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Disorder

Pigeon, Little Light’s girlfriend, posted this incredible comparison between eating disorders and addiction on Little Light’s blog:

Any anorectic can tell you that, initially, starving creates an amazing high. As someone who’s also abused amphetamines and has a tendency toward hypomania, I can tell you they all feel pretty similar. I felt utterly invincible. I had so much energy, I was hyper-productive, I could go to school and dance and hang out with friends and do all my homework and whatever the hell else I wanted to do, on next to no food or sleep. The sense of power that comes with this is tremendous.

But, pretty quickly, the high starts to wear off. Fatigue and hunger set in, it becomes difficult to focus, difficult to do much of anything. I spent a long time feeling like I couldn’t do anything right, anything good enough, trying to get back the high that I’d had. I had to eat even less to get that euphoric, super human feeling, and even then the feeling was short lived. Like building up a drug tolerance, as an anorectic you have to continually do more– more fasting, more exercise, more rules, more discipline, more whatever.

I’m not Every Anorexic, but I can’t tell you how true this essay read to me. I’m not entirely sure why the addiction paradigm would not be the immediate parallel. Most survivors I’ve talked to have nodded right along with the idea, even if their individual histories have involved different causes and coping strategies. And as Pigeon says, it’s difficult to resolve an eating disorder without using at least some of the same tools to unpack disordered patterns.

The most obvious reason is that it’s probably counterintuitive for people who don’t have a tendency toward eating disorders. Addictive behaviors are supposed to be, you know, appealing in some way. That starvation can be really enjoyable and satisfying on a physical level, that fiercely physically inimical eating patterns can in fact become more pleasurable than eating normally, that there might be more at work than an adherence to deprivation in the face of misery, may be difficult to believe. And eating disorders have–justifiably–become so tied up with the idea of self-torment that any high or hook is inconceivable.

I think the second might have to do with ideology, with the need to reduce the constellation of factors down to one or two for easy analysis. (This is not, mind you, an assertion that strict cultural adherence to a bodily ideal is not a very important factor both in the prevalence of eating disorders and in the way people with eating disorders seek to shape and regulate their bodies.) Perhaps it’s difficult to see the problem as a complex one, a perspective skew that touches many parts of the sufferer’s psyche, because eating disorders are more common among people whose selfhood is denigrated: women, girls, minors. I’m not sure.


50 thoughts on Disorder

  1. i know pretty much nothing about neuroscience, but this is so telling in that someone who is starving themselves and NOT anorexic just feels like shit – exhausted, lethargic, sleeping all the time, worn out because their body isn’t getting fuel. For an anorexic, by contrast, the rush of their addiction must be so strong that it – temporarily – overpowers the body’s normal response to not getting what it needs. What’s sad about this is that it’s not just the normal progression of an addiction demanding further commitment as it progresses – the loss of the rush is compounded by the destruction of the body.

    i am lucky in that I have never suffered from a serious eating disorder, but I do know that when I – usually inadvertantly – skip a meal or eat very little in a day, there is a rush for a bit – I feel so LEAN and unencumbered and powerful. Of course, this wears off the minute I start getting hungry again – but I can see how that effect could be enhanced in the case of addiction

  2. A lot of people associate anorexia solely with psychologically troubled young women. But it also occurs often among cancer patients. They not only lose their appetites, but food becomes repugnant to them.

    That’s what happened to my elderly father. He couldn’t eat and literally starved himself to death (or at least that was the main factor in his death). I saw him with his clothes off shortly before his death, and he looked like a concentration camp victim. It was anguish; we would urge him, day after day, to eat, and he just couldn’t do it.

  3. Oh, I’ve never had an eating disorder, but I know exactly what you’re talking about. I like to fast sometimes (nothing to do with the Lenten season, actually) just to see if I *can* go without food. It’s scared me how powerful it can make you feel.

    And as for the neurological basis, my skool’d knowledge of the biological basis of addiction says that it’s a good hypothesis. Consider the effect many stimulant drugs like cocaine have on appetites (food, sex, sleep). EDs and substance abuse apparently also have some significant co-morbidity.

  4. How true this is. It is absolutely an addiction. Eat less, and there’s a kind of euphoria. Eat, and it makes you feel sluggish and whale-like. Exercise-induced endorphins feed into it, too, of course. If I go for a run when I haven’t eaten all day, I feel more liberated than when I had a proper breakfast and lunch.

  5. It always makes me sad to see how people talk about these things. Eating makes us feel “sluggish” and “whale-like” where as food deprivation makes us feel “liberated” “lean” and “powerful”

    I say this is sad because we’ve taken the very act of nourishing ourselves, something that so many people in the world can’t take for granted because their starvation is not self-imposed, and we’ve turned it into a weakness, a sign that we’re not in control. Anorexia was first being diagnosed as a disease when I was in my teens in the 80s. At least then it really was considered a mental illness and not a healthy lifestyle choice as it is today.

    I’m also sad because a co-worker just gave me a box with 4 chocoate truffles to thank me for my help on a project. I haven’t eaten any sugar in over 2 weeks, but I really want the damn chocolates!

    I’m 36, not 16, why do I still obsess over this bullshit???

  6. I want to jump on the brief mention of going with no sleep, because I’ve had a tendency to pull all-nighters, or near all-nighters, not because I had to but just because I was miserable and I wanted that high you get when your body is so focused on not collapsing that you don’t have any energy left to think about, y’know, your life, or your problems.

    From what I understand (things I’ve read, people I know who have done it), self-injury is a similar sort of addiction, and it’s another one where people are like “but why would you be addicted to hurting yourself?” I agree that I can’t see any other way to frame it; I think anyway most self-destructive behaviors are somewhat parallel to each other, whether they have physical consequences or not, since a lot of times (again, in my limited experience) it seems the person is trying to escape whatever the real problem is, trying to distract themselves. This obviously is nowhere near all-inclusive but I would guess it happens fairly often.

  7. I’m in the middle of taking a graduate course on addictions, and eating disorders are included. So at least within some parts of the mental health establishment, they are considered in the same arena.

  8. Wow. Eye-opening for me. I had never considered the idea that anorexia could induce anything more/other than a mental feeling of control, as opposed to a (near-?) physical sense of exhilaration. But, this physical high sensation meshes very well with the presumably non-chemical high achieved by compulsive gamblers, another indisputable addiction.

    If only some neuroscientist could take this and run with it, for the good. Link the idea or possibility that there are self-achieving, self-creating highs and the power therein with a positive (could we heal ourselves or tap into more of the brain’s potential?), rather than a negative result (addiction and self-harm).

    What if we could subvert addictions and make their awesome powers help us instead of harming us?

  9. I’m in more of a position to have heard from bulimics and bingers than anorexics, but I’ve seen recent studies that bulimia and binging have a definite addictive component, so I’m not surprised to hear that there’s one to anorexia as well, especially since the three disorders like to travel together.

  10. If only some neuroscientist could take this and run with it, for the good.

    I’m willing to bet one or more has but no one outside the scientific community is paying them much interest. Communication of scientific progress through the media is dismal at best.

  11. It always makes me sad to see how people talk about these things. Eating makes us feel “sluggish” and “whale-like” where as food deprivation makes us feel “liberated” “lean” and “powerful”

    I know exactly what you mean–it is depressing to see people looking at fullness as a sign that they are not eating properly.

    However, a point I was making–albeit clumsily–in my post was that this is not only a self-engineered mindfuck. It’s possible to get an endorphin high both from hiking in the sunshine and from climbing on the treadmill for four tedious hours. Some of what is going on, in my lay opinion, is neurological. I think that fasting really can give you a feeling of exhilaration, intermittent with the feelings of, y’know, starvation and exhaustion. I experienced it, and I don’t think it was entirely due to my mindset around eating.

    Anorexia was first being diagnosed as a disease when I was in my teens in the 80s. At least then it really was considered a mental illness and not a healthy lifestyle choice as it is today.

    It’s still considered a disorder. And crash dieting or self-starvation for health has been around for more than twenty years. In fact, the trend AFAIK seems to be towards looking long and hard at the self-hatred and the sometimes subtle and counterintuitive ways it can manifest.

  12. I’ve been both as well. While I agree that there are definite similarities, I think the most important one is that psychology’s interpretation and treatment for both are profoundly off-base. Honestly, if your theories about the nature of the disease haven’t significantly changed in 150 years — and if there’s been no significant improvement in treatment — it’s time to turn to a methodologically rigorous discipline.

    I know may sound like a bit of a smartass, but I’m being serious here. Read psychological accounts of fasting in the 19th century, and then compare them to today: they’re virtually identical. There’s a bit more improvement in additictions, but not much. Today’s psychologists, like their 19th century counterparts, still view addictions as an individual weakness that is best addressed by absolute abstinence.

    Ultimately, I think both diseases are perfectly rational reactions to perverted environments. Live in a society where women are only valued for their physical appearance? Of course you’re going to wind up with hoardes of women with EDs. Live in a society where you’re perpetually subordinated with no hope for the future? It makes sense to self-medicate the stress away.

    Honestly, I only got better once I took a few HSMT classes and realized that EDs and addictions weren’t diseases at all. (To be fair, when I graduated no Historian of Medicine had argued that — which was precisely why it made a great thesis.) I wonder how many others floundering in conventional therapy would feel the same way.

  13. mackenzie–

    Read psychological accounts of fasting in the 19th century, and then compare them to today: they’re virtually identical. There’s a bit more improvement in additictions, but not much. Today’s psychologists, like their 19th century counterparts, still view addictions as an individual weakness that is best addressed by absolute abstinence.

    i think your assessment leaves out a lot.

    first of all, our understanding of addictions has grown by leaps and bounds since AA was founded in the 1930s. although abstinence is considered necessary for true recovery, it is emphasized that this is not about individual/moral weakness. it’s an addiction, over which the individual has no control, plain and simple. you don’t get to choose whether or not you’re an addict (though whether one is born an addict or becomes one because of one’s actions, environment, etc. is still much debated), you are or you aren’t. and if you are, there’s nothing you can do but figure out how to manage that addiction, learn new behaviors, ways of thinking, etc.

    an important language distinction here that can be confusing to people who are not familiar with addiction: continuing on with the model of substance abuse, there is a difference between abusing &/or becoming physically addicted to a substance, and being an addict. it’s a fine line, and more often than not one bleeds into the other. i can’t claim to understand the first group all that well, because i’m just not wired that i way. the key difference, that i’ve been able to identify, lies more in the way a person thinks than anything else. it is difficult to explain clearly to someone who isn’t also an addict, but addicts have a very particular kind of distorted thinking, the bare bones of which have been common to every addict i’ve met to date.

    so when i talk about addiciton, i’m talking about addicts.

    as far as therapy/the therapeutic system, it’s hit or miss. i’ve seen my share of really terrible professionals, and i’ve worked with some who’ve radically changed (not to mention, saved) my life. a lot of progress has been made in the field of eating disorders as well over the past 20-some years. not nearly enough– god knows i have my qualms with the diagnoses and treatment system– but to liken all of “today’s psychologists” to their “19th century counterparts” is grossly inaccurate.

    Ultimately, I think both diseases are perfectly rational reactions to perverted environments. Live in a society where women are only valued for their physical appearance? Of course you’re going to wind up with hoardes of women with EDs.

    that’s a pretty gross simplification of eating disorders. while i agree that our culture’s glorification of thinness & mainstream beauty ideals don’t help, and are a large factor in why those who are looking for that sort of coping skill turn to an eating disorder instead of something else, eating disorders are not about food or weight or appearance. those are symptoms of a much larger, much less tangible problem.

    Live in a society where you’re perpetually subordinated with no hope for the future? It makes sense to self-medicate the stress away.

    i have a question for you here. you say: Ultimately, I think both diseases are perfectly rational reactions to perverted environments. now i’m with you on the perverted environments. but are these really “perfectly rational reactions”? i mean, sure, they make a hell of a lot of sense to me, but i’m an addict. somewhere along the lines, self-medicate was ingrained in my bones as the way to respond to anything hard or painful or difficult. it’s my auto-pilot. but in spite of how prevalent eating disorders and other addictions may be, LOADS of people live in this same world with us, and aren’t addicts, don’t behave self-destructively, don’t pick up methods of self-harm as coping skills. sure, no one’s perfect, everyone’s got something, but most folks don’t have this kind of something.

    which isn’t to say that addicts are weaker than other people, or anything like that, only to say that there is a difference and it’s an important one. recognizing and dealing with that difference is what makes recovery possible, it’s what shifted doctor’s answers from “you just need to learn to drink like a gentleman” and “you just need to eat more” to things that can actually help those struggling.

    it also sounds like you disagree with the need for abstinence and that that’s one of your major qualms with the recommended treatment. may i ask why?

  14. i have a question for you here. you say: Ultimately, I think both diseases are perfectly rational reactions to perverted environments. now i’m with you on the perverted environments. but are these really “perfectly rational reactions”? i mean, sure, they make a hell of a lot of sense to me, but i’m an addict. somewhere along the lines, self-medicate was ingrained in my bones as the way to respond to anything hard or painful or difficult. it’s my auto-pilot. but in spite of how prevalent eating disorders and other addictions may be, LOADS of people live in this same world with us, and aren’t addicts, don’t behave self-destructively, don’t pick up methods of self-harm as coping skills. sure, no one’s perfect, everyone’s got something, but most folks don’t have this kind of something.

    I’m not the person you were asking this question of. I just wanted to comment on what you bring up, which I find so true. It has been so hard for me to admit thoughts and beliefs that are irrational, especially when offered standardized, clinical, socially-sanctioned treatments, therapeutic models, and so on (which I always see as part of the problem, part of the unequal power structures in our society). In the case of anorexia, which is still marked as a female illness, I think accepting help is harder because not only is the disease linked to sexism but so can be the treatment, when it reinforces a shaming loss of power for the person in treatment. Just my thoughts.

  15. Pigeon says:

    it also sounds like you disagree with the need for abstinence and that that’s one of your major qualms with the recommended treatment.

    You betcha. (Usually I don’t bring that one up until the third post in, and people don’t notice. 😉

    If abstinence is essential, then why are European substance abuse programs that emphasize moderation just as effective as AA programs?

    Honestly, I don’t have a robust answer yet. But I do think medical anthropology may be more useful for developing new addiction and ED treatments than conventional psychology.

    our understanding of addictions has grown by leaps and bounds since AA was founded in the 1930s. although abstinence is considered necessary for true recovery, it is emphasized that this is not about individual/moral weakness. it’s an addiction, over which the individual has no control, plain and simple.

    The problem with this argument is that, in our society, lack of control is a primary definition of moral weakness. Yes, the 1930s shift towards secular behaviorism did make psychologists somewhat more sensitive to Puritan thinking in psychology. Unfortunately, psychologists tweaked the form without overhauling the substance.

    an important language distinction here that can be confusing to people who are not familiar with addiction: continuing on with the model of substance abuse, there is a difference between abusing &/or becoming physically addicted to a substance, and being an addict

    I was restricting my comments to what you define as addicts. I agree that extreme physical addiction (i.e., heroin) is somewhat different.

    That said, I think the fact that they so frequently bleed into one another ultimately demonstrates that this tripartite division is incoherent. It seems that physical addiction is a spectrum, where differences are usually more quantative than qualitative. (But it seems like a lot of psychologists are starting to adopt this view.)

    a lot of progress has been made in the field of eating disorders as well over the past 20-some years.

    I’m not so sure. It seems to me that most of the apparent improvements in ED are statistical artifacts ultimately due to lead-time bias and shoddy methodology.

    that’s a pretty gross simplification of eating disorders.

    The simplest explanation that fits the facts is probably the most accurate one.

    those who are looking for that sort of coping skill turn to an eating disorder instead of something else

    But they do turn to other things, both before and during the onset of the disorder.

    god knows i have my qualms with the diagnoses and treatment system– but to liken all of “today’s psychologists” to their “19th century counterparts” is grossly inaccurate.

    If you think it’s grossly inaccurate, read the primary sources. As skeptical as my committee was initially, they wound up agreeing with me.

    those are symptoms of a much larger, much less tangible problem.

    If by “much larger, much less tangible problem” you mean “control” and/or “wish to cling to childhood,” then you can’t argue that there’s been significant change in the psychological community’s perception of EDs over the past 150 years? These two views are mutually exclusive.

    Furthermore, compare Daniel Goleman’s Emotional Intelligence to the stereotypical characterizations of ED patients: there’s a hell of a lot of overlap. Most of the other ED patients I know were overachievers, and simply realized that going getting into Harvard or Hopkins wasn’t good enough if you’re female in this society.

    LOADS of people live in this same world with us, and aren’t addicts, don’t behave self-destructively, don’t pick up methods of self-harm as coping skills. sure, no one’s perfect, everyone’s got something, but most folks don’t have this kind of something.

    You’re looking at society too broadly. Sure, most people in society aren’t addicts and don’t have EDs. But the fact that these disorders are highly correlated with socio-economic status. A majority of people in a community may not be addicts or have EDs, but in some communities there’s a significant plurality.

  16. but are these really “perfectly rational reactions”?

    The stimuli that produces anorexics is a culture that values thin over fat, and in fact goes further than that to actually demonise fat.

    Anorexia is the only sure fire way to lose weight.

    Anorexia is therefore a sane reaction to the stimuli that creates it – the trouble is that reactions are only as rational as the stimuli that produces them; garbage in, garbage out.

    Which means that anorexia being a disorder isn’t really the issue – and it is a disorder, a disgusting one at that – the trouble is that the society that creates it is fucked up to the point were unhealthy and distructive mental disorders are rational responses to it.

  17. Anorexia is the only sure fire way to lose weight? Pardon me?

    I’ve controlled my anorexia for 7 years now and been successful maintaining a healthy weight too. You statement makes me sick. There is hope beyond anorexia and for you to claim that there is no middle ground between obesity and anorexia is not only absurd but also terribly destructive.

    PLEASE try considering the consequenses of your statements before you share them in the future.

  18. Anorexia is the only sure fire way to lose weight.

    Actually, it’s not. There are a lot of anorexics who’ve found that they physically cannot drop below a certain threshold before their body starts putting on weight again as a survival mechanism. It’s a pretty small percentage of anorexics who are able to get down to the 60-80 pound range.

    That’s why the biggest risk of death from anorexia isn’t starvation, but cardiac arrest. You put so much strain on your body that it gives out on you, but you haven’t actually died of starvation.

  19. And eating disorders have–justifiably–become so tied up with the idea of self-torment that any high or hook is inconceivable.

    I think also that our society is addicted to worshipping and at the same time scorning the thin anorexic woman since the image of the denying, suffering woman is so tempting. In a society where the ideal woman gives up everything for everyone else, starvation seems the ultimate sacrifice and expression of self control.

    I know that when I was anorexic as a teenager, this control was a huge factor. I know well that high produced by the lack of eating. The body goes into panic mode and all sensation is heightened in a hormonally driven effort, to find food. The lack of sleep goes with the territory initially as the body goes into overdrive in a hunt for food.

    It has been interesting for me to note that once I left the very anglo upper middle class trappings of my teenage life and entered into the netherworlds of poverty and real deprivation, my eating disorder subsided and in fact took on a whole new dimension. I became a binge eater. Since deprivation became something that often occurred against my own desires or will, I had to find a new pleasure to control with food.

    Binge eating became the new focus. When food was not available in the quantity or quality that I needed, I fantasized about its availability. When that was realized, then consumption became paramount and the feeling of comfort derived from fullness gave its own sort of high. I developed this habit so badly that I got to where I couldn’t sit down at an table without gobbling everything up to the point of pain and wanting — and partaking in purging.

    Thankfully, life circumstances changed that caused me to be able to get that problem nipped in the bud.

    But my point in this ramble is that 1) I agree that ED is like any other addiction, in that the addict engages in the behavior because their is very often an immediate positive reward 2) that our popular perception still cannot allow the concept that anorexia is definable as a pure addiction instead of feeding into the martyr myth and 3) I want to point out through anecdote that ED is NOT just about starving oneself, but that overeating and food addiction are part of the same spectrum and have similar rewards and causes.

  20. Anorexia is the only sure fire way to lose weight.

    But it’s not the only eating disorder. If compulsive binge eaters and anorexics share so many characteristics in common, how can eating disorders be boiled down to overachievement translated through a culture that sees thinness as the ultimate achievement?

  21. The simplest explanation that fits the facts is probably the most accurate one.

    That’s the thing, though: you’re talking to someone who (as I understand it) doesn’t have a history that fits that explanation, on the comments thread to a post composed by someone whose history also doesn’t fit that explanation. And no, I wouldn’t argue that the larger problem was simply control or a desire to return to pre-adolescence.

  22. r. mildred–

    as a number of people have addressed above, my essay is not all about anorexia. it’s about eating disorders, and how– at least in my experience and the experience of other women that i’ve known– they function the same way other addictions do. most of my examples deal with anorexia, because that’s where my first hand experience lies, but i do think the model applies to all eating disorders.

    the point is, this is not about anorexia specifically. it’s not about the media or our society– which we can all agree is plenty fucked up. it’s about the experiences of those who are in the throws of addiction. i know for me, recognizing that i was an addict, & that my eating disorder was an addiction enabled me finally to do something about it. it made a lot of things make a lot more sense.

    but this piece, at least, was not about feminism in the let’s-deconstruct-the-media-and-the-patriarchy’s-oppressive-cultural -programming kind of way. it’s about actually clearing up misinformation and sharing information and the experiences of folks who’ve been there. so then as feminists, we’re informed enough to face this issue in a meaningful way. without demonizing or stigmatizing those who struggle with these disorders.

  23. mackenzie–

    The simplest explanation that fits the facts is probably the most accurate one.

    but that’s the thing. it doesn’t fit. i know a lot of people with eating disorders for whom it’s got very little to do with body image or weight. for whom it was *not* a reaction to society’s pressure to be thin, or whatever. a woman i met just recently is heavily involved in fat positive activism, and identifies as a fat person (in the reclaimed sense of the word). she is not a thin woman and her body image is pretty good, better than that of most women i know. and yet she’s been dealing with anorexia for the better part of a decade.

    it’s about self-medicating, it’s about coping skills, or a lack there of, it’s about control. it’s about a lot of things.

    white upper middle-class women are not the only ones with eating disorders. they are the ones who can afford help.

    If by “much larger, much less tangible problem” you mean “control” and/or “wish to cling to childhood,” then you can’t argue that there’s been significant change in the psychological community’s perception of EDs over the past 150 years? These two views are mutually exclusive.

    i don’t mean control and/or a wish to cling to childhood, at least not necessarily. i’m the first to say there’s a lot of outdated, incomplete pictures and stupid stereotypes out there. the “wish to cling to childhood” is one of the ones i hate the most. it has certainly never resonated with me, nor has it been particularly common amongst the women i’ve met, which have been quite a few now that i’ve got two treatment centers under my belt. as for control, it generally is an issue, but then isn’t the need for control symptomatic of larger things going on in one’s life to begin with?

    i’m not particularly well versed in the psychological community’s “official” literature– academic or otherwise. the bulk of my knowledge comes from my experiences and from working with others. and for all the issues i have with the psychological community as a whole– and i have plenty– there are some amazing individual professionals out there doing good work and i won’t just write them off. when it comes down it it, i’m a lot more interested in working with actual people, i think that’s where the biggest difference is made.

    The problem with this argument is that, in our society, lack of control is a primary definition of moral weakness. Yes, the 1930s shift towards secular behaviorism did make psychologists somewhat more sensitive to Puritan thinking in psychology. Unfortunately, psychologists tweaked the form without overhauling the substance.

    okay, but i wasn’t speaking about society’s view or the medical establishment’s view on addiction. i was talking about alcoholics anonymous, which is where most of our initial and current understanding of addiction & addiction treatment has come from. it doesn’t sound like you’re particularly famliar with the 12-step model or how it works.

    but speaking of abstinence, if we extend this addiction model to eating disorders, as i do, would you ever tell a bulimic “it’s okay to make yourself throw up, just do so in moderation?” or a heroin addict “just try not to shoot up too often, maybe save it for the weekends so it doesn’t interfere with work or school.” of course not. that argument only really holds with substances or behaviors that we consider more socially acceptable– namely, drinking, in some circles, marijauna, “dieting”, etc.

    If abstinence is essential, then why are European substance abuse programs that emphasize moderation just as effective as AA programs?

    i am less familiar with european programs, but i know that american moderation-based programs have not proven as effective as AA. for the most part, they’ve failed. but i think the big book of alcoholics anonymous puts it best:

    If anyone who is showing inability to control his drinking can do the right-about-face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!

    if you can find a way to control your drinking/cocaine abuuse/starving/purging/whatever on your own, more power to you. under my definition and understanding of the word, that would disqualify you from being an addict. but if you can do the right-about-face on your own, then what does it matter? sounds like you’re doing okay anyway.

    in the end, your recovery needs to be whatever works for you. if what you’ve found does, then keep doing it. this essay was about my experience, how i’ve come to understand it and a little bit of what’s worked for me. to each their own.

  24. I don’t have personal experience with anorexia or other eatings disorders, but I do have some with self-injury and I must say, I very much see a connection to addiction in that. It’s an endorphin high for sure which comes with the pain, and I absolutely see how it can happen with eating disorders as well. All these behaviours are rooted in the physical – in the body. If eating sugar can give you a rush that you can become slightly addicted to, then certainly starving and getting a high will do the same.

    As to moderation vs. abstinence – from what I remember from my courses on addictive behavior and relapse prevention, most programs have about the same failure rate, whether it’s AA, or outpatient counseling, or doing it at home by yourself. The real predictor of stopping a behavior is internal motivation.

  25. Mnemosyne Says:
    February 21st, 2007 at 1:26 am

    There are a lot of anorexics who’ve found that they physically cannot drop below a certain threshold before their body starts putting on weight again as a survival mechanism.

    pigeon Says:
    February 21st, 2007 at 4:16 am

    she is not a thin woman and her body image is pretty good, better than that of most women i know. and yet she’s been dealing with anorexia for the better part of a decade.

    This is why I get so upset when people talk about skinny people as anorexics. Sure, some skinny people are anorexic. Some skinny people are not. Some non-skinny people are. You can’t diagnose an eating disorder just by looking.

  26. This is why I get so upset when people talk about skinny people as anorexics. Sure, some skinny people are anorexic. Some skinny people are not. Some non-skinny people are. You can’t diagnose an eating disorder just by looking.

    Nonsense. Clearly, you have an eating disorder, and I don’t.

    I get annoyed because, well, it’s not exactly the point. It is absolutely true that disordered eating is usually physically unhealthy eating, and that the consequences of bingeing, purging, and self-starvation are not negligible. It is possible, however, to create a disordered perspective around many different regimens, even ones that are not physically harmful and which may seem physically beneficial. Most eating disorder survivors have to break the basic compulsive routine and find ways to think past the mindset that supports it. They’re related but different problems, but they’re both vital.

    And that’s why “moderation” is kind of a null set when it comes to ED recovery, I think–except insofar as moderate habits must be developed in order to become physically healthy.

  27. Dunno how you’d work abstinence into the equation, either–abstinence from dieting won’t solve anything, abstinence from food was the problem in the first place, and abstinence from self-conscious eating is unfeasible when self-starvation has become reflexive.

  28. Red:

    Anorexia is the only sure fire way to lose weight? Pardon me?

    Statistically speaking, it is. Conventional dieting always leads to a rebound weight gain. Although most anorexics eventually plateau, and some regain a little weight, statistically it’s nothing like conventional dieting. From a purely statistical standpoint, the only thing that keeps statistically significant amounts of weight off for extended periods of time is anorexia.

    If you’ve been able to maintain a healthy weight under your pre-anorexic weight, then from a statistical standpoint, you’re the exception — not the rule.

    Piny:

    I wouldn’t argue that the larger problem was simply control or a desire to return to pre-adolescence.

    Then you disagree with the bulk of contemporary psychology’s conception of anorexia. I applaud you for that.

    But it’s not the only eating disorder. If compulsive binge eaters and anorexics share so many characteristics in common, how can eating disorders be boiled down to overachievement translated through a culture that sees thinness as the ultimate achievement?

    Because they differ in one key respect: stress endurance.

  29. Pigeon:

    but that’s the thing. it doesn’t fit. i know a lot of people with eating disorders for whom it’s got very little to do with body image or weight. for whom it was *not* a reaction to society’s pressure to be thin, or whatever.

    Are you kidding me? I have never seen this. Not once. Neither has my hospital, which has treated thousands upon thousands of ED patients.

    it’s about self-medicating, it’s about coping skills, or a lack there of, it’s about control. it’s about a lot of things.

    Self-medicating, I agree with. How is it about a lack of coping skills, though?

    as for control, it generally is an issue, but then isn’t the need for control symptomatic of larger things going on in one’s life to begin with?

    Then why are Buddhists underrepresented among ED patients? If the need for control was symptomatic of larger things going on in patients’ lives, then you wouldn’t see that underrepresentation.

    That said, I do think many ED patients see their experience in control terms. Why? Because our therapists train us to. If we want to get released from the hospital, we quickly realize that we have to parrot back the doctor’s statements. After a while, we internalize it. I have noticed, however, that pre-treatment ED patients tend to describe their experiences in terms of “achievement.” If we’re looking at what is really responsible for a psychological disease, the best place to start is with the pre-treatment narratives — not with narratives tained by the doctor’s mold.

    and i have plenty– there are some amazing individual professionals out there doing good work and i won’t just write them off.

    I agree that there are a few amazing individuals — but I don’t think their success has anything to do with their profession. The fact that they are exceptions to the rule suggests that the rule is wrong.

    okay, but i wasn’t speaking about society’s view or the medical establishment’s view on addiction. i was talking about alcoholics anonymous, which is where most of our initial and current understanding of addiction & addiction treatment has come from.

    I was referring to both. The history of the organization demonstrates that there isn’t a significant separation between the medical establishment’s view of addiction and the views espoused by AA.

    it doesn’t sound like you’re particularly famliar with the 12-step model or how it works.

    Wrong again. My mother enrolled in AA when I was a teenager, and I then went on to study it in college and graduate school.

    if we extend this addiction model to eating disorders, as i do, would you ever tell a bulimic “it’s okay to make yourself throw up, just do so in moderation?” or a heroin addict “just try not to shoot up too often, maybe save it for the weekends so it doesn’t interfere with work or school.” of course not. that argument only really holds with substances or behaviors that we consider more socially acceptable– namely, drinking, in some circles, marijauna, “dieting”, etc.

    As you mentioned before, heroin addiction is different from the types of addiction we’re discussing here because of its physical nature.

    That said, I wouldn’t have a problem with telling a bulimic to throw up in moderation. Hell, we all do. The problems with potassium imbalances, enamel and esophageal erosion, etc. stem from repeated and frequent vomiting. Vomiting once every month or so probably isn’t bad for you. Neither is snorting coke once in a blue moon. Social acceptability has nothing to do for it.

    Ask yourself this: how on earth does the abstinence model make sense in anorexia? The entire problem is that they’ve internalized the Puritan ideal.

    i am less familiar with european programs, but i know that american moderation-based programs have not proven as effective as AA.

    Only in the studies cited by AA materials. The preponderance of the evidence suggests that the differences between American and European moderation programs aren’t statistically significantly different.

    In terms of the research that suggests AA’s superiority, the moderation programs differed in one key feature from established European practice: they did not give detailed guidance and support for altering the person’s social environment. To the extent that AA is successful, it is probably more due to the environmental changes than to its Puritanical philosophy.

    if you can find a way to control your drinking/cocaine abuuse/starving/purging/whatever on your own, more power to you. under my definition and understanding of the word, that would disqualify you from being an addict. but if you can do the right-about-face on your own, then what does it matter? sounds

    This statement demonstrates a profound misunderstanding of moderation programs promoted by AA. In moderation programs, no one “does it on their own.” In moderation programs, people do it by changing their environment. More specifically, it’s done by changing their social environment. (Sound familiar?) People are animals, and like any other kind of animal, our responses are primarily dictated by our environment. Change the environment, and you change the responses. I’m sure if I were to start watching t.v. again, I’d go right back to being anorexic.

  30. Then you disagree with the bulk of contemporary psychology’s conception of anorexia. I applaud you for that.

    You baited pigeon–and by extension me–by putting those words in our mouths, remember? Maybe my psychiatrists have all been mavericks, but they don’t seem terribly invested in this conception of the problem either.

    That said, I wouldn’t have a problem with telling a bulimic to throw up in moderation. Hell, we all do. The problems with potassium imbalances, enamel and esophageal erosion, etc. stem from repeated and frequent vomiting. Vomiting once every month or so probably isn’t bad for you. Neither is snorting coke once in a blue moon. Social acceptability has nothing to do for it.

    A cleansing purge cycle every third Wednesday? Sure, just make sure you brush your teeth afterwards!

    Bulimics don’t just throw up. When a bulimic is throwing up, they’re doing so for radically different reasons than, say, your average flu sufferer or Mardi Gras celebrant. Were I to purge at all, it would be a sign that I had lost a great deal of–for want of a better word–sanity. When I was throwing up regularly, it meant that I had no healthy or effective way to deal with problems. Now that I have built all that around me, I do not need to throw up. It’s not really an enjoyable thing outside of the context of the disorder, not something one can do recreationally. It’s not a moderate behavior because it will never arise from a moderated perspective.

    Ask yourself this: how on earth does the abstinence model make sense in anorexia? The entire problem is that they’ve internalized the Puritan ideal.

    Our problem is not reducible to internalizing a Puritan ideal; neither is refraining from behaviors like purging comparable to simple abstinence.

    This statement demonstrates a profound misunderstanding of moderation programs promoted by AA. In moderation programs, no one “does it on their own.” In moderation programs, people do it by changing their environment. More specifically, it’s done by changing their social environment. (Sound familiar?) People are animals, and like any other kind of animal, our responses are primarily dictated by our environment. Change the environment, and you change the responses. I’m sure if I were to start watching t.v. again, I’d go right back to being anorexic.

    So are you currently moderately anorexic?

    Changing routines is a pretty obvious way to change behavior. I had whole half-days that emptied out once I wasn’t devoting them to hurting myself. There was also a host of behaviors that weren’t appealing once I decided that I probably should try to make myself happy. All of this did have a palliative effect on the compulsion, but it did not get rid of it altogether. Moreover, I don’t think I’d consider myself healthy if I were still capable of reacting to misery by sliding right back into disordered behavior.

  31. Are you kidding me? I have never seen this. Not once. Neither has my hospital, which has treated thousands upon thousands of ED patients.

    well i have. it’s not the particularly common, but i known enough women for whom that was the case to know that a) it happens, and b) they absolutley had eating disorders, some of them quite severe. frankly, at this point in my recovery, my struggles with food generally nothing to do with my body image.

    which leads to coping skills.

    my anorexia has a tendency to kick in when my PTSD flares up. why? because that’s how i dealt with the initial trauma. and why that, then? because not eating was a distraction, it numbed out my emotions, it gave me a set of parameters within which to organize my world. so these days when my PTSD starts to get more intrusive, it is reflexive for me to stop eating. not because my body image has worsened or because i want to lose weight. at this point it is an ingrained response to stress of any kind. i won’t pretend that i don’t have residual body image issues, but my ed struggles today are most often not a reaction to that.

    i look at addictions in general as maladaptive coping skills. they were things i learned to use at a very early age. so instead of learning other ways to deal with difficult emotions, situations, discomfort, stress– instead of learning non-selfdestructive coping skills– i had anorexia and i had drugs.

    The history of the organization demonstrates that there isn’t a significant separation between the medical establishment’s view of addiction and the views espoused by AA

    this isn’t particuarly accurate. the medical estbalishment at the time thought chronic alcoholics were a hopeless case, destined to perpetual relapse and an early death. the founders of AA thought they’d found a solution, and once it had proven to work for a number of people, the medical establishment started to pay attention to the sudden turn-around in a number of late stage alcoholics.

    it doesn’t sound like you’re particularly famliar with the 12-step model or how it works.

    i stand by this.

    That said, I wouldn’t have a problem with telling a bulimic to throw up in moderation. Hell, we all do. The problems with potassium imbalances, enamel and esophageal erosion, etc. stem from repeated and frequent vomiting. Vomiting once every month or so probably isn’t bad for you. Neither is snorting coke once in a blue moon. Social acceptability has nothing to do for it.

    and this is where we fundamentally disagree. i don’t even really know how to respond to this, except to say, if that’s what works for you, you’re not the kind of addict i am. or like any of the many many other addicts i know.

    you’re not a doctor of some kind are you? because the idea of you telling bulimic patients it’s okay to self-induce vomit on occasion or a drug addict that they can snort cocaine once every other month is terrifying.

    This statement demonstrates a profound misunderstanding of moderation programs promoted by AA. In moderation programs, no one “does it on their own.” In moderation programs, people do it by changing their environment.

    by “does it on their own” i meant without a 12-step program or conventional therapy, the two things you’ve been disparaging. and what i said was genuine– if you’ve found something that works for you, by all means, keep doing it. but there’s no need to bash what is working for a lot of other people.

  32. well i have. it’s not the particularly common, but i known enough women for whom that was the case to know that a) it happens, and b) they absolutley had eating disorders, some of them quite severe. frankly, at this point in my recovery, my struggles with food generally nothing to do with my body image.

    Plus, given the way we’re taught to think about eating disorders–a reaction to society’s pressure to be thin–these women might be much less likely to seek help and much less likely to set off alarm bells amongst their near and dear. How could a fat activist be anorexic?

  33. Moderation programs for substance addiction require a lot of rules to keep the use at a “moderation” level.

  34. piny:

    You baited pigeon–and by extension me–by putting those words in our mouths, remember?

    Nope. I’m saying that the current psychological community is eerily similar to 19th century physicians; Pigeon argues that there’s been a significant improvement. In Pigeon’s own words: “to liken all of “today’s psychologists” to their “19th century counterparts” is grossly inaccurate.” However, if there has been a significant improvement, then why do the vast majority of psychologists — and why do most psychological training programs — still reinforce the 19th century views that EDs are about control and a wish to return to childhood?

    my psychiatrists have all been mavericks, but they don’t seem terribly invested in this conception of the problem either.

    Psychiatrists =/= Psychologists. Psychiatry is a medical discipline; psychology is a liberal arts/social science one. Psychiatry didn’t exist as a medical specialty in the 19th century when American medicine was professionalized into its modern form. However, psychology professionalized by forming their own Ph.D. departments.What’s confusing is the nomenclature: psychology and psychiatry were used synonymously in the 19th century, but they’re not used identically today. (For a more extensive account, see Rosemary Stevens, American Medicine in the Public Interest: A History of Specialization.)

    Because the two go through a significantly different professionalization structure, which tends to give its graduates profoundly different views of disease and personhood. Because they’re ultimately MDs, they tend to have a much more biological view of EDs. That said, even though they tend to eschew psychology’s views about clinging to childhood, they ultimately tend to conform to a more moderate version of control. (e.g., control, using medications to alleviate the anxiety associated with feeling out of control, etc.)

    Zuzu:

    Moderation programs for substance addiction require a lot of rules to keep the use at a “moderation” level.

    And AA doesn’t?

    Moderation programs for substance addiction require different sets of rules for different people. However, because habits are easier to follow when given simpler guidelines, participants are encouraged to streamline their plans. That’s doesn’t appear to be quite what you mean by “a lot of rules.”

  35. as far as a language goes, moderation and abstinence are commonly used but somewhat problematic vocabulary when it comes to addictions.

    with anorexia (& really all eds) it’s “abstinence” from eating disordered behavior and moderation with food itself.

    for substance abuse, it’s abstinence from the actual substances, and learning to apply moderation to one’s behavior and thinking in general.

    the overall idea, though, for all of the above, is to remove the addictive behaviors–the specifics of which will vary somewhat depending on the individual’s addiction– and to help that individual address the distorted thinking & underlying issues that propell/create a need for the addiction in the first place.

    i don’t really want to do the AA vs. moderation program argument anymore. my experience is that 12-step programs work for those who are willing to do the work (i think it’s safe to say that no program will work for someone who isn’t willing). i have yet to see a moderation program work. that’s my experience. if your experience is different, great.

  36. mackenzie–

    AA actually doesn’t have any rules. they have suggestions. the program is based on the experience of a handful of alcoholics who, in sharing their experiences, were able to help a handful of other alcoholics. the program grew organically. they outline the steps that they took that helped them. everyone works their program a little differently. as an agnostic young queer feminist with a handful of addictions, my program certainly looks much different than my conservative bible-thumping good ol’ boy uncle’s program. he’s been sober 28 years. his recovery doesn’t look like mine– nor would i want it to. it doesn’t have to.

    my experience is that an addict cannot moderately participate in their addiction. i can’t use everyone now and then no more than i can’t fast or purge every now and then. so if someone comes to me asking for help, that is the experience i have to share with them. no one is telling anyone else what is or is not true for them. you share your experience and if it resonates with someone else, they can do with it what they will.

  37. Because the two go through a significantly different professionalization structure, which tends to give its graduates profoundly different views of disease and personhood. Because they’re ultimately MDs, they tend to have a much more biological view of EDs. That said, even though they tend to eschew psychology’s views about clinging to childhood, they ultimately tend to conform to a more moderate version of control. (e.g., control, using medications to alleviate the anxiety associated with feeling out of control, etc.)

    That was my editing error. I am aware that psychiatrist and psychologist are not the same thing. Let me rephrase: every professional who has treated me, which group has included both psychiatrists and psychologists, has never referenced either a wish to return to childhood or a need for control. Which only stands to reason, given that I’ve been happily treated by the people you disparage and yet strongly disagree with that theory.

    the overall idea, though, for all of the above, is to remove the addictive behaviors–the specifics of which will vary somewhat depending on the individual’s addiction– and to help that individual address the distorted thinking & underlying issues that propell/create a need for the addiction in the first place.

    Exactly. And–again, just IME–you eventually want to get to a place where you aren’t one Law & Order marathon away from relapse. Abstinence is one behavioral approach, but I’ve also never encountered any care provider who believed that abstinence was the only thing necessary to make someone well.

  38. When I was throwing up regularly, it meant that I had no healthy or effective way to deal with problems. Now that I have built all that around me, I do not need to throw up. It’s not really an enjoyable thing outside of the context of the disorder, not something one can do recreationally. It’s not a moderate behavior because it will never arise from a moderated perspective.

    Then why does it exist in other cultures as a moderate perspective?

    So are you currently moderately anorexic?

    Yup.

    Pigeon:

    hey were things i learned to use at a very early age. so instead of learning other ways to deal with difficult emotions, situations, discomfort, stress– instead of learning non-selfdestructive coping skills– i had anorexia and i had drugs.

    That sucks. But this explanation doesn’t account for ED patients’ EQ results.

    this isn’t particuarly accurate

    The short version of my primer reading list:

    Rosemary Stevens, American Medicine and the Public Interest.
    Everything ever written by Charles Rosenberg. (Except for maybe the Cholera Years. It’s a fun read, but not directly related to the topic at hand.)
    Sarah W. Tracey, Alcoholism in America: From Reconstruction to Prohibition.

    you’re not a doctor of some kind are you? because the idea of you telling bulimic patients it’s okay to self-induce vomit on occasion or a drug addict that they can snort cocaine once every other month is terrifying.

    Is there an argument in here, or is this just a veiled personal attack?

    FYI: I’m a graduate student in a joint degree program. As I noted earlier, I have studied this topic in great detail and my master’s thesis on it is currently winding its way through peer review.

    but there’s no need to bash what is working for a lot of other people.

    First of all, the atrocious success rate of conventional treatment suggests that the current model isn’t helping the vast majority of people. If significant improvement hasn’t occured in 150+ years, it’s a bad idea to keep funding it.

    Secondly, yes, there is. Why? Because the conventional model is set up in such a way that it is “the” answer. Contemporary psychology doesn’t allow for multiple worldviews on psychological topics. If someone appears to be an “exception to the rule” — which seems to be how you perceive me — our views are reframed as an attack and we’re told to shut the hell up because “there’s no need to bash what is working for a lot of other people.”

  39. Piny:

    I am aware that psychiatrist and psychologist are not the same thing. Let me rephrase: every professional who has treated me, which group has included both psychiatrists and psychologists, has never referenced either a wish to return to childhood or a need for control.

    In therapy sessions, these ideas come out in far more subtle, indirect ways. If you’re not familiar with the specific disease constructions beforehand, you’ll probably miss them. (Hell, I did.)

    Pigeon:

    the overall idea, though, for all of the above, is to remove the addictive behaviors–the specifics of which will vary somewhat depending on the individual’s addiction– and to help that individual address the distorted thinking & underlying issues that propell/create a need for the addiction in the first place.

    I know. The entire point of my posts is to question this unquestioned assertion.

    AA actually doesn’t have any rules. they have suggestions.

    Think about this for a second. What happens if someone feels that the fourth step “suggestion” doesn’t apply to them? What’s the social consequence within the group? What happens for people ordered to AA for DUIs if they say that they don’t feel like following one or more suggestion?

    my experience is that 12-step programs work for those who are willing to do the work (i think it’s safe to say that no program will work for someone who isn’t willing).

    Isn’t this just blaming the victim?

  40. I’ve also never encountered any care provider who believed that abstinence was the only thing necessary to make someone well.

    ditto.

    most days i’d much rather deal with a “wet” drunk than a dry one. people who are simply abstaining from their addictive behaviors but have yet to implement any real changes are not fun to be around. you don’t get better just because you cut out x-behavior. i’ve yet to meet a care provider or a person in recovery who’d suggest as much.

  41. my experience is that an addict cannot moderately participate in their addiction. i can’t use everyone now and then no more than i can’t fast or purge every now and then. so if someone comes to me asking for help, that is the experience i have to share with them. no one is telling anyone else what is or is not true for them. you share your experience and if it resonates with someone else, they can do with it what they will.

    (shrug)

    I know people, myself included, who have gone through periods where their disordered behaviors were less frequent or less extreme. Sometimes that has to do with the amount of stress they’re under, and sometimes it has to do with changes in their surroundings or routine. I have no idea whether or not I could sustain a moderate level of disordered behavior indefinitely. It might be possible, but that’s…irrelevant. Frequency was sometimes a measure of how stressed out I was; it was not a measure of how unwell I was.

    If there are people who can only make it as far as starving themselves sometimes, then I respect their needs. And if there are people who somehow manage to exhibit some of the same disordered behavior without the disordered mindset, good for them. But that’s not how it works for me, or for anyone I’ve ever encountered.

  42. In therapy sessions, these ideas come out in far more subtle, indirect ways. If you’re not familiar with the specific disease constructions beforehand, you’ll probably miss them. (Hell, I did.)

    So subtle that I’d miss it entirely, but not subtle enough that I’d internalize it even slightly?

  43. my experience is that 12-step programs work for those who are willing to do the work (i think it’s safe to say that no program will work for someone who isn’t willing).

    how is that blaming the victim? i did not say 12-step programs are the only thing that work & those who didn’t find success in them weren’t willing to do the work. i said that that has been my experience within them.

    are you really going to argue that people who aren’t ready or willing to deal with their addictions miraculously fall into recovery? they become willing, or they don’t.

    Think about this for a second. What happens if someone feels that the fourth step “suggestion” doesn’t apply to them? What’s the social consequence within the group? What happens for people ordered to AA for DUIs if they say that they don’t feel like following one or more suggestion?

    if you’re going to AA because of a court mandate, you don’t *have* to do anything but show up. and the rules you’re being subject to are not set down by AA, they’re the court’s.

    and i know lots of people in AA who decided they didn’t need to do all the steps. do i agree with their decisions? no, not really. in my experience that doesn’t equate becoming an outcast within the group. do people judge? of course. AA is full of people, no one is perfect. we’re human. but AA is there for the alcoholic who still suffers, sober or drunk, and you stay sober by giving back to others. AA makes the suggestions it does because those suggestions have been incredibly successful in the lives of millions. that still doesn’t make them rules.

    I know. The entire point of my posts is to question this unquestioned assertion

    you and i fundamentally disagree about the nature of addiction. that doesn’t make my assertion “unquestioned” or mean that i’m parroting back what doctor’s have told me.

    as i said above more than once, this is my experience. you’re entitled to yours. i’m done arguing with you. to each their own.

  44. Then why does it exist in other cultures as a moderate perspective?

    What part of the eating disorder constitutes this moderate perspective in other cultures?

    Yup.

    Okay, so do you starve yourself sometimes? Are you able to keep from abstaining from food only so long as you abstain from television? What parts of the disorder do you refrain from, and what parts are you allowed to keep?

  45. white upper middle-class women are not the only ones with eating disorders. they are the ones who can afford help.

    I think this is the part that Mackenzie is missing. S/he’s seeing a very select group: people who can afford hospital treatment. That means that the people she sees are probably white (possibly Asian) and at least middle-class, probably upper-middle-class if they can take time out of their lives for hospitalization.

    Now that they’ve found that binging (without purging) is the most common eating disorder, don’t be surprised if an ED diagnosis suddenly becomes very declasse, so to speak.

    Conventional dieting always leads to a rebound weight gain.

    If by “conventional dieting” you mean people who do Atkins or South Beach Diet for a few weeks or months and then go back to their old habits, you’re pretty much right. But if you’re trying to say that any weight loss inevitably leads to a re-gain (as I’ve seen some people say in other threads), you should spend some time with this web site.

  46. piny:

    So subtle that I’d miss it entirely, but not subtle enough that I’d internalize it even slightly?

    You can internalize a subtle new view while missing it entirely at a conscious level. It’s not mutually exclusive.

    Look, if you changed your view about your disease during therapy, chances are it happened.

    What part of the eating disorder constitutes this moderate perspective in other cultures?

    Binging, purging, fasting, food rituals, social meanings for body size, etc. Pretty much everything cited in EDs.

    pigeon:

    i’ve yet to meet a care provider or a person in recovery who’d suggest as much.

    You’re conflating subsidary objectives with ultiamte objectives. I’m talking about the latter; you’re talking about the former.

    if you’re going to AA because of a court mandate, you don’t *have* to do anything but show up. and the rules you’re being subject to are not set down by AA, they’re the court’s.

    Wrong again. Courts frequently demand updates which must be confirmed by AA members. It’s why the step about surrendering power to God is problematic.

    how is that blaming the victim? i did not say 12-step programs are the only thing that work & those who didn’t find success in them weren’t willing to do the work. i said that that has been my experience within them.

    That’s the clear implication of your assertion: “my experience is that 12-step programs work for those who are willing to do the work.” If people are willing to do the work, then the programs work. Therefore, if the programs don’t work, it’s the fault of the individual. To the extent that this has been “your experience,” then you are blaming the victim.

    are you really going to argue that people who aren’t ready or willing to deal with their addictions miraculously fall into recovery? they become willing, or they don’t.

    Absolutely: I have considerable experience with the American legal system, particularly as it is related to health care issues.

    and i know lots of people in AA who decided they didn’t need to do all the steps. do i agree with their decisions? no, not really.

    Then this contradicts your assertion that 12 step programs aren’t the only things that work.

    in my experience that doesn’t equate becoming an outcast within the group.

    Of course this hasn’t been your experience — you’re not the one questioning the party line.

    I suggest you record the sessions and parse their reactions: body language and linguistic analysis supports this assertion. More importantly, so far I’ve yet to meet anyone who disagreed with the party line who didn’t feel ostracized.

    that doesn’t make my assertion “unquestioned” or mean that i’m parroting back what doctor’s have told me.

    Questioning my arguments =/= Questioning psychology’s assertions.

    Despite the fact that you claim this, I don’t see an iota of evidence in your substantive arguments that this is actually occurring.

    Mnemsomne:

    S/he’s seeing a very select group: people who can afford hospital treatment.

    Only because that’s the scope of the argument — we’re talking about psychological treatment. I’ve argued in the past (in academic forums, not here) that a major problem with the disease construction of both addictions and EDs has to do with how a tiny slice of patients are treated.

    But if you’re trying to say that any weight loss inevitably leads to a re-gain (as I’ve seen some people say in other threads)

    I have an epidemiology background, so I tend to not use the word “inevitable.” But statistically speaking, this is true.

    If by “conventional dieting” you mean people who do Atkins or South Beach Diet for a few weeks or months and then go back to their old habits, you’re pretty much right.

    Nope — I’m also including people who make committed “lifestyle changes.” I think the social demonization of fat has radically altered how researchers study fatness.

    But that’s a different subject for a different thread.

  47. Nope — I’m also including people who make committed “lifestyle changes.” I think the social demonization of fat has radically altered how researchers study fatness.

    Well, then, I’m glad to know that my husband and I are complete and utter freaks who have not only lost weight but — shocker! — kept it off for at least three years. (My husband has kept his off for over 10 years.)

    I actually know a lot of people who have lost weight and kept it off, but I guess they’re all freaks, because “everyone knows” that statistic from 20 years ago that says that it’s impossible to keep weight off.

  48. Annaham,
    I sure hope you’re right but I suspect you aren’t. There are far too many people who have never been the one stuggling but still think that they have all the answers.

    Mackenzie,

    I’m still willing to contest the statement that anorexia is the only sure fire way to lose weight.
    It isn’t a sure fire way to lose weight. The reality is that there are anorexics out there who are “heavy” and aren’t losing weight dispite their anorexia.
    You also claim that conventional dieting ALWAYS leads to rebound weight gain. That’s complete and utter BS. I’ll be the first one to raise my hand and attest to the fact that I’m eating and behaving in an intelligent manner and have for years now maintained a body weight below my pre-anorexic weight. I’m quite certain there are plenty of other wierdos like me who can blow your theories to bit if you would stop inundating us with your opinions long enough to witness our realities.

    I would love to understand why it is you think you know more about anorexia than anorexics do.
    Your black and white style of thought and preaching are over-simplified, destructive and completely wrong.

  49. I remember the high feeling too. Not at first, for me it took a while to set in. After a few months, when I couldn’t even feel hunger anymore, when I didn’t feel much of anything (which I guess was the point), I was floating through life. After being diagnosed, facing the fact that my life could actually end, boy that harshed my buzz. I had to gain weight, feel like a solid, living being again, and everything hurt again. After ten years I’m grateful for the people who helped save me, for helping me become one of the survivors who never wants to float by again. I always want to stomp my way through life, I want to feel it all.

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