The Deadliest One

A message about Anorexia Nervosa

October 2, 2020

Anne Schindler of First Coast News reports Kimberly Kessler, a Nassau County inmate charged with first degree murder, is in danger of dying of starvation. Corrections personnel are seeking a court order to force-feed her.

Her starvation is not the fault of the corrections staff, nor is it, I believe, willful behavior. I have not met Kessler. But I have met the monster I believe* is now threatening her life.

Fortunately, my loved one survived it.

Kessler’s life is most likely in danger from the deadly eating disorder, Anorexia Nervosa. If so, food is the first and most important prescription necessary to save her life.

It is no less important than insulin to a diabetic with high blood sugar, whom we would unquestionably medicate, even if his illness resulted in an altered mental state.

Further, the intervention needs to occur in a medical setting, not a jail.

Anorexia nervosa is a poorly understood mental illness.  

It’s a genetically based disease that some scientists believe may have benefitted our ancestors, long ago in our hunter-gatherer days, as they tried to avoid starvation. After a certain period of sustained, lowered caloric intake, the theory goes, the AN gene “flips on” to boost a person’s energy.

According to this evolutionary theory, the ones “blessed” with the AN gene during early human history experienced a manic state, and could venture out farther, with more endurance, to help their tribe find food. The tribe would presumably nurse them back to health after the ordeal.

Nowadays, however, our brain “hardware,” i.e., our genetic makeup, gets all tangled up with the “software,” i.e., culturally influenced behaviors.

Since the mania associated with AN is “ego syntonic,” the brain enjoys the feeling of euphoria and seeks to continue the behavior that activated the gene–foregoing food. Throw in prevailing cultural ideas about ideal body images, and you get a self-reinforcing, cultural-behavioral-genetic cycle that will absolutely persist until either the person gets fed, or dies.

Given our society’s strict gender norms regarding body image and thinness, most victims of AN are women.

Untreated, AN is the deadliest of all mental illnesses. Without forced feeding, Kessler will die.

*I’m not a trained psychologist or psychiatrist, but when you’ve seen the monster up close and personal—closely enough to have to learn how it operates—it becomes a duty to share one’s perspective with the rest of the world, particularly when someone’s life could be in danger. Again, I haven’t met Kessler.

From where I sit, however, the dots are presenting themselves too clearly to not connect them.

Our family had to travel hundreds of miles away to get competent, science-based help for our loved one. Dr. Sarah Ravin in Coral Gables provided lifesaving guidance, which helped our family member survive and thrive.

Information about evidence-based treatments for eating disorders can be found on Dr. Ravin’s website pages.

My heart, and my deepest condolences go out to the victims of Kimberly Kessler’s alleged murder, the beloved family of Joleen Cummings.  

I cannot imagine the pain of losing a loved one to homicide. Nor can I imagine the horror of facing the possibility that AN-related psychosis may have played a role in her (alleged) murder.

But I do know how deadly that monster is.

As the court personnel do their important and urgent work of parsing out the legal definitions of sanity, in light of what we know about mental illness, I hope they’ll prevent this monster from taking a second life.