Eating Disorders: Stigma & The Social Cure

Two decades ago, people would only whisper the words “breast cancer.”  Susan G. Komen, as she lay dying from the disease, asked her sister, Nancy Brinker to try to raise awareness. http://www.npr.org/2011/09/14/140477589/susan-g-komen-founder-discusses-her-book.  Because of Nancy’s tireless outreach, people now discuss breast cancer openly.   Along with this new openness, Susan G. Komen for the Cure has raised millions of dollars for research that has helped save lives.

Today the topic of eating disorders is where breast cancer was twenty years ago.  There is still tremendous shame and stigma surrounding these problems, which only increases the suffering of victims and their families.  Anorexia, binge eating and bulimia are still viewed as shameful, disgusting, embarrassing and a sign of mental weakness. 

There is a community of eating disorder survivors, family members and treatment providers working hard to remove this stigma.  I decided to use theater to break through defenses and touch folks at an emotional level.   Back in 1996, I wrote the play “What’s Eating Katie?” about a 13-year-old girl who struggles with an eating disorder.  In the show, the Eating Disorder (ED) is played by an actor representing a separate character (based in the Narrative Therapy approach which “externalizes” problems).  This technique allows the audience to hear what it sounds like inside of Katie’s head. Katie, like most eating disorder sufferers, is a high achiever, one of “the best and brightest.”  She is a perfectionist who want to make everyone happy. Like the canary in the toxic coalmine of our culture, she’s the one who succumbs to the stress and pressure.  Audience members relate to Katie since we all have an internal negative voice; the only difference may be that Katie’s internal negative voice is meaner, more controlling and highly destructive. 

   My goal in creating the show was to rip the lid off this topic, even though many adults are afraid to address eating disorders out of their fear of glamorizing them or giving kids ideas. In fact, the ideas that teens take from this show are: dieting is ridiculous; starving leads to moodiness, spaciness and weakness; binge eating is an out-of-control nightmare; and throwing up is both addictive and dangerous. The only rational conclusion is to respect, feed and take care of your body!

I’m happy to report that over the past 15 years, high schools and colleges around the country (as well as Scotland and Australia!) have performed this show.  Act I takes place over the course of one day, when ED recruits Katie into engaging in an extreme diet that takes a frightening turn.  Act II takes place three months later when we can see the toll that ED has taken on Katie, her family and her friends.  It ends with an uplifting scene in a therapist’s office where Katie begins her journey towards recovery.

Between scenes are hilarious “ads,” spoofing the diet, fashion, fast food and fitness industries.  The idea is not to “blame” these forces for Katie’s eating disorder but to place her struggle within a wider cultural context.  By seeing plainly the manipulations of the  corporations that profit from making us fat, insecure and then thin again, the audience will be better at critiquing the core messages that can lead to unhealthy behaviors (“You will be popular, loved and happy if you are THIN, so get there no matter what the price!”)  By making the messages explicit, they have less power to influence attitudes and behaviors.   

One of my favorite things about this project is that the purveyors of the new messages are the teens themselves. An audience of middle school kids is going to be much more open to messages in a show performed by high school students than to adults lecturing them about taking care of their bodies.  We know that peers are a potent influence regarding attitudes and behaviors; unfortunately we typically hear about how this influence leads kids to dangerous places (sex, drugs, rock 'n' roll!).  The idea of this show is to use "peer influence" for Good rather than Evil.  This process has been dubbed "The Social Cure." 

I recently updated the script to including cell phones and texting, Google and Facebook (none of which were around in 1996!). But I wanted to bring the show to the next level by turning it into a musical.  I stumbled upon a gifted actor-composer-music director named Bryan Mercer. He knows how to make a show fresh and engaging, hip and meaningful.  We feel that the combination of my 20 years as a psychologist combined with his 30 years in musical theater will allow us to create a show that will both educate and entertain today’s sophisticated youth audience.

In order to help fund this stage of the project, I decided to work through the Kickstarter.com website.   If you care about this issue, we want you to be part of this project!   Your donation (large or small) will allow us to fund the composing of nine songs and the recording of the tracks.  We’ll reach out nationwide to promote this as a fresh, bold way to address dieting, weight stigma, body image and eating disorders.  We’ll also approach local schools and community groups about performing the show in Atlanta in 2012.

This is a life-changing and potentially life-saving project. The show will engage and enlighten cast and audience members and provide hope for sufferers and loved ones. Ultimately, it encourages people to seek help because recovery is possible.  We hope that you want to be part of it!  Click here to find out the how we will be thanking you for your gift (including writing your name into the show!) http://www.kickstarter.com/projects/1746338650/whats-eating-katie-the-musical?ref=live

Thank you~

Read Dina's blogs on www.mindfullivingnetwork.com and www.sharewik.com.  Learn more about her at www.dinazeckhausen.com or www.powersferrypsychology.com.

Thinnest Girl in the Room

“Losing weight is the only thing I’m good at.”
I’ve heard these words spoken (with no irony) by gifted athletes, accomplished performers and class valedictorians. I’ve heard them uttered by people who are stand-outs in whatever it is they choose to accomplish in their lives. In Jane Fonda’s speech at a gala to raise money for our eating disorder organization, she shared the story of her 25-year battle with anorexia and bulimia. With compassion in her voice, she stated: “Eating disorders happen to the best and brightest…. We just want to be perfect.”
It appears that some kids come into the world perfectionists: no amount of external reinforcement will quell the sense of not being enough. Others are raised by critical or high-pressure parents whose high standards they’ve internalized. It appears most are born to loving parents who are only hard on themselves.
Whatever the causal combination of nature and nurture, negative self-talk is especially vicious for eating disorder sufferers.
Typically they’ve received accolades and awards for their many gifts and achievements, yet they feel invisible and unimportant. Some admit to me that they are afraid to give up their eating disorder because they believe it is the one thing that makes them special and unique.
In a world where the majority of the population is dieting and hating their bodies, it’s little wonder that our kids internalize the message that the one achievement that truly matters in life is the ability to deny oneself food. For those who discover that they have this capacity, it can be as exciting as discovering the Holy Grail. They may be starving, obsessed with food, and experiencing negative side effects of malnutrition yet they are still asked, “How do you do it?!” People who don’t know any better laud them for their “willpower,” “healthy eating” and“self-discipline.” They are even told by their doctors (who are weary of treating overweight patients) “You don’t LOOK anorexic.”
It’s no wonder they are confused when I describe their eating disorder as A Problem, when they (and many around them) view it as The Solution.
Abigail is bright, creative, intellectually gifted, artistically talented, keenly sensitive and perceptive. When I ask her about her fear of letting go of her eating disorder, she tells me, “It’s the one thing that I’m good at. It’s what makes me Special.”
I respond, “I think the fact that you are good at ignoring the needs of your body is, in fact,the least interesting thing about you.”
This remark is met with stunned silence. Abigail feels both insulted and flattered by me. “Rather than making you Unique and Special,”I explain, “your eating disorder robs you of your uniqueness. It causes you to think the same monotonous thoughts and act out the same food rituals as the millions of other eating disorder sufferers. The people who love you and know about your problem do not see you as more “Special” because of it. They thought you were unique and special BEFORE this eating disorder stole you from them. They miss you! In fact, they feel sad for you that you will not allow yourself to have fun when there’s food around. They are upset because your eating disorder is robbing the person they love of joy, laughter and pleasure. Instead of striving to be the Thinnest Girl in the Room, you can learn to be happy being the Abby-iest girl in the room.”
My hope is that this alternative perspective will provide a new way for her to start thinking of herself in relation to her eating disorder. It will take many repetitions before it starts to sink in. After all, it’s just one hour a week of me versus the 24/7 media-machine bombardment of the Anorexic-Belief-System (“You will be happyrichfamouswealthyenviedspecialloved if you are THIN THIN THIN”). You, too, can be a counter-cultural Force for Good. Simply pause for a second before you heap praise on someone for their healthy eating or their weight loss. It may seem like the right thing to do, complimenting someone’s efforts and accomplishments in this difficult arena. It may even seem insensitive to NOT say something, but use your words carefully. You never know what goes on behind the scenes; comments about food and weight can be highly loaded for some people.
Instead, if you want to truly give someone a meaningful gift of the heart, compliment them on their spirit, their laugh, their kindness, their integrity, their funny perspective on the world~ those things that TRULY make them unique.
There’s no real reward~ and there may be a heavy price to pay ~ for being crowned the Thinnest Girl in the Room.

Dina Zeckhausen is a nationally known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and  www.mindfullivingnetwork.com. You can visit her on the web atdinazeckhausen.com and MyEdin.org.

What Happens When Mom Has an Eating Disorder?

Flight attendants have it right – and the advice is just as useful for those on a plane as well as off. “Remember to place the oxygen mask over your nose and mouth before assisting your child.” In other words, fail to take care of yourself and you won’t have what it takes for your kid. This is especially true for mothers with eating disorders. Anorexia is the most blatant form of self-neglect. Its theme is the refusal to meet the body’s most basic needs (for food) but it often entails the denial of other important needs (i.e. love, pleasure, intimate connection).
While the stereotype is that eating disorders are a current day affliction caused by media images, they’ve been around for centuries. Generations of women have suffered, but they were undiagnosed and untreated. Some wound up in mental hospitals or experienced chronic illness and early death from malnutrition or suicide. Those who were higher functioning got married and had kids.

When an eating disorder goes untreated for decades it becomes an entrenched and defining quality of one’s self-concept.
I’m the thin one.
I’m the one who resists the treats at the restaurant.
I’m the one who cooks for others but never succumbs to temptation.

The “pride” in being able to achieve these victories over the body’s needs is a substitute for self-worth. Like saccharine, its momentary sweetness has no real substance behind it.
Unfortunately, the older generation of moms had little awareness of how living on nicotine, caffeine, saccharine and adrenaline would affect their offspring. Their adult children often struggle with a deep and abiding sense of emptiness.
Olivia sits in my office, the daughter of one of these moms. “I’m grumpy,” she starts off one summer morning. “Actually, I’m hung over, as in ‘Food Hangover.’ Had dinner with Mom last night.”
A successful, attractive professional in her late 40’s, Olivia secretly binge eats whenever she spends time in the presence of her mother. That night before, Mom had come through town and taken Olivia out for dinner, ordering a side salad with no dressing and black coffee (“…always the damn black coffee!” Olivia fumes). Her mom excused herself several times to step outside for a cigarette. She looked with judgment and disdain as Olivia ordered dinner off the menu. By the time dessert arrived, Olivia was planning her post-dinner binge back at the house.
Olivia felt like her mother wore her anorexia like a badge of honor. During her childhood Olivia’s mother never ate dinner with the family. When they went on vacation, her mother would avoid eating all day, admonishing the kids, “You’re not hungry!” when they started asking for lunch around 2:00 p.m. Sometimes Olivia would discover her mom quietly eating a box of crackers late at night in the dark kitchen; she’d hide the box like it was heroin.
Because she was chronically hungry, Olivia’s mother was often irritable and short-tempered, blaming Olivia for being “overly dramatic” or “too needy,” a trait most loathed by someone with anorexia. Because her mother’s cup was empty, she perceived her daughter’s normal needs (for love, food, attention) as burdensome. Because Olivia was a bright, sensitive child, she could come to no other conclusion than that she was faulty, unlovable, too much, a disappointment. Despite her many friends, her professional success, and her delightful and effervescent personality, for 47 years Olivia has held firmly to this core belief.

Thankfully, today there is less shame and greater awareness about treating eating disorders. Moms who are suffering are seeking help.
Kerri, a mother of three, had become so depressed from her food rituals that she was not able to parent her kids, spending hours every day in her darkened room. She avoided family meals, then binged and purged when they were otherwise occupied. She sought therapy when she became frightened by her suicidal plans. She’d written the good-bye letter to her kids and staked out the bridge she was planning to drive off. But her eldest daughter was on the verge of puberty and starting to worry about her body image. This was Kerri’s wake-up call. She did not want to abandon her daughter at such a crucial stage. She remembered feeling emotionally neglected by her mom at 13 and believed that this contributed to her bulimia.
She called me for help, petrified to reveal her secret to her husband, but ready to break bulimia’s 30-year grip.
Kerri has worked hard in therapy these past two years. She is now fully engaged as a mother because she is trying to meet her needs by getting sleep, eating meals, exercising, taking medication for depression (and having hot dates with her husband!). She has meaningful discussions with her daughters about their changing bodies, saying the things that she wished her mother had told her at that age. Her kids now see her as a source of love and support rather than a source of pain.

Meanwhile on a summer morning, I try to help Olivia stop taking her mother’s inability to love her personally. Even as the Adult Olivia knows her mother has an untreated illness, the Kid Olivia still believes the faulty messages that her mother conveyed. So Olivia will need to fill the emptiness with real acts of love. She can nourish her body with rest and exercise and delicious meals (with no guilt). She can fill her heart with the love of her close friends. She can feed her soul by making a difference in the world.
Food is as essential as oxygen for our survival, but you never hear people feeling guilty for breathing too much, or making ridiculous statements such as: “Wow, you look great! Are you cutting back on oxygen lately?”

Maybe when a woman decides to become a mother, her doctor should say something like: “You are about to embark on an important journey. Please be sure to feed and nurture yourself before you attempt to nourish a child.”

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and www.mindfullivingnetwork.com.  You can visit her on the web at dinazeckhausen.com and MyEdin.org.

Battling the Inner Bully

As an eating disorder specialist, I work with bullying victims all day, every day. The irony is that no one may be actually bullying them; they are not getting mean texts on their phone. No one is spreading cruel gossip, beating them up or even threatening them.

All of this bullying goes on inside his or her own head. They carry around their Inner Bully 24/7. This may actually be the WORST form of bullying because the victim rarely, if ever, gets a break from the constant stream of abuse.

Courtney, a beautiful mother married to a great guy, has suffered from her eating disorder for over half of her life. Her husband, Bob, wants nothing more than for his wife to love herself and take care of her body. But the Bully-in-her-Brain says:

You are fat, hideous and gross. Don’t let Bob near you; if he touches your flab, he’ll be disgusted. Don’t ask him for help when you’re having a tough time; he’s sick of your whiney demands; you’ve burdened him enough. Tell him everything’s fine; what he doesn’t know won’t hurt him. Besides, if he knew what a horrible person you really are, he would divorce you like a hot potato.

Then the most insidious part. Courtney’s Inner Bully tops it off with:

I know the Real you. I’m the only one who will tell you the Truth. All those people saying you are worthy, lovable and beautiful are lying, jealous, ignorant or want something from you. You cannot trust them. If they knew the Truth they would leave: but I will NEVER leave you.

This faulty but entrenched belief system reminds me of the character of the wife in the movie “Inception.” She spends so much time inside of her own dreams that she loses touch with Reality.
When people in the “outside world” (e.g. people who don’t understand eating disorders) picture people with eating disorders, they imagine the 58-pound woman on Oprah or the 800-pound man on Jerry Springer. They do not picture the attractive, well-put together, fit-looking, successful, career-woman or home-maker.

But looking OK doesn’t mean you’re OK. Eating disorders are only partly about weight. The other part is about eating behavior, about the Bully-in-the-Brain.

I wrote a play called “What’s Eating Katie?” in which the bully of the eating disorder is played by a separate character. This character starts off seductive and sexy, with lies and promises of Beauty, Popularity and Love. Over time he chips away at his victim, teenager Katie. He becomes an abusive, controlling and domineering creep while Katie becomes more isolated and unsure of herself.

People with eating disorders who’ve seen the show ask me, “How did you know what it sounds like inside of my head?”

Empathy is the antidote to bullying. We are hard-wired to respond with empathy when we see sadness or hurt on someone’s face. This is why the explosion in the use of technology has increased bullying incidents. Texting, e-mailing or internet posting removes the face-to-face contact, causing the loss of human connection. Sometimes it’s enough to remind kids, “If you wouldn’t say it, don’t send it. Be the same person online that you are in real life.”
But reforming a hard-core bully may necessitate a deeper intervention: pushing them to feel their own hurts. In treatment for offenders, bullies who lack empathy are asked, “Do you remember how it felt when your father yelled at you?” When they can re-connect to their OWN feelings, then their hearts crack open and they’re more likely to be able to empathize with others.

This is similar to the process used to help people recovering from eating disorders. When something bad happened to them, they were not encouraged to experience or express their feelings about it. To survive, they went numb (by starving or over-eating) and tried to control the pain by internalizing the bully. “I can beat myself up better than anyone else can.”

Rather than using their eating disorder to numb the pain, actually experiencing their feelings in a safe place can help the person develop empathy for the part of them that was victimized. “Remember how it felt when those kids were mean to you at school?” “What did you experience when your Dad beat up your Mom?” There is something about this process that is transformative.

True recovery means the Kind part of you becomes stronger and louder than the Inner Bully. Healing comes when you start seeking evidence to support the notion that you are loveable and worthy, instead of seeking (or distorting) evidence that you are worthless and evil. Over time, the voice of the Bully in the Brain will become softer, more distant and, best of all, impotent.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and www.mindfullivingnetwork.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.