Last month I opened up my blog as a platform for readers to post anonymous reviews of the books they'd read and didn't want to review because of possible blowback (trust me, the struggle is real). Well, today is another anonymous review: Sad Perfect by Stephanie Elliott.
Note: the original draft sent to me had a lot of beautiful formatting that Squarespace dumped. I've decided to leave the review as is rather than try to change anything and lose the voice of the reviewer. Any confusion is all my fault.
Updated 2-9-2017 12:11 PM EST: I've removed the passage about medication at the request of the reviewer.
Introduction, Summary, Disclaimers
A couple weeks ago, a post came up on my twitter feed. “Looking for someone who can review this ARC [advanced review copy] of a new YA book,” it said. (I’m paraphrasing because I don’t want to put anyone near the dumpster fire that often follows unfavourable book reviews—and this one’s a doozy.) The tweeter—let’s call her S—didn’t feel comfortable reviewing a book about eating disorders (EDs) because she didn’t identify as someone who’s suffered from one, and felt like the review should be by someone with that experience. She expressed the concern that the author of the book was not an example of own voices, either.
So I stepped up, offered my services, and we had a really great chat over direct message about my qualifications, and the extortionate price of imported American candy. I’m writing this review anonymously, but I think I should cover a little bit about myself, my background, and why I think I was a good and fair choice to review this book. Trust me, it’s relevant.
I’ve been a writer for decades, and an editor for almost as long. I’ve done editing work for YA and the adult market, in various genres (contemporary, women’s fiction, memoir, speculative fiction, romance, historical, et cetera, et cetera).
The reason I stepped up is because I’ve suffered from an eating disorder for seventeen or eighteen years, to a greater or lesser extent. It has landed me in the hospital twice, but because it was an unusual presentation it wasn’t diagnosed until my mid-twenties. I have what’s called purge-restrictive anorexia, which means that I both restrict my diet and force myself to purge even if I don’t binge.
This book, “Sad Perfect” by Stephanie Elliot, is not about my ED; it’s about a newly identified disorder called “ARFID”, or “avoidant/restrictive food intake disorder”. There can be some overlap with anorexia or bulimia, but ARFID is identified as a disorder in which the sufferer avoids foods that aren’t “safe”, or experiences the vast majority of foods as disgusting. It seems to be exacerbated by trauma and anxiety: a sufferer is more restrictive when anxious, and the disorder can be triggered by trauma. Sufferers are often characterised as “picky eaters”, which delegitimises their genuine suffering and prevents them from getting a diagnosis or the proper treatment.
In recent years I’ve been able to keep my anorexia under control, but there are certain things that bring about an episode. When I do suffer a resurgence of symptoms these days, my anorexia looks a lot like ARFID: I’ll associate certain foods with safety and sometimes certain classes of foods will taste horrible. A couple of years ago, a psychologist suggested to me that I might be experiencing ARFID-like symptoms.
When I first offered to do the review I told S that she didn’t have to worry about me reading the book, that I was mostly out of danger and I didn’t think it would hurt me.
Well, I was wrong.
“Sad Perfect” is not just problematic. It’s not just inaccurate. It’s dangerous. The night I first read this book I sat on my bed and sobbed for nearly an hour. I had to give my husband instructions to watch my food intake like a hawk because of how tempted I was to starve myself.
I’ll say this again: the reason I have been so determined to do this review is because I am terrified that a teenager with an ED will pick up this book and that reading it will pose a serious risk to their health.
If you suffer from an ED, especially if you suffer from anorexia or bulimia, I suggest you stop reading this review right now. The quotes I provide are really, very, super triggering, because in order to ingratiate herself with teen sufferers of ARFID, the author of “Sad Perfect” has decided to vilify sufferers of anorexia and bulimia.
Oh, there are other problems too: there’s a total of one PoC and white heteronormativity is held up as beautiful; the love interest is a classic example of you’re-so-special-not-like-all-those-other-girly-girls misogyny; the manuscript is rife with inaccurate, generalised information about EDs and other mental illnesses; and of course the author of the book is not an example of own voices (Elliot’s daughter suffers from ARFID, but she has no ED herself).
So much for the general disclaimers and summary. Let’s get to the specifics—and I’m not kidding, if you have anorexia or bulimia, I REALLY suggest you skip the rest of this review, and unless a lot of stuff gets fixed, the entire book.
Sixteen year old Pea unknowingly suffers from ARFID, and it affects her every single day. She can’t socialise normally because social occasions revolve around food. She can’t enjoy dinner at the table with her painfully generic, Home Improvement family. Her utter tool of an older brother doesn’t seem to care about her. But then Pea meets Ben, a teenage boy written by an adult author who has perhaps never even seen or spoken to a teenage boy in her entire life, but who does know exactly what she’d want to see in a potential boyfriend for her daughter, and writes accordingly.
Right after Pea meets Ben, she’s diagnosed and begins therapy. One on one therapy helps, but not as much as Ben, whose bulging, veiny arms (not joking) are always ready to engulf Pea in their calming embrace. Pea decides that she doesn’t need her medication because of how much better Ben makes her feel, which is characterised as a bad decision even though the author makes it clear that Ben totally helps Pea more than medication or therapy can (???). Pea, off her medication, begins to get surly and anxious, which leads to a fight with Ben. To cope, she begins to scratch at her skin with safety pins (Which are featured on the cover. Way to romanticise self-harm, publishing!). After someone anonymously tips her school, Pea finds herself in a hospital ward, under suicide watch with other kids who are deemed at-risk. Her family blames Ben for her worsening symptoms and her self-harm.
This is very traumatic for Pea, because the hospital ward is apparently run by villains from rejected Harry Potter drafts or A Series of Unfortunate Events, and because her parents are clearly casting blame where it doesn’t belong, because Ben makes no mistakes whatsoever and is like a cross between a bodybuilder and a messiah—but she eventually gets out, and after her brother beats up Ben when Pea sneaks out to meet him, and Ben admits he called in the anonymous tip, everything is okay and Pea sets out with new resolve to stay on her meds and happy that her boyfriend is just omg so perfect.
Anorexics and Bulimics Are, Apparently, Just Awful
Pea is diagnosed with ARFID at a clinic for eating disorders, which is also where she participates in her one-on-one and group therapy sessions. Immediately Pea disassociates herself from the other girls, who all have anorexia and bulimia.
Shayna said your disorder isn’t like theirs—and you want nothing to do with these girls. - p48
The first encounter with the anorexics and bulimics is an example of mild othering, and it put me on guard. Elliot, having written Pea with a likeable voice (even though it’s in the second person), immediately proceeds to write every other girl with an ED as if she’s casting for Heathers:
“So she’s just like a picky eater?” a very thin girl says. - p49
Given that Pea has spent most of the book up until now ragging on girls who want to be popular (specifically, girls who care about nothing but Instagram likes, a fact she mentions so often I went back and marked every instance of it with a specifically coloured index tag), this kind of speech clearly codes anorexics and bulimics as the kind of bitchy, popular girls that Pea hates. Likewise, the constant reminder that Pea is not like “other girls”—not in everyday life, and not in the specific realm of eating disorders either. ARFID, too, is set apart as more serious, somehow more “special” than the boring anorexia or bulimia that the other girls have.
‘ “I’m not like any of you,” you start, and every single one of them shifts in her seat. […]
“That’s bullshit. Your parents wouldn’t have brought you here if you weren’t exactly like us.” She crosses her arms over her chest and nods to the other girls, waiting for them [to] say something, anything to agree with her.
Shayna says, “Hailey, judgment-free. That sounds like an assumption to me.” ’- p71
Notice how the therapist and voice of authority, Shayna, backs up Pea’s claim that she’s special. This happens every time someone in group therapy challenges this idea. On the next page, after Pea makes some (unchallenged and incorrect) assumptions about anorexia and bulimia, there’s this paragraph:
‘You totally called them out, and were not so nice about it, telling the girls that your stuff was more serious than their own problems, and that they didn’t understand what you were going through.’ - p72
In context, it’s very clear that this is Elliot’s opinion, not just her protagonist’s. I began to suspect that Elliot held some very real and serious grudges against anorexics and bulimics, presumably because her daughter suffered some bullying from either a person with anorexia or bulimia or because her daughter’s ARFID was sneeringly compared to those disorders.
‘ “The other night, I made my boyfriend leave because of the monster, and he wasn’t doing anything wrong. […] This monster makes me do bad things. Do you guys have any idea what I’m talking about?”
“You mean like Ed?” one of the girls asks.
Shayna interrupts. “Ed is a term we use for eating disorder, like we’ve given it an identity.”
You look at Shayna and then address the girls again. “It’s worse than Ed. It’s like having Ed plus having a real monster.[…]” ’ - p151
Uh, what the fuck? Yeah, some therapists use the name “Ed” to personify EDs, but trust me when I say that for every person with an ED there’s a different manifestation of the voice that tells you to do horrible things to yourself. For some people there’s not even a separate voice, just the compulsion. My voice was certainly a monster, a monster much more graphic, nasty, and horrible than Pea’s monster is described in this book—a monster who called me a pile of garbage in human skin, a monster who told me I shouldn’t exist, a monster who made me avoid mirrors and other reflective surfaces, who said that the only way to purify the wretchedness of my own existence was to starve myself away from it, like a waif or a ghost.
This kind of othering would be okay in a book with a narrator that the author acknowledges is unreliable. If Elliot had made it clear that Pea is mistaken, or being unfair, that anorexia and bulimia are in fact very serious indeed, and that they have the highest mortality rates of any mental illness, it would have been okay—but she doesn’t. Pea’s assumptions about these disorders are left entirely unchallenged, and readers are left with the distinct impression that the author thinks that all anorexics and bulimics are foolish and melodramatic. This is utterly unforgivable; Elliot is making villains of suffering teenagers who are at risk of serious health problems and death. Nowhere does she mention that bulimic patterns cause heart problems or that anorexia can lead to osteoporosis.
There’s more: the anorexics and bulimics in this book are coded as unpleasant, even disgusting. Here’s what Pea has to say about the above bulimic who tried to claim kinship with her, Hailey:
‘Hailey, the worst of the bulimics, the one who binges on Oreos and pancakes, who hides candy bars in her sock drawer, who purges everything she puts into her mouth[…]’ - p71
It gets nastier.
‘[Y]ou sit with the other girls—the ones who don’t eat and the ones who throw up—and you are quiet as you listen to everyone talk about how they are either struggling to eat a salad or struggling not to puke[…].’ p150
‘One of the girls—Nina, she’s textbook anorexic—comes over and hugs you. She’s standing and you’re still sitting and it’s a totally awkward hug, because she’s much too thin and has sharp elbow edges, plus you don’t even know her.’
‘Her breath stinks. You imagine it’s what death smells like.’ - p152
This is never, ever addressed again, not once in the entire book. Every time Pea interacts with anorexics or bulimics it’s in this kind of setting, and using this kind of tone. Pea never thinks about how unfairly she thought of the girls in her group, how dismissive she was of their EDs, how deadly their illnesses might be. Bulimics and anorexics are always equated with “girly” girls, girls obsessed with popularity, girls obsessed with their own looks while Pea achieves normative beauty without trying, the kind of girl that Ben specifically mentions with dislike when he’s describing why Pea is so special. The tagline for the book even echoes this: “Perfect is only on the surface.” What bullshit.
Here and there in this review, I’ve mentioned that “Sad Perfect” is full of worrying inaccuracies about EDs and mental health in general. There are examples and examples and examples, so I’m not going to go into every single one, but the instances that concerned me the most were inaccuracies about mental health treatment.
In her othering and vilification of anorexics and bulimics, Elliot stereotypes these disorders and sufferers of these disorders in harmful ways. I mentioned one of them above, girls-who-starve-and-girls-who-puke, and this stereotype is echoed by Shayna, the voice of authority about ED facts that Elliot provides. Bulimia can manifest in a lot of ways—purging can be done with excessive laxatives, or through excessive exercise, for example. Elliot does have Pea acknowledge that bulimics can use laxatives, but it’s a brief one-off, overshadowed by mentions of vomiting and associated imagery.
Yet another example of harmful inaccuracy:
‘And you know your problem is not anorexia or bulimia, because you’ve never wanted to lose weight[…].
You’ve always had a healthy-looking body, and that’s one of the reasons your parents could keep denying something was wrong. You’re neither too thin nor heavy.’ - p19
Here’s where own voices makes a difference: I said my anorexia presented in an unusual way because I always looked normal, even when I was literally eating nothing but one sandwich a week, plus the occasional mouthful when I needed to seem like someone who ate. Most of my calories came from alcohol. I looked really skinny, but normal. I still suffer from anorexia, and now I’m on the heavier side of normal, because I have no natural guide for portion control and am afraid of eating too little and getting into bad habits again. (I think of it as a sort of whiplash.) I never obsessed about losing weight. It was all about food: how food was a taboo, how it was indulgent to eat at all, how “good” I was for avoiding food. On bad days my body is ugly to me because it’s evidence of all the nasty, horrible food I “gave in” and ate. I didn’t want to be thin; I wanted to disappear. Saying an anorexic wants to lose weight is like saying a junkie wants to feel happy.
But if you don’t have an ED, and your only concern is your daughter’s well-being, how likely are you to concern yourself with portraying other people’s experiences accurately? Especially if your strategy for connecting with teens who suffer from ARFID is to make them feel special and superior to those boring anorexics and bulimics.
‘ “You guys, from what I heard last week, have had traumatic experiences at older ages, like divorce or abuse, or something bad happening later. […] [Y]ou used to be able to eat normally before you had your disorder. […] But I never ate normally.” ’ - p72
First, childhood anorexia is a real disorder. People can develop it at extremely young ages. Secondly, Elliot is contradicting herself: a little earlier in the book, her mother says that Pea ate normally until she was about three years old. ARFID is actually closely associated with autism (one of the reasons it’s common in young men), a fact that Elliot completely fails to mention, and autism generally manifests from birth. You’d think she would mention something that important about ARFID while writing a book intended to help kids who suffer from ARFID, right?
And then there’s THIS:
‘You go straight to the psych ward. Because that’s really what it is. A place for crazies.
You don’t talk to your parents on the way to the “hospital” as they call it, although you know it’s the Crazy House. You’re scared to death, because you’ve seen movies about crazy people and you know it’s all just about taking your meds in small paper cups and wearing hospital gowns and maybe even getting strapped to your bed at night. And freaky people shouting out the answers to Jeopardy! every evening, and crappy food they might shove down your throat to force you to eat.’ - p196
After much wtf-ing, I thought, how great it would be if Pea were to have a mostly good but mixed experience of the hospital ward? She’d meet some good people, think about how she was mistaken in characterising them as “crazies”, perhaps have some problems with the staff who don’t understand her ED for what it is, a passage that corrects a character’s mistaken assumptions…you know, good writing. Instead, one of the kids that Pea gets to know commits suicide (in a closed ward, and it’s never explained how this is possible); Pea is not given any of her “safe” foods and so is left to starve for weeks; bullying is rampant and horribly addressed; and, as I’ve mentioned, the majority of authority figures in the ward are cartoonishly villainous. Pea refers to the ward as the Crazy House for the rest of the book, even after she leaves it.
The problem with this characterisation is that it’s clearly done to drive plot, and not out of any concern about the well-being of the real kids who have experienced being under suicide watch at a hospital ward and who might read this book. Emergency intervention saves a lot of lives, but Elliot doesn’t acknowledge this. What happens when a teenager reads this book? How will they feel about emergency suicide intervention? Pitting teenagers emotionally against the people who are trying to help them is a dangerous practice.
Boys Don’t Get Eating Disorders
Shortly after I read and was reeling from this book, I think the next morning, I had my weekly therapy appointment. My therapist is a qualified psychologist, who’s worked in both the private and public sectors for decades. I described this book to her, about how dangerous I thought it was, and she made an excellent point.
I told her that nowhere in this book is it acknowledged that anybody but girls can get an ED, that the clinic’s therapist specifically mentions “our girls”, that Ben’s lack of knowledge about EDs in general is coded as gendered knowledge, that there is not one single whiff of a suggestion that a) genders outside the binary even exist, that b) trans people exist, or that b) anyone who is not a cis female can get an ED, and she said that this aspect of the book was what upset her the most.
My psychologist told me that anorexia and bulimia are more common in women because they’re often tied up with gender-specific social pressures, but that actually newly named disorders like ARFID are more common in young men. It was her opinion that the erasure of non-female sufferers was dangerous, especially given the enforcing of traditional gender roles that I described to her.
So let’s talk about those next!
I Ran Out of The Colour of Sticky Flags I Used to Mark Misogyny — Twice
Here is a photo of my ARC copy of “Sad Perfect”.