"Why are you betraying me? Why aren't you listening?" the voice shouts. "We went so long doing this together, and we're so strong."
The voice inside Zoe Prather's head gets loudest as she begins the re-feeding process. It is angry that she's undoing what anorexia has done to her body.
Prather, 18, of Lawrence, said once you've had an eating disorder with you for so long, it becomes like your protector.
"That's where the intention is in the beginning — its intention is never to kill you slowly, but that's what it does," she said.
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The voice teaches you how to lie, how to hide and how to push people away.
"If no one knows how much you're eating, and how little calories you're putting in, then no one can say anything." It sounds like your own voice in your head, but it's louder, and eventually it starts to blend with your own, Prather said.
The Lawrence Journal-World reports that for Prather and many others who struggle with eating disorders, the disease sprouts not only from negative body image but also a need for control. Prather noted roots in a childhood that gave her little authority over her own schedule or meals, coupled with a desire to be the perfect, obedient only child. She had little self-worth and was never happy with her body, plus she was bullied frequently.
But once she started to lose weight, her peers' affirmations of, "Oh, you look good," meant she needed to keep going. She was also a competitive swimmer, and she felt that she could be a better athlete if she started counting calories and over-exercising to counter everything she ate.
"I've kind of always felt like I don't belong and I shouldn't be here, and I'll never be pretty enough or skinny enough," Prather said. "And once you start losing weight and feel like you have control over something, it's hard to stop."
Tina Spanos, Prather's mother, said there's also a genetic predisposition to eating disorders, and oftentimes they're spurred by trauma.
Eating disorders also affect visual perception.
"We don't see our bodies the way other people do. When I was at 100 pounds, I thought that I looked like I weighed 200," Prather said. "I didn't understand why my clothes didn't fit because I looked like I'd gained weight instead of lost it."
By spring of her junior year at Free State High School, Prather was a shadow of herself.
"Her eating disorder had completely taken over," Spanos said. "The eating disorder is sneaky, it's angry, it's dark and it's loud."
That was when Prather entered treatment for the first time at McCallum Place, an eating disorder center in St. Louis. It was really her only option — mother and daughter both searched for treatment in Lawrence, but there aren't any specialists in town. They couldn't even find a support group.
"Our town does have a lot of really good support groups ... but this is a place where there's a hole," Spanos said.
Prather finished her junior year in treatment, but she knew it was a temporary state of recovery. By her second semester away at Missouri University of Science and Technology, Prather relapsed.
"I kind of knew that eventually I'd want that control back, and I always told myself, 'Well, when you're in college, you can eat what you want and when you want,'" Prather said. "It wasn't the right mindset to have, but it was what I had because I didn't want to let go of it for the first time."
Since her first stint in treatment, McCallum Place has opened a location at Menorah Medical Center in Leawood, and Prather is in its partial hospitalization program. She spends 10 hours there every day.
Each morning, the patients don hospital gowns to weigh in and get their blood pressure and pulses taken. On Mondays, they have their temperatures checked and blood drawn to make sure their bodies are relearning how to process nutrients correctly.
The patients work with therapists, psychiatrists and dietitians. They relearn how to eat, and they face their "fear foods" — the foods they've vilified most in their minds as ones that will make them gain weight instantly. They learn about the harmful effects starvation has on their bodies internally, such as damaging the heart and kidneys, and they work in several group sessions, one of which teaches them to distinguish between their own voice and the eating disorder's voice in their heads.
That voice makes the journey to recovery that much harder — there's a constant back-and-forth between "reminding yourself if you want to be in recovery or if you're just trying to go through the motions to get out of treatment," Prather said.
Spanos and Prather hope to raise awareness in Lawrence. The Lied Center, joining 90 other national landmarks, lit up with blue and green lights last week as part of National Eating Disorders Awareness Week.
Prather said she wants people to understand that this is a disease, it's not just about weight and it's not something people do for attention.
"It's not just about, 'Well, just eat. Just put the food in your mouth,'" she said. "It's gotten to the point where you're afraid of everything, and it's more about finding a reason to be happy, and finding the happiness within yourself, and finding love in yourself."
Spanos said it's crucial for loved ones to attend therapy sessions and do what they can to be good supporters when it's time to come home.
"Go to everything you can to learn and to get good, solid information, so when you're in a position to start helping that person with their meals, mentally, whatever that might be, that you have some skill and you're saying the right things," Spanos said. "Sometimes we'd have to sit for two hours to get through lunch. It takes a lot of patience."
Now, Prather is taking recovery one day at a time. She's learning to view her body as her "home."
"I want to be able to get to a place in my life where maybe I don't love my home, and I didn't get to pick it, but to be content with it and be able to fuel my home and continue to keep it healthy and clean — and living," she said. "Because I do know that even when it doesn't feel like it, I want to keep living, and that's not something I thought I wanted for a long time."
Information from: Lawrence (Kan.) Journal-World, http://www.ljworld.com
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