On ‘Bad Media’ and Bingeing

[Content note: eating disorders]

I still think about this article on writing about eating disorders:

Ginia Bellafante put it well a few years ago, in a book review for the New York Times:“Anorexia is a disease of contradiction: it demands both discipline and indulgence …. The anorexic disappears in order to be seen; she labors to self-improve as she self-annihilates.” Bellafante describes the condition as “an intellectualized hallucination.” That concise definition is better than any I’ve read, and it points to the conflicted way in which we talk about the disease: our intention is critical, but our language is celebratory.

I don’t have a good answer to the main premise–that we are too easily awed and worshipful of deprivation, even when we try to talk about the horrors. I’m wary of overusing the word ‘fetishize’, but it does seem to fit, drawing closer and closer as we write about the horror. Moths and flames, you know.

And I don’t want to object to writing more articles about eating disorders–but there’s a definitive trend in what aspects of eating disorders we talk about. Mainly, we talk about the ones we can link to Big Societal Problems–supermodels and photoshop are making us all want to be unrealistically thin! Young girls are feeling pressure earlier and earlier to diet! And this seems to result in prioritizing a certain kind of story.

Nearly every article about eating disorders ever will describe in painful, clear detail how someone (usually a girl) deprives themselves. 
How they think about it, the tricks they use, how good it feels. 
And nobody ever manages to write about bingeing, though most people who deprive binge as well, and most people with an ED end up wandering through diagnoses. Several targeted google searches for eating disorder articles, and I couldn’t find a intimate interview. No first-person stories that centered around bingeing–the purging afterwards, sure, the bouncing-back into depriving, sure, but not the gripping, hollow, band-around-your-chest feeling of bingeing. 

It’s nice that you want to write those articles about eating disorders, and I’m all in favor. But please, let’s not talk about how bad it is that Other, Bad Media glorifies disordered behavior when all you’ll write about is the stuff that makes you skinnier.

Illusory Bodies, or What If We Totally Confused Your Sense of Owning Your Body?

The short version of our research is that some scientists got together and had this conversation:

“Hey, hey, you know that iconic study where researchers made people think a rubber hand belonged to them?!”
“Yeah! and how it’s been used in research about racism, pain, empathy, and like, basically everything?”
 “WAIT. WAIT. What if we did that. But with someone’s WHOLE BODY?”
“Oh, that’s been done before too.”
“No, no, no, what if we did it with a different SIZED body?”

…and then some scientists turned that into a serious sounding grant application and now here we are, making people believe they inhabit slimmer and larger bodies.

But why? I mean, besides the sheer fun of it, of course. Because eating disorders. One of the common clinical assumptions about eating disorders, especially anorexia nervosa, has been that a component of not-eating comes from inaccurately perceiving body size. Specifically, people with anorexia think they’re larger than they are1. An interesting demonstration of this phenomenon involves making people with anorexia walk between progressive narrower spaces, and then making non-anorexic controls do the same. From the study [AN = anorexia nervosa participants, HC = healthy controls]:

AN patients started rotating for openings 40% wider than their own shoulders, while HC started rotating for apertures only 25% wider than their shoulders. The results imply abnormalities in AN even at the level of the unconscious, action oriented body schema. Body representation disturbances in AN are thus more pervasive than previously assumed: They do not only affect (conscious) cognition and perception, but (unconscious) actions as well.  (Here’s an interesting followup investigating this behavior in perspective-taking)

Anyways, the question was, it seems like perception of your body size being inaccurate would result in an eating disorder symptoms…except that thus far, we’d not determined a causal connection. BUT, what if we could make people perceive their body incorrectly?  If we could make them think their body was larger or smaller than they thought, would we see a measurable increase or decrease in eating disorder pathology? Okay, but how do we do this?

Creepy headless mannequins.

Obviously.

The illusion takes inspiration from the rubber hand studies. Picture this: you hide the participants arm from their field of view–put it in a box or somesuch. Then, in full view, you put a rubber hand. Tickle the hand with a feather, while simultaneously tickling the participant’s hand. Repeat, with a variety of sensations: tapping, tickling, rubbing. Then threaten the rubber hand: jab it with a pin2, make as though you’re about to stab it with a knife. The participant will react as if you’d just jabbed them with a pin, often experiencing pain in the location of the pin in the rubber hand, or sharply increasing heart rate and comical flinching when menaced with a knife.

Our proprioception–the sense of knowing where your body is in space–is frighteningly malleable. If it appears that that detatched hand on the table in front of you is yours, and if you feel sensation when you see the hand touched, well, then of course that thing in front of you is your hand.

Further, after a bunch of duplications and manipulations of the rubber [bodypart] illusion, we also know that post-experiment, people have weird beliefs about their actual body, thinking features are longer or larger. So, if we trick you into believing the rubber hand with the long fingers is yours, then stop the experiment, when you look down at your actual hands, you might perceive the fingers to be longer. Now, let’s do it with a whole body.

So of course, the first thing you have to do is pull the head off the mannequin and replace it with a camera, angled downwards so the mannequin is facing downwards, and looking at the shape of its body. That camera feed is then linked to a set of goggles, which the participant wears. One RA, who will probably avoid clearly describing her job on her resume, stands between the mannequin and the participant, and touches both simultaneously.

Participant feels: contact of RA touching him.
Participant sees: view from mannequin perspective, with a small or large body, but also sees a hand touching the mannequin.

Do this for enough trials, and the participant’s brain will synchronize the incoming information and, rather than keep trying to remember that the mannequin is a mannequin, decide that all the incoming sensory information lines up, and the view through the goggles is the view when looking down.

Then the RA threatens the participant with a knife3.

bodiesbodiesbodies

 

 

 

 

Well, not quite. The RA pretends to slash the mannequin with the knife, which is captured by the camera and relayed to the participant. Skin conductance, a known measure of fear, is taken, and we can get a fairly good guess about whether the participant thought we had made them sign a consent form and then stabbed them. (This is the scientific equivalent of “Made ya look, didn’t I? Didn’t I?)

This process is repeated with the slimmer mannequin and the larger mannequin for each participant. Between each illusion, they’re run through a battery of tests measuring body satisfaction and measures of eating disorder psychopathology. Two results stand out.

1. Firstly, in the larger body condition (LB), the participants didn’t seem to have much of an emotional reaction. Body satisfaction didd’t change significantly, nor did participants misperceive their actual body to be larger. The mannequin was 115% of the size of the participants (who all clustered around the same BMI). Increasing your size 15% is significant, but unlike in the smaller body (SB) condition, participants seemed non-reactive.

A few theories here. It might be that the participants just entered with inaccurate perceptions about their bodies, believing them to be larger than they are. So, when presented with a larger body, in front of them, they just didn’t notice much change. Also interestingly, it seems as though size-change illusions aren’t asymmetric. Participants in other research more readily believed that they possessed doll-sized legs than giant legs.

The third part of this isn’t directly related to the results, but the researchers noted that the LB condition still had a flat stomach and muscle definition, so it may be that the participants still viewed themselves as having a socially desirable body. I’d want a replication with a flabbier dummy.

2. ‘Owning’ a smaller body did have an impact on body satisfaction. Predictably, it increased. However, I want to point out that all of these participants had normal-BMIs, and the slim mannequins were approximate 85% the size of the participants. Or, to put it another way, the bodies were at the size considered the cutoff for anorexia.

Secondly, after the SB condition had ended, and participants were away from the mannequin, they believed their actual body to be smaller, and gave smaller estimated hip-size numbers than prior to the condition. This, as noted in 1, didn’t occur with the large body.

—

I admit, I completely expected the LB condition to have the larges effect, emotionally and in terms of ED psychopathology. Even funhouse mirrors can startle and upset me, and I assumed that believing you owned a larger body would cause the same. Importantly, these were non-clinical participants–without an eating disorder diagnosis. It may be possible that they simply had more immunity to such an experience, or that their interactions with proprioception are fundamentally different.

Either way, I think we can agree that creepy mannequin studies are creepy.

Full paper located here. [I didn’t distinguish strongly between Experiment 1 & 2, as found in the paper, and didn’t cover all of the scales and correlations]

1Caveat: historically, anorexia has included an upper bound of weight in the definition, meaning that not-eating-while-overweight wasn’t called anorexia. This radically impacts who is studied and while it leaves me frustrated at research, I can’t conjure up better methodology retroactively. So, this statement reads better as “people in a specific definition of anorexia who would probably be described as slim already think they’re larger than they are”

2This is a stickup!
…I’m so sorry. 

3“And what were your duties while working at the Body and Self Laboratory?” “Well, I beheaded mannequins and threatened people with knives.” “You’re hired!”

Losing at Brain Games

[TW: ED]
Small post today, because I’m feeling contemplative.

I had something confirmed for me last week–that I have an unusual presentation and persistence of eating disorder/disordered eating* symptoms, given all the treatment, work, time I throw at it. In short, standard and adapted-for-me coping mechanisms and approaches for my anorexia tendencies (henceforth anorexia!brain) trigger my bulimic/bingeing tendencies…and coping mechanisms for bulimia!brain trigger my anorexic tendencies. Having both aspects isn’t terribly unusual, but that I split the difference so equally means that I never have an obvious choice about which eating habits to encourage. On days or weeks when I managed to eat properly, I’m balancing on a tightrope of tolerating the anorexia!brain and the bulimia!brain.

Which made this quote from Allie Brosh especially poignant:

For me, motivation is this horrible, scary game where I try to make myself do something while I actively avoid doing it. If I win, I have to do something I don’t want to do. If I lose, I’m one step closer to ruining my entire life. And I never know if I’m going to win or lose until the last second.

Replace ‘motivation’ with ‘eating’ and you have a summary of my mental calculus in sixty-two words.

Take this: It’s 3pm. I’m hungry.

Do I:

Eat an apple? After all, responding to hunger is important, and eating snacks is a skill I need to teach anorexia!brain.
On the other hand, this may lead to:
-I ate food at an unreasonable hour! All is lost! I’m uncomfortable and upset about this and now I want to binge.
-I ate food as a snack, and now maybe I can/should skip dinner.

So should I skip the apple? After all, dinner is more calories, and if eating the apple might trigger a binge or mean I don’t eat dinner, perhaps I should go for a solid option of a meal in a few hours?
On the other hand:
-I almost never feel hunger, and I need to learn to respond to it. Not to mention needing to get used to snacking. Teaching myself to ignore hunger didn’t exactly do good things for this whole eating disorder business.
-If I skip this snack, I might be so hungry at dinner that I accidentally overeat or trigger bingeing.

If I ‘win’ and eat enough food but not too much, anorexia!brain beats me up for eating, and bulimia!brain beats me up for the bingeing impulses I’m ignoring.  And so I spend cycle after mental cycle, trying to figure out which brain I can cope with when, how to trigger the least severe options, and only finding out if I’ve succeeded at the very last second.**

And nearly everyone else?

They just eat the damn apple.

*I don’t quite meet criteria for an eating disorder because I ‘win’ at feeding myself properly enough, but it fucks up my functioning and eats my willpower and brain enough that the distinction isn’t terribly clear. 

**A rough estimate, from the few times my brain has spontaneously clicked to non-ED (glorious weeks, those were) has me spending about 50% of my motivation/willpower towards eating properly. 

A Week

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There aren’t really any pre-eating disorder Kate photos in my possession–very few exist–but this isn’t long after it started.

[The eating disorder content note on this post is so loud it tapdances in sequined tights. Skip the latter half if that seems bad for you.]

It’s a Friday. 12:42 in the morning. And I’ve done something for the first time in seven years. I have fed myself properly for a week.

Twenty-one meals in a row.

I have eaten seven breakfasts and seven lunches and seven dinners, one each day, and the last time I can point to and say, “that happened” was when I was fourteen.

It has always made me feel like a child, in the helpless, immature, possibly-unfair-to-children way. Accomplish all manner of things, come of age, go to college, hold a job, spend years working on recovering, and you still can’t feed yourself for a week, can you?

I am twenty one years old, and I have spent one third my life depriving and counting and adding and crying over calorie totals. I have binged and exercised obsessively and hallucinated and measured and feared
and
and

And I did it.

I haven’t beaten the parts of my brain that want this to be a loss–who think failure is eating when you are hungry. But they’re a little quieter, a little cowed. And that’s enough.

Seven years ago, I wore braces. I hadn’t been kissed, and Kate Donovan certainly didn’t exist. I wanted to be a ballet dancer. Was one, actually. And nearly the happiest I could be was starving.

There was this sharp piece in the New Yorker two months ago. We write about anorexia too positively, the author claimed. And she wasn’t wrong. It’s hard to capture what it takes to override something like wanting to survive. So you dig deep when you write, and try to find it–what could possibly be worth all of that?

There was something, though. That intersection of feeling competent and sparkling and happy. God, the happiness. Hard and diamond-bright and just so easy to get. You can’t get away from hunger easily, and the two melded a bit. Feel clenching hunger? A rush of joy. Over and over and over. And the choice? Happiness or food and feeling slightly duller and slower and sadder? Why, you’d have to be crazy to pick eating.

I felt a little bit of it today–late to dinner with an errand that ate into my time. My stomach growled and it flared.

Be happier…go to the gym instead.

It’s a hell of a drug, this madness.

But I’m winning. I will sleep and tomorrow, I will eat breakfast before class. I will come home for lunch, and commiserate with housemates about approaching midterms over dinner. In the coming days and weeks, I’ll slip up at some point. Rome and days of building, you know. It’ll be harder to come back if I make this an all-or-nothing game. So I’ll expect that sometimes, the feelings will win.

But for now? For now, I’ll be really goddamn proud. Proud of eating, imagine that. I’m not sure fourteen-year-old-Kate could have. I’m going to have a hell of a Friday for her.

Intake Ramblings

The ramblings part of the title is veeeery accurate here! This is about my experience with intake and therapy and (1) I most certainly do not want to discourage you from seeking therapy if you have access to it! Intake may suck, but it is (usually) worth it. (2) I wrote this last night and refused to let myself do anything fun until I’d sent in my therapist request. So these are Thoughts and Feelings, but they are also out of date. 

It’s 2 a.m. and I can’t sleep. It feels a little like the insomnia is coming back. 2:30 am last night. Probably even later tonight. And awake at six, disoriented, but not exhausted.

There’s no AC, and a hot day turned into a warm and sticky night. So I’m on the couch, and I can’t sleep, with a mug of tea that won’t help.

I need to send in a request for assignment to a school therapist. I’ve been delaying. Again. I was late last year, too. My file will get a little bit longer, and a small and silly part of me thinks that’s worse than the feelings.

Eating disorder. Then, eating disorder again, with a new year and a new therapist, and a footnote–obsessive tendencies?
This year: anxiety.  Maybe. Probably.

I’m going to have to do intake again and auuuuugh. I will sit in a room and cross my legs and quietly spell out the last few years. I will ramble a little, because you’re speaking into silence and getting nods in return and I want to sound functional, but I need them to help me, and that means finding the worst parts.

“I believed I had the tendencies under control when I left for college.”
“And by the end of that year I was unable to keep from swinging between bingeing and depriving.”
“Invasive thoughts…trouble leaving my house once or twice.”

There will be a series of questions when I stop talking. I’ve sat on the other side and asked them myself, ticking boxes and nodding. I know what they are, and I know why they’re asked and I will still feel weird and shift uncomfortably, even as I answer honestly.

Have you ever felt suicidal?

Have you ever been sexually assaulted? Raped?

And then they will nod and smile and thank me for sharing, as though I’d set pretty cupcakes on the table between us, instead of my insides.

They’ll let me know when they have a therapist for me, they say as we shake hands. I’ll go sit in the campus garden for a bit when I leave. It’s become a ritual, this. The story, the niceties, the third bench on the right, behind the tulips, letting the feelings crash down.

And then, in a week or so, I’ll get an email from my new therapist. She’ll have my file, but she’ll ask me to explain why I’m there, and I will retell the story again. And then, finally, the work will begin.