Motivated at first by an attachment to her strict and demanding ballet teacher, as well as frustration and disgust with her own body compared to other dancers', Francesca develops an obsession with weight loss and increasingly ritualized forms of self-discipline in eating and exercise that lead to severe anorexia nervosa. It takes her family several months to see and acknowledge what is happening in front of them, during which she has trained herself to eat less and less, to throw up after meals, and to push herself to the point of exhaustion.

She becomes secretive, isolates herself from friends, and puts up a wall between herself and her parents, who are unable fully to understand the degree to which her behavior has gone beyond her control, but are worried. A compassionate male therapist with clear boundaries and a non-judgmental approach finally succeeds in disengaging Francesca from the mutually destructive downward spiral of family conflict around her illness;

he helps her to envision and desire her own health and to take responsibility for recovery. The story is told in the third person, but from Francesca's point of view.


This is a sensitive but forthright book about a hard subject. Fraught with taboos, the subject of anorexia nervosa and all its accompanying behaviors, and the grotesque ways it manifests itself in its more severe forms, is difficult for many to bring to discussion, or even to full consciousness. The book succeeds in portraying the young girl's predicament compassionately without, however, overlooking her own responsibility for self-destructive choices.

The therapist does not emerge as a hero figure, but as someone who has learned a particular kind of doggedness and patience with a particularly stubborn kind of disease. The parents might have been treated in a more complex fashion, but they are not reduced to the stereotypically obtuse authoritarians or helpless hand-wringers of so many current popular media portrayals.

They are concerned people who have gradually lost touch with their daughter's changing needs and inner life, and who need to open themselves to reexamining their marriage and family dynamics, and to accepting the child's illness as, in part, a function of family system disorder. A hard book to read, but useful, informative and accessibly written.


Steven Levenkron is a psychotherapist who has written about treatment of anorexia nervosa and obsessive-compulsive disorders. This novel won the American Library Association Best Book for Young Adults Award.



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