I never planned on sneaking contraband into a foreign country, especially on a school trip. Yet there I was, sprawled out on the floor of the Haneda Airport as teachers, peers, and random parents glanced over concerningly. Despite having a Duolingo streak for three days, I wasn’t completely fluent in Japanese; however, the sign with the enormous cow head with a red cross through it made it clear that I couldn’t bring meat through Tokyo customs.
When this rule was established, I’m sure the Japan Civil Aviation Bureau didn’t expect a skeletal 5-foot-2 teenage girl to sneak in an entire family’s worth of Slim Jim Savage Sticks into the Land of the Rising Sun.
I didn’t necessarily have a choice, nor did I want to eat my bodyweight in Big Boss Meaty
Treats. But I was stuck to a weight-gain meal plan of 8,000 calories a day, delegated to me by a
team of faceless telehealth professionals and forced upon me by my mother.
My Story
The previous September, my hair started falling out. In October, I was anemic. November, I was osteoporotic, and December, I started to black out. In January, I was diagnosed with anorexia. If I didn’t make a change, I could have died by February.
I wasn’t even supposed to be on this trip in March, but I convinced myself I felt fine, looked fine, and attempted to convince my mom I would be fine away from her.
Both my mom and I are control fanatics: not of other people, but of our circumstances. As a kid, she would obsessively only walk on a specific side of the hallway. I went from compulsively counting the ceramic slabs in our kitchen to counting calories. Not because I initially thought I was ugly: if I couldn’t have control of what was happening in my life externally, I could manipulate my body to feel better internally by creating the best version of myself.
It was addictive, and my pediatrician picked up on it instantly. I wasted time and money with online nutritionists who begged me to eat a piece of bread. I disregarded and destroyed
relationships, prioritizing my “wellness journey” diet over actual healthy human interaction.
Denial was the name of the game, which was due primarily to embarrassment. Yet by destroying my body, I destroyed any sense of autonomy I had.
Getting Help
I was unwillingly enrolled in an eating disorder program. Our options were as slim as my daily dose of beef jerky, and so was our insurance coverage. My family either had to uproot our lives completely, moving to Ann Arbor to attend a daily facility, or I would wave bon voyage and
book it to an inpatient downstate during the middle of junior year.
Through research, we discovered a telehealth-based treatment center specializing in eating disorders called Equip.
Since 2019, Equip has functioned as an evidence-based practice facility that treats across the lifespan, initiated to assist those who needed treatment and couldn’t afford the cost of a typical center. Although I was allowed to live my life by the program’s standards, every second of every day centered around Equip.
I only met with one person out of eight on my mysterious medical Zoom team, my therapist. Despite having constant appointments, meetings, and weigh-ins, I was in the dark about my position in the recovery process.
Melodie Simms, a clinical instructor at Equip, is professionally trained and certified in
Family-Based Treatment, or FBT. Simms has been working in counseling since 2008, following
her experience in the modeling industry and experiencing the lethality of eating disorders.
“When we look at FBT, it’s primarily for ARFID and Anorexia, which usually both require
weight restoration, even if they don’t have a low BMI,” Simms says. She explains that there are
usually three phases of FBT: Eight to 10 weeks is usually phase one, six to 10 weeks is usually
phase two, and phase three is about eight weeks.
In phase one, the accountability partner supports that patient. Or, if it’s a kid, the parents take complete and full control. “We take the responsibility from the patient and give it completely to the adult, until they start reaching that goal weight,” Simms says. “After 90 percent of their target weight is restored, and their return to independence is whatever is developmentally appropriate, like eating lunch at school, [we turn it over to the patient].”
Once a patient is out of the metaphorical woods, phase three about independence, relapse prevention, and coping skills.
“It’s not completely focused on the eating disorder, but on gaining privileges, like going to prom. When they start reaching that weight restoration, oftentimes loved ones will say, ‘the lights went on.’ When we see the lights come on, and their disorder isn’t in control, that is when they truly return to themselves,” Simms says.
Looking for Community
Although I was slowly gaining weight, I was far from myself. I never openly told any of my friends, although they most definitely assumed. Even though I was enrolled in the family-based treatment, it felt like our family was falling apart. My relationship with my mother diverged from mother-daughter to doctor-patient due to the constant surveillance.
After I got back from Japan, I plateaued for five months straight: I would ramp up the calories past sumo-wrestler status and weigh myself multiple times a day, but I was static in my progress. My physical body felt fine, better than it had previously—it was my mind that felt moldy, decomposing day by day due to the isolation and stress.
Nothing felt worthwhile: hobbies I once enjoyed were deteriorating, friendships were falling through the cracks, my personal bubble de-bloated to just me, my mom, and my six meals a day.
I craved a community of others who shared my experience, who knew what I was experiencing. I joined an Equip therapy group session and almost immediately quit. Everyone seemed worse than I was: lighter than a speck of dust, tubes attached to their nostrils, lamenting about their guardians ripping off every door in their house. During these calls, an Equip employee drearily talked through a PowerPoint on coping mechanisms while grumbling about how “your body is a vehicle” for an hour.
There was no discussion, no camaraderie. Nobody was paying attention; everyone was looking at themselves at the bottom of the screen, comparing themselves to the rest of the class. It didn’t feel like a community; it felt like a competition.
Ultimately, I felt like I wasn’t sick enough. I didn’t feel worthy of healing. I didn’t feel worthy of living.
“Groups are what you make of it. The group is also as good as the group facilitator. If the group facilitator doesn’t frame things correctly or manage the group well, it can become toxic and unhelpful,” Simms says. “That goes for both brick and mortar [healthcare centers] and within the virtual setting.
She adds that “I know that virtual group settings can be large, numerically. It can be difficult to connect with people; it defeats the purpose of a group. It can feel more like a lecture. It feels more like you’re being talked at over telehealth, compared to in person, where you’re actually seeing these people, sitting next to them, being around them, connecting with and really getting them.”
The Breaking Point
I reached a breaking point. In May, I was on my hands and knees begging my mother to send me away. I couldn’t cope with my family observing me fall apart firsthand, couldn’t deal with the
blinding limelight highlighting the fact that for every one step forward I took, I plunged eight
floors down. At the time, it felt like the solution was suicide.
My mother understood the severity, but couldn’t do anything about it: we didn’t have the funds for further treatment downstate of any kind.
Simms addresses the cost of inpatient treatment. “Some people may be reimbursing at the inpatient treatment level, around five to eight thousand dollars a day,” she says. “Equip isn’t a billing per service program; it’s significantly cheaper. For example, one hourlong therapy session may cost $175 for the whole hour. If you think about an inpatient program, you’re getting 24-hour supervision, you’re getting 24-hour nursing, three meals, and three snacks. You’re getting programming, groups for six hours a day, and individual twice a week.”
When the school year ended, I was all in on treatment from June through August. My doctors forced me to quit my job, which was my sole source of any social interaction, along with any form of unnecessary movement.
Yet it wasn’t until I rediscovered exercise that I started to reform myself. Going to the gym, roller skating, gardening, dancing around the kitchen table: I yearned to be stronger, to be able, to recognize a future where I was myself again. Something clicked, and I regained the weight.
What Lies Ahead
As I recovered and was discharged from Equip, my mom slowly stepped away from her warden responsibilities. Currently, my future is still shady, with a looming cloud of relapse storming over my head. As much as I want to deny it, my mother and I both know it’s inevitable—the next stages of my life are uncertain, and so are my coping mechanisms. The lights could be switched off at any moment.
We’ve been actively looking for affordable resources in northern Michigan to keep my progress stable. We haven’t had much luck. There’s a severe lack of mental health resources in Traverse City, especially regarding eating disorders. There are mental health and physical therapy clinics, but nothing accessible and affordable for local adolescents balancing the two.
I think of the pre-teens and teens I’ve seen through computer screens, who were tube-fed their nutrition, who weren’t allowed to have in-person care because they lacked the resources. These children are going to live within the cycle of their eating disorder, live in the dark, almost endlessly, because there’s no in-person connection.
Considering Equip discharges when insurance runs out, or after a year in the program, it leaves teenagers with a sense of false expectations and a flickering sense of fatality. What do we do in this circumstance? We try to find hope.
More Resources Needed
I talked to Lisa Carpenter, who is the founder and executive director of the Center of Hope Counseling, a program that specializes in treating eating disorders. The Center of Hope moved to Logan’s Landing in the Traverse Area from Mt. Pleasant two years ago and is currently trying to expand its practice through promoting stabilized recovery on an inpatient basis.
“They say the average length of treatment for someone who struggles with an eating disorder is seven years,” Carpenter says. “There’s a saying we say: we always leave the light on for our clients. We have to eat. I see clients, [for] six months or six years, [and] I’ve been working with my clients off and on. Right now, I’m working with a client I’ve worked with years ago because she’s pregnant now. Her body is changing, and she’s really struggling with that. Different stages in life, there might be things that they may need to reassess and do a little bit of work on.”
Carpenter believes that meeting patients in person whenever possible makes a huge difference in their outcomes.
“If you don’t have the support on an outpatient basis, it’s going to be tough. There’s nothing like that in-person contact: you can see their whole body, their expressions, you can see them for who they are. I just think that ideally working in person, especially with eating disorders, is more effective,” she says. “There’s really no shame for teenagers or anybody struggling with mental health issues, including eating disorders. I’m right here with you.”
Our community in Traverse City needs to prioritize healthcare for its youth. We, as teenagers, are extremely vulnerable to the outcome caused by the absence of mental health resources. That also means that we, as teenagers, need to speak up and advocate for what we lack.
We, as teenagers, need to band together to advance our community. We, as teenagers, are the light, and we will keep it on for the future.