College of the Holy Cross | Holy Cross Magazine

Caroline Fallon, a cheerful and ambitious 21-year-old from Breezy Point, N.Y., graduated from Holy Cross this past May with a degree in psychology/premed—but not without a struggle. Academics weren’t her problem. Anorexia was.

Fallon had grappled with anorexia nervosa, an extremely serious eating disorder, throughout high school. She had been hospitalized due to the disorder four times before coming to Holy Cross. Her ordeal began on her 14th birthday: “For some reason, the singing, the cake, the candles and the presents weren’t enough,” she recalls. “I felt unloved, forgotten about, and alone. I remember looking in the mirror and telling myself I had to change, but the only thing I could do was change who was outside. That is when I stuck my fingers down my throat and threw up everything that I had in my stomach. It hurt, I cried, and I went to bed.”

Within a few months, she’d stopped eating altogether. “I threw up any meal that I was forced to eat; hunger pains made me feel stronger, and for once I felt in control,” continues Fallon, who was a star athlete and attended high school on an academic scholarship. “I could resist eating; how many other people could do that? I would only eat dinner because my parents were around for that meal, and I’d find ways to lie about the other meals. ‘I had a big breakfast … I just ate lunch …my stomach hurts.’ You name it, I used it. I lost about 10 pounds in two months. I went from 112 pounds to 98 pounds (she’s 5 feet, 4 inches tall), but still felt like I could do better.”

Her parents, frightened for her life, said she could go away to college only if her eating disorder was under control. So Fallon set her mind to it, remaining stable long enough to enroll at Holy Cross. But the disease flared up again. In the spring of her second year, she left school and entered Long Island Jewish Hospital in New York, at an all-time low of 76 pounds. Doctors told her parents they didn’t think she would make it. “I had a feeding tube in my nose, IVs in my veins, and a heart monitor on my chest,” she says. “I could only use a wheelchair to get around. My heart was so weak they would have to wake me up in the middle of the night to make sure I was OK, because the monitor was beeping.”

Miraculously, something changed during this terribly dark time. “My dad said, ‘Caroline, we can’t help you anymore; only you can beat this,’” she continues. “It was like a switch flipped. From that point on, I was sick of being sick. I decided I wanted to go back to school. That summer, I began to realize that I could still be thin and happy and in control. I didn’t have to be one or the other.

Hard to Explain, Hard to Understand
Fallon’s story, while gripping, is not unlike those of other people with anorexia nervosa. Anorexia and bulimia, the other well-known eating disorder, are terrifying and confusing mental illnesses that develop for a variety of complicated reasons. For those who have them, they are hard to explain; for those who don’t, they are equally hard to comprehend.

“The hardest thing about an eating disorder—or any addiction, for that matter—is understanding the motives behind it,” says Fallon, the third of four girls in her family. “You can’t understand it until you’ve lived it.”

For these people, food is not simply fuel, or an appreciation of taste and texture, or even an occasion for sharing companionable time with family and friends. Instead, food is fraught with tension, with all sorts of issues that have nothing to do with the very basic human need to satisfy physical hunger.

“Eating disorders are really coping mechanisms,” explains Neal Lipsitz, director of the Holy Cross Counseling Center. “People are using these behaviors as a way to cope with life circumstances that are otherwise hard to deal with.”

In adolescence, which is when anorexia generally begins, it may be a girl’s fear of a changing body and impending womanhood, combined with a desire to separate from her parents and exert control over her own life. Anorexia sets in: She starves herself, eating less and less until her bony frame seems so frail one would think she could be knocked down by a strong gust of wind. Anorexia can be deadly: More people die from it than from any other mental illness.

For an older girl—often college age—the disorder may start with a simple desire to lose some extra pounds but quickly spirals downward into bulimia, which is characterized by a furious effort to get rid of calories either by throwing up, exercising for hours, or using laxatives or diet pills. Like anorexia, bulimia has serious health consequences, including damage to the stomach and esophagus, and possible infertility.

Statistics suggest that eating disorders are very rare, both nationally and at Holy Cross. It’s hard to find precise data, Lipsitz says, but most experts agree that about 5-10 million American women and 1 million men struggle with eating disorders, primarily anorexia, bulimia and binge-eating (in which large amounts of food are consumed in a frenzy). Officially, anorexia afflicts less than 1 percent of the population, while bulimia affects about 1-3 percent. Of course, these numbers count only those people who seek treatment.

And, in any event, the numbers are clearly higher on college campuses, according to Lipsitz. “A good estimate is that 15-20 percent of college-age females suffer from subclinical conditions or meet criteria for diagnosis of anorexia, bulimia or binge-eating disorder,” he says. “I’ve seen statistics suggesting that 15 percent of women aged 17-24 have disordered eating, 91 percent of college women have attempted to control their weight through dieting, and 54 percent of men are unhappy with their appearance and wish their bodies were different.”

At the Counseling Center, he says, they see about two or three students per year with anorexia, and another dozen or so who have bulimia. But those are just the ones who actually come in to the Counseling Center to get help. He says he doesn’t know how many more may be struggling with unhealthy relationships with food and appearance—which, although undiagnosed, can be considered forms of disordered eating.

What’s the Cause?
Clearly, our weight-conscious culture, combined with media images of impossible thinness, influence all of our perceptions of a desirable body image—even if almost no one in the real world possesses one. Indeed, one of the great ironies of our culture is that the number of obese Americans keeps increasing, even as others are fretting about being thin enough.

So why does one person develop an eating disorder, and another does not?

“ Why?” repeats Lipsitz with a sigh. “A lot of different factors come together in a very complex way. It’s multiply determined and complex, ranging from developmental issues, to genetic predisposition, to personality characteristics, to media influences. In some cases, but not all, an eating disorder shows up in people who also have depression, obsessive-compulsive disorder or other mental illness.”

They are hard to treat, because they require a dual approach—healing the body and the mind.

“This can’t be just contained to a medical diagnosis and solved with a pill,” says Betsy Cracco ’89, who worked as a staff psychologist at Holy Cross for three years before moving to private practice and part-time work at Connecticut College this past summer. “It took a long time to get entrenched, and it will take a long time—months, even years—to get a handle on it.”

“A medical doctor works on the physical conditions—heart rate, blood and urine tests, weight checks—but to really help deal with the problem there also needs to be a counseling role,” adds Lipsitz. “It’s a very secretive illness. They don’t want to talk about it. What we try to do is help them look at the fact that the eating disorder is a coping mechanism, and they need to find another way to cope. It takes a long time to achieve that.”

Even those who don’t have full-blown eating disorders may still worry to an inordinate degree about their appearance, focusing as much on food and exercise as they do on their studies, their extracurricular activities and their friends. This insidious problem, which could be dubbed “appearance preoccupation,” for want of a better name, is also hard to crack—especially on a college campus where hundreds of young people are living together in very close quarters, exerting enormous influence on each other.

“ When I came to Holy Cross, I was surprised to see the numbers of overweight people are very low,” says Kristin Tyman, a fourth-year student from Revere, Mass. “You see a very thin population. It’s tough, especially if you are struggling with losing weight because you gained it, as I did freshman year.”

“Society looks at a slim figure as another mark of accomplishment,” observes Cracco. “Holy Cross students consider themselves (and others consider them to be) ‘put together.’ Being thin is perceived to be part of that. So the focus on weight consciousness and self-criticism is very common.

“There are full-length mirrors in every residence hall, and you can see what’s happening as people are getting ready to go out at night,” she adds. “Everybody’s standing around saying: ‘I’m so fat.’”

“There are too many mirrors—way too many mirrors,” agrees Tyman with a laugh. “Obviously you need to look at yourself to make sure you’re put together and have no stains. But you don’t need to check yourself out constantly.”

Small wonder, then, that so many try to do all they can to keep their weight in check—even if they are not pursuing such extreme habits as self-induced vomiting. Indeed, many use a more socially acceptable means: exercise.

“I see a lot of obsessive exercisers,” says Lauren Dehler, a fourth-year student from Ho-Ho-Kus, N.J., who is double majoring in visual arts and psychology. “There are people who weigh themselves when they get to the gym – and weigh themselves again after exercising another hour.”

“By 8 a.m., the elliptical machines are all taken—and some of those people have already been there for hours,” confirms Tyman. “The gym can be a really tough place to go when you’re in college.”

Dehler says this preoccupation with appearance is partly what inspired a painting she made this past spring for a class assignment. Untitled, it is an oil image of a painfully thin girl, illustrated by a quote Dehler found in a memoir she was reading about anorexia—part of her research for the honors thesis she will write this year on the topic.

“ I haven’t suffered from an eating disorder myself, but I haven’t found anyone who’s immune to media images of what we should look like,” she says. “No one ever feels that their body is good enough. I thought this would be a powerful way to draw people into the subject.”

What Can Be Done?
Dehler also tries to build awareness through her work with a campus peer education program known as NEED (Nutrition, Exercise, Eating Disorders). The mission of the group, which is made up of about 20 students trained by the Counseling Center, is to promote healthy body image and a healthy lifestyle overall. These students are also educated about the signs of eating disorders and know how to respond if they encounter the problem on campus (see sidebar).

“The peer-to-peer contact is very effective,” says Lipsitz. “Students can ask their peers, ‘where do I go, what do I do?’ Then the NEED educators can refer the person to the Counseling Center for professional help.”

“ Having the students involved is very important, because students listen to other students more than to adults,” agrees Cracco, who was the faculty adviser to the NEED program.

The members of the NEED program do their best to change perceptions about body image. In February, they organized a “Love Your Body Week,” in conjunction with a national eating disorders awareness effort. “We made a CD with songs celebrating our bodies and blasted it for a night in Kimball,” recalls Christine Clark, a fourth-year student from Melville, N.Y., who is an executive board member of NEED along with Tyman. “We also gave out 500 pins that said ‘I love my body.’ It was very interesting to see people’s reactions to wearing that.”

“We had very good feedback at our events,” adds Tyman. “One of the most moving things was eight anonymous testimonials we got about people’s personal struggles with food. We hung them on a central bulletin board. That was huge.”

And, in conjunction with the Holy Cross athletic department and Girls Inc. of Worcester, they also helped to run a weeklong camp in April for fourth- to sixth-grade girls from the city. It was designed to teach them to accept their bodies and to enjoy physical activity for its own sake.

Interestingly, the Holy Cross students said they learned as much that week as the younger girls did. “We had the girls look at magazines and point out pictures of women they liked or didn’t like,” says Clark. “We all realized that they were already getting ideas about skinny being ‘good’ and fat being ‘bad.’ It was horrific for us to see how much society pushes these ideas on kids, at younger and younger ages.”

Change Will Be Slow—But It’s Possible
“To some degree, eating disorders are diseases of our culture, and if you can change the climate, you can reduce the frequency of the disease,” says Cracco. “But change is slow. It is sort of a Herculean task. It’s not going to happen overnight. And men need to be involved as well. Men don’t realize that their comments about women’s bodies play as much, if not more, of a role as women talking about it themselves.”

Respected national eating-disorder treatment organizations, such as the Renfrew Center, say there are things we all can do to help prevent eating disorders in the first place: don’t label foods as “good” or “bad”; don’t use food as a reward or punishment; encourage healthy eating habits and exercise; and discuss how different body types can all be accepted and appreciated.

“One major thing for parents to remember is that ‘do as I say, not as I do’ thing just doesn’t work,” says Cracco. “If you yourself are striving for an impossible ideal, and engaging in surgery or restrictive dieting to get there, then this is about the most potent message about what you value in people, in life and in yourself.

“If you are commenting about ‘how nice and thin’ this or that person is, you send the message,” she continues. "That will be passed on. And for gosh sakes, if you by Barbie, at least have the discussion that no one could possibly look like that!"

Today, Caroline Fallon still struggles with anorexia - "I don't think an addict can ever be totally recovered," she says, "mostly because it's a part of you forever, no matter how much better you get" - but she's doing well. At 105 pounds, she now weighs herself to make sure she's maintaining weight. She works at Mount Sinai Hospital in Manhattan, and plans to take the Medical College Admissions Test (MCAT) next spring, with hopes of working as an emergency room physician someday.

"Your body isn't who you are - the Jesuits will tell you that it's just a covering over your soul," concluded Clark. "It's just like a little costume that you wear. You really can't make major change in your body. I think people just need to remember to love people for who they are, not what they look like."