I am a medically diagnosed binge eater. Not just a person that eats a lot and lacks the self-control or motivation to stop. I have a clinical eating disorder. Most people don’t know that binge eating disorder exists, right alongside anorexia, bulimia, and orthorexia, in the ED pantheon, but yes. It is a “severe, life-threatening, and treatable eating disorder,” according to the National Eating Disorders Association. And it is a huge source of shame for me.
For those that will predictably and inevitably scoff at the idea of binge eating being a medical disorder, I offer you the diagnostic criteria for BED:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- The binge eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least once a week for 3 months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
I offer you this list of symptoms:
- Appears uncomfortable eating around others
- Fear of eating in public or with others
- Steals or hoards food in strange places
- Creates lifestyle schedules or rituals to make time for binge sessions
- Withdraws from usual friends and activities
- Frequently diets; engaging in sporadic fasting or repetitive dieting
- Shows extreme concern with body weight and shape
- Frequent checking in the mirror for perceived flaws in appearance
- Has secret recurring episodes of binge eating
- Feels lack of control over ability to stop eating
- Disruption in normal eating behaviors
- Developing food rituals
- Eating alone out of embarrassment at the quantity of food being eaten
- Feelings of disgust, depression, or guilt after overeating
- Feelings of low self-esteem
- Noticeable fluctuations in weight, both up and down
- Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
- Difficulties concentrating
And I offer you these two important points about the causes of BED put forward by neurobiologist Dr. Tamara Pryor: BED is not a choice; it is a neurobiological condition that involves mind and body.
As she says in her article, “Binge Eating Disorder Recovery – It’s Not About Weight Loss”: “No one would choose the shame, discomfort, and depression that comes [sic] with BED.”
I can personally attest to that.
Risk factors for BED include genetics, a history of trauma, and a culture “that idealizes thinness.”
I don’t know whether I inherited my propensity toward developing BED, but I do believe that trauma and indoctrination played their part in my pathology.
I think that I developed binge eating disorder over a long span of time, from pre-adolescence until I gave birth to my daughter and suffered a protracted clinical bout of PPD (postpartum depression).
Certainly, I remember loving food as a kid, but I don’t feel like I was fixated on it at that age. I think things took a turn when I put on the pre-puberty pudge that most kids do in fourth grade, but got labeled “fat” for it by my very thin grandmother (God bless her – she only wanted me to be attractive because in her worldview it increased the chances of me being happy) and very unkind classmates.
I remember my perception of and attitude toward my body changing at that time. This was fourth grade, right before middle school. Suddenly, I cared about fatness and thinness. I not only wanted to be thin, but I began believing that I needed to be thin in order to be liked and treated with respect.
I was the new kid at a school with a very rough social climate in fourth grade – a very dreamy, bookish girl with straight As and ideas about becoming a writer amongst a bunch of rather rough-and-tumble kids that were more into athletics and being cool and dressing as a competitive sport. I was an outcast with very few friends or spaces in which I could feel validated outside of my family and home. So eating began to be more than just what I did at meals to fuel my body. I began to look forward to eating because it gave me pure, uncomplicated pleasure, and I began to fixate on food because that’s what you eat. Lunchtime became an emotional haven for me even as recess and rec periods – with all their social politics – became more and more hellish.
I began to suffocate my feelings, which I literally felt in my gut (that good old “second brain”) with food. I began to eat away all of my anxiety and unhappiness at being “fat” and not fitting in with my peers, as ironic as that is. I continued to do this – eat and obsess over the way I looked and in particular my weight – until I turned 25 and lost around 25 lbs. during a really brutal Crohn’s disease episode. Then, I was thin. I wanted desperately to stay that way. So I began dieting and restricting in order to remain thin. But it didn’t work because by then food had become my drug. And as life got more complicated, I needed my drug even more than ever to numb all of the pain I was experiencing.
My grandmother got sick with cancer in the winter of 2005. She was a life-long smoker, but she had quit several years before that, so my family didn’t suspect that her illness was cancer. We didn’t know what was going on. We just knew that she stopped eating and started to have an extremely hard time swallowing even her saliva.
She starved down to 70 lbs. as we shuttled her from specialist to specialist, hospital to hospital, trying to figure out what was happening with her. And she stopped talking to us, which made it even harder to help her. Looking back, I wonder whether she feared the worst deep done; I wonder whether she knew intuitively that she was dying, and there was nothing any of us could do about it.
Either way, by the time the doctors stopped poking around her digestive system in August of 2006 and looked up into her chest, it was too late. They found cancer in both of her lungs, but she was too thin and fragile to undergo chemo or radiation. They said she had three months to live, and all they could do was keep her comfortable during that time.
She didn’t live three more months. She died days later on September 18 – my parents’ wedding anniversary. She was the first close family member I ever lost. Hers was the first funeral I ever attended in my life. I was 30-years-old.
My grandmother had been my harshest critic at times, but also my most enthusiastic and steadfast cheerleader. She loved me out loud with her own special sort of grandma gusto, and her loss was devastating to me. And everyone else in the family.
We are small on my mother’s side: my great-grandmother only had my grandmother; my grandmother had three girls, but only my mother had children; my sister and I are those kids, and at the time, I didn’t have my daughter. My dad was the only husband – the only man. I wasn’t married then, and neither were my great-grandmother, aunts, or sister. We went from nine to eight, which sounds bearable, but we lost our leader, so it was a shattering loss.
I wasn’t equipped to handle the grief of losing my grandmother because I hadn’t practiced feeling pain or processing it. I ate it away. So that’s what I began doing. All my dieting went out of the window. I was hurting, and I needed medicine. Food became that for me.
Then, in December of that year, I found out I was pregnant. My husband and I (he was my boyfriend then) hadn’t planned for a baby, and we weren’t ready for one.
But like so many women before me – yes, likely because I was carrying the baby – I became a lot more prepared a lot more quickly than he did for our daughter’s arrival. And I got monumentally pissed when he didn’t help me to fashion a fairy tale (“and they all lived happily ever after”) into which she could be born. I broke up with him the day after I delivered because I deemed that he wasn’t taking the baby’s birth seriously enough, and I moved home to my mother’s because I had lost my teaching job at a Jewish day school – I suspect because I was unmarried and having a baby – and couldn’t keep my apartment.
Six weeks after having my daughter, I was up and out in the world again – adjunct teaching and trying my hardest to find full-time work. So when the postpartum depression came down on me, I was too busy to notice it. It took years before I realized how deeply unhappy I was and how drastically I had changed from the person I was before I had my daughter. Two, to be exact.
Thanks in part to my old school male doctor that just kept insisting I get back with my boyfriend – that that was the reason I was “sad” – I was clinically depressed for 22 months before my PPD was diagnosed (by a new woman doctor). I had gained about 80-90 lbs. by that point, and my own clever way of binging. I ate regular sized portions; I just ate 3-4 of them in the two-hour window.
So, for example, I would buy cookie dough. I would be sitting at home, get triggered, and start feeling like shit. I would go back and forth in my head about baking the cookies. No, yes, no, yes, no, yes, no, yes, fuck it! Bake four then eat them. Tell myself that’s it. I’m good. Then bake four more. Eat those. Bake four more. Eat those. Bake four more. Eat those. Yes, that’s sixteen cookies. On top of the Pepsi and chips and fast food meals. Yes, that happened on a regular basis. Yes, my loved ones noticed and tried to talk to me about it. Yes, I resolved a million times to stop. But I couldn’t stop. My brain had been successfully rigged.
As my thoughts got darker, the numbers racked up. As the shame over the eating got thicker, the thoughts got darker. One thing kept feeding into the other.
This is the cycle of ED. You are mired in your own shit, and you can’t get out of it. It hurts, so you eat. You eat, then you hate yourself. And hating yourself hurts, so . . . unfortunately . . . onward you go.
On good days, you see if happening. Sometimes, you can even stop it. On bad days, though, all you do is feel. You hurt, you eat, take that breather, try to stretch it out, the shit snaps, you’re hurting again, so you eat again. And then again. And then again.
It can take hours for you to sputter out or something really jarring can sometimes snap you out of your loop. This is usually someone pointing out to you how much you’ve eaten or making a comment about your weight or something like that. Sometimes you make yourself sick, and that stops you. Sometimes you run out of food or money, and you’re not in a position to do anything about it. It’s the middle of the night. So you go to sleep. But you wake up scheming. Trying to get more food or more money.
However it looks on the outside, though, you are never not eating. If you aren’t actually stuffing your face, you are daydreaming about it. You are planning the next time you can eat. You are regretting the last time you did eat. You are obsessed. Eating is always on your mind. It is your version of a gravitational force.
I have never been addicted to drugs (this includes alcohol). But I have read a lot of literature on addiction because I thought at one time I was addicted to food. This was before I had heard of BED. I knew something was very wrong with my relationship to food, so I went looking for answers. I wanted to understand what was happening to me and what I could do to fix myself.
After I was diagnosed I found that technically BED is not an addiction. However, a lot of the same emotional and neurological mechanisms are at play in both illnesses. And one of the most debilitating aspects of one is a major part of the other as well, and that is shame.
I have enough shame about having BED – not being able to control my relationship with food without drugs and therapy and brain-bending work – to fill every food container I have ever emptied in my whole 42 years of life.
So, when I found this article in the New York Times, about this new trend – police departments making videos of addicts overdosing on opioids and posting them on YouTube – I felt a giant swell of outrage and empathy. All I could think was how horribly these poor people must feel when they realize their suffering at the hands of their addiction has been made into a public spectacle.
All I could imagine was someone taping me without my consent or even my knowledge while I am binging, trying to deal with my private pain in my private way, however wrongheaded that is, and then posting that, also without my consent – putting me “out there” on the internet so strangers can know something insanely personal and possibly damning about me without any context.
All I could imagine was how I would be savaged because the only thing America hates more than a drug addict is a fat person – or any body that reflects imperfection or frailty or suffering or vulnerability – any unvarnished humanity.
I wrote this before in a post about Tess Holliday, but I will say it again for the latecomers: Humiliation can never serve as a form of compassion, and all people – particularly those in crisis – deserve compassion.
No one deserves to be treated like shit because they have made mistakes or they are wired differently than others, and it makes even less sense if the mistake they are making is abusing themselves or their own wiring is causing them to self-destruct.
I know that the opioid crisis is terrifying. I know that innocents are suffering because of it. And I do feel that they need our help. But I say so do the addicts.
Addiction is a chronic disease, not a moral failing, so treating addicts like assholes that are making fucked-up choices and deserve to be punished for those choices is not only off-base, it’s ignorant, and it will not help to abate the effects of their addiction.
According to the article in The New York Times about this overdose video trend, “Addiction experts say the videos are doing little else than publicly shaming drug users, and the blunt horror of the images may actually increase the stigma against them.”
“We’re showing you this video of them at the worst, most humiliating moment of their life,” said Daniel Raymond, deputy director of policy and planning at the Harm Reduction Coalition, an advocacy group. “The intent is not to help these people. The intent is to use them as an object lesson by scapegoating them.”
Police departments say they just want to reveal the “brutal reality” of what they see in the streets as they are forced to deal with opioid crisis, but making and posting these videos smacks of resentment to me, not concern or compassion and certainly not logic or sensibleness.
It just seems to me that officers and drug enforcement agents are tired of being charged with managing a problem that they are not equipped to manage because just like humiliating addicts on YouTube won’t stop them from using and dying, neither does arresting and jailing them.
They want the public to know what they are up against, and I get that, but I also question whether there is anyone out there in America at this point that doesn’t know what they are up against.
I posit that they are directing their frustration at failing to manage this crisis at the wrong segment of the population. That they need to target the government and not the people when trying to engender an understanding of what it will take to put a halt to the opioid crisis.
People know that opioid addiction is killing an increasing number of Americans every year. People know that opioids are highly addictive and ruinous to users’ health and well-being. The crux of the issue at the heart of the crisis is not obliviousness; it’s desperation.
What people apparently don’t know is what to do with their pain – how to manage it without the use of substances – how to face it – how to end it – how to put it behind them for good.
And if they aren’t lacking in knowledge, then they are lacking in resources and access. They are lacking in assistance and solutions.
But posting these videos won’t provide them with any of that.
So people – and especially law enforcement and public officials – need to stop posting them. They need to stop exploiting these addicts in an attempt to illustrate for the public how impossible it is for them alone to end the opioid crisis in America.
Because those of us that care about it already know how thorny an issue it is, and the people that don’t care are too hardened to the issue to be moved even by this rather awful form of pain porn.
Increasing the stigma around opioid addicts isn’t going to help them. Just as it didn’t help blacks during the crack epidemic. Just as it hasn’t helped stem the spread of AIDS or lessened the number of abortions sought by American women, if we really want to talk about the inefficacy of public shaming.
Demonization is a horrible “rehabilitation” tactic, and it doesn’t work as a deterrent, either, so we Americans – pathetic little leftover Puritans that we are – need to knock it the-fuck off. We need to find a better way to approach the problem.
Hitting bottom may be necessary for some addicts to realize the seriousness of their disease and seek help, but being forced to the bottom of the social ladder doesn’t do anything except deepen their pain, exacerbate their alienation, and make it that much harder for them to find help or take help whenever they are truly ready for it.
In “How Do You Recover After Millions Have Watched You Overdose?” authors Katharine Seelye, Julie Turkewitz, Jack Healy, and Alan Blinder write, “In Lawrence, Mass., a former mill town at the heart of New England’s opioid crisis, the police chief released a particularly gut-wrenching video [that] showed a mother who had collapsed from a fentanyl overdose sprawled out in the toy aisle of a Family Dollar while her sobbing 2-year-old daughter tugged at her arm.”
The mother in the Family Dollar video, according to Seelye et al. was Mandy McGowan, 38.
McGowan says she was sexually molested when she was young and experienced a chain of abusive relationships. She got addicted to opioids when she had neck surgery in 2006, and her doctor prescribed her a “menu” of painkillers including OxyContin, Percocet, and fentanyl in patch form.
She tried to end her addiction using Suboxone, but, when her supply ran out, she turned to heroin. The day she overdosed, a friend came over with powder fentanyl, and she sniffed a line. She collapsed in the Family Dollar and woke up in the hospital with custody of her daughter stripped from her, facing charges of child neglect and endangerment. She pleaded guilty to both and got probation.
Now, you could say that she deserved a stricter punishment than probation for endangering her daughter as she did. You could say she should’ve tried harder to get off the drugs – that one attempt isn’t enough. You could say she should’ve been smarter about going ahead with the doctor’s advice and taking all those painkillers and getting hooked on them in the first place since they had a reputation even back in the early 2000s for being highly addictive.
And I would argue that all of this is valid. But I would also argue that having her overdose recorded by strangers and posted to the web site for her local paper and police station, played on the local news, and broadcast on CNN and Fox News – having it go viral – doesn’t mitigate or make up for any of this.
McGowan says, “I know what I did, and I can’t change it. I live with that guilt every single day. But it’s also wrong to take video and not help.”
She also has proof in her own life that videos like this or the possibility of being a “star” in such a video doesn’t dissuade anyone that is an addict from using.
After her video went viral, her daughter’s father still died of an overdose. Two months after that, his 19-year-old son died of an overdose. A little bit after that, McGowan herself went back to using and violated her probation.
She did 64 days in jail, got kicked out of a halfway house, and ended up in a shelter. She was raped in that shelter. She was so traumatized after the rape that she checked herself into a psychiatric ward for five weeks. It was only then that she began to seriously seek help for her addiction.
And so I say again – if these so-called overdose videos are not going to be successful deterrents for drug users and abusers – if they’re not going to ease addicts onto a shorter or smoother path to recovery – then there is really no justification for them.
They are just another sick form of reality entertainment feeding our increasingly perverse appetites for suffering or in other words something that we really don’t need and shouldn’t even want if we truly are the “decent” people that we claim to be.
I know for me, being held up to certain forms of scrutiny for my ED and/or the resultant obesity has not motivated me to “do better” as people like to put it.
It has only made me feel worse about myself and sent me reeling in another round of my disordered cycle.
And I believe that pain is the root of addiction, and addiction is a disease. Ignoring the fact that addiction is a disease doesn’t help to address it, and shaming people that have the disease doesn’t help them get better.
I believe that addiction can only be treated with science served up with some love, as corny as that sounds.
I think there may be procedural solutions to this opioid crisis – and human solutions to this opioid crisis – but there are probably no insta- or easily uploadable ones.
In sum, the internet is not the fucking answer to everything, and it absolutely isn’t the answer to the opioid epidemic.