The Best Little Girl In The World By Steven Levenkron

The idea came to her with a flash of excitement. Francesca was fat. Francesca was dead.

I feel like this is one of those titles that for a couple of decades was as widely-known and widely-read as Are You There God? It’s Me Margaret, Flowers in the Attic, and Go Ask Alice; it was adapted by Aaron Spelling (!!!) as a popular TV movie in 1981, starring a teenaged Jennifer Jason Leigh. The novel was at least 10 years old when I read it as a YA (and when I asked my 8-years younger sister is she had read it her response was “Duh, of course”). The copy I have is the 1997 reissue, which the cover touts “Over ½ million copies in print!” A quick Google search turned up a number of study guides for the book, which makes me suspect it is on a number of middle-school curriculums. So I’d say that even if the kids these days aren’t reading it, psychotherapist Steven Levenkron’s debut novel about the ravages of eating disorders is pretty well steeped into our cultural consciousness- when Marti Noxon’s To the Bone premiered on Netflix in 2017, almost every review refenced the Spelling’s TV movie.

I was surprised that I encountered a dearth of criticism about the actual book; aside from a few vague references that it wasn’t “realistic” or that Levenkron comes off like an egomaniac. I remember a major component of the book’s allure was the fear that it would serve as a how-to manual for anorexia for teen girls, and that forbidden quality making it all the more fascinating, copies loaned out on the DL amongst friends.

Reading it for the first time in at least 30 years, I was prepared to be underwhelmed, but was actually surprised how compelling most of the story is- and how many details I remembered, starting with the opening scene.

Ambitious ballet student Francesca Louise Dietrich (I even remembered her middle name) is in the midst of being drilled through a routine by the martinet-like teacher, Madame, when suddenly she has a flash of inspiration and new a personality emerges

The idea came with a flash of excitement… She quickened her movements. One, two slim, firm, three, four, well, done, and then, as if it came from the beat itself, the new girl was born, Kes-sa, Kes-sa. The name was brief, firm and hard, just as Kessa would be. The name was born. The body would follow.

Kessa not only becomes Francesca’s new identity, it also serves as a mantra, as a way to cope through meals with her parents. Now wealthy residents of New York’s Upper West Side, Hal Dietrich is a self-made man in manufacturing some sort of machinery; there still seems to be some class tension with his more refined wife, Grace. Kessa’s siblings are much older: Golden Boy Gregg, off at Harvard medical school, excused from having much contact with his family at all; and Susanna, the family screw-up, a college dropout who moves from commune to commune on the west coast, living on her parents’ dime.

Petrified at facing meals with her parents, Kessa gets by cutting her food up into ever-smaller portions and pushing it around on her plate, and making up new rituals, like not allowing her mouth to touch the tines of her fork, all the while tapping out her new name on the side of her chair.

The Dietrichs don’t notice Kessa’s already small frame dwindling, until her mother walks in on her in her underwear and insists that she see her pediatrician

Dr. Gordon immediately suspects, but does not say, anorexia nervosa, a newly emerging disease that seems to only effect upper- and upper-middle class white girls (Levenkron repeats this idea throughout the book, which dates it more than anything else), and scolds Grace before arranging a follow up appointment:

“Mrs. Dietrich, Francesca is fifteen years old. You’re her mother. If she’s doing something foolish, dangerously foolish, and you tell her to stop, you’re not bullying her. You’re fulfilling your responsibility as a parent.”

And I never wanted to be, Grace thought, but did not say to Dr. Gordon. She hadn’t planned to have Francesca. Two children, a boy and a girl, were enough. She had a perfect family- then she’d gotten pregnant with Francesca.

This is the point where the book’s point of view subtly shifts from Kessa’s to that of her parents, as she continues to lose weight, and is next recommended (against her father’s will) to a Psychiatrist. Dad blames “a bunch of fag fashion designers tell women to look like men- not even like men, like flagpoles- and women all over the world start dieting their asses off” for Kessa’s condition.

Dr. Smith sees Kessa twice a week… and continues to bill the Dietrichs after Kessa stops showing up for her sessions, enraging Hal, who bodily drags his daughter to an old classmate…

 “an old-fashioned GP. No fancy Park Avenue office and no specialties. Waldman doesn’t treat an ear or a lung or a leg… And I think that’s what Francesca needs right now, someone to knock some sense into her.”

Waldman tries to throw the fear of hospitalization into her, threatening her with a glucose drip and a feeding tube, and ordering her to put on some weight and to stop “all of this dieting nonsense” and reassuring Hal that he took a firm hand with her.

But Kessa’s weight continues to drop, and she blows an elite audition for a summer ballet program because she appears so lethargic; initially taken aback when Madame doesn’t even seem to care, Kessa soon discovers that she doesn’t really care either.

It is Kessa’s pediatrician, Dr. Gordon, who at last calls the Dietrichs with a suggestion to meet with a young, hip psychologist who is doing some cutting edge work with anorexics, Dr. Alexander “Sandy” Sherman.

Have we at last encountered our Steven Levenkron-surrogate? We have, and the point of view shifts again for one last, boring time as Dr. Sandy (he is so insecure that he a PhD and not an MD!) is the only one who can break through Kessa’s defenses, and really rap with her about her problems.

But Kessa continues to lose weight, even as she develops a rapport with Dr. Sandy, and when her blood pressure drops so low that she in eminent danger of collapsing, she is hospitalized.

Kessa is admitted as a medical patient, not a psychiatric patient, so aside from sessions with Dr. Sandy, the hospital is only interested in having her gain enough weight to be discharged.

Also in the ward are Myrna, another anorexic and harbinger of what could be to come for Kessa, telling tales of the various hospitals she’s stayed at and sharing tricks to ingratiating oneself to the staff and hiding food for binging and how-tos of purging it, but Myrna also regards Kessa as competition for her place as top anorexic in the ward.

Kessa’s roommate, Lila, a charity case from Harlem recovering from a club foot operation, mainly serves to remind the reader that only rich white people could get anorexia in 1978, and shake her head in disbelief at Kessa and Myrna’s antics.

There is a lot of Dr. Sandy’s point of view, as he butts head with the actual doctors over his unorthodox methods

“Doesn’t everything you’ve said-“ the young man’s tone was belligerent- “fly in the face of traditional psychiatric practice. Whatever that is,” he added pointedly. “Taking kids over, telling them you’re in charge of their lives, touching them, hugging them, getting involved with the.” He said the last as if it were an unspeakably filthy thing to do.

Kessa eventually does end up with a feeding tube, and as a result of that and various breakthroughs about her homelife, she eventually gains enough weight to be discharged, Dr. Sandy diagnosing the cause of her illness as a vague stew of fashion magazines, ballet training, sibling rivalry and parental neglect. As Kessa prepares to return home, he promises they will keep in touch:

“You’ll be able to call me whenever you want, Kessa. You know why?”

She smiled, knowing the answer he wanted her to give. “Because I don’t have to be sick to get attention?”

“Because you don’t have to be sick to get attention.”

Well, done and done then, that problem was solved in 250 pages….

…OR IS IT? Stay tuned next week, Constant Readers!