by Kay (pseudonym) presented with author's permission
by Joanna Poppink, M.F.T.

(Only names have been changed to protect the privacy of family members) Followed by author's correspondence with Joanna Poppink, L.M.F.T.

Dear Joanna,

I am writing in the hopes of saving my sister Janet. Janet has always been one of my best friends, and my other sister Wilma and I are certain Janet will die if she doesn't t get help.

Janet is 36 years old and has been suffering from Anorexia Nervosa since the age of 16. She has been in an out of treatment and hospitals over the years. It has been about one year since her last 5-month stay at XX (a well known eating disorder treatment center). Since her release last April, she has had 4 hospitalizations and three seizures all caused by her eating disorder.

Janet insists on living in her studio apartment in the city while most of the family is in the suburbs. She comes out to the suburbs often, but despite our efforts to keep her to stay with us she insists on going back to her apartment, and has even called cabs to take her back home.

She can no longer drive because of her seizures and has been on disability for the last year and a half. Janet is also an alcoholic and often turns to binge drinking to escape her problems. On one occasion we picked her up at an El stop bombed drunk. She does not remember the incident.

Janet admits that she drinks to escape her depression. It s a non-ending cycle and I m convinced she will die soon if something drastic doesn't change.

Janet is the middle daughter of three girls. Wilma is 37, and I am 33. In everyone's eyes, Janet is an outgoing person with a bubbly personality. Janet was the lead in many plays in high school. She was an honor student in high school with practically a perfect straight A report card. She was the 2nd runner up in our town beauty pageant at the age of 20.

Janet is a people pleaser. She would do anything to help a friend, relative or stranger. She just can t seem to help herself.

I believe God has saved her time and time again. All of her seizures occurred when she was either around family, or in public. They could just as well have happened while she was alone in her apartment, which is where she spends most of her time these days. When we picked her up, drunk, at the El stop, we found her because she called dad from a payphone. She doesn't remember the incident or the phone call.

My five year old son Chris and Janet have a special bond. Janet lived with us for the first few years of Chris's life. Chris knows Janet is sick because she doesn't t eat. He recently overheard my cries and conversation with my husband in which I stated that I didn't want Janet to die. He pretty much went hysterical crying, "I don t want Auntie Janety to die."

How do you explain Anorexia to a 5 year old? Janet has often said that she doesn't t want to live, but is going on for her nieces and nephew.

Janet loves children. Her first job out of college was teaching preschoolers at a Montessori school. Janet has told me, "The kids love me for me." If only she could love herself the same way.

She has had several bad relationships over the years. The most recent one was with a married lawyer who was getting divorced. This scum was at my house on Thanksgiving a couple of years ago and even held my baby daughter, which now makes me sick to my stomach. He used Janet for very selfish reasons and then Janet found out that his wife was pregnant again. This put Janet over the edge and back in the hospital. Still though, he tracked her down in the hospital and continued to call her.

Because Janet is so sick and has no self-esteem, she immediately got her hopes up and started the relationship back up. Once she was out of the hospital; the relationship resumed and consisted only of lunchtime visits to her apartment for sex. He is now out of the picture because we told his wife.

I have every crazy story you can imagine about the abnormal behavior of a severe anorexic. These memories go back at least 15 years. Janet and I lived together right after I got out of college. This was after her first in-patient stay at a treatment center in Illinois. Janet has specific foods that are okay for her to eat. This list consists of vegetables, diet soda, a morning bagel if you are feeling thin that day, pickles, olives, and pretzels.

She has shared with me every thought that goes through her mind. Nothing I could say helped her. She usually denied that she still had a problem. I've even gone as far as going through the garbage even after it was outside in the trash can to prove to Janet that her anorexia/bulimia was no secret. I found wrappers of all the food she ate during a binge.

We had fights on a regular basis that would end up in tears and hugs. Tough love has never been my expertise. She was staying at our house recently and I asked her to try a little chicken breast on her salad. She did put it on and ate it, but later threw it up. She admitted to me that she threw it up, and broke down in tears saying she had to do it because she ate a lot at mom and dad's the last weekend and gained a few pounds and was freaking out about it.

She also told me in tears that she couldn't t be alone. Sure enough, two days later she demanded going back to her apartment. Her cycle now is to eat when she's visiting us out in the suburbs, and then she starves for 3-5 days.

Her body is so messed up. Among many of her problems is severe osteoporosis. Recent test showed her bones to be as frail as those of a 98 year-old woman. She had to have all her teeth drilled down to just nubs, and have caps put on all of her them because her teeth deteriorated so much due to vomiting. Her blond hair was once healthy. Now, it is thin and sparse.

She started in therapy after her release from the hospital last April at WW, a well-known eating disorder center here. I tried to get her there for the past ten years! I was very hopeful. That didn't last because it required her to go in for weigh-ins and stick to certain commitments.