Promoting Mental Health in the Workplace

[Content note: mental illness, including eating disorders]

This post was requested by Kate [not FtB!Kate], who donated to my conference fundraiser. She wanted to hear my opinion on mental health in the workplace and how employees and employers can foster a culture that values and promotes mental health. She had some of her own suggestions, which I’ve incorporated into this piece with her permission.

Work is often a concern for people who suffer from mental illnesses. They might worry, for instance, that their struggles will impact their work performance, that coworkers or employers will find out that they have a diagnosis and stigmatize (or even fire) them, or that offhand comments at work could trigger eating disorder symptoms.

I wrote about this topic much more generally in this piece, which was about how to prioritize and promote mental health in one’s community. Workplaces are particular types of communities, so a lot of this still applies. At the same time, workplaces present particular challenges to promoting mental health, as well as particular capabilities that might help.

Note that I’m writing this as a person with a mental illness, as a person who works, and as a person who observes human behavior. I’m not writing this as someone who’s ever been a manager or a supervisor, so while I can speak to what I would like to see from managers and supervisors, I don’t have firsthand knowledge of what it’s like to be one. If you have that experience and you’d like to weigh in in the comments, feel free to do so.

For employers/managers/supervisors

1. Ensure that the assignments you give your employees and the culture you foster in the office encourage and allow employees to take good care of themselves.

Every workplace that expects people to skip lunch or sleep less than 7 hours a night is a workplace that is detrimental not only to physical health, but mental health as well. Sleep deprivation can dangerously exacerbate many mental illnesses, and having to skip meals can cause people with eating disorders to relapse. Obviously this is unavoidable with certain jobs or when a big important project is nearing completion, but it’s avoidable with most jobs most of the time.

(At the same time, recognize that this is a problem with American culture at large, and companies feel pressure to pressure their employees in this way because if they don’t, a competitor will, and it’ll reap the profits.)

2. Make sure that new employees understand the health coverage they’re receiving under the company’s benefits plan, especially as it pertains to mental health.

Explain in as little legalese as possible what the coverage includes and doesn’t include, and where they can go to find more detailed information or look up specialists in their area. In my experience, many people are worried that if they see a mental health professional using their employer-provided insurance plan, their employer will somehow have access to their medical records. Emphasize that it’s none of your business as an employer what your employees do with their health insurance and that providers cannot disclose such information to you without a patient’s consent. For extra points, give a short overview of HIPAA.

Going over this information not only improves the odds that employees are able to get the mental healthcare they need, but it shows that you’re comfortable discussing mental health with employees and that your company thinks it’s important.

3. If you choose to have health-related contests at the office, focus them on fitness goals or healthy eating, not weight loss.

Personally, though, I’d avoid these altogether because many people consider health a personal matter and feel pretty uncomfortable about having to discuss it publicly and competitively. Even if the contest is optional, keep in mind that people will feel a strong social pressure to join in. Who wants to be the only person in the office who doesn’t seem to care about staying in shape?

In any case, framing weight loss as an intrinsically healthy and positive goal is harmful and counterproductive. You can weigh little and be very unhealthy, and if you lose weight in an unhealthy way, you’ll probably gain it back anyway. A better way to structure a health contest is by encouraging participants to achieve goals that are proven to be healthy and doable.

4. Make sure employees understand the policies and processes about taking time off for medical reasons (and remember that mental health is a medical issue).

It’s especially important to find a way to emphasize that mental health is just as important as physical health, and little gestures make a big difference. For example, you could say something like, “If you know in advance you’re going to need time off, like for a physical or a therapy appointment, you can submit the form to me at at least a week’s notice.” That provides important information while also implicitly conveying the fact that you consider therapy to be a legitimate reason to leave work an hour early.

For employees

1. Consider your own mental health when choosing responsibilities to take on at work.

It’s understandable, especially in this economy, to try to impress your boss by offering to do as much as possible and overworking yourself. However, good mental health should be seen as an investment. If you take good care of it, you’ll ultimately be more productive than if you neglect it and burn out.

This applies to all those little volunteer opportunities that aren’t directly job-related, either. If you have social anxiety, it might be a bad idea to offer to organize a social outing for the office. If you have an eating disorder that makes it really stressful to choose food to buy, it might be a bad idea to offer to bring snacks for a meeting. You know yourself best.

2. If you feel safe and comfortable, let your boss know about mental health issues that may affect your performance and how you plan to deal with them.

The “if you feel safe and comfortable” is the key part. I’m absolutely not suggesting that everyone can and should come out about their mental illness to their boss, since I know that in many cases that’s a really bad idea. (It shouldn’t be, but it is.) But personally, I know people who did this and found it really helpful because they were able to work collaboratively with their boss to make sure that they can get the time off they need and that they can fulfill their responsibilities rather than having to keep it a secret and try to solve potential problems on their own. Disclosing also makes it possible to receive any accommodations you may need, which brings me to:

3. Educate yourself about laws related to mental illness and the workplace.

The Americans with Disabilities Act (ADA) is obviously a major one, but so is HIPAA, which I mentioned earlier. The definition of “disability” in the ADA is intentionally quite general, but mental illnesses are included: depression, anxiety, PTSD, ADHD, and so on. Title I of the ADA concerns employment. There’s a lot of useful information in there; for instance, an employer cannot ask you in a job interview whether or not you’ve been treated for mental health problems, or which medications you’re taking. Keep in mind that the ADA only applies to businesses with 15 or more employees, however. Here’s another useful article about it.

For everyone

1. When someone asks you how you’re doing, be honest (within reason).

In the piece I linked to earlier, I wrote:

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

At work, there are obviously different standards than in other communities, or with friends and family. But even at work, there’s room for honesty and mutual support.

2. Be mindful of using language that relates to mental illness.

Casual usage of diagnostic terms (“That’s so OCD,” “You’re being delusional,” etc.) hurts people with mental illnesses by trivializing their conditions and turning them into the butt of a joke. It also makes it more difficult for people to disclose mental illnesses because it keeps people from taking them seriously. If “ADHD” is what you call it when you can’t focus on a boring project and someone tells you they have “ADHD,” you’re not going to think, “Oh, this person has a serious condition that makes it neurologically impossible for them to focus on a task unless they get treatment.” You’re going to think, “Oh, come on, they just need to close Facebook and get focused.”

3. Remember that talking about dieting and weight loss can be very triggering for people with past or current eating disorders.

Fat talk (as it’s called) is so ingrained in our culture and communication patterns that it’s hard to imagine that it could be such a serious issue for someone. But anecdotally, it seems that eating disorders in particular are very easily triggered by offhand remarks like “Ugh I need to work off this cupcake” or “My thighs are huge.” Even when not actually triggering, these comments encourage unhealthy behavior and create a social norm of dieting and preoccupation with weight loss.

I sometimes dread being around groups of women who are not my friends because more likely than not, I’m going to hear these comments. And it’s not like you can avoid your coworkers. So if you must do it, try not to do it to a captive audience.

4. Respect others’ privacy when it comes to mental health issues.

Just as you should never out an LGBT person without their permission, you shouldn’t discuss someone’s mental health with others at the office. Although I generally encourage people to be open about mental illness if they feel they can be, that has to be on their terms, not someone else’s. If you’re concerned that someone’s mental health problems are causing them to be unable to do their work, do the same thing you’d (probably) do anytime a coworker isn’t pulling their weight: talk to them about it in a kind and considerate way rather than going straight to the boss.

(An exception to this is if you’re worried that someone may harm themselves or someone else. In that case, please call 911. )

When it comes to structural issues like ableism and stigma, no community can be an island, unfortunately. There will not be stigma-free workplaces until there is a stigma-free society. But the more power you have in a workplace, the more influence yo have over its culture.

Thank you to Kate for her donation and for this prompt. 

~~~

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All These Years I Thought I Was Just Lazy

[Content note: eating disorders/weight loss stuff]

My arms are on fire. When I woke up this morning I felt the burn immediately. I’ve been stretching and moving them around all day, simultaneously wincing and savoring the feeling because it tells me that I’m getting stronger.

I’m on spring break right now and have been taking advantage of the sudden free time by going to the gym every day. It may not sound like a big deal, but for me it is–with the exception of a few random workouts, I’ve been largely avoiding the gym for at least three years.

When I was in high school it was a different story. Back then going to the gym was punishment. I felt that I’d done a lot of things that I deserved to be punished for; not looking right being the main one. I was furious with myself because no amount of exercise seemed to be enough to make me look the way I wanted to, so I combined that with brief spurts of severe caloric restriction. That didn’t help, either. I couldn’t tolerate the feeling of hunger.

So I went to the gym and took my fury out on my body. At least, that’s how it felt to me psychologically. In reality, of course, exercise within reason is good for you. But I couldn’t feel that. Working out for me was only about two things: 1) losing weight, and 2) punishing myself for not losing enough weight quickly enough.

Then I stopped. Partially because I got too busy to make it to the gym, but also because I realized that, at the time, the only way to recover would be to give up on exercise for a while. I still did stuff like walking, swimming, and biking in the summers, but that was only because I find that stuff fun, not because I was trying to work out.

And, to be sure, whenever I attempted exercise for its own sake, I quickly fell back into my old mentality of “needing” to lose weight at all costs. Along with exercising came calorie counting, bending over naked to assess the gap between my thighs, pinching my stomach mindlessly while sitting in class and trying to hide it, freaking out when my jeans came out of the wash a bit too tight, dreading buying new clothes, and on and on and on.

So I’d inevitably stop going to the gym after a few days. When it feels like that, it’s not at all worth it.

But when spring break started a few days ago, I decided to try it one more time. And this time, it worked.

This time I look forward to it. This time I keep eating whatever the fuck I want. This time I don’t even touch the scale in the locker room. This time I don’t tell people about my workouts if I know they’re going to preemptively congratulate me on the weight I’m going to lose. This time I get to do the exercises I feel like doing, not the ones that burn the most calories. This time I get to do what I thought was impossible–see exercise as a treat, not a punishment.

And let me tell you something. I am fucking furious that this–the ability to feel such joy and pleasure from exercising, to focus on how my body feels rather than how it looks–was taken away from me for so many years. I don’t mean literally taken away. Nobody forbade me from choosing to exercise because it’s good for you. But the way we talk about exercise, both among the people I knew and in our culture in general, precluded that. It’s almost like we lack the language to talk about working out without also talking about losing weight.

And when I go to the gym now and see signs advertising personal training programs to make you “Lose X Pounds in Just Y Weeks!”, it makes me sad. Not because it affects me anymore, but because I know what it’s like to walk into the gym and know in the back of your mind that you are there for that reason only. Not because you’ll feel good. Not because you’ll sleep better at night. Not to feel your muscles ache the morning after. Not to finally be able to run a marathon or bike to work every day without being exhausted or just so that you never have to ask anyone to help you carry things. Not to make friends with people who like doing the same stuff you do. Not because it helps keep depression at bay. Not even because it’s a better way to pass the time than sitting around looking out the window.

Only, only to watch the numbers slip further and further, not even knowing when you want them to stop.

For all these years I thought I didn’t exercise because I’m lazy and pathetic. I never thought to ask myself why someone who somehow has the wherewithal to do well at a competitive university and write 1000-word blog posts several times a week suddenly finds hidden reserves of laziness whenever the question of exercise comes up.

I wasn’t lazy. I straight-up didn’t want to, because I’d never found a way to think about exercise, let alone actually do it, without feeling waves of shame, inadequacy, boredom, and misery.

Now I have. Maybe because enough time has finally passed, or because of feminism, or because of the fantastic friends I have who work out and make it clear that for them, it’s got nothing to do with weight.

I’d be lying if I said that I’m not hoping to lose weight at all, or that I won’t be at least a little bit happy if it happens. I’m not sure that’ll ever completely get out of my system. But even if I lose absolutely zero pounds, it won’t feel like working out is all for nothing. If a doctor told me right now that there is absolutely no chance that I’ll lose any weight given how I’m exercising and eating, I’d keep doing it anyway.

Two years ago, I would not have done the same thing.

For me, personally, that’s as close as it gets to silencing the countless voices telling us to be thin and perfect. That’s as close as it gets to declaring victory.

[In Brief] How to Talk About Mental Illness Recovery Without Shaming

Lucy Hale covers this month’s Cosmo.

Remember that post about celebrity gossip I just wrote? Well, here’s an example of how reading that stuff can be useful and enlightening.

I’m reading an interview in the September issue of Cosmo with Lucy Hale, a 23-year-old actress most known for her role on Pretty Little Liars, a guilty pleasure of mine. In the interview, Hale opens up (apparently for the first time) about the eating disorder she struggled with as a teenager:

But behind the scenes, Lucy developed a dangerous habit all too common among young starlets. ‘I’ve never really talked about this, but I would go days without eating. Or maybe I’d have some fruit and then go to the gym for three hours. I knew I had a problem,’ Lucy says of the issue that plagued her for two years. Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around. ‘It was a gradual process, but I changed myself,’ she says.

Except for the following paragraph, in which Hale talks about cutting damaging friendships out of her life, no other details are given about how she recovered from her eating disorder, and I won’t assume. However she did it, it’s awesome and she deserves to feel great about having accomplished that.

However, the Cosmo writer takes it a bit further with this sentence: “Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around.”

Wait…what? So people who succumb to the “downward slide” of eating disorders, or who need professional help to recover, just lack the “strength” that Hale has?

Obviously, I disagree.

If Hale really did recover without any professional help–which, again, she does not make that clear–there are many potential reasons for that. Perhaps she had a great support system of friends and family. Maybe she’s not genetically predisposed to eating disorders. Maybe her parents have healthy eating habits that they were able to model for her. She might’ve not had as serious a case as others do. Or perhaps she just got lucky.

None of this means that actresses who are “unable to escape the downward slide” have any less “strength” than Hale did. It means, probably, that they had different circumstances. Different lives.

So, how does one talk about people who have recovered from mental illness on their own without putting down those who cannot? My answer would be, by not comparing them to each other. Hale recovered? That’s awesome. Another actress didn’t? That’s a tragedy, and she deserves help and support. Their illnesses are not comparable, even if they happen to share the same name.

As Leo Tolstoy said, unhappy families are all unhappy in their own way. Similarly, people who suffer from mental illness all do so in their own way. Just because one recovers and another does not doesn’t mean that one has more “strength” than the other.

P.S. Before anybody goes all “but it’s just Cosmo, who cares!”, Cosmo has a circulation of over 3 million in the United States and is also distributed in over 100 other countries in 32 languages. Readers of this blog probably think Cosmo is silly and not something to be taken seriously (which it’s not), but the truth is that many people around the world probably get most of their information about things like mental illness from media like this. So it’s definitely worth examining and critiquing.

Surprise! Elle Magazine Editor Doesn't Really Care About Eating Disorders

Nope, no Photoshopping. Nothing to see here, move along now.

Confession: sometimes I read women’s magazines. They’re fun to make critique and laugh at.

This time, though, I didn’t even get past the magazine’s front matter before finding something objectionable. In her opening letter for Elle magazine’s August issue, Editor-in-Chief Roberta Myers discusses the recent legislation in the U.K. that would require digitally altered photographs of models to be labeled as such. You can practically feel the derision and dismissal dripping off the page:

So now the National Academy of Sciences is getting into the act, trying to define what ‘impossibly beautiful’ means. In response to legislation pending in the UK to require digitally altered photos to be labeled out of concern for public health, as well as the American Medical Association’s campaign against changing pictures ‘in a manner that could promote unrealistic expectations of appropriate body image,’ two Dartmouth computer scientists proposed a ‘metric’ at a recent NAS meeting designed to rate how much retouched photos have ‘strayed from reality.’ The authors noted that ‘highly idealized’ images have been associated with eating disorders, such as anorexia.

Scare quotes aside, I have the feeling that Myers knows exactly what “impossibly beautiful” means, even if the idea of defining it operationally seems a bit silly. I do think that regulatory measures like these should be approached with a certain degree of healthy skepticism, because government regulation should not be undertaken lightly and without good evidence. But Myers isn’t critiquing it skeptically. She’s sticking her head in the sand and denying that a problem exists.

Furthermore, the regulations don’t even propose to ban severely Photoshopped images, but merely to place labels on them. Is putting an extra little bit of text on the bottom of an image really such a burden for Myers? I think not. Note that some countries are going even further–Israel, for instance, banned the use of underweight models in advertising entirely.

Myers continues:

Yet according to David Scott Rosen, MD…eating disorders are as old as the Bible. They cropped up in popular literature 200 years ago–long before Photoshop but right around the time when John Singer Sargent painted his famous Madame X (Madame Pierre Gautreau), a most flattering oil-on-canvas portrait that left out many a “flaw.”

I couldn’t find a citation for this, but it’s probably true. However, nobody’s claiming that eating disorders exist solely because of unrealistic beauty standards in the media. It’s not like a perfectly healthy young woman (or man, but that’s a slightly different conversation) opens up Elle magazine, sees a picture of a thin model, and immediately starts starving herself. Eating disorders arise from a complicated interaction of genetics, family life, and the surrounding culture. They involve complex cognitive processes, such as the ones described in this study. As another example, research shows that people determine attractiveness based on what they have seen the most. So if you’ve been looking at images of impossibly thin women for your entire life, that may be what you’re going to find attractive–and that’s what you may aspire to be.

We can’t prevent genes that predispose one to eating disorders from being passed down, and we can’t make it illegal for parents to teach their daughters that their appearance is the most important thing and that one should use unhealthy means to maintain it (though, with more education, we might be able to prevent that). We can, however, place restrictions on the images that permeate our media.

Furthermore, Myers conveniently ignores the fact that eating disorders have been growing more and more prevalent over the past century, especially among young women. Studies have also shown possible links between media that promotes thinness and eating disorders. It is impossible to establish a causative link with certainty, but that’s because 1) nothing is ever certain in science, and 2) we live within a culture that promotes and glorifies thinness. You can’t really evaluate phenomena like this accurately when you exist within the system that you’re trying to evaluate.

But luckily, studies done with non-Western cultures are very revealing. One extremely compelling study showed that girls in Fiji, who previously had little exposure to Western media, became much more likely to show signs of disordered eating after watching Western television shows for the first time.

Several Google searches brought up countless studies like these. Myers seems to consider them irrelevant here. She continues:

My point is that trying to define “impossible beauty,” and then regulate its dissemination by putting warning labels on retouched images, seems rather preposterous. You know, my chocolate bar never looks quite as creamy as it does in the ads; cars are never quite that sexy and sleek; and the milk in my cereal bowl never looks quite that white. Oh, wait! It’s not milk at all! It’s some gelatinous concoction meant to look like milk while it stays sturdy under hours of hot lights. Shall we label those photos, too?

This passage is as laughable as it is offensive. First of all, cool slippery slope fallacy, bro. Second, while one may argue over the sleekness of a car or the whiteness of a bowl of milk, it is completely unmistakable when magazines alter photos of models such that they appear to thin to actually be alive.

Third, and most importantly, the comparisons Myers makes are flippant to the point of inanity. The worst thing that can happen in her examples is that one’s chocolate bar isn’t creamy enough. The worst thing that can happen when magazines use Photoshop to excess is that, you know, someone develops anorexia and dies.

As I mentioned, the link between digitally altered images and eating disorders probably isn’t simple. But research is increasingly showing that it is there. It is worth noting that Myers never makes any comments about her own magazine’s use of Photoshop, which tells me that she’s fully aware of what she’s doing and is just willfully playing dumb. She knows. And she’s threatened by it, because things are starting to change.

But she’s not done. She goes on to cite an article in this month’s issue:

I wonder what the National Academy would have to say about the photograph we ran in this issue of novelist and essayist Ann Bauer, who writes so eloquently about growing up “ugly”–bearing a steady stream of abuse about her looks from classmates, strangers, and even lovers.

This bit confirms for me what I already suspected–that magazines like Elle print articles like this solely from the purpose of distracting people from the role they play in upholding our society’s beauty standards. These magazines can trot these articles out as examples of their commitment to portraying “women of all shapes and sizes,” when, in fact, they use these women as tokens.

The article in question is indeed a beautiful article. But what’s ironic is that Myers doesn’t even realize how magazines like her own have contributed to the bullying and abuse that women like Bauer face. Of course, people have always valued beauty and mistreated those who are deemed “ugly.” But lately, the box into which women must fit in order to be considered beautiful has been shrinking, whereas the “ugly” box has been growing. Magazines like Elle may not be the only (or even the main) causes of this trend, but it would be naive not to implicate them in it.

Furthermore, that photo of Bauer that Myers is so proud to have featured? It takes up one corner of a page and measures about two by three inches. Compare this to the dozens of full-page Photoshopped models in the magazine.

The most telling (and touching) part of Bauer’s piece, to me, is the end, in which she describes visiting Hungary with her husband and going to the opera in Budapest:

I turned and found myself looking into a full-length mirror. And I saw something I’d never seen before: myself, in a sea of women who looked just like me.

[…]Everywhere I looked in that lighted glass, there were women with large features, deep-set eyes, rounded cheeks, riotous hair, and delicate-yet-meaty little bodies. We were, in other words, an army of ugly people.

Only, for the first time in my memory, we weren’t. I wasn’t. I was normal, even conventionally attractive. Stylish. Interesting. Sexy. Simply that.

I stood in front of that mirror in the Hungarian State Opera House, watching couples mill. Men holding the arms and hands of dozens of women who could’ve been my sisters, mother, and daughters, tipping their heads back, kissing them lightly, gazing with naked admiration at faces like mine.

Bauer shows, ultimately, that she is not ugly. It is American culture that makes her out to be so. In Hungary, women who look like her are not bullied. They are not sent anonymous emails about how ugly they are. They are not denied jobs or pressured to lose weight and get plastic surgery.

This makes Myers’ stubborn refusal to examine the potential effects of her magazine even more ironic (and upsetting). Magazine editors seem to feel that they are being solely blamed for the devastating experiences of many women (and, increasingly, men), but no informed researcher or critic would say that magazines directly cause eating disorders. We have to examine this phenomenon as a system of interacting elements–the mass media, politics, families, and individual brains and bodies–in order to begin to understand how to prevent unhealthy beauty standards, poor body image, and eating disorders.

We can’t start without making sure that everyone knows that the images they see around them every day of their lives are not realistic. They’re not something to aspire to, because they cannot be obtained–except perhaps at a very high cost.

The editorial this photo belongs to is totally unironically called “The Surreal World.” Photo credit: Elle August 2012

[Guest Post] An open letter to the woman who said I wasn’t skinny enough to have an eating disorder

Another guest post, this time by my friend Kate.

You are the mother of my greatest friend. Your house was my refuge in high school. I wanted to surprise you and share my happiness with you when I got into my dream college. By my senior year, I spent almost every day after school at your house. You offered to cover for me, to be a hiding place when I simply could not deal with my family…and you became someone I trusted. You knew me in the worst throes of my starvation. I was skinny then. I was too skinny, and faint and malnourished and mentally ill. You didn’t know it then, but your son guessed, and for that, he has my eternal gratitude. Without him, I do not know that I would have survived to this point. That is not hyperbole.

You saw me this summer, back home for the worst summer I’ve had. I have gone off therapy for these three months, because you see, my parents don’t use modern medicine, and I cannot trust them to care for me. I am dependent on the kindness of my university to have treatment in the first place. This summer, all I have are friends, and my own will to do anything to keep from slipping back into a hell of calorie counting and obsessive thoughts and the nightmare of reflective surfaces. I used to hate myself, you know. It still creeps up on me and strangles and pulls at loose skin, until all I can do is hold off from screaming and curl up in bed.

You don’t know this. I would have told you, had you asked. I speak about my cesspit of destructive behavior, because you can’t tell when you look at me. That is true of most eating disorders, and someone has to talk about it. I will be that person.

You can’t tell that some days I realize all I’ve had is a cup of coffee in twenty-four hours, and I am blisteringly happy. You can’t tell because I force myself to hold a normal weight. I have for four years, and on especially good days, that is a source of pride.

That number on the scale isn’t the weight I want, but it is healthy. It is perfectly in the range for my height, a muscular build that runs and leaps and cartwheels, but it isn’t skinny. It isn’t skinny, and that is all you see. I am not starving, and so I cannot possibly suffer. I should get over it.

I’d like to, but if the past six years are any lesson, I won’t. I will always depend on alarms to remind me when to eat. I will plan my workouts ahead of time, because when I don’t, I become obsessive, and exercise until I cannot see straight. I will never eat with abandon. Meals will be planned for. Eating out will be stressful. I will have an uneasy truce with food.

And there will be people like you. I hate saying that because, until yesterday, when I said that I meant people who would care, and make me laugh, and be one of the solid ones. There will be people like you, who think I’m making a fuss, playing victim. You were one of the good ones, once, so I’d like to set the record straight.

I am recovering from an eating disorder. For two years, I averaged less than 800 calories per day. I danced intensively, as much as four hours a day. I lost too much weight. I was starving and bony. I did permanent harm to my body.

I have bradycardia. That means my heart beats too slowly; it doesn’t speed up enough when I exercise. If I push too far? I’ll faint. I do not trust myself to exercise outside of a gym. I cannot know when my vision will narrow, but in a building, I at least know that if I stay unconscious, someone will be there. I want you to consider that my safety net is the kindness of strangers to notice if I do not wake up.

The rate for attempted suicide in those with eating disorders is as high as three times that of the general population. Everyone quotes statistics, but I want you to take a hard look at that one. If you combine the neurotypical people out there with those who have PTSD, with those who have major depression, with everyone else who has considered their life not worth living, they attempt suicide at one third the rate of those with eating disorders. You know what makes me hurt so badly I want nothing more than to make it stop any way I can? When people I trust decide some number on a scale measures the weight of my claims, when they reinforce the horrible things I believe about myself. I just never thought one of them would be you.

I want you to know something important about your son. Your son cared for me without knowing any of those facts or statistics or numbers. He just thought I was worth time. He thought I was too skinny, that I was maybe hurting myself, and so he did what he could. He held me and took me to dinner and made sure I ate. He never demanded justification—he waited until I told him I had an eating disorder—the first person I ever confessed to. He smiled, and said he knew, and then we went back to life as normal. We talk every day, because we take care of each other.

I want you to understand something, more than anything else in this letter. You
said I didn’t really have an eating disorder. But that wasn’t the worst thing. You also told my greatest friend, your son, that he should back away from me. You said he shouldn’t ‘have’ to take care of me. You wanted him to back off, because I was being whiny. I cannot forgive that.

I can forgive your careless misunderstanding of my eating disorder. You won’t be the last. You hurt me badly, but it’s ignorance like the words you spoke that keep me speaking up. I cannot forgive your wish to destroy my support.

You spoke selfishly. It is the selfless spirit of your son, and his love that quite literally, saved my life. I’m sorry you can’t see that. I’m sorry I don’t want to see any more of you.

Relevant citations: here and here.

Kate Donovan is a junior studying psychology and human development at Northwestern University. She is the president of Northwestern’s Secular Student Alliance and a writer at Teen Skepchick and the Friendly Atheist blog.

"If You're Fat, Then What Am I?"

There are a lot of misconceptions out there about body image and eating disorders. I can’t even begin to address all of them here. But there’s one I’ve been thinking about lately–that problems with body image are caused solely by comparing yourself to unrealistic standards, and can be solved by simply comparing yourself to the “real” bodies around you instead.

First, a disclaimer–I’ve never had anorexia or bulimia. However, I’m not entirely out of my depth here. Had I gone to see a psychiatrist at some point prior to this year, he or she would probably have taken note of my obsessive calorie-counting, severe dietary restrictions, compulsive weight-checking and fat-pinching, and general conviction that I was “fat,” and diagnosed me with something called “eating disorder not otherwise specified,” or “EDNOS.” This means that one doesn’t meet the diagnostic criteria for any of the eating disorders, but is definitely disordered nonetheless.

(For the record, I’m much better now.)

Anyway, one thing I remember very vividly from my years of thinking I’m fat was one particular response that I often encountered. Some people (mostly other girls), upon learning how I felt, would respond with this: “If you’re fat, then what am I?”

Now, I understand exactly where this comes from. Many of my peers were probably insecure, too, and it makes sense that they would be reminded of their own insecurity once I mentioned mine. Since I was indeed thinner than many other people, that response makes sense on some level. If I’m fat, they must be obese!

But it doesn’t really work that way. It would certainly be convenient if people’s self-concepts were always rational and based on reality. But the very definition of mental problems is that they’re distortions of reality–they’re unrealistic. That’s why grief after the death of a loved one isn’t considered a mental disorder, but depression is.

And that’s exactly why “If you’re fat then what am I” is not an effective response. At the time, I didn’t give two shits what other people were. It didn’t enter my thought process. In my case, my conviction that I was fat was mostly caused by cultural factors; namely, the fact that Russians are fucking preoccupied with beauty and weight. Absolutely preoccupied. It was also caused by years of ballet lessons, my depressive personality (which magnifies personal flaws), the belief that I could lose 10-20 pounds and still be healthy, fear that guys wouldn’t find me attractive if I had folds on my stomach, and many other causes.

For other people with body image and eating issues, the causes may be different. Some people develop the feeling that they’re unable to control their environment, so they control the only thing they can–their body. Others may start out actually overweight, start to diet and lose weight, and find that they’re addicted to the feeling of getting thinner. Others develop an overwhelming guilt whenever they eat, especially when they eat unhealthily, and they start to purge after eating. Some may have friends who constantly talk about their bodies’ flaws (remember Mean Girls?) and start to think the same way.

Whatever the causes are, these issues are much too complicated to be defeated by a simple glance at someone who weighs more than you.

Of course, “If you’re fat then what am I” also fails one of the most basic requirements of being a good listener–don’t change the subject to yourself. If your friend feels crappy and needs to talk to you, don’t make it about you. If your own issues are making it difficult for you to listen, tell your friend that. Sure, they might be disappointed that you can’t listen to them, but that’s much better than how they’re going to feel when you take their pain and turn it into a conversation about you and your weight.

It’s easy to resent people who, according to you, “should” be perfectly happy with their weight but are not. I can’t say I don’t get a twinge of annoyance whenever I witness a girl much smaller than me freaking out about her weight. But then I remind myself that she’s not me. Poor body image seems almost like a cliche among young women these days, but it’s so much more complex than you might think.