National Eating Disorders Association

Stories of Hope

Battling Anorexia – An Immigrant’s Perspective
By Dr. Amba Balu


Would I have developed anorexia nervosa had we not emigrated from India to Canada?  Would I have felt compelled to engage in behaviors to the brink of death, only to have to battle and claw my way back to normalcy, somehow finding the strength to finish medical school in the process? Would I have fallen prey to the disorder if I hadn't become involved in high school sports?  And, paradoxically, did these same factors--being Indian and wanting to be competitive in sports--play a role in my recovery?  These are questions that are very difficult to answer.  

I was ten when our tight-knit family emigrated from India to Canada in the late 1960s.  My parents, two younger sisters, and I initially settled in a small prairie town.  My uncle was the highly regarded local doctor, which may have played a role in how warmly we were received by the townspeople.  The fact that we spoke fluent English--learned at British-initiated schools in India--made the acculturation process easier.  Although our parents urged us to speak our language--Tamil--at home, they also encouraged us to assimilate into the Canadian way of life.  We learned to figure skate, square dance, and play winter soccer on icy fields.  In school I excelled academically, played on sports teams, and made good friends.  However, deep down, I was fully aware of the fact that we were different from all the fair-skinned, fine-haired people.  Our accents, which had sounded so polished in India, here sounded alien to my ears.  And occasional taunts from ignorant schoolmates only reinforced the sense of displacement.  Our parents advised us to ignore it and focus on the many positives this country had to offer, something that for the most part I succeeded in doing.

I was about to begin high school when we moved to a large city.  Canada had just expanded its immigration policy, and scores of people from India and refugees from East Africa were settling throughout the country.  Taunts of racial slurs were directed at any brown-skinned, dark-haired person.  Although I recall only once being at the receiving end of this slur, the impact was deep and lasting.

It was during my first year of high school that I discovered activities that would become lifelong hobbies--running and the intense racquet sport of squash.  I had joined the track team, and quickly came to love the feeling of exhilaration while running and the sense of well-being afterwards.  Squash was a revelation.  We were introduced to it in gym class, and while I was mediocre in other sports, I quickly found myself winning matches against bigger and stronger players.  It's a sport I would pursue with a passion--and a truly competitive streak-- in university. 

The first two years in our new home town were happy ones for our family.   We had all settled into our routines--my father in his engineering job, my mother in her role as a wonderful homemaker, and my sisters and I with a good balance of school work, hobbies, and socializing.  Though we were by no means rich, there was enough for the occasional movies, dinners out, and fun-filled summer vacations to Disneyland and British Columbia.  My grandparents and other relatives visited, bringing with them love and the familiarity of our homeland.  In a way, though, I found their visits a bit disconcerting; for it reinforced for me the ever present feeling of "differentness" that I tried hard to suppress. Within the circle of my extended family, I truly belonged.  I was one of them; within Canadian society, not so much.  For the most part, though, we were a contented family.  

It was midway through my junior year in high school that the fabric of our lives began to slowly unravel.  Activities that were rites of passage for Canadian high school students were frowned upon in India because they were co-ed.  I wanted to attend dances and school camping trips.  My parents, loving though they were, disapproved.  Then the unthinkable happened.  I--who had been the perfect, obedient child--started defying my parents and arguing with them.  "Why did you bring us here,” I would shout, “if you wanted us to behave like we were in India?"  My sense of righteous indignation was mixed with deep disappointment that I had let them down.  I had always been a role model for my sisters, and I felt like I was letting everyone down.

Meanwhile, I became even more immersed in sporting activities, and friends began telling me how good I looked.  For the first time in Canada I was being complimented on my appearance, and it felt fantastic.  

During my years in India, I don't recall any discussions about weight, and most of the idolized movie stars were plump.  Here, other than boys, it seemed to be THE topic of conversation among many of my female schoolmates.  The skeletal-looking models on magazine covers were held up as ideals of beauty.  

My interest in this started as an obsession, then, almost imperceptibly into full blown anorexia nervosa. My parents began to be by turns worried and angry.  In the mid- seventies, eating disorders were still largely unknown entities, even within the medical establishment.  My father felt I was being defiant, my mother, ever the peacemaker, was frantic.  My poor bewildered sisters, reaching teenage themselves, found themselves taking a back seat for our parents' attention.  

As I became increasingly ill, my parents dragged me to a family physician who, unbelievably, told them I was fine and that it was just my genetic make-up -- something I used as fodder to continue my self-destructive behavior.  Even as compliments stopped and I was dropped from sports teams by concerned coaches, I refused to believe I had a problem.

It was by a stroke of good luck that my doctor uncle, always up on his medical reading, came for a visit.  One look at my emaciated body, thinning hair, swollen feet and ankles, and he knew that I needed immediate hospitalization.  He suggested I had severe anorexia nervosa, and that I had to be brought back from near-death before beginning psychiatric therapy.

We were also extremely fortunate to have been living in a city with a highly regarded medical school with its own teaching hospital, and in a country with universal health care. It's a testament to the incredible skills and knowledge of my medical team of doctors, nurses, psychologists, dieticians, physiotherapists and occupational therapists that I not only didn't die, but began recovering relatively quickly.  At a time when formal eating disorder programs were essentially nonexistent, I spent a month on complete bed rest in the internal medicine ward, and three months in the psychiatric unit.  I was by no means a cooperative patient, especially in the beginning.  But as my physical health improved and my brain received nourishment, my thought processes became more rational.  I started to see that I did have a serious illness, and that my family and friends truly cared about my well-being.  I began to be a more willing participant in family and group therapy sessions.  Within two months, I was given the green light--with conditions attached-- to start attending pre-med classes at the medical school building next to the hospital.  I was still in a weakened state, and often drowsy from medication side-effects.  For the first time in my academic life, I had to struggle to make passing grades.  But with the help of understanding professors and classmates, I managed to get through the first year.  

Although I had a come long way by the time of my discharge from hospital, my doctors knew that the risk of relapse was high.  I was still preoccupied with food and body image, though not as obsessively as before.  The medical team gave my parents detailed information and instructions to monitor my diet and exercise regimes. For a time I would have to attend the hospital outpatient clinic on a weekly basis, and we would continue regular family therapy sessions.  

Two things may have played roles in preventing a relapse.  As I became healthier, my performance level in sports improved.  I became a faster runner and stronger squash player.  Slowly my focus shifted from body image to sports achievement.  Another factor may have been my parents' decision to take me away for a while from the seemingly non-stop preoccupation in the western world with body image and dieting.  My mother and I spent the summer in India.

It has now been nearly forty years since my hospitalization.  I feel extremely fortunate never to have had a relapse.  I not only survived, but thrived.  I went on to finish medical school, and practiced as a physician before recently retiring. I have a happy home life.  My focus is on health and a sense of well-being, not on body image.  Most importantly, rather than feeling like an outsider, I have learned to celebrate my uniqueness, and the experience of having grown up in two wonderful countries.   I am forever grateful to all the incredible people--my amazing family in North America and in India, loyal friends, and incomparable health care professionals--who stood by me through the toughest of times to ease my path to recovery.

There have been silver linings.  Knowing I was so close to death has made me embrace life more.  As my physical recovery lead to mental and psychological healing, self-obsession slowly evolved into concern for others (which expanded still to empathy for all non-human beings as well).  I believe my ordeal made me a more compassionate physician, particularly towards those struggling with eating disorders—more than merely sympathize, I could truly relate to their struggles.  Most importantly, recovery has instilled in me a sense of accomplishment, and self-confidence that I can achieve anything if I set my mind to it.  

I share this story as a message of hope to those struggling with this awful illness.


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