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Purge: Rehab Diaries

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Purge chronicles Nicole Johns' memoir of her time in a eating disorders rehab center in Wisconsin for 88 days in 2004, when she was 23 years old, for EDNOS, a term meaning Eating Disorder Not Otherwise Specified. The writing is stark, interspersed with clinical documents like her intake documents, guidelines from the clinic, and the $24,500 bill for her treatment ($15,500 was covered by her insurance).

While anyone who's read any other first-person accounts of eating disorders, or lived with one, will find much that's familiar here--stuffing one's feelings with food, trauma, body dismoprhia--there are several things different about Johns' story. She isn't a stick-thin anorexic, but rather a woman who's a size 9, who struggles with being at the upper end of the weight scale in the clinic. Yet by constantly purging (making herself vomit), she's wound up in the hospital and suffers from heart problems and had a concussion, along with other medical issues that will be with her for a long time, if not forever. She's also bisexual, though that isn't presented as a factor in her diagnosis; in fact, it's treated, refreshingly, as a nonissue, and seems to be a given to Johns.

When she writes things like, "My body has lost its integrity," it's something many, many women can relate to. Yet this is not a self-help book or one with a moral lesson per se. Johns is not holding herself up as an example, and in fact alludes to the danger of doing so when she writes that Marya Hornbacher's memoir Wasted is considered an "eating disorder bible" to many women suffering from eating disorders, and was banned from the treatment facility she attended.

Sometimes the point of view here is challenging, and I wished she had given us a little bit more of a glimpse of her current life, to see whether the back-and-forth nature of her attitude toward her eating disorder, which is omnipresent in the text presented, still holds. Yet Johns keeps her focus firmly on her time in treatment, with occasional hints of her growth in the years since. There are humorous moments, such as when one resident asks about the vibrator policy of the center (the therapist doesn't think they're allowed) and going skating with the elderly. There's repetition here that while probably deliberate, at times makes for tepid reading, but does mimic what surely was the repetitious days involved in her treatment.

Johns is at her best when telling the stories that are likely the most difficult for her; not the details of how and when and what she purged, but her feelings about and experiences with her family, and the possible date rape from her college advisor. These are told in a stark, direct way that serves to highlight these stories.

Purge is not an easy book, but an important one that will speak to those who've suffered eating disorders, known people who do or simply want to know more. The closing scene is a tearjerker, and highlights one of the biggest takeaways for me of Purge: the lasting, often life-threatening physical damage that can be done by bulimia. The medical reports that are included here certainly don't have the passion of her writing, but they can be just as chilling. Johns is open about how she didn't think she was doing that badly because she wasn't scrawny, and that is a reminder that one's outside appearance doesn't tell the entire story.

Purge: Rehab Diaries is not your run-of-the-mill memoir of someone struggling with an eating disorder ... it offers a refreshing account of a young women struggling with EDNOS (Eating Disorder Not Otherwise Specified), which is often overlooked. It gives the outsider a detailed and honest look at what it's like to be suffering from EDNOS and then put into treatment. The memoir gives samples of documents from the treatment center she was in, including her perspective of things ... which often were much different than what was written about her. The book is graphic without being triggering (as many memoirs on this subject are) and truly gives anyone, one suffering from an eating disorder or a loved one, a good glimpse of life inside a treatment center. It is a perfect read for someone who feels like they are "not bad enough" to get help or wants to know exactly what it's like to get help. Definitely a refreshing first-hand account of the illness ... an easy read that you can't put down!

I stumbled upon this book accidentally and it was just what I needed. I have had trouble in the past finding books on EDNOS, or any eating disorder related book that I can fully relate to. I loved how honest and straightforward Nicole Johns was about her experience in treatment. I enjoyed reading about her life after treatment, and really felt like she said things that I wish I could say. The feelings I often have, Johns is able to put words to and give those with EDNOS a voice. I highly recommend this book.

I finished the majority of this memoir in one night. Powerful book--very easy to read. Most people are only aware of anorexia and bulimia but Purge takes the reader inside the experience of a not-so-well-known eating disorder: EDNOS. (Which stands for Eating Disorder Not Otherwise Specified.)

The book starts with an introduction by Nicole Johns in which she references Wasted by Marya Hornbacher. I wasn't sure how to take this: on one hand, she just referenced my favorite memoir and probably the most intense book out there that deals with the subject of eating disorders. On the other hand, I didn't want Purge to be a wannabe-Wasted. Turns out I didn't have to worry.

The book takes place during Johns' days of recovery in an eating disorder clinic. Not only does she take the reader through the hectic life of a person with EDNOS, she also takes them through the long hard road to recovery. The style has sort of a journal-like feel to it. (This is reflected by the first chapter which contains selected entry from Johns' diary.) This made the book feel a bit more personal, which is one of the things that made this book very powerful. A few chapters after the first were written in second person which I found a little bit annoying, but I won't sit here and complain about something as trivial as that.

The book really gets going when Nicole is checked into the clinic. We meet the other residents, as well as the staff, and we're all set to get familiar with the treatment from the moment of arrival. (I knew before that rehab centers had very strict rules--I didn't know the extent until I read this book. Some of the rules just seemed completely random; I would never have thought of half the policies and procedures Johns describes.)

I don't want to say too much about it, but the ending was a punch in the stomach. (And I mean that in a good way.) Though the whole book is affecting, the ending does a good job of capping it off and leaving the reader reeling.

Only one thing left me feeling a bit put off: I wish that Johns would have discussed her evolution into EDNOS a bit more thoroughly. As I said before, the story focuses on her stay in treatment and the most background that we get is that her parents wanted her to be perfect and that she developed her disorder when she was fourteen. I wanted to hear a bit more about the train ride to EDNOS: was there something specific that pushed her over the edge? What childhood incidents defined her choice? When did she make the conscious decision to engage in ED behavior? Was there ever a conscious incident at all, or did she one day just find herself purging?

Perhaps a companion book detailing how she got from Point A to Point B would be ideal to compliment this one. (Perhaps one is already in the works--I would certainly buy it.) But nonetheless, this book is a keeper. If you like memoirs, check it out. If you liked Wasted and want something more, check it out. If you often find yourself in the addiction/recovery section of Barnes and Noble, check it out. You won't be disappointed.

This book was amazing. If you currently suffer or have suffered from an eating disorder, chances are you will feel like it was written for you. The perspective that Nicole Johns shares is so real, genuine, and honest. I could relate to nearly everything she was saying, which made it impossible to put the book down. I'd definitely recommend this book to anyone who currently suffers, has suffered, or wants to know more about what it's like to suffer from an eating disorder. It doesn't get much better than this.

I've been doing a fair amount of reading lately, with most of my book selections falling under the umbrella of young adult literature, often with a fairy tale-like element. My most recent choice, Purge: Rehab Diaries, certainly doesn't delve into fantastical realms, nor would it likely be classified as Young Adult, though it might well be of value to many teenagers who are struggling with eating disorders. In this frank memoir, Nicole Johns chronicles her experience at a treatment facility where she spent three months during the summer of 2004.

Purge doesn't shy away from the grittiness of a battle with an eating disorder; there are graphic descriptions of the physical and emotional effects, both from her direct experience and her observations of the young women who became her friends during her stay. Augmenting her own recollections are documents from the facility with matter-of-fact statements about her condition and treatment, but it's her own voice that is so compelling. Sometimes sarcastic, sometimes despairing, sometimes warmly basking in those things that make her battle to beat her disease worth it, she writes with wit, honesty and a beauty that cuts through the brutality.

Johns, who was a graduate student at the time, checked into rehab with an Eating Disorder Not Otherwise Specified, which includes symptoms of both anorexia and bulimia. Over the course of about 270 pages and 70 chapters, she describes the ins and outs of the treatment facility, the counselors and her fellow residents, while occasionally reaching further back into her past to discuss formative parts of her life. Some were positive, like her wonderful relationship with her Italian grandparents, while others, particularly a painful experience with a college professor, were destructive. Because the chapters are short and Johns' style is so accessible, the book doesn't take long to read; once I started it, I was engrossed enough that I got through it in a single sitting of several hours.

It's interesting to see Johns' perspective evolve over the course of the book as she recalls becoming more comfortable with her body image and less disdainful of the efforts of the staff to keep her eating behavior in check. Even during the depths of her own struggle, her compassion for others in similar condition is evident, and one of the most powerful portions of the book deals with her trying to encourage a fellow rehab resident after they leave the program and find it difficult to resist relapsing into old habits.

Purge: Rehab Diaries is a harsh memoir, but Johns herself is a testament to the value of hope and perseverance. She notes in the prologue that the urges that accompany most eating disorders may not ever dissipate entirely, but reading about her determined efforts to reclaim her life is a step in the right direction for the many who are currently floundering.

I thought, at first, I wouldn't like this book...and I was worried about her intentions for writing it. But as I read, I realised what a great writer the author is, and how well she relates anecodotes from her treatment and her life, in such an engaging and articulate way.

If you're wanting to see what life in a treatment centre is like (not all of it, but a great deal of the variety that happens there), then this is a great book as it FOCUSES almost SOLELY on the events within the treatment centre.

In addition to that, it's a valuable book for it shows and focuses on EDNOS, helping people understand that Eating Disorders are not all about being anorexic or bulimic but there are realms inbetween (the author is mostly bulimic and mostly normal weight).

It was also humourous and interesting. I really believe it would help families/therapists/friends gain an understanding into the nuerotic world of the eating disordered - how strange and surreal it actually is.

In addition, I think it DOES showcase how dangerous Eating Disorders are, as the author explains in detail the physical degeneration of her bulimic friend who ended up in ICU with Sepsis and organ failure (among other VERY painful descriptions of how a bulmic can ultimately die).


I do wonder if her friend passed on. The author never stated what happened.
This is a great read, with short entertaining chapters. I was engaged the whole way through (and I've read now about 30 ED memoir books).

I think this book is one of the better ones.

Purge was an amazing book!! The bright pink of the cover and scribble across the front had me intrigued. Personally, I have never struggled with an eating disorder but I wanted to find out more about EDNOS and how eating disorders affected people. The author presents the story in the perspective of journal entries during her stay in a rehabilitation clinic for patients with eating disorders. I could not put the book down...it was so good! The book was very informative and well written!

I honestly like it better than wasted, really.
It's one of my favorite Eating Disorder books.
It takes you, in it arms and tell you the story of her.
Its a classic in my book.

Memoirs are not usually that interesting to me. I find that they sound like they're airing baggage. They also usually lack craft or innovation. And no matter how much the author may confess to explore their own faults or wrongdoings, there is usually a tone of arrogance or self-righteousness. (See Dharma Punx, which explores two unlikely linked subjects I am interested in--Buddhism and punk rock.) Johns' Purge: Rehab Diaries is a refreshing exception.

Most of the book involves Johns' experience during her 88-day stay at the Eating Disorder Center, basically a voluntary psychiatric treatment center for those with Eating Disorders. While Johns could have fleshed out her experience with having an Eating Disorder, delving into her childhood and the development of her ED, I think that could have distracted from the compact focus of the book. Although I was curious to hear more about this aspect of her life, I did not feel it was necessary for the book itself.

For me, the format of the book made it an intriguing, enjoyable, and easy read. The chapters are often short, an average of two or three pages, based around a theme or experience. There are also reproductions of documents: regulations from the EDC, medical diagnoses, and Johns' own writings. This helped to break-up the text, while also complimenting it, and establishing a sense of the atmosphere of being at a treatment center.

The first word that comes to mind to describe this book is "honest." Johns explores the darkest parts of her life, and what it means to live with an Eating Disorder. I found none of the arrogance or self-righteousness found in other memoirs, even when she criticized others, because her criticisms are usually expressions of hurt, rather than condemnations. She also admitted times when she unfairly or immaturely lashed out at others. She does not blame others for her behavior, while also acknowledging how others have hurt or pressured her to react in self-destructive ways. Like all forms of mental illness, it isn't as easy as blaming either someone else or one's self, and there is no one "cause" to behavior; as Johns explains, Eating Disorders are a complex of behaviors, with a nexus of influences, beliefs, and causes.

With admittedly little knowledge of Eating Disorders, I found Johns' approach to the subject accessible and clarifying. She dispels many of the myths about EDs, such as that only those who are underweight and malnourished suffer from them. The most significant revelation to me, however, was discovering just how extensively EDs affect both mental and physical health. I had no idea about the array of physical problems associated: heart problems, electrolyte imbalances, injuries from inability to concentrate or exhaustion and weakness.

I also did not realize the depth of psychological damage that goes along with EDs. I knew, of course, that those with EDs must have distorted body image, and to an extent not be happy with themselves. But it goes deeper than being anxious about whether you are fat. Johns felt an intense loathing of her own self that led her to try to subsist on a diet of coffee, diet soda, and diet pills, all while pushing herself to succeed in her graduate studies in English (she was working on her MFA, which included teaching duties). This inevitably led to exhaustion, hospitalization for heart problems and a concussion, and finally the need to go to the EDC.

Johns' particular disorder is EDNOS: Eating Disorder Not Otherwise Specified. This involves aspects of both anorexia (restricting diet) and bulimia (binging and purging). I imagine that this poses a difficulty that having one or the other may not, since behavior may alternate between the two, and weight may fluctuate from underweight to overweight, making it difficult for others to tell something is wrong. Ultimately, though, Johns' peers and students could tell her state was worsening, and confronted her about it. This seems to me to show how important it is for us to pay attention to those around us, and offer help and encouragement when we feel necessary.

The world of the EDC is a bit surreal for me. There are many rules, especially around food. But their access to many things is restricted: certain personal effects such as phones, razors, and hair spray can be accessed only with the permission of staff, and under certain circumstances. The residents' behavior determines their privilege level. Depending on their level, they may or may not get to take walks alone outside, go on outings with staff and other residents, and have certain foods. There is also a great deal of drama: other residents having breakdowns, requiring hospitalization for health problems, in-fighting among the residents, and confrontations with staff. A cast of characters parades through the book, though it was hard for me to keep track of more than a few who were depicted in detail, and Johns seemed closest to.

However, it was interesting to see how, counter to my perhaps naïve expectations, there was not solidarity between the residents. They clearly grate on each other at times: they steal from each other, they lash out at each other for irrational reasons. And despite having an Eating Disorder in common, they are all complex people, and don't necessarily have other things in common or share personality traits. Johns felt clearly drawn to others who were like her: intense, boisterous, and artistic, in contrast to those who were more shy, passive, and who seemed to want to get through their treatment in quiet, pedestrian ways. There is even a confrontation about team-building, to which Johns is antagonistic and resistant. This was perhaps the part of the book that I found it hardest to sympathize with Johns: though I sense she is conscious of her own irascibility here, she seems not to have lost her feeling of disdain for the whole experience.

Despite all this, Johns also describes how they supported and empathized with each other. There are a number of scenes where Johns relates her own difficulties and breakdowns, and how both other residents and staff helped her through them. Even when they broke the rules, they got each other through tough times.

The staff, too, are depicted as complex people with both good qualities and faults. Again, sometimes they were at odds, sometimes they were supportive. Johns does not hesitate to lay out what she saw as inappropriate behavior, such as when the staff acted out of homophobia by expressing concerns about her closeness with another resident, who is a lesbian (and Johns herself is bisexual). I also appreciated Johns' candid discussion of the methods of one therapist that she considered to be unproductive or even harmful. While others may be helped by this therapists' techniques, Johns clearly had a bad reaction to them. And while therapy should not always be easy and comfortable, there needs to be a degree of communication and responsiveness between therapist and patient that did not seem to be going on between them.

The level of self-doubt and self-loathing is most evident when Johns actually reproduces her own words through diary entries. Johns is a writer, and it is her intense dedication to writing that seems to anchor her throughout this experience. At the beginning of the book, some diary entries ring with power:
"I made myself sick and it felt really good. I liked it. I'm one sick f***."
"I threw up my birthday dinner."
"My hair is falling out, my nails are a mess. I'm dizzy and on the verge of passing out a lot. I look like s***, except I'm thinner, and everyone notices and the compliments keep rolling in the more I drop. I need the muscle spasms and irregular heartbeat to stop."
There is also a drawing that Johns did for Art Therapy, divided into two sides: one drawn by Johns showing how she thought her own body looked, the other half an actual trace of her outline by staff. The difference between the two is significant. It seems to have been a wake-up call for her.

What is surprising though is how staff claimed she (ab)used writing as a method of "purging" her emotions, rather than coping with them. She seems to give some credence to this idea. I guess that is a danger of autobiographical writing. I'm not sure whether I wholly agree with this notion; I wish there had been more discussion of it. Perhaps this is one of the reasons I am wary of memoirs, as I feel they are more purge than craft.

Johns' experience at the EDC was fraught with a number of setbacks and relapses. She breaks rules, and sneaks off to purge. Also, she starts to spiral after her parents visit. Although she clearly feels close to her parents, they have not always understood what she is going through, and find it hard to tell others about it--one of her major causes of pain is that her parents lie to her grandparents about being at the EDC.

At another point, Johns is troubled by a painful experience in the past, in which a teacher made inappropriate advances on her. This was for me the most disturbing part of the book. Although she does not know exactly what happened because she blacked out, she remembers him groping her. The fact that she blacked out makes it likely that he drugged her, so regardless of the degree of physical violation, the fact remains that she was violated and her control over the situation was taken from her. And even though she reported it to teachers and campus authorities, he remained teaching at the school, and the whole thing was kept quiet. Aside from the actual experience, this caused a great deal of hurt and humiliation, that also fed into her Eating Disorder behaviors. Many of the other residents recount rape experiences, or have other traumas or mental illnesses besides ED. This cross-feeding of trauma and illness is one of the most difficult things about dealing with mental illness, both for the sufferers and those trying to help them.

At times, Johns' tone is rather clinical and matter-of-fact, even when describing emotional, troubling experiences. I did not find this to be a problem, but it was a little curious. It made me wonder how differently I would feel had it been described with more feeling. Would it sound more authentic, more resonant and powerful, or would it sound too high-handed and melodramatic? It's hard to say. For the most part, I tried to let Johns tell it the way she wanted to, and see it as a way of trying to convey what were obviously difficult feelings and events.

The book ends with her discharge: she has had moderate success in treatment, and is advised about follow-up treatment and the danger of relapse. Johns also talks about bonding with another resident, Holly, after both of them are discharged. Both have numerous relapses, Holly's leading to her being hospitalized into an ICU for the severe problems brought on by her ED. While I can understand ending the book with this poignant scene, and the harsh reality that treatment does not usually end happily ever-after, it was a depressing way to close. Perhaps she meant it as a sobering wake-up call to take Eating Disorders seriously and realize the ways they can eat away one's life.