In a Cinch

In The Beauty Myth (2002), Naomi Wolf writes, “During the past decade, women breached the power structure; meanwhile, eating disorders rose exponentially and cosmetic surgery became the fastest-growing medical specialty. . . . We are in the midst of a violent backlash against feminism that uses images of female beauty as a political weapon against women’s advancement: the beauty myth.”

With this in mind, I began thinking about the relationship between feminism and our bodies, and a number of questions emerged: Can you be a true feminist and still want to dip below your natural weight? As women make unprecedented professional strides, are our bodies more prone to evaluation and scrutiny? Are we all tacit supporters of the unpublished truth that in order to be successful, you must be thin?

Considering the amount of mental energy we devote to judging/denigrating/whipping our bodies into shape, it’s amazing we have the resources to work, love, and raise kids. A friend in college once remarked, “If I could take all the time I’ve spent so far trying to lose weight and to manage my body hair. . .” The sentence was incomplete, but the implication clear—who knows what else she, at only 20 years old, or any of us could have accomplished? And, what cultural forces dictate that we focus on these concerns, at the expense of larger ones? What might happen, if our energies were to be unleashed?

I’m reminded of a holiday weight-control tip I found on prevention.com. The site offered: “For the duration of the holidays, wear your snuggest clothes that don't allow much room for expansion.” Reading this, I found myself cringing at the discomfort (physical and emotional) of constriction. And now, I find myself wondering, is a diet just a modern-day corset?

How Old Are You?

Kind of an odd question, I know. But, as I'm thinking about developing this project, which involves marketing the book, one question that arises is the age of my target reading audience. I'm trying, therefore, to get a sense of to whom my writing may appeal--women in their teens, 20s, 30's, 40's 50's, 60's, beyond?

So, if you don't mind, I'd love to hear how old you are (or in which bracket you fall). If you're not comfortable announcing this in a public forum, feel free to email me. Or, to approach it differently, do you have any idea as to which age brackets this blog/book may most effectively target? I'm curious about how appropriate both the content and writing style are for different age groups.

Thanks!

There's No Free Lunch

In a general psychotherapy group I lead, one patient asked, "Are you an eating therapist?" By this, she meant, "Am I allowed to eat in group?" The answer, for my groups, is yes (provided the munching is unobtrusive). I'm too much of a proponent of intuitive eating plans not to let a hungry person eat (though I might challenge this if it became a pattern). Some therapists, however, look at eating (in group or in individual therapy) as a sign of resistance--to eat is to avoid (usually emotions), and a prohibition of eating, therefore, encourages patients to tackle their reluctance head-on.

But, what about food choices at work, what you eat in front of colleagues and your boss?

In a New York Times article from the Sunday Styles section, wrter Abby Ellin takes us on a journalistic jaunt into eating at the workplace. In her article, "When the Food Critics Are Deskside," employers weigh in about their office policies and thoughts and feelings related to employee lunches. Should you go out or stay in? Entertain clients or nibble at your desk?

And, then what about WHAT you eat? It comes as no surprise that folks are judging our food choices and extrapolating to characterological conclusions. Ellin writes: "No matter how private you think it is, what you eat-and how much--sends telltale signals. People make assumptions about your character, whether you're driven (grilled salmon) or lazy (pepperoni pizza). " It might seem short-sighted, but we make these assumptions left and right. Everyone wants a disciplined politician, right?

But, sometimes it goes too far. According to the article, the most fastidious food critic may your pre-employment interviewer. Steven Viscusi, the owner of a headhunting firm in New York states: "'When I'm interviewing someone and I see their bones protruding, I know it's a good hire. "

Is Viscusi just stating the (typically) unstated--the fact that we all associate dieting and thinness with self-control, which we then associate with a host of other positive attributes? Might we allow a slender woman her pork fried rice, but expect cottage cheese (and, on a good day, a slice of fruit) from our heavy office mate? To me, it's alarming how food choices transcend the kitchen and enter our social psychology--a heuristic for assessing good and bad, right and wrong.

Did You Lose Weight?

Several months back, I had lunch with a friend, whom I hadn’t seen for a while. Walking out of the restaurant, my friend observed, “You look like you’ve lost weight." Lest I forget that thinness equals greatness, she continued, “You look great!” While I didn’t know if I had or hadn’t actually lost weight, her comments spurred an interesting internal dialogue: Wouldn’t it be really great if we didn’t have to have conversations about each other’s bodies? (Apparently, my friend isn’t up-to-date on this little project I’ve been working on.) And, if this isn’t possible, wouldn’t it be interesting if we could comment on people’s weight-gains and –losses with the same emotional valence? In this way, perhaps my friend could see me several months later, notice that I’ve put on a few pounds and offer, if she were to offer anything at all, “Looks like you’ve gained some weight,” and I, recognizing my weight as just one aspect of my appearance (which is just once aspect of who am I) and knowing that my weight and shape have absolutely no bearing on my happiness or success would be able to shrug off her comment as easily I did the last time.

More on the Perfect Body

From a print ad from Cotton Incorporated ("The Fabric of Our Lives"): "Nothing complements imperfect genes like the perfect jeans."

At the birth of a baby, most parents will focus on the baby's health, experiencing relief when genetic disorders, congenital conditions, etc. are ruled out. The baby has all its reflexes and 10 finger and toes? Perfect. So, why are "a few extra pounds" considered imperfect later on?

The Perfect Body

Perfection. It seems to me, it's an individual concept, subject to our personal ideas and whims.

The perfect partner.
The perfect home.
The perfect job.
The perfect night out.

Chances are, we're likely to find a large degree in variation in our responses. You prefer an upscale condo, I like simple on the beach. You like steady/stable, I like uncertainty and change.

Why, then, do so many of us agree upon the perfect body?

Pushy, Overweight Women (and Other Stereotypes)

Seen the trailer for the movie Norbit? New York magazine summarizes for us: "In the recently rejuvenated Oscar nominee Eddie Murphy's latest comedy, he dons a fat suit yet again to play (opposite himself) an overweight, pushy woman who forces him into marriage."

You didn't really think that an overweight woman could land a man on his own volition, did ya?

The Tyra Banks Show

Jessica Weiner, the author of the 4th book on the EWHAED book club (scroll down and check the right side of your screen. . . I'll hold on) will be a guest on today's Tyra show, helping the talk show host confront the scandal the media has created about her body. I've seen Jessica speak and really enjoy her approach--check it out, if you get the chance.

Intervention

Palmtreechick, over at Just Babbling, recently forwarded me a Google search that landed a reader on her site. The search? "How to be anorexic." I got to thinking about what I would say to this (likely young, female) reader if I had the opportunity to chat with her, how I, armed with all my information and training, would probably still feel powerless, as I tried to address what feels like preliminary step down a long and winding road. Or, is it preliminary? Is the die cast, the story just unfolding?

I find myself humbled by the disempowerment of language, when up against a daunting, persuasive disease. Yet, if there's a question, then there's uncertainty and hopefully some room to move.

What would you say?

Tyrascope

People magazine's latest issue features a story on Tyra Banks, who, if you haven't noticed, has gained some weight as of late. It seems, however, that public opinion is mixed--while some may feel Tyra to be more "relatable" at a heavier weight, others have quite a different reaction--according to the article, Tyra's been labeled "ugly" and "disgusting" and headlines abound: "Tyra Porkchop" and "America's Next Top Waddle."

Tyra says: "I've made millions of dollars with the body I have, so where's the pain in that? If I was in pain, I would have dieted. The pain is not there – the pain is someone printing a picture of me and saying those (horrible) things."

Why must we pick apart her body, flaunt her cellulite in print, and focus on her weight, rather than her accomplishments?

Let's keep in mind that at 5'10" and a reported 161 pounds, Tyra's hardly obese. And, with two hit shows, she's become an American media sensation, rumored to follow Oprah's lead.

But, let's not let her get. . . too big.

Feed Science

Recently, a psychologist at the New York State Psychiatric Institute/Columbia University Medical Center contacted me, seeking participants for a study. I told her I'd post the study information on my site, since I support the scientific exploration of e.d.'s and since it's an opportunity for those who struggle with e.d.'s to learn about themselves and earn a little cash on the side. So, if you're in the NYC area and are 12-21 years old (or know anyone who is), check it out:

I am conducting an NIMH-funded, IRB-approved study of adolescents with Bulimia Nervosa (BN). I am recruiting adolescent girls between the ages of 12 and 21. If they decide to participate, they will be asked to fill out surveys and answer questions about their medical history, moods and behavior. At this point, they will also receive a psychiatric interview from an experienced psychiatrist in our Eating Disorders Clinic. A one hour MRI scan of the brain will follow in which we will acquire both anatomical and functional images. The functional images will be acquired while they perform a simple task/game in the scanner. MRI does not involve any radiation exposure; it is an extremely safe and painless imaging modality. The scans, surveys and any other information provided will be kept strictly confidential. In addition, the patients will be compensated for participation with a payment of $100. Participation in this study is entirely voluntary.

Prospective participants can call the research assistant herself at (212)543-5151 and schedule an appointment to come in.

Sure Beats The Swan

Lifetime Television is currently hosting casing calls for a new show, Make My Body Over. The series will focus not on bodies, but on body image--making over the way we look at ourselves. If you're interested in addressing problems with body image or self-esteem (and would like to do so in a public venue), click here for more information.

Finally, television for women.

Expansion or Constriction?

According to The New York Times article, “In the Land of Bold Beauty, a Trusted Mirror Cracks,” six Brazilian women have died of anorexia as of late. The article, penned by Larry Rohter, traces the transformation of the Brazilian beauty ideal from the guitar-shaped frame (heavy on the waist, hips, and butt) epitomized by the original “Girl from Ipanema” to the Euro-American shrunken hourglass. Gisele Bundchen, the busty-yet-lanky Brazilian model and ex-Leonardo DiCaprio squeeze, seems to epitomize the shift.

Now, Brazilian girls, instead of wishing for larger bottoms (what Brazilian men have traditionally deemed attractive) are pining for the stick-thin figures popular in the (industrialized) rest of the world. Late model Ana Carolinia Reston went too far, as did a handful of other Brazilian twenty-somethings. As the article suggests, the shift from guitar to twig, aside from begging the question of why we must compare women’s bodies to inanimate objects, signals a “rebellion against machismo,” with Brazilian women eschewing Brazilian men’s standards of beauty. But does it? Is this really cultural growth, or the shift from one standard of beauty (promoted by the men of one culture) to another?

Mary del Priore, a historian quoted in the article suggests:

“'Men are still resisting and clearly prefer the rounder, fleshier type. But women want to be free and powerful, and one way to reject submission is to adopt these international standards that have nothing to do with Brazilian society.'”

True, these women may be bucking cultural tradition, but it seems that now they’re simply playing by a different set of rules, characterized by an alternative submission that proves lethal at times.

Busted

Last week, the Federal Trade Commission targeted the marketing of four weight-loss pills, fining them $25 million for false advertising claims. Xenadrine EFX, One A Day Weight Smart, CortiSlim and TrimSpa were assessed fines for advertising unproven product efficacy, from claims about swift weight loss to the prevention of cancer and Alzheimer’s disease. The products will remain on shelves but must adjust their marketing campaigns to remove false claims.

FTC chairperson Deborah Platt Majoras suggested that in a study investigating the weight-loss efficacy Xenadrine, for example, those who took the pill actually lost less weight than those taking a placebo. Still, diet pills represent a 1.6 billion dollar industry, fueled largely, as we see, by celebrity endorsements and emotional pipe dreams.

No Joke

(Eating disorder cartoons from cartoonstock.com)


I visited an ophthalmologist recently, whose suite is across the hall from the office where I work part-time at a university medical center. As he tinkered with bright lights and dilating drops, he asked me if I had any areas of specialty. “I do a lot with addictions and eating disorders,” I said.

“An eating disorder—now that’s something I’d like to have.”

“No, you wouldn’t,” I replied.

“Actually, it would be kind of nice to have an eating disorder for a little while, lose 30 pounds, and then get rid of it,” he parried.

And, here, I found myself in familiar territory, defending why one shouldn’t aspire to an eating disorder, challenging the conversational levity associated with a specific diagnosis. He didn’t, for example, suggest he’d like to dabble in opiate addiction. When I talk about working with anxiety and depression, no one jokes about how appealing a stint as a depressive would be, or how nice it would be to have a panic attack now and then. Eating disorders, however, seem to have attained “class clown” status in the arena of psychiatric diagnosis. Even amongst a medical professional. . .

Why is this? Why not consider the gravity of such conditions? How did one of the most fatal psychiatric diagnoses become convenient fodder for jokes? Is it because the pain and suffering of eating disorders is largely internal and therefore unknown? Is it because eating disorders have become so popular in our current zeitgeist (especially among models and celebrities) that they’re almost considered trendy? Is it because the manifest goal of an eating disorder (to lose weight/be thin) is so noble that we’re willing to overlook the process as means to a coveted end?

Stories: Part II

I developed an eating disorder for same reason most other sufferers do. I thought that it worked; I thought that my diet and weight loss were solving my problems. Not a radical belief in this society where weight-loss is touted as the cure-all, food is the ultimate comfort and indulgence, and appearance holds absurd import. The coping mechanisms that snowball into an eating disorder – starving, counting calories, binging and purging – erase shame and guilt, curb feelings of worthlessness, repress confusion and absorb anger. How’s that for a quick fix?

***

My life is about to change drastically. In a few days, I’m moving to a new state, to attend college. I’m leaving my therapist. I’m leaving my acquaintances and my routine. I was only mildly surprised, then, when a few days ago I felt a panicked pining for my old, familiar, sick self. Though my recovery is my greatest and most profound accomplishment, in that moment of panic I needed to see that self: the frail self that deflected all negative emotions; the tiny self insulated from criticism and failure. I tore my room apart looking for pictures. Unlike some survivors I know, I keep few pictures of that years-long period. But suddenly, I wanted to see pictures – I needed to see, again, that it was real.

After a primordially frantic search, I inserted a CD into my computer. Pictures filled the computer screen, one after another. Time stopped; I swam in the digital representation of my past. In one picture, I’m standing in front of a full-length mirror, in my underwear. My upper thighs are no wider than my knees. My chest is a field of ridges and shadows, my bra two flat, droopy triangles. My knee-jerk reaction: that stomach’s not flat! How familiar.

In that picture, my face is hidden behind the camera, which I grip with bony hands. Only the shaded hollow of a cheekbone is visible. That’s what an eating disorder is like: living behind a lens, obscured, clinging to the object of one’s destruction with all of one’s will. No head, no face – the ultimate dehumanization. I needed to share the pictures with someone, to validate my experience; I emailed them to my therapist. “I almost had tears in my eyes,” she wrote back, “to think that that was what you once were.”

***

A very wise friend once told me a story. She’s a larger-than-life character whom I’ll never forget, and this story, thankfully, has stuck with me.

There once was a monastery of monks, high on a foggy mountain in a far-off place where monasteries still exist uninterrupted by documentary filmmakers. The head monk was a prudent and much loved man, but he knew, when his eyes began to curdle with cataracts like frying egg white, and his once pliant hands curled into cold, stiff fists each morning, that he was getting old. It was time to appoint another monk to take his place. To choose his successor, he would submit his monks to the Hall of a Thousand Demons.

There’s a great deal of scholarly controversy surrounding the legendary Hall of a Thousand Demons. Some say its title is more figurative than literal, and the Hall contains only some beasts, a vengeful spirit or two, and a few witchy Slavic peasants. The popular consensus, though, is that the Hall holds one’s thousand greatest fears, infinitely magnified and rendered more real than the beating of your heart.

On a clear evening, the head monk gathered his monastic brothers and explained the task ahead of them. One at a time, the monks would enter the Hall of a Thousand Demons. The monk who reached the back doors of the Hall (and though the head monk seriously doubted that there would be more than one to do so, he figured they’d cross that bridge if and when they got to it) would become the next head monk. The monks nodded. One by one, they entered the front doors, some cocky and strutting, others apprehensive, still others with legs trembling like noodles. And one by one, the monks burst forth from the front doors of the Hall of a Thousand Demons.

“It’s all so real!” they gasped. “We can’t do it! It’s too much!” A defeated crowd congregated around the head monk.

“Ah, my brothers,” the head monk sighed. “Not one of you has cracked the secret of the Hall of a Thousand Demons. With this secret, anyone can pass through. The secret is this: no matter what you see, no matter what you hear, no matter what you feel, just keep putting one foot in front of the other.”

***

The concept of recovery is infuriatingly abstract, especially for a population which tends toward precision and rigidity and control. One of the scariest things about living within the confines of anorexia was my inability – and this seems to be the rule rather than the exception among the eating disorder population – to understand recovery. So I had to have faith. Not necessarily in a higher power – faith in my therapist’s words; faith in my sister’s love for me; faith in my worth as a person, and my capacity to take risks. Faith that I was meant for something greater than this lonely captivity. Like the monks marching through the Hall of a Thousand Demons, the recovering person must persevere, no matter what she sees in the mirror, or feels in her body or mind, or hears from her head. That means unlimited forgiveness and self-acceptance. That means letting go of expectations. That means sitting with uncomfortable emotions instead of fleeing (or starving, or binging). I know very few people who were able to accomplish something so tremendous on their own, and I have unspeakable admiration for everyone who doesn’t give up, who picks up and keeps going.

The saying goes that happiness is the journey rather than the destination, but I take issue in the case of recovering. Recovery isn’t linear progress, and the progress definitely isn’t concerned with happiness. The “journey” of an eating disorder can be full of moments of artificial happiness – the rush, the numbness, the sense of security that comes from dropping pounds, emptying one’s stomach into the toilet or fitting fingers around one’s thigh. An eating disorder is a vaudeville of happiness. Such happiness is not fulfilling, or lasting, or constructive. The more of it that you generate, the more you want next time. So it only makes sense that one would wish to stay in this comfortable fortress, exchanging physical comfort for manufactured emotional OK-ness, rather than leave the fortress and become suddenly vulnerable in so many ways, in pursuit of something intangible and undefined, whose very existence one doubts.

Early in my treatment, I could imagine recovery only as a visual symbol – a great flowing energy. A sort of amorphous life spirit. Getting dressed recently, I caught sight of myself in the mirror – the curve of my spine and my hips, my toned shoulders, my imperfect stomach – and that life spirit is who I saw. Beauty is in the I of the beholder. The I: the being, the identity, the life and energy. My body isn’t perfect. It doesn’t look like anyone else’s – it looks like mine. And my body is perfect because it’s me.

Thought Question

Can you love yourself and hate your body?

Or, in a less extreme version, is it possible to achieve self-acceptance, if you haven't accepted the way you look?

Curious as to your thoughts. . .

Diet Coke

21-year-old Miss USA Tara Conner recently faced the ultimate boardroom challenge--appear before Mr. Trump with the possibility of losing her pageant crown. It seems Ms. Conner has been suspected of alcohol and drug (primarily cocaine) abuse. The verdict? She earned herself a rehab stint but gets to keep her crown.

Just because you test positive for cocaine means you can't be a role model for young girls? Not true (see Kate Moss, Nicole Ritchie, etc.). And, if we're really going to start cracking down on model/celebrity cocaine use, we'll be left with a decimated roster of American royalty--those who remain will likely be a tad more "big-boned" than models past.

So, in keeping Ms. Conner aboard, Trump accomplished quite a bit--he preserved our celebrity culture, reinforced the notion that it's important to do whatever it takes to stay thin (quite discrepant from the idea of substance use in sports), and provided us the opportunity to witness Conner's heartwarming metamorphosis from MADD spokesperson/party girl to recovering addict, reforming her ways and rising above the chaos to bring us all, of course, world peace.

Cada Mujer Tiene un Desorden el Comer

In honor of the upcoming wide release of Dreamgirls, I present to you a
Spanish-language version of an old post I found while browsing on the web. I find this Google-based translation funny, particularly since my Spanish vocabulary is about as paltry as Beyonce's preparatory meals.

Word around town is that Jennifer Hudson's debut is amazing--her performance has been greeted with standing ovations around New York.

Now can we stop talking about her weight?

ED & OCD

In a recent article in the OCD Newsletter, entitled “OCD and Anorexia,” psychologists Eda Gorbis, Ph.D. and Jenny Yip, Psy.D. highlight the striking similarities between these disorders. Obsessive-compulsive disorder (OCD), an anxiety disorder characterized by obsessive thought patterns and/or behavioral (or mental) compulsions, seems to be linked to the restriction and compulsions around food, typical of eating disorders. In fact, it’s estimated that almost half of those diagnosed with anorexia also meet criteria for OCD. Looking at an eating disorder, it’s hard not to see the components of OCD: ruminations about calories consumed or weight gained, compulsive weighing/mirror-checking/exercise, purging as compulsive compensation for a binge.

Both OCD and EDs have been linked with imbalances in the neurotransmitter, serotonin. As such, selective serotonin reuptake inhibitors (SSRIs) are the psychotropic line of defense for both. And finally, similar therapeutic interventions are effective for both. Cognitive-behavioral therapy, which addresses dysfunctional thought and behavioral patterns works quite well in both group and individual settings with each patient population. Exposure and response prevention, a specific behavioral intervention that involves exposure to anxiety-provoking stimuli with the simultaneous prevention of a target behavioral response (e.g., OCD patients might be instructed to “sit with” feelings of contamination while avoiding hand-washing, ED patients might be instructed to “sit with” feelings of fullness after a meal without purging or running to the scale or mirror for self-evaluation) has demonstrated significant efficacy rates as well.

According to Gorbis and Yip, some researchers are considering the idea of subsuming eating disorders under the OCD diagnosis. Taking a look at the criteria for OCD from the current Diagnostic and Statistical Manual (DSM-IV; APA, 1994) below, it seems clear that if we substitute calorie counting, fears of gaining weight, mirror-checking/weighing, and/or bingeing/purging with some of the behaviors provided, we might just have a good fit. One notable difference is that described under criterion B, which suggests that in OCD, the obsessions or compulsions are recognized to be unreasonable. In some eating disorder constellations, particularly those that are more restrictive in nature, it seems that this criterion may not be met.
______________________________________________________
A. The Person Exhibits Either Obsessions or Compulsions

Obsessions are indicated by the following:
1) The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.
4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).

Compulsions are indicated by the following:
1) The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).

E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.