What Really Happens Inside an Anorexia Clinic

"Tell me a bit about what brings you here." The psychiatrist across the table has an interested, if professionally detached, demeanor. Points for this, as I know he spends his days asking the exact same question of a population of women largely similar to me: white. Privileged. Angry.

It's an absurdly simplistic question. He knows it, and I—a therapist myself and now a patient—know it, too. There is no elevator pitch to explain why I've checked myself into this treatment center in the Arizona desert. No single explanation as to why I've opted to be stripped of every coping mechanism I have. Not to mention my books, bobby pins, and flatiron. (On the bright side, they tell me Arizona heat is a dry heat. I might not even need the flatiron.)

I answer as simply as I can: "I'm anorexic." I have accomplished something that no one can take from me: I am Thin. I am Sick. And still, I am not as accomplished as many of the other women around the lodge, these students, professionals, mothers—largely middle or upper-middle class, given the astronomical cost of treatment. (Inpatient treatment can cost upwards of $3,000 per day; we are all here for 45 days minimum.) In and around the lodge, these women spend their hours between individual and group therapy sessions, equine and art therapy, and meals and snacks. I watch them. Crossing the lawn, reading and journaling beneath the sparse palm trees that border the lodge, are women thinner than me.

Frantic, I categorize my competitors. There are the walking-dead women, with feeding tubes snaking from their nostrils and the hunched walk that says they want to disappear. They are Better Than Me. Stronger. There are women with bodies similar to mine: painfully thin but without feeding tubes or wheelchairs. Our worth is equal. And there are women who take up more space than me, who are not disciplined enough to be anorexic. They are Less Than. I recognize bulimia and half-assed anorexia when I see them: bodies that might seem "normal" to others but are actually fat. (I consider myself an excellent judge of reality, of course.)

"Tell me about your family." While the psychiatrist takes notes, I rattle off my personal history. Eldest, perfectionist child of high-achieving parents. Genetic predisposition to anxiety, depression, and addiction. Tortured romantic relationship with a man I love desperately but will never have. It's the perfect storm. Genetics has loaded the gun; environment has pulled the trigger.

"And can you talk a little bit about your symptoms?"

This is my time to shine. I tell him that I have been restricting myself to around 300 calories a day, but that I don't generally go more than a day without eating. (There are women here who could boast up to three days on water and cigarettes alone. I've never been more envious of anything in my life.) I tell him that I purge all regular meals and most restricted meals. And then, ashamed, I mention the occasional binge episode: periods of time in which I eat everything around me, induce vomiting, go out to buy more food, and repeat the cycle. I don't know how long these episodes last or how much I consume. I know only this: For a fleeting moment after I purge, I feel calm. Relaxed. I can best describe it as a brief, sweet release from my life. It's what everyone here is looking for.

"All right." The psychiatrist takes a few more notes, then releases his pen to the notepad. I lean forward, waiting for The Verdict. The confirmation that I am good enough.

"Considering your history and symptoms, I'm diagnosing you with bulimia nervosa."

No. This is a mistake. "Bulimia?" I choke. It's the bad diagnosis, the label that means I am impulsive, weak. I want my old identity back. In less than five seconds, this man has erased me.

"You don't meet the diagnostic criteria for anorexia nervosa, given that you're still menstruating," he explains. Right. I know this. I make a few quick mental calculations: It will probably take only a few more pounds for me to lose my period. I've been fighting to do that anyway, to rid myself of the one final reminder that I am a woman and that I am alive.

He tells me that it is time to choose. That every moment I am making a choice for Recovery—for health—or for my eating disorder. He tells me that there are no other choices. He is right. I can opt for health, for life. Or I can continue to find my identity in my illness, can work for the diagnosis for which I am literally dying. It's the ultimate choice: life or death.

I am still reeling a week later, and not only from the diagnosis. They have taken everything from me here, and I can feel the anger growing. It gets a little thicker every time a staff member stares at me while I pick at my meal. Every time I have to ask a nurse for a tampon (we are allowed only one tampon at a time, supposedly to prevent us from soaking them in water and swallowing them to fake weight gain). Every time I have to ask a staff member to flush the toilet for me, as we are not permitted to flush on our own.

This afternoon, I am on my way to bulimic group therapy. I'll humor them, I tell myself. But I'm not like these people. I'm riding in the back of a golf cart since the hospital bracelet on my wrist is stamped with a T, for transport. Given my low weight, I am not permitted to walk to group on my own.

Bulimic group is held in the kitchen of a small house on the grounds, around a long wooden table. For some of us, the kitchen table is the only place we have ever been able to exert control, and the place we most fear losing it. For others, the kitchen is linked with memories of trauma. For all of us, it is a terrifying place to be.

The other women and I know the second we step through the doors that something is horribly wrong. Our chatter stops the instant the sickeningly sweet smell registers in our psyches: a combination of baking cinnamon rolls, frosting, and melted chocolate. My stomach lurches. I wonder whether I could outrun a golf cart.

"Come on in, ladies." Our dietitian and one of the therapists are standing next to the kitchen counter, which is packed with every snack food imaginable. "Today is our binge-food experiential." Peanut butter, chocolate, cakes, and cookies: The assortment is literally dizzying. I grip the edge of the kitchen table, hard. I can't do this. Next to me, one of the women starts to cry.

Somehow, we all find our way to a seat around the table. Our dietitian explains: We are to take a small amount of our favorite foods typical of a binge. We are meant to taste it, to show ourselves that we are capable of enjoying food, neither avoiding it entirely nor consuming all of it. For many psychologically healthy women, such a task might be enjoyable. The smells might evoke pleasant memories of time with family or friends. Special occasions. But I am instantly transported back to my worst binge/purge episode in recent months.

I am lying in bed next to my best friend, a man I love desperately, but who is in a relationship with another woman. He is holding me; his heartbeat is grounding. It reminds me that I am here, that I am alive. But he needs me to understand that I am not the only woman in his life. Why can't I understand that?

The phone rings. It's her. He lies, hangs up the phone, and asks me to try to understand how painful this is for him. And then he is gone. He has left, confirming what I already know: that I am defective. That there is something fundamentally wrong with me. The rage and shame are too much to bear. I stumble blindly into the kitchen and pour a bowl of cereal. And another. And another. There is ice cream in the freezer. Robotically, I consume it all, stumble back to my bathroom, and throw up. The cycle continues until there is nothing left. Exhausted, I pass out on the cold tile floor of my bathroom. I have reached my end goal. I feel nothing.

"Meg?" The dietitian prompts me. "Will you choose some food, please?"

She's kind, and I want to bean her with one of these pies. She's not just asking me to eat. She's asking me to value myself enough to stay alive.

Stomach clenched, I choose a scoop of ice cream and a bit of cookie dough. I'll choose Recovery tomorrow. Just don't make me do this. I'm a glutton for punishment, I suppose: This is the same food I chose during my binge episode. But my experience of it now could not be more different. I am sitting at a table instead of standing in my kitchen in the dark. I am with others who understand exactly why this is so frightening. And after a week or so of regular meals, I'm thinking more clearly. I'm thinking that maybe I am capable of change. I'm thinking that maybe I don't want my experience with a broken, selfish man to affect my will to live. That maybe I have it in me to move past this. And damn it, I'm thinking that that cookie dough smells really good.

So now you choose. You choose Recovery, or you choose your eating disorder. There is no other choice.

I lift my spoon and take a bite.

"IT'S A GRIEVING PROCESS." My body-image therapist, a beautiful woman with an enviable comfort in her own curvy flesh, is sitting next to me. "When you make the choice for Recovery, you have to grieve the loss of your eating disorder, like losing a close friend."

The shame I feel for my tears makes it impossible to look at her. "I want my old body back." Already there is softness where there was none before, a sway to my hips that betrays my womanness. "This body isn't mine."

"It is," she corrects me gently. "It just takes time to accept it, to relearn it."

I know she's right. We have just finished an exercise in which I have shaped pieces of string into what I believe to be the circumference of my thighs, hips, and waist. I learned that I view myself to be at least 50 pounds heavier than I actually am. How can I begin to accept a new body, a new relationship with myself, when my view of myself is so horribly distorted?

So this is the real work that begins in the hours, days, months, and years after treatment. To grieve the loss of my illness just as I do the loss of my relationship, of what I thought both could do for me. To allow myself to feel anger, sadness, and betrayal. To accept that health means softness and curves, embracing my identity as a woman.

The grieving process is not linear; there are still many days when I long for my old body or am tempted to cope with life's stresses in unhealthy ways. But I am learning. I am learning to celebrate my identity as a writer, a daughter, and a sister, instead of a sick woman. To nurture with gratitude a body that can move and make love and, should I choose, bear a child. I am a Recovering Woman who makes a choice for health every day. Because there is no other choice.