Good Girls: A Story and Study of Anorexia Hardcover – April 18, 2023

I bought this book to better understand an illness that has impacted both my partner's daughter, and a former friend who cut me off for confronting her. This book has giving me both greater understanding of and much more compassion for sufferers of anorexia. I would caution prospective readers to understand that this is not a self-help book, nor is it a compendium of clinical practice guidelines. It's a memoir, and at no time does the author represent hers as the universal experience of anorexia. If you're buying it to try to help someone you care about, or to aid yourself in your own recovery, you may want to supplement with other resources. No one person's trajectory is ever going to be the same, and treatment guidelines have and will continue to evolve.

Although, as others have noted, one must use care in accepting one case as typical of a condition, her description of the attitude of her and her fellow sufferers toward caregivers' attempts to change their behavior seems typical of many I saw so long ago. As an undergraduate working part time in hospital labs in the 1950s, I recall most studies, such as blood potassium and kidney function tests, were done as isolated tests, generally only ordered for specific reasons, but, by the time I had graduated from medical school and during my last years of specialty training and early practice, such tests were done as part of panels by automated machines and almost ubiquitous on hospitalized patients. As a result, young women and girls were often admitted for undiagnosed problems, found to have a low potassium, and I would be called for aid in diagnosis and treatment recommendations. Virtually all would be anorectic, bulemic, diuretic abusers, or, in the case of many with similar characteristics and kidney function abnormalities, pain pill abusers (in those days common pain pills usually contained a combination of aspirin and phenacetin). ~90% were female, all, at least in the early stages, were liars, almost all hostile, and many appeared depressed. The ages ranged from young teens to middle aged, roughly in the order listed above. In many cases, at that time, the family and primary physician would not have known the hidden history of their illness, so that I, a total stranger, would often be the first to challenge the patient and inform the mother of the problem and suggest psychiatric consultation--usually not a happy moment for anyone. The description of patient behavior, particularly the hiding of their activities, as described by the author, fits perfectly with my experience; the effort and ingenuity of some were incredible, and their willingness to undergo truly dangerous medical procedures without admitting what they were doing was frightening; sometimes only chance discoveries saved them from harm from other physicians who could not believe what was going on and felt some rare condition was present. Even after 50+ years, I can still see the vision of a skeletonized young girl walking down the hallway pushing her IV pole with potassium drip with the sinking feeling that this was surely the patient I had been called to see.The description of wanting to be something else or someone special seems to me to have fit these young women and I was very struck by her quoting one of the psychiatrists who felt there were similarities between these girls/women and many of today's gender dysphorics; I had little contact with the cutters he mentioned, but certainly believe that today's society has resulted in the present "epidemic" of gender dysphoria being so poorly served by US medicine, in my opinion, compared to most other western countries.The author's story may not be that of all anorectics, but surely is not far from some others, and she describes it well and has made a real effort to interview experts in the field. I found it a fascinating and meaningful book.

Thank you, Hadley, for this searingly honest and vulnerable telling of your experience with anorexia. This book will truly help those struggling to understand why they are anorexic and help them to feel less alone. You were so brave to share all of the details of the good, bad, and ugly of your illness and recovery. It will make sufferers of this cruel disease feel seen and feel hope.

Hadley, you wrote an amazing book. Your writing is compelling with a subtle humor. I found myself and many that I know within this book. Thank you for your great honesty and effort! This book will be impactful to many. Best wishes to you always.

"Anorexics…are like a child looking for their own vegetable patch, their own identity…So much of anorexia is about suppressed conversations…It really isn't about the food. It's about trying to say something without having to speak; it's about fear of sexualization and fear of womanhood; it's about sadness and anger and the belief you're not allowed to be sad and angry because you're supposed to be perfect; and it's about feeling completely overwhelmed by the world so you create a new, smaller world with one easy-to-understand rule: don't eat.”“(There has never been a more perfect expression of that feminine desire for self-erasure than‘size zero’)” with “a stomach so shrunken and sunken it becomes a sagging hammock strung between the hip bones…Thinness is proof of a woman's lack of appetite…You do become a good girl when you're ill and in bed, because nothing is expected of you, so there's nothing to be angry about.”“Being anorexic traps you in the liminal state…like having a fear of flying and living forever in an airport, watching everyone else board the planes while you pace nervously around the duty free…I was trying to move back to my childhood, and sadly, British Airways doesn't do flights to there…There was a world away from steamed vegetables;” hope was an open window, a voice whispered on the wind: “This present moment is not all there is for you. A different future is still waiting for you, if you want it.”“A voice from a dark and tender part inside myself says, ‘Lucky her, she is free to eat whatever she wants, and she'll still be perfect and free.’ But then the light comes in and I remember that the reverse is true: the more perfect I was, the less free I was to do anything…Even though I'm free…I will never forget…and even though I'm recovered, the splitting never fully mended, so I'm always standing a little to the side of myself, looking at the life I have and thinking about the one I don't…I raised my glass, to the past, present and future, and I ate.”