Dying To Be Fashionable Thin

"Do I look heavier?"
"Many people today called me brave [after end-stage kidney failure diagnosis], and I have to say that is the last word I would use to describe myself."
Michelle Stewart, 32-year victim of anorexia nervosa, bulimia

Courtesy of Karen Flello MIchelle Stewart was in a hospital in Saanich Peninsula, B.C., dying from kidney failure. But she had refused dialysis or a transplant, because that would mean agreeing to a strict diet and never voluntarily vomiting again. Last year, she died at age 49.

"It was almost like there was nothing wrong with her. But she could never, ever accept a compliment. She didn't think she was worthy."
Kirk Mason, Michelle Stewart's partner

"They see these images and think, 'She's more successful than me, she travels more than me, she has more friends -- and, she's thinner than me'."
"I ask them, 'What is it that's eating you inside? What is it about you that you're trying to compartmentalize, or put away, that's just coming out in this behaviour?"
"And people will say, 'My partner had an affair', or 'My kid is sick', or 'I was just diagnosed with breast cancer and I feel like my body isn't mine anymore."
"We're having kids later and trying to manage our work lives and debt loads and getting these messages that our bodies have to look like when we were in our 20s. Women feel out of control, not just of their lives but their emotions, and they don't feel like they have a place to actually go and say, 'I'm losing my s--t, and I'm scared'."
Debbie Berlin-Romalis, executive director, Sheena's Place, Toronto

"It goes to this feeling of success -- 'This shows I'm strong, this shows I'm successful. I can be the CEO, I can do anything'."
"It may not be conscious, but it's there."                                                                        Dr. Valerie Taylor, psychiatrist-in-chief, Women's College Hospital, Toronto

According to Dr. Monique Jericho, medical director of the Calgary Eating Disorders Program, eating disorders reflect issues around control or perfection, but certainly also depression, mood disorders, anxiety and impulsive behaviour. Society has raised an image in women's consciousness, that of an attractive, youthful appearance, healthy and vibrant, and despite age, slender as a sylph.

Famously, the American divorcee whose attraction led Edward VIII of the British House of Windsor to give up the throne to marry her, stated "you can never be too rich or too thin", back before the mid-20th Century, so there is nothing particularly new about the passion for thinness. Where once being wealthy a century earlier meant a placidly full-bodied presentation as proof that one was able to eat well, in Wallis Simpson's time a thin body meant a patrician and wealthy cosmopolitanism.

Michelle Stewart refused dialysis after she was diagnosed with kidney failure. She had no wish to undergo a kidney transplant to save her life since it would require that she agree to a strict diet and to surrender her self-destructive habit of forcing herself to vomit. She suffered from a mental illness revolving around what some might interpret as an egotistical will to present as thin. Thin she was, yet she viewed herself as fat.

She died a year ago aged 49. Even on the verge of death when she weighed 30 kilograms, a weight that was less than she weighed as a ten-year-old, she was concerned whether she appeared as though her stomach was protruding. Her life was reduced to being in a wheelchair, but she was focused on being thin. Being thin and the practices she faithfully undertook to ensure she remained that way, killed her.

Some research suggests that anorexia can leave women with the feeling of control. A paper published a year ago in the journal Clinical Psychological Science had researchers from Rutgers University reporting that women with anorexia felt a sense of pride and accomplishment as they continued to lose weight, alongside feelings of shame, sadness and guilt. The conclusion was that even women who appeared to "have it all" valued controlling their physical size as a symbol of willpower.

Dr. Monique Jericho, medical director of the Calgary Eating Disorders Program points out that eating disorders reflect depression, mood disorders, anxiety and impulsive behaviour as well as issues of control or values of achieving perfection. Dr. Blake Woodside, director of the in-patient eating disorders service at Toronto General Hospital, deplores the fact that when seeking medical help, women are met with misdiagnoses reflecting the "appalling low" level among health professionals of eating disorders.

Eating disorders remain viewed as a pseudo-illness illustrative of the idle privilege values that young women chose to follow, an ingrained habit. In reality they now appear to be ranked among the most lethal of mental illnesses resulting in a death rate of between ten to 20 percent. Dr. Woodside's oldest patient appeared for help at age 70, ill with anorexia since age 14.

While she was dying, Michelle Stewart reflexively weighed herself in anxiety that she might have gained weight. She kept appraising herself in mirrors to determine whether her stomach appeared prominent. She had written a blog to chronicle her last year of life set to be published as a book titled Shell: A Memoir -- One woman's Final Year After a Lifelong Struggle with Anorexia and Bulimia.

Some might say she did have it all. She had a partner who loved her. She had a supportive family. She was a radio journalist, and director of communications for the British Columbia health ministry in Victoria. In her blog she described how she succumbed to lowering her weight goal from year to hear "and the denial a little deeper". In her late 30s she had once admitted herself to hospital, dangerously dehydrated. She was placed on intravenous feeding.

She gained over three kg from the intravenous fluids. "That was it", her sister Karen Flello said. "She signed herself out." Her partner Kirk Mason described a bright, sharp, generous and amusing person. He recalls trips to emergency when her potassium levels plummeted. He remembers being the first couple to leave dinner parties to enable Michelle to get home "and take care of herself"; purge.

Courtesy of Karen Flello  Michelle Stewart, a former director of communications for the B.C. Ministry of Health who died in 2014 at age 49 from kidney failure, the result of a decades-long battle with anorexia and bulimia. She is pictured with her partner, Kirk Mason.