A THOUSAND HUNGERS: THE PROGRESSION OF EATING PROBLEMS

Bingeing and dieting often begin as a sensible response to trauma, but eventually they usually cause problems of their own. Joselyn appropriately characterized them as "coping skills/antiskills," an accurate summation of how many of the women I interviewed described the progression of their eating problems.

Bingeing became a problem partly because, as they grew up, they increasingly internalized the cultural demand for thinness. Those who began to binge when they were only four or five years old were not self-conscious about their eating, nor did they necessarily feel guilty about it. They simply did it. Some were not yet aware of the popular misconception that all people who are fat "got that way" by eating too much, and therefore didn't know they would be blamed if they were big. By the time they were eight or nine years old, however, many had effectively internalized cultural messages about eating and their bodies: that their eating habits were the sole reason for their body size, that bingeing is a sign of lack of willpower and self-discipline, and that they should feel ashamed of having big appetites.

For many, dieting that began as a response to an invasion of their bodily integrity eventually hindered them rather than helped them control what they ate; cycles of bingeing and dieting undermined their confidence that they could control their eating. As a consequence of long-term dieting—which lowers metabolism —some of them found that they could only eat small amounts without gaining weight. Bingeing was a frequent reaction to hunger caused by dieting.

Had they not internalized the cultural ideology, their use of food to cope with childhood trauma might have remained simply that, but once they were familiar with bingeing or dieting, they continued to use these methods when they were faced with later traumas: rape, violent relationships, racist and heterosexist discrimination. Consequently, in addition to the physiological effects of cycles of dieting and bingeing, the women had to deal with the psychological effects of their method of coping. Bingeing, purging, and dieting helped them get by but did little to help them combat the source of their pain or to untangle the reasons behind their actions. In fact, bingeing and dieting often put on hold the emotional work they needed to do. With each painful experience they countered with bingeing or yet another severe diet, more unresolved feelings accumulated. Many of the women have spent years coming to terms with this reality. As Laura says, "It took me a long time to realize that the thing that I turned to for comfort was the thing that would turn on me."

Some of the women characterize their eating problems as addictions that became increasingly worse. A few believe they were born with a partially genetically determined food addiction;11 Laura is one of them:

I have the earliest memories of just savoring Twinkies. I was very little. I would go to people's houses and I would end up in the kitchen trying to find those little sprinkles you put on cakes. I just had this very bizarre relationship with food. I learned very quickly that clearing the table as a chore was a good thing to do because I got to eat everybody's leftovers.

By the time she was three years old she was sneaking shots of liquor from a cabinet. Since her nuclear and extended family included people addicted to alcohol and heroin —in addition to those she considers food addicts —she believes that her addiction to alcohol and food was "in my blood" and that it was impossible for her to escape it. Most of the women do not consider their eating problems genetic, but do link them with other family members' abuse of alcohol, illegal drugs, and food. Almost all of the women had at least one parent who was addicted to alcohol or other drugs or had a long-term eating problem; as youngsters, they watched their parents use alcohol, drugs, and food to get through the day.

Some of the women's eating problems eventually became life-threatening—Dawn's, for example. She began to diet, binge, and purge intermittently prior to adolescence, consuming many sweets and carbohydrates. By the end of high school, she was eating all of the sweets in the house, including those in the freezer. Before adolescence she binged with others, but by the end of high school and early adulthood, she no longer let anyone see her eat. In her last binges she would consume massive quantities of food beginning in the early morning and continue until she could eat no more. Then she would throw everything up, and within half an hour or so she would begin to eat again. During the year before she sought treatment, Dawn says, all of a sudden this feeling would come over me . . . the compulsion to eat would start at my head and go down through my body. Then I would just grab my keys and run out of the apartment and run to the store and shove food in my mouth so that I could continue to eat.

A combination of anorexia, bulimia, and intravenous drug abuse brought her dangerously close to death in her mid-twenties. She had begun to use Ipecac, an inexpensive over-the-counter drug that is used to induce vomiting to counter poisoning:

Sticking my fingers down my throat was a nice way to puke because you don't get all those body shivers. You know when you have a fever? Well, taking Ipecac makes you all clammy and disgusting. Then you start to dry heave and then food starts coming up. You have no control over it. You have convulsions. It is the most horrifying experience of my entire life. That is where my bingeing brought me. That is how far it progressed. I stopped being able to go to Narcotics Anonymous meetings. I was eating a dozen doughnuts and puking.

It was at this point that Dawn sought the inpatient treatment program that she credits with saving her life.

Rosalee's compulsive eating became progressively worse, to the point where "milk was not enough. I would want to drink cream. I would open a box of cereal in the morning and by afternoon, the whole box of cereal would be gone." In the months before she joined Overeaters Anonymous, Rosalee was

taking steaks out of the freezer and fixing myself full dinners at four in the morning. I'd sit and eat them on the floor and cry. It is like I wasn't thinking. I would wake up from a terrible night and think: food. In the kitchen like a zombie. Start fixing, defrost, and just sit there and shovel right in. . . . My whole being was centered around food. This was something that had been getting increasingly worse.

Nicole describes her eating problems in three increasingly severe stages. In stage one, during her childhood, bingeing was neither conscious nor deliberate. She binged on whatever food was available and felt neither guilt nor remorse. During stage two, which began in college, bingeing became much more deliberate; for the first time, she began to steal food and to buy it in bulk. She attempted many diets and went on bingeing sprees with her best friend, who taught her to be bulimic. She was bingeing and purging for the same reasons she had binged in childhood—racist exclusion at school and her mother's physical and emotional abuse —but it had begun to be debilitating. Stage three began after college. She binged "no holds barred" and gained a lot of weight, topping three hundred pounds. In stage three, I would be eating in order to get to the place I was going to get food to binge with. My skid row period. All of my day revolved around food. Everything—school, work, and people—were secondary to that. ... It was a whole other stage for me. ... It wasn't any more emptying out to fill it up again. Purging was an integral part of the binge . . . bingeing and throwing up were the goal. One was not relieving the other. That is when I would say I really had an eating disorder. It was deliberate but it was uncontrollable. The terror and pain and self-hate as well as, I just learned in working with my therapist, a sense of soothing came from the bulimia. . . . The consistency of it [purging] was soothing, but it was also terrifying because I was afraid I would kill myself. I would throw up until I saw blood and then that would be the only thing that would stop me for that moment. I feared a lot that I would choke. The only thing that would stop me is when I would see blood.

By stage three, the control over bingeing and purging she had when she was younger was gone as the physiological addiction to purging began to take hold. At this point, Nicole was in extreme physical danger since she could not stop herself from throwing up. What had begun as a protective response had turned on her, leading her to reach out for help.

The trajectory of most of the women's eating difficulties, however, was not as overtly progressive, which suggests that the framework of eating problems as an addictive disease cannot be applied universally. Many women binged, purged, or dieted during stressful or traumatic times: when the stress diminished, their problems with food subsided too; increased stress would cause their eating problems to flare up again. But—unlike those of the women whose eating problems were progressive and addictive—these eating patterns were no more intense than they had been during previous times in the women's lives.

In general, intermittent eating problems tended to be less physically and psychologically harmful than those described as progressive addictions. Among the women who characterized eating problems as progressive, most had been through several traumas when they were very young children. In addition, they appeared to have fewer means of escaping their pain than those whose eating problems flared up and subsided in response to specific stresses. For example, three women whose eating problems were progressive and addictive were African-American women who endured various types of abuse at home and experienced racist exclusion at school. Facing trauma both privately and publicly, they had nowhere to escape pain.

Those who described not being able to leave their bodies as children were among those whose eating problems became progressively worse, to the point of becoming life-threatening. This suggests that leaving their bodies in the face of trauma may have protected some of the women from long-term consequences in a way not afforded to those who did not or could not escape psychically or physically. Whether the women's eating problems were progressive or intermittent, what began as helpful methods of coping eventually became impediments they decided to change.

The progression of eating problems over time illuminates why a strategy of resistance against a hostile and injurious environment is not necessarily the same as a strategy for liberation. In their research on African-American adolescent girls, Tracy Robinson and Janie Victoria Ward explain that while

African-American people, particularly women, have become expert developers and appropriators of resistant attitudes, we believe that all these forms of resistance are not always in our best interest.

Some methods of coping may serve women in the short term but may be counterproductive psychically or physically over the long term. The progression of eating problems is a powerful example of how and why eating is not a strategy of liberation. As Ann Kearney-Cooke explains, "mechanisms that allow for psychic survival as an abused child become impediments for effective coping as an adult."

With the right resources and sources of support, the women I talked to began to heal—to develop sane relationships to food and their bodies —and to make the transition from surviving to flourishing, from resistance toward liberation.

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