With HOPE AND OTHER LUXURIES, successful YA novelist Clare B. Dunkle joins a long line of celebrities, including journalist Marya Hornbacher and actor Portia de Rossi, who have shared their physically painful and emotionally tumultuous experiences with eating disorders.

The Diagnostic and Statistical Manual V (DSM-V) --- essentially the psychologist’s handbook --- defines several “feeding and eating disorders,” all of which are marked by persistent and harmful deviations from what we define as normal eating patterns. To date, researchers have yet to discover a definitive reason for why and how these disorders develop. As far as we know, eating disorders such as anorexia and bulimia tend to primarily affect women, and often occur in response to a traumatic event (e.g., rape, sexual assault, divorce). The symptoms that arise include severe food restricting, binging and purging, or excessive exercise, and function to exert control in an uncontrollable world, meet media-propagated beauty standards or dampen intense negative emotions --- and sometimes to deal with all three.

Unlike Hornbacher and de Rossi, Dunkle offers a fairly unique perspective in the eating disorders memoir literature by providing a voice for the family members who suffer alongside their ill relatives. Perhaps unintentionally, her book is coming out at a time when family-based treatment is becoming increasingly popular among eating disorder researchers and clinicians. The Maudsley Method, a recent but widely used type of treatment, attempts to instruct families how to help their adolescents with anorexia by encouraging them to normalize their weight and eating patterns. Psychologists, however, have yet to pay adequate attention to the emotional and psychological experiences of patients’ loved ones. Dunkle provides them with a voice.

"Overall, HOPE AND OTHER LUXURIES is important, informative and provocative. I hope that Dunkle’s story will inspire others who love those suffering from mental illness to speak up about their experiences."

In HOPE AND OTHER LUXURIES, Dunkle shares her experiences raising her daughter Elena, who struggles with anorexia during her adolescent years. Dunkle, her husband Joe, and their two daughters move from their home state of Texas to Germany, where Elena and her sister initially flourish in an all-girls boarding school. The young Elena is described as an enthusiastic go-getter. She takes delight in telling her mom fantastical stories and fighting for the bullied, underserved and ill. But suddenly, Elena loses her zest for life. She holes up in her room, sleeps all day, and snaps at her family members when they try to connect with her.

Although Dunkle had some prior experience with mental health and the treatment system --- her other daughter, Valerie, attempted suicide prior to the onset of Elena’s eating disorder --- she spends the majority of the book describing her struggles both accepting Elena’s diagnosis and getting her the treatment she so desperately needs. Their first encounter with an eating disorder treatment provider, Dr. Petras, did not augur well for the rest of their experiences. Although the doctor aptly diagnosed Elena with anorexia nervosa, his abrasive delivery, in addition to mixed messages from subsequent treatment providers, encouraged Dunkle to fight against Elena’s diagnosis. Elena, who also resisted the term, eventually tells her mother about the traumas she had experienced prior to exhibiting symptoms of the disorder. While away at boarding school, she was raped at the tragically young age of 13. Later, she suffered an unrelated miscarriage.

Finally, Dunkle begins to understand what Elena had really been through. I don’t say this to blame Dunkle for misunderstanding. The scarcity of information about, and funded treatment for, eating disorders is criminal. Dunkle’s admission that she had incomplete understanding of her daughter’s illness is powerful and brave. Undeserved self-blame and guilt on the part of parents of the mentally ill is common, yet there are few who are willing to tell their stories for the benefit of others as Dunkle does here.

Dunkle also highlights the inadequacy of treatment for eating disorders and, frankly, all mental health issues in this country. Elena bounces from program to program, where many of her providers are not versed in eating disorder symptomatology or treatment. When Dunkle is able to find a specialized program for Elena, her insurance cuts her off as soon as she starts making progress. She describes her tedious and often expensive process in navigating the medical insurance system, and determines that when it comes down to it, our insurance system is more concerned with money than health.

Dunkle brings up several important points about the emotional, interpersonal and monetary costs of living with someone afflicted with an eating disorder. Her book, however, suffers somewhat from a lack of editing. Clocking in at a whopping 557 pages, it can feel more like an emotional exorcism than a memoir. Throughout, she weaves in excerpts from her YA novels, attempting to give readers insight into how her struggles with Elena influenced her writing. The impulse is understandable --- art imitates life, and vice versa --- but reading about her writing process felt exhausting at times.

Overall, HOPE AND OTHER LUXURIES is important, informative and provocative. I hope that Dunkle’s story will inspire others who love those suffering from mental illness to speak up about their experiences. Only with awareness and understanding can we achieve better treatment for ourselves and our loved ones.