Jack Knight can remember the day singer Karen Carpenter died. It wasn't
a drug overdose or car crash that killed the 1970s music star: it was starvation.
She was anorexic and died because she simply didn't feed herself.
"I was a teenager, and I can remember wondering how and why someone could
starve themselves. It didn't make sense," says Knight, a social worker
who specializes in eating disorders. "I had no idea that I'd get involved
in things like anorexia and bulimia."
Knight has a bachelor's degree in social work. After finishing university,
he had intended to pursue a career in the government. Instead, the first job
he got was as a student counselor for a small school district.
"I realized quite quickly that I really enjoyed working with kids, and
it's really rewarding to help someone who is so young move on to another
step in life. You hate to see them waste their youth."
Now Knight runs his own therapy groups for teens, and is a respected expert
on eating disorders. He has several special groups set up for sufferers of
anorexia, bulimia and compulsive eating, which affect many teens, especially
girls.
"They see all these models on TV and aspire to be a size two. Quite often,
that image combines with an emotional problem, a traumatic event or low self-esteem,
to make girls have bad eating habits," says Knight.
Sometimes the result is starvation, and sometimes the result is eating
to make yourself feel better.
"Food is such an odd symbol in our lives," says nutritionist Jacqui Gingras.
"My mother used to eat comfort food when she was upset, and for most people
that food is high-fat, sweet stuff."
Gingras, who helps many patients with eating disorders balance their eating,
tells the story of one woman who treated food as a kind of painkiller.
"She had had a rough childhood, and was very depressed and moody. When
someone got mad at her or called her names, her first reaction was to eat
and eat and eat," she says.
"At first, the food makes you feel better, but then a lot of guilt and
shame builds in. That can lead to bulimia, and vomiting everything you just
swallowed."
Eventually, through psychotherapy, the girl learned that food wasn't
the way to feel better, and she began believing in herself and managing her
eating. Gingras worked with a medical doctor and a psychologist, as well as
with the girl's family, to help her recover.
"It's a team effort. These people -- and don't forget that there
are men with these problems, too -- need counseling and medical treatment,
along with the nutrition counseling that I do."
Carol Nemeroff was part of just such a team at a clinic in California,
before she became a professor at Arizona State University.
"The clinic was for people who were in bad shape. Some came in at 80 pounds,
and some with bulimia had done so much damage to their digestion that it was
almost impossible for them to eat comfortably."
Nemeroff was chief mental health counselor at the clinic -- usually the
first person that a patient saw for help. The clinic also had dietitians and
nutritionists, family therapy counselors, doctors and dentists.
"I once had a case of a woman in her late 20s who had been bulimic for
so long that the stomach acid she had been upchucking for years had almost
fully rotted her teeth," says Nemeroff.
Both Knight and Nemeroff say that you have to be very patient and understanding
to work in this profession. You've got to be able to deal with some pretty
grim work.
"Patient[s] die, families give up," says Nemeroff. "It can
get very emotional. You have to remember that you're treating a disease
that's very complex. You don't just take a pill for it."
However, Gingras says that the most rewarding part of the job is seeing
a patient for the last time.
"That means they've recovered, and that they realize that they do
deserve to live normal lives. But once you see a client for the last time,
you have to remember that the disease could very easily return. It's
like alcoholism. You're anorexic for life, but you learn to control it."