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.

Size Ate

Size Ate is a one-woman show that captures playwright/actress Margaux Laskey's struggle with eating and body-image concerns. I stumbled upon the show last year and was immediately struck by the sincerity of her story and performance. I contacted Ms. Laskey after seeing Size Ate and talk of professional collaboration ensued. Here is Ms. Laskey's promotional video for Size Ate:



Not too long ago, Ms. Laskey asked me to write a blurb for her promotional materials. Here it was:

I saw Size Ate twice and enjoyed it both personally and professionally. Margaux Laskey is a talented actress (and singer) who has penned a touching, autobiographical piece that is alternately funny and serious, personal, insightful, and most of all, heartfelt. While I believe Ms. Laskey’s performance would be enjoyable to any audience, I would especially encourage women who struggle with eating and body-image concerns to see this show.

It's possible that Size Ate may go on tour--for now, the greater possibility is another NYC run. If so, I invite you all to come join me in New York for some hot chocolate and a healthy dose of introspective theater.