The Thought Process: Redux

Every day, multiple times a day, I have to reason with myself why I should or should not look/feel the way I do. Every day, multiple times a day, for instance, I have to make the choice to eat or not to eat; to purge or not to purge; and to attack myself or to let it slide. Every day, from the minute I wake up until the minute I finally (sometimes mercifully) fall asleep, I have to wrestle with a dichotomy of thought along these lines:

A: "I can get down to [blank] pounds/size again. I can do it in a healthy way this time; I can do it for good."
B: "No - I've been at [blank] pounds/size, give or take [medically reasonable amount of lbs./sizes], for the past four years, while doing my damndest to follow the advice of ED treatment professionals. This is where my body wants to be."
A: "I can do it: Cut down to [blank] for breakfast, and [blank] for lunch and dinner. It won't be that hard. I'll take multivitamins and calcium this time; it will be healthier."
B: "No - all these things will happen, instead of losing [blank] pounds: My skin will get dry. My hair will stop growing. I will lose my energy. I will further jeopardize my fertility. I will become boring and obsessed again. I will damage my marriage and relationships. I will build debt on food and diet pills. I know, because I've done it before."
A: "But you don't have to look like this/weigh this. Even the charts say you can be [blank] sizes/pounds lower than you are now and still be 'healthy.' Why not just look like/weigh that? What's wrong with you that you can't stop at the minimum?"
B: "OMG, STFU."

I think in Internet acronyms.

No one in the eating disorders world speaks in hard and fast rules or timelines. You can't say, "After five years of intensive psych and medical treatment and nutritional counseling, Jane Doe will be cured of bulimia or anorexia." You can get your weight as firmly in a stable range as you like, but that doesn't mean the disease itself stops chewing on your brain. I don't know why this is so shocking to some people, including ED patients (and me, of course). You can't any more accurately say, "After five rounds of chemo and radiation, Jane Doe will be cured of non-Hodgkin's lymphoma." More relevantly, you also can't say, "After five years of intensive treatment, John Doe will be cured of major depressive disorder," or "borderline personality disorder." It's not done with more mental illnesses/disorders, nor with most addictions. No one who knows the bare minimum of information expects it.*

And yet, here I am, among millions, wondering where the hell is my cure and what the hell am I doing to avoid it? Five years, two months and two weeks ago I started clinic treatment. (Five years, six months and two weeks ago I started individual counseling.) I figured by this point, surely, I'd be fine. Or, if not fine, then not absorbed in the ED thought process at quite such a frequency. I try my best - most of the time - but I am NOT finding the ease of "act as if" to be a naturally occurring phenomenon for me. Never did, no matter my level of counseling or medication. The pitch and frequency remains just about steady as it was, maybe, four years ago. Perhaps being a facts-oriented personality, rather than some more open-minded type, hinders my conception of the process. However, I can tell you that no matter how much I "act as if" I am secretly thinking as if NOT.

It's frustrating.

In the ED world five years is not necessarily a long time, especially when you consider that that's when treatment actually begins. My disordered behaviors started closer to twelve years ago, and those "behaviors" matched up and surpassed clinical definitions closer to seven years ago. "They" say that eating disorders are lifestyles that much resemble blood stains: The longer it's there, the better chance that it's never going away completely. I don't believe that. I won't. But that doesn't minimize my frustration and anger at not having an "off" switch for this thing, let alone a general time frame. I can't never eat again (without dying), and I can't never to look at or feel my body again (without bizarre consequences, such as really, really awful makeup and a wardrobe consisting of mumus). There isn't a precise cut-off date, like enrolling for classes each semester.

Let's just say that when President Bush suddenly came up with a timeline for withdrawl from Iraqi cities? I was a little jealous.**



* Except the recovering alcoholic father of a recovering alcoholic/fellow bulimia patient five years ago. He was curious why she was still in our treatment program after 28 days. After all, he reasoned, alcohol rehab had done the trick in that timeframe. Why shouldn't an eating disorder clinic work the same way?

** Considering it used to be tantamount to "setting a date for failure."

Eating Disorders in the Media: The Little Misconception That Could

BusinessWeek Debate Room: Anorexia: A Media-Borne Illness?

Carrie already posted about it, and I reeeeally wanted to avoid it, because I knew it was going to piss me off. (And, atypically, I was not in a mood to be willfully pissed off today. It's got to happen at least once in my life, right?)

But I then caved. I still wasn't going to write about it after reading the piece, because, what else is there to say about such idiocy? The article itself isn't worth talking about, except for the fact that it got published at all. The guy they have writing the "Pro" side of the argument, Matthew Lawyue, is a reporting intern for BusinessWeek. Intern. INTERN. The gal (Oriana Schwindt) on the "Con" end (astutely titled, "Blame the Eaters") is a recent graduate. In journalism. NOT PSYCHOLOGY. Or NUTRITION. "She writes for the Innovation and Managing channels of BusinessWeek.com." Yes, she's very innovative: They switched it up. Have a female excoriate people with eating disorders, and a male stand up for them. I get that these are "kids" trying to launch their career, get their foot in the door, get their name out there, etc. and so forth, so after making some scorching comments in my head, I'll give them a pass, this once. Plus, Carrie already got 'em.

But I then read the comments and I said to myself: "Self," pausing to appreciate that I'm so terribly original, "We have to write about this one." "You're right, Self," I continued, undaunted by the cliché, "Someone has to point out the utter futility of improving the human race, and thus explain the title of this blog*." "Let's get to it." "Yes, let's."

Most of the comments are insightful and factually correct. The comments by parents of ED patients are heartbreaking. I wish I could find the mother of the 11-year-old boy (anorexic) and give her a long hug. But there are also idiots in full bloom. The one that provoked my Self's realization that We must write:

If eating disorders are simply inherited diseases, why is their occurrence so great in actresses and other women in the public eye --Terri Hatcher, Calista Flockhart, Princess Diana? And why was there no anorexia or bulimia problem in the 1940s and 1950s, when being beautiful wasn't all about being thin? And why does anorexia suddenly become a problem when people in the developing world get their first access to U.S. television shows? Oh, right, they must have experienced a collective genetic mutation that prompted them to get eating disorders in unison.

-- RR, Nobel Prize winner for Psychology and Logic.

A) Eating disorders have been around for a long, loooooong time. As another commenter points out, at LEAST since the 1600's. Only recently (fluctuating since about 1920, actually, RR) has extreme thinness been obsessed over in the media at large. Meanwhile, if you do something as easy as read Jane Fonda's autobiography, you will learn that anorexia and bulimia didn't go anywhere during those idyllic decades you cite.

B) No one is saying that EDs are "simply" inherited - only that there is a genetic COMPONENT. Has it occurred to you that eating disorders, like other mental illnesses, can be tripped by specific environmental triggers? Certainly Princess Diana, suddenly thrust into a pressure cooker of public attention and criticism, is more at risk than her imaginary/hypothetical identical twin (for genetic similarity purposes, you see) who remains shrouded away from public scrutiny? As we like to say in the ED world, genetics loads the gun and environment pulls the trigger. (Oh look - Harriet, right below RR, uses that very phrase.)

And above RR, joemama makes the astoundingly astute observation that most women in New York look "chubby" rather than anorexic. Really? REALLY? *God.*

Okay, I think I'm sufficiently pissed off and dejected to carry me the whole weekend. See you on the other side.

* cyn·i·cal /ˈsɪnɪkəl/ –adjective: 3. bitterly or sneeringly distrustful, contemptuous, or pessimistic. ... Sounds about right.

Because we all know who the victims are here: the companies.

Eating-Disorder Class Actions Get Judge's Go-Ahead
Mary Pat Gallagher
New Jersey Law Journal
August 12, 2008

Since I can't really bring myself to total up the amount of money I've cost my parents and myself trying to "just get over it already," I viewed this article with a mix of hope and resignation. Relatively speaking, my ED tag isn't even that pricey (no long or repeated in-patient stays). Over the course of 6+ years, though, it's hard to think about where all that money coulda woulda shoulda gone.

To summarize, some parents are suing BlueCross BlueShield of New Jersey (hey! that might be relevant to me in 2 years! I'd better read this!) for coverage of their daughters' eating disorders as biologically based illnesses. However,

"In a ruling released last week, [Judge] Hochberg refused to dismiss the case or abstain from decision[.]"

Yay! Oh, wait:

"[B]ut she threw out a significant chunk of the litigation."

Hm. Which part, I wonder?

"The result was to knock out those plaintiffs' claims under the Mental Health Parity Law and the Consumer Fraud Act, along with common-law claims for breach of contract, breach of implied duty of good faith and fair dealing, misrepresentation, unjust enrichment and tortious interference with contract. They are left only with their claims under ERISA, which does not afford a jury trial and often requires review under an arbitrary and capricious standard.

"On the other hand, the plaintiffs insured under policies not subject to ERISA can go forward with most of their claims. It is not clear, however, whether they can assert a claim under the Mental Health Parity Law. Hochberg left undecided the novel question of whether there exists an implied private right of action under the 1999 law."

BC/BS (and other insurance co.'s, historically, won't pay, which means (intuitively, but maybe not in legalese) that BC/BS thinks that eating disorders aren't "real" diseases. Thanks, Insurance Industry. You've got your priorities really straight. Next you'll have Bill O'Reilly in court for you, testifying how he doesn't want his premiums to go up because of some rich, white teenager's "choice." Speaking from a standpoint of total ignorance about the actual legal angle of this, I'd just like to say that an insurance policy not covering mental health benefits, including eating disorder treatment, has always seemed like "breach of implied duty of good faith and fair dealing" to me. And speaking from that same perspective, "arbitrary and capricious standard" doesn't sound... um... hopeful. Yeah. But if you ask me, however, what the above paragraphs *actually* mean, I will stare at you with a glassy look in my eyes, while secretly thinking about Alexander Skarsgard.

Mmmmmmm. Sweeeedes. Mmmmmm.

And one last thing, about one of the statements made by a lawyer for the "defendant" [i.e., bloated corporate machine]: "He emphasizes that the company did not deny coverage and that the plaintiffs seek unlimited coverage, beyond what the policy provides."

Dear Mister Lawyer Person: I may deal with a different state plan of BC/BS, but under my plan - all my plans ever with BC/BS - I have never been given ANY coverage for eating disorder-related costs. My doctors have had to jump through hoops so EKGs would be covered, of all things. We won't even get started on the lack of therapy reimbursement or the laughable response my parents got when submitting for outpatient benefits a few years ago. However, HAD you paid, you might have avoided, by this point, quite a bit of pharmaceutical costs from THIS particular account number, which I'm sure have run way up for you, being that I've never been prescribed a generic. You know. For my "depression." Not to the "eating disorder." For the "depression." For which you "offer [a pittance of] coverage." Ha. Ha ha ha. That's all I have to say about that.

For some general context, here's a good two-liner:

"Pending legislation, S-607/A-2077, would eliminate disparate treatment for nonbiologically based mental illness. A similar bill in the last legislative session passed the Senate and two Assembly committees but was never brought to a vote in the Assembly."

"Never brought to a vote" sums it up nicely, I think.

This also sums it up nicely:

Mmmmmmm.

"It's not like a real disease or something. It's a choice."

Quote from my husband's asshole friend, having no idea whatsoever to whom he was saying that sort of shit...

The next time someone tells me that my eating disorder is not a "real disease," but a choice I made because I wanted to be thinner, they're getting this, verbatim:

"AN (anorexia nervosa) and BN (bulimia nervosa) affect only an estimated 0.3% to 0.7% and 1.5% to 2.5%, respectively, of females in the general population. This disparity between the high prevalence of pressures for thinness and the low prevalence of eating disorders (EDs), combined with clear evidence of AN occurring at least several centuries ago, the stereotypic presentation, substantial heritability, and developmentally specific age-of-onset distribution, underscores the possibility of contributing biological vulnerabilities.

"... Twin studies of AN and BN suggest there is approximately a 50 to 80% genetic contribution to liability accounted for by additive genetic factors. These heritability estimates are similar to those found in schizophrenia and bipolar disorder, suggesting that AN and BN may be as genetically influenced as disorders traditionally viewed as biological in nature."

Those bits of Unmitigated Awesome are from the study "Neurobiology of anorexia and bulimia nervosa," by Walter Kaye. It appeared in Physiology and Behavior this April.

I'm serious. I'm memorizing all of that. Particularly the twin study part.

I have actually met people (mostly older or male) who would be surprised to learn that eating disorders may be as genetically linked as bipolar disorder. Similarly, I've met people (of all ages and sexes) who think that anorexics (and bulimics) are "lazy" in that they "don't want to get on the treadmill to stay thin," so THAT is why they restrict their caloric intake (or engage in purgative behaviors) and keep at it with the eating disorder.

Regardless of why/how they begin (that's a whole different post), there is clear evidence showing that eating disordered behaviors and symptoms continue not due to some superficial choice, but due to changes in brain chemistry and structure. There is less research into bulimia than into anorexia on this subject, but reading this study was the first time I've been able to see actual numbers in the context of for-real, no-shit hard evidence. Not that I totally understand what:

"increased 5-HT1A postsynaptic activity has been reported in ill BN subjects,"

or

"PET imaging data suggest that such behaviors are related to disturbances of 5-HT and DA neurotransmitter function in limbic and executive pathways,"

mean, but I get that there are measurable changes in brain chemicals/synapses/what have you during (and sometimes after) an ED. And I understand that chemical change in the brain is not the same as a strict "choice." At least, anything in a study that talks about brain function alterations, then says, "tend to be present in the ill state and persist after recovery," doesn't sound like much of a choice to me.

Of course it's a literal choice to eat only 500 or 2,000 calories a day. Of course it's a choice to go ahead and finish the macaroni and cheese, and the mashed potatoes, and the biscuits, and the cornbread, and some Oreos because your husband is out for the night and ohmygodfirstopportunitytobingeinmonthsandmonths, or to eat a well-balanced dinner until you are full, and then stop, even if you are home alone and free to indulge your most disordered impulses. Those are choices.

But much like there will always be people who don't. under. stand. why alcoholics can't just NOT have too much to drink*, there will always be people who are convinced that anorexia and bulimia are essentially about being thin, and that they're about a deliberate choice that was made and is being made. Or essentially about being lazy. Or about not liking food. Or liking it too much. And search me why, but I wonder if I will ALWAYS be like a fricking magnet for this type of person (because sometimes it really feels that way). Well, the next time my hidden polarity somehow attracts such an ignoramus, at least I'll have my handy little phrase all tucked away inside my warped, crazy little brain.

*There are studies that indicate alcohol as the MOST brain-changing dependency/addiction, even more so than heroin, so I'm not comparing ED neurological side affects with those of alcoholism. I'm bringing up alcoholism as another disease.

(By the way, my favorite section title in this study: "Clinical symptoms and puzzling behaviors." Yes, they are puzzling, aren't they?)

Two-Trick Pony

I've got the eating disorder commentary, and I've got the reproductive rights commentary. That seems to be about it. Oh, and language or arts commentary. So, three. Guess which one is on the plate (hint hint) for this post?

I've been spending more time than is strictly necessary reading and commenting on Broadsheet, Feministing, The Curvature, and Feministe. And I find that I [almost] always. go. back. to. my eating disorder. [say in circular voice. that's hard to describe. nvrmnd.]

This community post at Feministing rocks my world. I've never been at a weight one would call "fat," but jeeeeez did I get all sorts of "HELL YEAH!" reading this. I think it was the section on ASSUMPTIONS. People assume all kinds of damn things about you based on your body (no matter what it looks like), and we all know what happens when you assume. (Everybody together: "You make an ass out of you and me." Good job, class.) In the past 7 years since my eating disorder really kicked into high gear, I've gotten maybe two judgmental (negative) assumptions about my internal health based on my outward appearance - at least those assumptions that were shared with me, not including from parents or health professionals. That's NOT. FAIR. It's incredibly not fair to anyone who's not an "acceptable" weight or shape, and it's maybe a little unfair to me (and others like me). Let's just generalize and say it's unfair to everyone to assume that they're healthy or not based on outward appearance.

With that abbreviated conclusion, let me share with you one of my favorite, possibly relevant vignettes. It's very short. It took place about a month before I was made to go into intensive treatment for anorexic bulimia.

Scene: Apartment part, West 47th Street. The kitchen. CN's sitting there with two best friends, L and M. One of L's friends, E, comes in away from the living room crowd.

L (to CN): So how are you doing?

CN: Eh, I'm okay. I mean, I'm trying to not lose anymore for a month. It's not really working though.

M: Yeah, you look mad skinny.

E (just tuning in): Yeah, you look great! I remember seeing you last year in school. You've lost some weight!

CN (deadpan): I have anorexia. My parents are making me go into a semi-residential treatment program.

E: Oh. ... That sucks.

*FREAKING SCENE*

So. Yeah. She assumed that I was healthy? (At at 16.5 BMI. Are you kidding me?) And then I, in an uncharacteristic display of I-don't-care-if-this-embarrasses-youness, told her what was up. Because she assumed that I was, I don't know, on a regular diet or something. Was I a bitch for blatantly embarrassing her in front of people and clearly making her uncomfortable? Maybe. Should people make unsolicited comments on other people's bodies, just because they feel they're allowed to comment on weight? NO. NO, NO, NO AND NO.

End. Scene.

News relating to the English language

In today's NY Times crossword, the answer to 48-Across is "Edward Gorey." The answer to 49-Across is "Lye." What a great freaking crossword. (That's because "J is for James who took lye by mistake," for you non-Gashlycrumb Tinies readers.)

And in news not related to the English lanuage. We got a Wii. According to her, I'm pretty out of shape, but as far as I'm concerned she's not in a position to say anything about that. Look how skinny she is. She's clearly got an eating disorder. Get some help, Wii. And get me a donut.

In more English-related news, I just typed "Rook" and "creary" the first time I typed the above lines. This may have something to do with my having "I'm So Ronrey" stuck in my head. No complaints here.

In the effort to remember that it used to be okay to have a 27.5-inch waist.

I love going to the Met. (That would be the Metropolitain Metropolitan Museum of Art, not the Metropolitain Metropolitan Opera. Applesauce!* but I hate opera, unless I'm listening to it on my iPod and can stop and start it at will. Actually, I take that back. I legitimately enjoyed Carmen and La Boheme. And Don Giovanni. But I hated The Magic Flute. So, I guess you could say that I've enjoyed 75% of the opera I've ever seen in person. But I'm pretty sure that, horsefeathers!* I hate opera! Anyway, the point being that we're talking about "the Met" the big museum in New York, not the big opera house in New York. Hem hem.)

Last weekend, I was there for about two hours just wandering around 19th Century Painting and getting lost and losing my breath over Van Gogh and Degas. And Monet. And Renoir. After the Impressionists, I headed to the new Greek and Roman galleries, where I was tickled to see patrons being scolded for talking on cell phones, but not for palming the ancient works of art. I also did a quick dip into the Medieval wing to see some of the "treasures" on loan from the Victoria and Albert Museum. All in all, my tour left me feeling all sorts of copacetic.

Now, this is about the least, LEAST original point to make about art (particularly non-Modern art), but isn't it refreshing to see real bodies reflected in the marble and oil and wood and watercolors? Take this little filly, for example:



Not quite the same thing as, say, Angelina Jolie since she went from her Hackers-era body to her Wanted frame. Yikes.

My simple and for-once-brief point being that I think I'll spend less time at the movies, and more time at the Met. But not the opera Met. The museum Met. Because opera is boring. And also on the other side of town. Which would necessitate paying for a cab. No-ho-ho-ho way. Hahaha, twelve dollars. Riiiiight. (Oh, and the price of an opera ticket, which, riiiiiiiiiiiiiii, etc., ght.)

[* Trying to curse less now that my nephew, whom I only rarely get to see, even though he lives 6 blocks away, is turning 1, and will theoretically start to remember words like "fuck."]