An anorexic woman has been dy­ing for years — and there’s noth­ing her psy­chi­a­trist can do about it

The Walrus - - ARTS & CULTURE - By David Gold­bloom & Pier Bry­den il­lus­tra­tion by jean­nie phan

My as­sis­tant, Si­mone, calls through to tell me that Kirsten has ar­rived. When she en­ters my of­fice — twen­tythree years af­ter our first meet­ing — my im­me­di­ate impression is that she has not changed at all. This is be­cause one’s ini­tial re­sponse to Kirsten is shock at how painfully un­der­weight she is.

When I move be­yond this, I re­al­ize that of course she has aged, as have I. Not want­ing my re­ac­tion to her ap­pear­ance to be vis­i­ble, I move for­ward to shake her hand.

“Kirsten. It’s good to see you. It’s been a long time. I think the last time we met, I was still a brunette.”

For most of her adult life, Kirsten Halpin has been the thinnest per­son she — or any­one who knows her — knows. At five foot six, she has weighed be­tween sixty-five and a hun­dred pounds for the last twenty-five years. Now forty-seven, she has had anorexia ner­vosa far longer than she hasn’t, and it has af­fected her phys­i­cal health ru­inously. She has had ex­ten­sive den­tal prob­lems and has the bones of an eighty-year-old woman. Be­cause of her ema­ci­a­tion, she has not been able to have chil­dren, and she re­cently dis­cov­ered that she has early signs of kid­ney fail­ure. A fiercely in­tel­li­gent and ca­pa­ble woman, she has not had a paid job since her midtwen­ties.

Even hav­ing known many women with anorexia at var­i­ous states of ema­ci­a­tion, I find that the sight of Kirsten’s skele­tal frame cuts through my de­fences. I am con­fronted vis­i­bly by my fail­ure to help her, and I feel, in the mo­ment, use­less.

“How have you been since I saw you last?” I ask her as she sits down.

Anorexia ner­vosa has been well de­scribed for more than 150 years. Pri­mar­ily a dis­or­der of girls and women, typ­i­cally with on­set be­tween ages four­teen and eigh­teen, it is one of the few psy­chi­atric dis­or­ders that has mul­ti­ple phys­i­cal man­i­fes­ta­tions — in­clud­ing strik­ing thin­ness — that can cause nu­mer­ous health prob­lems and pre­ma­ture death. The pro­found weight loss that oc­curs comes from se­vere di­etary re­stric­tion, some­times punc­tu­ated by episodes of binge eat­ing and then fran­tic ef­forts to purge the in­gested calo­ries. For some­one with this dis­or­der, the body be­comes a me­taphor for self-ap­praisal, self-def­i­ni­tion, and con­trol taken

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