Misery loves company

Jul 31, 2002 at 12:00 am
No human condition — not race, religion, gender, ethnicity or disease state — compares to obesity in prevalence and prejudice, mortality and morbidity, sickness and stigma.
— from the Web site of the American Obesity Association

Drop whatever your eating immediately. There is a no eat policy on this Web site. If you continue to eat (you fat pig) then this site will close. You are such a fat fuck for eating you know that? I can't believe you . . . and you call yourself anorexic. . . . I bet when you sit down in the bathtub, your ass hangs over the sides. FAT FUCK.
— message to visitors on a "pro-ana" site

Eudora's singsongy chime calls me to the computer. These are e-mails I've been expecting — from some members-only anorexia mailing lists I'd inquired about joining. The postings sound like business as usual: "How ya doin'?" chatter; pleas for fasting tips and URLs for related sites; references to "ana solidarity." Then I see a link to a community chat room on a national online service. Other than myself, the participants appear to be teenagers, their screen names pseudonyms.

JJett: Does anyone take Xenadrine? I am, 500 mg.

80orBust: I did, JJett. I think Metabolite works better.

[Me]: No. I don't want to risk cardiac arrest.

80orBust: Nobody is going to die of a heart attack.

[Me]: False. Even pro-ana sites say you can die of cardiac arrest. People have died on diet pills at normal doses.

JJett: Honestly, a true ana knows how to configure things so that they don't die.

AnaLuv: Can't take too many in one day.

80orBust: My friend went from 196 to 106 in 5 months. She starved and took diet pills.

FaerieAna: Can I not eat, but take, like, two, three pills a day? Where do you get it?

[People mention a number of national health-product and discount chain stores.]

[Me]: The label says it's not recommended for under 18. Aren't you supposed to be 18???

ThinIsIn: They asked if I was 18 (I'm 16), I said yes, and they let me buy it.

FaerieAna: I'm 15 . . . So I can get it at . . . ?

Welcome to the world of "ana": Communities of teenagers, women, and men who believe carefully managed starvation is a lifestyle choice, not a disease. And who act on and talk about that choice, in voices ranging from militant pride to resigned despair, on here-today, gone-tomorrow sites across the Web.

Much of America was introduced to this phenomenon last summer, in a series of alarming and frequently alarmist national media reports. ABC News assailed the sites, describing them as "an unhealthy lure for those who suffer from eating disorders." Lurid, often frightening cautionary tales — some featuring still photos of emaciated, literally skeletal women — appeared on local and network TV reports and in stories in print and online publications ranging from Time to Salon to the Baptist-themed news site EthicsDaily.com. Well-meaning (and, often, just plain mean) Net surfers, outraged or worried by the news, visited sites — not to learn about the inhabitants, but to leave preachy, scolding, or insulting posts on ana-themed message boards and in chat rooms. Some still do.

Health professionals and organizations devoted to eating disorders went on the attack, urging Internet portals such as Yahoo! and the Microsoft Network to remove "pro-ana" sites from their servers on the grounds that their very existence put vulnerable people at serious risk. Dozens of sites were suddenly offline and out of business.

"They took down lots and lots of sites, and they were more than responsible to do so," says Christopher Athas, vice president of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). "We talked to them, yes. We were diligent in our mission to protect children. But it was their decision to adhere to their terms of service."

Internet companies won't speak directly to the pro-ana controversy, except to say that any shutdowns are done in accordance with their member agreements, which lay out guidelines for handling complaints about a site and the circumstances under which it may be terminated. Whether due to external pressure or internal procedures, however, the fact remains that many pro-ana sites disappeared quickly following the media outcry.

No doubt with the best of intentions. But you know what they say about good intentions. Now, justifiably concerned parents have one more thing to fear (as if their kids weren't starving themselves pre-Internet). Meanwhile, teenagers, feeling besieged, step up their efforts to hide food obsessions from the very people who should know what they are eating, and pro-ana Web communities go further underground to find new homes with new names and ever-larger rosters of "friends."

Why wouldn't they? They know that their obsessions largely mirror society's often contradictory relationships with food and weight. They see "fat and proud" activists applauded even as the medical community warns of the dangers of obesity and estimates that three in five Americans are overweight. They see the lithe TV and movie stars society adores, and the $40 billion-plus Americans spend each year trying to emulate them via weight-loss programs, low-fat foods, diet pills and potions, workout fashions, and gym memberships.

The only new wrinkle of the pro-ana phenomenon is the technology. Women, alone and in groups, have been starving themselves throughout the ages — for vanity, social or sexual favor, self-validation, even self-punishment. So if a twentysomething woman says publicly that she wants to be thin so badly that she chooses to risk illness and death, why can't society see this for what it is: a potentially dangerous but chillingly logical extension of the extreme weight-loss methods we often use ourselves, the creators and successful practitioners of which we richly reward?

The people I met on these sites are fully aware of the dangers. This comes from my e-mail in box:

newana: I read today that the average American model [stands] 5'11'' and [weighs] 117 lbs. What do you think of that? Nice size? Nice goal? If I got down to 110, would I be able to stop myself? At what point would people here urge me to stop losing? You would, wouldn't you? I mean, let me know if I ever got too thin?

mumstheword: There are a couple of us (not sure if it's this group or another one?) that want to make some sort of contract saying we can't get below a certain BMI [body mass index, the ratio of body fat to height and weight; normal range is between 18.5 and 24.9]. I mean it's great of groups to help us to be thin, but the other point is to make sure we don't go too far with things. I would hate to lose anyone from any of my groups to a heart attack or any other ana/mia [as in bulimia] related deaths. But what would that BMI be? It's hard to judge, ya know?

peaches: I would say, "I think you are getting too thin. That is just my opinion. Get a reality check. Your weight is below what is recommended for a person 10 inches shorter"

angel: On some lists like this, if you dare tell someone that they are too thin, people will accuse you of being "anti-ana." It's hard to know what to say when someone really thin asks for an honest opinion on how they look or what's too low. Are you honest with them, or do you honor their desire to be as thin as possible (even if it means they will drop dead from organ failure before long)?

wannabethin: That's tricky to do. That needs to be a personal decision really on how low is too low, and a lot of people develop eating disorders as a result of depression and/or obsession. If I weren't obsessing about food and weight loss, it would be something else. I don't know what I would do with myself if I got to a point where I told myself I couldn't lose anymore. I guess that's the plus side to weighing 161. I have room to lose.

In my four months traveling through pro-ana cyberspace, I found an incredibly diverse group of humans worth listening to: people of varying colors, religions, genders, sexual orientations, ages, and body weights who come together for camaraderie, fun, and support. This world almost sounds like one worth joining, and the relationships forged are no doubt beneficial on many levels.

A tall brick wall stands between this world and ours, and behind it the pro-anas really aren't interested in what we have to say — especially when so much of it is the public-health equivalent of "you're either with us or you're with the terrorists." There is no denying, though, that this largely hidden up-with-thin-people ministry — and for some, it does seem to take on religious proportions — promotes obsessions and behaviors that can and do lead to serious injury and death. Don't forget the 15-year-old girl anticipating her next trip to the drug store. But despite the risks, despite society's disapproval, pro-ana people are raising their fists together to declare, "We're anorexic and proud."

Truth in advertising: Chaos is the name she uses. She is 24, and she operates one of the most content-rich, populated, and active online pro-ana communities I have seen. The site is a time-intensive job, and it is but one of her many activities. She works full-time at a business-services shop, starts her sophomore year in college next month (once pre-law, now she's pre-med, and she pays her own way), and has just taken a part-time waitress gig. The rest of her time is about getting thinner.

"I never tell my weight," she says during one of our long phone chats. "It's not about weight anyway." Chaos is one of many of those who, caught between anorexic and bulimic behaviors, do not reach the low-weight requirement — 85 percent of minimum normal weight — set in the definition of anorexia in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Chaos has accomplished much while enduring much. Finances are a major issue right now, which is why she is crashing at her mom's Arizona home for the summer. (She lived in New York until a recent, sudden hospital stay cost her a live-in job; her college is in Georgia.) Her relationship with her parents is strained at best; even if they were willing to offer a financial hand, she says she wouldn't give them the satisfaction of taking it. She is behind the wheel, returning to her mother's from an impromptu road trip to Malibu, Calif., and I imagine her giving the car a little extra gas as she says this. It has been quite a trip — she wrecked her car along the way and is using a loaner.

Sick as a child, she spent a lot of time in and out of hospitals. Along the way, her parents' tumultuous marriage collapsed. She says she experienced abuse at the hands of a relative. Her family turned away from her, not the other way around, she insists: "They'd had enough of me and hospitals from when I was a kid. They'd done their bit."

A few days later Chaos phones with a sly, shy boast: She's just lost 17 and a half pounds in 12 days thanks to a diet of laxatives and gummi bears. "Achievement" aside, she is tense; having to go through the red tape of replacing a totaled car is a pain. And she has plenty of that already.

"My bones just ache today," she says. "My stomach is cramping, my spleen is sore, and I can feel my kidneys burning. Every inch of me hurts."

"God, how often do you feel like this?" I ask, as sense memory brings back searing stomach pains of yore.

"All the time. Whatever."

So she keeps going. Counting the number of calories she has burned off along the way.

Last year's flurry of media attention piqued my interest in the world of ana for several reasons, not least of them my own brush with eating-disorder behavior years ago. I set about looking for a way in.

Because of the crackdown on pro-ana sites, someone interested in finding them has to do a little digging. Some search engines offer very little; others are veritable troves of URLs. Many, perhaps most, turn out to be bum links for Web sites and e-mail groups purged from MSN, Yahoo!, and Geocities. But others do go somewhere. And each URL one finds leads to more.

Sometimes getting the address is not enough. Given the vast mistrust of outsiders in this world, many sites are protected by passwords, shared among members of pro-ana mailing lists. Some sites and lists ask would-be members to explain why they want to join. The requirements varied: In some situations, I needed to share my entire story; in others, "I have food issues, may I come in, please?" sufficed. I was never turned down. Often, though, simply finding an extant URL would take me directly to the action.

On one of those direct hits, I find a splash page featuring a grotesquely distorted photograph of a chocolate-chip cookie. I bite.

Bright red letters issue a warning: "Yeah this is an Anorexic Website. . . . If you don't like my content then leave. If this is what you were looking for or you are anorexic, then you are welcome. What I disallow: People coming in here and saying I am fucked up, well so what. I am proud to be fucked up. My whole life is fucked up and Ana is my only good thing in it!"

According to a 1999 study of people with eating disorders conducted by ANAD and Glamour magazine, 86 percent of those surveyed reported onset of illness by age 20, and 10 percent of them fell prey before they'd turned 10. So it is no surprise that the master of this site is a feisty 14-year-old girl. A page deeper, the flash of an ad catches the eye. "Anorexia is phat! Fuck food and buy a T-shirt!!" Horrible taste, but I can't help chuckling.

Though many of the sites reflect the uniqueness of their owners, most, like this one, hew to a basic format. They feature "triggering" photographs, snapshots of ultrathin celebrities and other grisly count-the-ribs photos that can cause intense feelings of self-loathing and determination and kick a vulnerable person's urge to get thin by any means necessary — or even to fade into oblivion — into overdrive. A painfully personal diary is often on display, usually a blog in which the Web master muses on his or (usually) her day-to-day trials and tribulations. Many site owners provide how-tos on fasting, self-induced vomiting, cutting and counting calories (complete with lists of "safe" and "bad" foods), using diet pills and supplements, and hiding one's disorder from family and friends. A lot of sites also present blunt facts, often prepared by pro-recovery organizations, acknowledging the widely accepted dangers of anorexia, bulimia, compulsive or binge eating, and self-mutilation. (Many young eating-disorder sufferers cut themselves with razor blades.) Members and visitors converse with others, join group fasts and calorie-cutting competitions, and share their own "thinspirational" tips, tricks, poems, triggers, rants, and confessions via message forums.

Visiting these communities, I was able to talk with or just listen to these girls and women (and quite a few men too) and get a sense of who they are, what makes them tick, and why they insist that having these sites is better than starving and puking and cutting themselves alone and in silence. I also realized that there may be something to that "unhealthy lure" business.

I stand 6 feet tall and have a large frame. Normal weight for me, according to the latest charts, is roughly 140 to 177 pounds. As a child, I was generally underweight to normal. At college, where dining-hall food and delivery pizza started adding pounds to my formerly slender self, I panicked. A très-thin sorority sister shared a hint that worked for her: lots of laxatives. She would go through an entire box in a single day sometimes. This purging worked for me too, for a short while. When I learned the hard way that abusing laxatives was a one-way trip to searing abdominal pain, I backed off.

That is, until I moved to New York City a few years later. I was in my early 20s, recently widowed, all alone, working a day job while trying my hand at every artistic opportunity that came along. One day, a pal dragged me along for a gig as a dresser for a fashion-design and apparel company that staged runway shows. One of the models' agents suggested that my poise, looks, and height might go over well in modeling. But first, she said, "you will have to lose some serious weight."

On that day I had weighed in at 138, two pounds underweight for my height and build. "How much should I shoot for?" I asked.

The agent — middle-aged, elegant, and impossibly thin — coolly gave me a once-over and handed me her card, along with what I heard as a challenge: "One hundred twenty-five. Give me a call if you get there."

After three weeks of starvation, running, and laxatives, I was down to 122 pounds. For the first time ever, I saw myself as beautiful and delicate — exquisitely so. I felt joy, and relief — from my recent troubles, and from an ugly-duckling past.

Afterward, out shopping, the sense the good lord gave me suddenly rushed back. Looking into a full-length, three-sided department-store mirror, I realized the young woman staring back at me was not exquisite; she looked underfed, even bony. Her gaunt face did not look proud or even like my own, save for my eyes. The reflection was a frail, sunken-cheeked wake-up call: Yes, I wanted to be thin, but I really wanted to be healthy. And I sure as hell didn't want to be dead.

I have never thought of myself as being anorexic or bulimic, but that does not mean I don't have food issues. When stress overwhelms and self-esteem falls, I have been known to forget to eat, sometimes for a couple of days at a time, only to realize the error after I've nearly fainted and my spouse freaks. Like many who don't suffer from a diagnosed eating disorder, I have taken the occasional brief fast in anticipation of a certain major event or clingy outfit. I do not use laxatives anymore, period, though I do have an odd habit of purchasing boxes of them in times of trouble. A never-opened box, bought just last week, sits in my medicine cabinet right now.

Are people finding real help through these sites? Or are they being recruited into the anorexic lifestyle, as some in the anti-ana/pro-recovery camp charge? There are site owners who post comments such as this one: "Hey, join the ana trend by wearing your red! Wear a red bracelet to show your ana pride and connect with anas all over the world!" But there is useful stuff too. The larger, more polished sites often include links to pro-recovery sites and suicide-prevention contact numbers.

"I am not trying to encourage new people to become anorexic," one Web master explains on her site. "Believe me, I don't want that. Anorexia and bulimia do not need my help to grow in number, and I will not give them my help. At no time do I ever say that an eating disorder is a good thing, or a glamorous thing, or even something to be desired. It's not. But neither will I deny persons who need it, a place to come together."

Another site regular offers this advice: "If you are [only] worried about your weight or want to look good in a swimsuit this summer, ana is not for you. I suggest a healthy diet filled with fruits and veggies and moderate exercise including strength training."

For most, "ana" is shorthand for anorexic people, or the lifestyle itself. It means, says one e-mailer, "being in control, having this everlasting desire to be perfect, and doing everything in my power to achieve it." Many of the teen girls sign off their posts with sentiments such as "ana love" and "ana pride." Another set characterizes Ana — uppercase — as a person or mystical authority figure who symbolizes the disease. ("Mia" is her equally bossy sister.) The opening line of the "Ana Creed," which can be found on many pro-ana sites, says it all: "I believe in Control, the only force mighty enough to bring order to the chaos that is my world."

On a pro-recovery site, one struggling woman describes her ana experience via a letter she wrote to "my Anorexia":

You rope people in with your promises. "You will be thin." . . . "You will be in control." "You will be loved." . . . You roped me in and dangled my dreams in front of my face. And when I reached for them, when I reached my "goal," you yanked them away. . . . "Another five pounds . . ." "100 more sit-ups . . ." And now. . . . You are all I think about. You are all I dream about. You are my only friend, my biggest enemy. I worship you, and you destroy me . . .

Given the secretive nature of eating disorders and the fact that many sufferers are isolated, their relationships with Ana and/or Mia are all too often the only connections they have with a "person" who truly knows them. Ana is the only one they can trust — especially when confronted with other life challenges.

"Racism, poverty, homophobia, or the stress of acculturation from immigration--those are the disorders. Anorexia, bulimia, and compulsive eating are very orderly . . . responses to those disorders," feminist sociologist Becky Thompson, author of A Hunger so Wide and so Deep: A Multiracial View of Women's Eating Problems, says in an interview with AdiosBarbie.com, a site that promotes appreciation for the panoply of human body types. "[I shift] the focus away from the notion of eating problems as pathology, and instead [label] forms of discrimination as pathological. I even thought for a while that I should say 'eating issues.' But I ended up using the term ['problem'] because eating problems do become problems for women."

But labeling these issues as "problems" rather than "disorders" — and treating them as such — does not mean they are swept under pro-ana rugs.

"This is proof that there are consequences," an 18-year-old new wife and expectant mother cautions her pro-ana "sisters" via e-mail. "For four years of my life I had a severe eating disorder; I got down to 72 pounds at one point and I have been hospitalized several times. I knew the risks, but they were never real to me. Now I am paying and this baby of ours is paying also. So think about that before you [refuse] treatment.

"Consequences happen, and I wish I would have noticed that before. But I didn't. And even now with a baby inside me, I struggle with eating three healthy meals a day and with not over-exercising. No more four hours a day exercising. In a way, this pregnancy has helped me to understand what exactly I was not only doing to myself, and loved ones, but to this baby who isn't even born yet. So please think about this before you fall into it all too deep, and if you are in too deep, get out now."

Nor are the conversations on these sites all about eating, fasting, purging, and hiding. Participants talk music and girlfriends and school and careers and husbands and life. Sometimes, they even talk about recovery.

"I am 29 years old and was ana in my previous years," one member writes. "After having a baby at 24 and not getting the weight off, I have resorted back to my old ways — my son is five and I still have this weight that makes me sick. I am 5'1" and at my lowest was 104 pounds, oh, the days. I am now at 136 pounds, but have lost 13 pounds in the last month.

"I know how each of you feel, but just remember not to go overboard," she warns her younger friends. "I never wanted to be sickeningly thin, but I was happy to have my hip bones show just a tad. It is all about control and you just have to take it off some, then stop, then start again. I try to keep healthy. Now I will go for a couple of weeks again and lose some more. I just hope you all are careful and enjoy life while losing."

Cool, I think. The more the girls hear the "Don't overdo it" message, the better. But the cautionary pose is one taken carefully within the pro-ana Web. Most of its habitués avoid recovery sites.

"They get so damn preachy and talk to us like children," writes a longtime ana in her early 30s. "The younger [anas] will at least listen when I tell them to slow down, because they trust me. Some get stubborn, though, and if you keep at them, they'll call you a 'hater' or 'anti-ana.' Anything to shut you up. But I've been there, so I understand it."

In four months I did not encounter one person who wanted to be called "anti-recovery." I have seen a few conversations in which someone is taken to task for announcing her imminent departure for more medically approved pastures — generally the anger comes from teenage girls who moan about being "abandoned" — but the pro-ana people I met say they generally are happy for friends who find recovery.

And being in recovery and visiting a pro-ana site are not mutually exclusive acts. Many members of e-mail lists I was on are in treatment; they remain on the lists and sites to keep in touch with their friends. Others take a break while in treatment programs but come flying back after they have been released. "I want to get back to 70 lbs. to remember how good it feels, then maybe I can move on," one prodigal sister writes upon her homecoming. "But not yet. I can't let go of ana yet, it's too hard."

Surfing by a pro-ana message board, I find a posting that sums up what is, I believe, a growing position within the pro-ana world:

I am more pro-choice than pro-ana, but to be honest, I think pro-choice sums most of us up better. I think the media tag us with the wrong label, I believe that pro-ana is actually pro-choice. . . . [E]veryone here sees recovery as a beautiful thing, [something] that would be great to achieve. What we realize, however, [unlike] all the doctors and the outside world, is that recovery is something that cannot be forced. You are only able to recover when you are ready.

A new e-mail awaits; a link takes me to an all-black page. This can not be good. A girl whose name and bubbly spirit I recognize from my online travels is pictured. The photo shows a jubilant, painfully thin young woman kicking up her heels in a clothing boutique with a friend. "This picture was taken in February, I think, and I was about 90 pounds. Now I [weigh] 69, and I am 5'4". Please don't hate me for my stupid picture!"

She's dead, of course. The day before. Weighed 58 pounds when she died, two days after her wedding. I click a link to send e-mail condolences to her family. It occurs to me that in the face of death, it is amazing to see the outpouring of love and support in e-mails and on many sites. I recall a list member's recent cry for help — the deluge of "suicide is never the answer!" pleas that followed was awe-inspiring, and the girl's eventual grateful promise to hang in there was blessed relief. If there is any beauty in the pro-ana web, it is in these friendships and in this support, I think. Then I turn to see the dead girl's photo again and can't help but cry.

The phone rings; it's Chaos. She tells me an M.D. friend — also ana — has a theory about the car wreck. "She told me, 'You blacked out. You know why.'"

I had suspected the same. "Do you?"

"Of course I do," she says. "No one's more aware that I'm sick than I am."

Chaos says she is seeking help now: "I went through intake at Remuda Ranch, which is supposed to be one of the best residential treatment centers around. They told me I needed intensive inpatient treatment right away."

Remuda Ranch, a private, Christian-based treatment facility near Phoenix, Ariz., offers an intensive continuum of medical, nutritional, and psychological care and claims the highest success rate in the nation for treating anorexia and bulimia. The center's nonprofit wing, the Remuda Foundation, works to educate the public on food issues and raises money for "tithes," biblically motivated partial scholarships given to those who can't afford full freight. Via e-mail, an admissions counselor told Chaos she needed immediate help — and quoted a cost of $62,775 for the minimum 45-day stay. Insurance, Remuda estimated, would cover $13,248; if the insurer refused to pay, Remuda would not hold Chaos responsible for that amount, and it also offered her a discount. That left a bottom line of $20,000, payable by certified check at time of arrival. Chaos says she doesn't have that kind of money, and has no way to get it.

An angry e-mail exchange with Remuda followed, but now the ever-controlled Chaos sounds philosophical. "I'm too poor to deserve recovery. It is what it is. My priority is school anyway."

Such stories are the flip side of the chats and postings about recovery. One day I find one of the e-mail lists abuzz over a pair of articles discovered in online archives, a March 2002 piece from Australia's Sydney Morning Herald and another from the December 1999 Glamour, that explored the obstacles many face in finding treatment: expensive facilities, insurance policies that don't cover needed therapies.

"The articles confirm my belief that hospitals intending to 'help' people with eating disorders often don't," one member comments. "Insurance companies don't even seem to acknowledge [eating disorders] as serious (perhaps because they are so prevalent)."

This seeming indifference helps explain the allure of an apparently caring community of like-minded people offering friendship and advice rather than rejection and scorn. But Dr. Steven Crawford of the acclaimed Center for Eating Disorders at St. Joseph Medical Center in Towson maintains the ana sites are far from conducive to getting well.

"You [should not] teach your illness to other people," he says. "These sites contribute to the progression of illness for people having trouble making healthy choices. It's very difficult to recover and easier to stay sick. It takes a lot of energy and hard work to get well. Ultimately, it's up to the person to make that choice."

"The tragedy is that people with these Web sites believe they are sincere," ANAD's Athas says. "But understand: Most of the people on the sites are teenagers, girls. They are learning dangerous things and ruining their bodies and their futures. Fifty percent of people with eating disorders never recover. Never. Anorexia and bulimia are not a young person's diseases."

"It is trendy, especially on the Internet, to angrily proclaim your disorders. . . . Why is suffering the cool thing? If these girls are true sufferers of whatever disorder, why do they make arty, pseudo-deep statements about it, give it cute little names, and hide the fact that it's all dizziness and rotting teeth and sneakiness and hopelessness and such?"

"Exactly. Too often you can be measured by how much pain you can stand and how close to the edge you can live, rather than [by] being content and making it through to a happier place."

"Some of us don't make arty, pseudo-deep statements about it' or give it cute little names.' Then again, I'm not anorexic. I'm just a freak [who has had] some nonspecific [eating disorder] for as long as I can remember. I don't love it, but it's pretty much a part of me. I don't glorify it. But it's there."

"I don't want to be ordinary. . . . Also, have you ever heard of passive aggression? It's emotional civil disobedience and I find it terribly fulfilling. (You make a good point though.)"

"I've often been a victim of my own passive aggression without even realizing it. Then I said, enough! I don't need to act out to be fulfilled. I understand where you come from, however."
— exchange from an eating-disorder "bridge" site

"Bridge" sites is what I've come to call them, online places such as the blog Anorexia Debate that aim to bring the pro-ana and pro-recovery sides together and get them talking, to increase understanding and respect. Sometimes the debate gets contentious ("There are two choices. Either you stop or you die. And either way, you stop. [S]o, bye," writes one departing pro-recovery poster.) At other times, the conversation becomes weighty, as people occupying varying points along the pro-ana/pro-recovery spectrum take on issues such as the Web-site closings, free speech and censorship, and the dangers of obesity. Sometimes the discussions achieve a rapprochement that builds friendships and furthers understanding, and can even lead people to recovery.

Perhaps, if the neutral-site trend grows, even more can be accomplished. A climate of agree-to-disagree respect could attract new voices to the effort to push for a place for anorexia and its sisters in the federal Mental Health Parity Bill. The legislation, which has already won passage in the U.S. Senate, would ensure that mental-health care receives the same insurance coverage as physical care. As things stand, insurance companies limit care for mental-health conditions (including treatments for eating disorders) through lower doctor-visit and hospital-stay limits, higher co-payments and deductibles, and lower annual and lifetime spending caps. Sources in the health-care field tell me they believe the bill will likely pass the House of Representatives late this summer — but that at this point the final version is not expected to include eating disorders.

Breaking down, or at least softening, the us/them barriers could also promote discussion of another topic Anorexia Debate participants dance around but no one, it seems, wants to talk about out loud: the prevalence of teenage girls on pro-ana sites. Can the anorexia underworld accommodate the civil-liberties rights of adults who choose to live a pro-ana life and respect others' rights to parent their teenage children by establishing a mandatory 18-and-older admittance policy (perhaps employing rules like those governing pornography sites)? Should it? I'm don't know. But this is about life-or-death matters. The "bridge" sites ask, Isn't it best for all involved to talk about these things in a climate of respect?

Chaos' plan is to pack up her new car in August, flee Phoenix, and head to Georgia and college. Today, however, it's late, and she's tired, sore, and miserable. "My Web site will explain," she says. Suddenly, I want very much to know something: What does she hope to be doing 20 years from now?

"I want to be a doctor."

What does she think she'll be doing?

"I'll be dead. Probably in two years, really."

"That's bullshit. It doesn't have to be that way."

"Natalie," she says, and it sounds like she's comforting me, "it is what it is."

Perhaps. I pray that Chaos doesn't let herself die, that she gets treatment instead and goes on to be a healthy, happy, terrific doctor and to make the most of her many gifts. I hope she learns to love herself. I want her to stick around for a long time, so we can continue our conversations.

But her Web-site message speaks for itself.

all i want to be is:
cared for
not for my website
not for being chaos
but for being ME goddamnit
. . .
now go ahead
go back to your life
and pretend you didn't even notice
like you always do

If You Choose Life . . .

All the health-care professionals contacted for this story give the same advice to pro-ana-site regulars: Give a pro-recovery site a try. The sites, which are popping up to counteract pro-disorder sites in a positive way, offer medical facts, treatment information, and communities that provide support and friendship.

ANAD: www.anad.org

Adios Barbie: www.adiosbarbie.com

Anorexia Debate: www.livejournal.com/users/ana_debate

Bodycage: www.bodycage.com

Empowered Parents: www.empoweredparents.com

Empowered Kidz: www.empoweredkidz.com

Makayla's Healing Place: www.makaylashealingplace.com

Renfrew Center Foundation: www.renfrew.org. (800) RENFREW

Something Fishy: www.something-fishy.org

The Ana Creed

The "Ana Creed" is a staple of pro-ana Web sites (along with "A Letter From Ana").

"I Believe in Hell, Because Sometimes I Think That I'm Living in It"

I believe in Control, the only force mighty enough to bring order to the chaos that is my world.

I believe that I am the most vile, worthless, and useless person ever to have existed on this planet, and that I am totally unworthy of anyone's time and attention.

I believe that other people who tell me differently must be idiots. If they could see how I really am, then they would hate me almost as much as I do.

I believe in oughts, musts, and shoulds as unbreakable laws to determine my daily behavior.

I believe in perfection and strive to attain it.

I believe in salvation through trying just a bit harder than I did yesterday.

I believe in calorie counters as the inspired word of god, and memorize them accordingly.

I believe in bathroom scales as an indicator of my daily successes and failures.

I believe in hell, because I sometimes think that I'm living in it.

I believe in a wholly black-and-white world, the losing of weight, recrimination for sins, the abnegation of the body, and a life ever fasting.

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