True, nothing has changed physically about my kitchen. Not even the rug I got a Target about 5 years ago for under three bucks. I live in an apartment. Tearing out the cabinetry ain't gonna happen. Certainly not by me and definitely not by management.

However, at the high tide of anorexia, I used the kitchen for one thing: coffee. And the microwave, with which to reheat the said coffee about a gazillion times. I tossed back shots of espresso like a barfly, but coffee took a wee bit longer. I cleaned my kitchen far more than I cooked in it. My fridge contained the following: three Dannon Light n Fit yogurts (vanilla), a bag of shriveling apples, and a case of Diet Coke. I darted in and darted out. I was the martyred Christian condemned to the lions, and the kitchen, my friends, contained those lions. It had, like, food. Food made you fat. I did not want to be fat. In fact, I was willing to die in order to prevent that. Which makes one realize that it's not control, it's fear that's driving anorexia. Pure, naked, frothing-at-the-mouth fear.

There are some things that scare me about my current kitchen. The dark recesses and crevices in which my kitty knocks stray pieces of kibble that can attract roaches, ants, rats, and tarantulas. Also the aging oven. Sounds emanate from its behemoth belly that should NOT be coming from inanimate objects. I swear I have a house elf cooking my food. If only the little dude would do my dishes...

My kitchen has undergone an Extreme Makeover. I actually own butter! Not only own it, but use it! It's quite odd. I can't believe it's not butter? I can. Also olive and sesame oils. Candy bars by the ton. Milk. Dirty pots and pans. Not the dirty pots and pans that sit out for days, attract flies, and then require the health department to bulldoze the place. Just pans that have actually been- I don't know- used in the past decade. And bread! I actually have a loaf of bread sitting around, half eaten. Of loaves and fishes I suppose.

Recovering from anorexia requires eating and gaining weight, certainly. But it's also about changing your whole outlook on life. Food is a part of life. When I was anorexic, I wasn't really alive, a sort of emaciated Lazarus wandering around. Food is bringing me back to life. And it's making me realize that being half-dead (or, as was my case, basically three-quarters dead most of the time, approaching 95% at the really bad moments) really sucks. It was a stable crappy feeling, as life tends to bash me about a bit, but there was no joy. The kitchen is a metaphor for my life.

Ouch. I feel like I'm back in high school English.

But I'm living in my kitchen, cooking in my kitchen, eating in my kitchen. The cabinetry and accouterments are the same. My life, from the outside, hasn't changed all that much. I'm at the same job, hated by the same co-workers, living in the same apartment, with the same aspirations to be a professional writer.* I look pretty much the same. I weigh a little more, but my hair is still a spiky copper color, I haven't taken out my nose stud (sorry, Mom), and I still tweeze my eyebrows on a frighteningly regular basis. Yet my whole means of existing in this world are different. I can smile and mean it- okay not a whole lot of the time, but it's better than avidly looking for cliffs from which to fling oneself to a certain death. Like a lemming. I don't fear things like "working lunch" or "dinner party" or any sort of hint that a piece of chocolate cake will be in a five mile radius.

Aw, crap. I'm getting all mushy now.

*Please note: I consider this blog to be amateur whining, NOT professional writing.

The battle of the Supers! The Clash of the Titans! I am Spartacus!

I am Spartacus! I am Spartacus! I am Spartacus!

Sorry. This post has nothing to do with Spartacus.

What it does have to do with is our strange, messed up society that has Mickey D's commercials immediately preceding those for Weight Watchers or Jenny Craig. We have Super-size and Supermodels. Super everything. Supersized fries are evil, supermodels are evil.

We are, it seems, a culture of extremes. The larger our portion sizes get, the smaller we're supposed to look. And, in a way that only Americans can, we're beginning to tackle the issue.

Health class. I remember my first health class. Fifth grade, the filmstrip "You're Becoming a Woman Now," where a pimply faced girl with one of those side ponytails (this was 1990, keep in mind) slides a Kotex into her backpack. End of story. Both the ponytail and the whole notion of a "filmstrip" date me horribly, but still.

Now we try to terrorize children into the dangers of the world around us. Yes, the world can be a dangerous place. You can get raped, mugged, kidnapped, beaten, the clap, AIDS, fat. The whole nine yards. So we show SuperSize Me and have 11-year-olds read "Fast Food Nation." I'm not saying go Biggie size your fries every single day. But if you have a hankering for fries, then go for it.

The supreme irony is that this lecture is, no doubt, followed by the one on eating disorders. It doesn't take a rocket scientist to connect the dots.

There is a book out called Fat is a Feminist Issue. Since I haven't read it, I won't comment upon it. What is interesting is how the whole notion of "Fat" as a social concept has changed. Fat is no longer (just) a feminist issue. Fat is a fear issue. One should be afraid of fat and obesity, of the millions of Americans just lumbering along down the street, arms swaying in the breeze, gleefully munching away on hot dogs. I remember watching ads for Sweatin' to the Oldies, and watching Richard Simmons cart the extremely obese out of their homes on a forklift. A couple of tapes and some spangly shorts later- fit and fabulous!!!

Again, I suppose this dates me horribly. But anyway.

People do not typically change their behavior because of a fear somewhere down the line. So we start telling kids "You're getting fat! Just look at that adipose multiply! You can see it before your very eyes! Don't touch that french fry!!!" So you take a kid prone to anxiety and make them fear fat. So they cut fat out of their diet. Except in a small percentage of the population, they keep going. And going and going and going, a veritable Energizer Bunny of dieting.

To be sure, health classes usually have a lecture on eating disorders, which tends to be quite "tippy" if you ask me. Thin is good, fat is bad, so anorexia must be, like, awesome. Sorry, but that's the message out there.

I'm not one of those people who idealizes the past and thinks that everything was better back then. Maybe it was, maybe it wasn't. But let me tell you this: if I want a Snickers bar, then I'm damn well going to have one.

That's so super.

As I was sitting at the keyboard and trying to decide what to whine about today, I realized I was hungry and went and grabbed my evening snack to munch while I wrote.

That's when it hit me: I was hungry therefore I ate. I have a food plan that I'm following, but even so.

I don't think people without eating disorders (or without an up close and personal knowledge of them) realize how much work and effort and blood, sweat, and tears has gone into that simple act. Before, when I was listening to the sweet nothings Ed was whispering into my ear, I would have thought I was strong if I didn't eat. Now I realize that not eating will just make me more hungry.

My first therapist (with whom I have many issues, but who has also provided me with at least a little insight) said that "Starving doesn't make you special; starving just makes you sick." I just deluded myself into thinking that avoiding food was what made me stand out from the crowd. The side effects of my illness (emaciation) made me stand out physically, but I was sick, not special.

Yeah yeah, I know I'm special, but not because I used to be anorexic. I did truly think that losing weight would make me special, would bring me to that magical pinnacle of perfection.

Perfection my ass.

Gaining weight- deliberately gaining weight- is grueling. I found out yesterday that I'm not as close to my target weight as I had thought. Which is both good and bad. First I thought "Geez...and if I'm fat NOW..." I feel like I've been turning into a hog. I'm going to give birth to piglets! Crap! Now it's a little more reassuring, that most hog-lettes don't weigh what I do, that my gain has been slow and steady. I still hate it. Mentally and physically, I feel like I have been just battered from head to toe and then dumped in the clothes dryer for a spin on extra high.

Yet still I eat. I have to. The only way out is through.

That really sucks. I'm eating my way out of anorexia, and I'm sick and tired of it. I hate this disease. Anyone who says it's a choice is off their rocker. You'd choose this? Good grief.

I have a poster on my wall behind my kitchen table that says "Recovery happens one meal at a time."

True, that.

Whew...and I thought I had bad PMS. Get a whole office full of women together, on the same cycle, except none of them will eat chocolate! No wonder they took the chocolate off of my desk the other day. (I put it back out in the morning) They're all crabby, and all they do is talk about food and how many pounds they've lost.

Payback's a bitch, huh? If only they knew...

Of course, they also began to discuss food servings and how many Weight Watchers Points were in each different item. I have yet to figure out the magical formula for determining how many points are in each particular piece of food. From the sounds of it, you could use all your points on a marshmallow roast and still come in okay. Whatever. However, the conversation then moved on to how to count up the points in a banana. Apparently, one banana is two servings of fruit.

There are numerous things I'd love to tell my coworkers, among them are the following:

• No I will NOT tell you how come I'm so skinny.
• I don't eat diet food so please don't ask.
• You're hungry because you're not eating enough.
• One serving of a banana is...a banana!

I'm starting to imagine all of these half-eaten bananas laying around in the fridge- next to all of the cans of diet Coke. But hey- they usually have some extra condoms lying around from the family planning clinic. Talk about a great banana preserver! It's hardly likely an extra banana or two is what made you gain weight, so why are you worrying about it?

Augh.

Part of me feels like I'm missing out on this game. First off, I'm definitely not used to being the heartiest eater in a place. Second, they don't talk about anything besides food and weight. If I'm going to talk to any of them, it has to be about one of the above two topics. I think about food and weight enough, and pay my therapist and dietician quite enough to discuss them. The LAST thing I want to do is talk about it some more.

Although one of the ladies admitted before lunch that she was so hungry she could eat the ass of a skunk.

Yes, Julie, but is a serving one butt cheek or two?

You decide.

Oh for crap's sake- get your minds out of the gutter.

Today was my first class in (get this!) hula dancing. It was a total hoot. I actually didn't suck that horribly, which was astounding given that I was gently encouraged to quit ballet at 5 years old because, well, there wasn't much hope. But it was okay- I got piano lessons instead. Now, I get a coconut bra. Kiwis, to be horribly honest.

The best part is how you move your body in Polynesian dance is strong and silky at the same time. It's actually a lot like Irish dance: the bottom half moves and the top half remains stationary. We all used a lava-lava, which is the same thing as a sarong. It sits low on your hips to give you a better sense of where they are as you move.

The dances tell a story, and this evening we learned the first two verses of a four verse dance. My moves are probably the Polynesian equivalent of the middle finger, but hey, it's all in good fun. The teacher is of Maori descent (though not a New Zealander herself), so we're going to be doing a tour of the South Pacific as we go. We started in Hawaii with a traditional hula meet 'n' greet dance.

Tahiti, here we come!

To my coworkers:

For the past seven years, I have been a loser.

Seriously. I have been suffering from anorexia nervosa. My whole life was about losing. Weight, mostly, but I ended up losing far more. My hair, for instance. Significant amounts of bone density. All four years of college, the two years of grad school. I have lost out on relationships with both men and women. I am 26 years old and have never had a boyfriend. Not one. I have only one friend nearby to speak of, but I see my therapist more often. I have also lost approximately half a million dollars in treatment costs, both inpatient and outpatient. I nearly lost my life, several times: three times from cardiac arrest, and one from an overdose.

I have been a loser for far too long. Now, I am a gainer. Weight, yes, but I am also gaining my life back. I can go out to eat at a restaurant. I can hold down a job. I can drive a car. I can live on my own.

If all of you at work want to play the "Big Fat Loser" game, do it knowing I can whip your asses in a heartbeat. When I walk in the doors to the office, I am filled with dread. I feel like an alcoholic forced to watch Bud Light ads on her computer non-stop, and then go into the break room for cocktail hour. And not drink. You know how they talk about "hostile work environments" in those sexual harassment sensitivity trainings? You might not have nudie pictures up in your cubes, but you do have signs saying "Nothing tastes like looking good feels." I've seen that phrase before. I've also seen group weight loss competitions. Wanna know where? On pro-anorexia websites. Yep. They got it from all of you.

This battle is simply a lose-lose situation. I am forced to become a loser; I have no other options. If I keep my mouth shut, I lose any sense of value and self-respect that I have fought so hard to earn these past few years. If I speak out, I will be blackballed. Ya'll know it's me who is objecting. I have made no secret of that. You can make nice, but I know. I've been the reject many times before. This time, I don't want to have to lose in order to win.

I never thought of any of you as losers. Until now. You have no idea what an eating disorder is like. The shivering, the praying "Please God, let me die, but make me skinny first." The blacking out on the treadmill. The endless hospitalizations and treatment. The loss of all sense of what it means to be normal.

So please respect MY right to eat how I want and keep the fucking chocolates on my desk. You are not weak if you eat a chocolate on your diet. You are weak because you cannot respect me.

Regards,
Carrie

I need some respect online because I sure don't get it at work.

Gah.

I'm sorry, but thus far I have magnanimously respected my co-workers' right to diet in public. Now why won't they let me NOT diet in public? All I did was put a bowl of chocolates out on my desk. And then the shit hit the fan. They voted that I should remove it. I refused.

What is this- some sort of "Survivor at Work"? You don't get to vote your fellow workers off the island. Nope. I feel like I'm perpetually stuck in high school, and I've been out for almost a decade. C'mon ladies, lets grow up. Do we need a diet club? Really? I don't ask what you did (or didn't) eat for dinner, so don't bug me. If I want to eat chocolate and keep them available for all, then I will. And by the way, I do actually hear you over the cube walls. I'm not deaf. I know when you're gossiping about me.

I had to restrain myself from telling the lady who yelled at me about the now infamous chocolates to "get some more willpower, chica!" But I didn't.

Then there was a mass email circulated updating the "Big Fat Loser" contest (the bank is beating the health department! Horrors!), and a tag line asking everyone to PLEASE respect those who are trying to lose weight and eat healthy.

So would you PLEASE respect my right to eat healthy? This includes chocolates. They're high in antioxidants you know.

Are diets and eating disorders connected? I was always taught that anorexia was just a "diet gone overboard." And while there are similarities to weight loss diets and anorexia, they're more similar biochemically than psychologically.

The "Big Fat Losers" in my office talk about food all the time. Seriously. It's annoying. I spend enough time obsessing about food- the last thing I want to do is hear my co-workers evaluating dark vs. milk chocolate. (Dark. All the way.) I don't know why it took me so long to figure it out but...

...they're HUNGRY! That's why people with anorexia talk about food all the time, and that's why dieters do, too. It's malnutrition! Perhaps on a different level, but malnutrition nonetheless.

And that's where things get tricky. I don't think diets per se cause anorexia. There is simply not enough evidence to imply causation, nor do I ever think they will be. Can anorexia start as a weight loss diet? Definitely. I've seen it. But there are other causes, such as an autoimmune reaction to a Type A Strep infection (aka, PANDAS- Pediatric AutoImmune Neurological Disorder Associated with Strep). At any rate, what I think happens is that most of the people who develop anorexia are genetically more vulnerable to the effects of malnutrition than the rest of the population. I don't think there is one gene, which certainly explains how EDs exist along a continuum. But if the conditions are right...out pops an ED.

Here's what bugs me about our diet-oriented society: it tolerates, even encourages, malnutrition as a way of life. It lets anorexia and bulimia and other eating disorders go unnoticed because the weight-loss obsession is so normal anymore. Dieting may be common, but deliberately depriving yourself of nutrients is not normal. No one bats an eyelash when a perfectly healthy adolescent or young adult wants to lose weight. For some, it may be a short lived effort, or yet another diet (followed by yet another binge), but for others, it's a whole different ballgame.

And I guess that's what really gets under my skin in my current office environment. I don't think most of these women have seen the deadly effects of malnutrition up close. I have. It's not pretty. And it doesn't just go away.

OK, before I start ranting, let me get one thing straight. I do NOT blame the diet industry for my eating disorder. I give my brain and DNA the full responsibility for that. However, I will say this: if dieting and weight loss were not promulgated as a means to happiness, I doubt I would have been as entranced by food restriction in the first place. In fact, I don't even know that dieting as a concept would have occurred to me.

All right, what happened today, in a nutshell, was this: I go back to work after a six week medical leave for a severe recurrence of depression. My boss, who is wonderful, knows the basics but not the details. I'm nervous but looking forward to being back. I walk in the door and am greeted by a sign that says "Nothing tastes like looking good feels." Aside from the grammar...

Talk about a big slap in the face!!!

So I go check my emails, have almost 200 new ones, and I would say at least one-quarter of them have to do with the "Big Fat Loser" weight loss contest at work. I, at 26, am the youngest employee, and am convinced this is completely infantile. I do not realize the depths of this depravity until I go into the break room for some coffee and see posters that tally how many pounds each person has lost.

I think my jaw is still on the floor.

I'm not going to say whether some people needed to lose weight for medical reasons. I don't want to know. That's between them and their doctor, just as mine is with my doctor. Weight Watchers at Work...c'mon now. Do you really want Betty in Accounts Payable knowing how many Points you tossed back at the holiday party last weekend? Author and activist Wendy Shanker advocates a separation between Body and Business, just like there is between church and state.

My problem isn't with the dieting. It's that it just feels like a slap in the face to all of the hard recovery work I've been doing. It was so excruciatingly difficult, and then it almost seemed like it was mocked by my co-workers. I don't know- they say I'm so Cute! and Tiny! Ugh. That pisses me off. I'm not cute and tiny- I'm sick. People who have chemo lose weight, and no one yakks them up for it. It's because they're sick. Me, too. Only it's a "socially acceptable" illness. I have a problem with that.

Then, at the end of the day, I went back home and had a Payday bar as part of my evening snack. So appropriate on so many levels... :)

It's no secret in the strange world of eating disorders that sufferers like to compete with each other. Usually it involves who weighs the least, but it can also be who exercises the most, has had their ED the longest, has come closest to death and lived to tell about it, etc. It's completely pointless in the grand scheme of things, but let me tell you, when you're locked up, it's one of the few constant sources of entertainment.

I've played this game for years, and never really come out on top. There was always someone sicker. Always. And there always will be. I have been sicker than others, and not as sick as some. Every person is this way. Every eating disorder is different.

I almost miss the game of trying to be the "best" anorexic. I'm kind of competitive (though I avoid competitions in general because I'm a pretty bad loser. Not the chuck the board game across the room bad loser, I just tend to hate myself after), so that game was a way to measure my worth. And a way for Ed to keep me within his grasp- I could always be better at my eating disorder. All this in spite of the fact that Hallmark does not make cards that say "Congratulations! You just got a tube stuffed up your nose!"

But today, one of my online friends said, "Why don't you try being the best WORST anorexic?"

It goes something like this: why not try to be better at achieving a healthy weight, at following your meal plan, at not exercising on the sly, at not purging or cutting or whatever. I like that. It's a positive competition- with myself. It's a challenge, even much more of a challenge than the anorexia ever was. The anorexia was part of my brain's wiring; recovery is rewiring my brain.

So there. I'm Carrie. The best worst anorexic in the world.

A little while ago, I read a rather interesting book called "The Paradox of Choice" by Barry Schwartz. Unfortunately, I don't have the book with me at the moment, but I've been thinking about it, off and on, for a month or two now, particularly from the standpoint of someone who suffers from OCD and anorexia.

The book is written from a sort of "less is more" standpoint, why the more choices we have, the more dissatisfied we are. It's hard to choose, and when we see all of the other choices out there, we begin to second-guess what we have. The process of actually making a decision is tough for me- I get overwhelmed easily by all of the different options, yet I need to have a decision made. Hanging ends does not bode well for my mental health.

However, with the OCD and a nice strong streak of perfectionism, I feel compelled to make the right choice, the "perfect" choice. That idea is so overwhelming that I get locked into the same old ways of doing things. Some of my routines are purely functional: I get ready the same way in the morning because the fewer decisions for a semi-comatose person, the better. But with the AN, I found myself locked into eating the same foods in the same order every single day. Ditto for exercise. Sometimes, I found myself unable to eat because I literally was so overwhelmed with anxiety that I couldn't choose. Even with my OCD habits, I had to do things a certain number of times so I didn't have to decide whether or not the bathroom was clean. If I scrubbed the counter five times, then I could be pretty damn sure it was clean.

I guess just reading this book helped me understand myself a little better. Why I was so relieved in treatment when I was told what to eat and when. The last time I was in a small residential facility, so there was only one menu choice. I was served my portions and had to eat them. Period. It was such a freaking RELIEF! No more agonizing over the "perfect" granola bar. Here we just had two different flavors of the same bar. Or apple juice vs. orange juice. I was a twenty-five year old young woman who had uber-public health powers at the state level, yet I couldn't decide what I wanted (or Ed would let me have) for dinner. It made no sense. Before, I was so terrified, I didn't choose and thus didn't eat. In treatment, I didn't choose because I didn't have to. And it felt good.

Now I am able to choose, and even now, that includes choosing to eat a sufficient volume of food to produce a weight gain. I hate that part. But I am able to do it- with some trade secrets, such as Coldstone ice cream and jumbo apple turnovers.

The paradox of choice. Sometimes less really is more.

Those are the words I have most regretted saying to myself: I just want to lose five pounds. I don't think one phrase could have changed my life more. I have spend endless hours in therapy analyzing why I wanted to lose those five pounds.

First I was told that I was vain. Mmm-hmmm. From a science major who doesn't wear makeup. Who chopped her hair off because braiding it in the morning was too much of a hassle.

Second I was told that I was getting revenge upon my mom for any number of things in my childhood, the worst of which was that she loved me too much. Do my mom and I have issues? Yep. And so do every other mother and daughter on the face of this earth. Yet the problem remains: if the anorexia was my way of paying my mom back for something, why did all the pain I caused her still render so freaking much guilt that some days I don't know if I can stand i.

Third I was told that those five pounds were a means of control. I am, admittedly, a control freak. I like things done my way. So I usually just do them myself, rather than have to put up with someone else's slip-shod manner. But weight? Yes I could control my weight, but that wasn't quite it.

There are even more theories, several told to me in a medical ward by a random psychiatrist sitting at the foot of my bed who had known me for all of five minutes. Let's just say it was to his benefit I was a control freak because otherwise I may have bit his head off. Oh, wait- anorexics aren't supposed to eat meat. Darn... Lucky man, him.

I can't explain anymore what triggered the eating disorder, what on earth I was thinking. I thought that losing five pounds would make me happy. I didn't know that eating salad all day wasn't that healthy for an active young college student. I didn't know that there was such a thing as too much exercise. And then I found myself in a hole from which I couldn't escape.

I have spent so long on the "why." I don't know anymore that there is a why to the anorexia. It has simply become a biological process that takes on a life of its own. I am taking my life back from it, and I want to look towards the future, towards the Carrie I might become, rather than the Carrie who initially fell victim to AN.

The concept of "free will" that is so discussed in philosophical circles naturally involves one thing: choice. If we have a free will, then we can choose. Every choice, however, has its consequences, both good and bad. There is quite a difference, though, in ponying up to the results of your actions and blaming yourself for the outcome.

It might come as a shock to some of you that I'm not the shy retiring type. I typically don't find myself wallowing in blame and self-pity when something goes wrong. The one exception is regarding projects at work and school. I also know people who are like that 24/7, their little Atlas shoulders holding up the world.

I got thinking (always a dangerous pastime for me) about why, exactly, someone would find themselves trapped in a pattern of always blaming themselves for everything. Though I do understand that there are childhood links to behavior, I also think the issue of self-blame goes far deeper. It's not about blame, it's about control. If I feel I am responsible for something- even if it's my fault if it goes wrong- I have a sense of control over the issue.

I'm a backseat driver. It takes every fiber of my being to keep my bloody mouth shut when someone else is driving. Sometimes, it is that my friends are frightfully incompetent behind the wheel of a car. Mostly, though, it's that my annoying comments and suggestions are a way for me to feel more in control of where the vehicle is headed, short of seizing the steering wheel from the driver. That's why terrorism is so scary: there's not a whole lot you can do. Emergency preparedness is as much about allaying fear as it is about actually preparing.

So, if it's your fault that your father died of cancer, then you can have the feeling that you could have done something about it, that you could have had some control. Most New Year's resolutions are centered around control: get more organized, quit smoking, lose weight. Controlling your life better.

I could deliver a long lecture about the futility of self-hatred and blame, but that's not what I'm getting at. This isn't to say that you shouldn't take responsibility for your actions- far from it. But the more I think about it, the more I realize that humans naturally want a feeling of control in their lives, an ability to chose and deliberately effect their lives. And blaming yourself does give you that feeling, in a roundabout sort of way.

This part of "Defining Anorexia" is less about, well, defining anorexia, but about how to use that definition. Obviously, a case definition is important in diagnosing this rotten disease, but it's also important in other ways.

I have Master's of Public Health in epidemiology, and I have sat through an entire two hour lecture on the importance of a case definition in terms of measuring rates of disease. Say you survey people on coughs. You'll find out a lot of information on upper respiratory infections, but it's not very specific. You could have allergies. You could have pneumonia. Big difference there.

People disagree on whether there has been a true increase in the rate of anorexia in the last fifty years. Part of an increase is, no doubt, the increased awareness of the disease, as well as the simple epidemiological fact of you tend to find what you're looking for. Society is, as a whole, more messed up and obsessed about food than ever before. I'm sure you could design a survey to measure that (I'm for hire! I'll send you my resume!), but my mom could easily tell you that. For free.

So. Getting back to the point. Many people with eating disorders, even those admitted to an inpatient hospital unit, don't fit the exact criteria for anorexia nervosa. This is important for two reasons: 1) insurance coverage and 2) how much might this affect our ability to measure the rates of AN. Insurance companies have a hard enough time considering AN an actual illness; they are much more likely to kick a sufferer out prematurely because of some sort of mysterious weight formula they pull out of thin air. I have been discharged from the hospital on the exact day I was over 85% height-for-weight, though I was still 15 pounds under MY usual weight.

There is plenty of research being funded for obesity, heart disease, cancer, asthma, diabetes. While I am not going to debate the worthiness of these causes (except perhaps the first one), there is one thing they all have in common: they're easy to define, you know what to look for, and we know how much is out there. You can't get funding in the Christopher Columbus "let's go find a quicker route to Asia! See ya in a year!" type of way. I've written grant proposals. You'd need a route, funding for the crew, food, antibiotics, weapons to kill harmless indigenous peoples, the whole nine yards.

Therefore, in order to find a cure for anorexia, or at least more effective treatment, we need more research. In order to research anorexia and bulimia, we need to know specifically (specifically) what we want to measure. I think nutritional and neurochemical profiles are the future, as well as brain functioning tests (fMRI, PET scans, the works). That's where the money is at. I'm grateful for people like Cynthia Bulik and Walter Kaye who are truly doing the pioneering, groundbreaking, backbreaking work.

Cheers to them! With ice cream! And a cherry on top!

Here's a question that's near and dear to my heart: how do you define anorexia? There's the DSM-IV criteria which states the individual has to be less than 85% of ideal body weight, and not be menstruating. There's also the loosely used popular criteria of self-starvation. All of which can be true. So how, then, is someone anorexic versus just being a little muddled about how much to eat?

Luckily for us, scientists have been trying to answer those questions. Part of the problem with diagnosing anorexia is that most sufferers deny the presence of a problem. In my case, I didn't really think I was losing too much weight, or if I was, then it wasn't problematic. This all makes a clinical interview with a sufferer rather convoluted to say the least.

Then there's the next question: less than 85% of ideal body weight. It's clear that there is no one "ideal body weight," even when you control for age and height. Think about it: there's over 6 billion people on this earth, and that everyone who is, say, 5'5" like me should weigh precisely 125 pounds is ludicrous! For the vast majority of human history, there haven't even been scales! Yet the species persists.

(Dieters, take note of the above...)

Lastly, there's the need for amenorrhea. This doesn't work with men (obviously, unless the said male also has a functioning uterus, by which send the lad my way so I can write it up in JAMA and get rich!), as well as with young girls and post-menopausal women. However, there are specific hormonal changes that accompany anorexia (such as a decrease in the T3 thyroid hormone) as a side effect of malnutrition. There are also general decreases in sex hormones. This has been shown in men put on a semi-starvation diet- they have a decrease in sex drive and become completely and utterly obsessed with food. Sound familiar? I could go into the chicken and egg debate here, but that's just too much for one post.

There have been clear indications of the genetic links to both anorexia and bulimia, meaning that there's something more than just social pressures going on. There are also numerous structural brain changes that occur in people with anorexia, no doubt related to the malnutrition caused by the disease.

What would I like to see? Standard scientific tests to determine the bio/neurochemical changes that are hallmarks of malnutrition. A 500 pound woman can starve to death. Maybe it will take longer than someone who weighs 150, but it will happen. And it is the effects of malnutrition that need to be reversed, not necessarily weight gain (as would be the case for the starving 500 pound woman). I have had wonky thyroid levels at a weight higher than my usual. Right now, when I am a little shy of my pre-AN weight, my thyroid levels are within normal limits. Why? I'm giving my body the nutrition it needs. Weight be damned. I would also like to see PET scans used for diagnosis, rather than just research. They're expensive, to be sure, but a good diagnosis is worth its weight in gold.

No diagnosis is that easy. Hopefully, more and more people with anorexia will be diagnosed and treated before the disease becomes severe, which could make blood and brain tests less precise. But until we know more accurately what happens to a person suffering from anorexia, it will be hard to create an adequate case definition.

I was sitting in the waiting room of my therapist's office, paging through a recent newspaper when I was (mysteriously) attracted by an article that said "Test your nutrition IQ!" I read on and learned that this was a quiz about weight loss.

Think about it.

You're basically supposed to eat in order to...lose weight. That's all that "nutrition" means anymore. Recipes for kids have calories and fat grams at the bottom. That bugs me. I'm all for the consumption of fruits and veggies by anyone. But it's a matter of why. Since when do healthy, growing kids need to be focused on their weight?

Here's the supreme irony- the more Americans diet, the fatter they get. Maybe it's not that it's getting harder and harder to lose weight (though I did get a chuckle at the Jenny Craig ad that followed a McDonald's ad), but that diets aren't the solution. My co-worker (one of the members of the Weight Watchers at Work club) swore off chocolate a month or two ago. Not more than a day later, I found her sneaking a bite out of the communal jar of Hershey's kisses. I have long since learned better than to swear off chocolate. It's ludicrous. I also find it hilarious that while most Americans are buying low-fat food as part of their New Year's resolutions, I'm stocking up on premium ice cream and candy bars in order to recover from my eating disorder.

That being said, my favorite food irony is on the jar of my peanut butter. Warning: may contain peanuts. Which naturally poses the question- what if it doesn't?

Wow. I realized the title of this post sounds quite hoity-toity. I'm falling victim to my own vocabulary!!!!

Basically, the point of this is an exploration of the lovely old dead French dude by the name of Rene Descartes. My most striking memory of his name is when I got beaned with a plastic bust of him by my ninth grade geometry teacher (accidentally). Thus my memories of him started off on a bad note. He revolutionized geometry by the "Cartesian plane"- the X and Y axes. His most famous phrase was "Cogito, ergo sum." I think therefore I am.

That little phrase has created a LOT of controversy and trouble over the years. Why? It set off the mind-body split that has affects so many different things. Such as mental health. Insurance benefits are quite different for mental and physical health, as if the brain and the body were two different things. But you can't have the body without the brain running it, and the brain without the body is pointless as well.

Mental illnesses are brain diseases. The brain is an organ of the body. So is the heart. Why is it that psychiatric illnesses are so different, so apart from everything else about the body? Your brain affects your behavior so intimately, and that's quite powerful. When you suffer from a mental illness, as I do (three of 'em!), your life is just as critically affected as when you have diabetes. Or cancer.

People have traditionally been blamed for mental illness. It was the result of a weak character. A bad mother. An inability to potty train correctly. But what goes on in the brain is also a lot of neurotransmitters and chemicals zipping around. They're going nuts right now as I write and you read. They help to create emotion. A chemical imbalance is the cause of diabetes (lack of insulin). A similar chemical imbalance is the cause of depression (lack of serotonin, at least in part). So why isn't depression a medical condition? It can be a medical condition that affects the brain, but still a medical condition.

Which brings us back to Rene Descartes. He said, essentially, that the mind and body were separate. Yet we now know that this really isn't true. If it were, all those other French dudes who were guillotined during the French Revolution would still be somewhat alive. Their heads were intact. But they died when their heads were chopped off.

Mental illness is a type of physical illness, pure and simple. It affects us differently than other illnesses, but so does every different class of illness.

Take that, Mssr. Decartes.

I met with my dietician this afternoon, and my weight is finally coming up. I swear, I thought I was going to have to start raising my own cows. To eat. Whole. Several times a day. Well, breathe easy, Bessie. There may be hope yet.

My secret weapons? Peanut butter and ice cream. If I can combine them, all the better!

I've been calorie-counting free for a week as of first thing tomorrow morning. Yikes! I haven't managed that in several years! I'm kind of proud of it, but I also have to stay on guard. I can't count just once. I fall right back in. Ditto for weighing myself. I've finally gotten to the point where I've realized that these behaviors are very counterproductive. I always think I've consumed too many calories. I always think I can shave a few pounds off my current weight. It makes me miserable! So why do I do it?

Habit. Decrease in anxiety (very short term). Hell if I know.

I've been using a technique I heard about in the movie What the Bleep do we Know? where I'm actually visualizing the changes in my brain as I continue to refeed and recover. I picture the neurons in my brain that are attached to things related to the anorexia (calorie counting, weighing, restricting my food, exercise) withering and dying. At the same time, I'm picturing the neurons towards healthy and positive activities (writing, beading, crochet, etc) strengthening. With food and thought, I'm actually changing the structure of my brain.

Mind-boggling. I love neuropsychology. If I ever got a PhD, it would be in that. Instead, I'm just going to write about stuff like that as a profession. Easier and more interesting.

So Bessie, I'll see you tomorrow. Though watch out- I've been having quite a hankering for hamburgers!

Now that I've been eating regularly and providing my body with adequate nutrition for a several-day span (the joys...), I've been having an interesting dialogue within myself. There's the usual:

Ed: You're such a pig.
Carrie: Bite me. I need to eat in order to get better.
Ed: You're such a pig.
Carrie: When did I ask you?

There's also the ever-interesting conversation between my brain and my stomach that is going something like this:

Carrie's brain: Helooooooo....is anyone down there?
Carrie's stomach: Um, yeah. 'Bout time you checked in on me.
CB: Can I send any aid your way?
CS: How about some aid in the form of a visit from Ben and Jerry.
CB: Hey, Mom's buying. Why not?
CS: All right, B&J. C'mon down!
(15 minutes later)
CS: I'm still hungry!!!
CB: You need MORE?
CS: Hey, you only neglected me for 8 years. And, as they say, payback's a bitch.

That's been my reality for the past day or two. Loads of fun. I feel positively menopausal- hot flashes and all. I need to keep this in mind the next time I decide that anorexia is fun. Maybe it is, but then I have to go through this crap again (and again and again). I'm hungry and full at the SAME TIME. That's a mind warp if ever there was one.

Onward and upwards.
(I'll save the weight loss resolution rant for tomorrow. Stay tuned.)