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