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Challenging Behavior in Young Children


    Selected Work by Judy Sklar Rasminsky

Dying to Be Thin

Canadian Reader’s Digest, September 1989
Feature, 1900 words

In September 1983, at the beginning of the school year, Montreal teenager Julie Rossini (names of all family members have been changed) went on a diet. At 5 feet, 4½ inches and 115 pounds, the 15-year-old Grade XI student was far from fat, but she wanted to emulate her best friend, who was dieting too. Besides, like so many women, she believed the myth that being thin was the key to beauty, happiness and self-worth.

It all seemed innocent enough. Bringing only a salad or a grapefruit to school for lunch made Julie hungry, but using willpower to curb the urge to eat made her feel almost high. “You look great,” friends told her as she quickly shed five pounds, then ten.

The lower her weight fell, the less Julie wanted to put pounds back on. She ate less and less. At the same time she became obsessed with food—including grocery shopping and cooking, which had never interested her before.

Neither she nor her family realized that she could no longer control her own behaviour, that she was being sucked downward into a painful, life-threatening struggle with her own body that would last for years.

Julie’s parents, Italian immigrants Carlo Rossini, 44, an independent electrical contractor, and his wife, Maria, 44, a teacher, had worked all their lives to give their children a secure, comfortable future. They had selected strict schools for their two girls, who they believed should be closely supervised.

Julie was bright and sensitive, a model student, and although she sometimes chafed under her parents’ rigid rules, she usually obeyed them. As a young teenager, she had wanted to be different, and the family had fought over her punk haircuts and radical politics. But Carlo and Maria scarcely recognized the Julie who was living with them now. She was skinny, but just as alarming, she was anxious, irritable, prone to angry outbursts and increasingly withdrawn. Julie and her parents fought constantly about the way she was eating. One day in February 1984, her father saw with a shock that she was almost transparent. “You eat or you leave!” he shouted at her.

“This is my business,” Julie replied hotly, “not yours.”

That week the school principal phoned the Rossinis. Concerned about Julie’s severe weight loss, she urged them to seek medical advice immediately.

Skeletal appearance. The previous October Julie’s periods had stopped, and her worried mother had taken her to the family doctor for a checkup. But test results proved normal, so no further action had seemed necessary. Now the Rossinis were stunned by the principal’s words. They had had no idea that the situation was so desperate.

At the Montreal Children’s Hospital, Dr. Alan Pavilanis, an adolescent specialist, confirmed the principal’s fears: Julie was suffering from anorexia nervosa, an eating disorder in which the relentless pursuit of thinness can lead to starvation and death.

Most common among women between the ages of 14 and 25, anorexia affects an estimated 20,000 Canadians or more. At least another 100,000 are afflicted with anorexia’s sister disease, bulimia nervosa, an eating disorder whose victims binge-eat, then try to control their weight by purging (vomiting, taking laxatives or over-exercising). Both anorexics and bulimics are preoccupied with food as a result of their terror of being fat, and they often view their own bodies as if in a distorted mirror.

Contrary to popular belief, sufferers of eating disorders come from all age groups, social and economic classes, racial and religious backgrounds. Nor are they all female—one in ten is male.

Society’s obsession with slimness, an overprotective family environment, a family history of alcoholism or depression—all these factors and more come into play in eating disorders. The anorexic herself tends to be a perfectionist who, underneath, lacks self-esteem. A crisis—parents’ divorce, rejection by a boyfriend, emerging sexuality—can precipitate the illness.

While he searched for the causes of Julie’s illness, Pavilanis began to treat her as an outpatient, but regular appointments failed to halt her weight loss. On the day after Christmas 1984, Maria, exhausted by her daughter’s mood swings and terrified by her increasingly skeletal appearance, came to a decision. “You’re going to the hospital,” she told Julie.

Crying, Julie finally acquiesced. The emergency-room doctor admitted her immediately. She weighed 84 pounds.

It often takes years to overcome an eating disorder. Combatting the devastating physiological and psychological effects of starvation (which range from slow heartbeat and low blood pressure to inability to concentrate and severe emotional disturbance) is the first priority, but untangling submerged feelings and restoring normal eating habits are equally important.

To deal with starvation, the Montreal Children’s used a strict behavioural approach. For every two pounds Julie gained, she received a privilege—access to telephone, television, books. At the same time, she began to see a psychologist once a week. And with her parents and her sister, Anna, 18, she started family therapy.

Julie returned to school in February, while still under treatment. And although she found it harder and harder to eat as she approached 96 pounds, the doctors felt that her weight gain was sufficient. On February 23, 1985, they discharged her.

Within weeks, however, Julie began losing weight again. She became imprisoned in the dreamlike world of semi-starvation. Interested in little beyond herself, she led a withdrawn, muted existence. Unable to concentrate, she managed to pass her courses only with considerable help. She no longer went out with friends. Instead, Anna took Julie to parties she couldn't enjoy or to restaurants where the two sisters sat for hours while she dithered over the menu. Each evening, her helpless parents watched Julie lie on the sofa covered by a blanket to ward off the cold that anorexia brings.

After Julie’s graduation the following year, in May 1986, Maria took her fragile daughter to Italy. But once Maria had returned to Montreal, Julie’s grandparents could work no magic either. Eating one meal a day, Julie delayed her return home, aware that it meant going to the hospital. In October, when she developed a fever, she could avoid it no longer.

Worst moment. The month before, Maria had clipped a newspaper article about a new program at the Douglas Hospital in the Montreal suburb of Verdun for treatment of eating disorders. She and Anna drove there to look it over. Nurse Celine Johnston, the program’s co-ordinator, took them on a tour of the six-bed inpatient unit and its annex, and introduced them to a specially trained multidisciplinary team that included psychiatrists, a psychologist, social worker, occupational therapist, dietitian and nurses. The atmosphere was warm and reassuring.

Today the Douglas’s Eating Disorders Program has a waiting list of 200 names, but in November 1986 it had barely opened its doors. Julie, now 18, weighing 69 pounds and dangerously ill, was in luck: She was admitted within days.

Jean Burgin, Julie’s primary nurse and psychotherapist, eased her through the first week of observation in which she had a thorough physical exam, psychiatric evaluation, and time to get to know people. The worst moment of that week was the body-image video, designed to help her see herself more realistically. Confronting her gaunt face and emaciated shape, Julie sobbed to Jean, “I look like an old lady.”

But the video helped her to answer a question posed by Dr. Pierre Leichner, director of the program. “What do you expect from this hospitalization?” he asked.

“I want to get better, to change the way I think about food,” Julie replied hesitantly.

“We can help you if you wish,” Leichner said. “You alone can do it, but you cannot do it alone.”

Once a week Julie would meet with him and Jean to review her progress. Her obligation was to gain two pounds a week; and the responsibility for her recovery rested squarely on her own shoulders.

Julie met dietitian Linda Falcon to plan menus of three meals and three snacks a day. Gradually her daily consumption would increase to at least 3000 calories to help her gain weight, Falcon explained. She was allowed to replace three dishes she disliked, but not an entire food group. (She could leave out beef Stroganoff, for instance, not beef.)

Initially she ate at the nurses’ station under their watchful eyes. Once she was meeting her weekly target, she was permitted to eat unsupervised in the common room. It required effort to join in the centre’s regular program of individual and group therapy, cooking, arts and crafts, physiotherapy and exercise classes. She cried much of the time. She was sloppy in her personal habits, needing reminders to brush her teeth or change her clothes. To Jean she confided, “If I look too good, people will think I’m well, and I don’t feel well.”

New life. But by Christmas her condition had improved. With steady weight gain, both Julie's hygiene and thinking changed dramatically. She could concentrate better in therapy, where she and Jean discussed her feelings.

Typical of people with eating disorders, she confessed to Jean that she felt tremendous pressure to keep everyone happy. Even her diet had been a response to a challenge from her best friend. Ironically, she had loved the feeling it gave her: that she could control a part of her life.

Now Jean and the rest of the Douglas team were helping her to express her emotions and to stand up for herself. She began to take a more active part in group therapy. And in nutrition classes she was learning how to eat properly.

On March 13, 1987, after two weeks of maintaining her target weight and months of planning, she packed her bags to go home. Giving her a hug and a photo of the haggard young woman who had arrived at the Douglas in November, Jean said, “Hang this up over your bed. We don’t want you to forget us.”

Her new life was far from easy. Lonely and uncertain—for none of her girlfriends had stuck with her through her illness—Julie shared her fears and doubts with Celine Johnston in weekly visits to the Douglas. Celine checked her weight and continued the therapy she had begun as an inpatient, encouraging her attempts to start anew. Gradually Julie gained confidence as she landed a job in a coffee shop, acquired new friends and started studying towards an arts degree at McGill University.

In February 1988, almost a year after she reached 105 pounds, Julie reached a milestone: She began to menstruate again.

With anorexia it is not always possible to speak of a 100-percent cure. But Julie is certainly at 80 percent, says Celine. Her weight is holding so steady that Celine no longer weighs her at follow-up appointments. She copes with stress without refusing to eat; she has gained confidence in herself.

“Do I feel good inside my skin?” Julie asks. “Better than I ever did.” Her marks are excellent. She has a job and a busy social life. As Celine puts it, “Julie is well on her way. She has taken charge of herself.”

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