Cross Cultural Eating Disorders

It’s commonly held knowledge that eating disorders are a Western phenomenon. They came about because of beauty standards, small models, and photoshopping. They’re on the rise! Panic! It’s an epidemic!

Only this isn’t necessarily supported by a hard look at the data. One of the problems with assessing whether or not eating disorders exist in other cultures is that the diagnostics for the disorders were developed in the US and Western Europe, leading to a focus on the presentations that we tend to see in those places. As an example, one of the diagnostic criteria for anorexia is “Intense fear of gaining weight or becoming fat, even though you’re underweight.” While this is the motivation for many people to refuse food, it is not true of everyone who displays many of the symptoms of anorexia, and may simply have different motivation.

There are a few different sources of data that contradict the idea that eating disorders are culturally bound or that they are caused by Western beauty ideals. We can look at history or we can look to minorities or other countries that may not have been wholly influenced by Western concepts.

Historically, we have strong evidence that people have been choosing to starve themselves for hundreds of years. The book Fasting Saints and Anorexic Girls traces the history of self starvation from the earliest records through to the first recognition of eating disorders as psychiatric conditions. While the book suggests that these are distinct phenomena because in the past few people have practiced self starvation due to a fear of fatness, behaviorally it shows many parallels.

One particular group of individuals that have similar behaviors to modern patients with eating disorders are religious fasters. These tended to be young women who had little control over their lives in many ways and who chose to abstain from food for extreme periods of time in order to be morally better by ignoring their bodies and focusing on their spirits.

The book includes some quotes from people who chose to restrict their food intake in times past, and concerns about morality, space, selfhood, and perfection come up again and again, just as they do in current conversations about eating disorders. Many of the experiences are couched in religious terms, but the underlying fears (“I am not good enough”, “there is something wrong with my body”, “I need to be better”, “I don’t want this life”) could just as easily be pulled from a study of eating disordered patients today.

Individuals throughout history have chosen to abstain from food, often falling into something like depression and priding themselves on their ability to go without for long periods of time. Their motivations have changed as their social milieu has changed, going from religious, to entertainment, to aesthetic. However many of the sentiments that these individuals express ring similar across time and space.

“It’s like I never knew what self-respect was all about until now. The thinner I get, the better I feel . . . I’m proud of my stoic, Spartan existence. It reminds me of the lives of the saints and martyrs I used to read about when I was a child . . . This has become the most important thing I’ve ever done.” This kind of quote could easily be from a religious faster or a modern individual with anorexia.

Over at Science of Eating Disorders, Tetyana posits “Religious and spiritual reasons are not the only factors that could be contributing to AN in non-Western countries (or Western countries before the ‘thin ideal’). Personally, it would seem to be, that anorexics in those times, would just attribute their desire for weight loss to those reasons much like today it is often attributes to a fear of being fat. But, both of those could just be post hoc rationalizations on the part of the sufferer, to make sense of their otherwise perplexing desire to restrict their intake and lose weight. That’s my feeling.”

I’ve written elsewhere about how restricting food made me feel powerful, godly. I often imagined that my body was not subject to the same requirements that others were. Only the weak needed food, but I decided my morality, my meaning, and my body for myself.

“Comparable to the ascetic practices in the history of Christianity are the fasting practices in the Chinese Daoist tradition (Eskildsen, 1998). These practices sought to transform the body as a means of gaining immortality…  The history of Chinese thought thus suggests that, in certain traditions at least, the emaciated body has been highly valued and pursued in a manner highly reminiscent of Western observances.”

But in addition to historical examples, we can also look at current cases of eating disorders in non-Western countries. It’s a common trope that these are rare, and when they do appear they are evidence of growing Western influence in the country. The problem with that assumption is that many individuals who might be diagnosed with an eating disorder but lack fatphobia are not given the diagnosis. The unthinking assertion that the rise of eating disorders correlates to increased Western influence doesn’t look at the lived experiences of individuals in non-Western countries.

Again, from Science of Eating Disorders:

“For example, one study found that in British Asian girls, dietary restraint was correlated with traditional (rather than Western) values (Hill & Bhatti, 1995). This finding was supported in a study by Mumford and colleagues (1991) who essentially found the same correlation. On a Caribbean Island, with little Western media, Hoek et al (1998) found that the prevalence of AN was comparable to Western countries and a study by Apter et al (1994) showed that a group of village Muslim women (with minimal exposure to Western values) had eating pathology scores that were indistinguishable from patients with AN.”

Many of the patients quoted in this article don’t talk about a strong desire for thinness or weight loss, but point to their bodies as the site for other struggles in their lives, particularly around control and selfhood.

“… food restriction arose from a sense of powerlessness in the family context, it is possible that the patient experienced her emaciation as egosyntonic, with her low body weight consonant with the goal of not wanting “to ‘give in’ to her family, especially her mother, who forced her to eat even when she was not in a mood to.”

Again, these individuals exhibit many of the same behaviors as individuals diagnosed with eating disorders in the Western world, but don’t show the obsession with thinness or fatphobia that we assume is an essential part of an eating disorder.

An eating disorder is a coping mechanism that allows an individual to survive extremely difficult situations or feelings. Physically, it has effects that make it easier to live through strong emotions: it numbs out painful things, it leaves you sleepy and sedated, and it also provides a kind of high that makes you feel accomplished and safe. These are biological results. They are the same no matter where you are or when you’re living. And they are effective at helping someone survive a difficult situation no matter what kind of difficult situation that is: it could be not living up to religious expectations or not fitting into a beauty ideal.

And so I am continually dismayed at ridiculous articles like this that seem to think eating disorders are not only limited to the West, but also limited to young, naive, shallow teen girls who can’t figure out how to do basic things like feed themselves. Diagnosis, demographics, and etiology are complex and confusing. If you don’t know a little something about mental health, don’t write about it.

Embodiment

Eating disorders are about bodies. Duh. They’re about fat and losing weight and body image and skinny models and photoshop. Wait, what? That’s not right. Eating disorders are about the experience of being in a body, the limitations and lack of control that being embodied necessitates. Much better. I’ve been wanting to write about this article at Science of EDs on embodiment for quite some time, but I haven’t known exactly what to contribute beyond “yeah, that!” The article looks at a study of embodiment in which participants rated how much they experienced their body externally, through the feedback and sight of others, through objective measures, or through physical ways of controlling their bodies. Unsurprisingly, high scores on these measures were correlated with eating disorders.

When I read this, I felt a resonance with these experiences and questions: yes, what drove my eating disorder was a feeling of discomfort with having a body, an inability to imagine how my “self” fit into that body, a confusion about how my body actually fit into people’s conceptions of me, and a kind of certainty that the only time I really was in my body was when I was doing something to it or with it. But embodiment has always meant more than that to me. Having a body means you will die. That’s a pretty basic fact at this point in time (although there is the potential that through technology we will change it). Having a body also comes with a variety of limitations: you can only be doing one thing at a time, be in one place at a time, you are bounded by temporality and space. Even if you’re a highly capable person who can probably accomplish nearly anything they try, your embodied nature says that you can only try a limited number of things.

Bodies, and particularly bodily functions (like eating) are a constant reminder of these facts. For much of my life, I have not been able to stand being present in my own body (aware of my senses, my location, my body) because it was so limited. Some people are able to accept these limitations without struggle. Some people don’t find that being in a body is a constant reminder of their miniscule nature in the entirety of reality. But many of the people that I have met who also have eating disorders are the kinds of people who have been told their whole lives that they can do whatever they put their mind to, that they can do so at a high level of accomplishment, and that they can change the world. The perfectionism that this breeds hates limits, even ones that are utterly reasonable (like not being able to live forever).

Some people have certainly wondered why those with a high drive for control and perfection choose their bodies as the realm on which to enact their personal battles. The experience of embodiment as mortality and limitation gives a good window into this connection. It might seem that the whole world is not within our control, but the most basic level at which we have no control is the fact that we are embodied, our bodies do things we don’t want them to, we can get sick and die, and having a physical presence inherently limits the ways that we can affect the world.

It’s quite possible that few other people with eating disorders are consciously aware of hating their body because it represents the fact that they cannot do everything they’ve been told they could; I cannot cure cancer and reconstruct Proto Indo-European and become a bestselling author and be a feminist/atheist activist and play taiko for a living and learn neuroscience and solve the problem of consciousness and star in an amazing TV show. I have to pick and choose, and knowing that I am giving up on some potential opportunity is painful. But even if others don’t consciously recognize that the reason they can’t do all this is because they are physical beings, on some level I suspect they feel it: it comes out in the guttural anger at the body and at the failings of the body, it comes out in the unrealistic expectations of perfection in every way, it comes out in the unnaturally high achievements and the insistence that slack is for other people.

Embodiment might be at the heart of all eating disorders, but not because of bad body image or a struggle to reconcile self-image with the perception of others. Somewhere in there, all of us want to be little gods, capable of anything. Bodies will always remind us that we never can be.

 

Confession Syndrome

There’s a tendency that I have when I’ve done something cruel to myself to want to blurt it out at the most inopportune moments. Sometimes when I first meet people I have to tell them about the times when I went a week without eating, or how it feels to bleed on every object you own because you can’t go a day without cutting yourself. It’s like some sort of disease. Last week at a party I blurted out the story of the most recent time I felt suicidal to a friend, describing the moment in gross detail.

Things are not real until they are witnessed, until they have been woven into words and placed in context. There’s something especially painful about living through trauma silently. You begin to doubt whether it was real, whether it was as bad as it seemed, whether it’s actually a part of you. Every tiny thing you do to yourself is somehow validated as acceptable when there is no one to contradict it. Self harm or restriction or purging is a cruel thing to do to yourself, and appropriately they often come with guilt. If you did these things to someone else, you would feel you needed forgiveness. And so when you do them to yourself, there’s a need to confess and have someone forgive you, let you know that you can continue on.

I’ve started to call it confession syndrome. It’s a way to validate yourself and quickly signal to someone else that you trust them. But it’s cheating. There are absolutely circumstances in which you need to share these stories. They need to be heard and incorporated into your identity and forgiven by you and with the support of the people you love. You need reminders that you are still loved even with the darkest moments of yourself in full view.

But the unthinking moments of blurting out disturbing stories are not the same as honest and open communication that creates a validating environment. Instead, it puts other people in a circumstance in which they have to validate you and have to witness something about you that isn’t necessarily appropriate to your relationship. It bypasses the hard work of actually getting to know someone and shorthands to “we’re close” by disclosing personal information. And because you’ve pushed an interaction into a personal context, you’ve pressured your conversation partner into accepting and being close with you as well: validating you.

Confession syndrome is a horrible way to build relationships. One of the most important elements of trust is seeing how someone behaves over time in a variety of circumstances. You get a feel for someone’s character by doing this. It gives both parties time to increase their vulnerability on a fairly even level: one person might share something slightly more personal, then the other will reciprocate. When you drop a bomb like “I cut myself”, you don’t give the other person the option to reciprocate in any reasonable fashion. It’s a kind of emotional hostage situation: be close to me or else.

Having people in your life that will listen to the times you need to rehash the stories is important. Sometimes they weigh on you and you can’t help but need to say them out loud so that they will stop circling your mind over and over again. But learning how to be a whole human even with all the broken bits is not something to do with that person you just met or at that party while slightly tipsy. It’s for the quiet moments with loved ones. It’s for the places you are wholly safe. It’s for the people that don’t have to prove they will love you through the ugliness.

I’m putting away my confession syndrome, as best I can, moving forward. I have safe spaces to share these stories. I have people that I should tell about the things I’ve done to myself, people who want to know me more fully and who have shown they are trustworthy. These are the relationships that need these stories. These are the people who help me create myself with their narratives and their care. These are the people who want my confessions.

 

Hierarchies of Eating Disorders: A Spiritual Perspective

If you’re someone who reads lots about eating disorders, you’ve probably already seen this article by Maree Burns floating around recently. For those who aren’t enmeshed in the world of post-structuralist and feminist critiques of eating disorders, you may want to try to read it anyway. It’s a little long and at times jargon-y, but it’s also fascinating and makes important points about the hierarchies we set up around eating disorders. Similar to Burns, I will not be using this post to posit anything about the actual nature of eating disorders, but rather about how they’re constructed in the common conscience of Western society.

There are many points in Burns’ article that I’ve spent time grappling with: the fact that anorexia is both held up as perfect control and derided as sickness and disgusting, the way anorexia and bulimia can be mapped onto the virgin/whore dichotomy, and the tendency to view anorexia as the ideal eating disorder. There is an hierarchy of eating disorders, one that is held up by nearly everyone. Anorexia is considered cleaner, more respectable. Many people even view many of its characteristics as positive, but simply taken too far. On the other hand, bulimia is considered disgusting, animalistic, and out of control.

Burns looks at this hierarchy from the perspective of post-structuralism. I’d like to take a different perspective that I think can illuminate some other elements of the hierarchy and the ways that eating disorders make a certain kind of sense. Spirituality is something that Burns does not touch on at all in her article, despite the fact that moral language runs rampant in descriptions of eating disorders, and in the past eating disorders often happened in religious contexts.

Throughout her article, Burns draws on the Western concepts of dualism. She looks at it particularly from a feminist lens, in which female is associate with body/disorder/evil/animal, and male is associated with mind/rationality/control/order. However there is a slightly different version of this dualism that may actually shed more light on eating disorders, which is the body/soul split. Burns points out that society (including pop culture, psychological professionals, and those who actually have eating disorders) makes negative judgments of only certain elements of eating disorders. This includes the behaviors of bulimia (especially purging) and the skeletal body of someone with anorexia.

She posits that these are different types of judgment: the judgment of bulimia is about actions that don’t fit into the appropriate feminine mold, while the judgment of anorexia is about a body that makes a mockery of the thin ideal.  She looks to how each of these “negatives” deviates from acceptable feminine roles and how that deviation results in judgment. In contrast, the behaviors that make up anorexia (self-denial and self-control) are often viewed positively as movements from feminine (bodily) to masculine (rational).

However there is another way to interpret the negative judgments we cast on those with eating disorders and the ambiguous position of anorexia in society. We can find a clue in the religious language used by starving saints in past centuries and co-opted by some people with anorexia today (including myself). Oftentimes this language circulates around dismissing the body completely and moving into a fully spiritual realm. The prioritizing of the next world over this one still holds sway in Western culture (despite frequent cries about our society falling into horrible materialism).

These criticisms of eating disorders reveal that bodies, particularly bodies that remind us that we are animal, mortal, and fallible, are what receives criticism. Negative judgments of bulimia often center around the corruptness of the body and through the body, the individual. The body is seen as the ruler in this situation, but the focus on the body is often given a moral meaning. People with bulimia binge, however the binging on food is often extended into other realms: they’re posited to be kleptomaniacs, sex addicts, or out of control. Most of these assumptions focus on impurity and the fact that binging and purging “taints” the individual. I’ve often heard them referred to as “failed anorexics”. This means that they have failed at the purity that those with anorexia achieve because they allow their body and its needs to overtake them. The obsession with “how much did you eat” and “how did you throw it up” reveal society’s dark obsession with the animalistic elements of bulimia and how it affects the body, rather than an interest in the inner lives of those with bulimia.

Burns suggests that the negative judgments of bulimia are made in contrast to the self-control (often interpreted as rationality) of anorexia. She says: “Self-starving is also paradoxically privileged as a signifier of those qualities that have historically been associated with ‘masculinity’, such as self-control, persistence, transcendence of the (labile feminine) body, and strength” However I would argue that this type of self-control is often associated with spirituality rather than any kind of rationality, as she suggests. People recognize the irrationality of anorexia in the context of the material world. However starvation, asceticism, and self-denial have a long history in the religious tradition of transcending this whole plane of existence.

Something that I’ve posited for quite some time is that the end goal of anorexia is to become pure spirit, to no longer be held up by worldly, finite things.This is why anorexia is often held above bulimia. However the reality is that people with anorexia do have bodies and their actions do impact their bodies. When their bodies begin to appear abnormal, we’re reminded again that they are human, finite, and mortal and that their bodies are falling apart. We are reminded of death (see: focus on the “skeletal” nature of the anorexic figure). And especially as Western societies move closer to secularism, this reminder of death is viewed as disgusting and disturbing, garnering criticism. The combination of heavenly motivation with dying body creates the mixed reaction of most individuals.

This additionally explains the feminine coding of anorexia. It falls in line with the tradition of women who fade away into martyrdom and make their femininity acceptable by rejecting their bodies unequivocally. It is part of the “pure” woman, the history of women as keepers of the spiritual well-being of their families, of women as more moral and in touch with religion than men. Part of the push/pull response to anorexia is the fact that the very deadliness and extremity of it is considered admirable by some. Not everyone can do it: it refuses to accept human limitations and so in some ways appears almost supernatural. The extreme refusal of finitude almost appears to be a martyrdom, especially for those who are trapped within the eating disorder. There’s even a kind of cultish interest in the fact that many people with anorexia suffer from ammenorrhea. Their bodies no longer even produce blood, one of the most obvious markers of human finitude.

On the flip side, bulimia reminds us of our more animal side. We think of the behaviors not as outstanding or amazing, but as mundane and slightly disgusting. We associate overeating with animals, with bodies, and we view vomit as wholly animal (because bodily fluids are gross ya know?). It’s very easy to view the dichotomy between bulimia and anorexia as a struggle between our lower natures and our higher spiritual calling.

And of course if we are considering female morality and spirituality, sex must be play a role. The connections between food and sexuality have already been identified, particularly in Burns’ article. Abstinence is a largely spiritually driven quest. Few secular people feel the need to be abstinent for moral reasons (of course there are some, but it’s not nearly as common as within religious circles). The drift of the spiritual meaning of sexuality into food also colors our conceptions of eating disorders. Just as the body is dirtied and corrupted by inappropriate or out of context sex, so it is by inappropriate or out of context food: a binge. An important part of this connection is the way that sexuality is used to dehumanize, animalize, and objectify women. When we use phrases like “orgies of eating” to describe a binge, we sexualize not only the food, but also the individual participating, and through that sexualization we objectify. It portrays people with bulimia as less human, as more animal. The objectification of women through hypersexualization plays directly into the ways that anorexia (anti-sexual) is viewed as humanizing, pure, and spiritual while bulimia is viewed as animalistic: those who engage in it are objectified just as others who are hypersexualized are.

While the role of male/female dichotomies plays an important role in eating disorders, we should also consider the dichotomy of worldly/heavenly and how that can explain some of the behaviors and attitudes we have towards eating disorders. The history of eating disorders (particularly the long history of female saints starving themselves to death) is a good place to start in this perspective.

Bodies That Change: Weight Loss and Trans Narratives

There’s a parallel that’s been rumbling around in my mind for quite some time now that I’ve been hesitant to write about for fear of stepping into a topic that I know not nearly enough about. I’ve often noticed that whenever I read something written by a trans person, I see lots of parallels with recovery from an eating disorder and with weight loss narratives. And then last week I got a little kick in the pants from a friend who posted an article about weight loss and said they felt parallels with their experience of transitioning.

So I’m just going to go for it. I think there’s a lot of rich support and community that could be built by talking across these boundaries and experiences, and speaking to similarities. I obviously am not trans, so I’m going to do my best not to make statements about the experience that I don’t know anything about, but I will try to pull from places that I’ve heard others describe it and the struggles that they’ve mentioned. I would love to hear any trans perspectives or challenges.

The thing that strikes me most about recovery, weight loss, and transitioning, is that all of these processes circulate around bodies changing (and along the way minds and identities). There is probably some sort of final goal (lose weight, gain weight, present as female/male), but there are all sorts of small changes that a body goes through that must be incorporated into a new identity, projected to the world, adapted to, accepted, and understood as “me” by the individual who inhabits that body. While the particular changes may be different, the experience of “is this me? How does this work? Where did that muscle come from?” is shared. And there are many elements to it that are confusing and difficult which could be made easier by shared conversation from a variety of perspectives.

At the core of all of these things is the process of changing body so that it fits into your sense of who your are: it is creating an identity through a body. In many ways, I think that all of these processes of changing your body are coping mechanisms for feeling that something is wrong with the way you view yourself or the way that others view you, or for feeling as if your body is standing in the way of you creating a healthy identity and life for yourself.

This process is hard. Really, really hard. It doesn’t make sense and there’s really no template for it because asking “how can I get people to take me seriously when my body  no longer takes up the same amount of space?” is not considered Real, Deep, Appropriate work in the social justice community. But this is work. This is the work of understanding that we are physical creatures, and that our physicality can change who we are. This is the work of creating our own identities in such a way that we fully accept the body that is a part of us. Sometimes that involves large, sweeping moments of self-realization and sometimes it involves little things like “I really liked the way I could pick up a heavy couch when I was fat. How do I do things that need strength when I’m skinnier?” It’s the process of learning yourself all over again, but it’s not particularly sexy and it’s not particularly interesting unless it’s your life and you can’t for the life of you figure out how to move your damn bookshelf.

Everything about your body can affect the way you interact with and view the world (or yourself). Having different muscles can affect your mood and energy level, hormone levels can affect your basic perception and sensitivity to stimuli, the sheer amount of space you take up will affect how big, intimidating, powerful, or potentially dangerous you see the rest of the world as. It may seem simple to change your body and switch from checking “female” to checking “male” on the census form, but actually understanding how your body changes your perspective is a much harder and much more subtle process that involves figuring out all those little pieces and putting them together into a new conception of “this is me and this is how I see things and this is how I do things”.

For myself, I have found the process of adapting to my changing body to be frustrating and angering. I’ve often wished that I could talk about it more openly with others, that people were there to commiserate, or that there was just some sort of guide book (will I keep gaining weight forever????). I have heard some of these frustrations echoed in other places, by Zinnia Jones, by those who have lost a great deal of weight. Many of us just want some reassurance that our bodies haven’t turned into something alien and unknown. We want to know that other people’s bodies reacted the same way or similarly. We want to know that we’re still ourselves.

But we also want to know how to relate to the world with a new body. A body that was fat and is now thin is going to take up space differently, move differently, have different strength, touch things differently…even something as simple as sleep differently (welcome to skinniness, where you can’t sleep on your side because your knee bones rub together and it hurts like a bitch). And so many of us are looking for a model of “how do I do stuff when I’m like this”. We’re trying to figure out how to tell other people about our bodies and how our bodies match our selves and what part of our bodies fits our identities. It’s difficult when you’re in recovery to explain your body. The body is often in flux, you’re not “skinny like you were supposed to be”, you don’t entirely understand your body as “right” yet. It doesn’t wholly feel like you. The process of labeling your body and then explaining yourself to others is difficult and something that anyone whose body goes through a drastic change must learn how to deal with.

Learning about how to talk to others about a new body is something we could all use help and support with. How do you respond when someone says “you look different” or “you look healthier” or “you look great!”? How do you tell others what you identify as? How do you look down at yourself or look in the mirror and think “yeah, that’s me. That’s just me”? For me, this process is hardest when I think about my body in the long term. I keep thinking that I’ll drop the weight again, that I’ll go back to the “real me”, that somehow this is just a temporary state of unreality. I have no idea if there are trans individuals who feel this way, but I have heard from some people who went through weight loss regimens that they think about whether the weight will come back, and worry that they’re in a temporary state. I imagine there might be some parallels when you haven’t reached a point of feeling comfortable in your gender identity (sort of in the “still transitioning” point of being trans). I think all of us wonder if the changes will stick, if we should commit to ourselves as we are.

And a big part of that is learning how to internalize this new shape as “me”. While I have never transitioned, I would imagine that it takes a bit of time after hormones/surgery/whatever to get used to the changes (hey I have boobs that didn’t used to be there! That’s odd). For me, it was more along the lines of getting used to being present when I wasn’t entirely happy with how I looked. I wish that I could speak to some of those trans people about how they learned to see their bodies as them, how they learned to view those new manly muscles as “me”, how they started to see boobies as part of their bodies.

One piece of identifying with a new body or a changing body is accepting that there are both pros and cons to any change. For me, I am highly aware of the cons of my changing body (uuugh I’m fat and my thighs rub together) but I often forget about some of the positives (I don’t feel dizzy all the time, I am more physically capable, I’m not nearly as fragile and don’t expect others to walk all over me because of my petite and sickly frame). I think because of the very positive framing of transitioning in the mind of the person who transitions, speaking to people who have transitioned could be an amazing way to remind me of the benefits I’ve gotten from my new body. On the flip side, I think the perspective of someone who is more hesitant to change their body could be useful for someone who is TOTALLY GUN HO about their new body and might need a moment to slow down and learn the ways that their body can’t quite keep up to past expectations.

There are elements to being larger, to being male, to being more muscular that are AWESOME. You take up space. You feel powerful. You feel capable. You even feel like your body protects you from smaller things like hard surfaces or the boniness of your own ankles. But there are elements to being smaller, to being female, to being dainty, that also rock. The world fits you. You get to wear awesome fucking dresses. You’re often allowed to express more emotion and enthusiasm without ridiculous policing. It’s a great practice to recognize the good things about being you right now and being the you that was (sidenote: I am not saying that “female” equals smaller, more dainty and “male” equals bigger and stronger).

Part of this is being honest about the nitty gritty changes, which I believe is a place where all of those whose bodies go through extreme changes can support each other. Your hair fell out, or you get diarrhea constantly, or you get bizarre heart pains, or your mood is all over the place, or your tits are really tender. For people whose bodies haven’t changed these are uncomfortable and overly personal things that shouldn’t be shared. But when your whole world is in flux, it can be extremely comforting to be able to tell someone. I think that’s true no matter the cause of the changes. Recognizing out loud that these are things that are happening can be a big step towards actually accepting yourself. And I don’t think that it matters exactly the experience of the person being open, whenever someone is willing to be vulnerable about these things it makes it easier for others.

At the end of the day, trans narratives, weight loss narratives, and eating disorder narratives are all focused around a body that changes, usually in an attempt to make that body fit with an internal conception of “who I am”. Nobody likes to talk about how the body actually changes, but rather they like to focus on external categories like “fat” “thin” “male” “female”. But in all of these narratives, bodies change slowly, with little adjustments in how we walk and talk, in how much space we take up, in our strength, in how alert and awake we feel, in our moods, in our flipping bowel movements. And for most of these narratives there are pros and cons. Hopefully each person makes a choice that makes them feel more comfortable and more confident in their own body, but change always comes with some cost. I wish that we could talk about what it means to see your body change, to adjust in small and large ways, to move into a new category and identity, to say good bye to some things you might have liked.

I think some dialogue across these spaces could be good for both: we have different concerns about the ways that our bodies change, but I believe we can provide insight to each other. Having an outside perspective that isn’t so wrapped up in the same concerns (ah! gaining weight! ugliness!) might help us see some of the benefits of how bodies change, help us deal with the difficulties, and give us support around the weird little things that happen. And if we can speak across some of these boundaries and labels, we might learn to accept others’ identities a little bit better when we see the parallels to our own.

Things That An Eating Disorder Is Not

1.A fear of fatness
2. A diet
3. A choice
4. Stupid
5. Caused by Western media
6. Caused by beauty ideals
7. A new phenomenon
8. Understood
9. Anyone’s fault
10. Incurable
11. Easy
12. Sustainable
13. Irrational
14. A metaphor
15. Internalized fatphobia
16. Prejudiced
17. For white girls
18. A phase
19. Identifiable by size
20. Isolated from family/friends/society
21. Identical to any other eating disorder
22. Useless
23. About anyone else but the sufferer (and potentially close friends/family members whose emotions are deeply enmeshed)
24. For young people
25. For women
26. A ploy for attention
27. Trivial
28. Motivated by someone else’s body
29. Motivated by the sufferer’s body
30. Seriously, not about bodies
31. Isolated from other trauma/emotional issues that the sufferer might have
32. Fun
33. Shallow
34. Simple
35. Definable
36. Caused by any one thing
37. Entirely genetic
38. Entirely socialized
39. Making a statement (except possibly “help!” or “I can’t handle life!”)
40. About you
41. An epidemic
42. Getting more common (hey guess what more awareness does? Leads to more diagnoses!)
43. For you
44. To please men
45. To make women submissive
46. Weakness or powerlessness
47. A problem for you to fix
48. Something you get to define
49. An identity
50. A talking point or pawn for your theories about society
51. Manipulative
52. Blackmail
53. Seriously, still not about you
54. Gender roles taken to the extreme
55. Not really a problem
56. All in your head
57. Solved by “just eating” (or really by eating at all…that’s an important piece but really doesn’t fix the disorder)
58. A lifestyle
59. A fashion choice
60. Limited to anorexia and bulimia
61. Limited by your location, age, gender, race, ethnicity, religion, class, sexuality, education, or really anything else
62. The same as “wishing you were skinnier”
62. The same as weight discrimination
63. The same as skipping lunch that one time
64. Self-control
65. Submitting to patriarchal beauty ideals

Things that an eating disorder is:
1. A potentially deadly disease that is unique to each individual who has it.

Taking the Long View: On Recovery and Motivation

Recovery from a mental illness is a rough gig. I’ve written many times before about how I wish people would be more honest about just how difficult it is and what that difficulty looks like. Right now, my motivation is low. I want to be done with this stupid, frustrating, painful process. I want people to just leave me alone to wallow and make bad decisions. I want to be allowed to feel bad.

This is basically how I feel all the time right now

Now in the traditional narrative of recovery, this means that I’m slipping. It means the “eating disorder voice” or the depression is getting louder. It means that what I really need to do is double down and fight harder. It’s part of the “roller coaster ride” of recovery. If I don’t nip it in the bud though, then I’ll have given up, I’ll have wasted my progress. I’ll be back to square one, fallen harder than I did the first time and it’s all because I didn’t have “the proper motivation” or I didn’t “fight hard enough”. So if I’m slipping I need to keep my eye on the prize of recovery, think about how great I’ll feel, post a few affirmations around my house, and remind myself once again that I can’t live my life the way I have been living it (because who wants to live in the hell of an eating disorder if you can have recovery, amirite?)

If I was telling the story of my eating disorder, that would be the expectation of how I’d frame this. But that is not the reality. Here is the reality.

Recovery sucks. By most basic cost/benefit analysis standards, it’s a really risky, difficult, long venture. It takes flipping forever, and the time that you put into treatment is not fun. In fact it’s more than not fun: most of the time you feel even worse during treatment than you did when you were happily living out your delusion that starvation was the way to a great life. Things have suddenly gotten a whole hell of a lot more complicated and you can’t just rely on rules anymore. So say you’ve been trucking along in your mental illness and then treatment comes and hits you like a ton of bricks. You spend the next 2/3/4/5/forever years working through mountains of crap. And those years SUCK.

And the more you realize that they suck, the more you realize that a lot of the suckiness will still be there even if you do “recover” because life isn’t easy and being healthy isn’t easy and it’s hard work to enforce your boundaries and balance your needs with the needs of others and fight against sexist and damaging media and somehow put together a clear and cohesive identity that can stand up to the trials of life. So you get this picture that in the long run you’re going through a whole hell ton of suffering right now to maybe feel like you can cope with the fact that life is really hard later.

Now pile on the fact that it often looks as if you’ve made no progress whatsoever. Seriously. I’ve been at this for about 3 years (with the same therapist), through intensive programs, groups, dieticians and many, many, many hours of therapy, and a lot of commitment. Three years is a long time to be spending at least 2 hours every week in therapy and most of the time in between wrestling with all the hard questions. And yet when I think about the things that really get in the way of feeling content or grounded, I see no change. Perfectionism still drives me. I still feel unlovable. I still cannot accept praise and focus exclusively on the negative. I can still be flattened emotionally by one negative comment. I still personalize, I still tend towards black and white thinking, I still feel anxiety for no reason, I am still afraid of social interactions…

Logically, it makes sense to be a little low on motivation when there is little evidence of how far you’ve come, much evidence of the pain you’ve suffered and will continue to suffer, and no guarantee that things will be a whole lot better if you continue to work (for another 3/4/5 years?). Part of recovery is trying to make sense of what is worth it and what isn’t, what life can or can’t be like. This isn’t some sort of slip, this isn’t an indication that I just need to fight harder. This is coming to grips with reality.

But there’s another truth and it’s one that I’ve had a really hard time accepting. It’s about the long view. I spent the better part of 20 years developing these really bad coping strategies. It will take me a long time to change them, nearly certainly more than 3 years. For many things that I care about I am willing to invest huge amounts of time (schooling as an example), often because I can see that the end goal is worth it. And many times I can make these investments on faith (when someone tells me that I’ll get a diploma at the end as an example). With nearly everything else in my life, I can take the long view; I am willing to put up with the pain of the now to get something in the future, even when that something isn’t happiness or a perfect life. Why does the pay off for treatment have to be held to a different standard?

Now there are very real differences here. I like school, the pain that I’ve experienced while in treatment far outstrips anything else I’ve ever felt, and the evidence I have of the benefits of recovery aren’t as strong as the evidence I have of many other things (that, for example, a higher degree would make my life a lot easier). Recovery is harder than anything else I have done in my life because when I look at it logically I can’t guarantee that I’m making the right choice to pursue it. But if I look at the long haul, I can see that I can’t come to the conclusion that it’s failed yet. The experiment has to continue. And I do believe that when people are waning in their motivation, it’s because they are re-analyzing the long view and that view is scary.

But I hope others can join me in realizing that it has to be long, but we are capable.

 

 

 

NEDA Week: Writing the Experience

One of the things that I have often noticed about those in the eating disorder community is that many of the people in it often have difficulties speaking or telling their experiences, and that often they are far more comfortable with writing as their chosen form of expression (art is also common). As I think about eating disorder awareness, I’m really struck by the ways in which we write down what it is to have an eating disorder, particularly those pieces we conveniently leave out.

In particular, writing is a very different medium from speaking in that we have a lot of time to edit and only put down carefully crafted words. Oftentimes stories change a great deal when they get written down: certain parts are deemed unimportant or not fit for mass consumption, some parts are changed as we retell and rewrite, and we feel the need to create a coherent narrative. Who wants to read a story that ends “I’m still living my life and things are much the same. I learned a few things but I haven’t learned all my lessons yet and I’m still working the way I was through the whole story”?

Even as many of us find it easier to write, coming clean about the experiences of an eating disorder is still incredibly difficult. While the stigma and stereotypes are slowly being eroded, very few people actually want to hear the nitty gritty details of being on the inside of an eating disorder. No one wants to know about the puke you get on all your clothes when you purge. No one wants to know about the bizarre digestive problems and the sheer boredom of anorexia. No one really wants to know all the horrible things you say to yourself when you’re on your own. It’s incredibly difficult to pin down how honest is honest enough but not oversharing, and perhaps even more it’s hard to know how to frame your experience.

Eating disorders are your life. For as long as you have one, it tends to define  you, to take up almost every minute of your day, to affect nearly every decision. Imagine trying to summarize your life for the last year, being honest and giving someone the best insight into what the internal experience is like. This is the experience of trying to write what it is to have an eating disorder. To write it is in its very essence to try to pin down an entire life, to cut some things out, to forget, to choose a focus that may not wholly encapsulate who you are and who you were.

It is impossible to ever be wholly honest when you choose to write a piece about an eating disorder. As hard as it is to describe each individual experience that makes up the moments of an eating disorder, it is literally impossible to ever explain all of them. So what does it mean then to try to write an eating disorder? How do we choose which pieces to leave out?

In part, you define what it is to have an eating disorder by the pieces you choose to write. But you also choose how you want the world to view eating disorders (because as a minority, each one of us of course has to speak for all of us). You decide how to humanize eating disorders. Writing the experience is not telling others what your life personally has been: it is giving others a template for how to understand others with eating disorders. This may seem like a lot of pressure, but unfortunately many people out there will only ever hear one story of eating disorders and it may be yours. Most of us who write our stories know on some level that we aren’t just telling a story, we’re creating a narrative for People With Eating Disorders. This is part of why it’s so hard.

I believe that we’ve reached a point in eating disorder awareness where it’s become really important for us to start telling the ugly pieces. We took the time to write the narratives that show we can be positive and hopeful, the narratives that inspire, the narratives that people can relate to. But now we have to write our difference. No one will be able to help us until we’re willing to show them how we are not like other people, how our minds function in terrible ways, how we can spend hours debating a single bite, the mundane and disgusting and stupid parts of having an eating disorder.

Stories like this: last week my boyfriend was horrifically sick. It was something flu-like. He couldn’t keep anything down, he was miserable, he couldn’t leave the house because there was stuff coming out of both ends…and I was jealous because I knew he would be losing weight and I couldn’t.

I want our narratives to be whole and complex because we are whole and complex.

NAMI Week: Tropes and Strength

This morning on my way to work I was listening to NPR and I heard an interview with a woman who was in remission from breast cancer. She’d written about her experience, but unlike many other breast cancer stories, hers wasn’t bedecked in pink, she wasn’t painfully upbeat, and she didn’t have a story about how grateful she was for the experience. Instead, she spoke honestly about the fact that she wasn’t a breast cancer “warrior”, that it wasn’t about being strong all the time, that it truly sucked and she felt disgusted sometimes when she saw herself without eyebrows or hair, and that in the end her life went on in much the same way as it had before the diagnosis.

As she spoke, I felt some resonance with the experiences I’ve had of talking about eating disorders and the tendency to demand that those in treatment always remain upbeat, to turn the disorder into something you fight, and to gloss over the real and difficult elements of treatment and recovery that absolutely suck. No one honestly tells you how it feels to see yourself gaining weight, or how it feels to eat that first meal in your treatment program, or the circles you go in round and round in your own mind trying to decide what is healthy and what is good and what is right.

There are certain tropes in the eating disorder community about the right way to recover and the right way to seek treatment. The right way is with a positive attitude, with a desire to recover, with a strong inner motivation that turns you into a warrior against the eating disorder mind. The right way is following your meal plan and with mantras and with finding the joy in your life again so that you have the strength to battle on. The right way is by finding your inner beauty, by struggling through mechanical eating until you find love again, by having the very best family ever that you always rely on and always open up to. The right way is by learning the world is huge and beautiful and you are too, by realizing you would never judge others the way you do yourself, by finding your authentic self.

The right way to recover is to hold on to your eating disorder until you’re hospitalized repeatedly and nearly die, realize the importance of your life and then throw yourself into treatment, never looking back despite how hard it is. The right way is with breakdowns on the shoulders of those you love and moments of clarity.

These things are great for some people and I would never tell someone that they can’t hold on to these tropes or strategies if it works for them. Unfortunately there are many, many, MANY people for whom these things just aren’t their reality. Many people get dragged into treatment kicking and screaming, but that doesn’t mean that treatment will always be 100% useless for them. Many people don’t hit that moment of rock bottom and get a burst of clarity and momentum to move forward. Many people don’t find new joy or fun in life again, they simply have to remember how to manage in a contented way as they used to. Many people slog through years of treatment under different programs and therapists without a clear sense of where they’re going until they’ve finally found they have many of the pieces they need to do better.

It can be a wonderful thing to hold onto something positive. It can be inspiring to see that someone else has made it through and is in a better place than they used to be. Many of these tropes seem to have grown out of the idea that we can be strong and we can come out the other side better, the idea that we are not less than others or weaker than others or in need of pity. These are wonderful things to hold on to. But just like anyone else in the world, we also must be allowed to have difficulties and struggles. We must be allowed to have the complex experiences of being human.

Just as it is cruel to deny people of a certain group hope or happiness, it is just as cruel to deny them the experiences of being afraid or anxious or hurt. Part of what I would like to see in the awareness of eating disorders is the portrayal of real and complex people who have eating disorders: people who are sometimes hopeful and sometimes broken, people who work through each day like anyone else but who happen to have a few more things on their mind, people whose lives and trajectories aren’t a straight line down and then a straight line up. 

True awareness is not statistics or cut and dry stories that end just so. True awareness is a conception of how eating disorders fit into the real and messy lives of real and imperfect people. It is listening to someone speaking openly of what it’s like in their life. It’s not leaving out the parts that are hard or scary, or painting the illness to recovery journey as one of black to white. I would love to see more of this awareness.

NAMI Week: What Can I Do?

Welcome to National Eating Disorder Awareness Week 2014! I’m going to try to spend this week blogging about issues surrounding eating disorders and eating disorder visibility as my own small part of eating disorder awareness.

To start out the week, I want to try to make eating disorders a little less scary. Oftentimes when we try to shine a light on mental health issues, the average joe who does not have whatever condition we’re talking about gets overwhelmed. What am I supposed to do? If I see someone who seems like they might be dealing with this how do I help?

These are important questions because we are just scratching the surface of psychology and neuroscience, and for the most part we don’t have good understandings of the etiology of mental illnesses. It’s hard to tell someone what to do to help fight a particular illness when we don’t know what causes it. It isn’t like diabetes where we can promote healthier eating and more exercise. Eating disorders are complex beasts that can react negatively to almost anything you throw at them. So during this week of heightened awareness, what sorts of things can you commit to to improve relationships with bodies and fight against eating disorders?

To me, the best place to start is at home. We learn from each other and there are very few models of healthy body image and healthy eating. In a world filled with shitty messages about how you should treat your body and how you should relate to your body, the hard work of feeling at home in your skin is fairly radical.

Fight against Cartesian dualism and see if you can’t learn to see your body as an integral part of yourself. Practice less negative self-talk and judgments. Try engaging in activities that ask you to take up space, like dancing, and revel in taking up space. It may not seem like a lot, but your good mental health can be great for someone else. Some really concrete ways of doing this can be cutting out calorie talk. It’s one thing to say you want more protein and less sugar, but calories are actually really unhelpful at assessing the healthiness of a food and feed into diet culture.

Another thing to try to cut down on is “bad food” talk. Many people like to say things like “Oh I’m being so bad” when they eat something sugary or fatty. No, you’re not, you’re eating something tasty. There is no such thing as bad food and it is not a moral failing if you eat more fat or sugar than is maximally healthy. See if you can stop putting moral judgments on any food. It’s hard. You will see how ingrained size, food, and morality are. The more we can cut those ties the more we create a healthy environment.

But there’s a lot more to eating disorders than food and food discomfort. Obviously. So is there anything you can do to help create a positive environment that will help combat some of the underlying fears? YES! Something that I’ve noticed over and over with my friends and acquaintances who struggle with eating disorders is feelings of inadequacy, feelings that our emotions are bad and wrong, feelings that we will never be good enough or perfect enough.

A great thing to practice towards all people in your life is validation. Validation at its most basic is just letting someone know that what they’re feeling is real. It’s acknowledging their emotions and not passing judgment on those emotions. It can be as simple as saying “wow that sucks” when someone tells you they’re having a rough day. This can be done in conjunction with all sorts of other types of interactions like problem solving, but I’d suggest practicing validating all kinds of people for all kinds of things. You never know who needs it and it’s a good skill to get in the habit of doing. Your coworker says they’re swamped. Instead of one-upping or asking if you can help, start by simply saying “wow that sounds exhausting”. This may not seem like a lot but if you make a practice of it you can do a lot for other people by sending them the message that their feelings are valid, real, and acceptable.

Another good idea might be to educate yourself on some of the basics of mental illness. NAMI has some good resources. I would suggest in particular getting a basic understanding of depression since it’s one of the most common mental illnesses out there. A little bit of understanding can go a long way. Hand in hand with that it’s a good idea to keep your own mental house in order. If you’re struggling, be willing to see a therapist. Take some time to think about how you communicate and how you can improve your communication skills. Make sure you’re taking responsibility for your own emotions and learning about how to keep yourself stable and content. Tall orders yes, but the more we all work on these things the easier it is for people who have serious hurdles.

So say you’ve done all of this and made your best effort to keep yourself and your environment validating and fairly healthy. You’re paying attention to your friends and family, trying to be a helpful person, and you start to notice some of the signs of an eating disorder in a friend. They’ve suddenly become obsessed with food, they’ve started to isolate themselves, they avoid situations that involve food. They may have lost weight suddenly or just become secretive about their eating habits. You hear them making cruel remarks about their body. They start going to the gym ALL THE TIME, or eating huge amounts and then disappearing suddenly. You can tell their mood is down. What on earth do you do now that you’re faced with the real beast that is an eating disorder?

One of the most important things to remember in these kinds of situations is that you cannot fix your friend. It is not your responsibility nor is it possible. Hard to accept, but super important. It can be hard for someone who’s depressed or in the midst of an eating disorder to reach out for help. One good thing to do is offer yourself and your time. Ask them to hang out instead of waiting for an invitation (mustering up motivation and intention to do these things can be nearly impossible when depressed), make sure they know you’re available to talk to, offer to go for a walk with them or do something else you know appeals to them.

It’s important to remember that confronting someone about food is probably the least helpful thing you can do. The eating disorder will interpret this as a threat, double down, and make life hell for everyone. If you’re extremely close to the person you  might suggest that they see a therapist because their mood has been off or down and you’re worried about them, but food is a scary place for someone with an eating disorder. Provide them with options, make sure you’re eating enough and that you’re offering them opportunities to eat, and validate the hell out of them.

There is no one perfect answer to what you should do to support a friend or family member. These are some places to start, but there are also support groups available for friends and family members at some eating disorder clinics and that’s a great place to get yourself if you want some additional ideas and people to rely on. If you can spend some quality time with your loved one, try to listen to what’s really bothering them underneath the food. That may be the most helpful thing you can do.