March 1995
The afternoon breeze comes through the large, picturesque glass door, rustling the white feathers of a southwest mandella overhang, and diminishing the smell of cigarette smoke. The walls are lined with authentic Native American bows, arrows and artifacts that set the motif for this room with a view overlooking the hills of Marin.
As Steve Azzolino picks up his cup of coffee, his sixth one today, his olive-colored skin barely peeks through a dark turtleneck, sweatshirt and jeans. At 34, Azzolino, a successful produce buyer for independent Bay Area markets, has an energetic spirit that projects from his 6-foot frame and permeates the airy and immaculate Tiburon apartment, where he has lived for the past year.
Azzolino's amiable laugh may reflect his state on this sunny afternoon, but his delicate handshake and barren cupboards reflect a gentle demeanor that is seen when he is alone. Instead, they foster endless hours revolved around his eating patterns, which he labels his daily rituals.
Not a day passes in which Azzolino does not think about food. In the two weeks that he has taken time off from his job in South San Francisco, he has had dinner only three times. In his kitchen he has three apples, two boxes of fiber cereal, and one gallon of nonfat milk in his refrigerator door.
"I think about it [food] from the morning I wake up until I go to bed. I think about it constantly," he says.
When he doesn't eat, he feels weak, intense and impatient. He also gets headaches. It's difficult for him to be around people when he gets to that point in the day, so he isolates himself.
One year ago, Azzolino realized he had Anorexia Nervosa, an eating disorder that involves self-starvation and regressed and isolated social patterns. Within the last year, he has shed 50 pounds. While it may seem uncommon for a man to admit this, especially in a society that has associated eating disorders only with women, Azzolino believes there are other men like him.
"Society doesn't look at men when they're skinny, they just look at them as working out. Men that don't want to admit it, don't look at it as an eating disorder, they look at it as looking good," Azzolino says.
Recent literature, such as a November Los Angeles Times article, says that men are beginning to come forward for treatment, crediting the rise in men's fashion magazines and the new emphasis being placed on men and their body image. Another article in Cosmopolitan denies that men can have eating disorders. The article, titled, The Politics of Men, Women, and Food, says "Now try imagining two men engaging in such a conversation. Impossible, right? Because men simply eat food, they don't obsess about it."
Alan Goodfried, an East Bay licensed therapist who works with anorexic and bulimic men, believes men with eating disorders are prevalent and rejects the theories about the rise in image-oriented society as the major factor for men developing such a disease. He finds the real factors are generally personal issues, such as an overbearing mother and a very critical or absent father.
Goodfried, a former compulsive eater, wrote his master's thesis on men and eating disorders at John F. Kennedy University in Orinda, as a graduate student in psychology.
His idea for the thesis stemmed from his work as a counselor for a halfway house where he met an anorexic woman who expressed her "anorectic behavior as a last form of gaining control available to her." He began to look at his own issues with food and questioned the incidence with men.
There was hardly any information when he began to research and the little he did find was buried in medical journals.
In his thesis, Goodfried addresses the biases society has, one being that it "simply does not attend to the fact that males can also be concerned with body image and that they too can suffer from the same preoccupation with being thin as females."
The literature today, notes Goodfried, focuses 98 percent on women, even though the statistics may vary. He feels nobody really knows what the real statistics are, partly because men don't often go to therapy. And when they do go, he says, "they're not going to go for something they're not supposed to have."
Azzolino feels men are afraid to admit it, because they think they have power over it. "I'm sure there are a lot of men out there who could even be hurting to tell somebody about it. They just don't have the courage to walk through it," he says.
On a normal day, Azzolino awakes to spend 10 minutes in front of his mirror and on his scale, drink a pot of coffee and go to work. At work, he has fruit which helps him get through the day. He has no lunch, and if he eats dinner, it's at 4 p.m. and always Chinese food-only rice and chicken. Afterward, he lies down for an hour because it's a chore to eat. He'll wake up and figure out how he's going to get the food out of him. Usually he'll walk. Then, he may have a bowl of cereal before bed.
A common theme with anorexia, reveals Goodfried, is control. "Usually the anorexic feels that other areas of their lives are so out of control that this is the one area that nobody can control them. Nobody can make you eat. Nobody can make you keep it down. Nobody can make you do anything," he says. In his thesis, he states "The fear of fat and a need to establish control are central to the male anorectic's behavior."
Azzolino feels like he is in control, but when he gets the cravings to eat he feels paralysis. Then he suppresses the feeling with coffee or cigarettes. The control part for him is keeping himself empty.
"When I look in the mirror, I think, 'I've never been this thin before, I'm seeing bones on me that I never knew were there,' and when I see that bone I tell myself, 'I don't want to cover that bone again. It's good to see that bone.'"
For Azzolino, his eating disorder has been a 20-year battle. Born and raised in the North Beach area of San Francisco, and the youngest of three children, he lived in a wealthy, middle-class Italian family where there was always plenty of food in the house.
As a child growing up, it was normal to have a peanut butter and jelly sandwich before dinner. At 14, he felt like he was an overeater and began to use alcohol to suppress his appetite. At 25, he noticed that he was gaining weight from the alcohol, so he began to inhale lines of cocaine to induce bowel movements.
This was his method of dietary control, and to Azzolino, an unconscious act. It wasn't until he was in his second week of private therapy, that he realized he had an eating disorder.
At this time, he was exercising constantly, walking through Golden Gate Park down to the beach, back and forth. He grew tired of exercising and decided he would starve himself.
Starvation includes not feeling full for Azzolino. He gets a high when he goes to the bathroom. And he gets angry when people try to give him food.
"One night my mom brought me a pot of spaghetti and when she left, I didn't even bring it in the house. I left it on the sidewalk. I got really angry at that," he says.
Azzolino goes to therapy once a week for an hour and a half. He follows the 12-step program patterned after Alcoholics Anonymous, a program he also adhered to for his chemical dependency. Like AA, his anorexia is treated as an addiction. There's a lot of crying that goes on in therapy for Azzolino. It's easy for him to cry now and it feels good.
Yet he can't admit that he is powerless over eating right now. "They say your life becomes unmanageable and I don't think my life is unmanageable right now. I'm still in a little denial."
Visible signs of anorexia, according to Goodfried, are rapid weight loss, paranoia, depression and thought disorders. There is no typical anorexic man, says Goodfried. They cover a wide range of personalities. Some are married, asexual, bisexual, heterosexual and others, athletes.
He believes there are many men who aren't coming forward, or they're trying to, but they're not being accepted, so they give up.
Azzolino, who recently committed to a new men's group at the Henry Ohlhoff Outpatient Program in San Francisco, says he needs other men to talk to. "It's ok to say you have an eating disorder and that you are powerless over it and seek some help. There's no way that I could do it on my own."
Depression falls into Azzolino's daily battle, until he is outside, where there are no rules. The Native American mandella, along with the other art in his apartment, has spiritual meaning for Azzolino. Spirituality was the first thing he learned from the 12 steps, yet he can't connect it with his anorexia just now. The mandella is said to represent happiness, peace and prosperity. Perhaps, in time, it will bring peace into the room that is governed by rules and rituals.
A Men's Eating Disorder Support Group will be starting Wednesday evenings 7-8:30 p.m. at the Henry Ohlhoff Outpatient Program in San Francisco. (415) 221-3354.