Here is an excerpt from one of the comments:

“Why is it a crime to suggest (through images, words, whatever) that only a few people are ever going to represent the ideal? That’s not demeaning, it’s truth. If it hurts your little feelings, use that to motivate you to go after your personal best, not cry over cultural obsession or objectification and use that as an excuse to say how it makes you feel so demeaned. If you want something, you have to give up the excuses and blaming anyone other than yourself, and go for it. Effort = results. Actions = priorities. So showing a tight body with the message “get off your lazy ass if you want to look like this” is entirely appropriate to me.”

I think good physical health is an important part of good emotional health. I believe in taking care of and respecting our bodies, and I think there are a variety of ways to do that. But when the motivation to do so is extrinsic, as in when were are doing it to live up to some ideal determined by someone else — and promoted in many “fitspiration” or “thinspiration” pictures and quotes, it can lead to unhealthy consequences that at best bring an end to the commitment to achieve said ideals, and at worst can lead to unhealthy body and food obsessions, and deadly eating disorders, which are on the rise across genders, ethnic, and age groups.

The waistlines in our country have been growing for several decades. We’ve all heard the statistics — two thirds of Americans are overweight or obese. During the same time period, the diet and fitness industries have grown into multi-billion dollar money making factories. They provide plenty — let me repeat — plenty of thinspiration, fitspiration, and any other kind of inspiration that will make you want to spend money on their products and services because they know we all will ignore their dirty little secret: DIETS DON’T WORK. No matter how many posters and quotes and fitness magazines we look at, the reality is, 95 percent of us won’t be successful at losing weight for an extended period of time. If thinspiration and fitspiration really worked, surely there would be more than a 5 percent success rate among those who claim to be motivated by it.

It’s easy to call it a cop out to blame our culture for feeling demeaned, but the reality is, Madison Avenue has every intention of making you feel that way. After all, if you were happy with the way you were, what motivation would you have to buy the products that are supposed to make you better? Trust me, they wouldn’t spend the kazillions of dollars that they do if they weren’t absolutely sure that you would fall for their slight of hand tricks. They sell us a bill of goods, that if we look the way they tell us to look, we’ll be happy. Be thin and you’ll get the gorgeous guy, the big bank account, the McMansion, the convertible. Have six pack abs and your doctor will say hooray, forgetting to ask how many cigarettes you smoke each day and how much wine you drink at night to numb the self hate that comes from a life of always trying to please other people and live up to their standards, rather than exploring your genuine self. That’s not to say that everyone with six-pack abs or “tank-top ready” triceps is unhappy with who they are. My point is that if the reason for challenging and strengthening their body comes from external sources of motivation, ultimately the euphoria achieved from reaching goals (if that euphoria is actually ever achieved) will most likely be fleeting as soon as another standard arises for them to meet, compelling them back into a cycle of body dissatisfaction.

Again, I want to point out that I think good physical health is an important goal for anyone. I think most people could benefit from turning off their computers and/or TVs and moving for 30-60 minutes a day, and not just because the latest health reports say it’s good for our hearts, but because like rats in a cage, we go a little crazy if we don’t get to move our bodies, even if it’s in a “hamster wheel”. But I firmly believe that shaming people by convincing them that there is one ideal of health and beauty, as fitspiration/inspiration so often does not only is ineffective in providing long term motivation, but it also to perpetuates the idea that we are only as good as our bodies look. Someone may look at a picture of a beautiful body and suddenly feel compelled to go spend an hour on the eliptical, but the motivation has nothing to do with achieving a higher level of cardiovascular health and everything to do with molding their shameful body into something worth looking at. Some may argue that if the end result is the same — a healthier body — than what difference does it make? Well, if you are happy to achieve the short term “success” of a fit body while sacrificing the longer benefits that come from an intrinsically motivated health and fitness routine, I guess it’s not really a problem. But if you hope to achieve a balance in emotional and physical health, it might be useful to begin by ending the body shaming that comes from the media and so called “fitspiration.”

I LOVE my body. I am proud of my body. I don’t let my weight determine my value or my assessment of my health — all in spite of the fact that it is in no way shape or form any sort of ideal, at least by outward appearances. When I go to my doctors now, I don’t even let them weigh me anymore because I don’t want a number on the scale to be how my health is judged by them or by me. I have told them they can talk to me all they want about my blood pressure, cholesterol, blood sugar levels, and cardiovascular health, but so far, every year at my physical, all of those numbers indicate I’m in excellent health which is contrary to what they would think if they simply looked at my weight. Despite all of this, I still have to actively reject the constant messages that tell me I should be thinner if I am to be seen by our world as beautiful and/or healthy. And the key word there is ‘active’.

We live in a culture where we are constantly told that our body parts represent our value and place in our society, and some people don’t have a problem with that fact. I certainly can’t tell someone else what they should or shouldn’t be motivated by. I can simply state the facts and make choices for myself, and hopefully inspire people who wish to to achieve a healthy balance between mind and body. I will also continue to encourage people to think critically about the media they consume as well as continue to voice my opinions about the messages I see as damaging to the mind, body, and spirit.

As Jenni Schaefer said in her recent post Body Image: I Love How I Look in a World That Doesn’t, “Make a choice today to love your body. It will love you back.”

Amanda Doyle (aka 'Sister'), Glennon Doyle Melton of Momastery, and Michelle Cantrell of VenusVision

This morning I sat in a room full of women, most of whom had come for the opportunity to see Glennon Doyle Melton, the blogger behind Momastery who recently skyrocketed into the blogging stratosphere when The Huffington Post picked up and ran her blog post Don’t Carpe Diem on January 14, 2012. Between that noteworthy day and now, she has gained tens of thousands of fans on Facebook and countless more have been reading her blog, devouring and sharing each new post with the zeal of a fanatic. She had publishing companies battling for the rights to publish a book of her work and life story — which is due out next April, and is even in talks about turning her blog into a TV show. I think most of us in the room felt pretty lucky for having the opportunity to share a space with Glennon knowing full well that a year from now she’ll be able to fill a colloseum with thousands of women looking to connect with someone who deals in such raw honesty, revealing all sides of her authentic self and making us feel one step to being more comfortable doing the same.

After being introduced, along with her sister Amanda who can easily be called her life-line, Glennon, by virtue of being Glennon, began by confessing her nervousness about her new role as “public speaker” which was being put to the test for the first time on this occasion. But even when admitting her nervousness, and professing her preference for one-on-one chats over coffee (though she only drinks tea), her presence was very natural and relaxed as she sat, dressed in a cute top and jeans, cross-legged in her chair at the front of the room, holding a microphone and speaking casually about her outer self, her Facebook self, the self everyone sees on the outside, and her inner self — the side that makes her who she is and the person we read about and love precisely because it is so incredibly flawed.

Glennon talked about the outer self that some people know and choose to only see — the outer self that is a cute petite brunette who appears to have it all: a gorgeous husband (and if you don’t believe me, check out Momastery and see for yourself!), a beautiful family, a loving sister and parents, and the quintessential suburban life. I met one woman who is good friends with Glennon and admitted that when she first met her, she instantly hated her precisely because of what I just described. After all, how could someone who has it all (and was so thin!) possibly be nice? Well, there are two myths embedded in that belief, and yet so many of us would have jumped to the same conclusion. The first myth, of course, is that someone who has it all — ok, let’s be more specific, a woman who has it all, especially the looks, must be a bitch. Perhaps we like to think that because it makes us feel better about not being them. But of course, the second myth is that she didn’t — doesn’t have it all, and in fact, nobody does.

And then Glennon went on to break down that myth at least as it relates to herself by talking about her inner self. This included details about developing an eating disorder at the age of eight and spending the next couple of decades throwing up ten or more times daily. It included her foray into substance abuse which walked hand in hand with her eating disorder. She talked about blacking out through much of her college experience, and spoke with almost disbelief that she was actually able to graduate. She described her marriage to her husband and how they barely knew each other before she accidentally got pregnant, and walked down the aisle crossing their fingers, hoping for the best. She admitted honestly that while there are many good times, the bad times are there too and was not afraid to talk about being in counseling with her husband to get through the turbulent (though wonderful) events that have recently been thrust upon their entire family. She talked about her wonderful children and how she didn’t always love being around her wonderful children. She talked about her Lyme disease and the toll that takes, not just on her body but on her family and how they function as a result of her decreased energy levels.

And when she was done revealing her inner self, she opened up that inner self for questioning and with each answer she provided, the honesty and courage to say what she knows and, more importantly, what she doesn’t know came through over and over again. Being in the room and seeing how she interacted so lovingly (Love Always Wins!) to each person, taking the time to respond thoughtfully to each question and afterwards take pictures and hug everyone who wanted a little piece of Glennon to take with them, was a little like watching Momastery come to life.

What struck me as much as the power of Glennon to connect with the women in the room was the need of each of those women to find that connection, and I started contemplating what it was that made Glennon’s writings resonate with so many women. Of course, she’s a talented writer, able to combine the reality of the world, all that is brutifal as she likes to say, with a dose of humor that makes it easier to swallow.

But it goes much deeper than that, deeper than just connecting and relating to the things Glennon writes about — things people don’t often talk about but want to. And as I looked around this room, hearing one woman openly talk about her own ongoing struggle with sobriety and looking to Glennon for the answers, another woman worrying that as a middle aged 35-year-old woman (her summation, not mine!), she hadn’t found her “thing” as Glennon calls it, and what could she do to find her thing, I sensed this emptiness around me. An emptiness that’s calling for something to fill it and hoping that Glennon would be that something, or at least guide them to it. Of course, to a certain extent, Glennon does fill a void — a void that comes from the silence we live in when a person asks us “How are you doing?” and we respond “fine” when what we really want to do is scream at the top of our lungs about how frickin’ hard life is. But that “thing” Glennon referred to so frequently today is about that something that gets you out of bed each day, the something that keeps us excited about life, the something that we feel good about at the end of each day. And that “thing” is not to be filled by another person but by something from within. For Glennon, of course, that something is writing, and Momastery and all that it has become. Judging by the whispers around the room as Glennon talked about each person finding her thing, it seemed that perhaps Glennon is in the minority in having found hers.

So where does this emptiness come from? Well, that’s a big question and if one asked Glennon, I’m sure she would quickly admit to not having an answer. But if we are going to fill it, we need to understand it. My husband and I frequently talk about happiness and contentment and how it seems to be so far beyond the reach of most despite every attempt at achieving it by buying the next car or the next house, redoing the kitchen, getting the next promotion, losing those last 10 pounds, or twenty or fifty or one hundred, because, as Glennon pointed out today, we are always looking to the next thing to make us happy, sure that what we already have isn’t enough. She described a school assignment her 8 year old son had brought home in which he had to describe the moral of the story he had read in school. It was something along the lines of “life isn’t going to get any better so you might as well be happy with the way it is now.” Ah, from the mouths of babes. While one perspective on that statement might be a pessimistic one, another way of looking at it is that happiness, or more importantly, contentment, is always there for the taking. Happiness is a feeling and we can choose how we feel about things. And if we feel that it is the next thing that will make us happy, we can be assured that the happiness will be fleeting until our sights are set on something else.

I don’t have the answers, any more than Glennon does, but I think her rise to notoriety indicates a willingness — no a longing — to start dismantling the myths about what makes us happy while figuring out what our “thing” is if all that we thought it was turned out to be a farce, and search for deeper meaning and connection in life. After all, as Glennon quoted from Mother Theresa, “If we have no peace it is because we have forgotten that we belong to each other.” So as you carry on in your day, remember that we are all connected and that life is brutiful.

You can use the principle of intention with respect to planning meals and snacks or even generally applied to your food relationship. Weekly intentions might take the form of incorporating healthy snacks, packing your lunch to work, and/or having meals planned throughout the week. The reality is that those who are most successful are the ones who realize they are worth taking those extra ten minutes per day to pack their lunch or plan their meals. I recently had a client measure the time it took to create a healthy salad to pack in her lunch bag. To her surprise, creating and packing this salad took only three minutes. So sometimes we perceive that it will take longer than it actually will. Why not give yourself the challenge? I am sure you can find three extra minutes to pack your lunch.

Reflection Questions

1) Identify the sabotaging thoughts that get in the way of having a healthy food relationship (i.e., “I don’t have the time”, “It is too expensive”, “I am too tired”, “I’ll start next week”, “Next month, next year”).

2) Identify the supportive statements that you tell yourself about cultivating a healthy food relationship (i.e., one meal at a time, I am worth the time and investment, progress not perfection). In what ways are you already incorporating mindfulness in your food relationship?

Action Steps

How might you incorporate the act of intention with your food relationship? What will you commit to do over the next month? Make your act of intention focus on only one thing. Some ideas may include: starting your day with a healthy breakfast; practicing mindful eating at a minimum of one meal or snack per day; committing to having a regular day to grocery shop and meal plan. Some find it helpful to break down shopping and meal planning into two planning sessions and two shopping sessions per week. For example, on Sunday plan meals and snacks through Wednesday, and then again on Wednesday plan for Thursday through Saturday. Recognize that you are worth the investment of time. When you are able to plan and have healthy food options readily available you set yourself up for success.

Michelle Market, LPC is a Licensed Professional Counselor and Wellness Coach with more than 10 years of experience in Wellness and Women’s issues. She is dedicated to helping females feel better physically and emotionally. She has a private practice in Herndon, Virginia and works with Adults. Michelle provides counseling, coaching and workshops. She specializes in self-esteem and healthy food relationships. Her mission is to create and maintain positive change in the lives of her clients. She believes that beauty comes from the inside out. For more information visit her website www.michellemarket.com.

Abstract

In 2010, Americans spent nearly $10.7 billion on 9.5 million cosmetic procedures (American Society for Aesthetic Plastic Surgery, 2011). Since 1997, the first year in which the American Society for Aesthetic Plastic Surgery (ASAPS) began collecting data, there has been a 155% increase in the total number of cosmetic procedures. According to a recent survey, more than half of Americans approve of cosmetic plastic surgery. As surgical and nonsurgical cosmetic procedures become normalized in our culture, changing expectations about age and beauty ideals may be altered in a way that can impact physical, cognitive, social, and emotional development throughout the life cycle. This paper explores the culture of cosmetic medicine, the social implications of its increasing popularity, and the resulting shift in ideologies that can contribute to increasing ageism and the unending quest for unachievable ideals, while also considering a cross cultural perspective and counseling implications.

Literature Review

There has been extensive research on the motivations that drive consumers of cosmetic procedures. While much of the literature focuses on college-age females, some studies have looked at the attitudes of older men and women. Regardless of age, many respondents who have either had one or more cosmetic procedures performed, or approve of cosmetic procedures, place less emphasis on the features for which they sought alterations, and more on the extraphysical benefits of doing so (Adams, 2010). In a study of motivational narratives, Adams found that the most prominent theme for the basis of opting for one or more procedures was “the notion that having surgery would have extraphysical effects, such as increased self-esteem or increased attractiveness to potential partners.” (p. 764). Adams went on to add “there was also an acute cognizance of the societal pressures to look young and attractive, and many respondents suggested that these messages, from media outlets and society in general, played a role in their decisions to have surgery.” (p. 764). The impact of media and the expectations of society are shown to have an impact in virtually every piece of literature reviewed for this paper.

In a study of the factors affecting the likelihood of having cosmetic surgery, Swami et al. found that there is a greater sociocultural pressure on women than men to attain and incorporate beauty ideals, and because these pressures are seen as normative for women, cosmetic surgery can appeal to those seeking a way to feel better about their bodies. (p. 217). Sarwer et al. had similar findings in their study of body image in its relation to the pursuit of cosmetic procedures. Their conclusion revealed that “for many individuals, cosmetic surgery appears to be an adaptive strategy to address body image dissatisfaction … thus, the pursuit of cosmetic surgery may be related to some form of psychopathology, which may be more appropriately treated by psychotherapy than cosmetic surgery.” (p. 107). Indeed, in the same study, breast augmentation patients reported more appearance related teasing, and more frequently used psychotherapy than the control group. (p. 106). In a case study by Lijtmaer (2010), a patient’s preoccupation with her outward appearance was a way to mask her intrapsychic feelings which were a result of unresolved conflicts with her mother.

It’s important to note that the pressures to move closer to an idealized image are not limited to women. Returning to the study by Adams, we see that men are opting for procedures that will make them more attractive to others in the “dating scene” (p. 759) and possibly give them more opportunities in a competitive job market where a younger generation is entering the workforce (p. 757).

Because some findings indicate the presence of a cohort effect from Baby Boomers who tend to feel that their physical age is incongruent with their mental age and are, therefore, more likely to resist aging naturally than pre-Boomers (Clarke, 2007), it is important to examine the motivations behind the largest age cohort in America. (Ferguson, 2010). In their examination of older women’s perceptions of natural and unnatural aging, Clarke and Griffin found that while women who had not had any surgical or non-surgical procedures viewed natural aging as the acceptance of the physical realities of growing older, another group who subscribed to the benefits of cosmetic procedures viewed natural aging as “unattractive, if not objectionable, as well as risky in light of the social and physical realties of growing older.” (p. 198). To this group, using medical technology to enhance or alter their appearance is a requirement of aging as later life becomes “further devalued and socially repugnant in a society underscored by ageist values and norms.” (p. 199). In a study by Slevec and Tiggemann (2010), they proposed and confirmed that aging anxiety defined as a “combined concern and anticipation of losses centered around the aging process” (Lasher, 1993), is a strong component in the decision to pursue cosmetic procedures. Aging anxiety and the pursuit of beauty are reinforced in the media and perpetrated by the cosmetic industry with books like The Wrinkle Cure (2000) by dermatologist Nicholas Perricone (as cited by Bayer, 2005) in which he refers to “wrinkled, sagging skin” as a “disease, and you can fight it”. Additionally, with the emergence of reality television programming touting the life-altering effects of cosmetic procedures while minimizing the risks involved, a normalization of participating in cosmetic enhancements has had a persuasive effect on potential patients. (Slevec, 2010).

While some people argue that age-defying and beauty-enhancing products and procedures can be liberating against the seemingly unstoppable effects of aging, Bayer proposes that such options “buttress the notion that looking old — and thus, being old — is socially, medically, and personally undesirable.” As cosmetic surgery and non-surgical procedures become more affordable in a competitive market, it is important to consider the psychological and social ramifications of body altering procedures. (Gilmartin, 2010). In her review of current literature, Gilmartin concludes that the medical system “bolsters and benefits from the larger consumer-orientated society by colluding with the beauty ideal and cultural mores.” (p. 1807). In a report on ethical challenges within the cosmetic surgery industry, Atiyeh et al. also concluded that physicians participating in the selling of cosmetic services and offering aesthetic services face inherent conflicts of interest, pointing out that it becomes “ethically suspect, breaching obligations of beneficence and honesty, when a physician trades on the status of doctor to sell a clinically unproven product (2008).” In so doing, not only is the culture at large exploited through their insecurities and poor body image, but those with psychopathologies such as eating disorders and body dysmorphic disorder are at greater risk of exacerbating their condition through procedures which by virtue of their disorder can not produce the results they seek. (p. 1804).

Discussion

The increasing popularity in cosmetic surgery and non-surgical procedures seems to take us down a slippery slope. Where does one draw the line between getting a pedicure, putting on lipstick, using Botox injections, or having abdominoplasty (tummy tuck)? By participating in a beauty culture, are we adding to our potential or entering into a vicious cycle of body dissatisfaction? According to Sarwer, some studies have revealed continued improvements in psychological functioning in the first year following cosmetic surgery. However, Sarwer also points out it is possible that “improvements may diminish, particularly if they are related to the frequency of positive feedback patients receive about their postoperative appearance.” (p. 109). More studies need to be done to research the long-term psychological impact of cosmetic surgery, particularly in a culture of medicine where many surgeons’ mantra is said to be ‘start early, do often’, (Gilmartin, 2010), a philosophy internalized by many pro-cosmetic procedure participants across numerous studies reviewed for this paper. Additionally, with 19% of cosmetic procedures performed on racial and ethnic minorities in 2010, more research needs to be done on the relationship between the work being done and its psychological impact on members of different cultures who have to mitigate the ideals from their own cultures with those of a new culture in which they desire to become a part of.

Though ideals of beauty change over time as a result of many influences, Western cultures, and in particular, white cultures seem to dominate the ethos of beauty. In Lijtmaer’s review of the literature, she found numerous studies that point to an increase in body dissatisfaction as non-white groups become acculturated into American culture. (pp. 205-207). With the current widening in socioeconomic gaps, access to cosmetic procedures could further reinforce the difference in status between the haves and have nots, which may be delineated across cultures with minority groups in lower income brackets and less access to expensive procedures.

Another concern I have is the possible pressure exerted on those who otherwise have a healthy body image and self perception. As cosmetic procedures become more accepted and affordable, we run the risk that it becomes a new standard and practice in which we are to participate if we wish to be deemed normal. Take for example the predominantly female practice of hair removal. Though women may not want to participate in the practice, in American culture, it is seen as socially unacceptable to have hair on the legs and underarms, and indeed, according to Toerien et al., “body hair is a flaw, unfit for public display”, (2005). Therefore, women practice hair removal as a necessary part of maintaining femininity, an act, which Toerien suggests serves to “reinforce the view that underpins all the body-changing procedures, from make-up application to cosmetic surgery: that a women’s body is unacceptable if left unaltered.” (p. 400). So, although at this time, I choose not to color my hair, accepting the gray as it comes with age, there may come a time when I am competing for a job, or perhaps even a mate, against peers who participate more extensively in the beauty culture and present a younger facade which in turn may give them an advantage — an advantage that I too could obtain by making similar choices. So one can be faced with giving in to a new norm or facing the consequences of trying to stay true to oneself.

There is no denying the inherent appeal of beauty throughout animal nature. Birds have their plumage to attract a mate, flowers have bright, bold colors to attract their pollinators, male lions have large manes to intimidate their opponents. All of these attributes signify their potential ability to be successful in their environment, surviving challenges and attracting a mate to produce offspring. It could be and has been argued that humans, in this regard, are no different, at the basic level, which provides a basis for our quest for youth and beauty. If, at our core, our purpose is to pro-create, then we are likely to seek out those who reflect the ability to successfully do so. However, as humans, we have the benefit of higher thinking to take in a bigger picture when assessing the desirability of others, whether we are seeking a mate, an employee, a friend, or a nanny. What alarms me about the rising numbers of people seeking cosmetic procedures is that it places an increasing importance on outward appearance while potentially diminishing the value of what is inside. As discussed in depth by Namir (2006), when the outward body becomes the ultimate means for expression through transformation, a person risks abandoning the inside for the outside. In Namir’s interpretation of one patient’s decision to have procedures done, she chose to hide “in homogenization, looking as the world deemed attractive rather than emerging from her own aliveness, radiance, sensuality and self-expression.” (p. 218).

Counseling Considerations

The counseling considerations in relation to the booming cosmetic surgery industry are wide reaching since its impact spans all four domains of development across the stages. As children enter into adolescence and face changes in their bodies, pressure to make their bodies conform to physical ideals that may only be met through unnatural means could lead to risky behaviors such as disordered eating. At a time when identity formation is at its peak, increasing emphasis on physical appearance can lead to a devaluation on internal qualities that make up the identity. As a person continues throughout the life cycle, the pursuit of physical ideals might lead to continued disappointments as an individual tries in vain to live up to fabricated ideals that hold no basis in reality. Maintaining a focus on superficial traits can influence social relationships as a person forms personal connections with others based on externally formed values. And while the long term physical affects of plastic surgery and more recent cosmetic procedures have yet to be extensively measured, it seems impossible to escape at least some negative physical ramifications of these procedures.

Interventions

As clients evaluate their own self worth in the therapeutic setting, it is important to consider the impact of the beauty culture within which we live and work with clients to set standards for self evaluation that are less dependent on external measures while also allowing for the inevitable pressures placed on us by society to look our best on the outside regardless of how we feel on the inside. With patients who are considering or have already used cosmetic procedures to enhance their self perception, counselors should evaluate the goals the patient ultimately believes they will attain by having procedures done and work to understand the underlying psychopathologies that may be contributing to a diminished self image. Interventions could include working with a client to discover internal measures of value, focusing on past accomplishments that occurred irrespective of the client’s physical appearance, and working on goals that can continue to build on a person’s inner qualities. Also, since a focus on external appearance may be a coping mechanism for masking interpsychic conflicts (Lijtmaer, 2010), a greater understanding of unresolved issues that may have arisen even far in the past may present a relevant context for their attitudes and allow for an opportunity of resolution.

As a counselor, I would have to be cognizant of my own body image and views on cosmetic surgery. Past struggles with an eating disorder and defining my value based on physical appearance predisposes me to judgements about others in decisions they make based on their own physical appearances, particularly when they engage in surgical and non-surgical cosmetic procedures. Prior to researching this topic, I felt certain that in most cases, a patient’s body image and overall psychic well being would not benefit long term from cosmetic procedures because my assumption was they were focusing on external, easily manipulated “problems” rather than focusing on deeper issues that may present bigger challenges a patient is not ready to face. While that may be the case for some, I would need to remind myself that each person presents different experiences and therefore different responses to those experiences and some may in fact benefit from the very procedures I naturally find myself opposed to.

References

Adams, J. (2010). Motivational narratives and assessments of the body after cosmetic surgery. Qualitative Health Research 20(6), 755-767.
American Society of Aesthetic Plastic Surgery, Cosmetic Surgery National Data Bank Statistics, 2010.
Atiyeh, B., Rubeiz, M., & Hayek, S. (2008). Aesthetic/cosmetic surgery and ethical challenges. Aesthetic Plastic Surgery, 32, 829-839.
Bayer, K. (2005). Cosmetic surgery and cosmetics: redefining the appearance of age. Generations, Fall 2005, 13-18.
Clarke, L.H., & Griffin, M. (2006). The body natural and the body unnatural: beauty work and aging. Journal of Aging Studies, 21, 187-201.
Ferguson, R. & Brohaugh, B. (2010). The aging of Aquarius. Journal of Consumer Marketing, 27/1, 76-81.
Gilmartin, J. (2010). Contemporary cosmetic surgery: the potential risks and relevance for practice. Journal of Clinical Nursing, 20, 1801-1809.
Lasher, K.P., & Faulkender, P.J. (1993). Measurement of aging anxiety: development of the anxiety about aging scale. International Journal of Aging & Human Development, 37, 247-259.
Lijtmaer, R. (2010). The beauty and the beast inside: the American beauty — does cosmetic surgery help? Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 38 (2), 203-218.
Namir, S. (2006). Embodiments and disembodiments: the relation of body modifications to two psychoanalytic treatments. Psychoanalysis, Culture & Society, 11, 217-223.
Sarwer, D.B., & Crerand, C.E. (2004). Body image and cosmetic medical treatments. Body Image 1, 99-111.
Slevec, J., & Tiggemann, M. (2010). Attitudes toward cosmetic surgery in middle-aged women: body image, aging anxiety, and the media. Psychology of Women Quarterly, 34, 65-74.
Swami, V., Arteche, A., Chamorro-Premuzic, T., Furnham, A., Stieger, S., Haubner, T., & Voracek, M. (2008). Looking good: factors affecting the likelihood of having cosmetic surgery. European Journal of Plastic Surgery, 30, 211-218. DOI: 10.1007/ s00238-007-0185-z
Torien, M., Wilkonson, S., & Choi, P.Y.L. (2005). Body hair removal: the ‘mundane’ production of normative femininity. Sex Roles, 52, Nos. 5/6, 399-406. DOI: 10.1007/ s11199-005-2682-5.

After nearly three years of work, my novel, Confessions of a Failed Anorexic is finally available! Here is the description as it reads on Amazon:

Sarah Thompson went on her first diet when she was seven years old, and has been on a dieting roller coaster ever since. Longing for what she doesn’t have, the unfulfilled stay-at-home mom goes on a journey of self discovery tainted by the pursuit of a perfect body. An unlikely friendship with fun-loving and thin-obsessed Stacy Vargus leads Sarah down a path she believes will bring her closer to a world she has spent a lifetime chasing, only to realize it doesn’t exist. An unexpected reunion with an old friend unleashes a passion for life Sarah had long forgotten, giving her a new lens through which to view her world.

This debut novel by Michelle Cantrell offers an entertaining twist on keeping up with the Joneses while revealing the dangers of losing oneself to the superficial status symbols of suburban life.

Sharing this with the VenusVision community, I am aware that some readers may be fighting an eating disorder. For that reason, I would like to share what I wrote about the title in my novel.

Being involved in the Eating Disorder Community, I’m sensitive to the emotions Confessions of a Failed Anorexic might elicit in some. The reason I chose the title is that for much of my life, that’s how I felt. Years of disordered eating skewed my thinking to the point that I believed an eating disorder would bring me happiness in the form of a thin body. I was naive in thinking that if I could somehow become anorexic, I could control the eating disorder. Though I never did become anorexic, I periodically practiced starvation and purging, and was eventually diagnosed with an Eating Disorder Not Otherwise Specified (EDNOS). I finally sought help when thoughts of food and hatred towards my body, combined with destructive behaviors dominated every moment of my life.

Eating disorders come in all shapes and sizes and as many as 10 million females in the United States suffer from an eating disorder. Despite the fact that eating disorders have the highest mortality of any mental disorder, the majority of people with severe eating disorders do not receive adequate care. (National Eating Disorders Association, 2008)

It is my hope that this novel will demonstrate how the destructive nature of disordered eating can easily cross over into an eating disorder, and bring life and death complications with it. After recovering from my own eating disorder, I began discovering all life has to offer when one isn’t entirely devoted to achieving an arbitrary ideal of beauty and thinness. I hope that others can find the same hope and begin to aim for more in life than a number on the scale.

At this time, the novel is only available on the Kindle. If you don’t have a Kindle, there are still many devices for which a free Kindle reader application is available, such as PCs, Macs, iPads, iPhones, Droids and Blackberrys. To download a free app, go to Amazon.

I am hoping in the future there will be a print edition. Until then, I hope you will share my novel with anyone who has ever struggled with body image and their relationship with food.

Note: This book contains content that may be triggering for some who are suffering from or in recovery from an eating disorder.

Confessions of a Failed Anorexic

New Media Analysis Shows Room to Improve When Communicating About Weight and Health

WASHINGTON, D.C., May 9, 2011 – Unrealistic and uninformed media portrayals of weight not only can negatively influence individual behavior, but can impact how policymakers approach issues of weight and health. The result, according to experts from the Strategies to Overcome and Prevent (STOP) Obesity Alliance and the National Eating Disorders Association (NEDA), is a continued belief that these issues are largely a matter of personal responsibility and that little can or should be done in policy to address them.

Susan Dentzer, editor of Health Affairs, moderated a panel convened today on Capitol Hill to discuss the media’s role in shaping the policy environment surrounding weight and health. Panelists discussed whether policymakers believe that weight is an individual issue or a public health problem and whether media plays a role in driving who is responsible and who should take action.

“In a time of ongoing budget tightening and confusion regarding health care coverage, we must find a way to create policies that address obesity and eating disorders, without letting our own biases get in the way,” said Christine Ferguson, J.D., Director of the STOP Obesity Alliance. “There is no evidence that stigmatizing weight-related health issues prevents or treats these problems — in fact, the opposite appears to be true. It is an important opportunity for members of both the obesity and eating disorders communities to advocate for a focus on health rather than weight as a measure of well-being.”

The groups released a new analysis of media coverage that showed room to improve the reporting on weight and health, based on a series of media guidelines released by the STOP Obesity Alliance and NEDA last year.

The guidelines offer simple message themes to include when addressing weight and focus on the concept that weight status and the importance of maintaining a healthy weight is not about appearance, but about health. A comparison of coverage from sample outlets over the last year however — looking at media that target a “Beltway” audience and those that are more consumer oriented — found that 75 percent of articles initially reviewed were dismissed from the analysis because they lacked substantive content. While many consumer articles focused on weight-loss tips, characterized as “fighting flab”, “shrinking your middle” or “looking leaner naked”, most failed to mention the health implications.

“Our conversation today and the new media analysis echo the ongoing need for us to address the societal pressures and the unrealistic images that we know can be contributing factors among people who develop eating disorders, depression and other esteem issues,” said Lynn Grefe, President and CEO of NEDA. “It is why we have come together to address these issues. These pressures affect all of us.”

The media analysis also found that Beltway media publications were three times as likely to consider external factors beyond will power as playing a role in, and being affected by, weight issues. Examples of this were a higher rate of coverage in Beltway outlets that reported on how weight issues can impact the economy and the workplace.

The roundtable discussion, “Pounds and Policy: Effectively Communicating About Weight and Health” also included experts from a cross-section of fields including media, communications, eating disorders and obesity:

• Jean Kilbourne, EdD, media critic, author and expert on advertising and women
• Sarah Kliff, health reporter POLITICO
• Dianne Neumark-Sztainer, PhD, MPH, RD, Professor, School of Public Health, University of Minnesota
• Rebecca Puhl, PhD, Director of Research, Rudd Center for Food Policy & Obesity at Yale University
• Chevese Turner, Founder and Chief Executive Officer, Binge Eating Disorders Association

The STOP Obesity Alliance and NEDA will continue work and outreach to the media and policymakers regarding the joint guidelines.

The National Eating Disorders Association (NEDA), headquartered in Seattle, Wash., is the leading U.S. non-profit organization supporting individuals and families affected by eating disorders. NEDA serves as a catalyst for prevention, cures and access to quality care. Each year, NEDA helps millions of people across the country find information and appropriate treatment resources through its toll-free, live helpline, its many outreach programs and website. NEDA advocates for advancements in the field and envisions a world without eating disorders. For more information, visit www.NationalEatingDisorders.org.

The Strategies to Overcome and Prevent (STOP) Obesity Alliance is a collaboration of consumer, provider, government, labor, business, health insurers and quality-of-care organizations united to drive innovative and practical strategies that combat obesity. The STOP Obesity Alliance receives funding from founding sponsor, sanofi-aventis U.S. LLC, and supporting sponsors, Allergan, Inc. and Amylin Pharmaceuticals, Inc. For more information, visit www.stopobesityalliance.org.

Contact:
Alice Sofield
202-609-6006
asofield@ccapr.com

On the other hand, after hearing my therapist tell me I had an eating disorder, I felt relief. After all, I was there to get help, and if I could label my problem, perhaps the solution would come more easily. I was ready to silence the voice in my head that made me obsess over my body and food 24 hours a day 7 days a week, and if giving that voice the name ED (for Eating Disorder) would help, I was willing to accept it.

National Eating Disorder Awareness Week is February 21-27 this year, which seems like a good opportunity to bring attention to this lesser known sibling of Anorexia and Bulimia. Everyone knows about Anorexia and Bulimia, but EDNOS, which has only recently begun to receive recognition in the mental health community can be as equally dangerous and life consuming as its better known counterparts.

So what does Eating Disorder Not Otherwise Specified mean? Well, the short answer is a “category [of] disorders of eating that do not meet the criteria of a specific eating disorder,” according to the most recently updated version of the Diagnostic and Statistical Manual. Ultimately, the definition is more anecdotal which explains why it is often harder to identify, though according to the publication Eating Disorders: The Journal of Treatment and Prevention, 50 percent of individuals who present for treatment of an eating disorder receive the diagnosis of EDNOS which effects 4 to 6 percent of the general population.*

While many of the criteria for EDNOS may closely mimic anorexia or bulimia, some behaviors are less obvious, and in fact, within our diet and body-obsessed culture, can appear perfectly normal. What may look to an outsider as just another diet involving close monitoring of caloric intake as well as exercise, may in fact become — if not already — an unhealthy and unnatural way to control weight based on an intense drive to be thin combined with an unrealistic body image. On the flip side, EDNOS also includes the sub-category of Binge Eating Disorder (BED) which is often overlooked as a simple lack of willpower and/or self control. Regardless of wherever a patient lies in the spectrum of EDNOS, it is important to realize that the emotional trauma suffered as a result of the disorder is equal to that of Anorexia and Bulimia, and should not be seen as anything less than a serious illness.

The introduction of EDNOS as an accepted diagnosis “gives a voice to sufferers who don’t fit into the narrow diagnostic categories of Anorexia, Bulimia, and Binge Eating Disorder” said Shannon Cutts, author of ANA: How to Outsmart Your Eating Disorder and Take Your Life Back, and founder of Mentor Connect, a community of people in recovery from eating and related disorders.

Cutts, who herself suffered from Anorexia, Bulimia and EDNOS feels grateful for the recognition of EDNOS, and encourages sufferers to seek help. “If you know that your symptoms, thoughts, and behaviors are affecting your quality of life, then you both need and deserve help. Use your voice and ask for help. Do not assume you are the only one who “doesn’t fit” into a category and therefore you don’t deserve help. There are many people who suffer from EDNOS and you help not just yourself but everyone who suffers from it when you demand the care you deserve. Search out a medical professional who is familiar with eating disorders rather than struggling to educate an unsympathetic doctor or therapist. Be your own health care advocate. You know better than anyone else when you are struggling and need help. Eating disorders kill, and just because your symptoms don’t fall into the three most commonly-recognized categories does not mean they are not equally deadly.”

The health complications that arise from eating disorders are extensive, and include low blood pressure, slower heart rate, a decrease in bone density, a disruption in hormones, sometimes leading to infertility, and more. Even more alarming is the fact that eating disorders have the highest rate of death among any mental disorder — just one episode of bingeing and purging can cause an electrolyte imbalance causing sudden death. That is why it is so important to recognize that eating disorders come in all shapes and sizes, and present themselves in a variety of ways.

Is there treatment for EDNOS? Though whole rehabilitation centers have risen to address the problems specific to Anorexia, Bulimia, and even Binge Eating Disorder, there is help for other non specified eating disorders. The effort to overcome any eating disorder is extensive and should not be downplayed. Most of the times, the help of a mental health professional is necessary, and the journey through recovery is never quick and painless. But when you consider the alternative of living a life plagued by self loathing, fear of food, and serious health risks, including a premature death, the effort is one that must be undertaken to break free and live a full and happy life.

As for my own journey, to be honest, it’s an ongoing process. Sometimes it’s two steps forward, one step back. But as Jenni Schaefer, author of Life Without Ed, and Goodbye Ed, Hello Me likes to say, fall down seven times, stand up eight.

Let me preface this review by saying I am not a religious person, and when the book was first brought to my attention, I initially dismissed it, turned off by the title. I didn’t feel that God has anything to do with my relationship with food, and, I was guilty of judging a book by its cover (or in this case, the title). So, if you are inclined to dismiss it for those reasons, don’t. The book is less about God, and more about finding a space within ourselves — a space we often fill with food, rather than exploring to its depths. Some people, when they open themselves up to that space have a name for it in God. Others might define it in broader terms like spirituality. And some might simply feel it as being one with themselves and all around them. The point of the book is to demonstrate how the relationship so many people (or more specifically in this book, women) have with food keeps us from any of those things, and more importantly how to change that relationship.

In part one, Roth addresses the “God” part of the book and how God related to dieting for her in the past. “Dieting was like praying. It was a plaintive cry to whoever was listening: I know I am fat. I know I am ugly. I know I am undisciplined, but see how hard I try. See how violently I restrict myself, deprive myself, punish myself. Sure there must be a reward for those who know how horrible they are.” She talks about how dieting gave her a purpose — perhaps much in the same way religion might for some people, and then she goes on to say “bingeing gave me relief from the relentless attempt to be someone else.”

Roth has written many books (which I am sad to say I have not yet read) on the subject of emotional eating, but a realization she says she has only recently come to is that “the radical part of the tale is not that I stopped dieting; it’s that I stopped trying to fix myself.” This reminded me of a similar realization I came to and wrote about in the article Self Acceptance vs Body Acceptance in which I proclaimed to end the urge to fix myself.

And yet, it is often hard to imagine a world in which we are not constantly trying to fix ourselves, especially our bodies. For one, it’s how women have learned to relate to each other. As Roth points out, “we fit in by hating ourselves.” I’m sure from time to time you come across that person who seems to hold that secret to happiness and balance the rest of us struggle daily to find, and isn’t there just a tad of resentment towards them? Maybe you’re just waiting to see them fall in order to prove they too  are actually imperfect humans like you, which probably explains our obsession with celebrities and the great joy many find in seeing photos of their cellulite and jelly rolls as we go through the check out line with smirks on our faces. It’s almost as if there is something wrong with someone if they don’t hate themselves — or at least some part of themselves. And yet, the ability to see their imperfections and embrace them as part of a greater whole is what makes them happy, and it’s the lack of that ability that keeps others from achieving true happiness.

It’s also hard to let go of the belief that achieving weight loss will be accompanied with the answers to all of our problems. Though on a rational level, we can understand that a number on the scale won’t change the world, “the promise of weight loss is that it will allow [us] to live on a magical piece of earth from which everything else will be manageable … If I fix myself so that I am no longer myself, then everything will be fine. My feelings will be manageable.”

In the chapter entitled “Never Underestimate the Inclination to Bolt” Roth addresses head on why we might avoid overcoming compulsive eating (or dieting). She bluntly states it when she says “compulsive eaters wouldn’t have an obsession with food if we believed that life was tolerable without it … There is madness in obsession, yes, but its value is that it drowns out the madness of life.” This sentiment is followed by the chapter that hooked me on the book: It’s Not About the Weight, but It’s Not Not About the Weight. And that’s when Roth goes on to explain the conundrum of addressing the very real problems that are created by excess weight: diabetes, joint pain, shortness of breath, and for many, a general decrease in the quality of life due to health complications, while all the while trying to unsurface the deeper issues which are being covered up by the weight problems. Here is a very poignant passage from the chapter:

“The bottom line, whether you weight 340 pounds or 150 pounds, is that when you eat when you are not hungry, you are using food as a drug, grappling with boredom, or illness or loss or grief or emptiness or loneliness or rejection. Food is only the middleman, the means to the end. Of altering your emotions. Of making yourself numb. Of creating a secondary problem when the original problem becomes too uncomfortable. Of dying slowly rather than coming to terms with your messy, magnificent and very, very short — even at a hundred years old — life. The means to these ends happens to be food, but it could be alcohol, it could be work, it could be sex, it could be cocaine. Surfing the Internet. Talking on the phone … Weight (too much or too little) is a by product. Weight is what happens when you use food to flatten your life.”

And, if you’re thinking your compulsive eating stems from a simple case of too much love for food, Roth has an answer for that too: “When you like something — love something, you take time with it you want to be present for every second of the rapture … Overeating does not lead to rapture. It leads to burping and farting and being so sick that you can’t think of anything but how full you are. That’s not love; that’s suffering.” How can you love something that makes you sick over and over again? It’s like returning to an abusive partner every time they say they are sorry, and really, they do love you, and really, it won’t happen again. But like so many women who are abused and feel that they somehow deserve the abuse — as if they brought it on themselves, compulsive eaters and dieters continue to punish themselves through their relationship with food because they don’t feel worthy of something better.

Like most other books that address emotional eating, Women Food and God is for those ready to do some serious work and reflection on their lives. Roth challenges the reader to face head on the pain and uncomfortable feelings that drive them to eat when they’re bodies are telling them not to. What she reminds the reader over and over throughout the book is that the very feelings they feel will destroy them are the same feelings that allow us — everyone of us to feel alive. If you are ready to top numbing yourself with food and dieting, start feeling alive, this beautiful written, incredibly powerful book is for you.

It seems like most of us are either on a diet, trying to create a body that we can feel happy with, or treating our body with complete disregard, filling it beyond capacity with foods that would make our body scream in pain if it could talk. And then, when we can’t stand to look in the mirror anymore, or feel totally out of control around food, we go on a diet. Again. But let’s face it — diets don’t work.

Ninety-five percent of people who go on a diet regain the weight lost, and often more, within five years. But how are we supposed to reconcile those statistics with things like “obesity epidemic” or “1 in 3 Americans are overweight” and “war on obesity”. If diets don’t work, how are we supposed to cure our country of unhealthy eating habits and an inactive lifestyle? Jamie Oliver thinks he has the answer with his Food Revolution. Michelle Obama hopes she has the answers in trying to eradicate childhood obesity by encouraging kids to get off the sofa and get outdoors. In both cases, the focus, ultimately, is about teaching people to live healthier lives — to choose apple slices instead of chips, grilled chicken instead of burgers, bike riding instead of Playstation. But together, both Obama and Oliver are only getting at half the problem — which is what people eat, and without addressing the other half — why people eat, they will never reach the long term success they both genuinely want and hope to achieve.

The concept of intuitive eating is gaining momentum and working towards that goal with the help of books like Intuitive Eating, and Eat What You Love, Love What You Eat will be far more effective than wagging the finger at people in an effort to get them to make better choices. The Body Love Manual takes intuitive eating one step further by guiding readers through a process of identifying what it is that keeps them so disconnected from the bodies, preventing them from listening to and properly nourishing their bodies. Though the subtitle of the book is How to Love the Body You Have as You Create the Body You Want, don’t be mistaken. This is not a diet book in disguise. The Body Love Manual is for anyone ready to put away dieting forever, deciding to become an intuitive eater, and challenging the thoughts and feelings that so far have preventing you from achieving that goal. Integral to this process is learning, as the title suggests, to love your body. As Hills points out, “The human body is tragically under-appreciated, neglected, and abused…The fact is that it is very hard to feel motivated to take care of something you don’t care about. Conversely, when you care deeply for and truly honor your body, you will be far more likely to make the healthier choices for it.”

The Body Love Manual should not be a quick read. It requires reflection and real emotional work. But ask yourself if you identify with this passage from the book:

“As the number I saw on my bathroom scale went up, my sense of self-worth plummeted. During this period of my life, it was rare for me to appreciate and value any of my other qualities … [which] became secondary in comparison to my weight.”

If you feel like you could have written those words yourself, then perhaps it is time to begin the work towards loving your body because “When your thoughts about yourself are respectful and appreciative, you will begin to attract more positive experiences of all kinds into your life.”

Though the Body Love Manual talks about achieving your ideal weight, you might begin to question what your “ideal weight” is and in fact you may find that you are already there, because your “ideal weight” should reflect a healthy lifestyle that is not measured by a number on the scale but by the feelings that come from your mind and body which will tell you when you’ve reached it.

*As required by FCC law, I am disclosing that The Body Love Manual was donated by the author for purposes of this review.

Other early memories include giving my pudding away because I knew it would make me fat, and later on in elementary school, being offered incentives to lose weight (though again, I wasn’t fat, but perhaps on the high end of “normal” and therefore bigger than most of my peers).

The diets increased, though the weight loss never came, and as for so many girls and women it became nothing short of a quest. I was searching for the Holy Grail of weight loss because surely with it would come the label of success which I otherwise felt unable to reach.

I graduated from high school as an honor roll student after pulling my grades out of the gutter. But it didn’t mean anything when I put on my graduation dress and it was tight, revealing my large tummy. (As soon as I took off my graduation gown, I immediately changed out of my dress as well before anyone could see me in it.)

I graduated from college, again with high marks, but still didn’t feel as though I had reached success because I had not lost weight.

I earned a black belt in Karate, but could never stop thinking about how my Ghi pants never got looser during my training.

I ran half marathons, but felt defeated after looking at the race photos and seeing my flabby legs.

I birthed two children but always lamented my flabby middle from which they came.

I completed a triathlon, but worried about how I looked in my wet suit, and cropped the after-race photo before sharing with my friends to avoid showing my legs in my bike shorts.

No matter what great accomplishments I succeeded in, it was always overshadowed by one thing. My failure to lose weight.

Once, actually, I did manage to lose a fair amount of weight, reaching the lowest number on the scale I had ever seen as an adult. When I reached what I thought would be my “goal” weight, I wasn’t happy. That weight did not reveal the body I desired. So still, I felt like a failure.

And of course, any temporary weight loss I ever did manage to achieve was met with what seemed like far more recognition than any other accomplishment. I learned early on to judge others by their weight and assumed accordingly that every person judged me by mine.

So if I was able to do all of these other things, why couldn’t I succeed at the one thing I had been working at my whole life? At least that’s one way of looking at the situation. Of course, another way of looking at it was to ask myself why I defined success almost entirely by a number on a scale or the size clothing I was wearing? And, after living and thinking that way most of my life, how was I going to change that way of thinking?

Well, it’s taken a lot of work, much of which was done with the help of a professional. I have worked on reframing the constant barrage of negative thoughts that used to invade my head 24/7.  In the past, I would take note of every body (not ‘everybody’ but EVERY BODY) that came into my visual range, and compare my body to theirs. Was I thinner or fatter than each person in the room, I would think to myself. Now I still notice everyone in the room, but instead of seeing what might be noted as flaws, I look for their unique characteristics that make them beautiful.

By judging others less on their appearance, and  stopping the constant comparison of myself to them, I was able to begin the work of accepting my body, and end the cycle of constant dieting/deprivation/calorie counting that has made me miserable for so many years. Of course, there were many elements to my progress, many of which are highlighted in the article Celebrate Your Body.

I have come a long way, and most days, I can look in the mirror, noticing all the things about myself I used to see as flaws, and simply see them as they are — parts of me. At the same time, my reflection in the mirror has little do with any of the things I accomplish day to day. All of my successes, both large and small have come about through hard work and dedication, and are — I realize now — completely unrelated to a number on the scale.

Some days, every now and then, the old thoughts come creeping back in, and a voice starts telling me I am fat, but I know now that I need to ignore those voices, not just because they are  negative, but because they are irrelevant. Yet, what I have noticed, is those days crop up when other things are bothering me, and I don’t want to — or don’t know how to — deal with them. Dealing with feelings of self loathing may be pretty terrible, but they are familiar. And like an abusive spouse, you sometimes take comfort in what you know, even if it’s unpleasant.

With new coping tools and more attention to self care, I am now able to concentrate on the deeper issues. The effort it takes to push back at times like this is considerable, but I also know I have come a long way, and the effort is worth it. More importantly, I can finally look at all of the amazing things I have accomplished and take pride in each of them, rather than feeling inadequate