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 by Kerrie Baldwin

Back in 2012, I had been managing my eating disorder for a full decade. Restriction had enslaved me for ten very long years, and I could no longer deny that my body and mind were crumbling, that this mode was not sustainable. As I desperately searched the Internet for an escape hatch, I discovered Gwyneth’s first website. (continue reading below)

Available on Amazon now

I devoured the information there and, with the encouragement offered by this community, I soon dove into the thrilling promise of re-feeding and repairing my body. I expected that my boundless eating and faithful adherence to the now-termed Homeodynamic Recovery Method would ferry me right back to my old body, and my old self, in a matter of months. However, I had to not only accept but embrace a long and jostling journey.

During the perilous two and a half years that comprised my path to remission, I wrote it all down—my ambivalence about my expanding body, my realizations about weight and health, my frustration with the exhaustion and relentless aches in my limbs—as a record for myself and my family and, with much encouragement from those on these forums, as a kind of roadmap for you.

But like my recovery process, I, Dragonfly: A Memoir of Recovery and Flight ended up being much more than I ever imagined, and it required much more time and cultivation than I had planned.

I had originally conceived my story to conclude with my husband and I toasting a decade of marriage under our belts and the end of my era of anorexia. Instead, as I excavated and nurtured the self I left behind at age twenty-three, I discovered that the dynamic between him and me no longer seemed to fit with who I was becoming; it was like a dissonant chord in a symphony of self-actualization. The resulting unraveling of my marriage was devastating and the worst casualty of my recovery process—and thus something I had to write about.

As I’ve read on these forums and heard from others in recovery, many of us find our reclaimed selves now disconnected from aspects of our lives that had once felt vital and permanent. Sometimes this recognition results in a welcomed shift, such as the healing or strengthening of relationships with family or friends; sometimes this can demolish your life as you knew it, as you perhaps you force yourself out of a physically demanding career or, as in my case, choose to divorce your partner in life and parenting. I had to take the time to integrate these really difficult things. I had to learn how to write about the messy things that intimately involve others, in order for my book to offer a fully fleshed view of what recovery can entail.

In the following excerpt from I, Dragonfly, I share the immediate aftermath of my husband and I deciding to separate in the midst of the strains of recovery:

I moved through that day slowly, meandering through wreckage. At least it’s over. After dinner I went up to our bedroom, noting that soon it would be simply my bedroom. I pulled out the same bleach-spattered sweatpants that I’d been wearing as pajamas since October because I couldn’t bear to enter a dressing room and watch my body not fit in a size I could swallow. A little fist knocked low on the door. “Mommy, can I come in?” sang Eliza’s distinctly melodious voice.
“Sweetie, I’m getting dressed. I’ll come right out as soon as I’m finished.”
“But Mommy, I want to see you! Let me in!” I could hear her tiny three-year-old body slump to the floor, the sobs. This time I couldn’t tell her to go downstairs and see Daddy instead. They had to know how much they were loved, before their world would be thrown into confusion.
Eliza climbed onto the bed and watched. As I stripped off my leggings and a shirt losing its hem, I answered once again that the thing around my chest was a bra. I braced myself for one of those maddeningly sincere toddler comments like, “Mommy, your butt is big!” which I’d already heard at least once in the past month. Please don’t say anything. I can’t take it today. I turned away from her as I dressed, and not until I had the shirt completely over the belly I loathed—the extra fat that my body was still hoarding around my vital organs in case of another bout of starvation; the extra me that lipped over the C-section scar—did I spin to face her, expecting her to be focused on pulling at a loose thread in the duvet, she had been so quiet.
Her eyes, her cheeks, her wide smile framed by the rounded lips she inherited from me—all of her—were beaming at me as she remained seated at attention, hands in her lap. “Mommy, you look beautiful.” And she smiled some more. I grasped her soft upper arms, and tears rolled down my face. She kept smiling.
At first I cried because someone could think I was pretty even in that swollen body topped by a sleepless face. Then I cried for my daughter’s innate capacity to recognize beauty purely—not as a certain combination of straight and curved planes on a body, but as any shape illuminated from within, lighted by the soul fire that I had been stoking through my recovery. Cradling her head and smoothing her fine hair I wished for her a lifelong path toward such higher meaning, never to be shot down by the societal pressure to be anything that isn’t authentically Eliza, and absolutely never to be shackled by an eating disorder. And the only way for her and her siblings to fly like that was for me to continue my own course, to accept destiny, to go wherever recovery was taking me, even if that entailed the end of my marriage, their family as they knew it. I had to lead, and to be the example.
Those four words from a three-year-old—Mommy, you look beautiful—reconciled the terrible doubt that I was choosing myself over them. I was, in fact, choosing all of us.

In my story, the choice to honor physical hunger was merely the first step. For me, recovery unveiled all the further choices that had to be made, and it demonstrated that the process required healing and inhabiting every corner of myself. It taught me to be open to my own transformations; it challenged me to listen to the universe as I continued to evolve. And that is why I chose I, Dragonfly: A Memoir of Recovery and Flight as the final title for my book—because although the story is anchored in the swamp of the recovery process, it is a tale of becoming, and of flying forth.

I feel both proud and humbled to have sustained a state of remission for longer than three years and to share with you this memoir of my process, to give back to the community to whom I owe my life. While every recovery journey is different, I hope that you find camaraderie, encouragement, and solace in this chronicle of my own path. And ultimately, I hope that you, too, discover the profound and enduring contentment of honoring the needs of your body and soul every day.

I, Dragonfly: A Memoir of Recovery and Flight, which includes a foreword by Gwyneth Olwyn, will release in e-book and paperback editions through international online retailers Amazon, Barnes & Noble, iBooks, Kobo, and others on March 13, 2018.

All proceeds from preorders placed from February 26 through March 4—in conjunction with the US and UK National Eating Disorders Awareness Weeks—will be donated to F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders), an international organization promoting awareness, support, evidence-based treatment, and research and education advocacy around eating disorders.

Kerrie Baldwin is an editor and writer with twenty years’ experience in children’s and adult trade book publishing. Her interest in the science behind eating disorders is fueled by her additional work as a medical editor in the pharmaceutical industry. She lives with her family in the Catskill Mountains of upstate New York, and she can be followed on Twitter at @kerrie_baldwin.

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I often get asked this question from those embarking on applying the Homeodynamic Recovery Method (HDRM). Presumably it gets asked because we’ve designed the entire eating disorder treatment system as a get-in/get-out medical stabilization process and surrogates for “recovered” status are limited to a body weight and acceptable biomarker readings (resting heart rate, blood work and the like). If everything you’ve experienced to date has framed your process of recovery as something you do rather than something you are, it’s understandable you ask: “When will I be done?”

Caroline: Flickr.com

HDRM is not a doing thing, it’s a being thing. It’s more like learning a new language— or to be more specific, like re-learning a profoundly lost language. It gets easier as the years go by to be fluent and to even think in that language, but if you’re tired, stressed, or faced with vocabulary that’s specific to a particular profession, it’s easy to slip.

I know it’s really difficult to pry yourself away from using your weight being the definitive marker of your health status, but the longer you cling to that cultural fallacy (and that’s all it is), then the longer you live in a half-life of being beholden to false fears.

Staying completely energy balanced is the mother tongue of everyone around you who has never experienced an eating disorder first-hand. And we live in this weird world where all those natural speakers pretend that they actually speak the language of restriction.

They talk about their diets, their exercise regimes, their eating healthy, their getting back in shape...as though they really do manage to create energy deficits the way you do. So anxious and panicked are you (which is the eating disorder jammed into your threat identification system), you often fail to notice how those around you, in the world without eating disorders, actually make no sense at all.

How English sounds to non-English speakers - YouTube

If you’ve never had a chance to see the video above, it’s a really well-constructed piece on what English sounds like to non-English speakers. If you weren’t really paying attention, you’d think (given the inflection and pace) that they are speaking English.

That is the world of so-called healthy living— just gibberish masquerading as real language. All those around you without eating disorders actually thrive in their mother tongue of energy balance and it’s purely an action-based language. All the while, they speak gibberish at each other about their status-signaling healthy living.

Embracing HDRM for your recovery process is about ignoring the gibberish around you and developing a reconnection with your own mother tongue of energy balance. Those without eating disorders cannot sever ties with that energy balance; but for you it has likely become a completely foreign language where you don’t even recognize the basic words anymore, let alone are you able to construct a complete sentence.

It feels awkward, unnatural, severely anxiety-inducing and generates constant second-guessing:

— “Am I doing this right?” —

It does get easier as the years go by. You will get to be an absolute expert in picking up on the gibberish around you: “That’s not English,” or more to the point, “That’s not Energy Balance.” You won’t have to concentrate so hard to be fluent in Energy Balance.

But the restriction gibberish will always sound a bit more familiar to you, especially in times of stress or distraction.

I get criticized for speaking in terms of “never being recovered from an eating disorder,” on the grounds that it denies individuals their own agency and that no third party has the right to override an individual’s own definition of being recovered.

I absolutely agree with people’s rights to define their own state of health. But I am wary of anyone touting their “cure” to others as I believe that the rights of those convinced of that cure are as, if not more important than the individual’s right to self-identify as “cured,” or “recovered.”

All that is to say, having peer mentorship during your remission practice is invaluable but do consider clinging a bit more tightly to those who treat an eating disorder as the chronic condition that it is. No one is ever done with practicing remission.

And just as it’s really tough to learn a new language when everyone around you is still speaking the old one—  they want to practice their gibberish on you as you’re such a native speaker of restriction— consider carefully what environments and people support your efforts to be fluent in Energy Balance and then work to be surrounded by those things and people as much as possible.

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This post has a bit more of me in it than is usual, but I think my own experience may be of value to others who regularly read posts at the Eating Disorder Institute.

Jam Zhang: Flickr.com

I’ve often reinforced the fact that genes are not destiny, and that’s because it’s the truth. There’s an entire lineage on my maternal side with the genes that are linked to celiac disease but few of us have the condition. Genes are like literary tools in a mystery book: they might suggest foreshadowing, but then again it could be the reader is going to be thrown entirely off track by their presence, or perhaps they only had relevance to a subplot and not the main plot, and finally it might just be they served no purpose but to entertain.

But just as the arctic tundra is distinct from the alpine tundra is distinct the boreal forest, our own human living ecosystems thrive within a range and are brittle and resilient in their own distinct ways. And it is the relationship of our genes with our environments that shape the ways in which we might become brittle and the ways in which we might become resilient.

When I was a teen, I had orthodontic braces. It was done somewhat later than my peers because I had a traumatized tooth (from a fall as a kid) and the orthodontist was waiting to see whether the root would die or not (it did) before placing the braces. Unbeknownst to me, it appears I was someone who was predisposed alveolar bone loss when applying those kinds of forces on my teeth to straighten them. That, combined with a marked tendency to clench down hard on my teeth while sleeping and post-infection inflammatory responses that seem to be worsening with age, and my gums are now in a sorry state and I risk losing my teeth or having major dental surgery and bone grafts to attempt to save the teeth. I’m not there yet.

But at my latest dental hygiene appointment, it was made clear that things are trending poorly. I was really upset for a few days. I felt betrayed. I have always had impeccable dental hygiene. Because I am very difficult to freeze, the excruciating nerve pain that often accompanies fillings for me has been a great motivator for being absolutely rigorous about preventative treatment. I religiously have my teeth professionally cleaned on time, I floss and brush twice daily and I wear a night guard on my teeth every single night to try to minimize the damage of clenching as well.

After feeling my body had betrayed me then, as is my tendency, I felt fatalistic and wallowed in some good old-fashioned catastrophizing. Basically, I felt sorry for myself: “Of course, I will lose my teeth and be a frightening sight to little kids. I have all these chronic conditions with inexorable worsening inflammation and pain. I will age horribly, suffer and die alone.” Then of course I heaped on all the cultural moral implications our society places on how individuals look and the assumption of what a lack of teeth represents: “You didn’t take care of yourself, you had poor hygiene (ewww!), you were irresponsible, lazy and worthy of other people’s disgust.”

And finally, as I completed my process of assimilating the reality, I felt grateful and accepting. It’s possible I will lose my teeth. Everything that I, and my dental team, can do is being done to perhaps prevent that or at the very least delay it. But I haven’t lost them today and I feel very grateful for that. I cannot prepare in advance for what needs to be done should they fall out in any case. Worrying and being anxious for that day gets me nothing except worry and anxiety. As for my culture, well I’m not much of a fan of it in any case, so I’m capable of keeping its moralizing garbage out of my own headspace and heart.

There are of course a lot of “what if’s” I could focus on to keep me locked in fatalism and resentment. I could blame my parents for not forcing me to stop sucking my thumb as a child which may have avoided the need for braces. Or conversely, my parents could have persuaded me not to have braces later on. Or perhaps I could just have somehow avoided all the night-time clenching that started alongside full-time employment as an adult. But hindsight bias is such a misleading space to squat in. You change one thing about your past and what else changes with it? We don’t know because we experience time in a narrow linear construct where we also naïvely assume that we could keep all the good and magically excise the bad along that line from then to now. Even excising the bad of the past might have the unfortunate outcome of rendering you less resilient in the now in ways you could not possibly predict.

And there was one additional observation I made: I would know nothing of this possible future state had my dentist and hygienist not recently attended a conference wherein recommendations were made for specific x-rays to determine alveolar bone density. I gave my consent for those x-rays and yet had I not, then I would have been spared a lot of emotional processing of a likely future state for which there is nothing that can be done that is not already being done.                                  

And all this navel gazing brings me to the countless patients in recovery from eating disorders I’ve interacted with over the years. Some blame me for how their recovery processes went completely pear shaped (figuratively if not literally). Many more blame themselves for a recovery process that doesn’t seem to progress in the so-called right way, or worse just seems to go from one extreme crisis to the next.

I would never suggest that something as objectively irrelevant as losing your teeth is actually equivalent to some of the serious medical, emotional, financial and life changing crises that can occur for many during recovery from an eating disorder. But I can suggest that no matter the crisis, getting stuck in the damage of feeling betrayed, fatalistic and resentful adds insult to injury.

My experience is also a firsthand example of submitting to screening tests for which I did not assess whether I wanted to know and what, if anything, knowing would remediate should the results be less than ideal, before agreeing to the test (in this case checking alveolar bone density). Yes, this is yet another bias of mine that you can take or leave, but I have gained nothing by consenting to those x-rays except the need to process a whole bunch of anxiety and worry. Everything that can be done to save my teeth was already being done with regular excellent dental care, so the trajectory of treatment is no different before and after the x-rays.

So, if there is any what-if that I do take away from the experience it is that I must work harder to apply my prerogative for my own health outcomes by choosing not to know when that suits me best. I know that my medical mind is one that has no interest in pretending something is in my locus of control when it isn’t. If you don’t happen to know yet what your medical mind prefers, then I would recommend you get a hold of Your Medical Mind: How to Know What Is Right for You.

There are no assurances in life and in recovery. You can do everything and it’s not enough because it’s not all yours to control in any case. Just because all the excellent dental care in the world may not assure me a lifetime with my own teeth doesn’t mean that I would ever have been better off without that care. And hopefully no matter where your recovery effort might lead you, you will still know that a life in the grips of an eating disorder will never have been the “better off” scenario for you.

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That seems like a fitting title for what I want to discuss today. More important things are happening in the world now. Discussing eating disorders at all seems elitist, superficial and ultimately discordant to many at the moment.

Sophie Charlotte: Flickr.com

Nonetheless, there’s an important reason in my mind why eating disorders matter more now and not less. And no, it’s not actually because Trump is president; it’s because we live on a finite planet of dwindling resources with too many of us here (and aging) at one time. We are sliding into a bickering rating system for how much more important various social injustices are in comparison to each other.

The Women’s March of Saturday January 21st was about as broad and unifying an effort to counter the fight to stay on any particular rung on the social justice ladder as we’ve seen lately. And even then, transgendered, indigenous and black women correctly pointed out that the march side-stepped the inconvenient truth that, of the women who even voted in the US election, 53% of white women voted for Trump (not to mention many transgendered, indigenous and black women felt decidedly unwelcome at the march itself as well).

We will struggle to unite much of anything in the months and years to come. If I were to use another analogy (musical chairs rather than rungs on a ladder) then the time to unite was when there were still enough chairs in the game that everyone could have a seat. If you are already on the sidelines, having been left standing when the music stopped at some point in the distant or more recent past, then it’s understandable you are not really vested in cheering on those still circling the dwindling chairs.

We are mammals. Mammals have a predictable set of responses to overpopulation and dwindling resources and primates in particular have a long evolutionary history of getting downright evil in those circumstances. And we habitually identify the evil in others, always failing to identify that allowing an unexamined fight/flight/freeze threat response in ourselves precipitates the evil within us, and not just in others.

All that pretty much confirms that eating disorders don’t matter at all, right? But they do matter. Yes, we are mammals and, worse yet, primates. But primates can also look after each other. They can protect the weak, the injured or (in our civilized case) those with no chair to sit on. And they do all that by being both afraid and thinking at the same time.

An eating disorder is an anxiety disorder. Having that twitchy threat response system in the brain is not exclusively a drawback in life, assuming you can navigate it rather than it navigating you. Someone with an eating disorder in remission (or being actively managed too) is someone who can apply their anxiety-prone nervous system for good. And we need good in the world.

There are plenty of people naturally predisposed to having a resilient response to setbacks that occur in their lives. I don’t know whether natural resilience is more or less robust than one that is developed through practice, but I do know that getting an anxiety disorder to work for you, rather than against you, makes you resilient.

Therefore, if an eating disorder is standing between today’s you and the resilient you who might navigate whatever the future holds and help those who might need a hand, then nothing matters more than an eating disorder. Or, more specifically, nothing matters more than an eating disorder standing between you and your ability to both be and do something good in the world.

If there is anyone who truly knows how to examine the fight/flight/freeze response and refuse to behave in mindless reaction to it, it’s someone who has navigated a recovery effort from an eating disorder.

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“He made me sit and listen to him for hours and hours while he was going on about how unattractive he thought fat was, how he could barely stand the loss of my skinny body, how he thought I had tricked him into believing I could be thin. He made constant remarks about my weight, my intake and my lack of exercise, made me look at pictures of myself as underweight so I could see for myself how beautiful I looked.”

Deviant Art: alicexz

The above quote is from someone navigating her recovery process from an eating disorder. What follows is an edited version of the response I provided on the discussion thread where this quote originated:

Chattel comes to mind: an item of property other than real estate.

If the person you love is an item of property and not a living being in your framework, then that item cannot deteriorate, break or lose its cash value without it needing to be discarded and likely replaced.

We are complicit if we refer to this denigration of ourselves as “he loves me, but..,” or “she loves me, but…”

Most assuredly chronic illnesses are tough on relationships. And we can certainly say that an internalized loathing of fat can create levels of insecurity in patients undertaking recovery, such that their partners may find the constant need of reassurance somewhat exhausting and emotionally draining. Not to mention that the long periods of swelling, pain and exhaustion during recovery mean it’s hard for recovering patients to be full-fledged partners for quite some time as well. But that does not make them chattel.

Ragen Chastain posted this blog entry: Online dating in a fat suit in response to an original story on Huffington Post where both men and women went on dates set up through an online dating service where they were, in person, much larger than their online photographs suggested. A definite double standard showed up where the men really had little issue with being much larger in person when it came to the date itself, whereas the women were pretty much shunned and outright abused.

Ragen observed: “One man compared it to being a “breach of contract” which I think is pretty telling – the idea that how women look is a contract for services that they should not breach and that a reasonable response to the breach of that contract is a complete suspension of basic human decency.”

Services rendered and breach of contract: “Remain as an unchanging thing that I own and you shall have my love and devotion.”

If you have inadvertently ended up with a partner who believes your looks are a contract you must uphold, then it is wise to assume that the contract is not just about fatness. It will also be about aging, disability, illness, vulnerability and dependency.

Divorced or separated chronically ill and disabled adults comprise 20.7% vs. 13.1% for those without disabilities. 1, 2 The interpretation of these survey data suggests a lifetime 75% divorce rate for those with chronic illnesses compared to 50% for the population at large. The reality is that most of us can say “in sickness and health” in the abstract, but when the rubber hits the road it’s a whole different story.

But here’s the thing: you are the one doing all the work to get a chronic illness into complete remission. And if those nearest and dearest are not for that, then they are, by definition, against it. And chances are really quite good that they would not be there for you when the progression of that chronic illness starts to really impact your quality of life and generates progressive disabilities— which is the known trajectory for an active eating disorder over time.

They want the thin and emotionally acquiescent person, but not the progression of sexual organ atrophy, bones too brittle for sex, papery-dull skin, straw hair, broken nails, nor the financial dependence that disability involves either.

The ski-boot analogy (that I use often) works well here too:

When you are at the top of the mountain trying on the rental boots, if you ignore the slight pinching of one boot and head down that mountain, then you can be sure you’ll be halfway down with a blood-blisteringly painful foot.

Partners who believe your shape, looks, weight, or physical attributes are extensions of their status are going to fail you horribly halfway down that mountain. And importantly, it is indicative of boundary issues that go beyond your need to keep your eating disorder active for them.

By all means, if your partner is willing, then seek couples therapy to determine whether appropriate boundaries on both sides might be attainable. But in the absence of any recognition on their part that they would like to be able to salvage the relationship (when you make it clear you will not comply with their requirement that you remain thin) then that leaves you both pretending that the demilitarized zone between you enables you to stay a couple in some sense.

All those with an eating disorder, whether they pursue remission or not, deserve more than a chattel-based primary relationship— especially when that’s not likely to have been the understanding you had of the relationship at its outset. If you did knowingly sign up for being chattel, it’s also more than okay to change your mind; extract yourself from a contract that has outstayed its welcome; and move on.

And if you are navigating recovery and you don’t have a partner who is in absolute awe of your efforts to reach remission from such a deadly chronic condition, then he (or she) just isn’t welcome in your forever home. And I’m not saying you won’t have things you likely need to work on, on your side of the relationship, but being proud of our partner’s achievements and respectful of their struggles is love for a living being and not love of an item of property.

1. https://www.cdc.gov/nchs/nhis/

2. http://www.nytimes.com/1999/05/31/us/disabled-spouses-are-increasingly-forced-to-go-it-alone.html

 

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The services provided on this site are five years old as of October 31, 2016. There have been two name changes and three distinct online identities in that time frame as I have developed my own patient advocacy practice within the eating disorder treatment space. Each shift reflects, hopefully, improvements in our service offering and our ability to provide well-researched and conflict-of-interest-free information on how adults with eating disorders might navigate the condition into complete remission.

Nick Lee: Flickr.com

This latest change from Your Eatopia to The Eating Disorder Institute marks the biggest shift we have made so far, but one that I hope reflects the true breadth and depth of information we have synthesized over the years here in this online space.

Each change brings that familiar combination of excitement and trepidation for me, and likely for all of you who have come here over the years for information and support. This rework has been underway for the past six months and has necessarily involved my retreat from more frequent posts and updates on the former site as well. Thank you to our community for your patience over this past half year as you have waited for the changes to unfold.

We have become more well known within existing research and treatment spaces around the world and many now refer their patients to our site. And for those of you who stumbled upon this site perhaps many months or even years ago, you have provided feedback to confirm that the material was difficult to navigate at times and full references needed to be readily available for each post. We have addressed the gaps we felt were present in our former site and hopefully we have succeeded in generating all the improvements you have told us you wanted to see and more.

For an explanation of the new Eating Disorder Institute logo, please visit the EDI Logo under About in our menu bar.

Navigation

It may take some time for those of you familiar with the old site to navigate around the new categories and features of this site. The “SEARCH” function in the upper right hand corner is likely the best way to find what you might need— we are very pleased with how well this tool works (thank you Squarespace!). Squarespace remains our website host and provider.

If you are already a registered member, then you remain one and nothing has effectively changed for the forums with the exception of the name change for the site.

The main Your Eatopia site will completely resolve to the new Eating Disorder Institute site, so bookmarks from that site should work to take you to the same material on the new site here.

More Brand Name Changes   

The next big news is the renaming of the MinnieMaud Guidelines to the Homeodynamic Recovery Method (HDRM). Our white rabbit (with the green outline) remains as the logo for HDRM, but the new name reflects more accurately the holistic scope of the recovery method outlined on this site. For more information, please visit the Homeodynamic Treatment Method under Treatment in the menu bar.

There is also a new brand you’ll be seeing more of on the Eating Disorder Institute site in the months and years to come: the peacock of Anicca Managed Active Care. While the focus is, and will remain, the pursuit of full remission from eating disorders here at The Eating Disorder Institute, we intend to provide more information and materials that would be relevant for those needing to manage an active state of an eating disorder. While remission from an eating disorder is always possible at any age or stage of the condition, it is not always feasible. Many with active and enduring eating disorders quite rightly feel marginalized within the eating disorder treatment spaces both online and in real life.

The more that those who must navigate an active state of the condition are provided with information on harm reduction and protection of quality of life, then the more likely they may find themselves in a space where an effort towards full remission becomes feasible. But even when it remains outside the realm of feasibility, through absolutely nothing within the patient’s control, they deserve the opportunity to protect their health and quality of life as this should be an innate right for any patient.

AMAC material with the peacock as the logo to look for if such information is relevant to you. This is material that will be developed over the months and years to come.

   Skrifa

Skrifa is Old Norse for “writing.” As there are several heavily referenced, long format documents I have created over the years that provide in-depth information on recovery, I have split out what was once just a blog into categories that better reflect the topics covered on our site: Papers, Conferences, Obesity, Psychology, First Person and Blog.

With the exception of the Fat Series, all other posts now have embedded references at the end of each post. The Fat Series will have references added at a later date.

The Phases of Recovery post is now a thoroughly updated 5-part in-depth series providing comprehensive information on the various facets of recovery.

Videos

The videos that were available explaining the basics of recovery have now been removed from this site and the accompanying YouTube channel. There will be new videos made available at a later date to replace the ones that are now unavailable.

Frequently Asked Questions

The section once called the Usual Questions has been reformatted and now resides under Information in the menu as Frequently Asked Questions.

Use Search

The SEARCH tool will enable you to find things if you were used to the previous site and are trying to find things here on the new site.

Thank you for your continuing support and I hope that you will be as thrilled with this new site as I am!

Gwyneth.

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Unless we suffer significant levels of chronic depression, we all tend to believe in our own exceptionalism, or illusory superiority. 1 Fully 80% of us believe ourselves to be above-average drivers and that’s a statistical impossibility given that the majority of us must be average drivers at best. 2 Given illusory superiority is the norm in human experience, it probably has some good evolutionary value.

Getting to a stable level of practicing remission from an active eating disorder takes a very long time and is usually measured in multiple years, not months. It’s tempting to assume that it’s a straightforward mathematical equation: number of months restricting equals number of months navigating active recovery. It’s also understandable to want to get beyond the recovery process because it’s very not fun. I’ve talked before about the elapse time to remission in the blog post: Time and Scope: Recovery Is Tough.

Kelbv: Flickr.com

While many expect to sail through recovery in a matter of months, statistically it’s not likely to happen that way. But should I be bursting the illusory superiority bubble? Well yes, because fostering what I would call flexible realism appears to increase success at persisting with remission as a practice, at least in my first-person experience with patients.

The first thing that crosses your mind when you are several months into recovery and nothing seems to be improving is to ask yourself “What am I doing wrong?” The conclusion that something must be wrong is at least partially based on many assumptions you made at the outset—assumptions that set you up for expecting an exceptional journey through recovery.

One common assumption is the time spent actually restricting food intake and exercising in a way that created cumulative net energy deficits in the body was measured in months, not years.

The eating disorder prodrome usually has a long duration. A prodrome is when the condition is active but doesn’t meet either the clinical criteria for a full-blown syndrome and/or the patient is unaware the behaviors are anything other than “healthy”. The clinical research on the eating disorder prodrome is sparse and fraught with arbitrary Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. Dr. David Herzog and his colleagues undertook a prospective trial to identify conversion of sub-syndrome diagnosis to clinical diagnosis of anorexia nervosa (AN) and bulimia nervosa (BN). They found that conversion occurred within 2 to 4 years for half of all those with sub-syndrome AN and for two-thirds of those with sub-syndrome BN. 3

Everyone has different behaviors during the prodromal period but some common ones are: lean-focused fitness and exercise behaviors, removing food groups and food types from the diet (anything from desserts to presumed food ‘intolerances’), adopting vegetarian or vegan diets, restricting food intake and/or food type to try to remediate symptoms due to chronic conditions, or looking to change the shape or size of the body believing it will confer greater health benefits. As you can see from Dr. Herzog’s results, not everyone engaged in these preoccupations will progress to a clinical case of an eating disorder. But for those now in recovery, clearly the behaviors worsened culminating in a period of clinical severity.

In this framework, patients tend to measure the time of active restriction at its worst and overlook the years of progressive worsening prior to that period, but damage was accumulating the entire time.

Another common assumption is that a period of weight restoration represents remission and a return to an energy balanced state. Given that so many treatment approaches equate remission with hitting a number on a scale, you’re not to blame for thinking that you were “recovered” when released from an inpatient treatment setting.

The weight restoration experienced after severe restriction is more commonly not sufficient to return to an energy-balanced state. Usually it merely lessens the grade of deterioration from cumulative net energy deficits in the body.

When any one of us doesn’t meet our energy requirements, then we are instantly thrown into catabolism and metabolic suppression. The body destroys its own cells (catabolism) to release energy into the system as a way to support crucial life functions (breathing, heart beating) and it shuts down/slows as many biological functions as it can (metabolic suppression) to try to delay death due to critical energy deficit failure.

To give you an overly simplified linear sense of what that looks like: when you eat 1200 kcal/day for six months (or use exercise to create an equivalent net energy intake) as a 28-year old female, then that removes 234,000 calories from your living system. A calorie is a unit that measures energy.

If you begin recovery and eat 4000 kcal/day (assuming a sedentary life) then 5.2 months would restore that deficit. However problematically that equation doesn’t include the additional energy needed to repair the damage caused by catabolism and metabolic suppression in the body. And I cannot stress enough that healing doesn’t work at all like a months-in-to-months-out equation.

Much as we’d like a mechanistic math equation to determine how long it might be considered acceptable to be wiped out, in pain and exhausted in recovery, the body is much more quantum weirdness than simple math.

2500 kcal/day is what an energy balanced woman over the age of 25 needs on average to support her living system (for the references on that, look out this blog post). Our bodies are designed to be optimized when we run at over 100% with specific metabolic clamping enzymes and hormones keeping everything right at the 100% level. The minute we diet, we send that entire system into chaos. We have short-term emergency functions that can come online as soon as we’re not providing at (or above) 100% energy input (i.e. we’re dieting) but it’s at a high cost as these functions are not as efficient as those that support us when we are not restricting energy intake.

Non-exercise induced thermogenesis (NEAT) can account for up to 2000 kilo calories’ worth of expenditure (it varies from one person to the next). 4 NEAT is a subconscious and automatic expenditure of unneeded energy in the system. NEAT is one of the primary reasons that over feeding humans in experimentation results in the subjects returning to pre-experiment mass, often within weeks of the completion of the over-feeding period. 5 It should be noted that over feeding experimentation also involves prohibiting NEAT throughout the active experimentation phase to determine how mass increases when NEAT is suppressed.

NEAT is the bane of recovery from an active eating disorder, but it is also a central nervous system- and fat-derived hormone-directed process to maintain energy balance (and inherited mass) when excess energy is taken into the system for those with no history of an eating disorder. 6 I’ve discussed the problem of NEAT as it relates to hyperactivity and fidgetiness for those with a history of an eating disorder in the blog post: Insidious Activity.

Without any further consideration, we all tend to accept the cultural adage that we are optimized for famine and that it’s the massive availability of food today that means our bodies expand in mass indefinitely. Human populations across the planet have not faced, on an evolutionary scale, any serious famine pressures in a timeframe that would have acted on our gene pool. Famines are predominantly an unfortunate outcome of the move from hunter/gatherer and pastoralist lifestyles, to settled agriculture. 7

If you choose to delve into the scientific hypotheses for the presence of a range of fat organ sizes within human populations, there are none that presuppose fatness has any adaptive evolutionary value. To review this literature is a great lesson in the limits of scientific inquiry. Science is undertaken and enacted by human beings. Those human beings are optimized to communicate efficiently through culture—often referred to as “memes” or “viruses of the mind”. 8 Memes are efficient for human communication and greatly enhance our ability to live in complex societies and large settlements filled with strangers (cities). Memes also hobble scientific inquiry as we have a tendency to accept the concepts within a meme without any further examination or critical thought. Just as a virus is able to evade our immune systems’ natural defenses, so too does a virus of the mind evade our conscious immunity.

The dominant scientific discourse generating hypotheses for the presence of fatness in our populations is that the fat organ is just a storage unit for preventing death during famine and that in our modern food-laden cultures, the storage unit is over-filled. About the only scientist who has veered at all from this philosophy is Dr. John Speakman and even he assumes “obesity epidemic bad” is an incontrovertible truth. 9

Speakman coined the term “drifty gene” (a play on the original “thrifty gene” hypothesis for the presence of ‘obesity’ in our populations):

“I have suggested an alternative scenario that subsections of the population have a genetic predisposition to obesity due to an absence of selection, combined with genetic drift. The scenario presented earlier was based on evidence from prehistory concerning the release of our ancestors from heavy predation pressure around 2 million years ago. I suggest here that this is one of a number of potential scenarios based on random genetic drift that may explain the specific aetiology of the obesity epidemic.” 10

Apart from the fact that there is no obesity epidemic at all (prevalence has remained either flat or decreasing for approximately the past 15 years in developed nations across the globe) 11 and the fact that one could argue that neither presence nor absence of heavy predation would necessarily act upon metabolic function in human populations either way, Speakman fails to incorporate important “known knowns” in his drifty gene hypothesis.

The first known he overlooks is that fatness confers tremendous morbidity and mortality protection—known in the scientific literature as the “obesity paradox.” 12 Even that term reinforces the meme that obesity must necessarily be harmful and therefore its known protective value is paradoxical (pffft). The second known element that is left unexamined in the Speakman hypothesis is the fact that fat is not a storage unit, but an endocrine organ driving much our metabolic clamping and optimization. 13, 14

What does all this obesity talk have to do with time spent grinding through recovery from an eating disorder? It’s fundamental to the time spent in recovery on two counts: 1) memes associated with the assumed badness of fatness impact your ability to feed freely and 2) we don’t know (because no one has moved beyond circular memes in obesity research) how much time such a critical metabolic-driving organ needs to fix (or adjust to) the damage associated with having the bottom drop out of all the clamping mechanisms designed to work with us being in over-energized rather than under-energized states.

Basically, putting our populations under discretionary famines (diet-as-lifestyle) through memetic infection is a strange experiment with very little conscious and critical thought reviewing and assessing the outcomes of the experiment.

In order to develop flexible realism such that you can practice remission from an eating disorder, it helps to engage in psychoeducational and therapeutic treatment wherein you stop letting the fatness-is-bad meme evade your conscious and critical immunity. At the same time, your therapist can help you practice constantly approaching and eating food despite mounting anxiety (whether that anxiety has been linked to fat phobia or not). It also helps to incorporate the fact that your fat deserves some serious respect as a very complex and important organ responsible for metabolic optimization. Give it the time it needs to restore energy balance and provide it with the energy it needs to do so.

1. Allan, Lorraine G., Shepard Siegel, and Samuel Hannah. “The sad truth about depressive realism.” The Quarterly Journal of Experimental Psychology 60, no. 3 (2007): 482-495.

2. McCormick, Iain A., Frank H. Walkey, and Dianne E. Green. “Comparative perceptions of driver ability—a confirmation and expansion.” Accident Analysis & Prevention 18, no. 3 (1986): 205-208.

3. Herzog, D. B., J. D. Hopkins, and C. D. Burns. “A follow-up study of 33 subdiagnostic eating disordered women.” The International journal of eating disorders 14, no. 3 (1993): 261.

4. Levine, James A. “Non-exercise activity thermogenesis.” Proceedings of the Nutrition Society 62, no. 03 (2003): 667-679.

5. Pasquet, Patrick, and Marian Apfelbaum. “Recovery of initial body weight and composition after long-term massive overfeeding in men.” The American journal of clinical nutrition 60, no. 6 (1994): 861-863.

6. Teske, J. A., C. J. Billington, and C. M. Kotz. “Neuropeptidergic mediators of spontaneous physical activity and non-exercise activity thermogenesis.” Neuroendocrinology 87, no. 2 (2007): 71-90.

7. Berbesque, J. Colette, Frank W. Marlowe, Peter Shaw, and Peter Thompson. “Hunter–gatherers have less famine than agriculturalists.” Biology letters 10, no. 1 (2014): 20130853.

8. Greene, Penelope J., and Richard Dawkins. “From genes to memes?” (1978): 706-709.

9. Speakman, John R. “Thrifty genes for obesity, an attractive but flawed idea, and an alternative perspective: the ‘drifty gene’hypothesis.” International journal of obesity 32, no. 11 (2008): 1611-1617.

10. ibid.

11. Ogden, Cynthia L., Margaret D. Carroll, Brian K. Kit, and Katherine M. Flegal. "Prevalence of childhood and adult obesity in the United States, 2011-2012." Jama 311, no. 8 (2014): 806-814.

12. Romero-Corral, Abel, Victor M. Montori, Virend K. Somers, Josef Korinek, Randal J. Thomas, Thomas G. Allison, Farouk Mookadam, and Francisco Lopez-Jimenez. "Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies." The Lancet 368, no. 9536 (2006): 666-678.

13. Trayhurn, P. "Endocrine and signalling role of adipose tissue: new perspectives on fat." Acta Physiologica Scandinavica 184, no. 4 (2005): 285-293.

14. Harwood, H. James. "The adipocyte as an endocrine organ in the regulation of metabolic homeostasis." Neuropharmacology 63, no. 1 (2012): 57-75.

 

 

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Imagine you are definitely (BMI) 30++. You have had an active eating disorder for years. You restrict your food intake every. single. day. You have a host of mounting health problems and the number on the scale tells you and everyone else that you are “obese” and your health problems are all about your weight and nothing but your weight.

Sharon Brogan: Flickr.com

You stumble onto this website. You realize that there’s a very strong likelihood that the source of all your health problems is the fact that you under eat severely. You are shocked. You e-mail me as this site’s owner (and everyone who thinks that they aren't “thin” enough to have an eating disorder does this) to confirm that the re-feeding guidelines apply to you. You confer with trusted in-person family and friends and maybe if you’re very, very lucky, a decent doctor. You decide to support your energy requirements and begin the recovery process.

It’s a big deal when someone can overcome their own fattism directed at themselves. We all absorb the fattist culture around us and it’s an accomplishment to become self-aware enough to identify that cultural norms are not automatically good, right and true.

Eating disorders happen right across the BMI spectrum and this site and its forums try to be a particularly safe space for the two-thirds of those with active eating disorders who have never been (and will never be) “clinically” underweight and yet suffer the same misery and damage from an active eating disorder as those who get the anorexia nervosa diagnosis.

Many gain weight while actively restricting food intake relative to their energy requirements. They are starving and increasing in mass. I explain how this happens in the blog post Gaining Weight Despite Calorie Restriction.

Everyone is equipped with two ways of surviving an energy deficit in the body for a short time: one way is the body will catabolize cells (losing mass and destroying organs) and the other is that it will suppress metabolic function (slow or stop entire biological systems, such as reproductive functions). However, both these ways happen in different proportions in each individual (and the amount of catabolism vs. metabolic suppression may change over time too).

That’s why some individuals can gain mass on 1200 kcal/day and others cannot maintain mass with 2500 kcal/day—it’s all about how much metabolic suppression the body applies. A highly efficient metabolic clamp, and you gain despite calorie restriction of 1200 kcal/day; a very inefficient metabolic clamp, and the body depends entirely upon catabolism to handle the energy deficit and you are losing weight on 2500 kcal/day.

But the difference in metabolic efficiency does not reflect “less damage”—both catabolism and metabolic suppression are damaging to the body long term. Catabolism and metabolic suppression are only short term mechanisms to try to keep you alive until you can replenish the energy deficit that’s mounting in the body.

When attending the 4th Annual Weight Stigma Conference here in Vancouver last week, I crossed paths with an attendee who made the repeated assertion that body mass is correlated to food intake levels, although she allowed for the possibility that the correlation might be weak. I was taken aback as I had spent an entire lunch where I and many other attendees were all quoting the same critical literature at each other (ask Carmen Cool for the exact number for lowered mortality from Katherine Flegal’s NHANES studies—she has it memorized).

There are no systematic reviews and meta-analyses that actually reveal any correlation between food intake level and BMI. Many reviews of national nutritional surveys actually confirm there is no correlation between food intake level and BMI. Of course, we need to keep in mind that self-reports are as good as useless when it comes to accuracy. If you want to review the scientific material on this topic, consider the blog posts on Weight Gain Correlates: Part I and Part II where you can source the references at the end of those posts.

But upon reflection I realize that, were we not living in a fattist society, food intake levels would indeed correlate closely with body mass. While there are variations in energy requirements from one person to the next and even within the same person over time, the larger you are then the more energy you expend. It’s not a linear progression as there are presumably formulaic metabolic efficiencies associated with increased mass (Kleiber’s law), but we have so many of us not meeting energy needs with adequate energy intake that we have created a strange artifact in scientific research thanks to making permanent dieting a way of life in our populations. 

The close tie that should exist between the energy our body requires to function optimally and the food we consume is completely unhitched. It’s more accurate to say that body mass correlates with catabolic and metabolic compensations in response to progressive energy depletion.

Maybe, when we finally grind down the pervasive fattism within the research, medical and practitioner communities, we’ll experience yet another “science goes wrong” déjà-vu.

In the 1920s, when scientists were trying to identify the origins of sudden infant death syndrome (SIDS) they discovered, in post-mortems, that the thymus gland of children who had presumably died of SIDS was enlarged. It was theorized that the enlarged thymus was pressing down on the trachea thereby causing SIDS. From there, preventative treatment ensued:

“all experts in major pediatric circles advised that parents irradiate their children’s thymus glands to limit thymus swelling and growth. You were considered an irresponsible parent if your children did not undergo the procedure, so thousands of concerned parents urgently scheduled doctors’ appointments.” [1

The thymus glands of these children were not enlarged. They were of normal size. The catastrophic mistake that had been made was assuming that thymus gland size that had been seen repeatedly non-SIDS children and adult post-mortems reflected “normal.” However, the thymus gland size from those post-mortems reflected a shrunken size, the result of the body’s exposure to either prolonged illness and, more commonly, malnutrition.

I know, we’re pretty sure that we are the smartest people to ever walk the earth and therefore we couldn’t possibly make such tragic mistakes in medicine today as they did in the 1920s. Well except for the fact that we urge those with enlarged fat organs should undergo stomach mutilation—it’s the responsible thing to do right?

1. https://helix.northwestern.edu/blog/2010/02/when-science-goes-wrong

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Melissa Fabello recently asked her followers on Twitter what kind of book is lacking in the literature on body image that we might want to see written and published. My response is too long to fit in 140 characters, and so I will identify here what is I think is needed.

Binary Koala: Flickr.com

First up would be what we need to stop doing when we talk body image:

  1. No more just swapping out the “ism’s”: Big strong fit healthy girls just swaps out fattism with ableism and healthism.
  2. Body positivity and body love are terms that cannot be defined: if several centuries’ worth of poets, scholars and authors can’t nail down “love” then let's leave the ephemeral out of the body and our experience of it.
  3. Loving one’s body is additionally profoundly perplexing to those with chronic illness of any kind.
  4. Positivity and love assign a “should” to sensory input and interpretation: the curse of the normative on those deviating from the norm in any way.

What is body image? It’s equivalent to pain.

If I ask you to grab your left ear lobe right now between your thumb and fore finger I doubt many of you would need a mirror to do it (my apologies to those of you who may have chronic conditions that actually make that gesture difficult or impossible). The ability to know where your body is in three-dimensional space without having to use your eyes to confirm where your earlobe might be is called proprioception.

I talked a bit about proprioception in the blog post Body Checking: Safety Behaviors in Recovery. Like all our senses, proprioception develops in our very early years. A baby finds his toes fascinating not merely because they are fascinating, but because his brain is developing proprioception by using other sensory inputs: sight, touch, taste, pressure, equillibrioception etc.

Our bodies can change so rapidly in the teenage years that proprioception can lag a bit behind. Teenaged males who have grown very rapidly in height may experience some clumsiness, not because they are inattentive, but because their sense of themselves in three-dimensional space hasn’t yet updated to include a longer arm or higher center of gravity. 1

Our senses, roughly speaking, involve signals from the peripheral nervous system that are interpreted by the central nervous system. However, that interpretation is not equivalent to a computer deciphering a code. Our brains are social organs and we have to make meaning of our interpretation of various peripheral nervous system inputs and we use the world around us to do so.

Minus the meaning, body image is proprioception and pain is nociception. However both then get dollops of sociocultural meaning slathered on them as a way for us to make sense of the sensations.

“Mommy, my arm really hurts.”
“No it doesn’t dear, it was just a tiny bump. You’ll be fine.”

And with that exchange, the experience of nociception for the child now has emotional and cognitive meaning beyond just the perception of the arm hurting. And don’t be too hard on “Mommy” there, because we are all blithely denying each other’s senses and experiences all the time.

I cannot see the color green you see with my visual perception. I cannot feel your pain with my nociception. I cannot sense your body in three-dimensional space with my proprioception.

The book on body image that needs to be written is one that speaks about proprioception and its value as one of our senses. Human beings are remarkably adaptable. There are individuals who can lose their sense of proprioception and they then turn to using visual cues—looking at their feet first in order to move them forward.

Any sense you have of your body that includes an adjective is placing a sociocultural judgment on, and an emotional relevance to, the sensory function of proprioception. The real value of body image, in its biological sense, is the speed and accuracy with which we can co-ordinate the motion of our bodies through space.

There are plenty of books on how to manage pain: the emotional salience of pain is distinct from the sense of pain itself. Therefore meta-cognitive and mindfulness based exercises can help you perceive your pain in the absence of the distress and kindling created by emotion, thereby changing your experience of the pain itself. I speak of these concepts in the blog post: Pain III: Anxiety, Therapy & Dismissive Doctors.

The book that needs to be written on body image is how to practice extricating the amazing sense of proprioception from countless judgmental, denialist, fattist, healthist, ableist and cruel sociocultural fabrications on how you are and are not allowed to experience that sense. I have even picked out the title:

“How to Manage Body Image–extricating your internal critic and emotional distress from the wondrous sense of your self in three-dimensional space.”

Anyone care to write it?

1. Goble DJ, Lewis CA, Hurvitz EA, Brown SH. Development of upper limb proprioceptive accuracy in children and adolescents. Human movement science. 2005 Apr 30;24(2):155-70.

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There are many ways to reach remission from an eating disorder. Here on this website, we support science-based data suggesting exposure and response prevention helps those with eating disorders. 1 Approaching and eating the food, as is required within this recovery framework, is difficult and requires professional support. This post is excised from a recent discussion on our website’s forums on whether avoiding meat and animal products for ethical reasons is feasible while trying to get to, or maintain, remission from an eating disorder.

Kapitan Nano: Flickr.com

It’s not unequivocally impossible to reach remission when entire food groups are forbidden but it makes the chances of doing so far less likely. I won’t wade into all the misinterpretations of scientific data that reflect overblown correlations of restrictive diets with health outcomes—that’s for another time. For now, we are exclusively looking at the following conundrum: a history of an eating disorder and a desire to avoid eating meat for ethical reasons.

Anecdotally from my experience in the past seven years, those more likely to enter full remission from an eating disorder embrace omnivorism. In fact, many currently in remission were vegetarian (or formerly vegan) and decided that their recovery required of them that they be able to approach and eat all foods.

The ethical argument of eschewing meat, for those with eating disorders, is commonly a post-hoc rationalization of threat avoidance (anxiety).

If you think about eating meat, chances are that you have a surge of distress and your thoughts compulsively go to numerous traumatizing images associated with inhumane industrial meat production practices. The more you attempt to suppress those thoughts and intrusive images, the more they bombard your consciousness. That experience is a quintessential threat response and ideally an ethical decision should not be driven by fear and distress. Ethics are not very robust if they are driven purely from avoidance of the unsavory elements of our modern world.

One of my all-time favorite books is The World Without Us, by Alan Weisman. There is no ethical maneuver on our parts that is probably as beneficial to other living creatures and ecosystems on this planet as ensuring that fewer humans (or no humans) are around. As the concept of population reduction bumps up against the human rights of procreation, we generally prefer to avoid the most ethical option available to us—we could reduce our population with lower birth rates over time.

I am an omnivore. Wherever possible I choose meats where the animals have lived good, free-range lives with empathetic caretakers and stewards. I, however, am privileged and have the luxury of making such choices. Although I choose to scrimp on other luxuries for the benefit of having those kinds of meats in my home, it’s still a privileged choice utterly unavailable to most. In other words, it’s hard to tout my behavior as ethical, given I merely have the option handed to me.

Furthermore, the complexity of our modern world means that my very existence harms countless living creatures, including human beings. Components in my smartphone could be traced to the gang rape of women and the forced enslavement and labor of countless children within the various paramilitary spaces where coltan is mined in the Democratic Republic of Congo.

My clothes, almost entirely sourced as second-hand items, have provenance that invariably includes enslavement of rural Chinese in urban factories, or of Bangladeshi women working in firetraps 14-16 hours a day. All of my dutifully recycled electronic items end up poisoning countless human beings on the other side of the world tasked with breaking apart these obsolete gadgets filled with toxic substances.

Here in Canada, coal-fired plants in Alberta that support our electricity needs in British Columbia each night (so that our hydro-electric power can be routed to California) contribute to mercury vapor that circulates around the globe. The petroleum in my car likely has a direct line of sight to countless refugees that have perished in the Mediterranean after some 50 years or more of developed nations propping up despotic rule in the Middle East to ensure the flow of oil.

That's already a lot of blood and suffering on my hands. Short of going off-grid and becoming a seventh-level vegan (a nod to a legendary The Simpsons TV episode where Lisa develops a crush on an environmental activist who pocket mulches and eats nothing that casts a shadow) there is little about my existence that can really be held up as much more than shades of ethical-esque behavior.

We have out-sourced and off-shored our ethical responsibility to a point where we are as ensnared in our harm-inducing lifestyle as those harmed by our lifestyle. Yet our anxiety, distress, worry, obsession and/or panic regarding our ethical failures as active participants in the harm of others, saves not one soul.

That may sound supremely depressing and defeatist, but I don't choose to frame it that way. I’m not advocating pessimistic apathy (which is anxiety-based) such as thinking “As it’s hard to be ethical, why bother?” I'll explain...

When it comes to eating disorders, they are fundamentally anxiety disorders. It does no good to reinforce food avoidance in your life as the ill health and disability that results from that behavior does directly impact those who love you and depend on you for their well being and development as well (in the case of those with children and/or pets too). By all means try to lower your first-world burden of destruction around the world by consuming less. But consuming less food for those with eating disorders is the defeatist option and not the ethical option it is made out to be.

If we make ethical choices driven by fear and anxiety, then I believe we remain shackled to the complexity that will result in us making little to no difference in the overall disaster we've created. We have to be able to reason and think to find our way out of the mess and the amygdala hijack of fear and anxiety means we actually shut down our ability to think.

Not eating the steak on your plate may have much less impact than choosing to give up that smartphone. I don't know the answer to that, but I do know that those with eating disorders have to be more wily than their anxiety disorder and make sure that they are in remission and stay that way so that they can maximize their reasoned ethical impact—making the world the place in which they want to live and the place they share with all living creatures.

1. Steinglass, Joanna E., Anne Marie Albano, H. Blair Simpson, Yuanjia Wang, Jingjing Zou, Evelyn Attia, and B. Timothy Walsh. "Confronting fear using exposure and response prevention for anorexia nervosa: a randomized controlled pilot study." International Journal of Eating Disorders 47, no. 2 (2014): 174-180.

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