Page 30 of Since She's Been Gone

She kept trying to talk to me, and I kept giving her the silent treatment. Finally, one night, when we were getting ready for dinner, she had had enough.

“I’m not going to stop talking to you for the rest of the night until you tell me why you’re so mad at me,” she said. “What did I do?”

I turned to her and finally spoke my mind. “You told them I ran away.”

“No, I didn’t,” she said defensively.

“I don’t believe you,” I said.

“They check in on us every hour during the night, and you weren’t here,” she said.

“I don’t believe you,” I repeated.

“Why would I tell them you left when they’d find out anyway?” she dug in.

“Because I didn’t ‘leave.’ I ran away. Something you’ve never done. Something you’ve never even had the courage to try.”

Her lips narrowed. Her brows furrowed. She looked angrier than I’d ever seen her.

“Are you fucking kidding me?” she seethed. “I have nine hospitalizations under my belt, and this is my seventh time here. You’re not in the same league as me. Not even close!”

I was too ill to register how warped this conversation was. Both of us clinging to our disease like it was our greatest accomplishment, in competition for who was the best anorexic, unable to comprehend how sick we were.

Anosognosia is one of the defining features of anorexia—the medical term for when a patient is unable to understand that they are sick, stemming from anatomical changes to the brain due to starvation. It’s incredibly problematic because, without an awareness that one is sick, the patient has no desire to get better, which makes the disease so confounding and difficult to treat.

Families of ED patients and clinicians who treat them often hear things like, “I don’t have a problem. You’re the one with the problem!” even when often there’s ample and serious physical and medical evidence, including heart problems and organ failure, demonstrating otherwise.

With virtually any other illness, from cancer to depression, people understand that they are sick and want to get better. But the vast majority of the time, with anorexia, that understanding doesn’t exist, at least at first, which is why waiting for a sufferer of an eating disorder to have insight into their illness and be ready for treatment doesn’t work. If you keep waiting, they’ll keep restricting, suffer more brain damage, and risk dying in the interim. The saying goes:Treatment first, insight later.

So how do you get a person who doesn’t believe anything is wrong with them to change their behavior? By usingexternal motivations, making them earn things that they want, whether it’s material possessions, video games, or time with friends,through eating.

Dr. Larsen tried doing that with me when she told me I needed to eat to go to the dog shelter. And she was about to try this technique again.

Emily and I were still arguing when Kyle, a staff member, appeared at our door. “What’s all the shouting about?” he asked us.

“Did Emily tell on me when I ran away?” I asked him.

“Yes, she let the staff know,” he said.

“I knew it,” I said, staring her down.

“You owe her a debt of gratitude,” he added. “She probably saved your life.”

I thought about my mom and the car that had barreled down the street, killing her, and how often I had dreamt about what would have happened had someone been there to push her out of the way in time to save her.

Kyle suggesting that what Emily had done for me was akin to this didn’t mesh with what ED’s thundering voice told me—Emily had ruined my only chance of escaping Better Horizons. Who knows how far I might’ve gotten had she not ratted me out?

“Your dad’s coming tomorrow,” Kyle told me.

“I already know,” I snapped back at him. It was going to be Dad’s first visit, and I wasn’t looking forward to it at all.

“He’s supposed to bring your dog,” he said.

“Rascal?” I asked, surprised.

“Yes,” Kyle said. “But not if you keep shouting up here and not unless you go downstairs for dinner.”

I immediately jumped up, solely focused on the prospect of seeing Rascal. Emily was now an afterthought. I quickly ran downstairs to the dining room.

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