• the unreliable narrator • : orthorexia

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orthorexia

Monday 25 June 2007 | someone left a cookie

If the following is obsessively long and complicated, blame Mandarin, whose recent post has me all thinking and shit:

Dr. Steven Bratman, M.D. coined the term orthorexia and wrote a book called Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating. He has a wee website which links to several related articles and reveals that he himself suffered orthorexia and began recovering after a road-trip with Brother David Steindl-Rast. After invoking God, the slim and venerable monk devoured a buffet of Chinese food and invited the dogmatically organic-local-sugarless-vegan Dr. Bratman to eat [three scoops of!] ice cream. While the good doctor subsequently recovered from orthorexia, the website’s author photo indicates he is still in the throes of severe permed-mullet syndrome.

And Dr. Bratman does have an unfortunate eighties-Barbara-Streisand hairdo (per “What the Hell Is up with Your Author Photo?“). He writes:

Twenty years ago I was a wholehearted, impassioned advocate of healing through food….Today, as a physician who practices alternative medicine, I still almost always recommend dietary improvement to my patients. How could I not? A low-fat, semivegetarian diet helps prevent nearly all major illnesses, and more focused dietary interventions can dramatically improve specific health problems. But I’m no longer the true believer in nutritional medicine I used to be….I no longer have faith that dietary therapy is a uniformly wholesome intervention. I have come to regard it as I do drug therapy: as a useful treatment with serious potential side-effects.

Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic’s day.

Bratman’s book is out of print, but the central thesis seems compelling: that radical dietary change has as many potentially unpleasant side-effects as any other medical intervention or therapy.

Then there’s the Beyond Vegetarianism site ["Reports from veterans of vegetarian and raw-food diets, veganism, fruitarianism, and instinctive eating, plus new science from paleolithic diet research"], which has a surprisingly self-reflective article:

Close attention to diet is obviously needed and appropriate under the following circumstances: For a short period, while one is transitioning to a new diet. After the new diet becomes habit, your attention to dietary details can/should be reduced….Close attention to diet is usually not necessary when…one is established in a diet (it is habitual), it requires little thought, and one is not emotionally attached to the diet as a badge of self-identity. When one is stable in good health, then one may be able to make occasional exceptions to the usual dietary regime with limited or no antagonistic side-effects.

Emphasis mine—because can we chronically deluded humans really know when we’re using something for purposes of bolstering our identities? This seems a tall order to me, even for the most self-aware among us.

For years, and I mean years, I was able to convince myself that because I didn’t particularly want to lose weight or be thin, and had never missed a period, I clearly wasn’t anorexic, and therefore my eating wasn’t unduly restrictive—a curious bit of reverse engineering that smugly refused to take into account any empirical evidence, but instead worked from the DSM diagnostic criteria ass-backward into reality. And in college, I could easily tell myself that my eating was not disordered because there were so many women patently so much crazier than me—including the Italian girl who routinely brought her kitchen scales to the dinner table with her, to weigh her chicken breast. Yet finally there was too much feedback from too many people, some of them health professionals, telling me otherwise. My well-polished theories eventually caved under the overwhelming refrain of loved ones saying, You don’t look healthy and we’re worried. And my appalled reaction to my new post-medication curvy shape tells me that in fact I was incredibly attached to being thin—and not just thin, but thinner than others. Just as with whatwasithinking.com and my heretofore terrible taste in lovers—sometimes you don’t know what you don’t know until after you figure it out, and then you do know it. You know?

Perhaps most fascinating of all these documents is the brief apologia of bodybuilder Renee, tacked way down at the bottom of her orthorexia page as “Tiny Fine Print Disclaimer”:

I put the orthorexia info on here because it described me perfectly and I thought it was hilarious. Do I have orthorexia? Yeah, probably. Do I care? Nooooooo…I decided that whole “recovery” thing is for suckers and weaklings, LOL. Which probably means that I’ve gone **completely** over the deep end.

Several months ago I backed off the bodybuilding nutrition and decided I was going to re-learn to eat like a normal person. You know what? Normal people are fat and depressed!! I promptly gained 10 pounds, lost my abs, lost my definition, couldn’t button my jeans, started bulging out of my little spandex shorts…it was not pretty, not pretty at all. It was one of those Geneen Roth “embrace your inner cow” books that prompted me to stray from BFL. It was all about eat what you want, when you’re hungry, and stop when you’re full. Well, yeah, right! All I wanted was junk. I mean, that’s *all* I wanted. And whatever mechanism it is that tells people they’re full, I don’t have one of those. I’ll eat until I explode.

So, yes, if you’re less strict with your nutrition you will gain weight and you will compromise your results. I don’t miss eating pizza with friends because I do it every week. I also eat popcorn at movies, cake at birthday parties, glazed donuts for breakfast, and lunch at the McDonalds drive-thru. Only one day a week though!

One thing that occurs to me with the eat-until-I-explode thing is that she was perhaps just experiencing a rebound effect which would have mitigated with time and patience. Besides, is gaining ten pounds such an evil? I can’t even wrestle my old size-one jeans and shorts on over my hips anymore, much less button them. Does that mean I’m fat now, or does it mean my pants were probably too small for someone my height? (I think it just means I need to hold a damn yard sale and get rid of all those doll clothes.) Anyway Renee looks fantastic, still eats donuts once a week and practices taijutsu, which sounds enviably violent. And I think her sense of humor about it all (“So, I take little pictures of my food. What? It’s perfectly normal!”) probably proves she doesn’t have a life- (or sanity-) threatening eating disorder.

A pair of Guardian articles offers an unnerving first-hand perspective.

I am now vegan, which makes me a very difficult dinner guest indeed. If I was invited for lunch at Nigella Lawson’s, I would have to ask her if she had lied about using anchovy in the sauce. Going to restaurants is very difficult indeed; if they have a vegetarian option on the menu, it is often a cheese-endowed cholesterol fix. Even if they do come up with a plate of grilled vegetables (I would leave the onion, aubergine and giant mushroom on my plate), I always leave the table hungry.

And I worry about the serving area; have they sterilised the knife, or used a separate chopping board, for example? The waiters at most eating establishments roll their eyes towards heaven when I enter; at my local Pret A Manger, staff know to make my coffee with Evian, and not to touch their faces with their hands. As an anorexic, I looked down on people who ate heartily; I think orthorexics like being awkward and see people who eat what I would term ‘rubbish’ food as weak and unhealthy.

Do I want to seek treatment? No, I eat very well, but recently have been getting worse. When ordering a salad, I suddenly have a thing against spiky leaves. I do not like fennel. Or wild mushrooms. Or big tomatoes (baby plum are fine). Or peppers. Or spring onions, olives and cauliflower. Or biscuits. I love the feeling of being disciplined….

•

Among the qualities Bratman has defined as specific to orthorexics are an eagerness to evangelise about their regime and a conviction that their dietary path makes them a more spiritual person. McCandless does recognise these characteristics. ‘It’s almost spontaneous,’ he says. “As soon as you start eating healthily there’s a smug, self-righteous, judgmental, puritan, religious feeling that descends. I’m really proud, for instance, when my lacto-ovo vegetarian kosher airline meal is delivered to me first on the plane.”

He says eating like this is “almost like a form of devotion. We don’t have a devotional culture any more, really, but now people can devote themselves to their body and it really does become a temple.”

As for people who just eat what they like, McCandless says, “They will die.” I try to point out that everyone will die, but he jumps back in. “It will kill you. You will be dead. Who wants to die at 55? I don’t want to die at 55. I want to live to 178!’

Finally, there are those in the eating-disorders treatment community who think it’s dumb to come up with another name/category when plain old “anorexia” will do just fine:

Although many experts believe orthorexia may be a genuine concern, some think it’s not a clinically useful diagnosis. “I’ve had many patients who are bent on absolute purity, down to the last little vitamin,” says Joel Jahraus, medical director of Remuda Life Programs in Phoenix, Arizona. “But there’s already a name for it: anorexia.” Douglas Bunnell, president of the National Eating Disorders Association, agrees that while orthorexia may be important as a lay concept, in terms of treatment it differs from anorexia only in the finer points.

One of Bratman’s criteria seems off, to me, though, and I don’t know if it’s included in the anorexia diagnosis: it’s the symptom of “resulting social isolation” (which makes me think for some reason of Bridget Jones drunkenly singing “I wanna be / all by myself!” into her hairbrush). Anyway I don’t buy it—being on some kind of health-motivated diet is now considered practically normal and is thoroughly socially accepted, at least where I live; it’s gone from being a personal to a cultural obsession. (Anyway one’s own diet is considered normal; the weird thing is that the ayurvedics and macrobiotics and fruitarians can’t seem to agree on very much of anything, and judge one another relentlessly.) But at least, the Santa Fe raw foodists have potlucks and parties all the time. It’s not like that brutally vivid image of bulimia in Mike Leigh’s 1990 film Life Is Sweet, where the Jane Horrocks character is ruthlessly sealed inside her painful, shaming secret. Instead, it’s like there’s something wrong with you if you eat hamburgers.

Which, actually, I don’t. Or at least, I haven’t in ages. Though I sometimes still dream about bacon, and about very rare, tender steak….

Maybe this is all up for me right now because of the cat allergy thing (or it could still be seasonal/pollen stuff—probably both). Yesterday I had what I can only describe as my first ever asthma attack (is it asthma when your chest feels all tight and you wheeze and struggle to breathe?); I drove to the Brujo’s and conked out on his (cat-hair-free) bed, and woke later perfectly recovered. Then came home yesterday evening and cleaned house like I’ve never cleaned house before, though it was difficult with boxes everywhere, and finally capped off the whole joyous experience by (mostly) bathing Pye in (mostly) the sink. Which she just loved. (Oh God, the cat hates me.)

And Santa Feans tell me over (and over) (and over) that I should kick all my bad nutritional habits, starting with cane sugar, chocolate, wheat, soy, corn, and above all dairy. I look at them like they’re insane. Anyway they’ve clearly never taken psych meds, because if they had, they’d realize what it’s going to take for me to give up chocolate. (Maybe asthma.) And some people think honey and maple syrup are the devil, and some people swear by agave, and some people say you should never have anything sweeter than, like, a potato.

Then too, I had lunch with the Rough Princess yesterday, which was fabulous on so many counts, and also as always food (ar ar) for thought. The Princess had a nasty real-life bout with environmental illness a few years ago, which lasted for a few years, and as someone who witnessed it up close and personal I can say that my doubts about the existence of such phenomena faded into concern, worry and then near-panic (she was working for me and the Lascivious Boss at the time, and we seemed completely unable to find her an office which wouldn’t kill her). The last time I saw her before she left SF, she was tiny, pale and meager and without a single hair anywhere; she’s now rosy, robust, with shoulder-length nut-brown locks and, while she’ll always be physically small, she’s no longer haunted-looking. I could hug her without being scared I would break her. For her part, she reassured me that it’s nice to see me “looking healthy and not like a waif…you would always just eat a couple of bites and then push the food away saying you were full.” We compared our funny new tummies, wondered if it has to do not with diet or exercise but with being 38 years old, and decided it was probably worth it to have a small potbelly, as long as we feel good. She served leftover homemade sushi, a heavenly cool pomegranate-honey drink, and then we swung in the hammock and had vanilla Rice Dream and contemplated why Santa Fe is full of houses unoccupied for ten months out of the year, and why can’t artists live in those houses?

(But part of me misses looking like a waif, weighing a hundred pounds and wearing extra-small, having the concave stomach and no ass and straight upper arms and thighs, and is envious of those who still look as I did.)

My first visits to eating disorders groups, in Dallas in 1995, were revelatory. I would reel to Maman’s house at the end of a day spent with starving women, ranging from mildly haggard to skeletal and barely ambulatory but still fighting, arguing, repeating I feel fine, I don’t know why y’all think there’s anything wrong with me, you’re just jealous, I eat healthy food and not junk, I do not have anorexia, I’m just small-boned. Maman would listen attentively while serving chicken salad, cold ratatouille, vichyssoise (pureed cucumbers, potatoes and lots of cream) and white wine with ice cubes, followed by her infamous oatmeal cookies, in which the two pounds of butter per recipe is supposedly cancelled out by all the bran. If there was a lesson I only partially learned it. I was still too addicted to the physical and moral high of an empty stomach, which I had learned made it easier to stay up all night writing papers. “The valiant starved young ladies of Girton,” as Woolf wrote (though she was by no means in praise of this). And I still felt superior to and pitying toward bulimics and compulsive overeaters, if you can believe that. Poor wretches have no discipline. Very confused thinking, when compulsive restriction is confused with self-control, while pretty much its opposite.

(I remember a college girlfriend who actually stopped her car on the highway and locked the honey-roasted peanuts in the trunk so she would quit eating them. I reported this to my therapist with finicky horror. And can still remember said therapist’s snapping back at me, “Well, at least overeating is life-affirming! You, you’re trying to kill yourself the slow way. What’s so much better about that?” I shut up.)

Even when I did start really eating again, in my early thirties, I still exercised tremendous self-control over what I ate—abetted by my quite possibly gay, definitely body-Nazi, compulsively exercising and saturated-fat-fearing ex-husband. Probably the only guy I’ll ever be with who actually had a six-pack. He’d be horrified by my new womanly look. It’s only in the last two years, taking drugs which reduce me to the state of common carb-craving humanity—i.e., being unable to take my eyes off someone else’s unfinished dessert—that I can now see where I lived, and how fucked-up that tight little place was. How innocently self-righteous and how full of disclaimers and justifications and needless explanations—when in reality no one but me wanted to hear for the umpteeth time how I couldn’t digest chicken.

All this seems particularly out-of-control in my beloved People’s Republic of Santa Fe, where two out of three are on some kind of Pythagorean diet and at least one of them will display no compunction in boring you with its details, and trying to convert you. My eyes always widen and I nod and make affirmative sounds and privately resolve to eat gas-station hot dogs at the next available opportunity. My belief is that I should be able to eat whatever is put in front of me—as Herself once, in Tibet, was served a great delicacy of roasted yak testicles, the village’s pride, and she said she gagged on the tiny bristly hairs but she ate them, and expressed her gratitude. I don’t live up to this ideal. I often refuse food because it doesn’t meet my particular criteria.

On my last trip home to Texas, for the first time in decades I decided I wouldn’t make my own special food (usually brown rice and barely steamed vegetables) to supplement my parents’ high-fat, processed-food, red-meat-based diet, but would try just for once to eat with them and share what of their food I could manage. So I ate macaroni from a box, iceberg salads with grated cheese and croutons, and coconut pudding-mix cream pie with whipped topping. While they ate minute steaks and fried chicken, I helped myself liberally to the accompanying potato salad and french fries. And to my great surprise, I was fine. It didn’t kill me. It didn’t even make me feel ill. I felt totally okay and it made my mom happy, and I got to share their life in a way I hadn’t in years. And it hurt me to see how diffident and apologetic she was, serving the food—how convinced that I would be critical and judgmental and not want to eat it, and it made me realize how snidely and haughtily I must have behaved in visits past. But the bigger revelation, thankfully, was just that it’s entirely possible to eat overcooked broccoli and Cheeze Whiz for a week and not suffer lasting ill effects.

Strangely, the several raw-foodists of my acquaintance are to a person all a funny disturbingly pale mushroom color—why would that be? And why are they so zealous? I’m as suspicious of their evangelicism as that of the British missionaries who recently rang the Brujo’s doorbell and tried to engage him. (“Are you a person who reads the Bible? Would you like to have a conversation about the Bible?” The Brujo, shirtless, laughed. “That would be a very long conversation.” The lady averted her eyes fastidiously from his naked chest. “Yes, I can see that this is not a good time for you.”) In our DBT group, the therapist continually pushed a raw-foodist toward greater flexibility, around other issues as well: “But what might it be like to meet a person and get to know them without having their astrological information?” Rigidity unyielding: “I don’t know or care; this is the filter through which I see and understand the world. And I’m passionate about healthy food and I want to share that passion with others. What’s wrong with that?”

What indeed?

someone left a cookie

oleoptene said on Wednesday 27 Jun 2007 at 1.41 am:
thank you for this — spreading around the thinking and shit!

Right after baby #4 was born, my midwife was doing the raw thing and it seemed like I could eat this way and control this overwhelmament of postpartumness. Only I’d breastfed three babies so easily, taking it for granted, and all of the sudden at his 6 week appointment, my son hadn’t gained any weight in two weeks, and that was enough to get me bargaining with deities, I’ll take a pooched belly and sagging breasts, but let the kid be healthy. So for two weeks I did nothing but eat and sleep and nurse, and it got better, and I had permission to slow down, take care of myself, take care of him — and it was food and life, really elemental. And I had to deal with postpartum stuff being overwhelming in other ways besides quitting eating.

Anne Lamott describes learning to make herself throw up from the teen magazine articles warning of the dangers of bulimia… the thing about eating disordered thinking is how contagious it gets — you mention the specific number on the scale you’re at in your blog and I start in shame at my own number much higher. You’d think there would be a way to be supportive about it, and yet, again and again I am surprised at the amazing women (like my midwife) I meet with weird food/body issues. And you can never just say “But, damn, you’re gorgeous and wonderful, and it’s who you are that makes me happy, and I really don’t think the size jeans you’re wearing makes the slightest difference.” Because 1) I don’t want to dismiss your feelings 2) if it were me being addressed so (and it could be) I wouldn’t believe it and 3) I really have no clue how to get there. I was looking for information about the gorgeous and talented China Forbes and found http://www.edibleportland.com/pages/articles/win06/portlandFridge.htm which has the lovely line “I’ve always been on a diet.” I hate the idea of life spent dieting.

Little radio snippet I heard today praising M.F.K. Fisher threw out “Food isn’t a metaphor for life, food is life.” The woman I want to be embraces life, embraces food, is healthy. And by healthy I don’t mean so correct in her eating habits that the Vatican is considering a new sort of canonization based entirely on the virtue of eating right, no, I mean balancing the nutritional and pleasurable meanings of food and happy with the body that that results in, no mean thoughts or flagellation.

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