When Is It Time To Speak Up?

Nancy Matsumoto (a freelance journalist who has contributed to the New York Times, Newsweek, Time, etc..) and Marcia Herrin (a nutritionist specializing in eating disorders who founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program), have co-authored a great book called The Parent's Guide to Eating Disorders. They also have a blog called Eating Disorders and Nutritional News. To read a little more about Nancy and Marcia, follow this link! I wanted to share a recent blog post written by Nancy because I think it is a very authentic post that addresses a topic that people often ask and wonder about. The title of the post is 'Knowing When to Express Concern About a Friend's Eating Disorder.' Follow this link to read it, or you can read it below (copy and pasted).

In other fun news, I had the opportunity to ask both Nancy and Marcia some questions recently about some different eating disorder topics which I am excited to share with you soon! :) :) Follow this link to check out their website.

Knowing when to express concern about a friend's eating disorder

A recent experience reminded me that even when we know what the right thing to do is, it’s still hard to know when to do it. Over the course of the past year, I have become friends with a woman, I’ll call her Jane, in my Japanese language class. I recognized the telltale signs of anorexia in her right away: the hollow cheeks, the clothes hanging off her skeletal frame, the way she liked to bring food for others, but didn’t want to eat much herself.

Later, Jane told me that she did not see herself as too thin, she thought she looked normal, maybe even a little bit heavier than she wanted to be. This, too, is a classic symptom of the body dysmorphic disorder that often accompanies anorexia.

I wondered if I should say something, to express concern and find out if Jane was in treatment. Had I been just half as emaciated as Jane was, I would not have been able to think straight; I would have felt dizzy and probably fuzzy-headed from malnourishment. But Jane’s mind was razor sharp. She was an encyclopedia of kanjicharacters, devoured the finer points of grammar that made my eyes glaze over, and read the appendix of our dry text book for fun.

Although she was always the most prepared person in our class, Jane was also always late to class. I thought she had a job that she couldn’t leave early. Later, she told me that she had no job; the digestive problems caused by her anorexia meant that she simply had to wait until she felt well enough to leave her apartment. Often, she didn’t arrive until the last 20 or 30 minutes of our two-hour class.

Then Jane went away to Florida on vacation. It was sunny and warm there, but she returned with a wretched cold and looked thinner than ever. She looked terrible. “Feel my hands,” she told me and another classmate. Even though our classroom was overheated as usual, her hands were icy cold. Suddenly, she had entered crisis mode. Being in Florida surrounded by friends who were healthy, fit, and enjoyed active, outdoor lives had suddenly made her want those things for herself. She looked in the mirror and for a moment saw how different she looked, how starved and unhealthy the woman who stared back at her was. It was a moment of clarity that lasted long enough for Jane to realize she needed help.

For the first time, Jane also opened up to me and a few others in our class about her eating disorder. She was desperately seeking a treatment center, she told me. Even though all the doctors she spoke to felt she should be hospitalized, she hoped to stay at home and find outpatient treatment. I was scared for her life, and I could tell she was, too. I berated myself for not saying anything earlier. Maybe I could have prevented this sudden and horrible downturn. I knew what was happening to her and I didn’t say anything.

I thought that she would think me too pushy, or a know-it-all. I worried that I would be intruding. After Jane spoke openly about her worries, I was able to refer Jane to Marcia, who then recommended a good psychologist in New York for her to see. When I saw Jane at class yesterday, she told me she liked her therapist but was worried that she would not be able to afford many more treatments. She couldn’t afford to spend the $5,000 out-of-pocket minimum her insurance plan required before it would cover 50 percent of the therapist’s bills. Even paying for half of the treatments would be a stretch.

When I asked Jane today whether it would have offended her if I had spoken up, she told me, “I wouldn’t have reacted negatively, because I know what’s going on with me. I’m not sure that I would have done anything about it; you have to be ready.”

The kind of epiphany she had recently, when she recognized what she looked like and how sick she was, Jane told me, has happened before, although it never lasts. “I want to do something, and then I’ll go into hibernation again,” she said. Two weeks ago she had a phone interview with the Renfrew Center in Pennsylvania, but then decided not to go.

Jane said she wanted so much to be healthy and active but added, “I don’t know how to be active, to sleep and to squeeze food in. I can’t eat because it makes me feel bad, and I’m afraid I will get sick. I’m like a child; I want to be taught to eat again.” Then, she added, “I don’t know if I’m going to make it. If this can help someone else, please write about it.”

I asked Marcia if she thought I had done the wrong thing by waiting to voice my concerns to Jane. Marcia responded, “You have to trust your instincts on when to speak up, and it sounds like you did. I have reminded other concerned friends in similar situations that you can trust your instincts if your motives are pure. We all need to remember that we can't force another adult to take action (without taking legal action first). What Jane needs now is encouragement to hang in there long enough to benefit from treatment. Sometimes this is a good time to suggest or lend a book. Maybe Life Without Ed byJenni Schaefer or, Gaining: The Truth About Life After Eating Disorders, byAimee Liu. Good books can lead to good discussions, too. “

As a nutritionist who often sees eating disorders patients who cannot afford professional treatment and/or have difficulties with insurance issues, Marcia told me, “I have lots of thoughts about this.” The first is that Jane’s dilemma is typical of our insurance system, which slaps large deductibles on eating disorders treatment and follows with inadequate reimbursements. The patient goes without treatment and, in the worst cases, ends up hospitalized in an intensive care unit at upwards of $1,000 a day.

Marcia’s second thought was that it is often hard for patients make recovery their number one priority in life; everything else should be secondary. This is not easy in cases where the patient doesn’t have the complete support of loved ones, however.

Jane’s comment about feeling like a child who needs to learn how to eat again, Marcia noted, is a perfect description of what a good nutritionist can help an eating-disordered patient do, and why seeing a nutritionist or dietitian who specializes in eating disorders is so important.

“Another thing that can be inspiring,” Marcia said, “is to help the other person see that her life is important to others—children, spouses, families, friends, even pets, and to you!”

I will tell Jane that she is important to me, and to our class. I hope that if you are concerned about a loved who is in despair over an eating disorder, you will do the same thing.

Take care,

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors, The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

Plus-Size Models Don't Promote Positive Body Image??

The other day, I was reading The State Press-- Arizona State University's daily campus publication. To be honest, I rarely ever read it, but every so often I like to check in and see what it is going on around campus (it’s been almost two years since I graduated from my graduate program there!). Anyways, I came across a pretty interesting article on body image and marketing that I have been trying to make sense of!

One of the principle researchers in the study, Naomi Mandel, is an associate professor of marketing at ASU, and she partnered with two other professors from universities across the country to examine how advertisements (and the models used in them) impact women’s body image and self-esteem. They wanted to determine if using plus-size models and women of all sizes to sell products in ads promoted positive body image in women. What they found was that ‘plus-size models don’t promote positive body image for consumers.’ To read the entire article and to read more about their study, follow this link.

After reading this article, I was sort of confused because I was wondering if the researchers expected a different outcome? Let me explain. I know that we all hope (me included) that seeing women that are a range of sizes will contribute to us having a better and more healthy body image, and I really DO believe that it can and does help (in spite of these findings)-- but I also think that more than anything, our culture’s narrow definition of beauty is what really challenges us the most, and ultimately influences the context in which we view ourselves and others. Anyways, their study (as far as I’m aware) seems not to take this very important component into consideration, which is essential because the way in which we define beauty culturally impacts the way that we see and interpret what is beautiful (maybe they need a social scientist to join their research team!). I almost laughed this morning when I came across an opinion piece on the Huffington Post-- the title alone screamed at me in regards to this very issue- “Why Media Literacy Alone Won’t Make Women Love Their Bodies.” Follow this link to check it out. The premise of the article is based on a study done amongst Girl Scouts- and what they found was that while girls and women are able to critically observe models and unhealthy images that we see in the media, we still want to pursue unhealthy means to achieve this ideal standard of beauty that exists culturally. Here is a snippet that sums up it up, and sums up my thoughts about the ASU study as well..

The young women in the Girl Scouts study are media literate. They view the images they see in magazines and on television with critical eyes. They know full well that what they see presented as beautiful is all but impossible to achieve. They even suspect, rightly, that some of the women they're seeing are sick. And yet, they still think those women are beautiful, and they still want to look like them.

 What's clear then, is that changing how we see fashion models is only half the battle. That so large a proportion of the women surveyed in the Girl Scouts study were media literate, and were able to view fashion critically, represents enormous progress. But until we change what's considered beautiful in our culture, until we broaden the definition of female beauty to encompass more than 2% of the population, young women will continue to emulate the current ideal, even as they know it to be unrealistic and unhealthy. The other equally important half of the battle, though, is to change how we see beauty, to expand the definition beyond young, white and painfully thin. If we can do that, we can create a world in which young women who want to be considered beautiful by media standards, who want, like all teenagers, to be accepted and liked, don't feel the need to starve themselves in order to do so.

This is obviously a huge challenge and task- and as we all know, cultural change does not happen over night. Starting small is essential- one small way that you can participate is to take part in Operation Beautiful. For more information on Operation Beautiful, follow this link.

20 Ways to Love Your Body

I have been preparing for a presentation on eating disorders that I will be giving tomorrow at a local high school, so I have been scouring the NEDA website looking for cool ideas, stats and other things to make my presentation non-boring to high school students (who are probably going to think I'm old and boring anyways- JK!!). Anyways, while I was scanning some of NEDA's resources online, I came across a list of '20 Ways to Love Your Body' compiled by Margo Maine, PhD that I thought some of you might enjoy reading! I am just going to copy and paste it below (with my additions in italics:)), or, you can also follow this link and check it out on NEDA's site.

20 Ways to Love Your Body by Margo Maine

1. Think of your body as the vehicle to your dreams. Honor it. Respect it. Fuel it.

2. Create a list of all the things your body lets you do. Read it and add to it often.

3. Become aware of what your body can do each day. Remember it is the instrument of your life, not just an ornament.

4. Create a list of people you admire: people who have contributed to your life, your community, or the world. Consider whether their appearance was important to their success and accomplishments.

5. Walk with your head held high, supported by confidence in yourself as a person [who is made by God and created beautifully!].

6. Don't let your weight or shape keep you from activities that you enjoy.

7. Wear comfortable clothes that you like, that express your personal style, and that feel good to your body.

8. Count your blessings, not your blemishes.

9. Think about all the things you could accomplish with the time and energy you currently spend worrying about your body and appearance. Try one!

10. Be your body's friend and supporter, not its enemy.

11. Consider this: your skin replaces itself once a month, your stomach lining every five days, your liver ever six weeks, and your skeleton every three months. Your body is extraordinary--begin to respect and appreciate it.

12. Every morning when you wake up, thank your body for resting and rejuvenating itself so you can enjoy the day.

13. Every evening when you go to bed, tell your body how much you appreciate what it has allowed you to do throughout the day.

14. Find a method of exercise that you enjoy and do it regularly. Don't exercise to lose weight (or punish yourself because of what you have eaten) or to fight your body. Do it to make your body healthy and strong and because it makes you feel good. Exercise for the three F's: fun, fitness, and friendship.

15. Think back to a time when you felt good about your body. Tell yourself you can feel like that again, even in this body at this age.

16. Keep a list of 10 positive things about yourself (and look at it!)--without mentioning your appearance. Add to it!

17. Put a sign on each of your mirrors saying, "I'm beautiful inside and out."

18. Choose to find the beauty in the world and in yourself (because it is all around).

19. Start saying to yourself, "Life is too short to waste my time hating my body this way."

20. Eat when you are hungry. Rest when you are tired. Surround yourself with people that remind you of your inner strength and beauty.

Some of these may resonate with you more than others- I really appreciated number 4 and number 8. Gratitude is SO important; being thankful and having perspective can go a long way. Hopefully this list provides you with a few things to think about and some helpful pointers to start appreciating and loving your body! :)

Bring Change 2 Mind

I just started watching a TV show recently called Modern Family. It is hilarious. I've only seen it a few times, so I'm not sure I can do the premise justice, but it's essentially a sitcom that chronicles different members of an extended family and their interactions. (If you're curious, follow this link to check it out.) Anyways, I really do like it, but last week when I was watching, one of the characters made a joke about eating disorders. It's hard to explain what happened since I don't really know any of the characters names, but one of the children was annoyed with his mother and said- "mom, go tend to your eating disorder or something." I'm not sure if this was supposed to be funny, but after the day I had, I was NOT laughing. An eating disorder is a mental illness, and there's nothing funny about that. I didn't turn off the TV and refuse to watch the rest of the episode, but it just struck me that if you replaced 'eating disorder' with any other mental illness- say, schizophrenia- it probably wouldn't be funny either. So why did someone think making a joke about an eating disorder would be funny? This just reminded me that eating disorders aren't widely viewed as psychiatric illness yet.

I think one of the biggest myths about eating disorders is that they are a lifestyle choice- not a mental illness. Yes, there is choice involved in recovery- you have to choose to take steps to recover. But an eating disorder is a mental illness, so it's not as simple as 'just eating'. Glenn Close, the actress famously known for playing Cruella Deville in 101 Dalmatians (ha ha, just kidding- I think she is famous for her role in Fatal Attraction, which I've never seen-- and some other movies too..), started a non-profit called Bring Change 2 Mind. The mission is to raise awareness about mental illness, to work towards de-stigmatizing it while also providing support for those who deal with mental illness. Close's sister and nephew, who both suffer from different mental illnesses, were the inspiration that fueled her to initiate this endeavor. PsychCentral wrote a little article awhile back in October when it launched - to read it, click HERE.

I'd encourage you to check out her site! I'll be honest- right now, there is a slightly annoying pop-up when you access the site, but that's just because Bring Change 2 Mind recently partnered with NAMI (National Alliance on Mental Illness) for NAMIWalks Campaign (a walking campaign to raise money for and awareness of mental illness!). The pop-up is a video, and even though it's slightly annoying, it's actually worth watching :) Once you get past the video, the site is great- there are resources for those who want to learn about mental illness or find support if they are struggling with one, there are videos of people sharing their stories, and there is additional information available that serves to encourage real understanding of mental illness! Right now, eating disorders are not part of their featured mental illnesses- they feature depression, post traumatic stress disorder (PTSD), bipolar, and schizophrenia. However, there are many mental illnesses, eating disorders included, that will hopefully be added as their non-profit grows! At this point, what seems important is that this is an organization that is dedicated to promoting awareness and knowledge about mental illness to de-stigmatize... which is awesome. If you are interested in finding out how you can be involved in any capacity, you can check out the 'be involved' tab on their site!

Life Lessons by Goldilocks

It's a little funny that fairy tales and stories that were read to me as a little girl have been coming to mind lately. I'm not exactly sure what that means (haha), but what I would guess is that these stories come to mind because they actually have some good morals and principles rooted in them (that are not just meant for child-sized ears and lives) and are also relevant to daily happenings.

Today, through a couple of conversations that I had, I was thinking about and reminded of the extremes that we see in our culture when it comes to almost every single arena. Whether it's food, our bodies, and weight, or money, work, love, sex, success, sports, entertainment, etc.. extremes are everywhere. Whether it is an extreme diet, an extreme sport, an extreme behavior (like plastic surgery- Heidi Montag, anyone?), it seems that our culture is not only fixated on extremes but celebrates them. People are applauded and ridiculed based on their ability to conform to extremes. The media gives so much attention to extremes- whether these extremes are weight related or not. We are simultaneously fighting obesity as a nation, as well as a culture that fuels myths about eating disorders as a lifestyle choice. We are constantly made aware of great successes and great failures (which are defined and polarized by the media) and yet we don't necessarily have many positive role models that showcase what it's like to operate in a medium of balance- where both successes and failures are part of life, and where a gray area reigns, instead of the black and white. It seems to me that in a culture of extremes, one of the toughest things to achieve is balance. Outside of appearance and weight, some common questions that deal with balance include the following-- How much time do I spend working, and how much time do I spend playing? How much time should I spend with my family? How much time do I need to invest in cultivating my marriage/relationship? How much exercise is appropriate? How much time do I invest in my spiritual life? The questions can be endless and there is no sure answer for each individual. What I am sure of though is that we probably have a thing or two to learn from Goldilocks (strangely enough).

Goldilocks, for those of you who may need refreshing, broke into a cottage that belonged to three bears (probably not the part to emulate). She ate their porridge, sat in their chairs, and eventually fell asleep in one of their beds. The bears ended up returning home to find her asleep in one of their beds, and she ran out of the house, never to be seen again. Goldilocks is famous (to me, anyways) for the way in which she was a little picky, a little particular. When she tasted the bear's porridge, one bowl was too hot, and one bowl was too cold. But one was just right. The chairs and the beds were the same way-- not hot or cold, but too big, or too small, or too uncomfortable, etc. I guess the reason that she came to my mind today was because I think she is a good example of someone who was mindful of her surroundings and was able to make a decision based on what she felt was right in the moment. She may have been a little picky, but she noticed extremes and decided to operate in the gray area. While all of her options were benign and obviously not comparable to the kinds of things that I mentioned above regarding extremes, I think she is a good example of someone who is being mindful and balanced in her choices. I realize this is a bit of a stretch and may sound simplistic (it is), but I think being able to achieve balance is something that we really struggle with as a culture and as individuals.

This Goldilocks analogy does not apply to eating disorders (remember, EDs are a mental illness), but the analogy applies to the way that we view ourselves, perceptions of beauty, and life in general. So how do we work towards operating in the gray area so that we can live a life of balance? Being mindful, creating and maintaining boundaries, taking care of ourselves just as we take care of others, surrounding ourselves with kind and loving people, living out our values daily, and refuting and challenging irrational and negative thoughts/beliefs. Surely this list is not exhaustive. But I think by aiming to operate in this gray area and by finding a middle ground-- a balance, like Goldilocks did:)-- we might find that we are more content, that we feel better about ourselves, and that we become more accepting of ourselves and others. These are some of the things that give us character and ultimately make us beautiful.

To read about another children's story (the Velveteen Rabbit) and being real, follow this link.