People who are all about thinspiration engage in disordered eating in order to be as thin as possible — a common symptom of anorexia. But they don’t see it as a disorder or a problem, making this an insidious problem.

Nonetheless, such eating and self-image problems can result in health problems, even putting the individual’s life at risk.

Some people have sought to get common words or terms that people engaged in thinspiration use banned from social networking websites. One such woman is Torri Singer, a broadcast journalism major who has recently begun a petition to get such terms banned from Twitter.

Many social networks have already climbed aboard the bandwagon, including Tumblr, Instagram, Facebook and Pinterest. And while such policies have been implemented, thinspiration content is still easily found on many of these networks. I suspect that’s one of the challenges of implementing a policy like this — it’s extremely difficult to police, especially if people can just slightly alter the terms they use to talk about these issues.

But that hasn’t stopped Torri from putting Twitter on notice.

“[I want] to raise awareness about the harm of destructive thinspiration messages, and to prompt Twitter to make real change in order to stop the spread of this preventable growing trend,” Singer recently told me. Her inspiration for this campaign came from family:

My sister suffered on and off with eating disorders in her early adult life, so preventing other intelligent, strong, and beautiful girls from forming or elongating their disorders has always held a place of importance in my life. I know how difficult it is to be a girl and have constant exposure to beauty ideals, I don’t think we need any more pressure from self-generated pro-eating disordered “lifestyle” hashtags.

But when a website or social network changes its Terms of Use to remove such discussion from their networks, can it be an effective deterrent? “There is no doubt that other media sites such as Facebook, Instagram, Pinterest, and Tumblr have a long way to go before they are really safe and free of thinspiration triggers,” replied Singer.

“But they have made the first steps toward taking action and being responsible for the safety of their users.”

She also addressed people trying to change the spelling of terms they were using to get around the service’s policing efforts: “Instagram’s initial attempt to limit thinspiration led users to create new spellings (such as thynspo). Instead of giving up on the effort, Instagram revised the policy, stating it will disable “any account or hashtag found to be encouraging eating disorders.”

“The first step is ensuring that these messages are not readily available, and that is where policy change comes into play and really matters.”

Of course, trying to stamp out discussion of a topic on the Internet is impossible, given the hundreds of millions of websites, social networks, forums, and online communities. “By reducing the number of mainstream venues where these pro eating disorder messages are displayed,” Singer says, “we are reducing the exposure, and therefore the dangerous behavior that results (or continues) because of these online interactions.”

I agree — efforts such as Singer’s can make a perceivable impact on the popular, mainstream sites, reducing the likelihood of exposing this ideology to a new, naive audience. Especially when that site is a social network as large as Twitter.

“Banning thinspiration terminology means less accessibility to damaging phrases, encouragement, and images that propel disorders,” notes Singer. “It will prevent susceptible people from forming eating disorders, and people recovering/struggling with eating disorders from exposure to triggers.”

“In my mind, just getting people to have this conversation means that it has been some degree of successful. It is really amazing to see people who sign generating comments about their personal stories and their struggles. Many have said that thinspiration has been a big trigger in their lives and that they support any effort to ban it from impacting others like them.”

Efforts such as Singer’s are a good attempt at bringing attention to the problem and helping people understand that use of these kinds of keywords and hashtags only reinforce the disordered behavior — on a scale that wasn’t readily possible just five years ago. We applaud and support Singer’s petition and efforts to help reduce thinspiration messaging on mainstream social networks.

We encourage you to sign the petition:
Twitter: Restrict use of thinspiration language and hashtags

It’s the holidays.  Magazines focus on our waistlines and ways to survive the season while keeping a slender figure. I’m all for good health, but we’re frequently sold an image, product or diet that does not always result in good mental or physical health, particularly for women.

What’s your ideal weight?  In one alarming study, adolescent girls described their ideal girl as 5 feet 7 inches tall and weighing a mere 100 pounds.

This ideal is — at best — unhealthy and, for many, anorexic. 

And while it’s unattainable for most girls, they still hold it.  In doing so, they are more likely to be dissatisfied with their bodies, no matter their shape or size. They may feel disgust and revulsion toward themselves and envy and bitterness toward others.  Carrying this skin-and-bones ideal is associated with low self-esteem and the development of eating disorders.

Males also can hold unhealthy, unrealistic body ideals and suffer from similar dissatisfaction and distress.  According to one study, when boys experience body dissatisfaction, it is more likely associated with large, muscular bodies than a thin and skinny image.

Body image is believed to be a less prevalent issue for boys, who tend to view their bodies as a tool, rather than as a means of attracting others, but it is also a much less studied topic.

So where does the desire to be skinny come from?  The answer is both complex and simple.  It can be transmitted through family, peers, schools, athletics, business, and health care professionals.

But advertising is the most aggressive source of the overly slender image, according to a study in the International Journal of Eating Disorders. Thinness is equated with goodness and self-control.  Slender images are used to sell diets, cosmetics and exercise programs.  The female body is portrayed as an object of desire and when girls and women feel they don’t live up to the ideal, they are more likely to feel shame and anxiety.

Some simple strategies to improve body image include:

Putting down the magazine. 

Make a choice not to subject yourself to ideals and images that will make you feel worse about yourself.

Seeking healthy role models. 

Role models can help girls and women focus on eating to sustain healthy, functional bodies, rather than on dieting to become skinny.

Refusing to talk about dieting. 

Peers have a huge influence on adolescent girls, but our friends affect our worldview at any age. Resist the urge to talk about dieting, especially non-nutrition-based fad diets, with friends.

Not isolating yourself. 

Encouraging adolescent girls to develop healthy relationships with peers may prevent them from developing body dissatisfaction, according to one study.

If you or someone you know is struggling with body image problems or with an eating disorder, you can get more information from the National Eating Disorder Association.

It’s been hard in recent years to ignore young entertainers’ breakdowns, drug habits, and bad behavior. Demi Lovato, a 20-year-old singer/songwriter, actress, and newly appointed judge on the talent show “The X Factor,” has endured much internal struggle.

But she has courageously sought mental health assistance and boldly documented her journey to share with others for inspiration. Along with her “stay strong” motto, she’s demonstrated that obstacles can be overcome, which is what ultimately highlights her as a different type of role model.

Katie Couric (who struggled with an eating disorder during her college days) interviewed Lovato earlier this year. In a heartfelt discussion, the young celebrity opened up about the origins of her body image issues, and the time she spent at an Illinois treatment facility for anorexia, bulimia and self-mutilation.

“I always had self-confidence issues in my body and self-image problems,” Lovato said. “It also didn’t help that I had kids at school at such a young age that were really, really naturally thin, so I always felt like I was the bigger one of the group.”

She initially dealt with her insecurities by overeating, which then turned into starvation, along with binging and purging. Lovato said that certain traumatic situations could trigger those destructive habits, and she candidly spoke about being teased and berated by other peers at school.

“People don’t realize how badly cyber-bullying and verbal harassment affects you,” she said.

With regard to her eating disorders, she confirmed that being in control was important, and those unhealthy patterns developed as a coping mechanism. “Some people don’t want to feel the emotions that they have — I think I just didn’t want to feel.”

After Lovato instigated a physical altercation with one of her friends, she realized her emotions were out of control, and she knew she needed to get help. She checked herself into a rehab center shortly after the incident.

“Treatment was so difficult at first,” she said. “I remember walking around saying ‘I’m in prison,’ and they needed to have strict rules in order for me to understand how sick I was.”

The “X Factor” judge admits that while she’s currently in a comfortable place, these issues most likely will stay with her for the rest of her life. She noted that during these past two years, however, a new mindset recently clicked; a mindset of acceptance and embrace for her natural body.

This past July, Lovato told “Good Morning America” that she’s happier allowing others to see her flaws, and that’s what defines her as a new kind of role model.

“That’s what being a role model is about,” she said. “It’s not about being perfect. It’s about speaking about your issues and inspiring others to get help.”

Our taste buds are chemical sensors that pick up on taste acutely for the first few bites.  After eating a large amount, we may taste very little of what we’re eating.

So what does this have to do with belly fat and mindfulness?

According to clinical psychologist Jean Kristeller, PhD, president and co-founder of The Center for Mindful Eating, many of us are eating too often and too much.

We’re bombarded by advertisements for unhealthy foods and confronted with restaurant portions appropriate for two or three people.  Then we eat for all sorts of reasons: it’s time to eat, food is available or offered or we’re angry, anxious, depressed or bored.

With so many reasons and opportunities to eat, Kristeller suggests in this month’s Monitor on Psychology that we have become disconnected from feelings of hunger and satiety.

Kristeller first connected the practice of mindfulness with eating while studying food intake regulation at Yale with Judith Rodin, PhD.  Rodin was linking disregulated eating to a disconnect with hunger signals.  Kristeller began using mindfulness practice as a strategy to reconnect people with the body’s experience of hunger and satiety.

In her 10-week course in mindful eating, Kristeller teaches participants how to increase their awareness of their drives to eat and the triggers for overeating.  And yes, that includes teaching participants to pay attention to those first few scrumptious bites, but also to notice as food begins to lose its taste.

It’s about finding satisfaction in quality, not quantity, Kristeller says. And other researchers are testing her theory.  In one study, Gayle Timmerman, PhD, RN found that with mindful eating training for restaurant meals, participants showed a significant impact on weight and food intake.

In a second study with obese women, Elissa Epal, PhD, and her associate Jennifer Daubenmier found that the more mindfulness the women practiced, the more their anxiety, chronic stress and belly fat decreased.

By eating mindfully, you gain awareness of your enjoyment of food and eating.  By practicing awareness of hunger, noticing what your body feels like when full, and learning to savor foods, you also can recognize when the food in front of you no longer is enjoyable.

“I wondered what would happen if people started engaging with foods in this way,” Kristeller says in The Monitor.  Epal’s research studies so far indicate that with attention to eating, people can change their relationship to food “very quickly, and within a few sessions.”

In a recent study researchers compared taste sensitivity in obese children and adolescents to that of healthy weight children and adolescents.  According to this study, taste sensitivity is linked to weight.

Children and adolescents who were obese had less sensitive taste buds.  That means for obese children sweet foods tasted less intensely sweet, bitter foods were milder and salt was not as readily perceived.

What do these differences in taste perception mean?

What the study can’t reliably tell us is whether a decreased taste sensitivity causes obesity or whether obesity somehow causes a decrease in taste sensitivity.

We do know that our tastes change over our lifetimes as a result of certain life circumstances.  During pregnancy, for example, nearly two-thirds of women experience changes in taste.  Pregnant women have been found to have a reduced sensitivity to salty tastes, which may be the body’s way of ensuring increased salt intake during pregnancy.

Chemotherapy is another example of an experience that changes a sense of taste.  Forty-six percent of patients receiving chemotherapy report taste changes.

In another study (PDF), subjects who reduced salt intake voluntarily for a period of months, preferred less salt in their food, than those that ate a higher salt diet.  Voluntarily reducing salt intake caused an increased sensitivity to salty tastes.

In the case of pregnancy, changes in the body cause changes in taste sensitivity.  However, in the study on reduction in salt intake, changes in eating habits resulted in changes in taste preferences.

Normal aging, neurological problems, such as seizures and drug use can all cause changes in taste preferences and taste sensitivity.

However, the relationship between taste and obesity is still unclear.  Does a decreased sensitivity to certain flavors cause obesity, or is a loss of sensitivity to taste just another by-product of obesity?

Some doctors suggest from experience and anecdotal evidence that eating unhealthy foods, particularly those foods high in sodium and unhealthy fats that contribute to obesity, causes reduced sensitivity to taste.

In an article on The Huffington Post, David Katz, M.D., Director of the Yale Prevention Research Center, suggests that when we inundate our taste buds all day long with sugar, salt, and chemicals, they become insensitive to them.  Dr. Katz states that foods such as pasta sauces with added sugar, ice cream, potato chips and sugary breakfast cereals all contribute to losses in taste sensitivity.

If you regularly eat high sugar and high sodium foods, this news news can be discouraging.  We might all agree that food needs to provide us with energy and supply our nutritional needs, but we also all want to eat tasty foods and enjoy what we eat.

According to Dr. Katz, there is good news.  Better food choices, even cutting down on sugar and sodium intake for just a few weeks can change your preferences and your sensitivities to salt and fat.

So does obesity change your sense of taste?

The scientific evidence is still out, but anecdotal evidence and what we know about how our tastes change with what we eat suggests that eating high fat and sodium foods reduces sensitivity to taste. It is not obesity that causes changes to sense of taste, rather it’s eating the foods that contribute to obesity.

Knowing that food cravings are much like other addictions can be disheartening and you might despair that you will not be able to make changes.

The good news is that there are several effective strategies to delay eating craved food and weaken your habitual response to food.

Acceptance vs. Fighting Your Urges

Many turn to dieting, in an attempt to fight urges to eat.  But fighting urges has two problems: it often makes them stronger, rather than weaker; and when we lose the fight and ultimately give in to our cravings, we learn that we can’t control them and lose motivation.

It might seem counterintuitive, but accepting your cravings, rather than trying to fight them, is one of the most effective methods for changing your response to food.

In an experiment conducted by Dr Robyn Vast, participants learned to control urges to eat chocolate by accepting that they would have these urges.  They underwent training to notice thoughts and cravings related to eating the chocolate.  Rather than try to push these thoughts away, they were instructed to think of them as merely thoughts, not a physical need that must be acted upon.

81% of subjects who were taught this technique were successful in resisting the urge to eat chocolate, compared to 56% of a group taught different cognitive techniques and 43% of a group who were not taught any techniques.

This technique is similar to one used with drug and alcohol addictions, called “urge surfing.”  When “urge surfing,” you notice your urge and attend to it without acting.  You notice how these urges come and go like waves, at some times intense and at others weak.

Additional Strategies to Fight Food Cravings

Other techniques that delay acting upon cravings can weaken the strength of your cravings over time.  Some of them include the following:

• Imagine you are eating the craved food.  Simply imagining the food will increase your craving, but imagining eating the food can decrease your craving.
• A new study found that exercise can cut food cravings (found in the journal, Medicine & Science in Sports & Exercise).
• Distract yourself with scents of flowers or by chewing gum.  This delay in satisfying a craving can weaken the urge.
• Set a timer when you experience a craving and then distract yourself with something else.  Often when the time is up, the craving has passed.

In order to curb your cravings you may need to think about food and eating differently.  We are not in a war with food that requires us to avoid it, restrict it or fight what we long for.

Instead, we can recognize that our longings and desires for certain foods are just thoughts, often triggered by our environment, hormones or a desire for comfort.  Try telling yourself, “That’s a thought about craving food” the next time a craving hits, and then move on with what your were doing and see if you notice a change in how often you give in to a craving.

It’s no wonder we have both increasing incidents of eating disorders, such as anorexia and bulimia, as well as increasing prevalence of binge eating disorder and rates of obesity.

Navigating this confusing world without falling into an eating- or weight-related disorder does require a return to some basic facts.

There are truths about eating and bodies which seem to get lost somewhere between childhood and teenage years. Young babies and toddlers generally find joy in their bodies, no matter what their size or shape, and they listen to their bodily cues such as eating when they are hungry and stopping when they are full.

But somewhere in the preteen years, these certainties shift and doubt takes over. A negative body image can, and often does, lead to serious, life-altering illnesses in millions of Americans.

The National Eating Disorder Association (NEDA) is an organization that supports families and individuals who are battling eating disorders. NEDA offers information, resources, action-oriented advocacy and media campaigns to educate the public and policymakers about eating disorders. Another critical and vibrant part of NEDA relates to prevention of eating disorders, highlighted specifically during the Eating Disorder Awareness Week each February.

7 Steps for Success

Based on facts which have been promoted by NEDA, there are seven steps for success when it comes to preventing an eating disorder.

• Everybody is different. We all have a different set of genes which determine much of our size, weight and shape. Even if everyone started eating the same things and did the same amount of exercise for a whole year, we wouldn’t look the same at the end of the year. Your “ideal” body weight is the weight that allows you to feel strong and energetic and lets you lead a healthy, normal life. Be comfortable in your genes and jeans.
• Listen to your body. Eat what you want, when you are truly hungry. Enjoy wholesome, nutrient-rich foods. Know that there are no good and bad foods, but rather those which have more or less nutrient qualities. Stop when you’re full. Eat exactly what appeals to you in a moderate, balanced fashion.
• No dieting. Dieting doesn’t work. Many individuals were dieting at the time they developed their eating disorder.
• Move often. Enjoy regular, moderate exercise. Do things you enjoy. Exercise for fun, fitness and function, not for exhaustion, deprivation or punishment. This will help you be strong, fit and relaxed.
• Reject weight bias. We aim not to judge others by the color of their eyes or skin; can you avoid judging others or yourself on the basis of body weight or shape? Respect someone’s character traits and accomplishments rather than their body shape.
• Avoid comparing your body with your friends’ bodies or with the people you see in the media. Choose role models who reflect a realistic standard and who stand for values of importance. Become a critical consumer of media and recognize its influential power on you.
• Handle life difficulties with healthy coping techniques, not through over- or undereating. Problem-solve, rather than create problems to avoid dealing with the true source of stress. Seek true forms of happiness and fulfillment.

If men, women, parents, teachers, coaches, children, teens, doctors, movie producers, advertising agencies and everybody started absorbing and practicing these invaluable truths, we might begin the journey of ending the existence of eating- and weight-related disorders.

For more information about NEDA and related resources, visit this site.

In honor of this year’s message, “It’s your time,” I want to draw attention to the link between how we see ourselves and how we treat our bodies.

Currently, 80 percent of women in the U.S. are dissatisfied with their appearance. And more than 10 million are suffering from eating disorders.

So the question I have to ask, Why all the self-hatred?

Body Image and the Media

Historically, the ideal female body was strong and full-figured, as seen in icons such as Marilyn Monroe. Yet even as early as the 1800s, when painful, health-impairing corsets were used to accentuate the breasts, hips and buttocks, women were expected to strive for a specific ideal of beauty.

In the 1900s, the American public became more consumed with the thin, boyish physique, viewing full-figured women as indulgent and lacking in self-control – a trend that grew exponentially by the end of the century.

In modern times, we’ve witnessed a “thin at all costs” movement that now defines Western culture. The U.S. has the highest rates of obesity and eating disorders in the world. As a melting pot of people from all backgrounds, there is no genetic reason that explains this increased vulnerability to weight, body and food issues. Instead, we have to look at the messages our society sends about how we value our citizens.
From a young age, women aspire to Barbie-like measurements that are physiologically impossible without surgery and/or starvation:

• According to the National Eating Disorders Association, 42 percent of first- to third-grade girls want to lose weight, and 81 percent of 10-year-olds are afraid of being fat.
• According to a study in Pediatrics, about two-thirds of girls in the 5th to 12th grades said that magazine images influence their vision of an ideal body, and about half of the girls said the images made them want to lose weight.
• By adolescence, studies show that young people are receiving an estimated 5,260 “attractiveness messages” per year from network television commercials alone.
• According to Teen magazine, 35 percent of girls ages 6 to 12 have been on at least one diet, and 50 to 70 percent of normal-weight girls think they are overweight.

Over time, models have gone from thin to emaciated, which has been mirrored by a growing problem of eating disorders and body image dissatisfaction. In 1975 most models weighed 8 percent less than the average woman; today they weigh 23 percent less. Compared to the Playboy centerfolds and Miss America winners from the 1950s, at least one-quarter of present-day icons meet the weight criteria for anorexia. Meanwhile, the average woman’s weight has increased.

Today, the media is a far more powerful influence than ever before, sometimes taking precedence over friends, family or other real women. Whereas women used to look at role models who were average-sized, women are now comparing themselves with images (some of which are merely computerized conglomerations of body parts) that are unrealistically thin. In the old days, a young girl grew up wanting to look like her mother or best friend. Now she wants to look like Angelina Jolie.

Herein lies the real damage. The more an individual is exposed to the media, the more he or she believes it is reflective of the real world. What most people still don’t realize is that the majority of the pictures they see in magazines are altered in some way and that looking like their role models is physically impossible. It is a setup for self-hatred.

Genetics and Thin-Heritance

As a result of both genetic and environmental factors, body image issues and eating disorder behaviors may be passed down from generation to generation. This concept, recently labeled “thin-heritance,” explores how a mother’s views about food, dieting practices, and negative attitudes and comments about her own body or her child’s appearance increase her children’s risk for poor body image and eating disorders.

Cultural Messages

Body image also stems from cultural messages. For example, in Polynesian culture, bigger once meant being healthier and stronger. In a landmark 1998 study of girls in Fiji, Harvard researchers demonstrated how the introduction of television contributed to dramatic increases in eating disorders over a three-year period. In a culture that once valued a healthy, robust physique, girls began viewing themselves as fat, going on diets and feeling depressed about the way they looked, all in an effort to look more like the Western women they saw on shows like the original “Beverly Hills 90210.”

After three years, 74 percent of Fijian teenage girls described themselves as too fat. Those who watched TV three or more nights a week were 30 percent more likely to go on a diet than their peers who watched less TV. Being called “skinny” went from a cultural insult to a worthy life goal.

Similarly, African-American culture is beginning to see a shift. While there used to be greater acceptance of women who were full-figured, now the younger generations are buying into the thin ideal, and we’re seeing famous African-American singers and actresses advertising dramatic weight losses.

Relationships

In all relationships, whether a boyfriend, spouse, peer, coworker, sibling or parent, people look for acceptance and validation. When they receive criticism, rejection or judgment instead, they are at increased risk of a number of mental health issues, including poor body image and eating disorders. Troubling behaviors range from a dirty look when taking a second helping of food at the dinner table to persistent weight-related bullying by one’s peers. All of these exchanges, no matter how subtle, can have a lasting impact.

A Glimmer of Hope

Amidst all of the negative media messages, there have been a few glimmers of hope in the past decade:

• In an effort to become ambassadors for the message of healthy body image, Voguerecently announced that it would no longer feature models under age 16 or those who appear to have an eating disorder.
• Fashion organizations in Spain and Italy have specified a minimum healthy body mass index for models.
• Israel’s government recently passed a law that requires a healthy body mass index for models as well as full disclosure if fashion media and advertising use Photoshop to change a model’s figure.
• Dove has been leading “real beauty” empowerment campaigns and taking a stand against Photoshopping for almost a decade.
• In 2002, actress Jamie Lee Curtis posed for a magazine both “glammed up” and in “real life” fashion to bring awareness to the way media images are digitally altered.
• Social media websites such as Facebook, Tumblr and Pinterest are increasingly banning pro-anorexia and pro-bulimia messages. At the same time, there are a growing number of websites dedicated to healthy portrayals of real women, including the I Am That Girl blog.

In spite of these trailblazing changes, a lot of progress has yet to be made. The majority of magazines and other media have not replaced unrealistic images with normal, average-sized people. Although awareness is growing, parents and other authority figures can do more to model healthy self-image and diet, limit exposure to media, openly talk about media messages and share daily family meals. What we need is a broad-scale cultural shift that will only come about when we start demanding it.

Everything was booked and set via email. My choice. I hate calling people. She mailed me all the paperwork from her office to bring with me on my first visit. What I loved when I first met her was that she didn’t even want to look at the filled-out documents during session; she was eager to get down to talking. I was nervous being there, naturally, it’s sensitive material being shared with a stranger. I remember which chair I sat in and how she sat on the couch.

Eager. Ready.

So I tried to fill her in on my 18-year history of eating-disordered behavior. I had no idea what she would react to or even if she’d react at all. Turns out, she wasn’t one of those therapists that stare you down for minutes at a time. She often looked down and away when she was trying to express something to me. I could see the wheels in her head spinning. She often pushed my buttons. Going into therapy not really being able to express how I feel, I was able to tell her in the second year that she really made me mad. I knew I was making good progress when I was finally able to be 100 percent honest about my feelings.

I was worried I would offend her or make her mad. I am a big people pleaser, even when I pay them. Turns out, the more I talked and yammered on, the more she listened. I think she appreciated what I had to say and that I was just getting it out and showing some vulnerability. I was actively engaging in psychotherapy. That was tough for me, but she always went with my pace. I always had something to work on each week like homework. Or, more frequently, a goal to accomplish.

Then she got pregnant.

She informed me early and made sure I had a therapist for the interim. But I felt like a pool of jelly when she told me. I would be on my own for a while. Not only that, I had to try to reestablish a trusting relationship with someone else. Given the amount of maternity leave and knowing she was coming back, I just waited for her. I felt a new therapist would not be wise at the time. I did see one for one visit, but I got a bad vibe and backed off. The click wasn’t there. For me, if I can’t feel that connection, I’m not going to bother. That paid off for me.

Over the course of my three continuous years of seeing her on a weekly basis, we identified main areas of concern. I had to learn that it’s OK to think about myself once in a while. I deserve love and healing as well. She never put up with any of my games that I tried to play. She called me out on lies and bad attitudes. I swore at her once, and she swore back at me. I quickly learned that she was always, always paying attention to what I was doing.

One year around Thanksgiving, I brought in crayons and some paper. I made her sit down and draw or write what she was thankful for. I loved seeing this “real person.” And I loved when she laughed. For me, when my providers show or tell me little things about what they like and believe in, my trust in them escalates. A relationship is a two-way street. And that’s how I built my trust with her and my other doctors.

I did a lot of things because goals were set, and it was very encouraging to have someone who believed in me follow up on that goal. I didn’t want to disappoint her or myself. After all, I was paying this woman to help me.

This past January she informed me she’s moving. Relocating. I just said, “What?” No way. You can’t go. I greatly appreciated the amount of notice she gave me so I had time to adjust and prepare. During this time I stopped and reevaluated why I always showed up, even when I told her I didn’t want to come sometimes.

It was the encouragement. The challenges. The dedication she put in. The comfort of having a friendly person working with me. It was the confidence in myself that continued to rise each time I saw her. It was her unshakable faith in me. She never gave up. Ever.

I always thought therapy was for nutty people. In the beginning I was embarrassed to tell people I was even going. By the end I often said, “My therapist told me…” and I would conduct my own little psychotherapy sessions with friends. Whether or not I always showed it, I always listened to her. Even when I would stare out the window, watching rain and snow blow, my ears were never closed.

I said goodbye this last Wednesday. I had a very fun visit with her and was sure to show my appreciation for all the help she’d been. I was stoked to be there. I was ready. And much to my surprise….

I cried all the way home.

Psychotherapy proved to be an extremely rewarding experience. I always tried to outsmart my therapist, but she always had a one-up on me. It just humbled me and helped me realize there are just some things I don’t know much about. When you trust, you build and grow. It’s hard, yes. Just do it one time, and you’ll notice yourself doing it again and again. Before you even know what’s going on, you’ll start feeling that little pinch inside….confidence. I can hold my head high.

I’m worth it. And so are you.

So what constitutes trauma?

Trauma comes in many forms, including childhood abuse or neglect, growing up in an alcoholic or dysfunctional home, environmental catastrophes such as Hurricane Katrina, a serious accident, loss of a loved one, and violent attacks such as rape and sexual assault. What all of these experiences have in common is that they leave the individual feeling helpless and out of control.

Trauma isn’t the same as having post-traumatic stress disorder (PTSD). PTSD is a specific diagnosis with distinct criteria, involving a serious or life-threatening experience that results in nightmares, flashbacks, attempts to avoid situations similar to those that led to the trauma and a hyperactive startle response, among other symptoms.

How Trauma Contributes to Eating Disorders

An eating disorder may develop in an attempt to cope with the trauma, suppress painful emotions or to regain a sense of control. Here are a few examples of how trauma manifests in eating disorders:

• Example 1:After the death of a parent, a child is sent to live with a grandparent who isn’t as loving and kind as her mother. She had pleasant memories around food, cooking and eating as a family, and used food to comfort herself through the sadness of losing her mom. After bingeing, she feels consumed by guilt and self-loathing and begins purging through self-induced vomiting, use of laxatives or excessive exercise.
• Example 2: A young adult woman was raped in college. Because she was powerless to prevent the attack, she began restricting her food intake to feel a sense of control over her body. Losing weight became a way to disappear or to appear childlike so she could be cared for by others or appear less attractive to men. Others who have been sexually abused or traumatized by the men in their lives may overeat, using their weight as a protective mechanism to avoid being hurt again.

Treatment for Trauma and Eating Disorders

Individuals with a history of trauma may not fully recover from an eating disorder, or may experience chronic relapse from their eating disorder, until they address the underlying trauma. As part of an integrative approach to eating disorder treatment, patients may participate in the following interventions.

Somatic Experiencing

Trauma is held in the body and often can’t be resolved solely with intellectual processing. Somatic experiencing is a body-awareness technique that was developed by Peter Levine, PhD. With guidance from a therapist, patients explore the sensations in the body as they work to recognize and regulate their feelings of distress.

Eye Movement Desensitization and Reprocessing

In EMDR, the patient focuses on past memories, present triggers or experiences they anticipate in the future while focusing on an external stimulus (e.g., eye movements, tones or taps). For example, the patient may be asked to focus on a particular thought or bodily sensation while simultaneously moving their eyes back and forth, following the therapist’s fingers as they move across the patient’s field of vision for about 20-30 seconds. Each session is guided by a therapist to help the patient develop new insights or associations surrounding their experience of trauma.

Cognitive-Behavioral Therapy

Individuals who have experienced trauma often struggle with self-blame or feeling responsible for what happened to them. This maladaptive thought process may follow them into adulthood. Trauma victims may recreate the trauma in some form for themselves or by perpetrating the act of their abuser on others.

Cognitive-behavioral therapy helps patients work through anger, shame, guilt and other emotions by replacing negative thought and behavior patterns with new skills and problem-solving strategies. It is backed by extensive scientific research and is widely used to treat trauma, eating disorders and a variety of other mental illnesses. In a safe, supportive therapeutic setting, patients are able to openly talk about their traumatic experiences and disordered eating behaviors.

Coping Skills Training

Eating disorders frequently develop as a way to cope with trauma. If trauma occurs at a time in life when the individual lacks the coping mechanisms to process it, they may use food to feel a sense of control.

Rather than judging the coping mechanism as good or bad, the therapist helps the patient identify the purpose the eating disorder has served and recognize that it has begun to cost more than it helps. As an adult, the patient can develop more mature coping strategies and call upon different skills than they could at the time of the traumatic event.

Dialectical-behavior therapy helps trauma sufferers build the skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness to improve body image, manage painful feelings associated with trauma and guard against relapse. Learning how to trust and express anger in a healthy way are other important recovery tools.

Self-Help Support Groups

Social support is a major determinant of successful coping. A number of 12-step support groups exist for those suffering from an eating disorder, including Eating Disorders Anonymous, Overeaters Anonymous, and Anorexics and Bulimics Anonymous. Many eating disorder treatment programs invite family members to be part of the treatment team and to address their own emotional and psychological issues while their loved one is in treatment.

Nutritional Therapy

Beginning to address trauma can lead to an increase in eating disorder behaviors. By educating patients about nutrition and fueling the body with wholesome foods, patients can practice healthier patterns and boost their energy and mood.

Exercise

When a patient is working to manage their anger, certain forms of exercise may be a tool for healthy release of anger.

Nutraceuticals

Use of nutraceuticals – amino acids, nutrients and dietary supplements that improve overall health – can decrease distractions from trauma work and reduce some of the physical complaints of eating disorder recovery, such as bloating and constipation. Certain supplements and herbal remedies may also assist with symptoms of depression and co-occurring mood disorders.

Mind-Body Therapies

A number of mind-body therapies can aid in stress management and boost mood and memory. Meditation, acupuncture, yoga, massage, energy healing, self-hypnosis and breath work are a few examples of therapies that have been helpful in treating eating disorders and trauma.

The human mind is complex. A traumatic experience in childhood can manifest as an eating disorder years later. Both trauma and eating disorders can have profound, long-term consequences that make recovery challenging. Once the issues have been identified and are being treated simultaneously by a multidisciplinary team of professionals, lasting recovery is possible.

Q. Why doesn’t the current model of treating obesity — only telling people what and how much to eat — work for most people?

A. Great question, because the current model definitely doesn’t work. I can’t remember who said it, but there’s a saying that if you want to gain weight, go on a diet. Diets have a failure rate of about 95 percent. People may lose weight initially but then they usually gain it back and then some.

So this model doesn’t work for many reasons. For one thing, genetics plays a prominent role in our weight. This is why you can have two people who eat the same foods in the same quantities look very different. One may be thin; the other may be considered “overweight.” Our bodies are more complicated than the “calories in, calories out” equation assumes.

Instead of putting people on diets, which don’t work anyway, why not promote engaging in healthy behaviors directly? (By the way, many people have to do some pretty unhealthy things to lose weight and maintain that weight loss.) Instead of focusing on weight loss, focus on moving your body by doing activities that you enjoy — research has shown that fitness is critical for health — eating nutritious foods, getting enough sleep and listening to your body, along with other healthy self-care habits. Practicing these habits does help a person become healthier, whether they lose weight or not.

On a side note, there are plenty of skinny people who aren’t healthy, who smoke, lead sedentary lives and don’t nourish their bodies. But because they’re genetically predisposed to a slimmer frame, we don’t single them out and just assume that they’re healthy. The key is to encourage everyone to engage in healthy habits.

Health At Every Size is an approach that shifts the focus from weight to health. You can learn more here.   Also, check out these interviews on Weightless with Linda Bacon, author of Health At Every Size: The Surprising Truth About Your Weight — Part 1 and Part 2 and Evelyn Tribole, co-author of Intuitive Eating: A Revolutionary Program That Works — Part 1  and Part 2.

I also just wrote a post about healthy eating  on Weightless, which readers might be interested in.

Q. Are there reliable predictors for individuals who may become anorexic or bulimic?

A. Eating disorders are complicated and serious illnesses. A variety of complex factors contribute, including genetics, neurobiology and the environment. There’s a saying that genetics load the gun, and environment pulls the trigger.

Eating disorders tend to run in families. Also, traits such as perfectionism and cognitive rigidity can increase risk. Our appearance- and diet-obsessed culture serves as a trigger along with dieting. For people who are genetically and biologically vulnerable to eating disorders, dieting can serve as a gateway to an ED. But, again, there must be a genetic or biological vulnerability in order for the environment to play a role.

Q. Is there a relationship between ethnicity and anorexia? Or ethnicity and bulimia?

A. In the past, eating disorders were thought of as illnesses that solely strike white women. While the rates of eating disorders seem to be lower in ethnic groups like Asians and African-Americans, eating disorders can affect anyone, regardless of race, ethnicity, age, income, size, shape or sex. As one of my fave bloggers, Carrie Arnold of ED Bites, wrote in a post, “If you’re human, you can get an eating disorder.”

Q. What is the most commonly diagnosed eating disorder? Is there a substantial difference between the number of men and women diagnosed?

A. The most common eating disorder is binge eating disorder. According to the Binge Eating Disorder Association, it affects more than eight million men and women.

In general, more women do struggle with eating disorders. But plenty of men do, too. We used to think that about 10 percent of people with eating disorders were men. But it may be as high as 25 percent. Again, anyone can struggle with an eating disorder.

Q. What is your resolution for the new year?

A. My resolution is to listen to myself and my needs more when it comes to the decisions in my life, big or small. It could be everything from moving my body to eating to pursuing certain creative projects.

Q. Where do you see yourself in five years?

A. I see myself running after a few kids and writing my heart out.

Complementary and alternative therapies used in integrative medicine can include acupuncture, chiropractic, herbal medicine, dietary supplements and others that give the clinician a wide array of treatments for difficult conditions. This is particularly true in the integrative medicine approach to eating disorders.

Eating disorders have been documented in adolescents and adults for many years. More recently, there is evidence that these disorders can also affect young children.

The cornerstones of an integrative medicine model for eating disorders includes some components that are found in every approach to the treatment of eating disorders, but may be used in a unique manner. Others are more specific to the use of complementary and alternative medicine (CAM) therapies. The most important difference in this model when compared to other treatment strategies is the philosophical underpinning of integrative medicine — that is, the belief in the self-healing nature of body, mind and spirit.

The integrative medicine philosophy holds that the body, mind and spirit are able to heal with support from conventional and alternative therapies, given needed changes in lifestyle. These changes happen in concert with the therapeutic relationship the patient has with his or her therapist, physician or other healer.

The cornerstones of this integrative medicine approach can include:

• Medical treatment that focuses on reducing the risk of, detecting and treating complications of the disease and on improving overall health status.

• Nutritional therapies to improve nutritional status, help women improve their relationship with food, and improve digestion and absorption of needed nutrients.
• The use of botanical therapies to reduce side effects of pharmacological therapies.
• Body movement to help patients get back in touch with physical cues and learn healthy behaviors.
• Psychological testing to identify co-occurring diagnoses, including mood and personality disorders, and inform treatment strategies.
• Skills training, which may include the use of cognitive behavioral therapy or dialectical behavior therapy, to enable patients to cope more effectively with stressors in their lives and with situations and emotions that may trigger relapse.
• Complementary and alternative therapies, which may include massage, mind-body, chiropractic, acupuncture and energy medicine therapies.
• Prescription medications, which are used cautiously in children and adolescents and should be prescribed only to manage behavior that is life-threatening or therapy interrupting.

Eating disorders comprise a spectrum of disorders that are difficult to treat and have a high risk for morbidity and mortality. The integrative medicine approach offers many options to explore. While research into these therapies is still in the early stages, the benefit-to-risk ratio is favorable. Recovery from eating disorders is possible and the earlier they are treated, the better the prognosis.

The “residential” treatment approach has long been available for eating disorders, since the treatment of these disorders tends to be long and complicated. Andrew Pollack writing for the New York Times notes how these kinds of programs have now become the focus of insurance companies looking to cut back on treatment options.

It’s no surprise, really. With the rollout of mental health parity — requiring that insurance companies can no longer discriminate against people with mental disorders for their treatment options — those companies are looking for other places they can cut costs. Residential treatment for eating disorders appears to be one obvious area.

So is residential treatment a legitimate modality for helping people with eating disorders? Should insurance companies cover the costs of such care?

According to one study (Frisch et al., 2006), the average length of stay in a residential treatment center for an eating disorder is 83 days. That’s nearly 3 months of full-time, round-the-clock treatment and care. The cost for such care? On average, it’s $956 per day. You read that right — nearly $1,000/day is the average cost for such care. That means a single patient at such a treatment center is bringing in, on average, $79,348.

Proponents of residential treatment admit there’s little research to back its use for eating disorders, but are adamant such programs are effective and needed:

Dr Anne E. Becker, president of the Academy of Eating Disorders and director of the eating disorders program at Massachusetts General Hospital, said that despite a paucity of studies, “There’s no question that residential treatment is life-saving for some patients.”

Okay. But so is spiritual healing, according to many spiritual healers. What separates belief (the mainstay of religion) from fact (the mainstay of science) is data. Without data, we operate in a vacuum of knowledge.

Ah, but we apparently do have some data. Just not the kind that a residential treatment center wants to hear:

Ira Burnim, legal director of the Bazelon Center for Mental Health Law, which litigates for better mental health treatments, said that while he was not familiar with eating disorders, “study after study” had shown that residential centers for other mental or emotional disorders were not as effective as treatment at home. [...]

“There’s a wide variation in licensing across the country,” said Jena L. Estes, vice president for the federal employee program at the Blue Cross and Blue Shield Association. “There’s a lack of oversight of many of those residential treatment centers.”

There is some research data in the literature. But surprisingly very little, and nothing approaching a randomized controlled study — the gold standard of research. For instance, in Bean et al. (2004), the researchers did a 15-month phone followup with folks who had anorexia who had stayed at their residential treatment center. According to this study, women experienced a 7 lb weight gain, while men experienced an average of a 19 lb weight gain.

But we have no idea whether these are good or bad numbers. Would someone in outpatient treatment over the same time period experience more or less weight gain? Are these numbers even accurate, given they are self-reported by the patient over the telephone (and the research was conducted by biased researchers at their own treatment center)? So we have “data” here, but without context, it’s next to meaningless.

Another study by Bean & Weltzin (2001) showed that after a 6 month followup, anorexic and bulimic women retained some, but not all, of the improvements they made while in treatment. Again, without an outpatient or control group, it’s hard to say whether this is a good or bad finding.

There’s also a few dissertations that offer similar evidence — when pre- versus post- measures are used in a residential treatment program, most patients are improved at discharge. This is hardly a surprising finding. But is it due to the “treatment” portion of the program, or the “residential” component — or some important combination thereof — remains unanswered.

So I hate to say it, but the insurance companies in this case appear to have a pretty good case, at least based upon the paucity of research. I always say to people, if you want to shut up an insurance company, show them the research that your treatment modality works (and works better than cheaper treatment X).

For better or worse, judges don’t have to care about the research, and in this case ruled against the insurance company where the issue of paying for residential treatment for an eating disorder was brought to court:

The Ninth Circuit Appeals judges, based in San Francisco, ruled that residential treatment was medically necessary for eating disorders, and therefore had to be covered under the state’s parity law, even if no exact equivalent existed on the physical disease side.

Eating disorders are unique, and perhaps even more unique than drug and alcohol problems — therefore deserving of special treatment. After all, unlike alcohol or drugs, we all have to eat. The way eating disorders wrap themselves up into the person’s mind and their body image is very difficult to untangle.

But if we want people to have access to residential treatment centers to help with their eating disorders, shouldn’t the industry support far more well-designed, scientific studies to examine the effectiveness of this modality? I don’t think anybody would question these centers if such research existed today, but the fact that it doesn’t after more than 25 years raises more than just a few eyebrows.

Read the full article: Ruling Offers Hope to Eating Disorder Sufferers

References

Bean, Pamela; Loomis, Catherine C.; Timmel, Pamela; Hallinan, Patricia; Moore, Sara; Mammel, Jane; Weltzin, Theodore; (2004). Outcome Variables for Anorexic Males and Females One Year After Discharge from Residential Treatment. Journal of Addictive Diseases, 23, 83-94.

Bean, P. & Weltzin, T. (2001). Evolution of symptom severity during residential treatment of females with eating disorders. Eating and Weight Disorders, 6, 197-204

Frisch, Maria J.; Herzog, David B.; Franko, Debra L.; (2006). Residential Treatment for Eating Disorders. International Journal of Eating Disorders, 39, 434-442.

All there is to do now is listen to your roommate snore and mutter to herself in her sleep and the sounds of the nurses talking and phones ringing at the nurses station. You remember a Seroquel-induced nightmare you had previously in the night in which you were trapped in a house that was filling with water, drowning and gasping for air. You make a mental note to mention the dream to your doctor later on.

7:00 am: Morning checks. A tech bangs on your door just as you have started to drift off into a sweet sleep again and informs you that you must be up for breakfast in thirty minutes. You incoherently moan something that resembles an “OK,” roll over and close your eyes again.

7:10 am: Brush your teeth, brush your hair, make your bed, and put on a sweatshirt.

7:15 am: You drag your exhausted body out of bed and grab a cup of the weakest, wateriest coffee you have ever ingested from the nurses station. You line up against the wall and prepare to be paraded down to the cafeteria.

7:30 am: Breakfast time. Today is Friday so it’s pancake day, which means spirits are high among the residents. Eggs with cheese, bacon, grits and cereal are also served in the cafeteria, which reminds you of the one that you ate in during your elementary school years. You opt for Cheerios, which you will eat by putting three at a time into your spoon (you are very ritualistic when it comes to your eating habits) and a few sips of black coffee.

7:45 am: You are put on one-on-one after each and every meal, which means a nurse must accompany you at all times because you are bulimic and they don’t trust you not to vomit up your food. This upsets you greatly and you cry.

8:30 am: Community group. You discuss at length the rules and regulations of the hospital (only use the phone for 10 minutes at a time, bath buckets are under no circumstances to be kept in your room, no towels or food in your rooms, no physical contact with other patients.) Someone complains that their book is missing, someone else cries about something you can’t even comprehend. Someone always cries during your meetings. You set a daily goal (to finish your book, do laundry) and share why you are here.

Most people are there for depression, some for anxiety, many for suicide attempts. One or two are there for insomnia, a few for manic episodes and one boy about your age is there for homicidal ideation. It isn’t as scary as it sounds, he is actually very sweet, close to your age and you are already starting to become close with him. His name is Todd and he beat up one of his friends for stealing his now ex-girlfriend. You yourself are there for a suicide attempt (flashback to overdosing on 3000 milligrams of Seroquel, sleeping for 36 hours and then slitting your wrists, slicing each artery, spewing blood all over the walls of your college dormitory.)

9:10 am: You meet with Dr. Williams, your amazing psychiatrist. He is a young man who always looks perpetually concerned; he is unbelievably kind and compassionate. He runs through the usual routine of questions: do you feel like hurting yourself, how are you sleeping, how is your mood (no, bad, depressed) and he takes you off of your lithium and ups your Abilify. He also prescribes you Ambien, which is stronger than the sleep medicine.

9:47 am: Code one! A 90-pound schizophrenic girl screams and punches the walls (she hears voices and sees monsters that aren’t there) and a code team is called to sedate and restrain her. Incidents like this are uncommon on your unit but not unheard of. They take her away, kicking and screaming.

10:00 am: You and Todd sit side by side reading a book and holding hands. His hand is rough and you can’t help but smile. He makes you a little less scared in an unfamiliar setting like this. A tech glares and scolds you for breaking the coveted “no-touching” policy.

11:30 am: Process group with your social workers. Today’s topic is “combating negative thoughts.” You do an exercise where you write a negative thought and three positive ones to counteract it. Several people cry when they read theirs and one man launches into an off-topic diatribe on the importance of exercise until the social worker, Tonya, politely cuts him off.

A short, older lady who claims to have once been a backup singer for Aerosmith preaches on bipolar disorder.

12:30 pm: Lunchtime. Pizza is being served today so everyone is in good spirits, except for you who is a diagnosed anorexic. You get a salad which you drown in mustard and pepper (anorexics have strange eating habits) and a Diet Coke. You don’t finish your salad and a tech tells you you’re going to lose points for not eating, which means you might have to stay longer. You cry.

1:00 pm: Vital signs are taken. They weigh you and make you stand backward on the scale.

1:15 pm: You drink a ton of coffee and experience a sugar/caffeine-induced mania and decide you’re going to start writing a book. A tech tells you to calm down and makes you drink a glass of water.

2:00 pm: Recreational therapy. You watch the movie “The Karate Kid” and popcorn is served. You don’t eat it, which gets noted in your chart by a tech.

2:30 pm: Education group. A short, older lady who claims to have once been a backup singer for Aerosmith preaches on bipolar disorder and the evils of not being compliant with medication.

4:00 pm: Visitation hour.

5:00 pm: Line up for dinner. Tonight is beef stroganoff (everyone groans) and steamed carrots. You don’t eat and spend dinner hour making an elaborate design out of your peas and carrots.

6:00 pm: You sketch a picture of Todd and he draws one of you. It’s true love.

8:00 pm: Closure group. You review the daily goals you set. Some people meet them, others don’t. You met both of yours (to finish your book and do laundry.) A lady who is in there for bipolar disorder breaks down and sobs for 20 minutes about not achieving her goal.

8:30 pm: Finally out of sight from the techs, you and Todd watch TV, his head in your lap, you stroking his hair.

9:00 pm: Night meds, a very popular time of evening for obvious reasons. Everyone races to be at the front of the line. You would think they were giving out hundred dollar bills and not psychiatric medication. You dutifully take your Seroquel and Gabitril for sleep and your Abilify for depression.

9:30 pm: Everyone hangs out in the common room, laughing and talking about anything and everything. You are a big happy family and for a moment, just a moment, you feel like a normal teenager who is not spending her summer in a mental hospital for being a depressive-borderline personality-bipolar-bulimic-anorexic mess. Life is good.

11:00 pm: “Lights out!” a nurse shouts. The manic patients and insomniacs groan in disdain. Todd kisses you when a tech isn’t looking and your heart melts.

11:15 pm: You happily drift off into a deep, medicated slumber, thinking that today was not all that bad and tomorrow probably won’t be either.

Mental hospitals are very misunderstood places. There is a certain stigma not only attached to being a patient in a mental hospital, but to the whole field of mental health to begin with. The people I met during my stay at Holly Hill were not crazy. They were not nuts. They just needed a little extra help and a safe, relaxing place to recuperate from their problems. Most of the people I met were perfectly normal, functioning members of society with jobs, families, friends and a positive future. Some were students, like myself.

Going to a mental hospital is nothing to be ashamed of or embarrassed by and I encourage everyone to take that step if they find it necessary. Life can be overwhelming and sometimes we just need to heal. Holly Hill changed my life. I went in suicidal, depressed, and a terrified mess, and two months later, I came out, in the process of being healed, with new friends, and a new perspective on life. My hospitalization not only saved my life, it changed it.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.