I can’t remember what my friend Sophie and I were talking about that night in the spring of 2011. I know our families were having dinner together; I know I had just lost 30 pounds in three months, and would lose at least 10 more. What matters, though, is that for whatever reason, I said, “I’m not fat anymore,” laughing, expecting Sophie to grin and agree.

She didn’t. Instead, she gave me a response that I have not forgotten in seven years. Her face contorted into confusion, pure in its immediacy, framed by the platinum hair I so envied. Sophie looked me in the eye, without a trace of hesitation, and said the most shocking thing I’d ever heard: “You may be skinny now, but you were always slim.”

I don’t know how I responded. It’s possible I didn’t say anything. I may have laughed and brought up something, anything, else. But Sophie’s words have replayed in my mind too many times to count in the seven years since she said them—when I’ve tried to fall asleep, when I’ve hung out with friends, when I watched the trailer for the upcoming Netflix series Insatiable.

You were always slim, she said, the first person who ever told me that, when I was 14 years old.

When I Get Back To My Body
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When I think about the shows and movies I watched as a kid, only one features characters comfortable in their fatness, lovable at any weight: Dumbo, whose lovable, fat characters are elephants. The first human—or, at least, humanoid—fat characters I remember were villains, whose fatness seemed to correspond with greater deficits in character. The Powerpuff Girls’ Big Billy is as rotund as he is stupid: even when he wants to help Blossom, Bubbles and Buttercup, his weight and idiocy prevent him from doing so—until he can save the day by eating. Fuzzy Lumpkins, another recurring antagonist in The Powerpuff Girls, first enters the series by attacking Townsville with a weapon that turns everything into meat, and plans to eat the city. The Powerpuff Girls can only defeat him when he turns sweet Bubbles’ hair into a chicken drumstick, an affront on her appearance which enrages her so much, she gets a full action sequence beating him to a pulp.

And then, of course, there’s Ursula. Her hugeness in The Little Mermaid makes her a looming, frightening figure, so sharply contrasted with beautiful Ariel, whose waist is smaller than Ursula’s arm. In “Poor Unfortunate Souls,” Ursula convinces Ariel she uses her magic for good by talking about the time she made a fat mermaid skinny, which helped her get a boyfriend. It’s a small moment, but one which sets the tone for women’s weights in the movie. When Ursula turns herself into a human to win Prince Eric, armed with the voice he fell in love with in the first place, she can give herself any body imaginable. She makes herself tall, white and skinny.

These characters didn’t tell me all fat people were evil: I knew from my own experience that wasn’t true. I spent most of my childhood snugly chubby, and I adored my parents, who were both fat. However, these characters did tell me fatness was gross, fatness was wrong, and fat people should be considered unlovable. My parents unintentionally spread that idea, too. They hated their own, fat bodies, and fed me a steady stream of well-meaning encouragement to lose weight as a child. Part of that encouragement came from my doctor’s advice, but part of it came from their feelings, externalized: they didn’t want me to look like them.

When I think about the shows and movies I watched as a kid, only one features characters comfortable in their fatness, lovable at any weight: Dumbo.
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Although I loved my parents, their self-loathing told me I should not love their appearances. I took that self-loathing as my own. When I was 14—and 13, and 12, and 11—I felt like a beached whale. In reality, Sophie was right: I’d never been fat. Before I began losing weight that year, I weighed 132 pounds and stood at 5’1. I had a BMI of 24.9—just below the overweight range, but still, below it. I’d developed the kind of healthy lifestyle my doctor had always encouraged. I’d found exercise habits I enjoyed, such as swimming and biking; I began commuting by foot more; I ate enough food to make me happy.

It’s ironic, in retrospect, that those months of early pubescence were the physically healthiest time of my life. Back then, whenever I looked at myself in the mirror, all I could see was ballooned fat, suffocating me. That body dysmorphia was severe enough in suburban Ohio, where I grew up. It became worse in the summer of 2010, when I was still 13, and my family moved to Paris, France.

I had been chubby in Ohio, but so had plenty of other kids: my fat didn’t stand out much. Paris was different. A 2009 study at France’s National Institute of Demographic Studies found French women were the thinnest in Europe, with the highest proportion of clinically underweight women on the continent. Even at a private, international school in Paris, my classmates reflected this study’s findings. I was objectively one of the heaviest girls in my grade.

To their credit, none of my classmates called me “fat” to my face, but I felt isolated by my weight all the same. I couldn’t wear the same trendy fashions that everyone else did. I felt self-conscious eating anything in public because of France’s intense, ingrained stigma against eating too much. The country’s Catholic roots have popularized the notion of gluttony as a sin: portions are small, snacking is rare, and fatness is seen as a character flaw that any Jacques or Julienne has the right to talk about.

The most striking moment, though, happened in March, just as the winds had begun to warm. One day in the courtyard during our lunch break, I saw a crowd of boys throwing paper balls at a girl in the grade below me. She was one of the other “fat” girls. She wore a pale, yellow shirt that clashed with her reddening eyes, and she was cowering against a wall, yelling at the boys. I couldn’t understand everything they shouted back, but I could make out the words grosse and laide—fat and ugly.

My legs froze, and I stood watching that scene until the bell rang and a friend dragged me to class. No one else had seemed shocked by the bullying; no one had tried to intervene on the girl’s behalf. Those ranks of cowards included me: I was too scared. I knew, if I tried to help her, the boys would attack me, too.

I decided to start losing weight two weeks later.

‘It’s Because You’re Fat’ — And Other Lies My Doctors Told Me
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Yet the bullying I witnessed wasn’t enough, on its own, to make me want to lose weight. The bigger problem was my loneliness. In Ohio, I had a close-knit friend group with whom I spent countless hours, friends I trusted with my life. In Paris, my 10-person class hung out together after school sometimes. But I couldn’t make forever friendships, one on one, the way my other classmates did. They would hang out with each other in pairs instead of groups, they would spend hours texting each other and exploring the city. I got along with all my classmates, I consider them friends to this day, but they made close, personal friendships without me. In the entire year I lived in Paris, only once did I hang out one-on-one with a friend.

I decided my fat was the problem. I thought of Big Billy and Fuzzy Lumpkins and Ursula, whose weights were indistinguishable from their villainy; I thought of Natalie in Love Actually, whose so-called “tree trunk” thighs made her unattractive to nearly every character in the movie; I thought of Fat Monica on Friends, who exemplified the potential of a fat person to find love only once they lost weight.

Everyone else at school had found their BFFs; everyone else was thin. To me, the pattern was clear. I decided to lose weight, my parents celebrated my decision, and eventually, my dieting spiraled out of control. I lost 40 pounds in four months. At my lowest point, I weighed 92 pounds.

After a year in Paris, my family moved back to suburban Ohio. I started to see a therapist, who helped, and slowly I gained back weight. But I was never quite able to regain the healthy lifestyle I’d had when I was a preteen. It took me until college to realize where I’d gone wrong. Not only had I never been fat, but—more importantly—people’s opinions of me, nine times out of ten, didn’t depend on my weight. When I started high school in Ohio, no one became my friend because I had a toned stomach or because they could see my ribs. My new classmates became my friends because I made them laugh, treated them kindly, and showed I cared about them. And they remained my friends when I gained weight, knowing my body had no bearing on my personhood.

Yet movies, TV shows and books keep perpetuating the idea that fat people can’t be loved. The latest example, coming to Netflix on August 10, is Insatiable. The show’s premise is simple: “Fatty” Patty (Debby Ryan, in an awful fat suit) is bullied for her weight in high school, until a punch to the face forces her to spend the summer with her jaw wired shut. When she comes back to school after those three months, she has miraculously lost 70 pounds, looks like a Disney starlet, and her classmates all but salivate over her. Newly confident, she sets out to take revenge on everyone who bullied her while she was fat.

Everyone else at school had found their BFFs; everyone else was thin. To me, the pattern was clear.
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In plenty of ways, Patty is a far cry from the Big Billys and Ursulas of the world. She’s the hero; she’s clever and determined; she’s meant to receive the viewer’s sympathies, not their disdain or disgust. But Insatiable would not exist without the assumption that fat people can’t be loved—fat women, in particular. To care about Patty’s revenge crusade, the viewer has to believe in the pain she is avenging: that almost everyone she knew really did hate and bully her because of her weight.

That’s not to say no fat person has ever experienced such cruelty. Insatiable’s creator, Lauren Gussis, has said her own experiences inspired the show. The bullying she suffered as a 13-year-old because of her weight made her develop an eating disorder and want to seek revenge. Indeed, Gussis called Insatiable “a cautionary tale about how damaging it can be to believe the outsides are more important,” and said she’s trying to share her “pain and vulnerability through humor.”

Maybe Insatiable does succeed in that. But when over 150,000 people call for a show’s cancellation before it airs, and when thousands post selfies with the #NotYourBefore hashtag, a commentary on how fatness is often depicted as a sad or undesirable “before” to skinniness, there’s usually a reason. Gussis’ statement, in which she admits developing an eating disorder in her drive to “look pretty on the outside,” is revealing. Skinniness does not make a person more beautiful. Fat does not make its bearers ugly. I understand Gussis’ anguish: I grew up convinced that fat was the antithesis of beauty, too. But I have spent years unlearning that conception of bodies, letting myself find beauty in our skins’ folds and creases instead. Gussis seems to have done the opposite: she has internalized the idea that fat people can’t be pretty, can’t be successful, can’t be loved. For all her good intentions, she remains trapped in a twisted, dangerous cycle of fatphobia.

That cycle has infected almost every part of our lives. Our culture is oversaturated with fat jokes and narratives about overweight people’s—particularly overweight women’s—inability to be loved. We perpetuate this standard through negative representations in media, showing viewers over and over again that skinny bodies are aspirational and overweight bodies are not. A 2012 study from Durham University in the U.K. found that such exposure, called a “visual diet,” directly influences our perceptions of acceptable weights: seeing a series of large or small bodies, presented as aspirational or not, changed participants’ preferences for different body types. These perceptions, in turn, affect how we treat people with “unacceptable” weights, and the consequences can be devastating. Overweight women are significantly less likely to be believed if they report rapes or sexual assaults, obese patients often receive worse medical care than their thinner counterparts, and overweight people even face hiring discrimination, which is not illegal in the U.S. And that’s not even mentioning the social ramifications in day-to-day life activities such as dating.

Insatiable is a cog in that cycle, contributing to the stigmas and mistreatment overweight people face everyday. Even worse, it masquerades as a progressive, uplifting show, targeting young women most susceptible to its misguided messaging. When I was 14, I would have loved Insatiable. The premise would have given me hope: just like Fatty Patty, I could lose weight and get everyone to love me, too.

Skinniness does not make a person more beautiful. Fat does not make its bearers ugly.
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I am healthier mentally in every way now than I was when I lived in Paris. Still, I have a lot of work to do. I hate taking or looking at photos of myself because of the fat on my arms, chin and thighs. I’m too self-conscious to join #NotYourBefore, because to do so I’d have to share photos emphasizing my fat, and that idea nauseates me. Almost every day, I think with regret of the time Sophie told me I was slim, had always been slim, and how I couldn’t believe her.

I am self-aware enough now to understand how much media like Insatiable, which seem so innocuous, damaged me. Media with messages like Insatiable’s—that overweight people are ugly by default, that overweight people can’t be loved—nearly destroyed my life. Insatiable is an irresponsible, ill-conceived television program that can’t possibly be funny enough to make up for the harm it will cause. If Netflix does air it, against tens of thousands’ of people’s objections, they hold the blame for the children they will hurt.

Content warning: disordered eating

The first time I left my body, I was 15. It was revelatory. For no particular reason, I looked in the mirror and suddenly was meeting someone for the first time. It inspired me, with my adolescent faux-profundity, to write a poem about the illusory nature of the self.

Then things got…creepy.

It went from spiritual revelation to identity fragmentation. I became more and more conscious of the split between the image and the self it represented. I’d decide to move my hand and marvel that it moved in response to a mere thought. I wondered why my thoughts could control Suzy’s body and nobody else’s. I wondered how I even had access to Suzy’s thoughts. As I floated further and further away from Suzy, I felt invasive for even knowing she existed. I felt like a fraud for masquerading as her.

Then I felt misunderstood for being seen as her. I hated her.

I feel the same sickening severance when I look at a picture and think, “Who’s that ugly girl in the front?” only to realize it’s me. The same sensation occurs when I hear my own recorded voice, when I wonder why I see the world through my own eyes and nobody else’s. You may say—and I understand it feels obvious—because they’re your eyes. But they’re mine only because I see through them, because an optic nerve connects them to my brain — and what makes that brain mine? This feels like a similarly disturbing problem.

My brain is usually too tired to think about itself, but when it does, I feel like a snake eating its tail, so wound up it can’t escape its own belly, so thick from self-consumption that it chokes.

My childhood fantasies of the future always contained the hidden assumption that one day? I would leave my body. Sometimes my future self was a Maybelline model with luscious lips flanked by equally model-esque man-candy. Later, I envisioned myself as one of the giants of poststructuralist philosophy, sitting around a table with Jacques Derrida, Jacques Lacan, Michel Foucault, and Rolande Barthes—anachronistically—all at once.

I did not become a supermodel, and I did not become a French man.

I developed a devalued and objectified body unfit for a philosopher. Seeking an exit route, I grew so airy and detached, I felt my mind might expand like a balloon and float into space. Maybe it already had. I could be going about my daily routine without consciousness—like a very advanced robot. For all I knew, I was already floating in space, connected via some wireless network to my body, perceiving its immediate surroundings only by collecting data from its sensory organs.

For a while I forgot I needed to eat, or perhaps convinced myself I didn’t need to. My mind had no idea what my body wanted and that was fine with me. I didn’t want to associate myself with something as base and material as food. My body felt too heavy to express my inner ethereality. This asceticism bears similarities to anorexia mirabilis, a condition different from, but debatably a precursor to, anorexia nervosa, which afflicted several medieval holy women.

Saint Margaret of Cortona, who died of starvation in 1297, wrote:

“I have no intention of making peace between my body and my soul … allow me to tame my body by not altering my diet; I will not stop for the rest of my life, until there is no more life left.”

Saint Catherine of Siena claimed that she did not need food because she ate at the Banquet of God; she was above embodied existence. She renounced all carnal pleasures and had visions of marrying Jesus with a ring made of his foreskin, which some might say resulted from sexual repression, just as some might say her mystical visions were starvation-induced hallucinations.

But what I find more interesting is the possibility that it worked the other way around: She didn’t want food or sex because whatever satisfaction she could get from them paled in comparison to the fulfillment she got from her inner spiritual life.

My body felt too heavy to express my inner ethereality.
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The main difference I see is that the out-of-body experiences of St. Catherine consisted of self-discovery whereas I discovered a non-self. Rather than saying “this is what I am — an ethereal soul!” I felt as though my mind had no identity inherently coupled with my body.

It could attach itself to anyone or anything, a parasite surviving off its host. I couldn’t help but think of Voldemort on the back of Professor Quirrell’s head, feeding off his body until he gained the power to grow a body of his own. Perhaps my image of myself as a male poststructuralist philosopher came from this belief that my mind would eventually sprout a body to better fit its self-conception. But could a mind sans a physical body ever express itself? Maybe not.

Still, I can’t help but wonder whether, if I lived in a body less fraught, less subjugated by my mind — in other words, less female — the task would feel less impossible.

One account of disembodiment that sounds more akin to my experience came from Marya Hornbacher’s Wasted: A Memory of Anorexia and Bulimia:

“I suddenly felt a split in my brain: I didn’t recognize her. I divided into two: the self in my head and the girl in the mirror. It was a strange, not unpleasant feeling of disorientation, disassociation. I began to return to the mirror often, to see if I could get that feeling back. If I sat very still and thought: Not me-not me-not me over and over, I could retrieve the feeling of being two girls, staring at each other through the glass of the mirror. I didn’t know then that I would eventually have that feeling all the time. Ego and image. Body and brain.”

Like Hornbacher’s, my mind-body splitting was the precursor to an eating disorder, an auxiliary self that took up residence in my mind when I was 15, the age I first left my body.

Carolyn Costin, a psychotherapist specializing in eating disorders, articulates this phenomenon in The Eating Disorder Sourcebook: “Eating disorder symptoms are the behavioral component of a separate, split-off self, or what I have come to call the ‘eating disorder self.’ This self has a special set of needs, behaviors, feelings, and perceptions, all of which are dissociated from the individual’s core or what I call ‘healthy self.’”

I (the observer, the mind, the eating disorder self) stifled and silenced the other voice, “my” own, until I (the observed, the body, the healthy self) became a mere body used to fulfill my sadistic desires, or perhaps masochistic ones; it is hard for someone split in two to tell the difference. But I don’t think this sadomasochist was the only voice in me, or else its pleasures would have been fulfilled and it/I would have been happy. I imagine another voice calling out to me as I walked through the halls of my high school, a voice within my gut that grew softer as I floated away and away from “my” body.

Unlike my initial airy-fairy mirror split, this episode didn’t feel like a mystical revelation. It felt like the debilitating self-consciousness and self-objectification characteristic of this condition. I am not just talking about the condition of disordered eating; I am talking about the condition of being a woman. I am talking about internalizing an outsider’s image of my body until my face feels like a mask — all decoration, no sensation. I am talking about sensing that I can’t occupy the word “I” and thus becoming “you” to myself.

When I say “I,” I’m not sure whose words I’m using or who I’m referring to, but I’m sure that the speaker and the object of speech are not the same, and the words that define me are not my own. I cannot speak without splitting. Each “I” is a line drawn between me and the self I speak of. Each eye stares back at the other. Each act of speech masks me with another face, and through this mask I look down on my body in scorn, or at best, alienation.

“Given the coupling of mind with maleness and the body with femaleness and given philosophy’s own self-understanding as a conceptual enterprise, it follows that women and femininity are problematized as knowing philosophical subjects and as knowable epistemic subjects,” Elizabeth Grosz writes in Volatile Bodies.

Women are defined by materiality, men by mindedness. This is to say not that women are earthly, but that Earth has been made womanly; it is not to say that men are Godly, but that God has been made male. So many things have been imbued with references to men and women that we can’t speak of everyday concepts — presence and lack, hardness and softness, ether and earth — without speaking of gender. Man created God in his own image, and God created the world. It follows from this syllogism that man created the world in his own image.

I am not just talking about the condition of disordered eating; I am talking about the condition of being a woman.
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Just as St. Catherine of Siena configured her soul as a transcendent substance trapped in the confines of Mother Earth and her body, I am a masculine-coded mind trapped in feminine matter/mother, both from the Latin root mater.

I’ve chided myself for behaving as if the Cartesian illusion of mind-body separation is more than an illusion. I should know better, I think; I’ve studied the neural mechanisms of thought and emotion, the embodiment of cognition, the situatedness of knowledge, and how Descartes screwed us all over with the mind-body duality. Yet while I know this separation is merely symbolic, I can’t think away my own experience, an experience driven by symbolic distinctions: mind vs. matter, male vs. female. Our culture’s conflict between mind and body is raging inside me.

In Lacanian psychoanalysis, entry into language requires an extra step for women: the adoption of a male perspective, a perspective outside her own body, looking at her own head through eyes foreign yet all too familiar to her. To accomplish this, language relegates her to the object of an action, or at best she is written as a subject in the passive voice. It is said that women are more empathetic, that women spend more time considering what men think than vice versa, that women have more understanding of the male mind than men do of the female mind.

That’s because our culture has no concept of a female mind. If there is one, I leave it on the ground every time I float outside my body to think about it. Lacan famously stated that le femme n’existe pas; there is no such thing as a woman. I believe I am a woman until I catch myself uttering such a statement, and once again, the “I” who steps outside my head, sizes me up, and classifies me as a woman with impossible certainty is not the “I” who is a woman.

After years of therapy and months in treatment centers, the only way I’ve managed to maintain my recovery has been to forget that the woman I observe and classify is, by most definitions, me. Disembodiment can be your worst enemy and your best friend if you take it far enough. When I ate foods I’d deemed too meaty and fatty and fleshy, I convinced myself it wasn’t really me eating; it was just a body that happened to be attached to me.

When I couldn’t bear the weight I acquired in recovery, I told myself my body was just a temporary vessel for an everlasting soul anyway. When I finally got my period back, I reminded myself it was only by chance that my soul was born into a menstruating vehicle.

When I felt defeated by the regrowth of curves I’d resolved to remove since they transformed me from a human into a piece of meat, I made extra effort to use the vocabulary of the male intellectuals I admired so I could catch people off guard with discussions of postmodern theory before they had the chance to peg me as a potential conquest.

Le femme n’existe pas; there is no such thing as a woman.
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My mind is a magician, making the body invisible while chattering at the audience so they don’t notice it’s still there. This defense may have even spawned the essay you’re reading — though my body’s having the last laugh now, because this piece is from and about it.

The split is inevitable, necessary, even: without detaching from and observing our bodies, we would not be self-aware. There are just more and less unhealthy ways to deal with the detachment. Freud contended that the world’s greatest artists channeled physical desires into intellectual pursuits. Like solid matter evaporating into weightless gas, this is called sublimation. He deemed it the only successful defense mechanism. My immediate reaction is to agree; I’m happy this way, I think. But which “I” is saying this? What would the other “I” say if she could speak? Where is she? Asleep until thinking-I wakes her with a kiss? Trapped in a cave with Antigone and all the other traitors of the male I?

Luce Irigaray claims that since language is fit only for a masculine subject, women must speak a different language to connect to their own bodies. But that can’t happen if there’s no woman in the first place, and as empowering as it is to hear about vaginas engulfing penises, it isn’t making me feel more embodied. So I’ve tried yoga, but every time I get down on the mat, I know it’s just a matter of time before I start sublimating. What comes down must go up. Everyone’s in downward dog and I’m in la-la land trying to solve the problem of induction. Any bit of mind left on the ground gets so engrossed in the movements that it merges with the body and loses consciousness.

Irigaray says women defy language because they’re so close to themselves, and one needs distance from something to speak of it. As I write, I approach the object of inquiry, myself, but I will never reach it. If I arrive at my destination, I will have to abandon it. By the time I reach myself, there will be no self to reach. There will be no “I;” I will be too close to speak.

The sentence implodes, subject and object meld together, and the split disappears. I cannot speak without splitting into the self that speaks and the self that’s spoken of. So I float off the page, and in the distance I see a girl with a face.

It is a pretty face, but I take no pride in it; it is not mine. The most it is good for is to represent me so that I can float further and not be bothered. If I don’t become a Frenchman, I’ll get back to you when I get back to my body.

Most people know about bulimia and anorexia. But few know about pica.

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When I was younger, I would lie in bed and read stacks of Archie comics. Then I would slowly rip off pieces of the back covers and eat them until there was nothing left. I knew the dyes in the paper couldn’t be good for me; still, I couldn’t stop.

I ate many kinds of paper back then, but comic covers were undoubtedly my favorite. I relished the paper’s grainy taste, and the way it dissolved into a wet, chewy mass in my mouth.

And it wasn’t just paper that I craved—all kinds of non-food items routinely ended up in my mouth. Years later, while reading the book White is for Witching by Helen Oyeyemi for a university course, I would finally discover that my need to eat things had a name: pica.

I’ve been consuming items that aren’t food since I was a toddler eating sand. After entering school, I switched to pencils and erasers. I once had a plaid teddy bear; on its head was a little loop of material that could be used to hang the bear up. There’s a photo of me in my kindergarten classroom with the bear hanging from my mouth, chewing away on the loop. I also have an oversized comfortable jacket I stole from my dad when I was young, the corners of the collar chewed off to reveal the fluffy stuffing inside. I loved the feeling and taste of cotton fibers — they were so chewy, and I enjoyed pulling them out one thread at a time.

I remember the hot shame and guilt I felt when people caught me in the act — when yet another teacher told me to take that pencil out of my mouth, or when my best friend shot me disgusted looks as I chewed on a pink eraser until it disappeared. I would mumble words while gnawing on small bits of plastic at the back of my mouth; if people asked what I was eating, I’d panic and swallow. Once people tried to keep me from eating things, I started to slip items into my pockets to eat later when no one was around.

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When my mom told me to stop relentlessly chewing my hair, I began hiding behind books or my hands so she wouldn’t catch me in the act. Over time, I started cutting my hair shorter and shorter to keep it away from my mouth; when I decided to grow it out past my shoulders during the first year of university, I couldn’t help but pull out chunks of hair again to chew. A few months later, I cut it off into a short undercut, putting the hair safely out of my mouth’s reach once and for all.

No matter what I ate, there was a ritual to it, a process, that drew me in; each different substance had to be consumed a different way. I was careful to follow those rituals, whether it was slowly tearing strips off the Archie comic paper, or biting off tiny pieces of plastic and chewing them until they were malleable and could be swallowed.

When people think of eating disorders, they typically think of anorexia and bulimia. But millions struggle every day with other, lesser known disorders, like Ruminating Disorder (which involves people re-chewing regurgitated food) and Orthorexia (an obsession with proper or “healthful” eating).

Among these little-known disorders is pica, described by NEDA as “an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.” The disorder only encompasses items, NEDA emphasizes, that are not part of “culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).”

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The roots of pica are varied. For some, the disorder is rooted in a need to correct a nutritional deficiency; iron-deficiency anemia and malnutrition are listed by NEDA as the two of the most common causes of pica, and this can cause pregnant women, too, to develop it. Pica has additionally been linked to autism spectrum disorder, intellectual disability, and schizophrenia, as well as trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder.

Whatever the cause or risk factor, a lack of understanding about pica means many face stigmatization, and are unable to find help if they need it. This is especially concerning considering the condition seems to be growing in prevalence; one study found that hospitalizations for pica jumped a staggering 93% between 1999 and 2009.

Hospitalizations for pica in a 10-year span jumped a staggering 93%.

Health consequences include mechanical bowel problems, infections such as toxoplasmosis and toxocariasis, intestinal obstruction, and poisoning. In rare cases, it has even led to death. (In one documented case, a man died after consuming five kilograms of coins, necklaces, and needles; in another case, a man passed away after swallowing 10 buttons, a drawing pin, pieces of chain and bone, and a large amount of black foam rubber.)

Treatment varies depending on the circumstance. NEDA suggests first testing for mineral or nutrient deficiencies and correcting those; if that doesn’t work, it recommends turning to behavioral interventions.

My own recovery process hasn’t been easy — but it’s put me in a much better place now.

When I spoke with my mom to write about my experiences, she thought my pica stopped by the time I was 10 or so. In truth, I struggle even now.

I still put things in my mouth — like bottle caps and plastic earring backs — but for the most part, I just chew on them without swallowing. I’ve also started eating raw potatoes and raw pasta, which emulate the taste of non-food items. And to mimic what it’s like to break down dense, hard plastic through chewing, I’ve shoved handfuls of unpopped popcorn into my cheeks, moving the kernels around my mouth and grinding them into powder.

What’s really helped me is identifying the root of my pica: anxiety. Ritualistically chewing non-food items, I’ve realized, helps me feel in control when my mental state does the opposite. Since then, I’ve taken the time to manage my anxiety in healthy ways; with this progress, I’ve become less inclined to consume paper, or erasers, or strands of my own hair.

Eating disorder recovery is rarely linear, and I sometimes still eat non-food items, especially when I’m feeling particularly anxious. But these days, more often than not, my Archie comics remain just for reading.

If you think you might need help for pica or any other eating disorder, call the NEDA helpline at (800) 931–2237.

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]]> https://theestablishment.co/what-the-acas-future-means-for-eating-disorder-treatment-95b55825e813/ Wed, 19 Jul 2017 21:58:58 +0000 https://theestablishment.co/?p=3430 Read more]]>

The ACA Has Been A Lifesaver For Those With Eating Disorders — What Happens If It Goes Away?

Millions could be hurt by the GOP’s health-care plans. But one group in particular is often overlooked.

flickr / daniellehelm

This week, the United States Senate again failed to collect enough votes to complete one of President Donald Trump’s cornerstone campaign promises: repealing and replacing the Affordable Care Act. Senate Majority Leader Mitch McConnell has since proposed a vote to simply repeal the ACA without a plan for replacement (he promised a two-year “pause” without more specifics), though that plan doesn’t appear to have the votes required to pass, either. Meanwhile, the President stated that he’d be more inclined to just “let Obamacare fail,” an ominous threat without much substance or policy behind it.

This constant changing of the currents — an uncertain future that has left insurers skittish, local governments scrambling, and patients in fear — is largely due to political disagreements and power struggles between wealthy white men, but its impact is much greater and more deadly than they seem to realize.

The constant changing of the currents on health care is largely due to power struggles between wealthy white men.

Justly, more visible diseases, like diabetes and cancer, receive the lion’s share of the attention in discussions about the devastating impacts of the ACA. But there’s another, less talked-about group who may also die as a result of this politicking — those who are struggling with, and unable to get help for, their eating disorders.

The National Eating Disorder Association (NEDA) estimates that about 30 million people in the United States live with an eating disorder at some point in their life. Eating disorders are not fatal for the majority of those who get help — about 97% of patients who are treated survive — but when treatment is not available, the mortality rate jumps as high as 20%.

The fact is, despite targeted rhetoric about its costliness and general failure, the ACA has substantially increased access to treatment for many patients — and without it, many people with eating disorders would die.

Eating Disorders Before The Affordable Care Act

Though Netflix’s To The Bone made it look easy to get into a cushy in-patient program and stay for months at a time, the reality of eating-disorder treatment is much more bleak for many patients — and was even moreso prior to the adoption of the ACA.

In 2011, a court case in California pushed back on the idea that insurers don’t need to cover in-patient treatment, one of the most aggressive methods of treating eating disorders. The case stemmed from a perception that mental-health issues and physical ailments weren’t being treated equally, a violation of the state’s mental-health parity law and its federal counterpart, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

For years, insurers would cover only a limited number of days — a week, a month — in residential treatment, typically citing the cost; a week at Renfrew, the gold standard of eating disorder treatment, costs over $8,000 per week out-of-pocket. Other insurers flat-out wouldn’t cover any kind of residential treatment, despite recommendations from health-care providers.

Whether residential treatment is the most effective method is up for dispute — and there’s plenty of debate on that exact subject — the fact remains that in-patient treatment is still highly recommended by many doctors and therapists, and can be a lifeline for families who need help.

When You Include Your Eating Disorder On A Medical Intake Form

The ruling, which stated that insurers must strive toward parity of care between mental and physical ailments and thus, provide coverage for residential treatment programs, came down in 2012. NEDA CEO Lynn Grefe called it “a significant victory in the battle against eating disorders that we hope will have repercussions throughout the health insurance industries.”

It did not, however, help establish how patients would be able to access these resources if they couldn’t afford or obtain insurance in the first place. Crucially, despite the significance of the ruling, insurers could still find ways to avoid picking up the tab. Prior to the passage of the Affordable Care Act, they had one very handy tool: pre-existing conditions.

Though “being a woman” is not, in fact, a pre-existing condition, being a woman (or a person of any gender) with an eating disorder is — which means even if a person got coverage once, they could be denied it in the future. That’s challenging when dealing with a disease which tends to take multiple attempts at treatment (and many years) to fully recover from.

Thanks to Obamacare, insurers could no longer turn people away for trying again, and accessing health care was easier than ever.

Eating Disorders Are Expensive For Everyone

Even after the passage of the ACA, though, treatment for eating disorders was difficult to access — making the President’s threat of just “letting it fail” even more frightening.

At the time of the law’s passage, treatment of eating disorders had not qualified as an “essential health benefit” under the new law, despite lobbying from industry professionals. In a letter to then-Secretary of Health and Human Services Kathleen Sebelius, an organization of “more than 35 organizations in the eating disorders education, prevention, and treatment communities” stated their case:

“People with eating disorders experience discrimination in accessing proper treatment and this is a serious obstacle to recovery…According to a 2003 epidemiological study of more than 2000 women, only 1 in 4 white women and 1 in 20 black women who had a diagnosable eating disorder ever received any treatment for their eating disorder.”

Protecting benefits and Medicaid coverage is a matter of social justice. A lack of treatment options and funding methods means that the lethality of eating disorders can be extremely discriminating; if only one in 20 Black women receives treatment, the other 19 are at a much higher risk of death.

Protecting benefits and Medicaid coverage is a matter of social justice.

Reducing access to treatment may also skew research and perpetuate the myriad stereotypes about eating disorders — what they look like, who gets them, and how old they are. One of the most comprehensive ways to collect data about who suffers from eating disorders is to survey those who are getting help. However, when people from marginalized groups — LGBTQ individuals (particularly trans youths), people of color, immigrants, and the very poor, to name a few — don’t have access to treatment, they can’t be counted. The prevalence of eating disorders in poor, rural, and immigrant communities is fairly unknown because they just aren’t getting treatment. Additionally, because these stereotypes persist, primary-care physicians working with these populations may not know the signs or know when to refer someone to care.

The common perception is that eating disorders are private battles fought by thin white women (again, thanks a bundle, To the Bone), but the truth is that they frequently intersect with a whole lot of other issues.

Many eating disorders have nothing to do with restricting and may be masked by other behaviors, substance abuse issues, or trauma. It’s impossible to have conversations about obesity, diabetes, the opiate crisis, or the cost of health care in the United States without mentioning the fact that many of these issues impact and are impacted by the millions of Americans who are living with some kind of eating disorder.

Why We Need More ‘Hunger’ And Less ‘To The Bone’

Offering treatment, then, has far-reaching effects. But the case for offering it goes beyond being the right thing to do. Footing the bill for treatment also does what conservatives have claimed as their goal: saving money.

The sticker shock of a $30,000 per month tab for residential treatment may seem like a lot to a lawmaker looking to make cuts, but consider the cost of not treating those struggling. Again, from the provider letter sent to Secretary Sebelius:

“Consequences of not receiving necessary health insurance coverage include financial ruin for families paying out of pocket, a lack of life saving care, which leads to the worsening of symptoms and in some cases death. Anorexia has the highest mortality rate of all mental illnesses, upwards of 20%. Individuals with anorexia nervosa are 11 times more likely to die than their peers and they are 57 times more likely to die of suicide. Mortality rates are also higher for people with bulimia nervosa (3.9%), and eating disorder not otherwise specified (5.2%).”

Unlike many other ailments, which land sufferers in the emergency room for a round of antibiotics if they’re uninsured, eating disorders are an ongoing, deeply damaging experience that impacts both a person’s physical and mental health. It hinders lifetime productivity, can reduce earning power, and generally perpetuates the gender wage gap. Mental-health issues, particularly those with physical impacts, cost billions in unearned income, creating a cycle of economic despair and expense. They literally make people more poor, thus making them more reliant on social services.

The absence of a functional health-care system — whether that’s single-payer, an improved Obamacare, or something else — is also necessary for the ever-increasing number of children who develop eating disorders.

Yes, many eating-disorder patients are children — between 1999 and 2006, the number of children under 12 who were hospitalized for eating disorders increased 119%. These kids are unable to “go get jobs,” and may be reliant on their parents’ Medicaid, which is also in peril under the GOP’s health-care plan.

The Medicaid expansion portion of the ACA has been monumental for families; in some states, children are the single largest dependents on Medicaid. Meanwhile, children as young as 4 years old report disordered eating patterns that often go undiagnosed because they don’t have access to competent care. The younger these patterns are caught, the better a child’s chance of recovering early.

Repeal, Replace, Fail

There are necessary improvements to the ACA that must be made, but none of them are contained in the proposals coming from Republicans in the House, Senate, or Executive branches.

Each plan put forth by the GOP — from the AHCA to the BRCA to the plan to just plain old repeal — would put people with eating disorders at risk. Cuts to Medicaid spending, reduced coverage for pre-existing conditions, and trimmed mental-health-care coverage would all directly impact the millions of Americans seeking help.

They won’t help bring down the cost of treatment, either; with less insurance or Medicaid funding for eating disorder centers and recovery options, the patients will be expected to pony up. And in the absence of funding, many, many patients will opt not to get help, deferring the cost of treatment to a later date, and potentially dying while they do.

Each health-care plan put forth by the GOP would put people with eating disorders at risk.

McConnell’s two-year pause could also be lethal for patients; recovery is a long road, and many patients who are fortunate enough to be able to afford residential treatment, either through insurance or their own financial stockpile, will need ongoing aftercare. Putting a pause on coverage or temporarily cutting Medicaid will ensure that the long-term care is not an option — significantly increasing a patient’s risk of death.

And as for the President’s promise to “let it fail,” he may be waiting for a while. The ACA is far from perfect and there are still many reasons why treatment is just beyond reach for a lot of individuals, but it is not, as claimed, collapsing — despite concerted efforts from the President to make it so.

Regardless, this is a fight that’s being waged in Washington but fought with the weaponized bodies of people who are disproportionately young, disproportionately marginalized, and disproportionately struggling with other issues. Though the men in ties in the Beltway may view this as a high-level game of chess, the fact of the matter is that the future of the ACA is intimately tied to the future of many Americans who’ve only just got some semblance of hope.

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]]> https://theestablishment.co/see-me-fighting-the-invisibility-of-mental-illness-833f522cea04/ Tue, 08 Mar 2016 18:31:00 +0000 https://theestablishment.co/?p=9466 Read more]]> By Danielle Vintschger

Every day that I’m on the outside of a psych ward, I take up a little more space in the world.

CN: discussion of self-harm

I was eight years old, sitting in the garden next to our driveway when I first became invisible. My body faded away, leaving only a tiny hand holding a trowel with shaking fingers as I raised it above my left wrist and struck. The cut was small, the blood bright against my dirty hand. I stood up and walked up to my father, silently showing him the wound. He brought me inside to clean it up. It was just an accident. Some Neosporin and a bandaid, and it was forgotten.

Of course, I didn’t forget. And it was no accident.

I was 12 years old, sitting in math class when I again became invisible. The anxiety enveloped my body like a blanket, and I faded away, leaving nothing but a wispy pile of eyelashes on the desk. I only woke up when my teacher exclaimed “What are you doing?!” My fist at my eye, only feeling the tiny, sharp pop of the hairs as I pulled them out. “Nothing,” I whispered. And it was forgotten.

Of course, I didn’t forget. And it was not nothing.

I was 14 years old, alone at a table in the cafeteria, when I became invisible. The numbness trickling over my body until nothing was left except the food in front of me. I stared until my focus blurred, only feeling that my body was taking up too much space, that the monster I saw in the mirror was misshapen, so big, too big, and if I didn’t do something, this grotesque frame I was trapped in would explode. The bell rang, and I threw the food in the trash. And it was forgotten.

Of course, I didn’t forget. And it was no oversight.

I was 22 years old, watching the towers fall when I became invisible. The smell of burning concrete leaching through my windows, my heart thudding in my emaciated chest, my scarred body shaking as CNN showed the world ending over and over and over. I reached for the bottle of scotch that had been sitting in the cabinet for over a year. And I drank until everything around me was invisible too. Many people did that. And it was forgotten.

Of course, I didn’t forget. And it was no understandable reaction.

Each time I made myself invisible, I did not realize that I was slowly but surely falling down the rabbit hole of severe mental illness. Sure I was always sad, confused, solitary. I led a life of few friends, bad relationships, and constant self-harm. But that was simply the way things were. I never thought that when I took the trowel to my arm when I was eight years old that I would be sitting here 30 years later, frantic that my food stamps were just cut off and my disability check would never pay all the bills. I never thought that the breakdown I had right after grad school was actually a psychotic break, that my bipolar disorder was in control of my life now, and that as hard as I tried, I couldn’t hold a job, or a relationship, or even a place to live.

Each time I made myself invisible, I did not realize that I was slowly but surely falling down the rabbit hole of severe mental illness.
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When I was eight years old and cut my wrist with that trowel, I could never know that I would spend most of my thirties in various rehabs and psych units, so many times that the nurses knew me at my local hospital, moaning “not again” when I was wheeled into the sterile green locked halls over and over. I became a “frequent flyer” and the psych unit became my second home. There I was the president of all the invisible. I never thrived as much as I did amongst my own people, we who were thrown away or ran away from reality and the world in general. Us rejects and defects who didn’t fit in anywhere, who were shunned and spoken of only in whispers, when we were acknowledged at all. We were the lost children of this country, banished to behind the metal doors that protected us from the world and the world from us.

I never thrived as much as I did amongst my own people, we who were thrown away or ran away from reality and the world in general.
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It was behind those doors that I learned to adapt to the walls, and eventually to need them. I would be released: stay on my medications and away from alcohol and other self-destructive behaviors for a while, before the darkness overtook me again and I would crumble, quit outpatient therapy, stop taking my meds, and end up back in the hospital again. And again. And around and around we go. It’s been eight and a half years since I was diagnosed bipolar and borderline, with a heaping helping of PTSD, eating disorders, self-harm, and alcoholism, just to make things more interesting. And during those years, I have been in 12 psych hospitalizations, three rehabs, countless outpatient programs, and a partridge in a god damn pear tree. I have spent more time behind locked doors than not, and now that I have over a year since I was last in “The Bin” I am still learning how to live on the outside. It’s hard as hell, being invisible. It’s even harder when a part of you wants to stay that way.

It’s easier than one might think to stay invisible. When I speak out for mental health advocacy, when I tell my story, people get uncomfortable. Society wants us to stay behind locked doors, and if we are out, plenty of people want us to either accept the poverty level of living that being on permanent disability demands, or to fake being one of you “normals” and keep our illnesses invisible. I could give a string of facts and statistics about the dearth of care for those of us with mental illnesses, or I could spout off suicide statistics until my face turned blue, but that really never does any good. When we invisible women advocate for ourselves, we are attacked and told to shut up and deal, or mocked, or disregarded completely. I choose instead to tell you my story and hope that my pain can help others. But sometimes that’s a pipe dream.

For when I was eight years old and disappeared into my mind, I never thought that society would consider me invisible. To most of the country, I am a series of labels, not an actual person. Lazy. Crazy. Drunk. Selfish. Useless. Nothing but a drain on the people that are “normal” and why don’t I pull myself up by my bootstraps and suck it up and deal. The names I was called on Twitter alone would make a sailor blush. I wish I could say that I deleted and blocked and moved on, but I didn’t. Each of those insults was salt in my wounds, further encouragement to be invisible, to vanish into the crowd, to stay inpatient forever.

It’s hard as hell, being invisible. It’s even harder when a part of you wants to stay that way.
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I didn’t vanish. I continued, in my tiny way, to be there for other people living with mental illnesses. I continued to fight for my own life, in drips and drabs, stumbling along the way over and over, always hearing the hissing voice of self-doubt telling me to stay down. Just don’t get up the next time you get kicked. It’s that easy. Take all the pills. Drink a quart of vodka. Disappear. Just disappear. It would have been so easy.

But then friends started dying. And they didn’t stop. That handsome rogue from my second rehab who dazzled all the women around him? He died. That sweet girl from outpatient who I gave my number to, hoping she’d call? She died. My best friend’s brother, gone. My precious friend who was the embodiment of beauty and light and fun. Her bright eyes forever closed. I know too many people who are invisible forever now. I see myself in all of their shadows. It’s so easy to be invisible in a world that doesn’t want to see you. So I make the decision every day to be seen. I talk about my illnesses, my addictions, my pain. I encourage others to do the same. I give out my number. I even assure people that they can call me instead of texting. Little things like that to do anything and everything I can to keep us from vanishing into the ether.

I know too many people who are invisible forever now. I see myself in all of their shadows. It’s so easy to be invisible in a world that doesn’t want to see you.
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Of course I have bad times. Being bipolar means I can go full tilt Furiosa rescuing people left and right, and suddenly run into a wall of pain and lie in bed for a week, filthy and broken and staring at the wall, wanting to fade away. Every time I take my morning fistful of meds, or collapse into bed at night with another fistful of meds, I make the decision to not be invisible. Every time I look at a blade and imagine it separating my skin to release the bright red pain but set it aside instead, I make the decision not to be invisible. Every time I turn down a vodka tonic, or don’t purge my dinner, the lines of my frame solidify a little more. My hair is blacker, my eyes bluer. Every day that I’m on the outside of a psych ward, I take up a little more space in the world.

I’m not invisible. You can’t make me be invisible. I have reclaimed my place in this universe.