CHAPTER 1

CELEBRATION IS IN ORDER

You can never be too rich or too thin.

Wallis Simpson, Duchess of Windsor

By the time they brought the patient to him, the situationlooked grave. "Miss A," as she was called in medicaljournals, was visibly stricken, and her motor skills had beenreduced to semi-controlled trembles—the telltale movementsof someone nearing the end. In the confusing mix ofsymptoms, her family suspected tuberculosis or a blood disease.She looked less like a treatable patient and more like adiscarded cadaver from behind the town hospice. Her cheekswere sunken and her skin was like cheesecloth draped over afossil. The notion that this doctor could save her was a longshot. The possibility that she would make a complete recoverywas inconceivable.

Miss A's pulse was an exceptionally low forty-six, and herrespiration was weak. But there was a nervous energy abouther that suggested very high hormone levels. It didn't makesense. Her organ function, urine, and appetite were all normal.And yet she was clearly dying.

In 1866, modern medicine wasn't even a dream yet. Therewere no CAT scans or MRIs or tests to determine bloodcounts or endocrine levels. The practice of medicine waslittle more than a catalog of barbaric experiments. Commontechniques included bloodletting, opium injections, electricshock, and turpentine enemas. These grotesque procedureswere often the final nail in the coffin for someone alreadyweakened by fever or infection. Diseases were the leadingcause of death, followed closely by the trial methods devisedto treat them.

But Miss A had been brought to Sir William Gull. Andhe wasn't like other doctors of his era. He valued observationover action. He was slow to treat and quick to care. Whilehe was credited with numerous medical breakthroughs, hisgreatest skill was his keen bedside manner.

Perhaps it was his experience with the epidemics of theday—cholera, typhoid, and smallpox—that taught Gull tolook beyond symptoms for the deeper cause of a disease. Hewas a holistic problem solver. And the baffling case of MissA would require nothing less.

Most physicians would have surrendered her to death orturned her into a human lab specimen, possibly cauterizingher spine to stimulate healing or injecting her with creativeconcoctions designed to kill everything but the patient. ButGull was not intoxicated by the reckless practices of the day."We treat people, not diseases," he would remind his students.He believed that many cases would resolve themselvesif the physicians didn't meddle too much. Once when a ladywith a rare skin disease was brought to him, Gull simplyplaced an extraction from one of her sores under a microscope,showed it to her, and reassured her that she wouldrecover. It was the only treatment he gave her. And it worked.

Gull did not consider it a sign of incompetence to admithe lacked the answer to a problem either. "Fools and savagesexplain; wise men investigate," was one of his favoritesayings. So whenever he wasn't sure, he resorted to basicnursing duties while he continued to observe. He oncewrote, "Acquaint yourself with the causes that have led upto the disease. Don't guess at them, but know them throughand through if you can; and if you do not know them, knowthat you do not, and still inquire."

Only by immersing himself in the patient's experience didGull manage to discover what others overlooked. The caseof Miss A was to be a perfect example of this dedication. Fortwo years he oversaw her care, methodically nursing her backto full health with a regimen of remedies. Little by little, herstrength returned. And little by little, Gull gathered the certaintyhe needed to declare a name for the disease that hadalmost taken Miss A's life.

After careful consideration, he dubbed it: anorexia nervosa.

That's right. Anorexia. Sir William Gull had discoveredone of the most puzzling diseases of the twentieth century—morethan a hundred years before its time. He gave it thename that still haunts headlines today. And all on his own,he successfully treated dozens of cases—Miss B, Miss C,and so on—reversing the devastation and returning themto normal life. Gull meticulously documented the details ofeach one. And with each one he deepened our understandingof this crippling disease that offered virtually no clinicalfactors that a medical staff could treat.

Anorexia was one of the first psychological diseasesspawned by modern industrialized culture, and it has becomeone of its most enduring. "It is remarkable," wrote one ofGull's colleagues, "that a disease which no one had recognizedbefore its existence and characters were established by Gull,has since been found to exist not only in this country and onthe Continent, but in America and Australia."

Anorexia is among a class of diseases that attacks thebody despite the fact that it exists only in the hidden recessesof the brain—an invisible invader wreaking all-too-visiblehavoc. It's not a foreign agent like a virus or a bacteria or acancerous cell. It is a sinister deception that hijacks the mindand programs it to destroy its own host organism.

RECIPE FOR DELUSION

Gull's remarkable diagnosis makes perfect sense lookingbackward. Anorexia was an irrational delusion of the mind—aby-product of the social pressures of the day. Throughoutthe 1800s, civilizations were slowly shifting away from theiragrarian foundations. Cities were growing bigger and bigger.Cultures were being consolidated as people shared the samebuildings and read the same newspapers. Social norms wereestablished on a scale never seen before. Lifestyle magazinesbegan to blanket communities, propagating unwritten codesof conduct and rules for conformity. By 1850, the numberof British periodicals shot to over 100,000, and the use ofengravings made pictures and sketches a regular part of theliterary experience. For the first time in history, it was possibleto take any idea and promote it on a massive, graphicscale. The age of the mega-peddler had begun.

Thanks to industrialization, everything was bigger too.Basic goods became enormous industries. News sourcesbecame mass media. Large factories churned out products.The age of needs-based marketing was gone. To move themassive supply of goods being manufactured, industriesneeded to manufacture an equally massive level of demand.And one of the concepts they began to promote was theideal body image. Corsets were in style. Fashion was imperative.And the importance of having an hourglass figure wasemphasized for women everywhere.

Whenever something is blown out of proportion in culture,it has a ripple effect. Other things get blown out ofproportion too.

The ideal body in the 1800s was anything but thin. Itwas plump and shapely. But the corset took things in a wholenew direction. To accentuate the full-figured look that everyonewanted, the lace-up corset was designed to shrink thewaist, giving the appearance of fullness everywhere else. Itwas mostly an optical illusion at first. But the custom evolvedinto a trend that brought some very real ramifications. Tokeep up with the Joneses, women began drawing their corsetstighter and tighter. Then Mrs. Jones would tighten hersagain. Over time, a woman could push things around andtrain her midsection to achieve enormous reductions in herwaist. At its peak, the standard for an "attractive" waist wasanything under twenty inches. It was not uncommon for awoman's waist to be sixteen to eighteen inches after monthsof training. Many women learned to breathe using only thetop portion of their lungs, which caused mucus to fill theirlower lungs and left them with persistent coughs.

The health implications of corsets were debated rigorously.It was a hot topic in the same way that gun control orthe deficit is argued about today. It even had a name: "thecorset controversy." The newspapers were filled with editorialsarguing both sides. The volume of op-ed submissionson this topic hit its highest point in 1860—about the timeMiss A began to struggle. While opponents called the corseta form of oppression, many of the staunchest supporters werethe women who wore them. "There is not a single fashionablewoman who does not wear a corset," one woman wrote.Another said, "Go without my stays? Never. I wouldn't doanything so untidy. I think a woman without corsets is mostunsightly. You cannot look smart and have a pretty figurewithout stays. It is impossible."

In the middle of this social discourse, the young Miss Awas developing her worldview and learning the ways of theworld—exploring the meaning of life and discovering howto fit in. Undoubtedly, she would have been pondering thesethings at the height of the corset controversy.

Under the weight of this social pressure, Miss A consideredthe implications of being fashionable versus being comfortable.And perhaps, like numerous others, she concludedthat the risk of not measuring up to society's definition ofbeauty was too great.

A common myth about anorexics holds that when theylook in the mirror, they see a fat person. That's not reallyaccurate. What they see is someone who would be better offjust a little bit thinner. For Miss A, it probably meant sheneeded to tighten up her corset another inch or more, a goalshe obviously accomplished several times over as she returnedto her mirror and got the same feedback each time. A thinwaist is an abstract ideal. It's difficult to define and impossibleto own outright. At some point for Miss A, it becamean irrational, immeasurable, and unattainable pursuit.

There's something about living in a civilized, industrializedculture that compromises rational thought. Agrarianpeople didn't seem to wrestle with it as much. It's easier tokeep your priorities in perspective when they revolve aroundthe tangible elements of survival—like your next meal. Thericher you get, however, the more your priorities begin toseparate from actual needs. When all of our basic requirementsare met, our appetites for progress don't turn off. Wesimply turn from the things we need to the things we want.And that's when we enter the world of the subjective. Wantsare harder to define. And easier to confuse.

In America today, there are more than eight million casesof anorexia. And it's no secret that our culture's emphasison body image plays a huge role in that. We live in a culturethat encourages us to be thin. At a time when we enjoy themost abundant food supply in the history of the world, thenumber of people voluntarily starving themselves to deathcontinues to rise. The human mind is a powerful, yet fragilething.

The irony for anorexics is that they've already masteredthe thing they're working so hard to achieve. They're reallygood at losing weight. But they're really bad at knowingwhen to stop. For them, the destination has taken a backseatto the journey. They're so absorbed in the effort to get thin,they no longer recognize when they are thin.

THE RICHEST PEOPLE IN HISTORY

Anorexics aren't the only ones adrift in the world of the subjective.Our civilized, industrialized culture invites the restof us to compromise rational thought in another way. Notonly does it encourage us to be thin, it also encourages usto be rich. And the richer we become as a nation, the moreour priorities seem to separate from what are true needs. Ourbasic requirements have long since been met, but our appetitesfor progress haven't begun to turn off. When we lookin the mirror, we see altered versions of what's really there.

We're so absorbed in the effort to get rich, we no longerrecognize when we are rich.

The truth is we're already rich. No matter where youstand on the economy, we live in the richest time of the richestnation in history. In fact, if you can read this, you're automaticallyrich by global standards. And it's not just becauseyou can read and have access to books, but because you'vebeen given the individual freedom to do so, not to mentionthe time. That's not the case everywhere. And it certainlyhasn't been the case throughout history.

For example, in our Western culture today, we observe afive-day workweek. Think about what that means. Most peoplehave to work only five days in order to have seven days' worthof food and shelter and clothing and health care. We take it forgranted. But that's unique to our little window in history. Andit's still not the case everywhere. What's more, there are householdsof three, four, or more people that send only one personout into the workplace to earn money. And with that one person'searnings, the entire family can amass enough money infive days to give them food and shelter for seven days. In manycultures, that's inconceivable. Outside of work, that leaves atleast fifty hours per week for nothing but leisure. Most peoplein the world can only imagine such luxuries.

But let's be honest. Those examples don't really proveyou're rich. They only serve to convince you that you're notpoor. My hunch is you're a lot richer than you realize. It justdoesn't feel like it. So let me give you a few more scenariosto consider.

If I told you I was offering you a job with a salary of$37,000 a year, would you feel rich? Probably not. Chancesare, you wouldn't even be interested. A salary of $37,000would represent a pay cut for most Americans. But for 96percent of the world's population, $37,000 a year would bea significant increase.

Maybe there was a time when that sounded like a lot ofmoney to you. And it should. In fact, if you earn more than$37,000 a year, you are in the top 4 percent of wage earnersin the world! Congratulations! You are in the 4 percentclub. You are rich! Yet I'm guessing this startling realizationdidn't cause you to leave the comfort of your couch to dancearound the room. But you should have. On the world's scale,you should have no problems at all, other than a handful ofrich-person problems. Problems that the majority of folkson this planet would love to have. Bad cell phone coverage?That's a rich-people problem. Can't decide where togo on vacation? Rich-people problem. Computer crashed?Slow Internet? Car trouble? Flight delays? Amazon doesn'thave your size? All rich-people problems. Next time there'sa watering ban in your neighborhood, just remember thatmany people, mostly women, carry jugs on their heads forhundreds of yards just so they can have water for cookingand drinking. They can't imagine a place where there's somuch extra water that house after house just sprays it all overthe ground.

Feeling guilty? I hope not. That's not my purpose. Onthe contrary, I'm hoping our time together leaves you feelinggrateful. Guilt rarely results in positive behavior. But gratitude?Great things flow from a heart of gratitude. More onthat later.

While we are comparing, consider this. What we call"poverty" today would have been considered middle classjust a few generations ago. In 2000, the average "poor"family had goods and ser vices rivaling middle-class familiesof the 1970s: 60 percent had microwaves, 50 percent hadair conditioners, 93 percent had color televisions, and 60percent had video recorders. More impressive is the incomemobility within our economy. Most poor families don't staypoor. Over the sixteen-year period tracked by one study, 95percent of the families in the lowest income quintile climbedthe economic ladder to higher quintiles. Over 80 percentmoved to the top three quintiles, qualifying them as middleclass or better. As Michael Cox, an economist with theFederal Reserve, noted, "The rich may have gotten a littlericher, but the poor have gotten much richer."

Gallup conducted a poll to see how different socioeconomicgroups defined "rich." Not surprisingly, everybodyhad a different definition—and nobody thought he fit it.For each and every person, "rich" was roughly double theamount possessed by the person defining it. In other words,when they interviewed people who earned $30,000 a year,that group defined "rich" as someone who earns $60,000.When they interviewed people who earned $50,000 a year,the magic number was $100,000.

Similarly, Money magazine asked its readers how muchmoney it would take to make them feel rich. And accordingto the average reader of Money magazine, a person wouldneed $5 million in liquid assets to be considered rich. Basedon the trend found in the Gallup poll, the readers of Moneymagazine probably averaged about $2.5 million in net worth(half their definition of "rich"). Therefore, if we asked peopleworth $5 million to define "rich," they would probably say itwas anyone worth $10 million. And on and on it goes.

The moral of the story? "Rich" is a moving target. No matterhow much money we have or make, we will probably neverconsider ourselves rich. The biggest challenge facing rich peopleis that they've lost their ability to recognize that they're rich.

Silly rich people.

Hang on; our housekeeper just told me that our yardpeople tracked mud across our pool deck.

A THEORY OF RELATIVITY

We suffer from Maslow's dilemma. Surely you rememberAbraham Maslow and his "hierarchy of needs"? No? Maslowused a pyramid to explain a phenomenon we've all experienced.In essence, he said our needs are always changingdepending on our circumstances. His model starts at thebottom with what we'd all agree are basic needs, and it progressesall the way up to things that amount to luxuries—atleast for the people who haven't acquired them yet.