The Male Eating Disorder

GQ Magazine did an amazing article back in September 2012 about male eating disorders. The magazine followed four men who were either on a journey to recovery or relapsing. Each of the men have different stories to tell. Steven became bulimic after being dumped by his girlfriend who suffered from the same disease, it was a way of keeping her in his life. Blake became anorexic when he looked up dieting tips on a Eating Disorder forum. Will is someone who only weighed 55 pounds due to his anorexia brought on by inner struggles of not feeling good enough or loved. Finally John’s eating disorder was brought on by an extreme diet and yo-yo dieting mother. The article also brings to light the fact that 20% of men suffer from eating disorders and are unable to get treatment because it is seen as a “female” disease. I. Steven 280 lbs. By the time Steven’s girlfriend broke up with him for good, over Christmas of 2009, her bulimia had gotten so severe that her menstrual cycle had stopped. Her doctors in Saskatchewan, Canada, said she might be infertile. To Steven, who had been looking for a piece of land where they could build a house and start a family, the news was devastating. He had gone to family-support days at her residential treatment center, but he says her disease gradually shut him out—that’s what eating disorders do to loved ones. Danielle* had broken up with him over and over again, and each time the pain was unbearable for him. Twice he had tried to kill himself. To drown out the anguish, he had ramped up his partying. Bulimia was her thing, alcohol and cocaine were his. One night during that long, cold winter, after gorging on two plates of his mother’s lasagna, he went into the bathroom, turned on the shower to cover the sound, and stuck his fingers down his throat. Steven is five feet nine, and he weighed nearly 300 pounds at the time. In the past he had occasionally preempted a hangover by forcing himself to throw up. “It was like a high,” he says. “I felt like I’d gotten away with something. And then I knew that I could do it again, and pretty soon I was throwing up everything I was taking in.” His doctors would later call it trauma bonding—a way of keeping Danielle with him. Steven has another way of describing it: Getting dumped was like being bitten by a vampire. It turned him into her. 212 lbs. Steven comes from a family of “patch monkeys”—oil-field workers—and for two years he worked in electrical construction in the oil sands of Alberta, ten days on, four days off. His job was laying down power cable for the well pads. It was exhausting, dangerous work, but if you could hack it, you could make close to six figures straight out of high school. During winter, the temperature in the oil fields can fall below minus-forty degrees, cold enough for exposed skin to freeze instantly. Steven was risking frostbite when he would slip away into the bush after breakfast and lunch, pull aside his balaclava, and force himself to vomit. He’d kick snow over the steaming pile and hurry back to work. After dinner he’d return to his trailer, turn up his stereo, and puke into his garbage basket. Then he’d toss the bag in a Dumpster. This became his routine, but the secrecy wore him down. You had to hide the smell. The sound. Soon he found a neater, cleaner way: Instead of purging, he’d just eat less. By the early spring, he was consuming fewer than 400 calories a day—barely 15 percent of the recommended amount for a man of his size and occupation. He was drinking more than ever. In April 2010, after a bender nearly caused him to miss a flight back to the oil field, he checked himself into drug rehab. His diet by then was two rice cakes, two tablespoons of peanut butter, and one small banana. Per day. As recently as a decade ago, clinicians believed that only 5 percent of anorexics were male. Current estimates suggest it’s closer to 20 percent and rising fast: More men are getting ill, and more are being diagnosed. (One well-regarded Canadian study puts the number at 30 percent.) It’s unclear why, but certainly twenty years of lean, muscular male physiques in advertising, movies, sports, and of course, magazines like GQ—from Marky Mark to Brad Pitt to David Beckham—have changed the way both men and women regard the male body. And thanks to the web, those images are easy to seek out and collect. For American men, the chiseled six-pack has become the fetishized equivalent of bigger breasts. Like all fetish objects, it stands for something deeply desired: social acceptance, the love of a parent or partner, happiness. But many afflicted men feel too stigmatized to go to a doctor—and many doctors don’t recognize the early, ambiguous symptoms. “It is not what a primary-care physician will consider at first glance,” says Mark Warren, founder of the Cleveland Center for Eating Disorders. “Often it won’t be what they consider at fourth or fifth glance.” Diagnosis is hard. Finding treatment is even harder. Many residential centers don’t admit men, out of a belief that treatment should be sex-specific. There is no data to support this belief, though clinicians think that certain gender-specific issues are best addressed in therapy or in single-sex groups within a larger coed facility. Some centers prefer not to treat men, because they may inadvertently remind female clients of the trauma they have endured at the hands of abusive fathers, husbands, or lovers. Of the fifty-eight residential treatment centers listed in the Alliance for Eating Disorder Awareness’s 2011-12 guide, only twenty-five admit men. “Most men with eating disorders are living with them quietly and painfully,” says Warren. “I would guess at least three-quarters of them don’t get any treatment. They’re suffering without help.” 129 lbs. Steven got lucky in drug rehab: One of his counselors was a recovering bulimic. The first thing she told him was that he would die if he continued eating only 400 calories a day. Together they created an 800-calorie menu: two hard-boiled eggs and two pieces of toast for breakfast, a banana and a cheese stick for a snack, and portion-controlled versions of the day’s cafeteria meal for lunch and dinner. During his thirty-four days in rehab, Steven nonetheless lost almost a pound a day. Within two months of being discharged, he was consuming 1,200 calories daily, still a dangerously low amount. But he believed he was getting better. He was eating every two and a half hours. Steven had been overweight as a kid and often depressed. He remembered thinking that his life would be so much better if only he were thin. Even now he believed his weight was the only thing holding him back. He told himself that all his troubles were going to be over soon. In the first sixteen months of his disease, he lost more than 150 pounds. He was constantly sore, constantly tired; he remembers going for a massage and hearing the masseuse gasp when she saw his naked back. A summer breeze would make him shiver uncontrollably. His friends fell away as he descended into “deep, deep isolation.” He began calling residential eating-disorder facilities, but he couldn’t find one that would admit men. “It was incredibly frustrating,” he says with a pained smile. “It takes an incredible amount of balls to ask for help, because it’s thought of as a girl’s disease, and you finally work up the courage and there’s nothing there.” Drug rehab, he points out, isn’t gender-exclusive. Neither is rehab for sex addiction. For fear of encountering food, he rarely left his apartment. Instead he sat in front of his computer and made lists of dream meals he would never eat—a stuffed-crust pizza from Pizza Hut, a cheeseburger he read about online that used the halves of a Krispy Kreme doughnut for a bun. One doctor told him to try a nutrition shake called Ensure. “You just can’t,” Steven says. “Like, if I did, I might have a heart attack and die. They don’t understand the kind of anxiety you feel.” Being obese for so many years had permanently stretched the skin of his torso. To him, the folds that pooled around his navel and hung from his pecs looked like fat. His mother had been trying desperately to make Steven see how emaciated he’d become. What if I showed you a photo? she asked. As Steven stripped down to his boxers, she snapped four pictures. Above his jutting hipbones, his waist is so deeply indented that it looks Photoshopped. His features are masklike and vacant, but from behind the mask his eyes look bewildered and frightened. His physical wastedness is like a plea. Anorexics may not look the way they want to look, but they always look the way they feel. 158 lbs. “When I saw the pictures,” Steven, 25, says now, “I knew I was mentally fuckin’ crazy to think I was fat.” He began forcing himself to eat, progressively increasing his intake to 2,200 calories a day (the same willpower that has carried him into his third year of sobriety). But even now he weighs almost everything he eats. Breakfast, for example, is thirty grams of oatmeal with one chopped apple and one cup—”118 to 125 grams”—of blueberries. We are sitting in a hotel restaurant in Saskatoon. When the waiter appears, Steven interrupts his story to ask if the steak is prepared using oil and, if so, what kind and how much. The waiter is stumped. He leaves to confer with the chef. “A little bit of oil increases the calories,” Steven explains. “You never know by how many.” He tells me that he always orders steak or fish in restaurants, because the calories tend to be consistent. He glances around the room eagerly but furtively, as if he’s not sure he’s supposed to be here. Eating in restaurants makes him giddy, he says. It makes him feel as if he’s getting better. Steven now works for a company doing electrical-equipment estimates for major commercial construction projects. He’s good at his job. He’s obsessive about details, and he has an earnest manner that makes you trust him. His tattoos and long hair make him look like a heavy-metal drummer, and in fact he used to dream of being one. But it wasn’t just about the music. He was—still is—fascinated by gaunt musicians like Slash and Shannon Larkin. He collects photographs of them on his hard drive. He sees a therapist, and lately he’s been preoccupied with the same questions: Am I ready to start dating again? Why am I so emotionally detached? Why don’t I feel close to anything? She tells him that all the drugs and the malnourishment depleted his body of endorphins and that his body needs time to resume producing them. He has a new routine. Every Wednesday night, he stops eating and drinking at 7 p.m. He wakes up at six the next morning and turns on Howard Stern (another gaunt hero of his). He empties his bowels and his bladder. Then he steps onto a scale. Anorexia is diagnosed on the basis of three criteria: self-induced starvation, a morbid fear of fatness, and the suppression of sex-hormone production. Along with those symptoms, an anorexic either has a body-mass index below 18.5 (the statistic is a measurement of body fat; for a six-foot-tall man, a BMI of 18.5 would mean weighing less than 137 pounds) or has lost more than 30 percent of his ideal body weight. A male anorexic tends to conform to a particular personality type: “anxious, obsessive, persevering, and perfectionistic,” according to Arnold Andersen of the University of Iowa. He is desperate to please and hypersensitive to rejection and humiliation. The illness typically takes root during adolescence, and it is almost never the first, or only, way he tries to deal with social, sexual, or academic anxiety: He may also use drugs, or cut himself, or have OCD. A young man faces a heightened risk if he was overweight in grade school and teased for it, or if obesity or eating disorders run in his family, or if he participates in a sport that emphasizes speed or weight control (such as wrestling, distance running, or cycling), or if he’s gay, as are an estimated 18 percent of male anorexics. The neurological roots of anorexia remain elusive, but one promising avenue pinpoints a region of the brain’s gray matter called the insula. Among its functions are satiety and bodily awareness. When there’s too much norepinephrine (a stress hormone) in the insula, as there is in the brains of anorexics, these senses are distorted: Anorexics feel full when their stomachs are empty and see a fat person when they look in the mirror. Their pain threshold is elevated. Their fight-or-flight response is permanently switched on. Anorexics exist in a state of near-constant panic, and for reasons no one understands, that panic attaches itself to food. In the early stages of the disease, an anorexic experiences a sense of accomplishment and an exhilarating clarity of mind. His body is still making endorphins, and he throws himself into exercise with the single-mindedness of an Olympic athlete, even if his own goal is always receding. As the disease burrows in and the malnourished body begins to conserve its resources by shutting down hormone production, he goes numb. His libido vanishes. Other people cease to exist for him. The anorexic starts out trying to control food and ends up being controlled by it. Virtually every decision he makes is dictated by his horror of it. II. Blake* In the living room of his parents’ house, there is a framed montage of school photos of Blake from kindergarten through twelfth grade. A laughing blond little boy slowly dissolves into a dark-haired high school senior with pinched features. Beneath his wide shoulders and loose shirt, his bare arms look far too long and thin for his body, like the arms of an El Greco saint. When he was 12, Blake was a state-ranked chess player, a clarinetist, and a good soccer player and swimmer. In high school, though, he started becoming forgetful and unable to concentrate. He was tested and eventually diagnosed, dubiously, with a “processing-speed deficit.” Blake began dieting at 17. Then he discovered eating-disorder blogs, and his life changed. On a website called PrettyThin, he began communicating, and competing, with people who he says were “trying to get their numbers down.” He was six feet one, 145 pounds: thin, but not impressive in this world. People in the forums wrote scornfully about “wannarexics”—wannabe anorexics, and Blake was terrified that he might be one. Nothing could be worse than that—to be told he didn’t belong, not even here. To avoid eating, he’d apologetically point to the chewing gum in his mouth. (He carried gum everywhere.) He’d wear a medical-ID diabetes bracelet so that he could turn down sweets. He’d cut food into pieces too tiny to pick up with his fork. Sometimes he’d deliberately spill milk onto his plate. And if none of that worked, he’d make himself throw up. Today Blake weighs just enough to hold at bay the suspicions of his mother, who’s a PE teacher. He is what’s known as a subclinical anorexic. His weight is low but not life-endangering, and he eats only as much as he needs to maintain it. He still overexercises, but not to the same degree as before. He runs ten miles round-trip to go to his part-time job and shop for food. (He’s a vegetarian, and he eats mostly raw foods.) If he has to travel longer distances, he drives his father’s car but parks it in the most remote space in the lot. His attitude toward food is part of a consistent ascetic philosophy: He doesn’t listen to the radio, use air-conditioning or heat, watch TV, go to the movies, drink, or do drugs. He says that he’d prefer to be homeless, as long as he could take a shower before going to work. At a Whole Foods near his parents’ house, Blake surveys the salad bar. Salmon is off-limits, as are chicken, eggs, blue cheese… He says he wouldn’t even be eating this meal if I weren’t with him. I ask how he’d handle being here with a family member. He wouldn’t make a fuss, he says. “I have extreme paranoia about people finding out and trying to institutionalize me.” Blake is extremely gaunt, with startling green eyes, a prominent jaw, and a small, reddish goatee. Around his neck he wears a silver peace-symbol pendant the size of a drink coaster. He almost always has on a black cloth cap, and he uses its visor to avoid making eye contact. He frequently volunteers in his community, and today he’s wearing a T-shirt from a recent blood drive that reads ARE YOU MY TYPE? Blake is 21 now and says he can’t wait to move out of his parents’ house so he can eat less. Sometimes the portion sizes are just too big. Sometimes he’d prefer to skip a meal entirely. Although he loves being around people, he says, he also feels compelled to avoid them. “Because people are the ones who force you to eat.” His low GPA, the product of his illness, haunts him. He says he’s disappointed his parents. But this past semester he did well enough to transfer from community college to a good state university. He lights up when he talks about it. He just visited the campus, and what excited him most, he says, were all the hills and stairs. Anorexia has the highest mortality rate, between 5 and 10 percent, of any mental illness. Half of the deaths are by suicide, the other half from medical complications. The illness lasts an average of eight years in men, a third longer than in females, probably because men wait longer to seek treatment. Twenty percent of recovered anorexics die before reaching their life expectancy. Like a layer of soil that reveals a long-ago period of drought, the organs of an anorexic’s body seem to retain the scars of being starved. Without potassium, the muscles of the heart weaken and develop rhythmic abnormalities that can be fatal, particularly if the patient is a relentless overexerciser. Bones deprived of calcium lose their density, causing osteoporosis. The condition is insidious and hard to treat. You may think you’ve fully recovered from a five-year bout with anorexia, but without your realizing it, your bones have begun to rot. At 40, stepping off a curb, you might suffer a spinal-compression fracture, losing inches of height. The disease can also cause irreversible cognitive damage: The brains of severe anorexics are often indistinguishable on MRIs from those of Alzheimer’s patients. In preadolescents, anorexia halts puberty. A boy’s voice doesn’t change, he doesn’t grow facial or pubic hair, the growth plates of his bones don’t fuse. If he can return to a healthy weight, all these mechanisms will probably start up again, even after a decade. You can die from not eating, and you can also die from eating again. As an anorexic begins to ingest food, the rate of his blood circulation increases. Sometimes his atrophied heart can’t handle it. This condition is called refeeding syndrome, and it can be fatal. III. Will 55 lbs. The Acute Center treats the nation’s most desperately ill anorexics—men and women whose BMIs are in the single and low double digits and who weigh 70 percent or less of their ideal weight. Often patients arrive here on the verge of death. Sometimes they are brought by air ambulance. Sometimes, as if to make a statement about their self-sufficiency even amid the ravages of the disease, they gather bags that weigh more than they do and fly to Denver all alone. That’s what Will has done. A week ago, on the day of his arrival, he could barely lift his head from his pillow. Today, as his doctor and I enter his room, he stands up from his bed, his knees buckling. He is wearing shorts and a short-sleeve shirt. He looks like he’s 10 years old and 80 years old at the same time. His forearms are as wide as my two fingers, and his knees are wider than his thighs. His teeth protrude because the skin is stretched so tightly across his face. His thick blond hair sticks out in all directions; it looks as dry and brittle as dead grass. Will has been struggling with anorexia for a decade, since he was 11; the last year of school he attended from start to finish was sixth grade. He is a devout Christian, and this is his fourth hospitalization in the Acute Center in three years. “He’s been within days of death many times in his life,” says Jennifer Gaudiani, his doctor. “Will is one of a number of patients we’ve seen who get better but not well.” Will’s neatly folded clothes cover the room’s wide window ledge. He sits down at a small table nearby. He speaks with the voice of a child—the voice of an 11-year-old preserved in amber, the voice of a 21-year-old who has never gone through puberty. He is alternately proud, raging, despondent, helpless, anguished, and charming. During our conversation, he frequently weeps. It began when I was in middle school. I had grown up swimming competitively, and I was a pretty elite swimmer—went to state, placed in state. I was having panic attacks, so I quit. Both my parents were collegiate swimmers. They never said, “You gotta achieve, you gotta succeed.” They encouraged me and complimented me. But I took that as “You gotta go even above that.” When I was looking good, I may have only been four foot nothin’, but I had the six-pack and I was cut. I got the attention. But it was never enough. It wasn’t necessarily about my body at the beginning. It was more of, like, my size. The guys around me were starting to grow, and I wasn’t. In middle school I was insecure and wanting to make up for it. The new thing was about controlling my food and my body so that I could look and feel good, fit in. The eating disorder came because I needed something else to excel at. Up close, lanugo is visible on Will’s cheeks—the soft yellow hair that grows on an anorexic’s body, most likely to conserve heat. It gradually falls away as an anorexic returns to health. I was everybody’s friend in middle school, but I was always, like, the little buddy. Not having a sex drive because of the eating disorder was just a smack in the face. Like, that’s something else to make you different. I compared my insides with people’s outsides, you know? And the eating disorder became a numbing-out mechanism, a way to distract myself from how lonely and empty I felt. Getting help at that young of an age and being a male was like shooting in the dark and expecting to get a bull’s-eye. When I did find places, I was the only male, and a lot of the material that they were doing in the groups was all about females. On some issues, like the body-image stuff, their concern was completely different than mine. A lot of the females are dealing with abuse, so they’re not going to trust men. And I would take that personally at times, because I do just love people and want to help. Then it’s awkward because they don’t want to say certain things because I’m there, and I see that in them, and then you just don’t feel like you can open up to really anybody. Eventually it reinforced the insecurities and the feeling worthless. That even in getting help, I was still the odd man out. It made for almost a bitterness or an anger toward the eating-disorder community. He pauses repeatedly to open and close his jaw. Later his doctor explains to me that Will has lost fat even on the tiny pad near his middle ear that seals his Eustachian tube. With the tube open continuously, Will hears a constant rushing of air, as if he’s in a wind tunnel. Shifting his jaw closes the tube temporarily. Food became my identity: I’m good if I eat this, this, this, this; I’m bad if I don’t follow my meal plan. There was a lot of: “My parents are telling me to do this, and I can’t do it, and they’re disappointed in me.” It made me think that all their emotions depend on what I’m able to eat that day. You know that eating will make you healthy. What is it that prevents you from eating? Like, right now? Because then I don’t have an excuse anymore, I guess? For what? For not being perfect. Or I have to face that emptiness inside of me. Or at this point in my life, I have to face my past, you know? I have to face the bad choices of staying in the eating disorder and the loss that I have from that. Your doctors obviously care for you as a person, not simply because you’re their patient. There’s a tenderness in the way they talk about you. I guess that’s why I have this issue, because I don’t feel that. Ever. Do you understand that there are people who love you? That’s what I’m wrestling with right now. No matter what I do, I just don’t feel loved. But something keeps you coming back here to get help. What is it? It’s my God. It’s God. Because I know, I know, I know deep at my core, and I may not be able to live it out right now, and I may not be able to grasp it, but I know that love is there. I know that. From just intellectually looking at my life and just seeing His hand and His guidance. I remember lying in my bed, and I was praying—I was like 8 years old—I said, “God, you know I give my life to you.” I was this super-fired-up little kid: “I don’t care if I have to go in the cafeteria tomorrow and dive in front of ninjas who are throwing ninja stars at Betty and Steve and take it for the team. Use me whatever way you want!” I look back and I see what I’ve lost. But that’s where my hope is that I can get back to that childlike zest for life: in my God. And there’s no reason I should be alive. There’s no scientific reason that my body should still be functioning. I have been at death’s door way too many times. Something’s there. IV. JOHN* There are blank spots in John’s life that he can’t fill, periods of time he can’t remember: weeks, maybe months, living with his stepfather, who bullied him. Huge swaths of his adolescence, when he’d cut his arms with a razor blade to punish himself for overeating or to calm himself after some high school humiliation. The two days he went missing in July 2010, which ended with him waking up at the bottom of a ravine, bleeding and bruised, his car neatly parked on the mountain road above. Somewhere among these events may be a clue to the mystery of why he got sick. Or maybe the clue is at the very beginning of his story: When his brother was born, John was sent to preschool, where he refused to eat unless he was fed by hand. He was 3 years old. John, now 35, has several “body-checking” routines. He notes how loose his watch is, and the waistband of his pants. Then he spreads his fingers as wide as they’ll go and searches for the indentation on the back of his hand where the thumb tendons meet the wrist. He remembers seeing a close-up of Brad Pitt’s hands in Mr. & Mrs. Smith and thinking, “He’s got it!” He remembers Philip Seymour Hoffman’s hands in Mission: Impossible III: He didn’t have it. Entering college, John weighed 140 pounds. By the time he graduated from law school and began working full-time, his weight had doubled, to 280 pounds. He had seen drastic gains and losses in the past, but this time he “freaked.” He cut his daily intake to 350 calories—a sixteen-ounce Gatorade, a Subway grilled-chicken salad, and a cup of coffee—and began cycling to work, thirty-four miles round-trip. He lost more than one hundred pounds in eight months. In May 2008, his mother, visiting Los Angeles from out of town, told him he looked great. She was a yo-yo dieter herself. When she came back in August, she said it again: You look great. But this time, she confided, she actually meant it. He had just been let go from his job. John has degrees in law and engineering and a true photographic memory, but he’d become so malnourished that his mind couldn’t hold a thought. He’d also become so numb that he no longer cared. His anorexia was full-blown. He couldn’t control the overexercising, and he couldn’t stop overcontrolling the eating. In September his therapist at a Monte Nido outpatient program in Los Angeles recommended that he enter residential treatment. But Monte Nido’s residential centers didn’t admit men, nor did any other similar facility in Los Angeles County at the time. By December he weighed 160 pounds, and he was admitted to Castlewood in Missouri. There he finally began to improve. During Family Week, the clinical director gave a speech that resonated with him: If normal people are Ford Escorts, he said, then Castlewood’s clients are Ferraris—brilliant but high-maintenance and neurotic. John was discharged weighing 170 pounds. But after he returned to Los Angeles, he quickly relapsed. He spent the next two years in and out of treatment, trying and failing to control his disease. In April 2010, he entered an inpatient program in New Orleans, but before he’d even completed the stipulated thirty days, his insurance company cut him off, having decided his health was not immediately in jeopardy. He came home to a condo that was about to go into foreclosure. He was unemployed and living on disability insurance. He began trying to give away his car and his dog. He didn’t expect to live much longer. And yet, simultaneously, he began drafting a sex-discrimination lawsuit against Monte Nido’s residential centers in California. On August 30, he staged a call to the facility, knowing they’d tell him they admitted only women. “I think people have to see Monte Nido to understand, because it sounds just like full-on discrimination,” Carolyn Costin, the center’s founder and executive director, says today. “But I think if you’re there and you see the close quarters they’re in, in their jammies being weighed, you know, talking about their menstruation… Adolescent girls, they and their parents don’t want them to be next to adult men.” (Spurred by the rise in male anorexia, Costin says, she is thinking of adding a program for men.) On September 2, John filed his lawsuit in Los Angeles Superior Court. He was convinced he had the law on his side. Indisputably he had the inhuman discipline that accompanies his disease: Never go to court against an anorexic lawyer. In the filings that followed, John went punch for punch with Monte Nido’s counsel, which included a large international law firm. A jury trial was scheduled for May 29, 2012. John texts nonstop as he weaves through Santa Monica traffic in his red BMW convertible (“a piece-of-shit 3 Series,” he says later as he hands the keys to an admiring valet). He drives aggressively, gunning the engine to beat red lights, which causes me to repeatedly slam backward into my seat. On the stereo, he blasts Ke$ha, Mika, and Lisa Loeb. “All this music ended up on my iPod,” he says, “because I was spending three months with nothing but young women.” Taken together, his luxuries betray an affluence that ran out, somewhat suddenly, about four years ago. It’s slowly coming back; he has a new job that he loves, and it has allowed him to hold on to everything he was about to lose. John and I are on our way to a barbecue at his friend Kate’s house. Kate* is the only person who stuck by him as anorexia drove him further into himself. Her son, Andy,* who was 6 when John met him and is now 13, adores John, but Kate has only recently allowed them to spend time together again. She was protecting Andy. For much of the night, John and Andy quote dialogue at each other, from Futurama, South Park, and The Princess Bride. John has an Asperger’s-like fascination with the guts of machines—cameras, automobile engines, nuclear reactors—and he holds forth to Andy on the persistence-of-vision phenomenon and its implications for film and video (specifically in Peter Jackson’s The Hobbit). Andy is riveted. When food is served, John eats as if it’s a relearned behavior, as if he’s a robot trying to pass as human. He tells me he eats only because not eating will trigger a sequence of events that begins with him losing his job: “And if I lose the job…” Mordantly he observes that he still reads articles about the Golden Gate Bridge to see “whether or not they’ve ever gotten around to installing that suicide barrier.” He calls it his Plan C. We stand apart from the other guests for a moment, and John startles me by saying, abruptly, that he’s decided to settle his lawsuit. Monte Nido has hired new lawyers, and in his view they’re no longer arguing the case on its merits; instead, he says, they’re strategically outspending him. John can’t afford to depose their out-of-state witnesses or to hire his own experts. He knows that a judgment against him would have a chilling effect on future litigation of this kind, so he’s reached out to Monte Nido through a mediator. The terms of the settlement will be confidential. John likens himself to the John Travolta character in A Civil Action, who runs out of money fighting three giant corporations that have contaminated the water supply of a Massachusetts town. At the end of the movie, Travolta packs up his files and mails them to the EPA, hoping someone there will finish what he started. John tells me he still feels fat all the time. The goal is to not think this way—he knows that. “But the people I know who have gone through treatment and say they’re at that point? This is going to sound awful, but they’re fat.” Is it possible, I ask him, that he might feel differently if he had a partner who loved him? He snorts. “It’s kind of like saying, ‘Once you’re on the moon, what’s it going to be like to look at the earth?’ Ask me when I get there.”