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Fear and Self-Loathing in Adolescents 

Wednesday, Aug 26 1998
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Early on in Inner Hunger: A Young Woman's Struggle Through Anorexia and Bulimia, we learn that as a child, author Marianne Apostolides, now in her mid-20s, spent many a day "zipping from tennis lessons to Broadway shows to soccer games." Hers was a childhood, she writes, in which "the pleasures of life came without cost." It's tempting to slam the book shut right then: Do we really need another survivor story from a neurotic rich girl?

Well, yes. Apostolides is more honest than most as she takes the reader through her adolescence, reminding us just how vile that time of life can be, from the perfect older brother (he's class president, valedictorian and high school homecoming king), to the workaholic father, the fawning mother and the author's own lack of self-esteem. Not to mention the gym coach with "thin, long legs - the kind where the thighs are no thicker than the calves."

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Other kids find ways - through sports, music, friends, drugs - to deal with the yearning for acceptance, control, beauty and structure. Apostolides sought comfort in starvation. The more her life of plenty offered her, the less of it she wanted. After a traumatic Oreo binge at summer camp, weight loss became her obsession. "Calorie calculation was the first thing I did when I woke up," she writes. "It was the last thing I did at night." When Apostolides' weight began to plummet, her mother took her to a doctor, who found nothing wrong and advised the girl that she could "afford to eat an ice cream cone." At home, her mother monitored her eating habits, which led Apostolides to concoct elaborate schemes to foil her, including a series of strategically placed napkins to conceal food at the dinner table. When her mother threatened to prohibit Apostolides from going on a school trip to Russia unless she gained weight, the girl taped weights under her clothes before stepping on the scale.

After a while, Apostolides' cravings for food overwhelmed her desire to starve, and she began to binge. After the rest of the family had gone to bed, she would consume entire loaves of bread or boxes of cookies hidden by her mother. "Some nights I had to search for food in the garbage or take it out of the dog's bowl," she writes. Her weight soon doubled, and her well-meaning mother enrolled her in a weight-loss program. So began the spiral back to starvation. The reader begins to understand that anorexia is not simply a phase, but a deeply rooted psychological disorder.

In college, where things often get much better for teens who don't make it in the high school in-crowd, life for Marianne got worse. "I saw myself through the numbers on the scale and the folds in my stomach," she writes. "The food was no longer food. It was my drug. It was my lover. I had to devour it." Mired in self-loathing, Apostolides initiated a string of one-night stands, which only made her feel worse. "How could I feel sexy if I was thinking about sucking in my stomach and getting rid of the taste of vomit in my mouth?" This line - as well as an episode in which she binges her way through Paris - is both sad and funny, but Apostolides, perhaps still too close to her experiences to see their inherent absurdities, writes it straight.

In her anger and self-hatred, she started punching walls and generally freaking out. Finally she joined a support group at school, but the results were slow in coming. She managed to embark on a long-distance relationship, but during phone sex all she could think about was the urge to purge. She faked an orgasm, hung up and vomited. Ultimately she chose bulimia over her boyfriend.

It was not until Apostolides took Ecstasy that she saw the potential for self-acceptance. "I am very aware of the dangers of drugs - whether the drug is nicotine or alcohol or Ecstasy," she writes. But "That night I loved my body. I experienced a feeling I had never before known." Not that her problems were solved, but she began to explore notions of body image, experimenting with belly-dancing, massage, yoga and karate. She also began taking antidepressants, and tried hypnotherapy. Eventually she reconciled with her mother, whom she had pushed away in her frustration and rage. "I experienced a deep love that allowed me to get beyond the scab of anger towards compassion and understanding," she writes.

Inner Hunger is a sharply told coming-of-age story. What makes this book worth reading, or buying for your teenage daughter, is not simply Apostolides' account but the fact that she doesn't hide behind victimhood, doesn't offer 12 easy steps to a better you and, in the end, isn't "cured." She shows the brutality of the illness, the ugliness it brings out in her and how, as an adult, she continues to struggle.

In Cutting, psychoanalyst and anorexia specialist Steven Levenkron describes his treatment of teenage girls who carve deep gashes into their bodies - not in failed suicide attempts, but in attempts to relieve psychic pain and record it. They secretly slash their arms, thighs and breasts - any part of the body that is easy to conceal with clothing later. One of Levenkron's patients had long blackouts from which she would wake with blood running down her arms. Another regularly inserted soap into her vagina. As the author notes, this self-inflicted violence is "heartbreaking in someone we love."

Levenkron's approach is to adopt a parental posture with these girls. But instead of dispensing threats and advice, he is "warm and bossy, unflappably confident" in order to win the trust of patients who have steeled themselves against letting down their guard. He describes case after case of this strategy: After a while the vignettes become repetitive, wooden and not a little self-congratulatory. His patients are always "startled" and "surprised" at Levenkron's insights into their problems. Without fail, in the 29 accounts he offers, he succeeds in getting his patients to open up to him, often where other therapists have failed.

Although Levenkron is obviously dedicated to his work - in one case he takes a class in Cantonese to communicate more effectively with a patient - he emphasizes his appearances on television and radio, as if to assure us that others have recognized his achievements. But the "unflappably confident" tone that works so well with his patients rings rather hollow on the page. It's hard to believe that no girl rejected his approach, and one wants to know if any girls have overcome this behavior without psychotherapy. Levenkron doesn't seem to allow for this possibility. Not until the end of the book do we learn that eliminating self-mutilating behavior is far from a final solution. "As psychotherapy shrinks this psychological tumor, instead of healthy tissue, or mental health, being uncovered," he writes, "we enter the areas of hidden problems it had formerly unmasked."

Cutting contains much important information - especially when read alongside Inner Hunger, where Apostolides offers a rich, disturbing exploration so intimate in its detail, it leaves no room for generalization or stereotyping. Levenkron's brief account of his patients' troubles keeps us at a distance. He shows us only what he wants us to see, pieces and parts that keep us at a clinical remove. The girls in his book are specimens to be observed. The jacket design of Inner Hunger shows the blurred image of a woman curled in the fetal position. Cutting shows a girl in a similar pose, but the top half of her head is cut off. I'd prefer to see the whole girl.

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