"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."]

I dyed my hair red brown today

I did a Google blog search for "eating disorder," just to see what popped up.

There were, of course, plenty of "personal journey" blogs that came up, but I wasn't really looking for that category. I wanted to see what kind of facts and figures someone searching for eating disorder facts might find in the blogosphere, as defined by Google. So, among the blogs not being written from a patient's (or former patient's) perspective, what helpful info did I find?

... A lot of misinformation, e.g. "People with anorexia have distorted body images that cause them to restrict calorie intake." That's a bit like saying the egg had the chicken, but whatever.

The Royal We also stumbled across a blog written by someone claiming to be a clinical psychologist whose raison d'écrire is the belief that all women have some form of an "eating disorder." Well, We hate to prove her wrong, but We know fully TWO who do not. (One is Our nana; one is not Our grandma.)

We found some blogs stating that if one is fat, then one has an eating disorder. Um. No. The analogy "Fat Person : Eating Disorder as Male : Y Chromosome" does not work.

Our favorite was the blog We read suggesting that pregnant women who are concerned that their pregnancy may trigger an eating disorder (due to weight gain fears)... SHOULD CONCENTRATE ON EATING A LOT OF SALADS.

GAH. GAAAAAH!! GAH!!!!!!!!

Reading these "facts" on easily available media was like reading in the New York Times that the relationship between eating disorders and substance abuse is a New Discovery. In other words, it made me feel all stabby.

I'm not trying to pick on the writers of these blogs, per se... I mean, at least they're trying to get awareness of the issue drummed up, right? Except, NO, no, NOT right. Eating disorder awareness in the above forms is like... it's like my husband trying to pick out who's the stronger singer: Fiona Apple? or Miley Cyrus? ... and guessing WRONG, so wrong. A for effort, my tone-deaf love, but ur doin it rong.

So. What to do, what to do? Well, let's start with some fact correction on a couple of the points above:

1. Many low-weight eating disorder patients did not start out with distorted perceptions of their bodies; in many patients, the distortion progresses with the illness. Additionally, anorexics as well as bulimics can suffer from body dysmorphic disorder.
2. The pregnant woman afraid of developing an eating disorder should see a nutritionist or talk to her doctor, rather than getting info from a blog. Obsessively eating salads can trigger a diet cycle that is more likely to lead to anorexia or bulimia than generally being uneasy about weight gain. Telling a pregnant woman to mostly eat salads is like telling someone afraid of slipping into alcoholism to cut out 70% of their daily fluids. Or maybe that's just what it seems like to me.

Okay, now that that's that, how 'bout some WEBSITES WITH ACTUAL INFORMATION. Jeez.

http://www.womenshealth.gov/
http://www.renfrew.org/
http://www.nationaleatingdisorders.org/
http://www.anad.org/



Aaaaaahhhh. I feel much better now.