AAMC Reporter, August 2000: Med Student Chronicles Her Struggle With Anorexia

VOLUME 9, NUMBER 11

JORDAN J. COHEN, M.D., PRESIDENT

AUGUST 2000

Med Student Chronicles Her Struggle With Anorexia

By Barbara A. Gabriel

In In 1996, 29-year-old Lori Gottlieb went through what she jokingly describes as her "quarter-life crisis." A successful Hollywood executive, Gott-lieb was growing dissatisfied with the entertainment industry. She began considering medical school, and during a trip home to look for her old high school chemistry and physics notes, she stumbled upon a diary she kept while growing up in Beverly Hills in 1978.

The 11-year-old she discovered in those pages chronicled her battle with anorexia nervosa, providing an in-depth glimpse into the world of a precocious little girl living in a place where physical appearance meant everything and every female she knew was "on a diet."

Gottlieb's desire for acceptance eventually led to her determination to be "the thinnest 11-year-old on the planet." The result: her weight eventually plummeted to below 60 pounds, landing her in the hospital.

Gottlieb is now a first-year medical student at the Stanford University School of Medicine, and her diaries were recently published by Simon & Schuster in Stick Figure: A Diary of My Former Self. The book has been optioned by filmmaker Martin Scorsese.

The AAMC Reporter talked to Gottlieb about her battle with anorexia, physicians' attitudes toward eating disorders, and society's ideals for women.

Q: What made you decide to publish your diary?

A: When I first found my diary, I shared it with various friends, who invariably told me that the concerns I expressed in my writing mirrored their own feelings while growing up. I felt I had struck some kind of universal chord about what it's like to grow up female in our culture, and that having a first-person account of that was probably a very powerful way of raising some important issues.

Q: Have attitudes about women and thinness changed much since 1978?

A: I think that awareness has changed, but attitudes have not. At a very young age, girls are exposed to a lot of sexuality through the media, and along with that sexuality comes what we consider to be a sexual body-and today that's a very thin, anorexic-looking body. And so girls, no matter where they live, are saying to themselves, "I need to emulate that." The standard is so incredibly skinny at this point that I wonder whether the problem has gotten worse.

Q: From the perspective of a former Hollywood executive, what role do you feel popular culture plays in shaping young girls' self-conceptions?

A: I don't think that the media causes anorexia. I did have problems working in an environment in which we'd have actresses come in for casting sessions, and they would be discussed not in terms of their acting ability, but as if they were pieces of meat -whether they looked a certain way or whether they had gained weight. I'd go to lunch with actresses who would have only a diet Coke and give no explanation, as if that was perfectly normal behavior. It upset me because I knew that the girls who were watching the shows, movies, or magazines these women were in didn't know what they had to go through in order to look that way.

Q: You have said that Stick Figure is less about you personally and more about prevailing cultural beliefs about femininity. What cultural value systems do you hope to expose with your book?

A: I'm hoping the book will help people examine some of the gender assumptions that we take for granted in our culture. For example, when people see a little girl and a little boy, they usually compliment the girl on her appearance and ask the boy about his interests. I'm hoping that we can reexamine some of these assumptions- such as the belief that girls are by nature interested in clothes, shopping, and boys -and say, no, girls are interested in a lot of other things, and we need to develop those sides of them.

Q: What was effective and ineffective about how your doctors treated you?

A: What was ineffective was the way I was treated as a disease rather than a person. Anorexia was poorly understood, and I was on a pediatric unit in a hospital where the other patients around me had illnesses that were more quantifiable. There was a lot of disdain for something that my physicians thought could be easily controlled. However, one nurse in the hospital did take time to learn who I was and didn't constantly engage me in a battle of wills over whether I would eat or not.

I think people today know that extreme adolescent dieting is a symptom of a larger problem and needs to be addressed by a medical team. The focus should be on how physicians can find a way to instill in girls an appreciation of their bodies that incorporates a health perspective rather than the way they look in a mirror.

Q: What would you, as a future doctor, have told your 11-year-old anorexic self?

A: I was dealing with an overarching insecurity that I think is applicable to anorexics across the board. They doubt whether they will be loveable as themselves. The diet is a way to say, "Well, society loves people who look this way, so if I can be beautiful then people will notice me. I won't be invisible." But at the same time you are ironically becoming invisible. I would want to somehow get the message across to myself that I was a valuable person, and that making myself look a certain way was not going to change who I was.

08 February 2005