevitable May prom conversations focused on nails, coiffeurs and limousines.

The only dissenting voices we'd hear each year typically came from a few male seniors who argued that eating disorders were a "girl thing." However, recent studies have shown that eating disorders can affect both genders: therefore coaches, teachers, peers and family members need to encourage boys to share concerns about body image and weight. The guys' sometimes baiting comments during class provided a launching pad for dialogue: the male members of the interdisciplinary team reminded the dissenters that young men can also fall victim to eating disorders. In any event, they reiterated, most young men would be someday be involved in significant relationships as husbands, close friends or fathers of young women who might suffer from such devastating eating disorders. And they would need to be need to be sensitive and knowledgeable in dealing with these troubling issues. This approach didn't win over all skeptics, but it quelled the debate somewhat.

An outline of the Eating Disorders program we ran for seniors is noted below for teachers interested in replicating parts of our program…or the entire unit.

Outline: The North Salem Eatng Disorders Program

Day One:

Presenters: School Nurse and Physical Education Teacher

General Topics: Definitions, warning signs, causes, treatment, prognosis, body types.

Day Two :

Presenters: (s)

Topics: Changing images of beauty through the ages (slides depicting traditions practiced by African tribes, images from the Ancient World (Egypt, Greece and Rome), the Medieval Ages, the Victorian period, the Flapper Era; photo shoots of W.W.II film stars ending with teen models depicted in contemporary magazines)

Day Three/Four:

Presenters: Guidance Counselor(s) and Senior Year English Teacher(s)

Topic: full group discussion of a fictional single parent family almost destroyed by the young daughter's eating disorder in the short story "Mothers, Daughters" by Margaret Erhart, anthologized in My Mother's Daughter: Stories By Women, edited by Irene Zahava, Crossing Press, 1991 (currently out of print, but used copies are available online as well as in libraries)

Questions to launch class discussion of the short story :

• What events show that the family seems unable to communicate effectively about the daughter's near death experience from an eating disorder?
• Why/how does the young girl herself refuse to accept her developing body?
• Why is the great "sin" of the story the failure to "pay attention"?
• Is there hope at the end of the story?

Ways to link the short story to contemporary issues:

How does our "fat phobic" culture, the "thinness obsession" in the modeling industry, changing definitions of beauty (sometimes voluptuous/"busty" models are out and the ultra-thin "wispy waif" is in) affect the growing phenomenon of eating disorders?

What role does the family play? In the short story the parent is depicted as possessive, authoritative, over-protective, intrusive, coping with trauma (loss or separation). What impact does this type of family play on victims of eating disorders? (Research indicates that fathers of eating disorder victims are often rigid, aloof or absent.)

****Caveat: During classroom discussion it is important to emphasize that specific real life families may not follow the pattern depicted in the short story or in statistical studies.

Background: Information on Eating Disorders

(edited material obtained from the National Association of Anorexia Nervosa and Assorted Disorders and Anorexia Nervosa and Related Eating Disorders, Inc.)

General Information

• Eating disorders strike all ages (10-40), all socio-economic classes.
• Most are typically girls in early adolescence or leaving home for college/work, 86%

report onset by age 20.

• It is estimated that 7,000,000 females and 1,000,000 males suffer from eating disorders.
• Male cases are on the rise.
• Without treatment, up to 20% of those affected die from the disorders.

Causes of Eating Disorders:

• Victims may experience difficulty dealing with problems of self-esteem, alienation, and/or a crisis of identity.
• The disease may emerge within close, successful families with fixed roles/high expectations/strong demands.
• The disease often surfaces when the victim experiences stress from personal difficulties.
• On occasion a history of abuse may exist (not necessarily by a family member).

Anorexia:

• Identified in 1694 by Dr. Richard Morton "nervous consumption".
• Sir William Gull in late 1800's termed the disorder "anorexia nervosa,"
• The disease occurs most often among girls between 14-16 who falter in transitioning from childhood to adolescence although about 5% of anorexics are male.
• The victim may consume as few as 200 calories a day
• Emotional characteristics that sometimes correlate with anorexia are: distant, studious, compliant, conforming, conscientious, punctual, driven, preoccupied by control and rigid schedules, obsessed with academic/athletic excellence.
• Symptoms of anorexia include: 25% loss of body weight, morbid fear of weight gain, loss of menstrual periods, tiredness, cold extremities/fingers and toes blue, distorted body image, hair thinning on scalp, downy hair appearing on body (to conserve heat), low heart rate/blood pressure, kidney problems, constipation, anemia, bone loss, shrunken organs.
• Victims experience hunger but deny craving.

Bulimia:

--Greek : "huge appetite".

The disease is more common than anorexia but harder to detect since often maintain normal body weight and eat secretly all day, even when not hungry.

Victims' weight fluctuates.

They binge and purge in private; using diuretic or vomiting agents (ipecac).

They show laxative dependency.

The illness occurs most often among women in late teens and early 20's who have difficulty dealing with transition from adolescence to adulthood.

(10% of bulimics are male);

25% of all college age students plagued with various stages of bingeing/ purging;

75% of bulimics experience severe depression and 1/3 also have a substance abuse (drug/alcohol) problem.

--very social, perfectionists, skilled at role playing, well-behaved, often prettier than average.

--symptoms: eat high caloric, easily prepared/consumed carbohydrate-rich food (up to 10,000 calories/day). Wreaks havoc with gums/teeth (eroded enamel); linked to diabetes; causes bleeding of esophagus, overall weakness, heart/kidney disease, seizures, broken facial blood vessels, swollen parotid gland (cheek), dehydration, electrolyte imbalance.

Treatment of Eating Disorders:

-- individual psychotherapy, behavioral therapy, hospitalization when severe, force-feeding if suicidal, drug therapy for depression, family therapy to build conflict resolution skills, nutritional counseling (low fat/high carbohydrate) which emphasizes binge management not restrictive dieting and urges exercise as healthful safety valve. Highly treatable: complete cure achieved in more than 50% of cases.

Suggested Bibliography:

Arnold Anderson M.D. Practical Comprehensive Treatment of Anorexia Nervosa and Bulimia, Baltimore: Johns Hopkins University Press, 1985.

Hilde Bruch. The Golden Cage. New York: Random House, 1978.

Hilde Bruch. Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within. New York: Basic Books, 1973.

Hilde Bruch. Conversations with Anorexics. New York: Basic Books, 1988.

Joan Jacobs Brumberg. Fasting Girls. Cambridge, Mass.: Harvard University Press, 1988.

John Darnton, " 'Skeletal' Models Create Furor over British Vogue," The New York Times, June 3, 1996, D2.

D'Arcy Jenish and Sharon Doyle Driedger, "A Tragic Obsession: Eating Disorders Can Sometimes be Fatal," Maclean's. October 9, 1989, Vol 102, No. 41.

Louise Lague et. al., "How Thin Is Too Thin," People, September 20, 1993, 74-80.

Sheila Mac Leod, The Art of Starvation, New York: Schocken Books, 1982.

"Medical Report: New Treatment For Binge-Purge Sufferers," Glamour, October, 1988, 284, 287.

Salvador Minuchin. M.D. Psychosomatic Families: Anorexia Nervosa in Context, Cambridge: Harvard University Press, 1978.

Anne Rosenfeld, "New Treatment for Bulimia," Psychology Today, March 1989, Vol 23, 28.

Wendy Sheutlin, "Portraits of Anorexia," 60 minute documentary film/video, Fat Chance Films, 390 Elizabeth St., San Francisco, CA, 94114.

Donna Strobel, "Binging and Purging: Youth Who Suffer Bulimia," Camping Magazine, May 1990, 32-34.

For Information and Help

National Association of Anorexia Nervosa and Associated Disorders, Box 7, Highland Park, IL 60035, (708) 8311-3438.

Bulimia Anorexia Self-Help, P.O. 39903, Saint Louis, Mo 63139, (800) 762-3334.

Anorexia Nervosa and Related Eating Disorders, Inc., P.O. Box 51102, Eugene, OR 97405, (503) 344-1144.

American Anorexia-Bulimia Association, Inc., 418 East 76th Street, New York, NY 10021, (212) 734-1114.