Recovery from an Eating Disorder

How do you know when you’ve recovered from an eating disorder? The answer is not so simple. The challenge of determining whether someone no longer has an illness such as anorexia or bulimia was explored in a recent New York Times article, “In Fighting Anorexia, Recovery is Elusive” by Abby Ellin. Often — and certainly by insurance companies — recovery is measured simply in terms of a physical condition: restoration of normal-range body weight and, in the case of women, menstruation. But eating disorders are more than just physical symptoms; they’re also a complex mix of sufferers’ thoughts and behaviors. People with anorexia or bulimia can reach a normal body weight yet still have the traits of someone with the disorder: They remain preoccupied with what they eat, restrict certain foods, and have severe body image problems.

Can someone whose weight is stable but who retains these other thoughts and behaviors really be considered fully recovered? I don’t think so. In the wake of the article’s publication, some eating-disorder professionals have commented that they felt the story’s tone was overly negative, leading to the impression that recovery from eating disorders is not possible. Some described patients as reacting to the article with a feeling of hopelessness. Others found it reasonable to anticipate the possibility of a return of eating disorder symptoms during a time of high stress. They agree with the comments of a doctor quoted in the article, Daniel Le Grange, who says he tells patients, “This is your Achilles’ heel.”

I myself did not find the article especially discouraging. When people leave a treatment for any kind of disorder, they often want to believe that they are done with the problem. They feel that any kind of recurrence or a return to therapy is a mark of failure. I disagree. It’s realistic to understand that in times of stress, people tend to fall back on old habits and coping strategies. The depressed person may be vulnerable to a recurrence of depression; the anxious person to a recurrence of anxiety symptoms. Similarly, people with a history of an eating disorder may find themselves returning to their old practice of restricting their calorie intake. But this does nothing to discount the value of all the intervening time in which they lived without their eating disorder. Anticipating a return to old habits, and using it as a signal for intervention, can be helpful and protective.

Mistakes: What We Can Learn from Them

I generally regard mistakes as something I want to avoid. But a new book, Alina Tugend’s Better by Mistake: the Unexpected Benefits of Being Wrong, persuasively argues that making mistakes can have big psychological payoffs.

In her book, Tugend (she's also a columnist in The New York Times), takes an in-depth look at mistakes -- why we make them, and why we should try to learn from them rather than feel ashamed of them. One of the more interesting parts of Better by Mistake looks at the research of Carol Dweck, a psychologist at Stanford who studies how children react to mistakes, errors and imperfection. Dweck’s work was partially inspired by her sixth grade teacher, who seated kids in descending order, according to their IQ; kids who scored higher on IQ tests got greater privileges.

In her research, Dweck has found that when children are praised for their intelligence rather than for their effort, they are more fearful of making mistakes and less willing to take chances. But when they are praised for effort, or when they think being smart is a skill that they can work at, they try harder and aren’t as discouraged by their mistakes. In other words, it’s better to tell a child, “You worked really hard on that,” than it is to say, “You’re really smart.”

Jugglers are among the most inspirational people in their treatment of errors. If you watch jugglers performing, you will almost always see them goof up: They’ll drop a ball, a club or even a flaming stick. What’s great is how they incorporate the mistake into their performance and keep going. They’ll retrieve an errant ball and then start again; it’s no big deal, and it just seems like part of the act.

Many of us, on the other hand, come to a dead stop when we make mistakes. We berate ourselves, we get discouraged, or we’re filled with regret. We struggle with hindsight bias, in which we look back at a decision that we have made as if we had at the time all the relevant information that we learned only after we made our choice. An example Tugend uses is her father’s family’s decision to leave Germany in 1939. Looking back, knowing the result, it’s easy to say that they should have left the country sooner. But it wasn’t so obvious at the time.

This book got me to think a little more about mistakes, to try to take them less seriously, and to remember that there is not always one right answer out there that is the clearly best choice.

Thinking about the "Tiger Mother"

Thanks to her new book Battle Hymn of the Tiger Mother,Yale professor Amy Chua has almost overnight become one of the most famous -- and infamous -- mothers in America. First excerpted, to wide attention, in The Wall Street Journal, her book argues that the Chinese approach toward childrearing is superior to that practiced in most American households. Chua contends that “Chinese” mothers (they don’t necessarily have to be Chinese, in her opinion, or even Asian) are unconflicted about pushing their children to achieve and feel no qualms about taking scorched-earth measures in the process -- insulting their children, for example, or meting out harsh punishment for underperformance. Western mothers, on the other hand, are more wishy-washy about achievement, are reluctant to push their children hard, and care too much about mushy concepts such as self-esteem and happiness.

It’s Chua’s belief that the Chinese way results in children who not only grow up to be high achievers, but are ultimately happier, because of their skills and achievements, than coddled Western-raised kids. Battle Hymn of the Tiger Mother is the story of Chua’s efforts to raise her two daughters, now 18 and 15, and mold them into academic and musical standouts.

Since almost everyone who has heard even a fragment of Chua’s argument has a strong opinion about it, I thought it couldn’t hurt to read the actual book itself. What struck me, after finishing Tiger Mother, was how incredibly lucky Chua is. Her daughters are clearly amazingly smart and musically talented. Every time she prods them into going for some big audition, they end up getting it or at least being told they have the potential to be superstars. I try to imagine the effect of this kind of parenting on a child who has learning issues, is tone deaf, or does not end up at the top of her class no matter how hard she tries. Kids need to feel accepted and valued for things other than their achievements.Yes, it is true that having high expectations for a child can empower her. But having insanely high expectations can be destructive and debilitating. I think that Chua overestimates how much of her daughters’ happy outcomes should be attributed to parental prodding and underestimates how much is due to their natural gifts. Because first she pushed and nagged her daughters and later they achieved things, she can believe that she was what made it happen. But there’s not necessarily a cause-and-effect relationship there.

I also found myself wondering about Amy Chua’s attitude towards food. She writes, “Chinese mothers can say to their daughters, ‘Hey fatty--lose some weight.’” I’m not sure why anyone would want to speak to their child like that. For one thing, if hearing derisive comments about obesity were all it took to motivate people to become thin, overweight people would disappear from America. And while some children might be toughened by parental insults, others are beaten down. But my further problem with her attitude is that I wonder whether this is another way that Chua -- a thin person, judging from recent photos -- is luckier than she realizes. She gets to attribute her frame to her self-discipline and self-control when in fact she may be naturally thin. Yes, there are things we can do to control our weight, but there are limits to that, just as there are limits to our intellectual, musical, and athletic capabilities. Part of the job of being a parent is to help a child grow and develop as well as she can, but also to be satisfied if she’s not the smartest, fastest or thinnest child in her class.

Healthy Eating

For the last week, I’ve been following the blog Clean Plate by Ellen Tarlin, hosted on Slate. In her blog, Tarlin, a Slate writer, is documenting a 6-week effort to figure out how she can eat more sanely. Happily, the blog is not about losing weight or counting calories, but about eating healthfully without dieting. Each week has a theme; this past week, the blog's first, was devoted to figuring out how to sort through the immense amount of nutrition information available about our food. For the upcoming week, the theme is money and how much it costs to eat well.

It’s interesting to read about someone trying to figure out how to eat so that they feel better and feel healthier. One takeaway from the first week is how much more energetic she feels when eating regular meals, rather than going from coffee to chocolate to snack. At the same time, she’s noting some of the challenges: planning meals, shopping for food, lugging food around. But mainly it’s refreshing to see someone writing so much about everyday eating without also writing about calories, dieting, and weight loss.

Overcoming Procrastination

Why do we put off unpleasant tasks, especially when we know that we’re going to have to do them anyway? Procrastination is a universal human behavior, and it’s one that makes no logical sense. If you delay an unavoidable action, you’re still going to have to do it anyway; all you gain is a mounting sense of frustration or worry as the undone responsibility haunts you. When you finally get around to completing whatever it is you’ve been dodging, the experience is either worse because you put it off or not as bad as you feared, making you wonder why you procrastinated in the first place.

In the October 11, 2010 issue of The New Yorker, James Surowiecki reviews The Thief of Time, a book of essays about procrastination written by economists, philosophers, and psychologists. He summarizes procrastination as a “complex mixture of weakness, ambition, and inner conflict.”

The weakness lies in the mismatch between our immediate desires and long-term goals. While we may have very laudable plans for the future (be fit, eat right, and live in a clean, uncluttered house, for example), these goals are often overriden by our short-term impulses. As we shift our attention to pleasures today, we mislead ourselves and pretend that we won’t feel just as avoidant tomorrow.

Ambition and perfection also lead us to procrastinate. Surowiecki writes about the Civil War general George McClellan, who delayed engaging in battle, convinced his army wasn’t perfectly positioned. The combination of lacking confidence in what we can do, coupled with high expectations can be paralyzing. Rather than taking action and risking failure, it can feel safer to embrace the fantasy that if we wait, whatever we do will be great. Meanwhile, nothing gets done. A painful portrait of this is the recent movie Greenberg, in which Ben Stiller plays a man in his 40s who turned down a record deal in his 20s because it wasn’t exactly what he wanted, torpedoing his career.

So how to combat procrastination? I think first we have to recognize that we have what Surowiecki describes as “competing selves” with conflicting goals, and which need to be tamed and managed (a familiar notion to anyone who has read a little Freud). We can acknowledge that our short- and long-term goals can conflict, and we can learn strategies for focusing on the long-term goals we’re tempted to avoid. These strategies include things like breaking things down into more manageable tasks, setting deadlines, and rewarding ourselves with pleasurable experiences for completing less-than-pleasurable jobs.

It’s also important to gain some better understanding of one’s feelings about the task being avoided. What makes it procrastination is that you are acting against what you rationally know to be your own self-interest. Understanding your motivations behind self-defeating behavior can help you overcome it.

Trauma and Memory

People who are in therapy -- and a lot of people who aren’t -- often question the value of discussing traumatic events in their past. It happened, goes the argument. You can’t change it,so why talk about it? What’s the point? Well, a new book by a woman who spent years blocking out memories of her own trauma, then threw herself into an in-depth investigation of it, makes a convincing case for how helpful it can be to examine troubling events from one’s past.

Denial: a Memoir of Terror, by Jessica Stern, is the author’s account of her and her sister’s rape at gunpoint in 1973 and the aftermath of that crime. For years Stern -- who was 15 when she and her sister were attacked by a stranger -- didn’t talk about the event, nor did members of her family. And, judging from her achievements, she did not appear to suffer lasting psychological harm; she earned a doctorate in public policy from Harvard, wrote noteworthy books on the subject of international terrorism, and became a respected academic in her field.

But in fact, Stern was suffering from post-traumatic stress disorder, a condition most people associate with wartime experiences and battlefield violence. At times, she was nervous -- frightened by crowds or upset by the sound of a ticking clock. At other times, when as an adult she faced real danger (such as when she was the victim of an armed robbery) her reaction was to go into a trancelike state. She had difficulty maintaining relationships with the loved ones in her life.

At some point in her life, however, Stern decided to address her past head-on. She started by requesting the police file on her rape, for which no one had ever been arrested. She ended up researching the rape and its circumstances as thoroughly and as professionally as any of her books or articles. When a police officer subsequently re-investigated the rape and identified the likely perpetrator -- he was a serial rapist who had since committed suicide -- Stern researched the rapist’s life, speaking to his friends and interviewing another of his victims. She interviewed her father, too, whose emotionless response to the rape colored her experience of it; traveling at the time of his daughters’ assault, he didn’t cut his trip short to come home but waited three days until his previously scheduled return date.

Stern’s dissection of her traumatic experience -- via both this research project and psychotherapy -- ultimately made her life more satisfying, in several ways. She found she had a greater capacity to be in a romantic relationship. She was able to understand her father, a Holocaust survivor, in a way she never had before. And she was more conscious of how her ordeal had shaped her -- how she had developed the skill of functioning coolly under great pressure, such as when, as an adult, she was interviewing terrorists in the field.

In other words, Stern’s self-examination -- this dredging-up of a long-ignored nightmare from her past -- has enabled a richer life in the present. As she writes in her book (in the context of her relationship with her father), “I do not believe in ‘forgive and forget.’ To forgive in the truest sense, we must remember first and then forgive....”

Living up to your Potential--or Not

What do you do when you don’t quite live up to the dreams you have for yourself? That’s the question that writer Abby Ellin tries to answer for herself in the current issue of Psychology Today. Ellin, the author of the book Teenage Waistland, describes her own feeling of inadequacy in comparison to Tina Fey, the creator and star of the TV show 30 Rock. Ellin is smart and funny, she tells herself, and it nags at her that Tina Fey is winning Emmys and she isn’t. This vague feeling that she isn’t living up to her own potential is what Ellin labels the Contender syndrome, a reference to the scene in On the Waterfront in which Marlon Brando says, “I coulda had class. I coulda been a contender.” That envy of what she thinks she could be doing, Ellin recognizes, gets in the way of her taking pride in what she has actually done, from writing her book to climbing Mt. Kilimanjaro.

How can you prevent yourself from feeling bad about your non-accomplishments? Being “self-referential” for one. This means using yourself as your reference point, rather than just looking at how you stack up next to someone else. If you think about how slowly you’re running compared to the other runners you see at the park, you might feel bad. But if you think about how much faster you can run than you did when you first took up the sport, you’re more likely to feel good about your performance.

Seeing the idea of potential as something you can affect helps, too. When kids feel that being “smart” is a static trait that comes naturally--not something they can work at and improve--they are less likely to try new and difficult tasks. Similarly, if you see yourself as having “potential” but don’t connect that potential with a task or goal you can work on, you likely won’t realize that potential yet will be more envious of people who do live up to their dreams.

It also helps to broaden your idea of success. If your only definition of success as an actor, for example, is to win an Academy Award, then your odds of reaching your goal are slim. If you can focus on what you’re doing, your enjoyment of the process, then you’re likely to feel good along the way--and feel less cheated by others’ success.