I started small, noticing and ignoring body art. One girl with a small diamond stud in her nose had a huge diamond engagement band on her finger. We spent a lot of time discussing the enormity of her ring. No mention of the nose stud. Then came a girl from outside the city, a suburb so conservative that I’d imagined it as filled with horses. Her therapy was long and complicated, involving many family members. Somewhere during therapy she got a tattoo- the most popular sort at that time. Chinese characters were inscribed in black at the base of her spine. They showed only when you might bend over to give a customer change, or if you were scooping ice cream for a summer job.
Then an artist came to see me with forearms decorated like a Minoan snake goddess from Crete. We discussed the tattoos. The why, the when (a break-up), the choice of subject matter.
Later I saw a drug addict in remission- a girl with a straight spine and a pierced tongue which flicked like a snake, in and out as she talked. I had to ask. The piercing was unnerving to me. She had chosen to pierce the visible juncture between speech and silence. Not to ask her about this choice seemed like denying part of therapy. Then I began to ask more, much more. The foot covered with henna that looked like a fortuneteller’s palm.
The second recovered addict saved her money working retail to tattoo installments of Alice in Wonderland all over her body. Not somewhere subtle, the nape of her neck, a shoulder blade wing. She was writing on her body- the body as slate, the body as book. She said it was a constant reminder ” not to fall down the rabbit hole.”
All signs have meaning. If someone shifts and exhales- I ask. I shied away from discussing piercing and tattoos- though I had always asked directly if a patient cut or burned themselves. As the world spins on its axis the culture changes. I can make no assumptions. To assume that body art is culturally neutral is, itself, a convenient assumption. So I ask. Everyone wants to be known. What they inscribe, what they cut, what they pierce, needs translation. Use your words, we teach our children.
Make no assumptions. Do no harm.
The oath of the psychologist.
I was a guest contributor recently to WBUR’s Commonhealth Blog . You can read my entry here.
“Sometimes it is necessary to reteach a thing its loveliness” – Galway Kinnell
After years and tears spent treating girls with eating disorders, I found myself pregnant — in my 40s — with a daughter.
She is now 10, and suddenly, everything I’d preached and chiseled and chipped and interpreted in my office is getting put to the test. How was I going to try to prevent my own child from having an eating disorder? How would I prevail against a culture of young girls in short shorts, strappy tops and frankly lewd fashion, where my 4th grader must choose between “boyfriend jeans” and “skinny jeans”? As I had told my patients: “Many girls entertain diets — not everyone gets an eating disorder.”
Still, I reviewed the early dangers for developing such a disorder — flipping through my own brain for knowledge.
We had some family history of mood disorders but nothing that seemed so severe it couldn’t be tempered by attentive parenting.
2. Home obsession with foods
I made absolutely sure that nothing in my house was low-fat, low-calorie and insisted that dessert was part of the meal if you ate your ‘growing foods” a useful phrase I learned from her pre-school teacher.
3. Range of affect (or, enough feelings)
Yup, no problem there. My house was never one where feelings were suppressed. In fact, I might have spent too much time inquiring what my child thought or felt. I was politely interrupted. “Mom,” she said, “I’m watching the cars outside” or “Making a friendship bracelet” or “Telling myself a story.”
4. Too much affect
Yes, I wanted to tone this down. She neded to learn resilience — that horrible feelings, the dementors of loneliness, sadness and intense anger can be survived. She needed to endure them and learn to soothe herself. I reminded myself of this as I clenched my nails into my hand while she hurled about in her crib.
5. Too much talk about appearance
I failed on this. I could not even try to stop my outpouring of sheer joy at her natural beauty. I was, as C.S. Lewis said, “surprised by joy” in this department. I craved her attention like a jilted suitor. But it amuses both of us — and possibly helped her — that I would joke about my “separation issues.” I believe I gave her the freedom to express those same feelings and a good many more.
6. A sense of purpose
We are currently working on this. The most effective cure for the most recalcitrant eating disorders is — surprisingly — community service. Like people in a nursing home who thrive when they care for a plant, children do better when they feel their effect on the world is real. I ramped up on chores, folding laundry, carrying grocery bags. A child who danced for hours could use her legs to help me.
When my daughter was three, I saw a child in her nursery school crumple up a drawing, burst into tears and throw it away. I vowed I would do my best to melt perfectionist thinking. We practiced making mess-ups into other shapes. We practiced turning pages over and writing on the backs of things. I told her often, purposefully, about my own mess-ups, what caused them and how I still was growing. I learned to ask her if she felt proud of something — not to tell her that I was instead.
This huge piece of influence is almost indescribable. Culture is written across the bottom of shorts, the straps of shirts, the piercings and tattoos called body art. Wherever you stand on particular trends, it’s hard to deny that a new, frankly lewd look is popular. Somehow feminism has been replaced by exhibitionism. Reality TV and instagram make looks all that matters. Sexting seems a natural outcome from this atmosphere.
All I could do on this front is to hold my ship fast at home. I batten down the hatches. I encourage critical commentary about dolls that are too thin, pictures of girls who were too thin. Movies which demean fatties. I censure TV and books about mean girls.
What I cannot plan for is my daughter; her own self. She dances (at a studio she feels is like a second home). All I did was steer her toward the one that has the most diverse group of girls’ strong bodies I’ve seen.
But she is at a liminal age and it terrifies me. She is a perfectionist at times and it drives me nuts. I never want her to look at herself with loathing, to pinch a part of her skin with disgust and wish it gone. I detest the bonding that begins — very soon — when girls turn to each other and say: “I’m fat.” And the response — rather than saying “Don’t be ridiculous” or “How boring,” the only scripted response is: “Are you kidding, I’m fat. You’re thin.”
A few days ago we went to buy jeans — she’d grown again. I was sick to see that our choices were reduced to two categories: “Skinny jeans” or “Boyfriend jeans.’ Those are her choices.
Is she skinny or does she have a boyfriend whose clothes she borrows? She’s 10. Why can’t the pants simply be called straight or baggy?
I don’t know how we can hold back this enormous wave surging toward our girls. But we must keep trying. I hope I will not be reteaching Penelope her loveliness as I do, here, in my office, every day at work.
Over the last few years, I have noticed more women with eating disorders reporting early memories of obsessive-compulsive behavior. New research now links anorexia to a different area of rigidity: autism.
Trichitillomania (compulsive hair pulling), too, is associated with perfectionism and OCD. Perhaps these behaviors and thoughts do all start with a delicate and finely tuned sensibility to textures, shapes and symmetry. Body Dysmorphic Disorder, one of the least overlooked disorders, may be next to consider as part of the colors that make up the autistic spectrum.
To read about this research, please see the April 22, 2009 article “Anorexia linked to ‘autistic’ thinking” by Linda Geddes in The New Scientist. Here’s a short excerpt:
… “Eating disorders and autism spectrum disorders are obviously not the same thing, but they do have some things in common,” says Janet Treasure of the Institute of Psychiatry in London.
Anorexia and autism are obviously not the same thing, but they have some things in common. Treasure had already discovered that anorexia was associated with extreme attention to detail and a rigid, inflexible style of thinking traits also associated with ASD.
To investigate further, her team used neuropsychological tests to measure central coherence, or the ability to see the big picture as well as the finer details, in 42 women with anorexia and 42 without it. Women with anorexia had weaker central coherence, with a bias towards local, rather than global processing (International Journal of Eating Disorders, vol 41, p 143).
In a separate study, Treasure and her colleagues found that 45 per cent of people with anorexia or bulimia have problems “set-shifting,” or modifying their behaviour in response to changing goals, compared to just 10 per cent of healthy people. ….
Photo credit: Eugene Wei
Is hope a muscle? Do girls have more of it than boys?
Lots of people think so. We know girls have hope and determination. Since Title IX, we’ve been thrilled to see girls play team sports. The extraordinary achievements of the Amherst, Massachusetts’ girls basketball teams, the Williams sisters who changed tennis, the skaters and gymnasts, but also the soccer players and track stars. Girls soccer made soccer moms of many reluctant women. It is no surprise now when girls want in the game and to be taken seriously as athletes. We’ve started to believe anything is possible for our daughters. We are supposed to be proud. We are not supposed to be afraid.
There are other things we know about girls that make them take to sports differently. Anxious to please teammates, girls also know how to ignore their bodies. Little girls can break bones or get tendonitis. And girls often get too thin.
For example, recent studies suggest that female athletes are more likely to injure their knees than men and to ignore the doctor’s and coach’s instructions to rest. The affiliative nature of girls sports means that girls can be at higher risk for re-injuring themselves. Rather than worrying, we exult in their strength.
What I see now is that when girls are injured, their athleticism screeches to a halt and causes mental anguish. Girls gain weight without exercise. Girls grow depressed and blame themselves. Girls do not have other outlets for the feelings they are used to releasing through the daily grind of training. A sense of worthlessness sets in.
Injuries in girls and women athletes are often the start of depression and an accompanying distortion of body image. A strong swimmer hates her shoulders. A ballerina cannot see her hip bones and panics. Some athletes may also enjoy losing their periods for months at a time—not understanding the danger.
We have got to prepare girls—as we would boys—to succeed in sports. We must also prepare them injuries they may sustain. Sports injuries often have different meanings for girls—and different complications.
For more on this subject, I recommend Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports by Michael Sokolove. For information on girls and knee injuries and what girls need to know to prevent knee injuries, please visit ACL Prevent.
Please email me if you are interested to know when I may be speaking on this topic.
Photo credit: kurros