I am once again on the road for my freelance job (meeting to go to this morning- I left my place last night, spent the night in a nice hotel with crap Internet access), which means facing the task of eating on the road. I knew that I would need to eat dinner at about the halfway point of my 4.5 hour drive, seeing as I left at 5pm. I had found a craft store to pick up some yarn at the halfway point (I feel ridiculously oblique writing this, but I'm really paranoid about privacy since I use my real name), seeing as the store by me was all out of the one color that I needed, so I figured I would eat after I got my yarn.

Which I did.

I was going to go to Panera, since it's a pretty "safe" choice AND one where I know I could meet my meal plan requirements without flipping out. But en route from the craft store to Panera, I saw the sign that Moe's Southwestern Grille had recently opened. We have a Moe's by me, and it's a favorite of mine and my parents.

I have my "usual" that I get when I go. It started as a way to use a coupon or some other deal, and I really liked it, so I kept ordering it.  It's pretty much my default when I go. I don't go to Panera that much, so I didn't have a default decision.

The more I thought about it, the more I realized that one of the reasons I really wanted to go to Moe's was because there was a default. I didn't have to decide and calculate calories and things like that. I could just order and pretend I was sort of human instead of agonizing over the menu for half an hour and then spend the next little bit filled with gut-gnawing doubt that I had ordered the "right" thing.

It's hard to explain to someone who doesn't have an eating disorder, exactly how hard restaurants and ordering can be. I don't really have food fears anymore. I'm a little wary at the idea that I don't always know exactly what's in my food, but generally I'm over that. I can deal with it just fine, even if it isn't my favorite idea. For me, the anxiety is over having to decide what to eat from a vast array of options. I find it totally overwhelming.

So that's why I wanted to head to Moe's with my "usual."

Don't get me wrong- I loved my dinner and am glad I ate there over Panera, all other things being equal. But it made my life so much easier to just order without looking at the menu and second-guessing myself. I am that much of a creature of habit. I didn't even think to order anything else. And it was nice to be on my own and eat a complete restaurant meal by myself and not have a total breakdown.

Maybe that's part of the function of "safe foods." It's not just that they're generally lower calorie or whatever, it's also that they help limit our choices when things get overwhelming. Options are a good thing--really, they are--and I'm definitely glad that I've tackled my fear foods. But it also helps for me to have something to order when I can't make up my mind, too. That I can default to XYZ and meet my nutritional needs and also find a pressure release valve for my anxiety.

Does that make any sense? Do any of you do this, too? Please share in the comments, but also try to be mindful not to be too specific about foods and calories lest things get competitive or triggering. I want my blog to be a safe place!

I was reading one of Grey Thinking's posts from around Memorial Day (you don't want to see the number of unread items that are in my Google Reader right now), and she said this:

I think this is a huge roadblock for many people in recovery — having a lot of insight and knowing what they need to do, but not being able to do it and make changes (or not really wanting to).

It was certainly a massive roadblock for me.  Insight into the "whys" of an eating disorder was seen as my ticket out of my disorder.  Maybe if I uncovered the family dysfunction.  Or the ways in which I felt out of control.  Or could understand why I felt the need to be thin. My insight into insight is this: it's a little a lot overrated.

I knew I was a perfectionist and a control freak--in fact, I frequently thought I wasn't good enough to be considered a legitimate example of either of them.  And there was family stuff, sure.  Who doesn't have family stuff?  I'd always had body dysmorphia.  I didn't know it was body dysmorphia, of course, but there was that, too. Insight really wasn't my problem.  Many of the young adults I met in treatment had some amount of insight--and yet there they were, back in treatment.  Just like me. 

I'm not convinced that having insight into what caused your eating disorder will get you well. But insight is still important to recovery.

So what in the hell do I mean by that?

An eating disorder is hard to understand while you're actually in it.  It seems obvious and sensible at the time, but when you look back, you sort of scratch your head.  So having insight into why you're acting so weird only works if you know you're acting weird. As well, the strength of the insight that promotes change has to be greater than the anxiety (or whatever awful feeling you happen to experience) that will happen as a result of that change.  Let me tell you--insight is very vague and ephemeral. Anxiety provokes action. Anxiety wins every time.

For me, insight into my illness's origins hasn't been the most useful thing to get me on the road to recovery.  As for keeping me on the road to recovery, that's a different story.

Here's the thing: insight comes in many different flavors.  Thus far, I've talked about the "why" flavor--why did I get sick, what caused this, etc.  The insight that has been useful to me is of the "now what" flavor--what I need to do in order to stay well, what my triggers and weaknesses are, what to do if/when I start to struggle.  It's still insight, but it's a different variety, and I use it totally differently.

For one thing, this type of insight is being used by a brain that is at least on its way back to normal functioning.  For another, there's not quite the uphill battle.  It's more of a let's-keep-this-rock-from-rolling-back-downhill kind of effort.  Okay, yes, you're still fighting gravity, but at least you don't have to get the boulder moving.

To take a line from Forest Gump, insight is as insight does.  To take Grey Thinking's tagline, "Becoming aware of your crap and actually overcoming your crap are two different things."

This study just irritated me: Psychiatric 'diseases' versus behavioral disorders and degree of genetic influence

The study's premise was that

"Psychiatric conditions in which symptoms arise involuntarily ('diseases') might be assumed to be more heritable than those in which choices are essential (behavioral disorders). We sought to determine whether psychiatric 'diseases' (Alzheimer's disease, schizophrenia, and mood and anxiety disorders) are more heritable than behavioral disorders (substance use disorders and anorexia nervosa)."

...And what do they think drives behaviors? Have these researchers even thought about what anorexia actually is? No, it's not a bunch of skinny dieting champs. It's about being scared to eat. Which strikes me as less of a behavior and more of something arising "involuntarily."

I've heard some people say that they chose to be anorexic, but I would say that for the vast majority of people, they didn't choose their eating disorder. I know I didn't. Did I make the choice to lose a few pounds and exercise more? Yes, I'm not denying it. But choosing to head to the gym regularly is totally different than choosing to be anorexic. The first I will concede; the second I most definitely will not.

It frustrates me. It really does, especially because this is a scientific study carried out by actual professionals. I can grit my teeth and try and explain to Jim Bob that I wasn't randomly deciding to live on Diet Coke and look like a model because he very well might not know better. But psychiatric specialists? Seriously?

Interestingly, they didn't consider OCD in their spectrum of diseases, which would be interesting since it involves what they would term "involuntary" symptoms (obsessions) as well as chosen behaviors (compulsions). Nor did they address how people with depression are often told to cheer up and snap out of it, which implies that it really is a choice.

There are endless choices I've had to make as I've recovered from my eating disorder, although many of them were a choice amongst lack of alternatives. I've been told recovery is a choice, and although I don't think that's wrong, I don't think it's that simple. It's not as if recovery is one single choice, and it's not as if our brains always have the same capacity to make these choices as we move through recovery. There is some small amount of choice when my brain is compelling me to engage in ED behaviors or OCD behaviors, and I can see that now that I'm no longer in it on a minute to minute basis. But in the moment? I didn't see a choice, and my brain chemistry tipped the scales so heavily in favor of the disordered behaviors that I couldn't un-choose my disorder without a serious amount of support.

Ultimately, the study didn't find that "behavioral disorders" were any less heritable that psychiatric "diseases." They found a 60% heritability rate for anorexia, although other studies have found rates of 70% and Walt Kaye frequently uses an interval of 60-84% heritability (I believe this can be found in his Maudsley Parents lecture here).

The authors concluded:

No systematic relationship exists between the disease-like character of a psychiatric disorder and its heritability; many behavioral disorders seem to be more heritable than conditions commonly construed as diseases. These results suggest an error in 'common-sense' assumptions about the etiology of psychiatric disorders. That is, among psychiatric disorders, there is no close relationship between the strength of genetic influences and the etiologic importance of volitional processes.

Maybe that's because these "behavioral disorders" really are diseases...

On my move, I had lots of time in the car in which to listen to music, think, and try to ignore Aria's backseat yowling. To help pass the time and keep me awake, I downloaded a bunch of TED Talks onto my iPod. They were an eclectic mix, from anthropology to physics, but they kept me awake and alert for many hours.

One that left a lingering impression in my brain was a talk by Barry Schwartz, author of the book "The Paradox of Choice." I've blogged on the book before, but there was a brief phrase in the talk that really caught my attention. Schwartz was talking about buying jeans, and how many years ago there was only one style of jeans, and they fit very badly. More recently, Schwartz went out to buy a new pair of jeans because his old ones had worn out, and he found a mind-boggling array of jeans from which to choose. Ultimately, he did find a pair that fit better than before, but with such variety available, any issues with how his jeans fit was his problem, not the jeans'.

Let me try to explain this better. If you can only choose from one style of jeans, and they don't fit very well, you are more likely to blame the ill-fitting jeans than the size of your butt. But it's your only choice, so if you want jeans, you deal with the wonky fit. But when there are stonewashed and acid washed jeans, "skinny," tapered, straight, boyfriend, bootcut, and flare legs, when you have very low rise, low rise, mid-rise, at the waist, and above the waist cut, when you can opt for the "slimming silhouette," when the choices seem endless but you still can't find a decent pair of jeans (c'mon ladies, this has happened to EVERYONE), the problem doesn't seem like the jeans but more like the size of your butt--or thighs or waist or hips.

I'm not keen on having to choose. I ate the same cereal for breakfast for over two years because I couldn't choose anything different. I am still terrified of the cereal aisle at the grocery store, not because I consider cereal a "fear food," but because there are just so many things to choose from. It totally paralyzes me. Am I getting the right cereal? Is there something I might like more? Is there something at a better price? Does this cereal have too much sugar? Is the extra two grams of fiber per serving worth a dollar extra at checkout? Is extra protein worth the extra price? What about 20 fewer calories per serving- is that worth the extra dollar? What about less salt?

The cereal I was eating wasn't particularly cheap (though it wasn't particularly expensive, either), and I had already made my choice. So I grabbed the cereal and that was that. No choice necessary. I was so overwhelmed by having to choose that I avoided the choice altogether.

Sometimes when trying to choose a snack, I'll face the same paralyzing anxiety. What should I have? And, if left to my own devices, I've been known to skip a snack not because I was wanting to restrict, but simply because I couldn't decide what to have. Choosing the food--choosing to eat--was easily more overwhelming than the actual act of eating.

The solution, says Schwartz, is not no choice at all, because a long history of despotism and repression shows that people are willing to die for their right to choose government, the course of their lives, you name it. The solution is more limited choice. Not "what do you want to drink?" but "do you want apple juice or orange juice?" Lots of choice, in and of itself, isn't necessarily bad, but for those of us who find choice overwhelming, the task is to lower the anxiety of choosing without over-limiting our options in life.

Below is the whole 20 minute talk by Barry Schwartz. You can download the audio version on iTunes (just search for TED Talks). He's a great speaker.

So many times, the choices given to us by our eating disordered thoughts are false choices. A recent post from the blog The Happiness Project really illustrated how common these thoughts are, and how Ed can make it seem like these two options are the only possible outcome, when in truth, they're not.

For instance:

I'd rather have a crappy life with ED than a crappy life without it.
Now, without recovery, I can virtually guarantee that life will be crappy. And while recovery may seem crappy at first, it's the only shot you've got. What about the possibility that your life will turn out "okay"? Or at least less crappy than if you stayed with ED?

If I don't exercise, I will go crazy.
These are not the only two options: you can do something else. I've found coloring to be a good stress reliever. You can learn how to tolerate those unpleasant feelings. After all, if everyone who didn't exercise went crazy, we'd have quite a different population in the psych units!

I never eat cookies because I will eat the whole box.
I've been there. When I was first normalizing my eating after falling into more bulimic habits, I found that, indeed, keeping large quantities of binge foods around the house was a really bad idea. But now I can keep these foods around and eat fairly normal servings. It's not an either/or question. A happy medium exists. It takes time to figure this out, but it's definitely possible.

Blogger Gretchen Rubin writes:

I think false choices are tempting for a couple of reasons. First, instead of facing a bewildering array of options, you limit yourself to a few simple possibilities. Also, the way you set up the options usually makes it obvious that one choice is the high-minded, reasonable, laudable choice, and one is not.

But although false choices can be comforting, they can leave you feeling trapped, and they can blind you to other choices you might make. “Either I can be financially secure, or I can have a job I enjoy.” “I have to decide whether to marry this person now or to accept the fact that I’m never going to have a family.”

A lot of these false choices strike me as a form of black and white thinking, and many times, life can be lived in the middle. ED thinking makes it seem like these are the only two options--and that the eating disordered option is the correct answer!

What are some false choices you've found yourself facing? Did you ever find that you had more options than you were aware of?

I can't eat that.
I won't eat that.

Pretty much the same, right? The food won't be eaten. The difference, of course, is why. Can't says "I'm unable to." Won't says "I'm choosing not to."

When I was really into the eating disorder, my treatment team told me I needed to eat more. "I can't!" I wailed. "I just can't." Being rational folks, my team told me that, having a mouth that opened and a hand to hold a fork and an arm to bring it to my mouth, indeed could eat. I was only choosing not to.

Which was, I suppose, technically correct. But, for all intents and purposes, I was so phobic of food that I couldn't eat more than the handful of calories I had allocated to myself. It was as if the eating disorder was holding a gun to my head, hissing and whispering that eating a bite of burger was going to cause him to pull the trigger. Really? It wasn't much of a choice.

Yet I could eat, and being sat down at a table (whether at home, in treatment, or at a hospital) and told I had to eat the burger, the pasta, the fish sticks, usually resulted in the food being consumed. And digested. I might have preferred that the eating disorder make good on his gun-to-the-head threat, but I ate and survived.

By doing this time after time, I was able to see that the eating disorder held a squirt gun, not a revolver. And then that he was a complete impostor and held no gun at all.

Now, other than MSG (which I'm allergic to- gives me migraines and makes me puke), I can honestly say "I won't eat that" rather than "I can't." There is a sense of empowerment there.

I like to blog here that I say I can't skip a meal or I can't go on a diet because of my history. But the truth is that I can. I'm actually quite good at it. My years of anorexia have showed me that I'm a little too good at eating less and exercising more- pathologically so.

When my old office went on a diet, I felt left out. For one, all they talked about was food, which was boring. Second, I felt deprived. They got to diet and I couldn't. It wasn't FAIR! I had to eat my calorrific lunch and they got to munch on cucumber slices.

Now, I realize that I could technically have dieted along with them. I had the ability. I could freely make that choice. But I can't diet and have the negative effects come back and bite me in the ass. And those effects (namely, relapse) would come sooner, rather than later.

So I say: I don't diet. I won't diet. It's my choice.

(Much of my thinking on this subject has evolved through reading the book "Embracing Fear" by Thom Rutledge, the co-author of "Life Without Ed." I highly recommend both books.)

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.