My Brain Works Differently

I’m an alcoholic. I don’t have one drink. I don’t understand people who have one drink. I don’t understand people who leave half a glass of wine on the table. I don’t understand people who say they’ve had enough. How can you have enough of feeling like this? How can you not want to feel like this longer? My brain works differently. ~ Leo, The West Wing, Season 3 Episode 10 – Bartlet for America

I was watching this episode yesterday in anticipation of The West Wing Weekly podcast about it, and this quote really stuck out to me. Leo is talking about his experience as an alcoholic, but I can relate this very much to the eating disorder.

For most people, restricting their food intake is an adverse experience. They don’t have a chance to eat lunch or a snack one day, and they feel like crap and think “I am definitely going to make sure I have that tomorrow.” However, for me the opposite happens. I get this sort of high, and think “I want this feeling to continue.” I want to keep feeling that hunger, that emptiness. As Leo says, my brain works differently.

This is also why restricting is such a slippery slope for someone with anorexia. Just like Leo cannot have one drink, I cannot have one missed meal or snack. It just leads to more restricting. There are many days were I want to miss a little, and think it’s not that big of a deal. But if history is any indication, pretty soon that one exchange or one meal becomes two or three, and it just keeps on going. Why? Because as Leo says “My brain works differently.”

AN as Entrenched Habit

On Monday the New York Times had an interesting article about a new study looking at centers of brain activation in Anorexia Nervosa: http://www.nytimes.com/2015/10/13/health/extreme-dieting-of-anorexia-may-be-entrenched-habit-study-finds.html.

The New York Times provides a link to the actual study, but you can also read it here.

Basically, the study looked at women who were receiving inpatient treatment for Anorexia Nervosa compared to health controls.  They performed a number of different tasks (such as rating the healthiness and tastiness of 76 food items). Not surprisingly, women with AN were less likely to rate high-fat and high-calorie foods as tasty.  The big finding though is that the women with anorexia showed more activation in a part of the brain involved with habitual behavior – the dorsal striatum.  In other words, choosing the lower calorie and lower fat options had become (at least somewhat) habitual.

The authors note that this habituation may in part explain why individuals with AN struggle so much in treatment and have such high relapse rates.  As one of the authors explains about individuals with eating disorders, “they come into treatment saying they want to get better, and they can’t do it.”

When I read that, I thought “oh my gosh, that is me!”  I cannot count the number of times that I have thought before entering treatment that this time will be different.  Also, except for a handful of occasions where I sought treatment more to please others, usually I go in really wanting to get better.  However, when push comes to shove, I resort back to the same patterns.  I say going in that I am going to pick higher calorie foods or challenge certain fears, and then I resort back to the lower calorie options.  I say that I’m not going to look at the scale or get hung up on numbers, and then I do it anyway.

I’m not using this  study to justify this behavior or as an excuse for why I continue to struggle with several things.  Rather, it just helps explain to me perhaps why, despite going in with the best of intentions, I continue to struggle with radical acceptance and eating and weight gain.  As my therapist often says, I need to create a “new normal.”  Even though I am actively working on challenging my behavior, it still is habit to automatically reach for the lowest calorie option, or restrict at a meal or snack when given the opportunity.  However, I am trying to create new habits, such as making sure I get a lunch break at work, and not always going to the lowest option.  It is definitely slow going, but hopefully with time these behaviors will become the norm, as opposed to the disordered behaviors.

The study also sheds light as to why it is so critical to get those with AN into treatment as early as possible.  The less time there is for these neural pathways to make the disordered behavior a habit, the easier it will be (ideally) to re-wire those neural circuits involved.

Grey’s Again

From this past week’s episode of Grey’s Anatomy.  It really hit home about “managing” things.  I usually feel like I am managing things fine, and then seemingly out of nowhere things start to crumble.  But as Owen points out, perhaps I am actually doing too good a job of managing things.  Rather than trying to manage things and keep everything under control, I need to allow myself to experience the ups and downs, the good days and bad days.  Maybe the more I try to keep up this appearance of managing, the more I’m actually setting myself up to relapse.  Oh, and spoiler alert – Derek is dead.

Amelia: I’ve got the dead-Derek thing completely managed…but I’m good. I got this. I am fine….except today, I yelled at Richard… Who was only trying to invite me for coffee, and then I went and scored oxy from this junkie doctor. 

Owen: But you haven’t taken any? 

Amelia: Not yet. But I might. That’s the thing. I really actually might. I have been sober for 1,321 days, Owen. I was fine. It was managed. But I might. 

Owen: All this stuff you’re… managing… You’re not supposed to be managing it. You’re supposed to be feeling it… grief, loss, pain. It is normal. 

Amelia: It’s not normal. 

Owen: It is. It is normal. It’s not normal to you ’cause you’ve never done it… instead of feeling it, feeling the grief and the pain, you’ve shoved it all down and you do drugs instead. Instead of moving through the pain, you run from it. Instead of dealing with being hurt and alone and afraid that this horrible, empty feeling is all there is, I run from it. I run off, and I sign up for another tour of active duty. We do these things. We run off, and we medicate. We do whatever it takes to cover it up and dull the sensation, but it’s not normal. We’re supposed to feel. We’re supposed to love and hate and hurt and grieve and break and be destroyed and rebuild ourselves to be destroyed again. That is human. That is humanity. That’s being alive. That’s the point. That’s the entire point. Don’t avoid it. Don’t extinguish it. Derek died. [Voice breaking] He died. 

Amelia: I don’t want to feel it. I don’t think I can. I don’t think I even want to…I can’t. I can’t. I can’t do this. I can’t. 

Owen: You have to. If you don’t… 

Amelia: No, I can’t. Shh, I can’t do this! 

Owen: You have to. If you don’t, that bag of oxy’s not gonna be your last. You’re gonna be okay. You’re gonna survive this, okay? Everybody does. It’s perfectly normal. It’s boring, even. It’s so normal.