What I Lost by Alexandra Ballard

Sixteen-year-old Elizabeth Barnes finds herself entering Wallingfield Psychiatric Facility for her anorexia. In the lobby Elizabeth meets Lexi a very thin girl from Long Island Massapequa. Elizabeth and her parents meet Mary who will be Elizabeth's therapist who tells them that it is almost snack time. Mary explains that every day the girls meet in the dining room for breakfast, lunch and dinner and that there are three snacks each day. Sally the nutritionist will work with Elizabeth to set up a meal plan and at every meal a nurse will check to see that everything has been eaten. Every morning weights and vitals are taken but numbers are not revealed. Elizabeth is scheduled to have a bone density test done. Elizabeth learns that Lexi is her roommate.

First snack is horrifying to Elizabeth because it consists of milk, one muffin and one apple. Willa tells her if she doesn't eat, Kay the mean monitor will force her to drink Ensure. Elizabeth is unable to eat most of her snack but Kay lets her off because it's her first day. Willa who has hidden all of her muffin under her shoe has to drink an Ensure.

Elizabeth's roommate Lexi who exercises at night, tells Elizabeth she has been in treatment before and has had both an nasogastric tube and a stomach tube. Elizabeth's first breakfast is a nightmare as she struggles to eat all the food on her plate. Not being used to so much food at once, she vomits up her breakfast and is made to drink Ensure. Lunch is even more difficult, because it includes salad with a dressing.

Group therapy for Elizabeth's cohort is run by Marci, a twentysomething counselor. This group includes Elizabeth, Lexi, Willa, Beth, Jean and Margot Camby who is someone Elizabeth once knew from ballet class when she was six years old. None of the girls are eager to participate but to spare Margot, Elizabeth mentions about hating the lanugo (fine hair) that is growing all over her body.

Lunch is even more difficult for Elizabeth; she manages to eat everything but the salad which she must eat with salad dressing that she describes as "unhealthy" and "disgusting". Kay insists that she will have to drink an Ensure but with the support of Willa and Lexi,  Elizabeth manages to eat the salad.

As Elizabeth goes through treatment, she discovers an inner strength she didn't know she had. That courage will be needed as she confronts her own problems, struggles to deal with her parents and must find her place at school where she faces bullies and the fallout from social media.

Discussion

What I Lost offers a poignant, candid treatment of anorexia that will help readers better empathize and understand this serious illness.  Ballard knows her subject well and has captured many of the ritualistic behaviours and the thoughts experienced by those with an eating disorder. Through the experiences of both the main character, Elizabeth Barnes and several of the secondary characters, the author also demonstrates how difficult it can be to overcome this illness, presents some of the consequences anorexia can have on the body, but also offers hope to those who are impacted by anorexia.

What I Lost begins with Elizabeth's admittance to a treatment facility and focuses on portraying her struggle towards recovery. When Elizabeth arrives at Wallingfield she is in a state of denial; she believes she doesn't belong there. But her frame of mind is quickly revealed when she catches a glance of herself in the mirror above the fireplace in the common room. "That girl made me sick. I hated catching glimpses of her. It didn't matter where --whether in a mirror, or a window reflection, or on my phone screen after a group selfie."

Her state of mind reveals that she is focused on being thin, especially when she sees Lexi. "Her purple hoodie and black leggings hung off her like clothes on a hanger, and her legs, folded beneath her, were so thin they made her feet look too big for her body. My cheeks burned. I felt inferior. She was so much skinnier than me." Elizabeth notes that although she has her dad's genes, she is now skinnier than her mom, something she is proud of.

However Elizabeth's illness quickly manifests itself at Wallingfield when she struggles to eat her first snack. Unlike some of the other girls there however, Elizabeth does force herself to eat. This is a hint that deep down, Elizabeth wants to get well. This is demonstrated when Lexi explains how the treatment center works."You can either refuse to do everything, and then eventually  they'll kick you out...Or you can do what they tell you, get fat, and go home.." But Elizabeth wonders "What about girls who want to get well?", a thought she quickly suppresses.

After her first group therapy session Elizabeth realizes that she feels understood at Wallingfield but she also wants to go home and have a normal life. "These girls got me. And yet...a part of me wanted to cry. This wasn't normal. I wanted to be home, listening to Spotify wit Katrina, studying for my SAT's, reading Hamlet, and training for states with my cross-country team."

In therapy Elizabeth begins to explore some of the factors that have led her to where she is now. Elizabeth believes that her mother wants her to be thin. At first she can't tell Mary this because she doesn't know how she will react. Elizabeth knows her mother has "expectations" or hopes. "Hopes for my appearance, anyway." Memory of a shopping trip to Macy's brings up what Elizabeth's mother's hopes are. "Our shopping trips usually led to horrible fights where I begged her to leave me alone and she told me that if I let her dress me, I'd look great. You just have to purchase the right clothes for your figure, she'd say. You don't have the right body for the juniors' department. But the juniors department was where all my friends shopped, and I wanted to shop there too. And sometimes the things he hated on me, I didn't think looked that bad. Until she pointed out the flaws -- my hips, my thighs, my chubby knees." 

When her parents become involved in both group and family therapy Elizabeth must deal with intense conflict as she begins to realize that her mother's view of food is not a healthy one. In family group therapy Elizabeth decides to be honest about what's happening. "No one would ever have guessed my mom was anything besides a naturally thin woman who'd won the genetic lottery unless they ate with her." During a family phone call that includes her therapist, Elizabeth realizes that her mother's behaviour during meals makes her feel "ashamed that I was such a pig" and "ashamed of my appetite". Her parents' inability to confront this leaves Elizabeth feeling vulnerable and disappointed. Eventually Elizabeth is forced to confront her parents over her mother's disordered eating during lunch with parents. " 'Mom! It is so hard to eat when you're acting like that. You're supposed to model normal behavior for me!' Before Wallingfield I'd watch Mom eat and feel guilty if I ate more than she did. Now, though, I saw her eating for what it was. Screwed up..." As Elizabeth gets further into her recovery she recognizes her mother's disordered eating and understands her denial because she experienced the same thing.

Seeing the other girls struggling with the effects of anorexia on their bodies has a lasting impact on Elizabeth. When Lexi reveals that her anorexia has damaged her heart possibly irreparably, she tells Elizabeth "Be scared for yourself. Really, really scared, because that's what's going to make you better." Elizabeth knows from her previous support group twenty percent of girls never recover from anorexia and she doesn't want to be one of those girls. Yet Elizabeth continues to struggle. When Sally meets with her to plan  her meals, Elizabeth has the unrealistic expectation that she can cure herself while limiting her food to 800 calories per day. At the same time Elizabeth knows she has to eat if she wants to recover - a conundrum for many people suffering from anorexia. Elizabeth knows the increased food intake is changing her body and she states, "I was mourning the body I was losing each day a little, too."

As is the case with many girls with anorexia, eating begins to heal the body and the brain, something Elizabeth soon begins to recognize. "I did have things to be happy about. I'd finished my lunch. In fact, I was proud to report that I'd finished every meal and snack in the past week. Because of that, I felt better both in my body and my brain. I wasn't psyched to be gaining weight, but my thoughts were clearer and they moved through my head faster." 

In the end several things help Elizabeth to eat and begin to recover; she begins to confront the unhealthy approach to eating that her mother has and how that has affected her, she fears damaging her body as Lexi and Margot have done, and she realizes that she wants her life back and wants to be healthy. Ballard makes all of this seem realistic because Elizabeth still struggles with how she views her body. "I did want to stay how I was and eat pancakes. There were healthy size 0 girls. Why couldn't I be one?" The most important thing is that Elizabeth decides to get well for herself. "And right then I knew. If I went home and started to restrict my eating again, I would shrivel up like a dry plant. If I ever wanted to run again -- to live again-- I'd have to get better. And I'd have to do it for me."

And when she returns home, she almost immediately falls into her old pattern of lying and trying to get around eating. This too is a realistic portrayal. In the end, it is Elizabeth who owns her illness and decides she wants to recover. "Did I want to spend my life bouncing in and out of treatment centers, have bone scans and waiting for the bad one?...If I skipped lunch I'd find a way to skip dinner. Then breakfast, and lunch, and dinner again. It wasn't a slippery slope. It was a straight free fall, and I knew it." 

Ballard includes several subplots involving Elizabeth's friends which serve to provide context and setting later on in the novel when Elizabeth is released from treatment and must return to school. Elizabeth receives a series of mysterious packages which she believes comes from her ex-boyfriend. Ultimately, these packages help her to work through what happened between them, to heal from that experience and to recognize her own strength. There is also a second storyline involving her continued bullying by a classmate which Elizabeth faces with grace and courage. With her new found strength, Elizabeth with the help of friends and family, confronts these challenges and continues to move forward.

Overall What I Lost is a realistic portrayal of someone struggling with an eating disorder. While Elizabeth's recovery may seem somewhat fast-tracked, her timeline of actively restricting is relatively short. The longer disordered eating occurs, the more entrenched the behaviours become and the more difficult it is to remove them and the accompanying thoughts. Balland undertook considerable research for her book and this is evident throughout. The ending is positive and hopeful  - which is something people with an eating disorder need to know. Recovery is difficult and hard work but there is hope!


Book Details:

What I Lost by Alexandra Ballard
New York: Farrar Straus Giroux      2017
390 pp.