iParent Book Review: "Hungry" by Sheila & Lisa Himmel

In Hungry: A Mother and Daughter Fight Anorexia, a new book that has just been released by Berkley Books, Sheila Himmel writes:

Eating disorders, especially anorexia, are like what cancer was in my parent's generation, and what tuberculosis was to the generation before that: the shameful, mysterious disease that scares everyone to death. Until someone discovers the real physical causes, these diseases are invested with all kinds of treacherous powers to invade and destroy.

Why do some young women and young men become anorexic while others do not? It's a terribly difficult question to answer, and for parents who are dealing with eating disorders, the lack of clear causes is particularly maddening.

When Sheila Himmel's daughter Lisa began to exercise and obsess about food in high school, neither Sheila nor her husband suspected that Lisa's behaviors were early signs of an eating disorder. But as Hungry details, by the end of high school, Lisa was in it deep. Lisa's overexercising and undereating spiraled into full blown anorexia and bulimia which worsened in college, leading eventually to Lisa's hospitalization.

Hungry is one of the bravest, most courageous books I've ever read. Jointly written by Sheila and Lisa, it offers a mother and daughter's point of view. You can't help but to sympathize with both, as Sheila tries to do the right thing and as Lisa tries to free herself from the grip of the disease.

I was particularly struck by Lisa's accounts of how helpless and depressed she felt, even as she monitored every calorie and inch on her body. Sheila and husband Ned, intelligent, loving parents, find themselves with a daughter who is failing fast, becoming sicker while resisting help. They try to navigate a confusing terrain which includes grossly underqualified eating disorder therapists, conflicting medications, and bait-and-switch eating disorder treatment facilities. Not able to help her daughter find a clear path back to health, Sheila second guesses everything about herself, her relationship to her daughter, weight issues within the family, the amount of time she spent working as a professional journalist, and the culture of thinness in which we live. Lisa, in turn, blames her mom and dad for their interest in good food (Sheila was a well known newspaper food critic), and her peers for making her feel bad about herself in middle school.

From a parent's perspective, Hungry is a real eye-opener. It is a revealing portrait of a family that is brought to it's knees by anorexia and bulimia. For several years, Lisa's problems put the family into a state of crisis, effecting every aspect of the family. Once they are in the thick of it, Lisa'a eating disorders are like an untameable beast, and the best they can do is keep loving Lisa while dealing with each new crisis. Although Sheila tries to explain in the book how her and her husband's love of good food might have contributed to Lisa's problem, there is nothing in particular that the Himmels did wrong to cause Lisa's eating disorder. If it could happen to the Himmel's, it could happen to any family.

The internet plays a role in the book. Sheila tries to find helpful information about anorexia and bulimia on the internet. Meanwhile, Lisa visits anorexic websites ("pro-ana" sites) where she learns techniques for how to best induce vomiting.

Towards the mid-point of Lisa's battle with her eating disorders, before she begins to recover, Lisa is diagnosed with depression. Sheila reveals that the dual diagnosis of depression and anorexia was welcome information. Depression ran in the family, on both sides, so the diagnosis was not surprising. In a way, it was a relief, Sheila reveals. Better than say, just a diagnosis of one thing, such as bipolar disorder, she writes.

But, by the time the diagnosis is made, Lisa's brain chemistry had gone completely hayware from the starvation, purging, and lack of oxyen to the brain. She develops panic attacks and at times becomes delusional. Not only is is difficult for her doctors to pin point her psychiatric issues, the anti-depressants simply can not provide the relief they might once have. Lisa finds that the psychiatric medicines she is prescribed only complicate things more.

Lisa's depression might have been treatable in middle school and high school, when the signs began to appear. By the time it's diagnosed, however, anorexia and bulimia had been added to the mix by Lisa, initally as a way to manage her feelings. Unfortunately, once the switch was flipped, it was impossible to go back in time, and treat the depression alone.

As Sheila mentions in the book, insurance companies have been slow to recognize medical issues categorized as mental or behavioral issues, and so families have been on their own, both in terms of getting any initial diagnoses and then paying for treatment. This should change with the federal Mental Health Parity Act which is scheduled to go into effect in January 2010. Perhaps at that time, we will become a society more open to discussing the signs of depression in adolescents, and parents will feel supported when they suspect that their children (or themselves) need help.

Until then, Hungry is must-reading for any parent who is dealing with an eating disorder in their own family, or who knows of another parent going through it. Because of Sheila and Lisa Himmel's courage writing this book, we are offered an opportunity to understand the terrible price anorexia and bulimia exact from individuals and their families. To stay the course while a child or teen is suffering is not easy. It is harder still when the child tries to make sense of their distress by blaming his or her parents. With grace, wit and intelligence, Sheila and Lisa Himmel share their experience, and offer an unparalleled inside look at a tragic illness.