"The terrible tragedy of Karen's death," says Levenkron, who treated the singer for a year, "is that she had recovered from anorexia nervosa when she died. She had gained the necessary weight, and after she left the hospital she never abused laxatives or misbehaved in any anorexic ways. She fought a tough battle and she had won."
Karen first consulted the New York therapist (author of The Best Little Girl in the World, a novel about anorexia that was the basis for a 1981 TV movie) in December 1981. His practice was, and is, devoted to the treatment of anorexic women. They come to him regularly (sometimes daily, as in Karen's case) for hour-long sessions devoted to exploring the emotional basis for their inability to take nourishment.
For most anorexics, Levenkron says, the refusal to eat is a control mechanism: Often overwhelmed by family demands and their own desire for perfection, anorexics focus on consumption—or refusal—of food as a means of control. Part of Karen's therapy involved discussing her family problems as well as her self-destructive eating patterns, since "the weight loss and curbed eating are a symptom that you can't separate from the patient's life," he says.
Occasionally Karen and the therapist even lunched together—an event that would have been stressful for most anorexics, who typically are "frightened of being observed eating," he says. For them, "it's very private...there's a lot of cutting and taking minuscule bites and other peculiar things aimed at not eating."
Although Levenkron declines to detail the specific problems that the two discussed, he observes that "entertainers are the most vulnerable people in the world. They're caught in a world that's flying by. Controlling what you eat is a way of controlling that."
For some anorexics, counseling alone can lead to a weight gain. For others, including Karen, therapy helps vanquish the fear of putting on pounds, but hospitalization is needed before the weight will come back. In September 1982, Karen went into Lenox Hill Hospital, where, according to Dr. Gerald Bernstein, she was "terrified but determined." She regained her periods, which meant that she had improved emotionally and nutritionally. "The extent of her bravery has to be stressed," adds Bernstein. "These patients have enormous fear as they look at the pounds coming on."
Over the course of her hospitalization, Karen's intravenous feedings (which originally provided about 2,000 calories a day) were gradually decreased as she increased her consumption of food. By November (her self-imposed deadline for conquering anorexia), Karen was eating three meals a day and adjusting to her filled-out form. "She used to look at her arms and say, 'I'll just have to keep remembering that they're supposed to look like this,' " says Levenkron, who adds that erstwhile wraiths often must learn to cultivate the proper body image. (He recommends that they survey their bodies in a full-length mirror and tell themselves, "This is an acceptable appearance and I should fight to keep it.")
A buoyant Karen was released from the hospital on Nov. 8 and remained in New York for two more weeks. "She was very positive," Dr. Bernstein remembers. "She was a little anxious about the future, but also very eager to get back to L.A. and sing."
She agreed to keep in touch with Levenkron when she left for the West Coast late in November. Thanksgiving could have been a tough time for her: "Anorexics are anxiety-filled" during such holidays, the therapist says. "They feel as if they have to do an eating performance with the whole family watching." But Karen was different: "I never sensed she had any anxiety about Thanksgiving," Levenkron says. She telephoned him two or three times weekly until the week she died, and her mood was "very up."
After death claimed Karen last Feb. 4, Levenkron and Bernstein examined her records for oversights or omissions in her treatment. "Every way we could measure her heart we did, and it was normal," Levenkron says. He theorizes that the long years of self-imposed starvation, along with her addiction to laxatives (unlike many anorexics Karen wasn't known to have used self-induced vomiting to control her weight), simply took their toll.
Ironically, Karen had decided to share her story with the world via talk-show appearances and the like but died before she could reach a wider audience than the anorexics she knew at Lenox Hill. "In L.A. she used to call up the kids she'd met in the hospital to tell them she'd gained the weight and that they could, too," says Levenkron. "She wanted people to know anorexia could be cured."
Three months before her heart failed, 104-pound Karen Carpenter left the New York hospital where she had gained 24 pounds after being fed intravenously for six weeks. She was triumphant and presented therapist Steven Levenkron with a needlepoint banner that read: "You win—I gain" (right).