By the time Chaya was accepted into an eating-disorder treatment program in 2007, she weighed 52 pounds. Too weak to walk, she was carried in. Her hair and teeth had fallen out, and her pulse was a dangerously low 28, less than half a normal reading. Everything sounded like a shriek or a whisper to her, because the thin membrane of fat around the neurons in her ear had dissolved. Her eyesight faded in and out.
And then her heart stopped.
Chaya, an Orthodox woman whose anorexia had brought her to the brink of death, recovered after her stint in the treatment program—but her harrowing experience was far from over. Her story is not unique: The Orthodox community has begun to grapple openly with eating disorders in recent years. In 2008, the Orthodox Union released a documentary film to be shown in Jewish schools called Hungry To Be Heard, about eating disorders among observant Jews. And treatment programs that cater to Orthodox women have opened.
“Now practically everyone knows someone who suffers from an eating disorder,” said Dovid Goldwasser, one of the most prominent Orthodox rabbis to deal with eating disorders.
Roughly 1 percent of the population—disproportionately girls—suffers from anorexia nervosa, defined by the DSM IV as “the refusal to maintain body weight at or above a minimally normal weight for age or height.” The mortality rate for anorexia is between 20 and 25 percent; it is the highest rate of any psychiatric disorder. The exact figures in the Jewish community are unclear. A study from 1996 by Ira Sacker, an expert on eating disorders and author of Dying To Be Thin, found that one in 19 Jewish girls in an Orthodox Brooklyn high school suffered from some form of eating disorder, 50 percent higher than the rate in the general population. The study was never published; Sacker said that at that point, “people did not want that thing to be public knowledge.” A 2008 study in the Toronto Jewish community found that 25 percent of Jewish girls suffered from an eating disorder, compared to 18 percent of girls in the general population.
Many clinicians have described factors that may make Jewish girls receptive to eating disorders or disordered eating: perfectionism, stress, and an overly strong focus on the body. There is no conclusive evidence that the percentage of eating disorders inside the Orthodox community is higher than the percentage in the general population, or the Jewish community as a whole. “There’s nothing inherent in Orthodoxy that causes an eating disorder,” said Hilary Brodsky, a licensed social worker who works with several Orthodox patients.
What is clear is that the Orthodox community lagged behind others in recognizing the problem; the increasing number of individuals suffering from the disease caught many off guard. “We are usually somewhat of an insular community, and therefore we’re protected from the outside,” Goldwasser said. “What really sounded the alarm bells is that we mirror the outside community in eating disorders. How did we catch up?”
Despite the progress, a veil of silence still exists around eating disorders in the Orthodox world. Chaya agreed to share her story in hopes that it would end this silence and help other women facing similar problems.
I met Chaya last month at the only Starbucks in the ultra-Orthodox enclave of Borough Park, Brooklyn; she looked like every other young woman who wandered in and out of the store. She wore a patterned, ankle-length skirt and a long-sleeved T-shirt despite the humid July heat. A black bow on her short brown hair made her look far younger than her 31 years. Chaya is an outpatient at Renfrew Treatment Center, an eating-disorder clinic that opened a track in 2009 for religious Jewish women. As part of the regulations for Renfrew, a social worker from the organization was with us during our interview; aside from vigorously nodding her head to some of Chaya’s points and leaving us to feed her parking meter, she didn’t say anything.
Chaya was born in 1981, the fourth child in a family of 10, in a Toronto suburb. Her family was yeshivish, which roughly translates as being to the right of Modern Orthodoxy. Her father was a member of the Toronto Kollel, and her mother was a successful, self-taught entrepreneur who sold medical supplies. “I had a very good childhood,” Chaya said while she nursed a plastic bottle of water. “My childhood was very busy; I was not a quiet kid.”
Like many people who suffer from anorexia, Chaya was an overachiever and a diligent student, a type-A personality. She was valedictorian of both her elementary and high-school class. Her anorexia began innocently enough: a diet, when she was 13 years old. She wanted to lose some weight for her twin brother’s bar mitzvah.
“I got a lot of compliments and I thought that was nice,” she said. “If it looked good to lose some weight, I should probably lose some more. That’s something you’ll hear from everyone who has an eating disorder.”
Chaya began restricting what food she ate. She looked a little skinny and fainted twice, but school officials figured it was just because of stress. She also began running. “People thought it was normal I was so exhausted,” she said.
But a routine medical check-up in the 12th grade found otherwise: At 5-foot-3, she weighed 93 pounds. She was officially diagnosed with anorexia, and her doctor recommended a psychiatrist. The diagnosis shocked Chaya and her family. “I was a well-adjusted, happy teenager,” Chaya recalled. “Psychiatrists were for crazy people.”
Like many girls her age in the Orthodox world, Chaya intended to attend a seminary in Israel the year after she graduated. Her family worked out a deal with the doctor: Chaya would be allowed to go if her weight increased to 104 pounds. Gaining weight was harder than she initially imagined. Part of anorexia is a phobia around food. Chaya managed to boost her weight to 97 pounds and then discovered a way to trick the scale: drinking copious amount of water before being weighed. She got to go to Israel.
Away from her family, Chaya had an easier time not eating. She was weighed every two weeks by an oblivious doctor in Jerusalem. Before the appointment, she’d put on baggy clothing loaded with weights and down at least 20 water bottles; after her appointments, she’d pass out in an alleyway next to the office.
Despite her anorexia, however, Chaya still managed to be active in her seminary. She remembers her time there as one of the happiest of her life; she only realized something was wrong when the seasons changed. “I was getting colder and colder as winter set in,” she said.
Eventually, her hair began falling out and she found it harder to concentrate. Sitting in chairs was painful. Her weight was down to 80 pounds, and her heart rate dropped to the 40s. She flew home and enrolled in a day-treatment program in a Toronto hospital for teenagers suffering from eating disorders. “My family didn’t know what to do,” she said. “I wasn’t allowed to tell people [the truth]. We told people I had mono.”
In the program, where Chaya was the only Orthodox woman, she found that her goals and behavior didn’t always match up with those of the people around her. “I was coming in wanting to get better, and these were kids who were tricking the system,” she explained. “They taught me a whole bunch of things: how to hide my food, how to exercise when the staff wasn’t looking.”
Not wanting to trouble her parents to drive her every day, Chaya signed up to stay in the hospital. Since she was 18, the hospital placed her in the psychiatric ward where she signed a waiver giving them full control. “I was young and I didn’t understand the implications. It was horrible,” she said.
What occurred then, according to Chaya, was something straight out of One Flew Over the Cuckoo’s Nest. She was terrified of food, so she didn’t eat. Because she didn’t eat, she was punished. She wasn’t allowed to attend the day-treatment program; other privileges were revoked, and she was locked in an acute psychiatric ward. Her parents weren’t allowed to visit her. Eventually, she said, she was chained to a bed and force-fed through a naso-gastric tube that she pulled out repeatedly.
“I got a verbal apology [from the hospital] eleven years ago,” Chaya said. “They apologized that I had an ‘unpleasant stay and perhaps they should have done things differently.’ They didn’t say outright how wrong they were.”
Today, Chaya’s voice is still frequently hoarse from the damage done to her vocal cords. But the damage done to her psyche was even greater. Over five months in the hospital, she gained 10 pounds but became more troubled mentally. “I was gaining weight but getting sicker and sicker in my head,” she said. According to Sacker, punitive treatment doesn’t work because of the complicated nature of anorexia; in fact, he said, it can actually make things worse: “Punitive measures reinforce the power of the eating-disorder identity,” said Sacker.
Chaya eventually escaped from the hospital by memorizing when certain doors were unlocked, and she contacted her family, who signed her out of the treatment program. Over the next few months, Chaya’s weight dropped precariously. “I was mad at the doctors,” she explained. “I used to get up in the middle of the night, because my parents wouldn’t let me go [during the day], and run from 3 to 6 a.m. It became a goal: how much weight I could lose.”
In August of that year, when her sister got married, Chaya was unable to stand outside for the chuppah because she was too cold. At 68 pounds, she enrolled in a treatment program in Toronto General. Chaya experienced a radical recovery; in six months she was close to 103 pounds. At 21, she began to date. But that move, so hopeful at first, eventually led to a new and even lower low.
In religious circles, dating is arranged through matchmakers. “The matchmaking world has led to overwhelming pressure,” said Sarah Bateman, a licensed clinical social worker at Renfrew. “Women’s statistics are kept on file by the matchmaker. … The No. 1 question is about women’s size and weight.”
Chaya received a heter, or permission from a rabbi, to wait until she hit a third date with the same young man before telling him about her eating disorder. At the time, Chaya had fully recovered and was pursuing her college degree and teaching full-time.
“It became a lovely cycle of going out with fine young people,” she said. But, “every time they heard about my eating disorder, that was the end of it. … With each ‘no,’ I lost more weight.”
Relapse rates are high for anorexia—between 4 and 27 percent, according to a study out of the University of Maryland. The final break for Chaya came after a series of promising dates with one young man whose parents forbade him from asking her to marry him because they were afraid Chaya’s eating disorder was genetic. “If people will think I’m sick, what difference does it matter if I’m sick or not?” she recalled thinking. “No matter what I do or how happy I am, I’ll always be anorexic to them. I might as well stop fighting so hard.”
But the lowest point for Chaya came when she went down to Miami by herself for three weeks. She rented an apartment and ran for 10 hours a day and swam hundreds of laps, frequently passing out in the pool. She says she can’t recall eating even 100 calories a day at that time. She was wait-listed for another treatment program. Her parents were told that patients frequently die on the waiting list. She was down to 52 pounds by the time a bed opened up in 2007; that’s where her heart stopped in the waiting room.
Chaya doesn’t remember much about the next few weeks, except being hooked up to machines and being wheeled in and out of hospital rooms. When she did make it to a therapy session, someone had to hold her head up. Chaya’s parents threw away most of the photographs from that time, but during our interview, Chaya slid a few photos from an envelope. Her face is a skull with tufts of hair. In one, a ghastly figure lights a menorah.
The hospital allowed Chaya to return home for weekends, but this made things even more difficult; Shabbat and holidays tend to be a struggle for many people recovering from eating disorders. “There are a lot more meals and a lot more courses of food being served,” explained Brodsky. “It’s like sitting down with a room of spiders. These times are particularly hard because they’re faced with their most feared thing at a very abundant level.”
Chaya recovered, but due to a loophole in the system, she was discharged when she gained back half of her weight. Because of how serious her condition was, Chaya was still seriously underweight. “Outpatient treatment doesn’t work with low-weight individuals,” said Brodsky. “There’s too much cognitive impairment.”
Some members of her Orthodox community rallied around her, but the school where she had worked for eight years fired her because, a representative told her, they believed she had a mental illness. Her rabbi called the school, and the school allowed Chaya to continue teaching as long as she didn’t talk with her students outside of the classroom. Almost immediately, she lost her motivation.
She moved in with an aunt in a basement apartment in Brooklyn. At 26, she was back down to 64 pounds. She taught in a Brooklyn girl’s school but quit when she was no longer able to climb the stairs or remember the names of her students.
As Chaya’s heart rate and blood pressure steadily declined, her doctor called Hatzola, the Jewish volunteer emergency services. Two burly members of the organization attempted to take her to the hospital but she fled and slipped into an alcove belonging to a museum. She found an empty office and crawled under a desk. Chaya envisioned spending the rest of her life there. Outside she heard security guards ask if anyone had seen a “little girl with brown hair.”
Her first thought was that she was not little—she was fat.
She came out with her hands up.
Chaya went to three treatment programs after that, including Cornell, Columbia, and finally Renfrew, where she still attends a therapy group. She is considered to be in recovery. “I understood I had an illness and there had to be better treatment than I had experienced,” she said. “I wanted a different life.”
She now speaks frequently about anorexia inside the Orthodox community; her number is often passed around to worried parents and those suffering from eating disorders. (When our interview ended she checked her phone and found a message from one of the people who’d been passed her number: a 29-year-old who suffered from anorexia but couldn’t attend a treatment program because it was co-ed.) She is also teaching full-time again and is considering pursuing a Ph.D. in clinical psychology. And she is dating, though these days she’s more immediately open with what she’s been through. She still lives in Brooklyn but now shares a house with her grandmother. She attends a weekly support group at Renfrew for recovered professionals and works with a nutritionist and a social worker.
And for the first time since she was 15, Chaya has finally stopped exercising.
“I think I enjoy life more than most people, because I lost it,” Chaya said. “How beautiful life is when you’re better.”
Michael Orbach is a writer living in New York.