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her extreme withdrawal. It worried me, but I thought, ā€˜I was shy too: I got over it.ā€™ ā€

Elizabeth had been relieved when Joannie, in her junior year, burst from her cocoon to run for class president, win parts in local plays. Then, in early summer, she went off to Salzburg to the American Institute for Foreign Study. Something happened there. She had written to me that the program wasnā€™t what sheā€™d hoped for, and that she was ā€œeating far too much.ā€ Elizabeth knows that Joannie was extremely lonely, but beyond that, she isnā€™t sure what went wrong. She only knows that the daughter who came home wasnā€™t the emerging butterfly who left.

It was just before Thanksgiving when Joannie confided to her mother that her diet was out of control. The next day the two of them went to the family doctor. ā€œWhen I saw her stripped, I was appalled. The doctor said she must be anorectic, and I said, ā€˜Whatā€™s that?ā€™ ā€

The late August sunshine is strong, but that isnā€™t the reason Elizabeth shades her eyes with a long-fingered hand. Now, she knows as much as any lay person about anorexia. She has read all the textbooks, all the scholarly articles. She knows that anorectics tend to come predominantly from higher-social-class families, that their parents are described as overprotective, over-concerned and overambitious; that the typical anorecticā€™s family is dominated by the mother, with the father an emotional absentee.

Elizabeth was forty when Joannie was born, at a time when giving birth at forty was far less common than it is now. Everyone assumed the pregnancy was accidental. ā€œIt wasnā€™t. She was wanted.ā€

Over the years Elizabeth has had plenty of time to reflect on whether the gap in their ages caused problems, and to examine minutely every facet of her mothering. ā€œSometimes, when I read about the role of the anorecticā€™s mother, I see some of my traits described there. But I also see some that are not mine at all.ā€

Joannieā€™s troubled relationship with her father hadnā€™t seemed any worse than the usual frictions between a strict parent and a child entering adulthood. The irrationality of her anorectic behaviorā€”insisting on making elaborate, rich meals, then refusing to eat them, exercising compulsively despite her skeletal frailnessā€”aggravated her father intensely. ā€œI know it hurt him, when she chose to take my name and abandon his,ā€ Elizabeth says. It took years before ā€œhe realized that the things that got on his nerves were part of her illness, and he became more loving and pliable.ā€ Joannie had written to me, toward the end, that she and her father were getting along better, ā€œand thatā€™s nice.ā€ By then, she had resumed using his surname.

But there was one other way in which she had rejected him. Both Joannie and I, as girls, had thrown ourselves into obsessive interests. Talking about this trait with Elizabeth, I mention that my Mr. Spock mania had been replaced by an absorption with Israel and Jews. I tell Elizabeth how Iā€™d hoped that Joannie might be Jewish, or at least share my fascination, and how disappointed Iā€™d been when sheā€™d dismissed my outpourings on the subject with a few uninterested sentences.

Elizabethā€™s eyes widen. ā€œJoannie never told you that her father was Jewish?ā€

After the family doctor diagnosed her anorexia, Joannie told him she was anxious about the approach of Thanksgiving, with its compulsory feasting. ā€œHe said, ā€˜Just relax and let your mother make you a turkey sandwich,ā€™ ā€ Elizabeth recalls.

But Joannie couldnā€™t relax. She couldnā€™t sleep. Her refusal to eat and her exhausted state convinced her parents that she needed hospitalization. But Joannie became distraught at the suggestion. They gave her Thorazine to calm her. ā€œWe must have given her too much,ā€ Elizabeth says, because by the time they arrived at the emergency room her blood pressure had plummeted. Joannie was admitted for the months-long treatment about which sheā€™d written to me in early 1973.

And so the pattern began that would continue for the next eight years. Joannie thrived in the protected environment of the hospital, gained weight and pulled out of depression. But with each release came relapse. Elizabeth remembered getting Joannie ready to go to Vassarā€”making the Indian-print bedspread and curtains for the single room sheā€™d wanted, but had written to me that she disliked and found too lonely. ā€œHer balance was precariousā€”the hope was that sheā€™d find herself if everything went perfectly.ā€

But it didnā€™t. And on a weekend trip home she binged, felt guilty and took the overdose of antidepressant sheā€™d written about in her letter of November 1973. She told her parents sheā€™d taken the Tofranil. They rushed her to the bathroom and induced vomiting. Elizabeth was stunned by the amount of food that came upā€”the magnitude of the binge. Because sheā€™d vomited so much, they thought sheā€™d surely eliminated the drug from her system. ā€œShe went to take a nap, and then I couldnā€™t wake her up,ā€ Elizabeth recalls. And so began the nightmare weeks of emergency room, followed by intensive care, coronary care and psychiatric hospital again.

Joannie realized that she wasnā€™t psychologically strong enough for Vassar, but the fact that she couldnā€™t go back threw her into despair. For weeks, Elizabeth said, ā€œSheā€™d just sit with her head in her hands.ā€

Determined to find the best therapist, the family searched out Hilde Bruch, the eating-disorders specialist in Texas. She remembers the relief with which she left Joannie in Dr. Bruchā€™s care, feeling that for once she would be safe. Joannie did so well that Elizabeth urged her to stay on in Texas and enroll in university there, so that she could remain close to the therapist. But Joannie chose to come home. Once back, ā€œall the old stresses and temptationsā€ seized her again.

In her long search for answers, Elizabeth has wondered if Joannieā€™s voices and fears indicated a schizophrenia-like disorder. She feels reasonably sure that fear of growing up and unease with emerging sexuality were a large part of the problem.

Joannie had been just sixteen in the summer of 1971,

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