On her first night in the hospital, Becky Israel cried herself to sleep. She knew she needed helpshe just hadnt realized how awful getting help would be. Five-foot-four, cheerleader-pretty, with thick blonde hair cascading down her back, sixteen-year-old Becky had starved herself down to 93 pounds. She was faint all the time, her periods had stopped, and she was sleeping only two hours a night, staying awake and exercising to burn extra calories. Becky was still thinking shed look a lot better if she could just lose ten more poundsuntil the day she took a shower and a hunk of her long, beautiful hair came out in her hand. Sobbing and terrified, Becky called her best friend, who begged her to tell her mother. Becky left a checklist of anorexia symptoms in her moms room, with every symptom checked. Her mothers response was angry denial: "Youre being ridiculous," she told her daughter. "Youre fine! You dont have an eating disorder." Luckily, a neighbor intervened, insisting that Beckys mom take her to the eating disorders clinic at a hospital near their home in the suburbs of Chicago.
The hospital admitted Becky on the spot. Her body temperature was 93 degrees; her fingertips were blue; the nurse said Beckys heart could stop at any time, and that she had the lowest blood pressure shed ever taken outside the ICU. During her first days in the eating disorders unit, Becky felt she was surrounded by crazy people: a man who weighed 50 pounds, women her mothers age whose teeth had fallen out. Beckys roommate terrified her, waking up screaming and running out of the room each night. But worst of all, the nurses made her eat. Becky had worked so hard at getting thin during the past six months, eating only a dry bialy each morning, a fat-free frozen yogurt each afternoon. And now they were trying to make her fat, forcing all kinds of awful stuff down her throat. Pasta with cream sauce. Pizza. Buttered bread! Becky was fed in a tiny room, with a nurse supervising to make sure she didnt throw up after she ate. She couldnt even use the toilet without a nurse watching her. If she got caught exercising, or even running down the hall, they made her drink disgusting high-calorie drinks. Becky found ways around the rules, doing jumping jacks in the shower, sit-ups in her bed. But still, she was gaining weight.
Along with the forced feedings, Beckys seven-week hospital stay was packed with non-stop therapy sessions: art therapy, drama therapy, group therapy, video therapy (to convince Becky that her emaciated stomach wasnt huge and protruding, as she still perceived it to be), and family therapy. "My mom came late to our first family therapy session," recalls Becky, now 26. "She was at the gym!"
After a few weeks, Becky had gained enough weight to earn her first privilege: she was allowed to eat lunch with her mother in the hospital. "The nurse brought out our plates. It was pasta Alfredo," Becky says, laughing hollowly. "Mom took one look at it and whispered to me, Lets toss this fattening junk and go across the street and get a nice low-fat salad. I used all my strength to tell her, Mom, Im trying to get well. I have to eat this!" Becky sighs. "It was so hard for Mom to see her own anorexia, she couldnt see it in me."
That same day, Beckys doctors gave her mother what five-foot-one, 105-pound Lauri Israel calls "the biggest shock of my life." "The doctors told me that Beckys problem was in part because of me!" Lauri remembers. "They said Id set an example for my daughter that was life-threatening to her. It was like being hit right in the face."
Did Becky inherit the untreated, unacknowledged anorexia that had plagued her mother since she was sixteen? And if so, was the disease transmitted by nature, or by nurture? Did Becky learn to see herself in a funhouse mirror of distortion; to punish and reward herself with food, by watching her mother do the same thing to herself? Or did she inherit genes from Lauri that predisposed them both to anorexia?
Controversial new research suggests that eating disorders may in fact have a biological trigger. A study released in March, 2000 by the UCLA Eating Disorders Program found that female relatives of women who suffer from anorexia or bulimia are twelve times likelier to develop eating disorders. And a follow-up study, currently underway at several sites across the country, hopes to identify genes that increase a persons chances of suffering from anorexia or bulimia.
Dr. Walter Kay, Professor of Psychiatry at the University of Pittsburgh and the new studys principal investigator, says the research was prompted by clinicians long-time observations that eating disorders tend to run in families, and that identical twins seem to share the disease more frequently than fraternal twins. The goal of the research, he adds, is improved treatment of the disease, which currently afflicts seven million American females and one million males, most of whom become ill during their teen years. Today, the cure rate is estimated at only fifty percent; six percent of those with serious cases die. "Eating disorders have the highest death rate of any psychiatric illness," says Kay. "Im certain the studies will lead to improved medications, as well as improved psychological treatment."
When Lauri Israel was 16 and anorexic during the 1960s, there was no treatment for her disease; she didnt even know its name. Twiggy was the female role model of the day, and her own mother was on a constant diet. Only her father expressed concern, watching Lauri shrink from 105 to 88 pounds in time for her senior prom. "Everyone else was jealous, including my mom," she says.
Comparing Lauris weight-loss methods to her daughters is an eerie case of history repeating itself. As Becky would do years later, Lauri made a science of calorie-counting, eating one dry bialy a day (because someone told her bialys only had 72 caloriesa fact she passed along to her daughter); supplementing that with a can of Metracal, the only diet food available at the time. "There were no calorie counts on food packages the way there are today," says Lauri, who wrote a letter to Keeblers at age 17, inquiring about the calorie content of graham crackers. "You were running blind."
Lauri says it was her survival metabolism that probably saved her life: when she dropped below 90 pounds, no matter what she did, she started gaining weight again. The same thing happened during her next bout with anorexia twenty years later. Once again, Lauris weight plummeted from 112 to 88. Once again, her illness went undiagnosed. But this time, eleven-year-old Becky was watching.
Becky saw her mother eating only low-fat food, and very little of it. She saw her mother spending at least an hour each day at the gym, then another hour on the Stairmaster at home. She saw her mother becoming agitated in restaurants if the food wasnt served the way she always ordered it: dry, with everything on the side. "I was fighting my weight all the time," Lauri acknowledges. "And I didnt realize the effect it was having on my daughter."
That effect was profound. Although Lauri was so emaciated that people used to ask Becky if her mom had cancer, at age twelve Becky was quoting Lauris calorie-count warnings to her friends. At age fourteen, Becky scolded a woman at a birthday party for eating cake. "I thought being a grown-up woman meant exercising like a maniac and not eating," reflects Becky, an actress now living in Evanston, Illinois, a few miles from her parents house.
Whether it was her mothers example or a genetic predisposition that made Becky vulnerable, anorexia, she says, was "waiting right there to grab me" and it did just that during her junior year in high school. After a fat test at school showed Becky to be overweight, she plunged into an obsession that overtook the next eight years of her life. A straight-A student with a passion for acting, Becky punished herself for missing a question on a test or not getting a role in a play by lowering her daily calorie intake to 200. For their Friday night entertainment, she and her actor friends, several of whom were also anorexic, roamed grocery store aisles, counting calories on food packages. "Id look at the magazines," Becky says, "and realize that if I was going to live my dream of being an actress, Id have to be skinny."
Beckys obsession didnt end when she was released from the hospital in 1991. A year later she was away at college, starving herself again. Her first boyfriend, worn-out by Beckys crying about her weight, had broken up with her. Although her sorority had voted her prettiest girl and she was once again wearing a size zero, Becky was spending hours each day at the gym. Her parents came to visit her, her dad toting a scale. "If you dont get above 100 pounds, youre coming home," he warned her. Beckys mother took her shopping. "Your dad would kill me for saying this," Lauri confided to her daughter, "but you look great."
During her twenty years in private practice, Berkeley, California therapist Kim Chernin has heard many stories like Lauri and Beckys. But Chernin, a renowned eating disorders expert and author of The Hungry Self and several other books on the subject, discounts the new theory that the link is genetic. Rather, she asserts that anorexia is a socially transmitted disease, inextricably linked to media images of women who are small and powerless, "much less than they could be." "We live in a society that devalues women and associates female power with large size in a woman," she says. "Is it any surprise that six-year-old girls are already on the scales, worried about gaining weight? Thats not about DNA. Thats about the culture."
As for the family connection, Chernin believes that when both mother and daughter are anorexic, the mother is using the daughter to help her control her own illness. "The mother is terrified by the daughters appetite," Chernin says. "When the daughter eats, she feels as if the daughter is eating for her. Mother and daughter become a single entity with one body, one mouth, one appetite, four hands." Chernin calls this "a frightening version of the mother-daughter dilemma" faced by all young adult daughters: how to separate from their mothers, while still maintaining closeness.
This dilemma is a critical one for Becky, who cherishes her close relationship with her mom but is struggling to rebuild it on a healthier foundation. The first milestone was Beckys move to Los Angeles in 1999, to pursue her acting career. It was there, two thousand miles from home, that Becky experienced the epiphany that makes her confident shell never succumb to anorexia again. While shooting her first movie, Becky doubled over with stomach pain on the set and was rushed to the emergency room. Becky knew why she was sick: terrified that shed lose roles if she got fat, shed been subsisting on nothing but steamed vegetables. Lying on the gurney, she realized, "I cant have my dream and my eating disorder too." In that moment, she chose her dream.
Beckys life, and her relationship with her mother, have been changing for the better ever since. During her four years in Los Angeles, she won roles in movies, TV shows, and commercials. As her acting career blossomed, she started volunteering with inner-city teenagers, which inspired her to use her battle with anorexia to help prevent and treat the disease in other young women. She applied and was accepted to Northwestern Universitys graduate program in psychology, where shes studying to become an eating disorder specialist while continuing to act on stage, on TV shows, and in commercials. A bonus of her return to the Chicago area: she met and moved in with the man of her dreams; theyre going to be married in September, 2002.
"Its been a long recovery," Becky says. "And Im still recovering. Some days I wake up and say to my fiancé, Im a fat pig. But Im in the first stable relationship of my life with a wonderful man. And instead of working out to torture myself, I do things I like to do: hiking, roller blading, dancing." But the best outcome of her eight-year battle with anorexia, Becky says, has been learning to appreciate her body whether her mom does or not, realizing that shes her own person. That separation, she says, has made a new closeness possible.
Mom and I are planning my wedding together," Becky reports. "If we were still anorexic we couldnt do thatwed be fighting like cats and dogs. Now were like friends."
While acknowledging that she still falls off the wagon sometimes, Lauri says that Beckys hospitalization triggered a major life change for her. Her own weight is up to 115, she says her eating habits are more normal, and ongoing family therapy has helped her to be less controlling and more supportive of her daughter. "When this happens to your daughter, you blame yourself," Lauri says. "Beckys always been so sensitive to what I think. I can affect her so easily it freaks me out sometimes. I keep saying, Why do you listen to me? And Becky keeps saying, Because youre my mom."Becky chuckles, remembering a few of those off-the-wagon moments: when her mom made low-fat cheesecake for the holidays, then put the leftovers down the disposal so Becky wouldnt have any. And the time last year when Becky and Lauri were having dinner in a restaurant, and Becky returned from the bathroom to find the bread basket moved to the far side of the table. "I lost it," Becky admits. "I yelled at her, 'Did you move the bread? Do you think I'm getting fat?' Oh my God-was Mom ever sorry she moved that bread!"
Becky laughs, then adds soberly, "Somehow through all of this, Ive gained my mothers respect as an adult. And I know thats because I finally learned to accept myself."