Why She Feels Fat

2008-09-05T08:44:49-07:00

These lyrics are from a song that played on my ipod the other day: words can be sharper than a knife and cut just as deep.

How true is that? The words we choose are so important. They carry so much power (there's that word again: power- see how often it comes up?!).

So many times a family comes to see me and they have the best of intentions. Everyone wants to get along and make the relationships work. But much of the time they get into trouble with what they say and how they say it. A lot of my work is helping family members understand what each of them really want to convey to another person, then figure out how to best (the most effectively- how it can be said that allows the best chance for the other person to hear what is said and understand what it means; how it can be said so it doesn't miss the real point and so the statement doesn't contain misleading, superfluous, or unnecessarily emotionally loaded material; how the person saying the words can stay true to themselves and at the same time be truthful, gracious and not intentionally hurtful to the other person...).

Words are a major way human beings communicate. We need to be thoughtful about how we use them.

2008-09-04T09:15:51-07:00

Ari, I realize it seems odd to have "boundaries of steel" in some relationships, then no boundaries at all in others.

It isn't really odd at all. In fact, it's pretty common.

The reason this occurs is that boundaries of steel are an extreme type of boundary. No boundaries at all is also an extreme state (it is the exact opposite of boundaries of steel, right?). Life so often is like this; when one extreme is present, the other often shows up too.

There are many extremes present in EDs: restricting all day then bingeing at night, to name one.

I'd expect that if you have walls of steel, sometimes you'll also be stuck with "boundaries of vapor or air."

In your work on yourself, try to concentrate on what types of boundaries you truly need for the relationships in your life. I often have clients write down the major relationships they have in one column, then next to each one list some materials (cheesecloth, glass, tree bark, aluminum foil... the possibilities are just about infinite) that feel appropriate for that relationship (you can have several materials for each relationship if you want- there isn't a "right" way to conceptualize this- it's whatever is helpful for you). At first, you may find that you list steel for all relationships. That's fine. But then, challenge yourself (and get help with this from your therapist and/or anyone else trustworthy and knowledgeable) to assess if steel is the best choice (for each relationship, ask yourself, "Do I really, really need that level of impermeability for this particular relationship? If so, why? And, if not, what material/s might the right choice? Try to let yourself answer honestly. I'm not saying you can't have steel, only that I want you to be able to choose consciously, for specific reasons, to use something so impermeable). You'll likely find that your "default" setting has, over the years, become steel, but that it is often overkill in terms of impermeability (that you may not need it as much as you have been thinking you do is what I mean).

Go slow with this, as exploring it may make you nervous. Remember, no one will know you're experimenting with boundaries- it's not like you'll be wearing a sign on your back publicizing it, or something else obvious- so you needn't be afraid. All the exploring and experimenting is done internally, and you have complete control over it all. You don't have to make any changes in any of your boundaries unless you decide you want to. No one except you can make it happen and no one can make you do it. You own your own boundaries and you get to make decisions about them.

If you are willing to make some adjustments over time, and get a little bit more flexibility into your boundaries, you will feel less lonely (and, this may surprise you, I promise you that you'll end up feeling more in control and more protected than by default always using steel). And that is just a lot more comfortable and more fun.

2008-09-03T22:16:24-07:00

Your comment goes to both the issues of power and protection, Palmtreechick.

In an eating disorder, power is given to food, weight, exercise, body size (and all the other related things that go along with the disorders) because we learn to believe those things hold the key to protection (safety, stability, security...). You may never have put these exact words or thoughts to it, but I bet you feel safer if you weigh less, if you've "eaten better" (less) or exercised "enough" in any day.

Anything we feel can make us safe is afforded a "sacred place" in our minds, and therefore holds tremendous power for us.

The problem here is that a number on a scale, just to pick one example, in fact gives us zero protection. It is only a number, just like an apple is only an apple, or a cookie is just a cookie. None of these things has any power at all. We've simply learned to believe they do. And then we run our lives according to those beliefs and we become terrified to deviate even a millimeter from them, even for a second.

This is why what we see on the scale can "make or break" our day. If we are pleased with what we see (if the number is "low enough" for that moment), our day proceeds well (we feel organized, safe, protected, in control...). If the number is "bad" (too high) we feel out of control, in trouble, chaotic...

Amazing, isn't it, that a number can hold so much power.

Of course, the trick (it actually isn't a trick, it's a goal, and a lot of work, and achievable, and worth it) is to identify what can give us true power, and true protection. That's of course the work of recovery. (And there really are ways in life to have both of these. I'm not just making that up.)

Here's one way to work on this: each time you catch yourself giving power to the scale, to food, to your weight, etc., say to yourself something like, "Wow, how could a number (or whatever you're focused on at the moment) hold real power? How could that be real? What's the scientific basis for that being real?" At first, you won't even remember to ask yourself the question because you'll be so focused on the number and you'll be so convinced, as usual, that the number holds the key to so many important things. But if you keep trying to pay attention, you'll begin to not only remember to ask the questions, but you'll begin wondering about answers.

A crucial aspect of recovery can be summed up similarly to the bumper sticker that says: Question Authority. In recovery the sticker reads: Question our Assumptions, or Question our Beliefs about Food and Weight (ok, so that second one is a long bumper sticker, but you get the idea).

2008-09-02T19:22:26-07:00

Just a reminder... you know how real estate has the 3 L's?

Location, Location, Location (if I'm remembering correctly- real estate is SO not my area of expertise!).

Recovery, indeed, life, has its own version: the 3 R's.

Quality of Relationship, Quality of Relationship, Quality of Relationship.

OK, maybe I should call them the 3 QR's... who knows, but there you have it.

Pretty simple goal, not always easy to accomplish... always worth pursuing.

And my little reminder includes all types of relationships- with self; with others; with the world; with a higher being or the equivalent, for those of us who are religious and/or spiritually oriented.

2008-09-01T22:35:25-07:00

Usually the idea of power/powerlessness generates strong feelings, many questions and lots of discussion when I broach the subject with clients. So, I'm not surprised there were comments regarding the post. Since both Super Egg and Courtney asked questions related to the "power" post, I'm going to try answer them both here.

Again, these are general thoughts, because the issue of power is, as I've said, enormous, so don't consider this post exhaustive or 100% inclusive of relevant material. Just a beginning...

Yes, people often feel powerless to protect themselves. On a large scale, we see that in many facets of societies. Look at the history of countries who have totalitarian governments; the citizens of these nations often feel wholly unable to protect themselves, as if it is futile and impossible to do so. On a smaller (but no less important) scale, there are, sadly, many families where one or more member/s feels powerless to protect him/herself physical, emotionally, or both. And, we can even look at an individual level- by which I mean one person at a time- and there are ways that each of us can potentially feel unable to protect ourselves. For example, a long time ago I worked with a lovely young woman who had suffered a great deal of cruelty over many decades. She had developed an assortment of behaviors, all dangerous to herself, and she knew they were injurious, but she felt entirely powerless to stop herself from doing them. It took a long time for her to develop the belief that she deserved to get to protect herself from these actions, and then awhile longer to learn ways to actually do the protecting.

And this leads to Courtney's comments. How can we get the protection we need? Well, first of all, I think we have yet another opportunity to practice "scrupulous honesty." Before we can even take action on getting the protection we need, we have to come to grips with what we may have missed, and to grieve that loss. Courtney tells us that in her family she wasn't protected, at least in some of the ways, she needed. She can't move on with her life unless she truly comprehends this truth, accepts it (doesn't mean she has to like it), and then mourn the loss of what she would have wanted and needed. As she is able to do this, she can move on to questions like: what do I need now? can I get it from others or does it need to come from me, or from me and others also? Exactly what types of protection Courtney wants and needs will depend on many factors, having to do with her life, lifestyle, who she is as a person, and the ways she was left unprotected earlier in life.

I can say this for sure, though. What we want is protection that allows us to be involved with the world. All too often I see people who feel as though the only "truly secure" protection is to wall themselves off from others. I can see how doing this appears appealing if you have been terrible hurt; the thought being, "well, I just won't let anyone near me, and then I can't get hurt." Well, I have to say, that this path tends to backfire in a big way. First of all, it isolates you deeply. Second, it isn't very effective at protecting you, even though it seems as if it is. Think of it this way. If we sequester ourselves behind a "wall of steel" we may feel as though no one can get to us. But it's also true that we don't have a lot of good air in there, and it can be dark, and sure is lonely... we also can't see what's outside, and this is really problematic.

We end up being surprised and often blindsided by things that happen- things we would have seen coming if we weren't hiding behind all that steel. But, I'm not advocating having no boundaries- or ones that are made of, say, clouds or vapor, for instance- because they don't offer protection- anyone can get it anytime, anyplace, and there's little we can do. I vote for something semi-permeable- actually, I like the idea of a range of materials (I mean this metaphorically, I hope that's clear; obviously, these boundaries are intangible concepts that we create for ourselves- but I think it helps to have an image to work with. And it's the emotional boundaries I'm talking about here- there are physical boundaries we set for ourselves too and those are more tangible, like how far away from someone we feel comfortable standing, or whom we let come into our home)- like a toolbox full of different types of boundaries that we can use in a variety of situations, depending on what is called for.

Courtney's way of protecting herself sounds as if it is isolative; it may be that she is, in an attempt to be very safe, walling herself off from the world, in effect, restricting herself, so she "eliminates all risk" that she'll be hurt or left defenseless. She wouldn't be alone. It is so tempting to choose this path when we've been badly hurt. This is another place where recovery takes so much courage: we have to challenge ourselves to find ways to be and feel protected that simultaneously allow us to be part of the world.

2008-08-30T21:37:32-07:00

Protection. We all need it, we all want it, and we all deserve it.

But what, exactly does protection mean? And how do we know what kinds of protection we need?

There are a variety of kinds of protection. Beginning with perhaps the most general, in America, and most Western countries, we rely on protection from our legal system- we count on being considered innocent until proven guilty, for instance. We also rely on protection from our governments (in the form of information and regulation) for things like having safe water to drink and knowing what medications are safe to use.

There are other, institutional protections we need and depend upon; for instance, minimum age limits for teenagers to get certain types of jobs, or minimum ages for young athletes to compete (olympic gymnasts, for instance). These types of protection are there to help ensure children are not injured or exploited.

There are logistical or practical protections we need from parents (or others who are in charge of raising us). These include shelter, food, water, clothes, access to education or training...

Then, there are emotional protections we need, as children and throughout our lives. These may be intangible, even hard to spot or define, yet they turn out to be crucial; in their own ways, every bit as important as food, water, clothes, etc.

What kinds of emotional protections do we need? (I mean this to be a starting place for discussion, not an exhaustive list of type of emotional protection, so I may accidently omit something/s- you guys can remind me of things I miss). For starters, we need our caretakers to see, hear and understand us for who we really are. We need them to not make assumptions about what we think, feel or believe. We need them to ask us questions until they truly comprehend what we are saying.

We also need space to develop our emotional selves. We need to have protection from being told what we are "supposed" to feel, want and need. It takes time in our development for us to solidify our psychological and emotional selves. (Remember my 5 year old friend who simple knows what he wants, without having to make an intellectual decision about it? He can do that because he's lucky enough to have been afforded the safe space in which to learn to trust what he thinks and feels. All children deserve this.)

These are only a few examples.

In addition to having others in our lives who can help protect us, we need to protect ourselves. This becomes more and more true as we get more grown up and assume more responsibility for our lives and taking care of ourselves.

I was talking to a client at work this morning. We were discussing her earlier life, in which she had faced difficult trauma. There is a part of herself she feels is a bit stuck at the age where the trauma occurred (not at all an atypical occurrence when someone is traumatized in any way). This part of herself feels very young and inexperienced to her. She generally approaches it with distain, frustration and impatience, which of course gets her nowhere, because it leaves that part of herself feeling exposed, unprotected, unloved and deeply misunderstood (oh yeah, and worthless and undeserving). I was encouraging her to learn to "kindly and gently parent" this aspect of herself. She had not been protected as a child, and she now needs (and gets) to protect that part of herself so it can resume growing up, and learn that the world (and relationships) is an ok place to hang out.

Some people find it hard to imagine they deserve any kind of protection. This is especially true of those of us who have been treated badly, carelessly or harshly. The reality, however, is that everyone needs and deserves protection.

More on how we can get the protections we want and need later.

2008-08-28T23:11:47-07:00

Super Egg, power and powerlessness is an enormous component in eating disorders, and, in my experience, one that must be addressed for recovery to be possible.

The people in my examples of survivor guilt did indeed feel powerless- in fact, it's an emotion deep at the core of survivor guilt. Each one of them felt powerless to have either stopped, prevented or extricated themselves from their situation.

The client whose mother was so fragile felt powerless to help her mother, and almost lost her own life (emotionally, physically and metaphorically) in order to try to save the mother. The client whose sister had died in the accident felt wholly powerless to protect her sister (though to do so was entirely impossible, even for the adults also in the accident, and certainly impossible for a child to accomplish). And the client who felt she "had to be" mentally ill like her parents felt powerless to change and heal her mother and father; in some way, she had "offered" up herself as a "sacrifice"- as if doing so could somehow "make up" for their being ill.

Feeling powerless is an untenable state. We will do almost anything we can to make that feeling go away. this is one of the reasons an eating disorder can be so compelling- it appears able to make horrible feelings like powerlessness go away, or at least become a lot less strong and overwhelming.

There are many ways we can end up feeling powerless, and as many reasons for why it happens. The fact that you ended up feeling as though you were "floating around the room" I believe indicates that this issue is loaded for you- that it carries a significant amount of resonance. It may be helpful to explore this with someone you trust; certainly, if you have a therapist, this is an important thing to bring up with him or her. It's also of course ok to keep asking questions here about the issue of power. I'll try to remember to keep writing about power, since there is a lot to the idea.

2008-08-27T00:09:54-07:00

I've been reading the magazine "Runner's World" for about two decades.

Those of you who have seen it know the magazine focuses for the most part on techniques and tips for running, longer, better, and mostly, faster. Right in the middle of the magazine is a fabulous column called "No need for speed" by John "The Penguin" Bingham.

At first I thought the column seemed out of place amongst all the articles about training for speed and endurance, next to all the advice about how to win races and be a fierce competitor. Over the years, "No Need for Speed" has become one of my favorite articles to read- as soon as the magazine arrives in the mailbox I open right up to it to see what Mr. Bingham has to say that month.

He writes about things like the opportunity for constant improvement over the years, no matter how slow or fast a runner we are; about the joy of smelling the roses as we run; about not getting overly caught up in our times... about the pure elation of putting one foot in front of the other on a trail or road and seeing where it takes us.

He's interested in the process of running and in how running can enhance his life and his health. He makes it clear he's not out to win races.

Now, I'm a fan of sports and of competitive athletics. I'm not at all trying to say we shouldn't compete, or if we're competing that we shouldn't try to win. I don't see a problem with either of those. And, having just finished watching the Olympics, I'm the first one to say how truly awesome those athletes are.

I'm just relieved that Mr. Bingham reminds us to stay balanced. That not everything has to be a race; that we don't always have to be trying to win or get to the top. That there's often more to life that being so narrowly focused.

Perhaps the most fun part of the column is that each time he ends it with the phrase, "Waddle on, friends." How cool is that? I've been trying to come up with a catchy little phrase like that with which to end my posts. I can't come up with anything as descriptive and fitting as Waddle on, friends. Perhaps something will come to me at a future point. Until then, I'll try to remember to enjoy each step and to notice the scenery as I run by.

2008-08-26T23:14:07-07:00

Have you heard the term survivor guilt?

I've found it has relevance to eating disorders and treatment. In a literal way, survivor guilt refers to the type of guilt someone feels because he/she survived something that someone else did not. We often use the term, for example, in the case of a horrible accident, where one person is killed and another experiences profound feelings of guilt that he/she was spared, often accompanied by thoughts or beliefs that he/she is the one who should have died.

With regard to eating disorders, the term is useful literally and also a bit more broadly.

Some examples I've seen in my practice:
- a 23 year old college student who began several different years of college, only to become medically unstable within a month of the beginning of each year and then have to return home. She eventually realized she felt extreme guilt about "surpassing" (in terms of thriving and enjoying life) her mother, who was in an unhealthy marriage and a very unhappy life. She felt guilt that she had the capacity to thrive and to be healthy. Until she could free herself from this kind of "survivor guilt" she was unable to stay healthy at school.
- the 21 year old who could not recover from anorexia after 6 years. Exactly 6 years prior, she and her sister had been in a terrible car accident and the sister had died. This young woman was convinced the accident was her fault and she herself should be dead, not her sister.
- the 33 year old twin who desperately wanted to recover from bulimia and "get on with" her life, but who could not "set myself free" from the disorder because her sister also suffered from the same illness and showed no sign of being able to help herself work toward recovery.
- the 35 year old with anorexia, who clearly was innately very healthy, but also exhibited significant symptoms of the disorder. Upon reflection, she realized she felt obligated to "try to be like my parents," both of whom had significant psychiatric problems. She felt it "disloyal," even "arrogant" to be healthier than they were.

I've encountered many more examples over the years, but these will give you an idea of what I mean. This "survivor guilt" can be subtle- for example, none of the people in these examples had any idea they were suffering from something like it. And even after we began talking about the idea, each of them found it difficult to see it in themselves and even harder to set themselves free from the erroneous feelings of guilt.

You can see that this type of guilt severely impedes recovery. That's why it's so important to identify it where it exists and then to address the reality of the situation.

By the way, the movie "Ordinary People" (from sometime in the 1970s, I believe) is a powerful film that deals with this issue- it also has some terrific acting and is a pretty interesting story in and of itself.

2008-08-25T11:23:25-07:00

Courtney, it appears you are able to see what is in your heart.

You have an interesting way of going about it. And there may be an extra step in there that you'll find you don't always need... but, you do end up getting to the core of the issue. When you pick up the paper you have a gut-level reaction to what you read. That reaction shows what's true in your heart.

I hope you do pay attention to what the reaction is, and to trying to follow that reaction. I was worried when I read your comment, that you were going to say you made yourself stick to whatever outcome came from what the paper said, no matter if you liked it or not. But it sounds like maybe you make revisions based on how you feel once you've seen what the paper says. I hope so, because if you do, it means you are giving yourself true choice, and that's what we want and what is healthy for us.

There are a variety of ways we get tangled up about this issue: some people truly have no idea what they want, some may have an idea what they want but can't allow themselves to acknowledge it for one or more reasons, others know what they want or don't want but have had bad experience with trying to pursue it and so they actively dismiss wanting anything as a way of protecting themselves... there are other versions of this too- and it is important to try to figure out where each of us gets stuck because the way out of being stuck depends on where and in what way/s we are stuck.

Since you have the capacity to know what you want you can work to first understand why you've needed that extra step (of writing down the two choices and then randomly choosing one piece of paper) in the process and work towards eliminating it. If you want to. There's no law that says you have to do so- I'm just thinking it might make the whole process simpler and save you some energy!

Because you have that particular extra step in there (there could be a different kind of extra step, is what I mean- I've seen many of them throughout the years), I'd guess that the ways you get stuck with this "what do I want" issue have something to do with a kind of conflict between knowing what you want/don't want and being afraid you can't have it or shouldn't have it. I could be wrong, of course, but I smelled a bit of that in your comment. It might be worth having a look at. In any case, the really good news is that you do have a capacity for knowing what you want.

And there's nothing "dumb" about what you said. I think most things we do have meaning, and the process you've devised for making decisions was probably developed for some specific reasons- none of which are dumb.