Harriet Brown talks about Brave Girl Eating

I'm thrilled to have journalist Harriet Brown here. Brave Girl Eating is a fascinating mix of raw personal detail and extraordinary research about how her daughter Katie became anorexic and nearly died. The book turns everything most people think about anorexia on its head. And of course, the writing is wonderful, and the love Brown feels for her girl is palpable. Brown's work has appeared in the New York Times Magazine, O, Glamour, and on NPR. Thank you so much, Harriet for being here!

Brave Girl Eating is an extraordinary—and very different—look at anorexia when it hits home. I was fascinated at how you turned previously held thoughts on their heads, for example, that to “cure” anorexia, patients should be cut off from family and retrained in beliefs about food. Instead family based treatment seems to work. Could you talk a little bit about how a family can help here?

People with eating disorders are in the grip of powerful and terrible compulsions--to not eat, to exercise compulsively, to purge, and so on. The nature of an eating disorder is to be what's known as ego-syntonic, meaning it is perceived by the self to be a positive thing. In other words, you don't see the problem, or at least not until you've been sick quite a while, and even if you see it, it's very very hard to go up against it. What I observed in my daughter was that she needed my husband and me to be bigger and stronger than the anorexia, to stand with her and shield her somewhat from the punishments the disease inflicted on her. Have you ever read "I Never Promised You a Rose Garden"? I thought about that book a lot as we were going through this. We couldn't protect her from all of it, but we could protect her enough to get the food into her to help her recover. For teens and young people especially, parents and families are natural allies in fighting the illness. Older people with eating disorders need this too, but they rarely have that kind of support at hand.

It bothers me that so many people feel that anorexia is a choice. In fact, a lot of self-help (and this is not to denigrate it. I happen to like self help books) stress that choice aspect. While we can choose what we do about an illness or a situation, we don’t really choose the illness or the situation, do we?

No one chooses anorexia. When someone's deep in the grip of it, that ego-syntonic characteristic may be expressed--they'll say they're fine, no problem, they're not sick, you have the problem and not them, and so on. But this does not mean they have chosen to be ill. Nor does it mean they can "choose" (in any kind of simple or straightforward way) not to be ill. I think this is the most fundamental misconceptions we have of eating disorders, and I'm hoping to help set the record straight.

What I found fascinating was your desire that this not be “thinspiration” for anorexics, and that you not exploit your daughter, but you still stay open. How does one approach such a challenge in writing a book like this?

This book was so challenging on so many levels. Like all memoirists, I tried to cleave to the truth as I saw it while avoiding gratuitously hurting anyone else. I had my daughter's future in mind as I wrote as well as her past, all our pasts. The only measure of my success may be when the book doesn't become a hit with the pro-ana community. :)

Did Kitty know you were writing this book? Has she read it and if so, what did and does she think?

Kitty knew I was writing it. We discussed it many times. She gave her permission for me to write it and publish it, though it wouldn't have been her first choice for me to do this. She is a private person, which is why I don't use her name or any photos and why I've disguised certain elements in the book. People who know us obviously know it's about her. But I didn't want the world to be able to put her together with the book. She doesn't want to read it right now, though I'm guessing she will someday.

Do you think part of the problem with the medical community dealing with anorexia is that there is no real control of this disorder? You yourself use the metaphor of a demon taking over Kitty to explore anorexia, and you also mention those ads that caused a controversy, where were ransom notes from various diseases. (We have your daughter hostage.)

Not sure what you mean by control of this disorder. I do think part of the issue has been that treatments for anorexia are by and large pretty ineffective, in large part because of the fundamental misunderstandings we have about it. Much of the therapeutic community still seems invested in the notion that you have to "work out your issues" before you can recover, and that "it's not about the food." Well, it certainly is about the food when you're starving. And you can't work out any issues when you're malnourished.

What was the most terrifying thing about being in this situation? What’s the key pieces of advice you’d give to parents?

The most terrifying part of being in this situation was when my husband and I felt helpless--before we started doing family-based treatment. And I'd add to that the first few times the demon made an appearance-they were very scary moments. But I'd much rather be in it up to my elbows, engaged in a process of helping my daughter, than watching her dwindle and die by degrees. *that* was terrible.

What was it like working on a book when you weren’t sure of the ending? What are you working on now?

Working on a book when you don't know the ending keeps you very grounded in the present and in the narrative. It keeps the emphasis on process rather than product--an excellent reminder to me. :) Right now I'm finishing up a story for O magazine on forgiveness, a subject I'm deeply interested in.