Wasted: a memoir of anorexia and bulimia; Marya Hornbacher; HarperPerennial, New York; 1999 298 pp. $19 (paper) ISBN 06-093093-4
I read Marya Hornbacher's memoir Wasted at the same time as I read two other books about the lives of women: Margaret Negodaeff-Tomsik's Honour Due and Jenny Walton's Packing for a Woman's Journey. Honour Due is the biography of Dr. Leonora Howard King, a Canadian-born physician who spent 47 years practising medicine in Imperial China in the late 19th and early 20th century and who was the first Western woman to be made a mandarin. Jenny Walton is the pseudonym of Nancy Lindemeyer, the editor of Victoria magazine.
These books tell an interesting tale about this century, especially when read together. Leonora Howard King exemplified the devotion and service that Victorian women strove to achieve in their day-to-day lives. Nancy Lindemeyer's gentle account of a hopeful woman's life is full of the optimism typical of the 1950s and '60s. But there is nothing genteel or gentle about Marya (pronounced Mar-ya, we are reminded) Hornbacher's no-holds-barred account of a young woman's struggle with an eating disorder in the 1980s and '90s. As the 20th century ends, the number of Western women who are dissatisfied with a normal body weight is increasing. And here's a paradox: although the number of anorexic women rises, obesity is also becoming more prevalent. For all the progress made by women in the last hundred years, it would appear that we have also regressed to the point where we cannot even nourish ourselves properly.
Although Hornbacher has written this book for the general reader, there is a great deal the physicians can learn from it. While many physicians may believe that they see few cases of eating disorders in their practices, we are reminded many times that these diagnoses are easy to miss. Even those of us who work with people with eating disorders will regularly be fooled by one ruse or another in a patient's efforts to kill herself by starvation. This entire book is a humbling reminder of our collective inadequacy in the face of this disease.
I found this book a vivid rendering of the intrapsychic changes that occur as an unhappy, unhealthy mind heals. Hornbacher's unremitting honesty makes for compelling reading. Her subject is herself and her self-loathing. Nor do her intimates escape her harsh scrutiny: her parents, psychiatrists, mental health workers, friends and lovers are all dissected. In the end, the reader has to credit all these people and Hornbacher herself with tremendous inner strength. Again, a reminder for physicians: more people than the patient have to change before we can expect to find a solution to an eating disorder. Figure 1
This is a book that reads more easily in some places than in others. I struggled with some parts of the text while, elsewhere, I couldn't turn the pages fast enough. By the end of the second chapter, I realized that it was not writting style or awkward phrasing that made some parts difficult. They were difficult because I found the subject matter emotionally draining. I suspect that this will be true to some extent for any reader. For this reason, Wasted could be recommended in particular to mental health workers who would like to learn more about their own "blind spots" in treating patients with eating disorders. This book can also help us all to better understand the phenomenon of counter-transference.
I am writing this review at the Eastern Ontario Swimming Association's Long Course Championships. My 14-year-old daughter is competing, and this provides me with a unique opportunity to observed the attitudes of young men and women toward body size. There are few signs of anorexia among these well-muscled young athletes. Nonetheless, recalling Hornbacher's preoccupation with exercise at one point in her illness, I ask my daughter's coach about eating disorders among swimmers. Her was once a member of the Canadian swim team. He asks me, "Are you still reading that book?" I have been bringing the book to practice for the past week and it has attracted a lot of attention from the team. These adolescents are familiar with eating disorders and are very willing to share their views. As I listen to them, Hornbacher's warming is in my mind. I wonder if there are any afflicted in the group. As I chat with the coach at warm-up, I realize that Wasted had taught me something no textbook had. I have learned to be extremely careful when assessing appetite and ruling out eating disorders. I have learned that, despite this vigilance, I am bound to miss this diagnosis from time to time.
Leonora Howard King's life story is an inspiring tale of courage; Nancy Lindemeyer's is persistently positive. Marya Hornbacher gives us the insight that will enable us to be both courageous and optimistic.
Gail Beck, MD
Dr. Beck is a psychiatrist practising in Ottawa and is chair of the OMA's Committee on Women's Issues.