What I learned from my friend who couldn't eat

Sometimes I have to remind myself that there was time when I thought that there was no mental illness in my family. Sometimes I have to remind myself that there was a time when I thought that mental illness was not a part of me. Sometimes, I do, have to remind myself that I once saw mental illness as a sign of weakness. I have to remind myself that my views didn't change once I had my first encounter with mental illness or even a diagnosis. They evolved over time, where I began to see mental illness as a disease like diabetes, just as crippling, but with the upside of giving me perceptive and some talents I probably would not have otherwise had.

In recent lectures to college students on journalism, I have brought up the story of my friend from high school. The story is instructive about why I got into journalism - to help people, and I think that, as I say, while "it is hard for people to process the idea, to internalize the notion, that I once was so much like them" that it is "an important premise to looking at my career, because if you buy the idea that I could cross ethical lines that I did, you can buy the notion that you can."

"As F.B.I. profilers and forensic psychiatrists will tell you, recognizing that anyone is capable, under the right circumstances, of anything," I continue, "is the first step to guarding against the evil from within."

I talk about how I had been curious about writing and how as a high school student I saw the healing power of journalism in the form of a story in The Washington Post about a friend I had known who died. I saw the helping power of journalism in a series of stories in local newspapers and The Post about a classmate whose insurance company had denied medical treatment for anorexia nervosa that had her hospitalized and turned into a dying skeleton. "I saw the helping power of journalism when thousands of dollars were raised and the girl's insurance company reserved its decision because of bad publicity," I say.

What I don't tell them is another way that girl changed me. I learned from this friend that an eating disorder was not about pure vanity or purely about public perception. I learned that my friend did not not merely choose not to eat, a hallmark assumption of the pull-yourself-up-by-the-bootstraps version of mental health help, but that she couldn't eat. I learned that it took all her strength to live, to try to survive, to fight it. She was my hero.

Later in life, I would be able to take these lessons and apply the notion of will vs. treatment and support to substance abuse recovery, managing mania, dealing with depression and a host of other areas. I saw how important motivation for things to get better was, but I also saw that without the support systems, the treatment, insurance dollars and other elements, it was difficult to recovery from, and manage and cope with, these diseases.

It was not until later in life that I began to even see eating disorders as an intricate part of mental illness. They are not mental disorders simply because doctors cannot determine why people will not eat. Often, people develop eating disorders, such as binge-eating, to relive anxiety. I saw it first-hand in a good friend of mine and her 11-year-old daughter who was once found hiding within the cabinet sinks eating a can of cranberry toppings while she was supposed to be on a diet. It relieved her anxiety. I've seen how withholding, purging and other eating disorders often have to do with control - when a person feels they do not have much control over their lives, as teenagers often do, they turn to substances, cutting, not eating and other steps to exert control and relieve their anxiety.

Mental health professionals are busy working on a new taxonomy for eating disorders. There is something to be said for expanding the definitions of anxoerxia and bulima, and adding binge eating and other disorders. After all, as it stands now, research shows that 90 percent of people with eating disorders have subthreshold conditions, meaning they do not meet all the criteria of any particular disorder, and instead meet the criteria of a catch-all category called Eating Disorder, Not Otherwised Specified. Tightening the taxomony will help with research, diagnosis, education, awareness and possibility insurance reimbursement.

But the real next step is to see eating disorders, like cutting, often as a symptom of other psychological and psychiatric processes, such as obessive-compulsive disorder, anxiety disorders, postraumatic stress, personality disorders, mood disorders and others. Once people begin to look at eating disorders from that perspective we will be able to individually tailor treatment to each person, with harm-reduction, psychotherapy, medications, guided imagery, exposure therapy and other symptoms. No longer will eating disorders be seen as a confusing form of vanity.

Despite my early brush with this mental illness, even when I was diagnosed with bipolar disorder in 2003, I still saw mental illness as a sign of weakness, even though I also had been exposed to more and began to see some of the upsides. When I first walked into a psychiatric facility and they asked whether I had a family history of mental illness, I said no, not out of shame, but because no one told me that my grandfather was probably manic depressive, that I had an aunt who was probably schizophrenic, that I had another aunt who had bipolar disorder and I had substance abuse all over the other side of the family tree.

Well, the family I have now, both the biological one and the broader one is filled with mental illness. I recently reached out to my friend from high school who had the eating disorder to thank her for helping me learn, understand people better, grow and persue professions where Icould help people. She is doing well, but if she falls again, I'll be there for her, just as her example has long been with me.

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