Choosing between faith and health isn't kosher.
Meanwhile, for all the attempts to neatly define environmental causes, a 2007 study suggests that eating disorders might have biological roots, similar to how bipolar disorder and schizophrenia are believed to have biological causes.
Hilary says that even though recovering from an eating disorder as an observant Jewish woman presented its own unique challenges, treatment in a group setting at Renfrew made her realize she wasn’t alone.
“People come in of all different races, ages, backgrounds, ethnicities and cultures, with all kinds of different eating issues,” she says. “At the end of the day, they’re all there because this very basic thing about themselves is exactly the same.”
From the outside, Renfrew looks a lot like a yoga retreat. A long driveway winds down to a sprawling campus surrounded by woods. Inside the lobby on a recent weekday afternoon, a young girl and her mother sit together on the couch waiting to be greeted by an intake counselor. Like drug rehabs, Renfrew operates on a “continuum of care” model that determines treatment based on symptoms and insurance plan—though getting insurance to pay for residential therapy can be a fight. (To stop insurers from thwarting progress by dropping patients when they hit a weight near normal, state Sen. Daylin Leach proposed S.B. 1138 last November.)
Spending time with other women suffering with similar problems put her eating disorder into perspective.
“I think that first day at Renfrew you look around and see who you are and realize how pathetic life has become,” Hilary says. “You can’t eat anymore, you can’t care for yourself anymore, you don’t how know to recognize hunger signals, you can’t recognize signals for fullness and you don’t know why you can’t do these things.”
In a therapy room behind the foyer, a counselor is leading a psychodrama therapy session. About 20 girls sit in a huge semi-circle. Only about half are visibly sick. In these sessions, patients take turns acting out scenarios with people in their lives.
Today, a girl is having a hypothetical conversation with her mother, played by another patient. Other patients play the role of her father and other significant characters. The counselor chooses a patient to personify the eating disorder. The girl picked to play the part of the E.D. draws her knees up to her chin and hunches forward on the edge of her chair like a vulture.
“What is the eating disorder telling you?” the therapist asks. The patient, skeletal with a pained, pretty face anchored by brown half-moons beneath her eyes, stares at the girl playing the eating disorder. Ten seconds pass, no one speaks. “I want you alone,” she says finally. “I want you dead.”
The good news is that there are fewer obstacles to Jewish women seeking treatment for eating disorders than ever before. Renfrew recently established the first program that specifically caters to Jewish women. Fresh kosher food is served; a rabbi is on hand to perform the appropriate rituals and talk with patients; and staff is trained in Jewish holidays, practices and customs.
When CEO Sam Menaged, a “recovering lawyer” whose client roster once included Teddy Pendergrass, opened shop in Philadelphia facility in 1985, eating disorders usually landed sufferers in either the emergency room or a psychiatric ward of a hospital. Menaged, who grew up in an Orthodox household, says that he didn’t understand what an eating disorder was back then, either. He planned to open a drug and alcohol rehab, but changed his mind after a therapist friend who had patients with eating disorders urged him to open a residential eating-disorder rehab instead.
It was a shrewd business decision. Twenty-five years after opening the first 42-bed space in Philadelphia, Renfrew Center has ballooned to 10 locations that employ more than 500 people. Menaged says the organization has treated about 55,000 patients and trained more than 20,000 therapists, and their database contains the names of 53,000 referring teachers, doctors and coaches. As eating disorders spread beyond the typical profile of the young, middle-class white girl, the potential client pool expands. “We’ll be in more states by next year,” Menaged says.
This Friday, Renfrew is hosting a conference called “Food, Body Image and Eating Disorders in the Jewish Community” for mental-health experts, educators, clergy and family members of people struggling with eating disorders. In addition to addressing the prevalence of eating disorders in the Jewish community, the conference will explore strategies for using Jewish tradition and culture as a path toward healing. After all, the devout seek help at their spiritual home first.
“Renfrew is able to educate the synagogue in ways it wasn’t able to before and the synagogue is able to inform the program at Renfrew in ways it couldn’t before,” Hilary says. “Instead of Renfrew saying ‘I can give you 100 different kinds of therapy but you’re going to have to go to your rabbi to work out this Jewish thing,’ Renfrew’s able to do that now. That’s amazing.”
Hilary may liaison at the intersection of both communities herself. She hopes to bring in an expert from Renfrew next year to the synagogue where she works to talk to and educate teenagers about eating disorders. She hopes her honesty helps defuse the shame that keeps women from admitting they have a problem and finding help. Back when she first entered treatment at Renfrew six years ago, lying just made everything worse.
Even though Renfrew recommended in-patient therapy, she refused. “I basically told them to fuck off because I [wasn’t] going residential, and if they wanted to help me then they’d let me go as a day patient,” she says. “It allowed me to cheat the system a little bit. Or a lot.”
She secretly exercised while at home and “water-weighted,” guzzling water right before weigh-in to fool the scale. “Not following their rules was the biggest mistake I’ve ever made in my life because it set me back years,” she says. “I did not make as much progress at Renfrew as I should have. I take full responsibility for that now. It totally screwed me in the end.”
Six years later, every day is still a struggle. She’s seeing a specialist to figure out why she’s exhausted all the time. Emotionally, she says that in some ways she feels worse now that she carefully maintains her weight (though as part of recovery, she hasn’t stepped on a scale in years) and no longer looks sick. “Because I look fine, [people] don’t realize how hard it is every single day…how much I suffer all day long because of what goes on psychologically,” she says.
Hilary says it was hard to forgive herself for the ways her eating-disorder and her spiritual life have become entangled. “I need to listen to my body,” she says. “Which means that I have to kind of call in sick on the holidays.”
A conference today in Philadelphia will bring together health-care professionals, researchers and policymakers to discuss a public health approach to eating disorder prevention.