Surfacing After Silence

Life. After.

Nurture vs Nature

I recently received a comment in my Questions and Topics page about the biological basis of eating disorders: “As someone that has truly been there, who has struggled with an eating disorder for some time and then made it to recovery, what do you believe?  Where do you fall on the nature vs nuture?  What do you think the important components for treatment with the goal of full recovery are?”

This is a rather loaded question, and it’s had me thinking a lot during the day.  There have been studies about the biological nature of eating disorders, if certain people are, indeed, genetically predisposed to developing an eating disorder (article and article).  I do think that there may be a biological link to all of this, but I don’t think that it’s as easy as saying, “There’s a gene that causes anorexia” (they have not found such a gene).  A lot of people have a genetic predisposition for heart disease yet never develop heart disease because of their lifestyle.  Some people get exposed to germs and never get sick; some people get exposed to those very same germs and do get sick.  A certain medication works for some people yet doesn’t work for others.  Our bodies are amazingly complex and each individual body has unique characteristics and this challenges and frustrates medical doctors, let alone psychiatric doctors.

If an eating disorder were solely the result of faulty genetics, then restoring weight or stopping behaviors would mean the individual is cured.  However, that doesn’t seem to be the case for anyone I’ve met, talked to, read about, or heard about.  Nature alone cannot be blamed nor relied upon for a cure.  Nurture–the environment–must be accounted for.

Quite honestly, I think that once a person has been diagnosed with an eating disorder, the nature part is almost irrelevant and focusing on that alone would do more harm than good.  Each person needs to address the environmental triggers that contributed to his or her eating disorder.  Each individual needs to learn an entirely new way of living free of eating disorder symptoms.  Each individual must tackle the cognitive distortions that come along with an eating disorder.  All of this takes time–usually much longer than restoration of weight or cessation of outward symptoms.

So I suppose I fall on the nurture side of the debate.  I’m not denying that there may be a genetic predisposition for some people, but I think in the treatment of the eating disorder, in the treatment of the individual, environmental factors such as family, history of abuse, peers, personality traits, cognitive distortions, and one’s lifestyle hold more sway and, therefore, need more attention.  Successful recovery requires that you address not one small fraction of a person but the whole, complex individual.


June 17, 2011 Posted by | Eating Disorders, recovery, therapy | , , , , , , , , , , , , , , , , , | 5 Comments

what do we do with this?

My general policy has always been one of honesty.  And I’m not about to change that policy just because my mind resembles the mess of tangled yarn in the picture.  That mess will, at one point, become a rather neat and unique scarf.  So I’m hoping my mind will disentangle and become something spectacular as well.

I haven’t known how to bring this subject up without getting a whole bunch of “But I thought you were recovvvvveered?” type of comments.  I still don’t really know how to do so, so I’m just going to take my chances and lay it all out there.  In my “How I Did It” post, I described how recovery was a long process; it wasn’t just some place I woke up one morning to find I had arrived at.  It took time.  There were relapses, there were doubts, there were slips, and there were times when I didn’t think I would make it.  There were times no one else thought I’d make it, either.  But I did.  And there’s no going back.  I used to have a written out list of all the things I would lose if I relapsed.  I don’t need those things written out anymore–I know them and feel them in my gut.  Life has a hold of me, and it’s not going to let go.  I’m not going to let go.

So my mind right now is something I just don’t understand.  I find myself thinking about size and weight.  I find myself wishing I could be smaller. But the thought of returning to the eating disorder?  There’s a list of reasons why that’s not an option.  I know part of this is tied very tightly to the major depressive episode I’m currently entrenched in.  When these episodes happen, my logical thinking is severely impaired.  And if you spend enough time curled up in a tight little ball on your bed, you start wishing you really were that size even when you decided to move off the bed.

But then I went to therapy this week.  And in the middle of session, I looked up from the floor where I was gazing, and suddenly exclaimed, “I hate change!”  How this did not hit me before, I have no idea.  Maybe the depression is slowing my thinking down a bit, too.  For the first time in my life I am not a student, nor is there a plan for me to return to student status.  I’ve had jobs before, but now we’re using that word career.  Suddenly I’m thrown into the big adult world with no classroom to retreat to, except the one I’m teaching in, which is quite a bit different.   I’ll spare you all the self-deprecating thoughts and the questions I have about my abilities and will just sum it up rather bluntly: this scares the shit out of me.

No wonder I want to retreat.  No wonder I want to shrink from the world.  No wonder I want to disappear.  I know better than to fall back on those old coping skills, for I know that instead of saving me from the scary world, they only make things worse.  Much worse.  But I do take comfort in knowing why these thoughts suddenly popped into my head after years of absence.  My past is my past, but I now have the knowledge that I no longer have to let my past determine my present or my future.

Instead, I’m taking a lesson from my recent adventures in mindfulness:  I see the thoughts, acknowledge their presence, and let them be.  I am not judging myself for having them.  They are only thoughts.  If I attach any emotion or thought to these thoughts at all, it is to give myself credit and take pride in how far I’ve come that I can notice the thoughts and not let them define me or control me.  I determine what defines me, which has nothing to do with a set of habitual responses to massive change.  I am in control, not habits from another time.  

June 10, 2011 Posted by | Body Image, depression, Eating Disorders, mindfulness | , , , , , , , , , , , , , , , , , , | 1 Comment

An Open Letter to Those Losing Weight

Dear S0-and-So-Who-Is-Following-Doctor’s-Orders,

I realize that, medically, losing weight and becoming more in shape is healthy for you and what your body needs.  And I am proud of you for taking medical advice seriously and taking appropriate action.

Dear So-and-So-Who-May-Need-to-Lose-Weight-But-is-Doing-So-Unhealthily,

I realize that, medically, losing weight and becoming more in shape is healthy for you and what your body needs.  And while I commend your desire to follow medical advice, the manner in which you are going about it is disturbing and, if nothing else, borders on obsessive, and most likely falls into the official “disordered” category.

There is a misconception that you have to be stick thin and bony to fall into eating disorder behavior (and diagnosis), but there is no weight cut off.  Cutting out entire food groups and attending multiple exercise classes a day propel you into “unhealthy obsession” at the bare minimum.  I am worried about your physical and psychological health and would like to see you talk to someone so you can enjoy a healthy relationship with your body–regardless of its size and shape.

I am also concerned for those around you.  For anyone recovering from an eating disorder, let alone for someone trapped in the midst of an eating disorder, your behaviors and words encourage an eating disorder lifestyle and discourage someone from seeking recovery.  For someone in recovery from an eating disorder, your behaviors and words make us question our own recovery.  None of us are fooled by your claims of “health” and “nutrition” and “strength.”  We have used those excuses ourselves, and they only ever led us down a path of destruction, which is what we see happening in your life.  These excuses also hurt on a personal level because they make us realize that you do not respect what we went through in order to recover, and they also mean that you do not believe our reasons for our concern.  For someone on the verge of an eating disorder, your actions and words only encourage said individual to go ahead and plunge into the ice cold water of what is actually an illness and not a lifestyle.

Please know that you are cared for, and that we wish for you true health.  Please know that the path you are on will not lead to happiness, but will, in fact, lead to depression and self-hate.  Respect not only those around you, but also yourself.

June 2, 2011 Posted by | Body Image, Communication, Eating Disorders, relationships | , , , , , , , , , , , , , , , , , , , | 4 Comments