Thank you for all of your comments about Part I. To respond to Ms. Orenstein’s anti-princessistic views, I have asked my own Inner Princess to respond:
Peggy POV #1: Wanting to be a princess, princess-like, or admiring of princesses is bad for little girls.
The Princess graciously responds:
Peggy, I see beyond your fears to the princess within. Why not embrace your princess-longing to find your inner princess self! Those of us who have already realized that we are the Princess (or Queen if you wish) of our own domains are claiming our own power, not waiting for acceptance from others.
As every true princess knows, it is not the gown nor tiara that makes a princess. It is something inside that can never be taken away. Something like honor, character, perhaps even a spark of the divine! In other words, it is in every one of us, even the men and boys! It does not make us better than others, or more deserving, it gives us more responsibility. Believing in our princess-like powers does not mean we are selfish or deluded, it means we have imagination, and the ability to rise above our circumstances.
Like The Little Princess, Anastasia, or Elizabeth Smart, or any other princess who has been stripped of her trappings, even her identity, she still maintains her character. What is wrong with wanting to believe that you are special and deserving of respect? And one of the main things that helps a girl grow into a healthy self-respecting woman is a good relationship with her daddy… who of course thinks she is a princess!
Peggy POV #2: Disney princesses are an especially heinous influence on little girls and their development.
The Princess graciously responds:
Walt Disney did not invent princesses nor a fascination with them. Wanting to be a princess is a time-tested escape fantasy that does not correlate with stunted development. Imagining onself a princess does not equate with being spoiled or entitled – those are learned behaviors. And as every prince, princess or Disney movie-watcher knows, royalty is a responsibility as well as an honor.
Disney princesses (although remarkably slender as a group, and therefore not reflecting of all the shapes and sizes of the true princesses of the world) happen to be a very classy bunch. As evidenced by their depiction as individuals who:
Show kindness to others
Follow their own heart even when frowned upon by convention/society
Are resilient, do not give up without a fight
Try to right the wrongs they observe
Help others less fortunate than they
Speak with respect to others, never belittling or bullying
Respect their parents yet stand up to authority when it is unjust
Do not judge others based on appearance, social standing or financial success
Learn from their mistakes, admit their shortcomings, and are honest or learn to regret it
Are friends to nature
Believe in the good in all people (even their enemies can be redeemed if they are willing, because after all, they have character to, if only they choose to use it)
Demonstrate creative problem-solving and usually practice one or more creative pursuits
Are unique
And when they fall in love or marry, they choose partners who respect them, who do not belittle or abuse them, and who love them back.
I am sure you can agree that these are all qualities that we hope for our daughters to embrace.
Peggy POV #3: The commercialization of princesses is a juggernaut that no parent can stop.
The Princess graciously responds:
Don’t sell yourself short Peggy. Remember that as a mother you are the most influential person in your daughter’s life. It’s all in how you interpret princess culture with your daughter. If you reinforce that princess means “you are better than everyone else,” then you are more at fault than any marketer or DVD. If you discuss the movies with your daughter and the qualities that you admire (or don’t) in each of the characters, you guide your child’s response. I know from your previous books that you are very familiar with media literacy, and that it’s an ongoing conversation with your daughter about respecting herself. Please don’t give up on our next generation yet! There is so much that those little princes and princesses have left to learn. They are counting on us to use a language that they understand. And if that is the language of princess culture, let’s turn it into something wonderful!
All my best wishes,
The Princess of My Domain
I noticed Jillian Michaels, my nemesis, staring at me from the cover of Ladies Home Journal this month (no, of course I don’t subscribe, I was at the library). The caption:
Lose Weight Faster: The Biggest Loser Tips and Tricks.
Doesn’t anyone remember what “You’re the biggest loser” used to mean? It was not something you would want to brag about on national tv. But never mind, mission accomplished LHJ, you got my attention.
Reading further, the next teaser on the magazine cover was:
Raise a Girl with Body Confidence.
(Rule #1: Don’t let her catch you reading diet tips from Jillian Michaels?)
Amazed by the incredibly twisted placement but nevertheless hooked, I turned to the purported body confidence article. Only to find, not an article, but a useless excerpt from Peggy Orenstein’s latest book, Cinderella Ate My Daughter.
I say useless because Peggy’s main advice (?) was this: Hope that your daughter is genetically blessed with society’s ideal size and shape. That’s her only hope.
I know you think I’m joking, exaggerating, or making this up. But I’m not. Peggy writes that she’s glad that her daughter isn’t heavy, because life sure is harder for people who are bigger than society’s ideal. Unlike Peggy’s friend’s daughter who is slightly larger than society’s ideal, for whom Peggy predicts a sad life of dieting, disappointment, and self-hate.
I have a prediction to make, too: Peggy Orenstein’s daughter is going to struggle with her self-esteem. Why wouldn’t she? Her mom has no reason to help her daughter form a good body image, because apparently that comes naturally when you’re pretty. (Somehow I missed that memo.) She’s not willing to challenge society’s unrealistic expectations in her own head, how could she possibly teach her daughter to do so? And knowing that your mom judges and pities people who do not meet her limited standards of acceptability and weight is not going to help matters.
Peggy, you are part of the problem. You look with sadness at your friend’s daughter, worried that she won’t have a good self esteem, but that lucky girl has a mother who teaches her to accept herself as is and that beauty comes in all shapes and sizes. I wish she was the one who had written a book.
“This patient isn’t getting any better. Am I really helping? Should I stop meeting with him/her?”
Many of you have asked me these questions, and I have asked them of myself as well. Let’s put the patients who are clearly getting worse, those who are medically unstable, and those who are suicidal into a separate category, and focus for a moment on those who simply seem to be stagnating on the recovery path.
Ambivalence about recovery is to be expected when working in this field. It is part and parcel of eating disorder treatment. I respectfully propose that the questions you ask are less about your patient and more about your own self-doubts and fear. If you are immediately offended by this suggestion, then please feel free to stop reading. You’re right, it’s not about you. People with eating disorders are beyond help and you should probably leave the field for something more financially rewarding.
If you’re still reading, you know that our personal insecurities about our professional worth can flare up even when things are going well; but they are most likely to attack when it appears that a patient is not making progress in their work with you. For those of us trained as dietitians, it is the exchange (or more specifically the giving) of information that we are told to emphasize. We are also taught to use outcomes to determine if we are effective – good results are evidence of a good dietitian. “My patient is improving, that means I did a good job.” But the patient in question isn’t making any (more) progress. Does this mean you stink? Probably not. Does it mean you should stop working with him/her? The answer to that is more complicated.
After sessions in which you mostly listened, didn’t provide much information, and didn’t observe any measurable improvement, you may feel helpless, hopeless, ineffective, and drained. Instead of recognizing your bad feelings for what they are – normal and natural consequences of a tough job – you may perceive that poor outcomes are your fault – you didn’t adequately prepare, you talked too much, you talked too little, you are not a specialist in this disease, etc. It is in an effort to mollify these feelings of ours that we respond with clever ideas like blaming ourselves for not being good enough or feeling guilty for accepting payment for the session since we “didn’t do anything.” Wrong wrong wrong.
If you were present, listened without judgment, and even sat in silence, you have done a lot. You have been a witness to your patient’s pain. You have believed them and believed in them. And you have given a gift that no one else in their life is providing – otherwise they wouldn’t need you. These all are doing SOMETHING – all valid uses of your time. Not to mention the possibility that if you weren’t in the picture, your patient might be doing worse – preventing relapse is certainly worthwhile.
When you ask me if you are helping your patient, I help you look for clues that indicate that your sessions are beneficial to him/her. The most obvious clue is that your patient is PRESENT. Even the ones who don’t say much, or don’t do much, are physically there. If they arrive on time, cancel appointments when needed in a timely manner and for a legitimate reason, and sit with you for the full time period, they are participating appropriately and likely gaining something from the experience. So even if your patient does not seem engaged in the work you are doing, and even if they cannot put into words what exactly is being accomplished, the fact that they simply show up may be a sign of progress toward recovery. The fact that you choose to accept their presence without requiring additional effort may be a healing interaction that some patients have never experienced. In essence you are communicating “I accept you as a human being, even if you are not ‘doing’ anything.” I’m not suggesting that sessions like this aren’t uncomfortable, but that is a separate concern, not an issue of effectiveness.
The second clue that your patient is benefiting from your work together is when he/she participates in the session – sharing thoughts, feelings, concerns; answering questions; doing assignments. Even if no measurable “progress” has been made, following through on commitments, sharing insights, sharing feelings, are all signs that movement is occurring. Building the foundation of a healing relationship is essential, just as it is when building a house, yet nothing may be visible on the surface. One dietitian described this situation as “renting my patient a room.” She felt she offered nothing more to her patient than a hotel. I asked her to imagine her patient sitting in her office alone, with no dietitian present at all. I suspect the patient would not have a conversation (even a conversation that is more like a monologue) with an empty office. Your presence provides, at the very least, a foil for your patient; someone with whom to argue or bounce ideas around. Once the conversation has started, you have an opportunity to direct it toward productive changes and nutrition-related topics. And on the off off off chance that all your patient really needs is a reason to get out of the house or some down time to gather his/her thoughts, then your office is just the place where that time out can happen. If you think your patient could get just as much out of a massage or a movie, suggest it, and I bet your patient immediately tells you why that wouldn’t be the same.
The third clue to your effectiveness is that you are worried in the first place. If you weren’t good at your job, you wouldn’t be worried about your patient doing well. You want to see your patient succeed, and you are willing to let go if you are not the right person to help, rather than blaming the patient for not getting better fast enough or pushing him/her “out of the nest” prematurely. Worrying about your effectiveness mans you care! And believe me, there are many reasons to be worried about your effectiveness. Are you actually harming people? Is the licensure board coming to take you to jail? Is this patient going ruin your reputation by telling others that you are unhelpful? Or sue you? These are the same questions we all have. And if you have already confirmed with your patient’s treatment team that the patient is not in danger at this level of care (or that the patient has been made aware of the danger and has rejected additional recommended treatment) and that you are working within the expectations of the team, then these questions are the poisonous fruits of anxiety, ie they can’t be answered, only managed.
Some patients actually tell you that your sessions are not helping. They could be right, but I’d rather entertain the possibility that they are wrong. Some patients get scared when things are going well and try to abandon you before their imagined abandonment by you. This may manifest as you trying to think of ways to discharge the patient before they tell you they are leaving you. Even if they don’t say express them out loud, you may pick up on your patients’ feelings of hopelessness, helplessness, and ineffectiveness. This is normal given the immense amount of work that recovery entails. And you are willingly doing this work with the patient. So you may also feel frustration or even despair. But your feelings of doubt do not prove that you are ineffective. Seeking support for those feelings of doubt, and allowing another human to see our vulnerabilities is one of the very skills we hope to instill in our patients.
It is wise to speak with a colleague to gain perspective on the situation and to get your personal baggage out of the way before you bring it up with your patient. After reassurance from your colleague, you may feel resolved and leave it at that. Or you may choose to bring up your concerns with your patient in a therapeutic way. “Sometimes I wonder if you are making changes that I am unable to see. I know something is going on in there. Would you be willing to share with me how our sessions help you change?” The self-doubt you feel as a caregiver is an extreme form of the same empathy that allows you to care. You don’t want to become a robot who doesn’t care if patients ever get better or not. Open your definition of “effective” and I am hopeful that you will see that you do, in fact, fit that definition.
As if to prove my point that you don’t have to be pro-ana to promote eating disorders, learn about overexercising, undereating, and how to ruin food with condiments… just by reading “health” blogs!
http://www.marieclaire.com/health-fitness/news/articles/health-blogger-controversy
Yeah, you’ve missed quite a lot being off planet all this time. There’s a lot that’s new – the whole “Humanity’s on the Weigh Down” movement, the Sugar Limit Laws, the M Cards and K-Cal Regulations… Was candy still legal when you left? For a while Sugar Limits were different state to state, but that didn’t really control the problem of course – it was easy enough to cross state lines. Now they’re all federal mandates, so it’s uniform across the states. For a while you could still get free access to food in Canada and Mexico, but now you have to pass a physical fitness test before you’re allowed to cross the border. If you don’t pass, they send you to Fat Camp, so no one risks trying to cross any more. Not even the athletes will risk it, ‘cause of the BMI requirement. Heavy’s heavy, even if it’s all muscle. The anorexics could pass the BMI test and the 5 mile run, but don’t have the strength for the rest of the tests. And anyway, what do they care about getting more food?
I remember it started getting really bad around 2013. That was the year they started the mandatory BMI reports and the Sugar Limit Laws. All the taxes on sugary foods just drove the demand up and the prices sky high. After a while the grocery stores downsized their inventory to only carry the processed foods – since no one knows how to cook, they were losing their shirts from rotting produce. Everything is sold in individual servings, so you can only purchase one day’s worth at a time. It’s for our own protection, ‘cause if you eat all your groceries in one binge, you only have to wait till the next day to get more. In the old days, people would buy groceries at the beginning of the month but run out before the reload. They’d hang around the dumpsters at the end of the month or beg for leftovers at the restaurants. It was a losing deal though, since it’s rude not to eat everything on your plate.
Now it’s one M Card’s worth a day, so everyone goes to the store every day. With the lines so long, I don’t see the point. You’re not allowed to drive to the grocery stores anymore, you have to walk there to earn your food. I’d rather go to a restaurant since there’s no cost benefit to eating at home. See, all the food is subsidized by the government. You don’t use money to buy stuff, you use your state-issued M Card. It stands for Metabolic Card, but nobody calls it that any more. You get a certain number of K-Cals put on it each year when you go for your Health Check. They used to draw your blood and do all kinds of tests, but now that Health is determined solely by Weight, there’s no point in taking your blood pressure or doing a stress test. They just mask you for the Metabolic Calorizer and it’s over in ten minutes. That’s right – ten minutes and they tell you how many K-Cals you get for the year. I always try to breathe really hard, like hyperventilate, and I eat a huge meal, like all my K-Cals for the day, before I go in. I don’t know if it works for or against me, honestly, but it feels like I have some control over the process.
For a while there were ways to work the system. Like new moms would take their kid to three or four different Health Check offices in one day and enroll one baby three or four times. The computers didn’t sync, so it could take years till anyone caught it. Now the computers all sync at midnight, and the duplicate M Cards are deactivated immediately. What’s the point of all that work if you just have the extra K-Cals for one day? Although I’ve heard of people paying big bucks for black market Cards, then finding out that they don’t link to an account. So maybe that’s the payoff – you don’t get the K-Cals for more than one day, but you’re left with the dummy cards to sell.
The birth rate has skyrocketed since the only time you get your K-Cals increased is if you get pregnant. Now they take your baby as soon as it’s born and Mask it on the spot. By the time you hold your baby for the first time, it already has its K-Cals assigned. The fancy folk will add it to the birth announcement along with the BMI, but with the paper rations the way they are, only the super-rich can even afford to send birth announcements any more. I personally think it’s kind of sick to put your kid’s K-Cal level out there for the world to see. You’re basically saying, “Come beat up my kid on the way to school and steal his M Card.”
You’d think people have better things to do than care about other peoples’ kids’ metabolisms, but I tell you, it’s right up there with your BMI and your salary in terms of status symbols. I’ve heard of kids with high K-Cals picking on lower K-Cal kids, but the first reported suicide of a low K-Cal kid put a stop to them printing your K-Cals on your lunch tray. I don’t think it’s a big secret, though – even without the number right there, it’s obvious who’s getting dessert and who’s not. I wouldn’t be surprised if there’s a black market right there in the schools – trading dessert for doing someone else’s P.P. homework, or something like that. Oh yeah, P.P. – that’s what you all used to call P.E. It’s now called P.P., Physical Perfection. It’s where you learn all about how thinness equals superiority and how high burners are the privileged race. The low K-Cal kids have to do exercise during P.P., while the high K-Cal kids get to talk about their feelings and the responsibilities that come from being different.
I wouldn’t know, I’m a low burner. Nobody ever asked about my feelings till you. I’m not sure I feel them any more, but at the beginning I did, before I learned to stuff. The first 9 times you pull out your metabolic card at a restaurant and hear, “I’m sorry Mr. Sprat, your card has been declined, you’ve already consumed your allotted K-cals for today,” you simply flush a little and stammer that your wife must have borrowed your card, thanks. After that you just start avoiding the cashier completely and go for the vending machines, in the hopes that something will malfunction and you’ll end up getting something for nothing. My grandpa used to talk about the good old days when he’d check the coin return slot for a nickel that someone else had left behind, but magnetic strips don’t malfunction as often as you would think. Although I did hear a rumor that if you tie a rubber band around your cell phone and your Metabolic Card and call your cell from another phone, you could reprogram the magnetic strip to discharge all of your K-Cals for the month on the 1st day of the month. I don’t see how that would help, since you would just feast for days and then be dumpster-diving by the end of the month, but anyway it didn’t work.
You used to could find an anorexic on Craig’s List who would trade her Card for a case of cigarettes and a couple of Diet Cokes. They’d pay extra for the cigarettes supplemented with vitamins. But now that they give out cigarettes for free at the Weight Monitor’s office and Diet Coke is the only kind of Coke that’s allowed, they have no value on the black market. It’s the Regular Coke that’s sky high now. A case of that would wipe out your M Card for a week, so they just quit selling it in the stores and use the underground networks where people will trade their gold fillings for it. The state-subsidized dentistry is the problem. It’s a free ride for Coke addicts to get more gold – the more Coke you drink, the more fillings you need. Most Coke addicts don’t even brush their teeth in order to speed up the decay. I’ve heard that bulimia is the best method, since the combo of stomach acid and sugar on teeth rots them faster than anything else. Alcoholism is effective, too, but your gums get so rotted your teeth actually fall out. And no teeth means no fillings and no gold, so you end up worse than you started.
Every once in a while you get word about someone selling black market M Cards. You have to catch them right at the beginning of the sale, ‘cause the lines get so long so fast that supplies run out. You have to know somebody who knows somebody to get the hook up on where the sellers will be, because now that the government monitors text messages, the secret locations are only passed by word of mouth. And I’m not even saying that I’m in the loop.
In fact, I think I’ve said enough already. I can’t afford to have my K-Cals docked like that time I ran a yellow light. You can bet I won’t make that mistake again. Is there a vending machine around here?
Calorie content on menus leads to higher-calorie choices; consumers feel they are getting “more value.”
Vilifying pro-ana websites is giving a free pass to the real culprits.
Yesterday I read this item in the American Journal of Not Necessarily the News:
80-85% of pro-eating disorder websites contain interactive calorie counters or BMI calculators, thinspiration images, and overt suggestions on eating disordered behaviors, including tips to engage in extreme exercise and go on a multi-day fast.
REALLY?!?? Because the whole internet has that! The US Health and Human Services website has a BMI calculator on it for heaven’s sake! There’s proof that Big Brother is pro-eating disorders! Just as I suspected! (Listen to Why I hate BMIs if you have any doubt that our government is pro-ED).
If you want to point fingers, forget pro-ana websites…eating disorder tips are much easier to find than that!
I have never once used the internet to find out how to lose weight (as if!). Yet I am bombarded incessantly with ads for “multi-day fasts” (code name: “cleanses” – don’t get me started on why people want their poop to be “clean”!), “overt suggestions on eating disordered behaviors” (Lose 24 pounds in 5 days!), and “tips to engage in extreme exercise” (yes, Jillian Michaels, I am talking about you).
I have never looked for photos that would inspire me to starve, yet I am constantly faced with links to so-called “news” and “entertainment” reports with images of underweight, underfed and drug-addicted people whose bodies I am supposed to admire.
Now that my step-daughter has a Facebook account, I assume she is, too. And all my patients trying to avoid temptation… I get hives just thinking about how much they have to block out to stay in recovery.
But the pro-ana sites don’t advertise, and they don’t even charge for their crappy advice. They have the decency not to invade my privacy or lure my child like the legitimate mainstream weight loss industry. Why pick on pro-ana websites when the government-diet-industrial complex is neck deep in the same crud and spewing it right to my front door?
It’s kind of like when you color on the wall and get away with it, so your younger sibling does it, too, and gets caught. Only she gets punished, and you make off like a bandit.
Pro-ana sites are the little sis who got caught holding the crayon. Their same tired “tips” are just recycled diet advice from the 70′s and 80′s. It wasn’t called pro-ana back then, it was the T-Factor Diet, The Rotation Diet, Fit for Life, etc. And let me remind you, all those books cost money. The mainstream eating disorder pushers don’t give their junk for free.
Then there’s the complete red herring of “thinspiration.” No pro-ana blogger eating Special K one flake at a time (ALERT! Eating disorder tip! Understanding Nutrition is a pro-ana website!) in her parent’s basement created those pictures! They’re all cut and pasted or ripped and scanned from sources any three-year-old can see in the checkout line.
How come the people who ordered, altered, and served up those images aren’t hung out to dry? Why pick on the poor ana-wanna who snaps a pic of herself in the mirror wearing her undies? Calvin Klein puts it on a billboard! IN TIMES SQUARE!
I get spammed every day with encouragement to starve (Diet pills from Canada! Free shipping!), but I’ve never received one unsolicited email from a pro-ana website.
I know there are boycotts, media literacy campaigns, and public fury. But what I want to know is When there are people out there who really want recovery, and they can’t pry a dime out of the insurance vultures, WHY are we spending the limited dollars allotted to eating disorders research “investigating” pro-ana websites?
Pro-ana sites have the same idiotic content you can find in a hundred thousand other places on the web. It’s time to figure out how to help the poor kids who waste their time viewing it.
I had a blast bashing mandatory BMI screening last week on Carol Dunlop’s radio show. I’m the first guest after the intro: http://snipurl.com/bmirant.
