Saturday, January 25, 2014

Thoughts on Gaining: The Truth about Life after Eating Disorders (Part 1)

A few weeks ago, I finally finished reading Gaining: The Truth about Life after Eating Disorders by Aimee Liu. This is the second recovery book I've read, and coincidentally, the second book by Aimee Liu that I've read. It's taken me a while to get through. 

I first bought Gaining when I was a senior in high school. I thought, A recovery book? Yeah. I'll read it and find out all the ways that I can look like I'm better, look like I'm recovered. I'll read it so I can find all the ways to hide my disorder. Before Aimee Liu, the only ED books I've ever read were memoirs or fiction--essentially instruction manuals for how to become sick, or in my case, sicker. Don't get me wrong--I love ED memoirs. I love that young adult authors are touching on EDs, which leads to conversations and early intervention. I just worry that sometimes they are too real. Too triggering. Too much of a how-to guide.

But Gaining wasn't like that. Gaining was research, put into real people terms, mixed with personal stories (shout out to Dr. Warren, who spoke on both of those sides and whom I've had the pleasure of working with for three years). Throw in Aimee Liu's wisdom looking back on her journey, along with bits and pieces of "You are not alone. There are others out there who feel exactly like you do," and you have a recipe for a very insightful and informative book for sufferers, researchers, loved ones, or the curious. However, this isn't a book review (okay... maybe it kind of is...), so I'm not going to go on and on about the value of Aimee Liu's work.

I am, however, going to go back through the book and highlight some of the important takeaways I got from each chapter--the things I've found helpful in motivating my recovery, the things that have been shocking, the things that have bothered me, the quotes that struck me, the times when she took the words right out of my mouth, all of it. Because I think in doing this, it will help me to figure out a better picture of what my recovery looks like, I think, going forward.

In order to overcome any problem, we must first admit we have that problem. We must face it, examine it honestly, and learn how to manage it. (p. xii)

Introduction--To Gain Is Good. 

To gain is good. We gain confidence as we grow, status and health as we prosper, and--so we hope--wisdom as we age. A gain of intimacy is essential for love, of toughness for survival. By definition, gaining is a source of pleasure and progress. Why, then, do so many women (and, increasingly, men) confound the meaning of this simple, satisfying word with shame and dread? [...] The greatest fear, however, is that gaining will expose some shameful inner truth. It's not about the numbers on the scale. Deep down, we all know that. (p. xiii)

It's true. Gaining is no longer about pleasure or progress, at least when it comes to weight. I remember being 12 and my dad saying something to my aunt about how I almost weighed as much as she did and all I remember is the incredible amount of shame that I felt around gaining. I was at an age where I was supposed to gain! And I was ashamed of it. It goes to show what value we put on numbers and gains in weight in our society. Look at Special K and their slogan, "What will you gain when you lose?" They are associating gaining with loss. What does that even mean?! It's a complete oxymoron. 

And that's not even about the numbers! It's about losing. EDs are not about the numbers. They become about the numbers, but they're not about the numbers. They're about what, exactly? I have yet to figure that out. Everyone is different. But my ED did not start from being about the numbers. I wasn't the least concerned with the numbers. I was concerned with feeling better and being better. 

Yet I now wanted to believe that gaining weight was enough to make me feel normal... What did "normal" even feel like? How did "normal" think? Anorexia had so distorted my perspective that I had no idea. (p. xx)

So let's talk about this one, because it's kind of where I'm at right now. It's not enough to be back in my weight range (which in this moment, I'm not yet in--so close!). Yes, the weight and the medical stability are part of it, but without normalizing food behaviors, without figuring out thoughts and triggers and everything else, relapse is basically inevitable. But what exactly is this "normal" thing? I'm at a place where my normal has, for almost seven years, consisted of being sick, and now, I have to reinvent normal from nothing, at 19. It's something that I'm struggling with as I'm seeking what recovery looks like for me. Which Aimee Liu goes on to talk about: 

Gaining back a full, healthy life in the wake of an eating disorder is largely a process of restoring these three realms of experience [inner self, relationships, experience of culture and society] to their rightful order. The first, most important, and in many cases ongoing challenge is to look beyond the surface of the person in the mirror. As University of New Mexico psychiatrist Joel Yager told me, "Know thyself in a very profound Greek way. What is your biology? What is your calling? How are you built? Study your temperament. Be respectful of it." The second stage involves reexamining and adjusting relationships with families, lovers, and friends. "You're not going to turn yourself into someone you aren't," Yager explained, "and nobody should try to turn you into someone you're not built to be." With enough self-awareness, we can rebuild or form new relationships around trust instead of judgment. Then, aided by this genuine support, we can renegotiate our responses to our culture and society from a position of personal confidence instead of emptiness. When what we do, want, and admire is shaped by a strong sense of self that operates from the inside out, we gain true power over our lives. (p. xxviii-xxix, emphasis mine)

Chapter 1--Connecting the Dots: A Genetic Link

The facts: 
  • More than 2/3 of anorexics and bulimics have a lifelong history of anxiety disorders
  • Typical anorexic qualities--perfectionistic, cautious, highly regimented, disciplined, suffer from self-perceived inadequacy
  • Anorexia nervosa has the strongest correlation to temperament of any psychological illness
  • Bulimia nervosa has a correlation but less so 
  • Even years later, recovered patients will show abnormally high rates of anxiety and obsessive thinking, especially perfectionism

Dear everyone everywhere who ever thought that EDs were choices: they are not, in fact. So let's bust that myth right now. This at least makes me feel a bit better--knowing that this isn't my fault. In another of Aimee Liu's books, she writes that genetics form the gun, and it's true. Research has proved it. 

What completely freaks me out though, is that last point. Recovered patients will show abnormally high rates of anxiety and obsessive thinking, especially perfectionism. WHAT?!

The solution is not to eliminate these traits but to learn to manage them. So in treatment we try to move patients to a new framework, to enable them to accept growth and change. (p. 22)

I think this is what my therapist meant yesterday when she told me that I needed to learn how to be okay with ambiguity--that she really meant that I need to be okay with not knowing, with not being in control, with having my same temperament and not engaging in behaviors to make me feel better when my genetic wiring makes me feel like I need to. This is gonna take some time. 

Chapter 2--Portrait of a Hunger Artist: The Face of Fear

But the turning point, while critical, is not the same as a conclusion. [...] Virtually everyone who recovers from an eating disorder experiences such a moment. It might take a comment, a look, or the scare of a medical prognosis, but suddenly the obsession that just seconds before seemed all-powerful is revealed, like the Wizard of Oz, to be nothing more than the trick of a frightened mind. Once this truth is revealed it becomes safe to say, "I'm sick of this," or simply, "Enough!" (p. 28)

I reached my turning point. About three months ago. Check. However... 


Patterns of eating, thinking, feeling, and behaving that have taken years to develop and that may stem from inborn disposition are not going to reverse in a single afternoon. I know this now from my own experience. I also know it from Caroline Knapp, who at forty-one wrote, "I'm still prone to periods of isolation, still more fearful of the world out there and more averse to pleasure and risk than I'd like to be; I still direct more energy toward controlling and minimizing appetites than toward indulging them; I am one of the least spontaneous people I know." I know it from Marya Hornbacher's observation following her long battle with bulimia: "Always, there is an odd distance between you and the people you love and the people you meet, a barrier, thin as the glass of a mirror." (p. 29) 

Now that's depressing...

People who develop EDs tend to fall into three distinct and mostly lifelong temperamental groups: 

1. Overcontrolled
  • Most restricting anorexics and a minority of bulimics 
  • "Feel like they have nothing inside" 
  • Avoid social contact
  • Tightly control appetites for food and sex
  • Limit pleasures 
  • Withdraw from excitement, sensation, and risk

2. Perfectionistic
  • Most bulimics and a minority of restricting anorexics
  • Tend to be conscientious "good girls"
  • Aim to please, excel, and conform
  • Worry about details 
  • So fearful of mistakes they can't get their work in on time 
  • "Read an arched eyebrow as contempt, a frown as a stiletto through the heart" 
  • Intensely self-critical

3. Undercontrolled 
  • Split about evenly between bulimics and anorexics who binge/purge
  • Emotions are intense
  • Behaviors are impulsive
  • Tend to fly into rages instead of expressing anger passively or turning it inward
  • Desperately seek relationships to soothe themselves

(Crossover exists, particularly between the perfectionistic and undercontrolled groups, particularly during recovery) 

Lifelong?! Ughhh. That makes this SO MUCH harder. But is ultimately, good to know. Because now, instead of fighting my temperament, I can learn how to manage it, to work with it, to direct it in ways that allow it to flourish instead of wither and die. 

The question that must precede any meaningful or lasting change is, Who cares? Who cares whether you live or die, become a janitor or a rocket scientist, wear a size 2--or a size 20? The answer may seem obvious. Given the obsessiveness with which the eating disordered worry about their bodies, they clearly care a great deal. Just consider the language of these disorders. Though filled with self-loathing, anorexics excel at self-discipline and selfless acts of humility and generosity, which they often take to extremes of self-denial and self-punishment. Bulimics tend to be more selfish and self-motivated, but like anorexics, they are acutely self-conscious and riven with self-doubt and self-contempt. Both groups resist self-awareness even as they behave in ways that appear utterly self-involved. Eating disorders are all about the self--a self that somehow claims the center of attention while refusing to claim its own true needs and wants. Recovery begs the larger question: If I'm the one who cares so much, who, then, am I? Until we gain the courage to solve this complex riddle, the figure in the mirror--at any weight--will go right on tormenting us. (p. 39)

Melinda explained to me the other day that this phase of recovery is like me standing on the edge of a cliff and my team telling me to trust them and jump, when all that I can see below me is a giant black hole. Yep. Basically how I feel right there. It's terrifying. 


But I guess it's also exciting. Professor Barlett put it to me this way: 

"It is a time for you to figure out who you are and how that aligns with who you want to be. It's tough. You would think 'who you are' would be innate and we would not have to think about developing it, but that is why so many people just move along in life not questioning anything. It's hard."

At the same time, though, I have this opportunity to figure out who I am. I have the chance to discover my likes and my dislikes, what I'm passionate about and what I couldn't care less about--EVERYTHING. But the sheer open-ended-ness of the possibilities, is, I think, what is so scary. 

Chapter 3--The Laws of Perfection: Obsession and Compulsion

The facts:
  • Most people who have had an ED believe perfection is real and attainable and that it is their duty to reach it
  • Perfection is by definition unattainable, leaving perfectionists perpetually frustrated and disappointed
  • Perfectionism is innate--a function of the temperament one is born with
  • Obsessive-compulsive personality--defined as one who is cautious, rigidly focused, stubborn, perfectionistic, convinced their way is right and everyone else is wrong, terrified of making mistakes
  • Stress heightens perfectionism

“The greatest obstacle to perfection is our own inescapably human fallibility. The more we try to prove our infallibility, the more we are bound to fail.” (p. 47)

“The emotional promise of perfection is security: no one will criticize you, try to change you, or touch you if you have your universe in order. But perfection is impossible, frustration is inevitable and at times unbearable.” (p.53)

Guilty as charged. I am a perfectionist. I feel more secure when everything appears to be "perfect." It's true. I freely admit that. 

People with EDs, especially anorexia, tend to have high serotonin levels all the time, which heighten anxiety and lead to these personality traits--
  • Organized
  • Driven
  • Somewhat compulsive
  • Extremely obedient
  • Overachieving
  • Good at following through
  • Sleep too much
  • Rarely impulsive
  • Rarely domineering
  • Timid
  • Risk-averse
  • Need routine
  • Do worse in novel situations
  • Prone to depression

I mostly fit all of these characteristics. I also know that my serotonin levels are wonky, hence being on SSRIs. But. This is just super interesting to me (it also makes neuro easier because it gives me a real-life application! #psychnerd).

“Character is the real stuff of recovery because it consists of the traits we can change—unlike temperament, which is largely innate and permanent. If one thinks of temperament as the genetic wiring of personality, then character consists of the circuit boards that route, suppress, or maximize the currents flowing through that wiring. The three traits that comprise character—self-directedness, self-transcendence, and cooperativeness—are shaped less by genetics than by experience (how we are raised by our parents, for example, or trained by our culture) and free will (how we choose to interpret and react to experience).” (p. 61-62)

1. Self-directedness
  • Measured by the degree of meaning and purpose we feel in our lives
  • Less to do with what we want and more to do with why we want it
  • Highly self-directed people: realistic about abilities, effective in choices, persistent in problem-solving, hold themselves accountable, take pride in reliability
  • Not the same as self-sufficiency
  • Allows us to work, play, and love others without fearing we’ll lose ourselves while doing it

 2. Cooperativeness
  • Makes us feel part of society
  • Benefits from self-directedness
  • Highly cooperative people: personal passions and talents flourish in groups, high empathy, tolerance, and compassion for others, broad perspective on self

3. Self-transcendence
  • Allows us to feel part of the greater universe
  • Gives us faith
  • Alleviates fear
  • Measure of “the depths of self-aware consciousness, such as awareness of what it means to see the colors of a rainbow or the beauty of a painting….Individuals high in self-transcendence recognize the beauty and meaning of sensory experiences intuitively.” (p. 64)
I guess these are the things that I need to focus on right now--what gives me meaning and purpose, what makes me feel part of society, what allows me to feel part of the greater universe. Those aren't easy things to identify, for anyone, much less someone in recovery. But they are things that I can explore right now, things that I have the time to explore right now, and even though that's terrifying, it's pretty amazing. 

“The struggle between who we are and who we want to be is what motivates most human beings to grow….Unfortunately, what perfectionists strive to prove is impossible. No one is perfect, and everyone has limits. What kills us will not make us stronger or prettier or more lovable. A sense of purpose, connection, and perspective, however, can and will.” (p. 64)

Growth comes from struggling to get from who I am to who I want to be. Struggling. Not moving, not swimming, but struggling. It's not going to be easy. It's going to be difficult. It is a struggle.  And it will not be perfect.


“Error sometimes supplies the surprise that makes life interesting. Sometimes it opens up new opportunities. There’s a good reason why we rarely remember, much less tell stories about, the perfect landings.” (p. 66)

New opportunities. Different opportunities. Terrifying, but opportunities, which will lead to gaining things. 


Progress.
Pleasure.
Life.

(Stay tuned for part 2 of my review of Gaining! I don't want to overwhelm anyone--or myself--with an absurdly long blog post.)