Sunday, December 30, 2007


Fillyjonk over at Shapely Prose has a great post on New Year's resolutions. Check it out.

This year, I resolve to:

Make progress toward learning to love my body the way it is, not the way I wish it were.

Finish my second anthology.

Sell the guitar I bought last year, and which I've played twice. Take voice lessons instead.

Do something surprising every day. OK, every week.

How about you?

Saturday, December 29, 2007

The portable Love-Your-Body Pledge

Thanks to my pal Mary Ketarkus Brown for making the I Love My Body! pledge pretty and portable. Use it as a bookmark, tape it to the inside of your cabinet door or mirror, hand it out on street corners. Say it out loud to yourself once a day. Try to mean it.

Then spread the word.

Friday, December 28, 2007

In loco parentis

Colleges should stand in loco parentis to their students, but when it comes to eating disorders and psychiatric illnesses, they rarely do.

So three cheers for this Cornell University custodian, who went above and beyond the call of duty to get help when she suspected that a student had bulimia.

We've got a long way to go, though. What if the student had refused treatment? Would the college call her parents? Probably not in this current privacy-oriented climate.

Well, it's a start.

Thursday, December 27, 2007


is what this is. Truly. I cannot speak of it. Children being harmed, mutilated, possibly killed, all because they're considered overweight. As one of the so-called surgeons involved says, “I am very pleased that youngsters will soon be offered gastric banding. Of course this will only be in extreme cases when everything has been tried and the child just cannot lose weight...."

And why exactly does a child need to lose weight so badly that s/he must be mutilated? Where does the urgency come from, the pressing need? And just how in the world can a child give informed consent for such an operation?

I don't know which is more sickening, the fat hatred that inspires such vile acts or the profit motive that no doubt encourages these surgeries. Or the thought that someday parents who refuse such surgeries on behalf of their children may be censured or have their children removed from their care.

Where are the yellow stars?

I'm going to throw up now.

Thanks to Sandy Szwarc for posting on this. I think. I'll be having nightmares. . . .

Wednesday, December 26, 2007

Meaning and metaphor

Laura Collins over at Eating With Your Anorexic posted an interesting entry today, on a topic that's close to both my heart and my obsessions. Writing about our tendency to ascribe meaning to experience after the fact, she points out some of the "meanings" that have been ascribed to eating disorders over the centuries, from piety to family pathology to cultural norms around thinness. Her point is that eating disorders neither represent nor are caused by any of these hindsight insights, and simply are biological diseases.

It's a point I can agree with. Only I find that I keep wanting to add, "But there's more!"

As a poet and a journalist, I know both sides of the dichotomy. I've written here about growing up with panic disorder, and have alluded to the levels of meaning I assigned to my anxiety over the years. I've been through more than my share of therapy for anxiety, and have often gained insight from dreams, journaling, and exploring the metaphors and allusions that come with this disorder. Writing for me became a redemptive act very early on. Even in my teens I was aware that I wanted to make meaning out of suffering. If an important poem grew out of many nights of insomnia and philosophy, existential terror and affliction, well, maybe it was all worth it. And if not, I'd still created something beautiful—or at least meaningful—out of my pain. I'd made something out of, well, not nothing, but nothing useful.

The journalist part of me understands the concepts of neurotransmitters, genetics, and brain chemistry. I've had ample evidence of my panic disorder as a biological disease, often triggered by hormonal shifts and other physiological upheavals.

But. Still. I don't think that makes the poems, the metaphors, or the insights less important or meaningful. In fact they are deeply meaningful to me and, I hope, to others.

But. Still. Years of insight-based therapy have not changed the panic attacks or anxiety in any appreciable way.

So what does it all mean? Is retrospective insight always a chimera? Should we discount it altogether and stick to the facts, ma'am, just the facts?

I think when it comes to treatments for eating disorders and other psychiatric illnesses, the answer is yes. If I dream, as I once did, that my grandmother is trying to pierce my ears with a blunt knitting needle, and causing a lot of pain in the process, I don't believe this is a clue to the roots of my panic attacks.

But I'd hate to give up the relentless and quintessentially human quest for meaning and metaphor. That's the fertile terrain of all art and much spiritual and emotional growth.

All of which is a very long-winded way to say that I think what's needed here is a separation of church and state. When it comes to causes and treatments of eating disorders and other illnesses, I'm with the scientists; give me DNA and anatomy and chemistry. But when it comes to being alive and human, I need meaning and mystery and the indirect but often achingly apt language of symbol and metaphor. We need it.

Tuesday, December 25, 2007

And another Leaden Fork award goes to

all the folks involved with this incredibly tasteless book.

How to Get Fat is one of a series of so-called "self hurt" books. We know they're supposed to be funny because of the Dick-and-Jane-style illustrations. Other titles in the series include How to Get Into Debt, How to Drive Like a Maniac, and How to Traumatize Your Children. Now there's a knee-slapper. They're all published by an outfit called Knock Knock, which describes itself this way:

We are Knock Knock, a semi-spanking-new design company with aspirations to greatness. We concoct, manufacture, and distribute witty objects of cosmopolitan panache. . . . Our customers comprise the impish, the dapper, the droll, the young-at-heart—those who feel misunderstood by Santa-inflected wrapping paper and maudlin gilded greeting-card sentiments that rhyme. . . . Knock Knock seeks to integrate art and commerce—creating original, authentic, noncynical products that support themselves in the marketplace so that we don’t have to deal with “clients.”. . . Rather than a product category, material, or target market, Knock Knock’s unifying force is a sensibility. Also, we read a lot.

I'm all for poking fun at ourselves, but this one just doesn't seem funny. The humor here derives from the usual assumption that being thin is a choice and that any idiot would certainly choose it. It's really nothing more than a po-mo diet book.

Should you feel like weighing in on this book, you can contact the publisher at or call (800) 656-5662.

Friday, December 21, 2007

Passing the Roar

A couple of days ago, writer/blogger Lisa Romeo gave me a "roar" (thanks, Lisa!) with a directive to do two things: list three things I think are crucial to powerful writing, and "roar" at a few of my favorite and fearless writers.

My three requirements for powerful writing:
Move the story forward. Good writing, like life, doesn't stay still. It's gotta move. Don't linger. Keep going.

Less is more. I'm a poet, so I learned early on that shorter is almost always better--punchier, sharper, more vivid. Compress, compress, compress.

Sound and fury. Powerful writing lives in the ear as well as on the page. Read it out loud to yourself. The sound of the words carries part of the meaning and effect.

Now, on to the roaring part. I'm going to tag a few bloggers, since this is, after all, a blog.

Kate Harding. Kate's blog, Shapely Prose, wins the I-wish-I'd-written-that award. Kate's prose is lucid, compelling, and as much fun to read as it is to write. She's a fat activist, feminista, and all-around fascinating writer. Fearless? Ya mon. Go read her. You won't be sorry.

Sandy Szwarc. Sandy's blog, Junkfood Science, takes on all manner of sacred cows, from Big Pharma to Big Science and more. If you've ever read a news article that scared you--"Obesity is contagious," for instance--check it out on Sandy's site. She's blown open a lot of b.s.

Rachel over at The F Word. It's the internet age, so I don't even know Rachel's last name. But I do know that her trifecta of obsessions--food, fat, and feminism--makes for some powerful writing. We don't always agree, but I'm always interested in what Rachel has to say.

Laura Collins. The author of Eating With your Anorexic is one of the feistiest writers/activists I know. Her book, and her online parent forum, have saved many lives. She's not afraid to take on the powers that be.

Caroline Leavitt. One of the best essayists I know. And I'm not just saying that because she's got pieces in both my first and second anthologies, either. Caroline has a gift for writing personal narratives that hit home for others.

I could probably keep going. Maybe I'll do installment 2 tomorrow.

Wednesday, December 19, 2007

Keep Santa fat and feed the hungry

I have a feeling I've come to this story late here in the fatosphere . . . but no matter. Better late than never. Thanks to littlem for sending me the link to this awesome site.

Sign the petition there to Keep Santa Fat, and the keepers of the site will donate a pound of food to America's Second Harvest.

While you're at it, make your own donation. I hate to think of anyone going hungry, at this time of year or any other.

Tuesday, December 18, 2007

Et tu, Santa?

I don't know about you, but I'd like to take this guy's red suit away.

He's a Scottish dime store Santa who refuses to pad his middle with a pillow because he thinks it makes children think it's OK to be overweight.

No, indeed. We wouldn't want the little children to grow up loving their bodies or anything.

I say we vote him off the island.

Saturday, December 15, 2007

Against blogging

I've often wondered if blogging gets in the way of my writing, if the sometimes obsessive world of the internet mucks up the quiet place I require to be creative in. So I was very interested to read Doris Lessing's Nobel Prize acceptance speech, which got very little play here in the U.S. Lessing has always been one of my favorite writers, and this speech--like so many of the Nobel acceptance speeches--gives real food for thought.

What do you think?

A hunger for books
Doris Lessing

I am standing in a doorway looking through clouds of blowing dust to where I am told there is still uncut forest. Yesterday I drove through miles of stumps, and charred remains of fires where, in 1956, there was the most wonderful forest I have ever seen, all now destroyed. People have to eat. They have to get fuel for fires.

This is north-west Zimbabwe early in the 80s, and I am visiting a friend who was a teacher in a school in London. He is here "to help Africa", as we put it. He is a gently idealistic soul and what he found in this school shocked him into a depression, from which it was hard to recover. This school is like every other built after Independence. It consists of four large brick rooms side by side, put straight into the dust, one two three four, with a half room at one end, which is the library. In these classrooms are blackboards, but my friend keeps the chalks in his pocket, as otherwise they would be stolen. There is no atlas or globe in the school, no textbooks, no exercise books or Biros. In the library there are no books of the kind the pupils would like to read, but only tomes from American universities, hard even to lift, rejects from white libraries, detective stories, or titles like Weekend in Paris and Felicity Finds Love.

There is a goat trying to find sustenance in some aged grass. The headmaster has embezzled the school funds and is suspended. My friend doesn't have any money because everyone, pupils and teachers, borrow from him when he is paid and will probably never pay it back. The pupils range from six to 26, because some who did not get schooling as children are here to make it up. Some pupils walk many miles every morning, rain or shine and across rivers. They cannot do homework because there is no electricity in the villages, and you can't study easily by the light of a burning log. The girls have to fetch water and cook before they set off for school and when they get back.

As I sit with my friend in his room, people shyly drop in, and everyone begs for books. "Please send us books when you get back to London," one man says. "They taught us to read but we have no books." Everybody I met, everyone, begged for books.

I was there some days. The dust blew. The pumps had broken and the women were having to fetch water from the river. Another idealistic teacher from England was rather ill after seeing what this "school" was like.

On the last day they slaughtered the goat. They cut it into bits and cooked it in a great tin. This was the much anticipated end-of-term feast: boiled goat and porridge. I drove away while it was still going on, back through the charred remains and stumps of the forest.

I do not think many of the pupils of this school will get prizes.

The next day I am to give a talk at a school in North London, a very good school. It is a school for boys, with beautiful buildings and gardens. The children here have a visit from some well-known person every week: these may be fathers, relatives, even mothers of the pupils; a visit from a celebrity is not unusual for them.

As I talk to them, the school in the blowing dust of north-west Zimbabwe is in my mind, and I look at the mildly expectant English faces in front of me and try to tell them about what I have seen in the last week. Classrooms without books, without textbooks, or an atlas, or even a map pinned to a wall. A school where the teachers beg to be sent books to tell them how to teach, they being only 18 or 19 themselves. I tell these English boys how everybody begs for books: "Please send us books." But there are no images in their minds to match what I am telling them: of a school standing in dust clouds, where water is short, and where the end-of-term treat is a just-killed goat cooked in a great pot.

Is it really so impossible for these privileged students to imagine such bare poverty?

I do my best. They are polite.

I'm sure that some of them will one day win prizes.

Then the talk is over. Afterwards I ask the teachers how the library is, and if the pupils read. In this privileged school, I hear what I always hear when I go to such schools and even universities. "You know how it is," one of the teachers says. "A lot of the boys have never read at all, and the library is only half used."

Yes, indeed we do know how it is. All of us.

We are in a fragmenting culture, where our certainties of even a few decades ago are questioned and where it is common for young men and women, who have had years of education, to know nothing of the world, to have read nothing, knowing only some speciality or other, for instance, computers.

What has happened to us is an amazing invention - computers and the internet and TV. It is a revolution. This is not the first revolution the human race has dealt with. The printing revolution, which did not take place in a matter of a few decades, but took much longer, transformed our minds and ways of thinking. A foolhardy lot, we accepted it all, as we always do, never asked: "What is going to happen to us now, with this invention of print?" In the same way, we never thought to ask, "How will our lives, our way of thinking, be changed by the internet, which has seduced a whole generation with its inanities so that even quite reasonable people will confess that, once they are hooked, it is hard to cut free, and they may find a whole day has passed in blogging etc?"

Very recently, anyone even mildly educated would respect learning, education and our great store of literature. Of course we all know that when this happy state was with us, people would pretend to read, would pretend respect for learning. But it is on record that working men and women longed for books, evidenced by the founding of working-men's libraries, institutes, and the colleges of the 18th and 19th centuries. Reading, books, used to be part of a general education. Older people, talking to young ones, must understand just how much of an education reading was, because the young ones know so much less.

We all know this sad story. But we do not know the end of it. We think of the old adage, "Reading maketh a full man" - reading makes a woman and a man full of information, of history, of all kinds of knowledge.

Not long ago, a friend in Zimbabwe told me about a village where the people had not eaten for three days, but they were still talking about books and how to get them, about education.

I belong to an organisation which started out with the intention of getting books into the villages. There was a group of people who in another connection had travelled Zimbabwe at its grassroots. They told me that the villages, unlike what is reported, are full of intelligent people, teachers retired, teachers on leave, children on holidays, old people. I myself paid for a little survey to discover what people in Zimbabwe wanted to read, and found the results were the same as those of a Swedish survey I had not known about. People want to read the same kind of books that people in Europe want to read - novels of all kinds, science fiction, poetry, detective stories, plays, and do-it-yourself books, like how to open a bank account. All of Shakespeare too. A problem with finding books for villagers is that they don't know what is available, so a set book, like The Mayor of Casterbridge, becomes popular simply because it just happens to be there. Animal Farm, for obvious reasons, is the most popular of all novels.

Our organisation was helped from the very start by Norway, and then by Sweden. Without this kind of support our supplies of books would have dried up. We got books from wherever we could. Remember, a good paperback from England costs a month's wages in Zimbabwe: that was before Mugabe's reign of terror. Now, with inflation, it would cost several years' wages. But having taken a box of books out to a village - and remember there is a terrible shortage of petrol - I can tell you that the box was greeted with tears. The library may be a plank on bricks under a tree. And within a week there will be literacy classes - people who can read teaching those who can't, citizenship classes - and in one remote village, since there were no novels written in the Tonga language, a couple of lads sat down to write novels in Tonga. There are six or so main languages in Zimbabwe and there are novels in all of them: violent, incestuous, full of crime and murder.

It is said that a people gets the government it deserves, but I do not think it is true of Zimbabwe. And we must remember that this respect and hunger for books comes, not from Mugabe's regime, but from the one before it, the whites. It is an astonishing phenomenon, this hunger for books, and it can be seen everywhere from Kenya down to the Cape of Good Hope.

This links up improbably with a fact: I was brought up in what was virtually a mud hut, thatched. This kind of house has been built always, everywhere where there are reeds or grass, suitable mud, poles for walls - Saxon England, for example. The one I was brought up in had four rooms, one beside another, and it was full of books. Not only did my parents take books from England to Africa, but my mother ordered books by post from England for her children. Books arrived in great brown paper parcels, and they were the joy of my young life. A mud hut, but full of books.

Even today I get letters from people living in a village that might not have electricity or running water, just like our family in our elongated mud hut. "I shall be a writer too," they say, "because I've the same kind of house you were in."

But here is the difficulty. Writing, writers, do not come out of houses without books.

I have been looking at the speeches by some of the recent Nobel prizewinners. Take last year's winner, the magnificent Orhan Pamuk. He said his father had 500 books. His talent did not come out of the air, he was connected with the great tradition. Take VS Naipaul. He mentions that the Indian Vedas were close behind the memory of his family. His father encouraged him to write, and when he got to England he would visit the British Library. So he was close to the great tradition. Let us take John Coetzee. He was not only close to the great tradition, he was the tradition: he taught literature in Cape Town. And how sorry I am that I was never in one of his classes; taught by that wonderfully brave, bold mind. In order to write, in order to make literature, there must be a close connection with libraries, books, the tradition.

I have a friend from Zimbabwe, a black writer. He taught himself to read from the labels on jam jars, the labels on preserved fruit cans. He was brought up in an area I have driven through, an area for rural blacks. The earth is grit and gravel, there are low sparse bushes. The huts are poor, nothing like the well-cared-for huts of the better off. There was a school, but like the one I have described. He found a discarded children's encyclopaedia on a rubbish heap and taught himself from that.

On Independence in 1980 there was a group of good writers in Zimbabwe, truly a nest of singing birds. They were bred in old Southern Rhodesia, under the whites - the mission schools, the better schools. Writers are not made in Zimbabwe, not easily, not under Mugabe.

All the writers travelled a difficult road to literacy, let alone to becoming writers. I would say learning to read from the printed labels on jam jars and discarded encyclopaedias was not uncommon. And we are talking about people hungering for standards of education beyond them, living in huts with many children - an overworked mother, a fight for food and clothing.

Yet despite these difficulties, writers came into being. And we should also remember that this was Zimbabwe, conquered less than 100 years before. The grandparents of these people might have been storytellers working in the oral tradition. In one or two generations, the transition was made from these stories remembered and passed on, to print, to books.

Books were literally wrested from rubbish heaps and the detritus of the white man's world. But a sheaf of paper is one thing, a published book quite another. I have had several accounts sent to me of the publishing scene in Africa. Even in more privileged places like North Africa, to talk of a publishing scene is a dream of possibilities.

Here I am talking about books never written, writers who could not make it because the publishers are not there. Voices unheard. It is not possible to estimate this great waste of talent, of potential. But even before that stage of a book's creation which demands a publisher, an advance, encouragement, there is something else lacking.

Writers are often asked: "How do you write? With a word processor? an electric typewriter? a quill? longhand?" But the essential question is: "Have you found a space, that empty space, which should surround you when you write? Into that space, which is like a form of listening, of attention, will come the words, the words your characters will speak, ideas - inspiration." If a writer cannot find this space, then poems and stories may be stillborn. When writers talk to each other, what they discuss is always to do with this imaginative space, this other time. "Have you found it? Are you holding it fast?"

Let us now jump to an apparently very different scene. We are in London, one of the big cities. There is a new writer. We cynically enquire: "Is she good-looking?" If this is a man: "Charismatic? Handsome?" We joke, but it is not a joke.

This new find is acclaimed, possibly given a lot of money. The buzzing of hype begins in their poor ears. They are feted, lauded, whisked about the world. Us old ones, who have seen it all, are sorry for this neophyte, who has no idea of what is really happening. He, she, is flattered, pleased. But ask in a year's time what he or she is thinking: "This is the worst thing that could have happened to me."

Some much-publicised new writers haven't written again, or haven't written what they wanted to, meant to. And we, the old ones, want to whisper into those innocent ears: "Have you still got your space? Your soul, your own and necessary place where your own voices may speak to you, you alone, where you may dream. Oh, hold on to it, don't let it go."

My mind is full of splendid memories of Africa that I can revive and look at whenever I want. How about those sunsets, gold and purple and orange, spreading across the sky at evening? How about butterflies and moths and bees on the aromatic bushes of the Kalahari? Or, sitting on the pale grassy banks of the Zambesi, the water dark and glossy, with all the birds of Africa darting about? Yes, elephants, giraffes, lions and the rest, there were plenty of those, but how about the sky at night, still unpolluted, black and wonderful, full of restless stars?

There are other memories too. A young African man, 18 perhaps, in tears, standing in what he hopes will be his "library". A visiting American, seeing that his library had no books, had sent a crate of them. The young man had taken each one out, reverently, and wrapped them in plastic. "But," we say, "these books were sent to be read, surely?" "No," he replies, "they will get dirty, and where will I get any more?"

I have seen a teacher in a school where there were no textbooks, not even a chalk for the blackboard. He taught his class of six- to 18-year-olds by moving stones in the dust, chanting: "Two times two is ... " and so on. I have seen a girl - perhaps not more than 20, also lacking textbooks, exercise books, biros - teach the ABC by scratching the letters in the dirt with a stick, while the sun beat down and the dust swirled.

I would like you to imagine yourselves somewhere in Southern Africa, standing in an Indian store, in a poor area, in a time of bad drought. There is a line of people, mostly women, with every kind of container for water. This store gets a bowser of precious water every afternoon from the town, and here the people wait.

The Indian is standing with the heels of his hands pressed down on the counter, and he is watching a black woman, who is bending over a wadge of paper that looks as if it has been torn out of a book. She is reading Anna Karenina. She is reading slowly, mouthing the words. It looks a difficult book. This is a young woman with two little children clutching at her legs. She is pregnant. The Indian is distressed, because the young woman's headscarf, which should be white, is yellow with dust. Dust lies between her breasts and on her arms. This man is distressed because of the lines of people, all thirsty, but he doesn't have enough water for them. He is angry because he knows there are people dying out there, beyond the dust clouds.

This man is curious. He says to the young woman: "What are you reading?"

"It is about Russia," says the girl.

"Do you know where Russia is?" He hardly knows himself.

The young woman looks straight at him, full of dignity, though her eyes are red from dust. "I was best in the class. My teacher said I was best."

The young woman resumes her reading: she wants to get to the end of the paragraph.

The Indian looks at the two little children and reaches for some Fanta, but the mother says: "Fanta makes them thirsty."

The Indian knows he shouldn't do this, but he reaches down to a great plastic container beside him, behind the counter, and pours out two plastic mugs of water, which he hands to the children. He watches while the girl looks at her children drinking, her mouth moving. He gives her a mug of water. It hurts him to see her drinking it, so painfully thirsty is she.

Now she hands over to him a plastic water container, which he fills. The young woman and the children watch him closely so that he doesn't spill any.

She is bending again over the book. She reads slowly but the paragraph fascinates her and she reads it again.

"Varenka, with her white kerchief over her black hair, surrounded by the children and gaily and good-humouredly busy with them, and at the same time visibly excited at the possibility of an offer of marriage from a man she cared for, Varenka looked very attractive. Koznyshev walked by her side and kept casting admiring glances at her. Looking at her, he recalled all the delightful things he had heard from her lips, all the good he knew about her, and became more and more conscious that the feeling he had for her was something rare, something he had felt but once before, long, long ago, in his early youth. The joy of being near her increased step by step, and at last reached such a point that, as he put a huge birch mushroom with a slender stalk and up-curling top into her basket, he looked into her eyes and, noting the flush of glad and frightened agitation that suffused her face, he was confused himself, and in silence gave her a smile that said too much."

This lump of print is lying on the counter, together with some old copies of magazines, some pages of newspapers, girls in bikinis.

It is time for her to leave the haven of the Indian store, and set off back along the four miles to her village. Outside, the lines of waiting women clamour and complain. But still the Indian lingers. He knows what it will cost this girl, going back home with the two clinging children. He would give her the piece of prose that so fascinates her, but he cannot really believe this splinter of a girl with her great belly can really understand it.

Why is perhaps a third of Anna Karenina stuck here on this counter in a remote Indian store? It is like this.

A certain high official, United Nations, as it happens, bought a copy of this novel in the bookshop when he set out on his journeys to cross several oceans and seas. On the plane, settled in his business-class seat, he tore the book into three parts. He looked around at his fellow passengers as he did this, knowing he would see looks of shock, curiosity, but some of amusement. When he was settled, his seatbelt tight, he said aloud to whomever could hear: "I always do this when I've a long trip. You don't want to have to hold up some heavy great book." The novel was a paperback, but, true, it is a long book. This man was used to people listening when he spoke. When people looked his way, curiously or not, he confided in them. "No, it is really the only way to travel."

When he reached the end of a section of the book, he called the airhostess, and sent it back to his secretary, who was travelling in the cheaper seats. This caused much interest, condemnation, certainly curiosity, every time a section of the great Russian novel arrived, mutilated, but readable, in the back part of the plane.

Meanwhile, down in the Indian store, the young woman is holding on to the counter, her little children clinging to her skirts. She wears jeans, since she is a modern woman, but over them she has put on the heavy woollen skirt, part of traditional garb of her people: her children can easily cling on to it, the thick folds.

She sends a thankful look at the Indian, who she knows likes her and is sorry for her, and she steps out into the blowing clouds. The children have gone past crying, and their throats are full of dust anyway.

This is hard, oh yes, it is hard, this stepping, one foot after another, through the dust that lays in soft deceiving mounds under her feet. Hard, hard - but she is used to hardship, is she not? Her mind is on the story she has been reading. She is thinking: "She is just like me, in her white headscarf, and she is looking after children, too. I could be her, that Russian girl. And the man there, he loves her and will ask her to marry him. (She has not finished more than that one paragraph). Yes, and a man will come for me, and take me away from all this, take me and the children, yes, he will love me and look after me."

She thinks. My teacher said there was a library there, bigger than the supermarket, a big building, and it is full of books. The young woman is smiling as she moves on, the dust blowing in her face. I am clever, she thinks. Teacher said I am clever. The cleverest in the school. My children will be clever, like me. I will take them to the library, the place full of books, and they will go to school, and they will be teachers - my teacher told me I could be a teacher. They will live far from here, earning money. They will live near the big library and enjoy a good life.

You may ask how that piece of the Russian novel ever ended up on that counter in the Indian store?

It would make a pretty story. Perhaps someone will tell it.

On goes that poor girl, held upright by thoughts of the water she would give her children once home, and drink a little herself. On she goes, through the dreaded dusts of an African drought.

We are a jaded lot, we in our world - our threatened world. We are good for irony and even cynicism. Some words and ideas we hardly use, so worn out have they become. But we may want to restore some words that have lost their potency.

We have a treasure-house of literature, going back to the Egyptians, the Greeks, the Romans. It is all there, this wealth of literature, to be discovered again and again by whoever is lucky enough to come up on it. Suppose it did not exist. How impoverished, how empty we would be.

We have a bequest of stories, tales from the old storytellers, some of whose names we know, but some not. The storytellers go back and back, to a clearing in the forest where a great fire burns, and the old shamans dance and sing, for our heritage of stories began in fire, magic, the spirit world. And that is where it is held, today.

Ask any modern storyteller and they will say there is always a moment when they are touched with fire, with what we like to call inspiration, and this goes back and back to the beginning of our race, to fire and ice and the great winds that shaped us and our world.

The storyteller is deep inside everyone of us. The story-maker is always with us. Let us suppose our world is attacked by war, by the horrors that we all of us easily imagine. Let us suppose floods wash through our cities, the seas rise . . . but the storyteller will be there, for it is our imaginations which shape us, keep us, create us - for good and for ill. It is our stories that will recreate us, when we are torn, hurt, even destroyed. It is the storyteller, the dream-maker, the myth-maker, that is our phoenix, that represents us at our best, and at our most creative.

That poor girl trudging through the dust, dreaming of an education for her children, do we think that we are better than she is - we, stuffed full of food, our cupboards full of clothes, stifling in our superfluities?

I think it is that girl and the women who were talking about books and an education when they had not eaten for three days, that may yet define us.

Thursday, December 13, 2007

Ransom me

NYU's "Ransom Notes" ad campaign has taken a lot of heat in the form of bad press lately.

In case you've been in Tahiti for the last few weeks, these ads are written in the form of mock ransom notes from children with a range of psychiatric disorders, from autism to anorexia. The premise is that these illnesses "kidnap" kids, and that treatment "rescues" them.

And guess what? I think this is BLOODY BRILLIANT. I had panic disorder--undiagnosed and untreated--for my entire childhood, and this is exactly how it felt even to me at the time. I wish someone had noticed my distress and rescued me. And as the parent of a teen with anorexia, I appreciate the sentiment here--that parents need to wake up and do something.

I get the counterarguments, especially as they come from parents in the autism advocacy movement. And I'm just as cynical as the average reader (maybe more so) about the drug company lobbies. There's money to be made in peddling medications, and kids are a big market.

But none of this holds a candle to the absolute life-shattering despair of living with an untreated psychiatric illness. Of feeling like you're going mad and no one is noticing. Of the fallout of years and years of feeling so alone and helpless.

I often wonder how my life might be different had someone helped me with panic disorder when I was a child. I suspect I'd be a very different person today. And while those who know and love me might say, "We wouldn't want that!"--I'd take it in a heartbeat.

Sometimes a strong message is what's needed. I think BBDO, the agency that created this campaign, got it right.

Tuesday, December 11, 2007

Shopping for ice cream in a fatphobic world

Whether you're in recovery from an eating disorder, or just have your head on straight when it comes to food and eating, I hope you'll enjoy this piece in today's New York Times.

Saturday, December 08, 2007


This new "study" deserves its very own made-up word--that's how utterly ridiculous and misleading it is.

It's a classic case of distortion, from the headline--"Obese? Drive at Your Own Risk!"--to the bait-and-switch of its conclusion. Based on research involving people in car accidents, it purports to look at how BMI affects your risk of dying in a car accident.

Here's how it opens:

Being obese may increase the risk of perilous diseases like diabetes, heart attack, stroke and cancer. And it can be fatal in one more way -- it enhances the risk of dying in a car crash.

What's the connection? Well might you ask. This is one of those reviews masquerading as a study, where researchers look at data--in this case, data on people involved in car accidents and their BMI.

Researchers divided over 230,000 people into groups based on their body mass index (BMI) . The rate of always wearing seat belts was 82.6 per cent for non-obese motorists (BMI less than 25), 80.1 per cent for overweight motorists (BMI 25-29), 76.6 per cent for obese motorists (BMI 30-39) and 69.8 per cent for extremely obese motorists (BMI 40 and above). The gap climbed from 2.5 per cent for overweight, to 6.0 per cent among the obese, to 12.8 per cent among the extremely obese.

Um, what we've got here is a correlation between not wearing your seat belt and dying in a car crash, along with a statistical analysis of percentage of seat belt wearers and their BMI.

As Sandy Szwarc is fond of saying correlation is not causation. Or, to put it another way: The media is willing, but the evidence is weak.

Practicing with a license

I've given serious thought to going back to school and getting an MSW so I could get licensed as a therapist and work with people who have eating disorders. I've often felt this year like I was practicing without a license--giving therapeutic advice while not being a therapist or having any medical training myself--and wondered if I should get some training.

And I probably will get more training, at some point. But this advice column reminded me that a license doesn't necessarily mean that a) you know what you're talking about, or b) you give good advice.

It's written by someone with an MSW who displays appalling ignorance about eating disorders and the state of treatment. She sounds a lot like the first therapist we saw when my daughter was diagnosed with anorexia. A mother wrote in about her young daughter, who she believes is showing signs of anorexia, and this social worker responded by, first, pooh-poohing the mother's sense of her daughter's health:

Though child anorexia is now being diagnosed in girls as young as six years old, my gut tells me that it’s not the case here. X's weight is stable, and girls suffering from anorexia usually exhibit a rapid and profound weight loss.

Wrong, wrong, wrong. That's what I thought when my daughter got sick, and because she hadn't lost a lot of weight, I figured she couldn't have anorexia. In fact with children and adolescents the issue is often a failure to gain weight rather than a dramatic weight loss. When you weigh only 70 pounds to begin with, it doesn't take much to tip you into a state of malnutrition.

The therapist goes on to say that

Anorexia, which is an eating disorder, is linked to an emotional problem. It is not about food, but rather about feelings. These are often feelings of intense levels of tension and anxiety, or an inability to cope with one’s surroundings. It’s complicated, and it’s certainly not something that most parents would be qualified to “fix.”

Wrong again on every count. As readers of this blog already know, the latest research on eating disorders shows that they are biological illnesses--brain disorders. The head of NIMH has gone on the record saying so. And while they surely are complicated illnesses, there's no one in a better position to help "fix" them than a parent, because the treatment is food. Not psychobabble*. Not circular discussions about feelings. There may be value in therapy, but later on, when the brain is nourished and working properly again.

I guess having a license doesn't mean you know what you're talking about. And not having one doesn't mean you don't. I won't be going back to school but I'm going to keep on trying to educate families and professionals about the realities of eating disorders until the so-called professionals get a clue.

*Apologies to my therapist friends. I'm a big believer in therapy--just not for someone who's acutely malnourished. Food first, talk later.

Monday, December 03, 2007

Would you rather be fat or live another 20 years?

Readers of this blog have no doubt heard about the study* that showed a shockingly high percentage of people would rather be blind, lose a limb, live a shortened lifespan, and suffer other calamities--so long as they didn't have to be fat.

Now a new study may put that fatphobia to the test. Researchers at the Fred Hutchinson Cancer Research Center in Seattle have found that nematode worms who were exposed to one of the tricyclic antidepressants lived up to 30 percent longer lifespans. Their hypothesis: the drug disturbed the balance of chemicals in the brain and created a "perceived, but not real" state of starvation that altered the creatures' natural lifespans.**

Sounds like sci fi, doesn't it? After all, humans have been chasing a longer lifespan since Ponce de Leon hunted for that fountain--and probably long before that. But wait, said the researchers, even if this effect could be shown in people, they're not going to go for it, because that class of medications causes "weight gain and increased appetite."

So someday we really might be faced with a choice between being fat and living significantly longer.

What would *you* do?

** See

Sunday, December 02, 2007

Want to lose weight fast?

Carrie over at Ed-Bites has some brilliant ideas for you.*

*Please note: My tongue is inserted firmly in my cheek.

Saturday, December 01, 2007

Mom's off the hook, Dad's on the hot seat

For the last 60 years or so, parents have been blamed for their children's eating disorders. Doctors have believed, and said, that anorexia and bulimia are caused by overcontrolling parents, by abusive parents, by sexual trauma, by inattentive parents, by cold parents, hypercritical parents. New research on the biology of eating disorders has slowly begun to offer an alternative to the blame game--a combination of genetics, biology, and environment is probably responsible for eating disorders, or so goes the latest thinking. (Though some folks clearly have some catching up to do on this score.)

Now a study from Australia points the finger once more at parents--specifically fathers, who are charged with contributing to a child's anorexia when they exert too much control. Mothers, on the other hand, played no apparent role.

I haven't read the original study, but the article reporting it makes me wonder how, exactly, this data was gathered. Reading between the lines, it seems the descriptions of the paternal relationships were reported by the teens with anorexia. Well, they'd have to be, wouldn't they?

Anyone who's parented a teen with anorexia knows that someone in the grip of an eating disorder may reflect a lot of anger toward parents, especially if those parents are insisting that the teen eat. It's really not the teen talking but the disease, which famously warps perceptions and behaviors.

While I'm sure there are overcontrolling fathers out there who contribute to their child's unhappiness in various ways, I'm a little leery of this kind of thing being reported as fact in a scientific study--and of what may come of it down the line.

As Daniel Le Grange once pointed out to me, by the time families come in for help with a teen's eating disorder, they tend to look pretty overcontrolling, because they're terrified at their child's behavior and frightened for her/his health and life. So even if the observations are made by someone outside the family, I wonder how meaningful observations made in a time of family crisis really are when thinking about causation.

God knows we need more studies about anorexia and bulimia--the lack of them is in part responsible for the dreadful lack of effective treatment options. I just wonder if this is the best use of research dollars. Wouldn't the money and time be better spent looking at ways to help teens recover rather than blaming their parents?

Um, just a thought.

Thursday, November 29, 2007


That's about all I can say right now about this destructive, damaging, obscene board game meant for preschoolers. It's about as subtle as a fart gag, and about a million times more noxious, because it seems designed to turn young children into budding anorexics.

The incomparable Sandy Szwarc had a lot to say about this today. As she points out, "[The game] teaches that foods, especially “bad” foods, make them fat. The message illustrated is that when a food is eaten, they must purge by expending a certain number of calories in exercise to avoid getting fat. Calorie counting before they can count."

The game reminds me of another ill-advised project of the last year, the inexplicable collaboration between two of my favorite children's authors on a book demonizing fat people and making plenty o' assumptions about them.

May Hungry Hank go the way of The Gulps. And fast.

Talking to middle school staff

Yesterday I made the first of what I hope will be many presentations to middle school staff--at my younger daughter's middle school, because that seemed like a good place to start. I'd put together a PowerPoint on 6 things I wanted them to know about eating disorders and 8 ways they could help.

The group was smaller than I'd hoped for, but they were really engaged. These are people who do truly care about the lives of kids. I was very heartened by that. Like doctors, they don't get any special training in eating disorders, and they're often frustrated and frightened by what they see.

I was also heartened by a conversation we got into on the "wellness" curricula--the same cockamamie stuff that bans syrup from elementary school lunchrooms and forbids a second slice of pizza to 4th-graders. One of the messages I tried to convey was how the increasing and heavy-handed emphasis on "eating healthy" and the war on obesity as played out in the schools was likely to trigger more eating disorders. It certainly sends a screwed-up message to kids and disrupts their lifelong relationship with food and eating. I'd braced myself for pushback along the lines of "Well kids are unhealthy and it's our job to help them learn to control themselves!" Instead, I got lots of nodding heads and comments about how worried they, teachers and staff, are about the shrill curriculum.

That made me feel good. There is room to broach these subjects, in public, and to begin a dialogue on them. Nothing changes if we just sit at home bitterly blogging about this stuff. We've got to get out in the real world, say our piece, and talk about it.

Tuesday, November 27, 2007


It all started innocently enough, with a 4th-grader and a school lunch. Said 4th-grader was having the school's hot lunch that day--French Toast Stix [sic]--and mentioned to her mother that maple syrup was no longer served with this, um, lunch, thanks to the new "wellness" policy in our school district.

So Mom sent along the tail end of a bottle of maple syrup with 4th-grader. And Mom got a phone call the very next day, reminding her that it is not OK to send in maple syrup, which is now apparently considered a controlled substance in the lunchroom.

Of course, I can see why maple syrup would be banned from an elementary school lunchroom. It's way too unhealthy to be eaten by children. And it no doubt contributes to the Obesity Epidemic! Whereas serving deep-fried bread sticks--or stix--does not.

No less a personage than the principal herself got involved in Syrupgate, because there's nothing more important than our children's BMIs (I mean health).

It's the same ridiculous pseudo-reasoning that limits all children in elementary schools here to one and only one slice of pizza on pizza day. Have you ever seen an elementary-school-size slice of pizza? It wouldn't fill a rat's stomach for an hour, let alone the stomach of a growing child for the rest of the afternoon.

Two slices of pizza and a swig of maple syrup might satisfy the children's hunger . . . but it might also Make Them Fat. And we all know it's better to be hungry than to be fat, right?

At least in my town.

Sunday, November 25, 2007

"Mom, I'm too fat!"

These are the words to strike terror into a mother's heart, especially if you've ever dealt with anorexia or bulimia in your house. Every child or teen with an eating disorder says these words at one time or another. They reflect the delusion at the heart of an eating disorder, the distorted perceptions of her/his own body and the anguish caused by those distortions.

I heard them many times in the year my older daughter was sick with anorexia. But this time, this weekend, they were uttered by my younger daughter.

My younger daughter sat with us at the table during the year and a half of re-feeding. She lived through the horror and terror of it all with us. We tried to protect her from the worst of it, but she certainly experienced firsthand the nightmare of living with an eating disorder. This may contribute to the reality that as the sibling of a child with anorexia, she's 8 times more likely to have it than other kids her age.

And we've talked about it. Boy, have we talked. We've talked about unrealistic body images and the media. We've talked about food-as-fuel. We've talked about bodies-come-in-all-shapes-and-sizes. We've talked about health-at-every-size.

I thought we'd talked our way through the dangerous parts and onto the solid shores of reason and understanding.

But the trouble is, as my younger daughter informed me, I just don't understand. I don't understand what it's like to be in 7th grade and be a girl. I don't understand what it's like to be a year or two behind when it comes to puberty, to still have a child's body, a child's shape, in a world full of budding young women.

"They look like this, Mom," she cried one night this weekend, sucking in her stomach to show me. Whereas my younger daughter still has the round shape of a child. She's younger than everyone else in her class, shorter, and clearly going through puberty later.

I don't think other kids are making fun of her for her childish figure. I think this is a case of institutionalized self-loathing. But I don't know for sure. I do know that seventh grade girls diet. A lot. And that they talk about their diets. And they talk, as young women (and some young men) do, about how fat they are.

They talk about how fat their butts and thighs and stomachs are. I know these kids; I've chaperoned them on field trips and come into their classrooms for years. They are not fat. They are not the headless fat children whose photos you see accompanying every media scare on the subject of childhood obesity. They look no different from kids of my generation, except that maybe they're a little taller.

Even if they were fat, of course, it would make no difference.

These children are bombarded with media images of super-thin women and men, and so that body type and paradigm comes to look very normal to them. They watch a lot of TV and movies and they learn to see themselves as sexualized from an early age.

They're bombarded at school with hysterical warnings about body fat and obesity and unhealthy eating. They are forced to watch Supersize Me. They are weighed and their BMIs calculated, in front of other children. Their body fat is "measured" (however inaccurately) with calipers, all in front of other children. They are taught that there's good food and bad food, that some foods are unhealthy, that some bodies are unacceptable. They're taught that you can never strive hard enough to be thin, to exercise, to avoid certain foods.

Some of them develop eating disorders. Maybe they would anyway; there's no way to know. We do know that some kids come hard-wired to be susceptible to an e.d., and that those disorders can then be triggered by environment and other factors. So maybe if they grew up in a culture that wasn't obsessed by issues of weight and body size and shape, they would pass through the dangerous time of adolescence without ever developing an e.d. If they grew up in a culture where it was OK to be who you are--fat or thin, intellectual or street-savvy, funny or serious--they would come out of adolescence loving themselves, not hating who they are.

Maybe this is all wishful, deluded thinking on my part.

I do know that those words my younger daughter said struck pure terror into my heart. That we will be talking about this from every direction I can think of over the next few months and years. That I'll be watching her like a hawk for the first inklings of an eating disorder, watching with terror a lump in my throat, with the memories of my older daughter still fresh, and with the determination to do whatever it takes to save her if she is in fact in danger.

But my god, how I wish I didn't have to. It occurs to me for pretty much the first time how different this would feel is the culture supported me rather than fought me. But in this culture and time, to advocate for, as Ellyn Satter says, a "joyful, comptent relationship with food," is to swim against the current, to fight the mainstream, to be perceived in many ways and places as a nutcase, a fruitcake, a mom-with-an-agenda in the worst possible sense of the word.

I've developed a thick skin. I don't care what the powers that be think. I care only about my children, and other people's children. But it's so easy to buy in to the culture's sick obsession. So easy, in a certain way, to turn to my younger daughter and say, "You do have a little tummy, dear--why don't we go on a diet? Together?" To unwittingly set her up for either a lifetime of physical self-loathing or disordered eating, or the hell of a full-blown eating disorder.

Not today. Not my daughter.

Wednesday, November 21, 2007

Media misunderstandings

I suppose I should be glad that my local newspaper is covering eating disorders in this article on a 41-year-old woman with bulimia.

But you know, it's hard to feel encouraged when you read lines like this:

Thanksgiving, challenging for anyone on a diet, is particularly problematic for people with eating disorders, whose troubles with food generally stem from deep psychological issues, therapists say.

There's a whole lotta sloppy thinking and reporting packed into that one paragraph. For one thing, it conflates "anyone on a diet" with "people with eating disorders," as if an eating disorder was the same phenomenon as a diet, only taken to an extreme.

And of course the line about "deep psychological issues" is just the same old b.s. we've been hearing since Hilde Bruch started writing about anorexia.

We know a hell of a lot more about these diseases now than Bruch did. We know they're biological illnesses. We know that genetics plays a huge role. And we know that you don't need "psychological issues" to develop anorexia or bulimia.

SOmeone who's lived with an e.d. for 20-some years may well have "deep psychological issues" with food. But it's a chicken and egg thing. The illness comes first, the "issues" come later.

The article goes on to describe how the woman with bulimia has been hospitalized seven times (six times at Rogers Memorial) for her eating disorder and still struggles with it. The tone smacks of prurience--"She actually might get up from the Thanksgiving table and vomit!"--and the continued conflation of eating disorders and dieting leads to comments like "Therapists encourage people with eating disorders — and anyone with more routine concerns about overeating on Thanksgiving — to plan ahead. Consider what items might be served and decide how much of each you'll eat."

Um, that sounds exactly like eating disorder talk to me.

It's all about the food

I love this article, which talks about new research showing that when it comes to getting nutritional bang for your buck, it's food itself rather than supplements, vitamins, etc. that holds the key.

The article refers to recent studies that have looked at whether ingesting specific nutrients--B vitamins and beta-carotene--can prevent heart disease, cancer, and other ailments. All of these studies so far have shown no value, or even a slight negative value, to the supplement approach.

These researchers argue that it's the food, not what's in it, that's good for us. Sitting down to a plate of steamed kale with olive oil and garlic is an entirely different matter, nutritionally, than dosing yourself with B-vitamins, iron, etc. This follows along with conclusions from a 1970s study showing that when you enjoy what you're eating, you actually get more nutritional value from it. Shocking!

Here's the money quote in my book:

[Researchers] focus on the concept of food synergy - the idea that more information about the impact of human health can be obtained by looking at whole foods than a single food component (such as vitamin C, or calcium added to a container of orange juice).

Just as some of us have been saying all along, food is medicine.

So on this Thanksgiving week, lift a fork in honor of the pleasures and privileges of food. Say thanks to your body, a splendid machine that knows how to make use of food, and to your taste buds, which let you enjoy it.

Then dig in.

Thursday, November 15, 2007

The obesity paradox, redux

In the category of why-is-this-so-hard-to-believe, Reuters reports that the effects of the so-called "obesity paradox" have prevailed in yet another study, this one on people with heart disease and high blood pressure.

The results substantiate earlier results showing the now-famous J-shaped mortality curve described by Dr. Katherine Flegal, wherein overall mortality rates are highest at either end of the spectrum and lowest in those in the "overweight" category. What's significant about this study is that it concentrated on people with heart disease--who are, if you listen to the media at all on this subject, in imminent danger of death if they carry even a couple of "extra" pounds.

This study of 22,576 people with high blood pressure and coronary artery disease found that

compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater).

The article is accompanied by--what else?--the obligatory shot of headless fatties. And its wrap-up leaves something to be desired:

In a commentary, Dr. Carl J. Lavie and colleagues of the Ochsner Medical Center, New Orleans caution that while improved outcomes appear to be consistently associated with increased BMI, "one should not conclude that weight reduction is detrimental in overweight populations."

I'm not sure what we should be concluding then, except that the media coverage on this subject is, as usual, beyond biased.

Sunday, November 11, 2007

And the next Leaden Fork award goes to . . .

Dr. John Tickell, billed as an "Australian expert in nutrition and weight control," for his passionate campaign to charge obese airline passengers extra for being fat.

"Airlines are buying fuel, and if you are carrying a heavy weight on a plane you have to pay more for it. But instead, the rest of the public is paying for it. It's got to be restricted," said Tickell.

Uh-oh. Do I hear the sound of thin entitlement?

Tickell went on to greater heights of hyperbole with this comment: "Flight attendants in the US have to go down the aisle handing extension seatbelts out like headphones."

Maybe he'd prefer that fat people didn't wear seat belts on a plane. Maybe some bruises and broken bones in case of turbulence would open our eyes to the fact that , golly, we're fat!

Turns out Tickell is ticked off because he was once charged $100 to check golf clubs, while a passenger who "outweighed him and his golf clubs" didn't have to pay extra.

Maybe security should just require surgical removal of excess fat at the checkpoint. That would solve the problem, right, Dr. Tickell?

Thursday, November 08, 2007

What we all can do

A young woman I didn’t know died last week. She was bright and talented and had many interests—acting, writing, music. She wanted to teach and have a family when she grew up. Only she’s never going to grow up.

I didn’t know this young woman, but I know the kind of disease that killed her, because it nearly killed my daughter. We don’t talk about these illnesses much. We don’t talk about the fact that one of them is the deadliest psychiatric disease, or that it kills 20 percent of its victims and makes life hell for the other 80 percent—for a year, for five years, forever.

We don’t talk about it because so many people still think that people with these diseases are spoiled rich kids acting out, looking for attention, or trying to punish their parents. They think these illnesses are a lifestyle choice, and they can’t imagine why anyone would choose it.

The diseases are eating disorders. The reality is that people don’t choose them and can no more choose to recover from them than you can choose to cure yourself of cancer.

I don’t know this young woman’s family, but I know something of what they’ve gone through, because our family went through it, too. Lots of families in my community have gone through it, but few will talk about it. They don’t talk about how an eating disorder steals a teenager’s life, or how insidious it is, and they sure as hell don’t talk about how deeply ashamed and guilty they are about their child’s illness.

There are doctors and nurses in my community who still blame families when a child has an eating disorder. Who will tell you, with a look of disdain, that you did this to your child. You’re the reason your child weighs 70 pounds and is too weak to sit up in bed. You’re the reason your bright, charming, funny child can do nothing but shake and cry and still, even though she’s starving to death, cannot eat. You're the reason your National Merit Scholar throws up everything she eats. It’s because of you that your child has died, because you’re too smothering, too cold, too enmeshed, too anxious, too controlling, too permissive.

The latest research on eating disorders clearly shows that genetics and biology are the biggest risk factor for an eating disorder. But we as a society haven’t caught up to scientific reality yet. We still blame families, the way we used to blame them for autism and schizophrenia and homosexuality. We still brand them with a devastating stigma.

And as long as this shame and stigma prevail, other young women and men will suffer and die. We need more effective and more evidence-based treatments for eating disorders, and one reason we don’t have them is because so little research has been done. And one reason for that is that so few parents are able or willing to step up and become advocates for their children. The stigma and shame are too great.

We can do better than this. As a community, we can come together around a family struggling with an eating disorder the way we come together for families struggling with cancer or other terrible illnesses. Our children need compassion and empathy. They need us to understand that they don’t choose to have an eating disorder and they can’t unchoose it. They need and deserve better treatments and more understanding.

I cried when I read this young woman’s obituary. I cried for a girl I will never know. I cried for my daughter and for all the young women in this community and elsewhere who are battling the demons of an eating disorder.

My tears won’t change a thing. But I’m hoping my words will change the way you think about anorexia and bulimia. And the next time you hear about a child who’s been diagnosed with anorexia or bulimia, instead of wondering what went wrong in that family, you’ll wonder instead what you can do to support them through the most terrible and difficult time of their lives.

Wednesday, October 31, 2007

In the category of "We coulda told ya"

comes this story from the International Journal of Obesity, which reports that there's something even worse for you than being too fat or too thin: thinking that you're too fat or too thin.

According to the article,

. . . individuals with overweight or underweight perceptions have an increased chance of experiencing medium (40 per cent and 50 per cent, respectively) and high levels of psychological distress (50 per cent and 120 per cent, respectively).

By comparison, being fat or thin in and of themselves were

not associated with psychological distress.

According to lead researcher Dr. Evan Atlantis from the University of Sydney, "weight perceptions that deviate from societal 'ideals' are more closely and consistently associated with psychological distress than actual weight status, regardless of weight misperception."

In other words, to misquote Maria Muldauer (and to make an unforgiveably bad pun), it ain't the meat, it's the emotion.

Atlantis went on to say, "Our findings suggest that public health initiatives targeting psychological distress at the population level may need to promote healthy attitudes towards body weight and self-acceptance, regardless of weight status."

Yup. We coulda told ya that. But it's nice to hear it from someone in the science community anyway.

Boycott this company

for its repulsive and unfunny Halloween costume glorifying and romanticizing the most lethal psychiatric disorder there is.

Write them a letter: 3WISHES.COM, Inc. 2144 East Lyon Station Road, Creedmoor, NC 27522. Better yet, call them on their own toll-free line: 800-438-6605.


Sunday, October 28, 2007

New York Times blogger Judith Warner wrote recently an interesting post about migraines and her attempts to get off medication for them. Her new approach included an extremely restrictive diet, which eliminated coffee, chocolate, MSG, nuts, vinegar, citrus fruits, bananas, raspberries, avocados, onions, fresh bagels and donuts, pizza, yogurt, sour cream, ice cream, aspartame and all aged, cured, fermented, marinated, smoked, tenderized or nitrate-preserved meats.

It sounds something like the diet I went on when my children were very colicky babies, which cut out everything worth eating and left me, as Warner writes about herself,

ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. . . . But . . . once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.

That's certainly what I experienced on the colic diet: a sense of pride and self-righteousness that almost made it all worth it.

Knowing what I now know about eating disorders and how crucial reinforcement is in creating the feedback loop that sustains them, I wonder whether any kind of restrictive diet can put you into that mindset. Maybe if Warner or I were genetically susceptible to eating disorders, we'd have developed them.

It makes me even clearer that dieting is not a good idea, especially for teens, who are most vulnerable to the development of an eating disorder. Better to stay away from that kind of reinforcement.

For the record, Warner writes that while the migraine diet helped for a couple of weeks, it failed to cure her migraines. So she's back on meds and back to eating a more normal diet. Good for her.

Friday, October 26, 2007

One hospital that gets it

I'm deeply encouraged by a new study from the Children's Hospital at Westmead, in Sydney, Australia, where in 2002 clinicians set out to reduce the rate of readmissions and relapses they were seeing on the eating disorders ward. They began offering the Maudsley method for families with children and teens being discharged, and saw their readmission rates drop significantly.

They also identified four "practice challenges," aspects of treatment to pay attention, and I think three of them are worth repeating here because they get to the core of the challenges of family-based treatment.

1. Parallel process, or getting families and treatment providers on the same page. "Failure to achieve this tends to replicate the dynamic seen in a split parental team and leads to conflict, confusion and treatment failure," wrote the study's authors.

2. The therapeutic relationship with the family. "The therapists connection with the parents plays a significant role in helping them remain focused and energized for the task at hand. . . . The relationship for single parents with the therapist and supporting team is particularly significant, taking on an important role of emotional support that parallels the support that parents would give each other in an intact family."

3. Difficulty in predicting which families will succeed. "Clinicians need to maintain optimism and faith in a family's capacity, regardless of how they present."

Parents, if you're looking for treatment for your child, I hope you'll keep these important lessons in mind. Don't be afraid to bring them up with your treatment team.

Saturday, October 20, 2007

5 Things You Should Never Say

We've talked about the kind of corporeal self-loathing that's become institutionalized in American culture, especially among women. We've promised to try to love our own bodies. (Right?) Now let's take all that a step further and think about the kinds of things we say to one another about the way we and other people look.

Here's my vote for 5 things you should never, ever say to anyone. No matter how thin or fat s/he is. No matter how much you really want to. Because not one of these comments is helpful, and some are harmful--to you if not to the other person involved.

1. You look great! While there's nothing wrong with a sincere compliment, this is typically not sincere. It's usually code, meaning either You look great, you've lost some weight! or You look great even though you're still fat! Try, instead, something specific, like I love your hair like that. Better yet, skip the comments on other people's appearance and find something more interesting to talk about.

2. I never eat X. Maybe you're a vegetarian who hasn't eaten meat in 20 years. Maybe you're allergic to chocolate. Or maybe you're caught up in the good food/bad food syndrome, where the demon du jour is carbs or fat or whatever. My advice: Keep your food tics to yourself. Better yet, get over them. Learn to love your body and respect the fuel that keeps it going.

3. I guess you got the thin genes! This comment was actually directed to my daughter by a salesperson. I was the one shopping; I'd just come out of the dressing room with an outfit on. My daughter had recently been diagnosed with anorexia and was emaciated and awful looking; she was with me that day because she was too anxious to be home alone. This salesperson managed to insult both of us with one comment. I haven't shopped in that store (which used to be one of my favorites) since.

4. Aren't you worried about your health? Translation: You should damn well be worried about your health, you fatso. Given what we know about the tenuous to nonexistent relationship between weight and health (see Sandy Szwarc's righteous columns, Paul Campos' writings, Gina Kolata's book, and other up-to-date treatments of this subject), this comment is outdated and ineffective. And just plain cruel.

5. I wish I had a little anorexia! Do I need to tell you why this is a stupid, cruel thing to say? I don't think so. You realized that the minute it came out of your mouth.

Now that you've developed your inner editor, here's one thing you can always say: I love you. Repeat as needed.

Friday, October 19, 2007

National Love Your Body Day

In honor of National Love Your Body Day, I want to remind my readers to take the "I Love My Body" pledge.

Then check out the Love Your Body show.

Then do something fun for your body today--take a walk, eat some chocolate, go dancing,sunbathe (well, not if you live in Wisconsin). Be kind to your body and yourself. Doctor Harriet's orders.

Wednesday, October 17, 2007

Attention chocoholics

According to this study, there are two kinds of people in the world (metabolically speaking): chocolate lovers and those who are (can it be?) indifferent to chocolate's virtues.

The idea behind the study, frankly, smacks a bit of Big Brother:

This study by Swiss and British scientists breaks new ground in a rapidly emerging field that may eventually classify individuals on the basis of their metabolic type, or metabotype, which can ultimately be used to design healthier diets that are customized to an individual's needs.

I'm not sure I want to go there, or anywhere where someone is going to design a "healthier" diet just for me. Been there, done that (Weight Watchers, 1974).

Still, if it included chocolate, maybe it wouldn't be so bad. . . .

Monday, October 15, 2007

Bet you won't see any mainstream news stories about this

And by "this" I'm referring to the results of the biggest clinical trial of healthy eating ever, as reported by Sandy Szwarc over at Junkfood Science. We're talking about part one of the Women's Health Initiative Dietary Modification Trial, which posted results like these:

• Healthy eating had no effects on rates of cardiovascular disease.
• Healthy eating had no effects on rates of breast or colorectal cancers.
• Women who followed a "healthy (lower-fat) diet did not wind up thinner.
• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.

Did you read any news stories about this? Me neither.

Results from Part II are about to come out. I can't wait to not read those, too.

Stick it to Ed (musically)

One of the great pleasures of the NEDA conference for me was meeting Jenni Schaefer, author of the book Life Without Ed. Jenni is a courageous and articulate advocate for all those who have struggled with eating disorders.

And she also happens to be a pretty rockin' songwriter, too! Her new single CD is called, what else, "Life Without Ed," and it's inspiring listening. Have a listen here. It's very cool.

Do your Monday morning best for mental health parity

This just in from the Eating Disorders Coalition:

"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!

If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"

And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”

Go forth and help make policy. And parity.


John D. Dingell (MI), Chairman

Ratio: 31-26
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

Saturday, October 13, 2007

See a video on Maudsley

Here at NBC Chicago. Try not to pay attention to the misleading title, and you will have to watch a short ad before the video loads, and of course there are the usual caveats at the end of the piece. But it seems like a good look at an ordinary family who are helping their daughter through family-based treatment Features Dan Le Grange. I think it's worth a watch.

Thursday, October 11, 2007

I just don't get it

It is just shocking to me that so many people misperceive and fear family-based treatment.

I'm no dummy: I know even FBT is no panacea. It won't cure everyone. But it cures a damn sight more folks than anything else we've got. And a lot quicker, too.

So what's the problem? We don't advise against penicillin because some people are allergic to it, do we? We don't dismiss Prozac because hey, it doesn't work for everyone.

So why are people so dismissive of Maudsley? I'm talking about people who haven't worked with it, who are going only by what others say about it.

Maybe it's like a generic medication--there's no big money to be made on it, so there's no incentive to fall in love with it.

But as Daniel Le Grange said to me recently, "We're not doing very well by our children." FBT helps children and adolescents, no question about it. The statistics are very good--80 to 90 percent of those treated with it are still recovered after five years.

FBT doesn't get into cause. It doesn't have an opinion, so to speak, on psychodynamic issues. It rather neatly sidesteps them, at least for phase 1 of treatment--weight restoration.

Is there anyone out there who can truly argue with the need for someone who is severely malnourished to gain weight?

I just don't get it.

Tuesday, October 09, 2007

6 lessons I learned at NEDA

1. There are lots and lots of well-meaning but ineffectual folks working in the eating disorders field.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.

I'm sure there are more, and I'm sure I'll be posting about them too.

Sunday, October 07, 2007

Sunday morning at NEDA

The NEDA conference is officially over, but I've still got a bag full of brochures and other stuff I collected here (and I'm not going home until tomorrow morning), so I thought I'd offer another deconstruction of e.d. programs and what they offer to parents.

The reason I'm doing this, by the way, is not just to make enemies (though I'm sure I am) but to try to offer one parent's view of what's on offer. I think it's especially important given a snippet of conversation I had yesterday with one of the long-time NEDA folks, whose comment about Maudsley was, "But you have to be a very, very special family to make that work, don't you?" This is, of course, the mainstream view, and of course it's completely erroneous. It's part of the disempowerment of parents within the eating disorders field that just burns my boat.

So. Within that context, it's not surprising to find brochures like the one I picked up from the Women's Center at Pine Grove, in Hattiesburg, Mississippi, a treatment facility that treats e.d.s, addictions, and both. Here are some of the phrases that jumped out at me from this 12-page glossy brochure: "Components of the treatment experience include understanding the disease process and the camouflaged self, helping women reclaim and celebrate their feminine spirit, empowering women to come to their own assistance. . . . " There's a family week--sounds good, right?--described as "40 hours of intensive therapy where the healing process between family members begins." OK, this center is for women strugglng with addiction as well as e.d.s, and does not seem geared toward adolescents. There are photos of lovely flower arrangements and wooden staircases. Under Amenities, the brochure says, "We offer gender-responsive treatment in a quiet, peaceful, and secluded environment." I'm not sure what gender-responsive treatment means. The next paragraph goes on: "We encourage our patients to take advantage of the nearby YMCA . . . a facility that includes weights, cardiovascular equipment, indoor track and pool, indoor racquetball and basketball course."

Hello? For women in the throes of anorexia?

Nowhere in this brochure is there any mention of food or eating. Nowhere. There is one line under "Components of Treatment" that says "Nutritional counseling." It's about halfway down a list that includes items like "Boundaries & Relationships," "Exercise & Fitness," and "Psychodrama."

I don't think so.

Saturday, October 06, 2007

Saturday morning at NEDA

This morning's program featured two parents and a husband, all of whom had family members who had anorexia, all of whom had the same therapist. I have tremendous respect for all three of these people, who obviously went through tremendous suffering. I'm happy to say that all three of their family members recovered and are now doing well--but only after many years of being ill. One spouse was ill for 10 years; one of the children was sick for 6 or 7 years, and the other for 10 years.

One of the parents made a comment that for me crystallized everything that's wrong with the way eating disorders have been traditionally treated. He said, speaking of his then-11-year-old daughter, "My wife and I quickly had to accept the fact that this thing was bigger than we were, bigger than our family. There was no way we could help her. We had to turn to the professionals."

His child's recovery followed a fairly typical trajectory: years of very slow progress and relapse, until, as he put it, "She *decided to join us in the fight against her illness."

I got tears in my eyes at that moment, tears of rage for the clinicians who disempowered this family and made them believe there was *no way* they could help their daughter, who taught them that their daughter had to "choose" to get well. For all the families who have accepted that over the years, who have sat at dinner tables watching their children starve and felt there was nothing they could do. Who, frankly, wasted years of their own and their child's life in useless and even counterproductive treatment.

I am so grateful for family-based treatment, for having my role as a parent validated and for being able to help my daughter. Another of the parents said, "I wanted to just march in there and get this thing fixed! But we had to embrace the illness and accept that it would be with us for a long, long time."

If only she'd been told about FBT, how might her life and the life of her daughter have been different?

Friday, October 05, 2007

If only they knew . . .

Over the last two days I've collected quite a bit of material from the many residential treatment centers that are exhibiting here at NEDA. I'm going to be writing about a few of them, starting with the brochure from Rogers Memorial Hospital in Oconomowoc.

If only the people who'd put this slick piece of marketing together knew how parents really reacted to it--or should. I already have an opinion about the programs at Rogers, but if I didn't, this would certainly sway me.

For starters, the image on the cover is of a girl. A young woman, really, maybe 14 or 15 years old. She's smiling, she's very pretty--and she's excruciatingly thin. It's hard to tell just how thin because she's wearing a hoodie over a shirt. But she's a lot thinner than I'd want any child of mine to be. Is she supposed to be recovered? In recovery? Newly arrived at Rogers? If this is a picture of the Rogers recovery, I'd run in the opposite direction. Fast.

Then there are the words that go with this image: "At Rogers Memorial, we utilize proven, evidence-based treatment components that give individuals with an eating disorder the best chance at recovery."

So far, so good. But there's more: "Our philosophy encourages self-empowerment, so that the individual's recoveryt is a result of his or her own success."

Uh-oh. If I'm a new parent I might think this sounds good. But everyone else will read this and know what it refers to: the tired, disproven notion that the individual must "choose" recovery.

Next come some quotes, presumably from Rogers patients, though they're not identified. Top of the list: "The treatment and therapies helped me realize it was my choice to get better." I say stop reading right there and throw the darn thing away. But if you insist on continuing, you'll find this one: "The art therapy was extremely helpful and provided another way for me to explore my eating disorder."

Explore your eating disorder? Honey, I don't want you to explore your eating disorder. I want you to RECOVER from it. Big difference. In fact we may be talking an oxymoron here.

Seen enough? No? Then turn the page for more on the Rogers approach: "Our treatment approach encourages self-empowerment. From admission to discharge and aftercare planning, individuals are involved in every step of the treatment process."

As the parent of a child who's recovered from an e.d., I can't think of anything worse than to have my child involved at every step of the way. As those of us who have been through this know, a child is INCAPABLE of "choosing" recovery, and when she's very very ill, such insistence will a) prolong the course of the disease, b) make treatment ineffective, c) exacerbate the child's already sky-high anxiety, and d) make veryone involved feel guilty as hell for not being able to "choose" recovery.

And here's the thing that gets me: This brochure is supposed to be marketing the program, making it sound irresistible to parents.

I'd say the Rogers folks haven't got a clue about what at least some parents want. And judging from this brochure, I'd say my confidence in their ability to help my child recover is pretty minimal.

That's it for tonight. I'll pick apart some more tomorrow.

More from NEDA

One of the heartening things about the conference so far has been that the amount and kind of discussion around family-based (Maudsley) treatment for anorexia and bulimia. There's been a lot! And all of it's been positive, at least that I've heard. In fact I would say that Maudsley has become something of a buzzword. Some of the people using it seem to have only a hazy idea of what it means, but I guess that's part of the process of this kind of social change.

The general session speakers have been a real mixed bag. This morning's speaker spent more time telling anecdotes about her cats, her children, and herself than anything else, and when she did finally get down to brass tacks, she mostly talked about body image. I'm all for discussions of body image, and how to improve it, but what got to me was her automatic assumptions that disturbances of body image = eating disorders. There was a lot of talk about things like guided visualizations, talking "to" problem body parts, and so on, none of which interests me but hey, I can see that it might be of interest to some people.

The thing that got me, though, was when she tried to connect these kinds of problems and solutions to anorexia. I asked her, if body image disturbance causes e.d.s, why don't we have way more prevalence of anorexia and bulimia? She had no answer. Later, someone else suggested to me that while AN and BN are relatively low incidence, there are a lot of eating disorder not specified cases that don't show up in the statistics. Maybe. What bugs me is the thought of people with anorexia and bulimia who are valiantly trying to recover through these kinds of treatment techniques. There is no evidence to suggest that they're effective. Common sense, and having gone through anorexia with my daughter, tells me they can be worse than useless--they can destructive because they take focus off the things that really matter, like refeeding. So I'm not thrilled with what I heard there.

This afternoon's speaker, Michael Strober, did a very good job of discussion some of the neurobiology of comorbidities. He made one interesting point (well, he made more, but this one was of most interest to me): he said that while most depression that you see in patients with anorexia comes as a result of the starvation, and shows up after and as a byproduct of malnutrition, the heightened anxiety you see almost always precedes the dieting and weight loss behaviors. This was certainly the case in our family: my first inkling that anything was wrong with my daughter was her anxiety level skyrocketed, and she'd never been an anxious kid. No one understands the mechanism, but it was a very interesting observation.

That's it for now--gotta go get in the hot tub! (LOL)

More from San Diego later.