Authors: Kathryn Hansen
24
: Brain over Binge, Step 1:
View Urges to Binge as Neurological Junk
I
n order to stop acting on my urges to binge, I had to see them as essentially meaningless. I could not hold on to the idea that I somehow needed to binge for this or that reason, or that my urges signaled an emotional need. I had to view the urges as junk and only junk, emanating from the depths of my brain and not worth any further consideration whatsoever.
As I've said, therapy concepts and secondary benefits were some of the reasons I followed my urges, and this step involved completely letting them go. If I would have held to the belief that I binged to cope with life or some underlying emotional problem, I probably wouldn't have been able to stop so abruptly. If I had remained under the false impression that I needed to binge for some mysterious psychological reason, then I would have taken that as an excuse to continue my behavior indefinitely.
I was fortunate to have the experience with the medication Topamax that temporarily alleviated my urges to binge. Nearly two years prior to my recovery, Topamax taught me that the problem wasn't my life or my inability to cope with it. It also taught me that, without urges to binge, I didn't need the secondary benefits of binge eating—nor did I want them. When my urges to binge temporarily subsided while on the drug, I didn't feel a need to be sugar-drunk; I didn't feel a need to be temporarily numb to my problems; I didn't feel a need for the pleasure that binge eating brought me.
This information was invaluable to me when I finally recovered. Since I knew my urges to binge weren't symbolic indicators of what I truly wanted or needed—physically or emotionally—and since I knew I could easily do without the secondary benefits of binge eating, it was relatively easy to start viewing the urges as neurological junk from my lower brain. I could clearly see that the urges were merely products of my "binge-created brain-wiring problem," completely apart from my higher self, which brings me to the second step in my recovery.
25
: Brain over Binge, Step 2:
Separate the Highest Human Brain from Urges to Binge
M
y urges to binge weren't truly mine—I was not my habit. I wanted a better life than stuffing large amounts of food in my mouth and then desperately purging to undo the damage. I had goals for myself that I knew were inconsistent with my eating disorder. I knew I wanted a real life, but my habit kept me trapped in destructive patterns of behavior.
Part of me—the seat of my consciousness and identity—knew binge eating was wrong, and that part of me regretted each and every binge. That part of me was my highest human brain, my prefrontal cortex, my true self.
EGO-DYSTONIC URGES
Rational Recovery
introduced me to the idea that there are two separate brain functions at work in addictions. In the case of my bulimia, there was my lower brain, which involuntarily generated my urges to binge (first due to survival instincts, then due to habit), and my highest human brain. My urges to binge were ego-dystonic, meaning that they seemed "apart from, and at odds with, [my] intrinsic sense of self."
170
My true self's desire was to be healthy, but my urges to binge interfered.
I first learned the term
ego-dystonic
about a year after my recovery, while reading about a study of patients with obsessive-compulsive disorder (OCD) directed by neuropsychiatrist Jeffrey Schwartz. This study shows remarkable similarities to how I stopped my bulimia, and it explained to me how my recovery was possible and why it was permanent. Like bulimia, OCD is ego-dystonic in that sufferers have intrusive urges that they feel driven to follow. They have recurring obsessive thoughts and feelings urging them to repeat the same compulsive behaviors (e.g., hand washing), which are akin to the intrusive, recurring thoughts and feelings that drive a bulimic to binge.
Like bulimics, those with OCD feel that the urges are apart from their true selves, and they know rationally that they shouldn't follow those urges—but they can't seem to resist. For example, an OCD patient who has urges to repeatedly wash his hands knows quite clearly, in a part of his mind, that his hands are not really dirty. This is because in OCD, the faulty brain connections that give rise to the obsessions and compulsions spare some of the patient's brain. The spared brain regions are the most sophisticated and evolutionarily recent parts of the brain, located in the prefrontal cortex.
171
In other words, the highest human brain is spared in OCD, just as I believe it is spared in the habit of bulimia.
My urges to binge were not a function of my highest human brain, regardless of exactly where and how the urges arose in my lower brain. It didn't matter what neural pathways drove my habit, my habit remained separate from my highest human brain, and my highest human brain remained capable of resisting the urges. Even if a habit of impulsivity (see Chapter 20) was the primary mechanism—meaning some circuits in my prefrontal cortex indeed weakened through lack of use in resisting the urges to binge—my prefrontal cortex was still distinct from the source of the urges, and it still remained capable of learning to say no and therefore strengthening.
In Schwartz's OCD patients, and in my case as a bulimic, the "core reasoning power and sense of identity remain[ed] largely intact."
172
There were "two competing systems of brain circuitry": one system generated the faulty brain messages of OCD (or, in my case, the intrusive urges to binge); and the other was the patient's mind—the prefrontal cortex— which remained capable of overcoming the faulty brain messages.
173
Put another way, the lower brain and the highest human brain competed in my bulimia. When I didn't know this competition was due to two separate brain mechanisms, it was nearly impossible to resist my urges.
EXPERIENCING URGES IN A NEW WAY
It wasn't until I separated the most sophisticated and most uniquely human part of my brain from my urges, and really felt that separation, that I felt capable of saying no. Separating my urges to binge from my highest human brain was so important because it allowed me to experience those urges in a completely different way. It allowed me to see that they were just automatic functions of my binge-created brain-wiring problem. I learned to recognize any thought or feeling that encouraged me to binge as something completely apart from my true self, as merely a product of the habit. This immediately made my urges to binge less threatening and gave me the sense that I was above them.
I was able to look at my lower brain from a distance, so to speak. Each time I experienced an urge to binge, I was able to monitor what was going on in my brain and observe what I was thinking and feeling. I felt I could float above my lower brain and look down on all the thoughts and feelings encouraging me to binge, all the while viewing those thoughts and feelings as neurological junk. I was able to see clearly that my urges to binge were not an indication of any real needs, but merely an indication that my brain was on autopilot, trying to maintain my habit. I was able to disconnect from those thoughts and feelings and not get so wrapped up in them.
A SIDE NOTE ABOUT ANOREXIA
The ability to separate oneself from urges is not as easy when it comes to anorexia, which is why I believe that it can be more difficult to treat. In anorexia, resistance to eating is not ego-dystonic, but ego-syntonic,
174
meaning it is usually what the anorexic's true self wants to do. Anorexics, at least in the early stages of the disorder, rarely lose their appetite; rather, they willfully refuse food
175
and feel successful, powerful doing so. Indeed, when I was caught up in restrictive dieting, it was hard for me to see that what I was doing was wrong. I wanted to lose weight and that's what I was doing, so I didn't see why it was a problem. My extreme appetite, on the other hand—I could definitely see why that was a big problem, because it was so out of line with what I set out to do: lose weight.
I think this is why anorexics are usually not as motivated to overcome their problem as binge eaters, because that would certainly involve gaining weight, and often a significant amount of weight. This resistance to weight gain and lack of motivation to change makes anorexia more dangerous and deadly than bulimia. Furthermore, if the willed starvation continues long enough, anorexics eventually do lose their appetites.
176
A starvation habit (which could be called a "starvation-created brain-wiring problem") sets in, so that eating normal or even small amounts of food feels downright wrong. Anorexics can then follow their starvation habit right to hospitals and, sadly, even to the grave. Indeed, anorexia has the highest mortality rate of any psychiatric disorder.
177
Despite health consequences, the anorexic's ego-syntonic drive to be thin makes them feel they doing the right thing; whereas, in the case of a binge eater, it is easier for her to see what she is doing as abnormal and thus separate herself from it.
MINDFULNESS AND THE POWER OF ATTENTION
I found remarkable similarities between the way I separated myself from urges to binge and the process Schwartz used in his study. Specifically, Schwartz taught his OCD patients a skill called "mindfulness," which is essentially "the practice of observing one's inner experiences in a way that is fully aware but nonjudgmental. You stand outside your own mind, observing the spontaneous thoughts and feelings that the brain throws up, observing all this as if it were happening to someone else."
178
Schwartz thought that experiencing brain-generated OCD urges with mindfulness—the calm clarity of an external witness—could strengthen his patients' ability to resist them. Without knowing the name of that thinking skill, I was using mindfulness to experience my urges to binge with detachment.
Schwartz believed mindfulness could help his patients because they could use the healthy part of their brain, their prefrontal cortex, to observe their own symptoms, which would give them "an impartial, detached perspective on [their] own thoughts."
179
He hypothesized that mindfulness, which " puts mental space between [the] will and the unwanted urges that would otherwise overpower the will,"
180
could empower the prefrontal cortex to resist the urges.
Indeed, the prefrontal cortex is capable of resisting urges to binge, which brings me to an important implication of this step. I had to view my prefrontal cortex—my highest human brain—as extremely powerful, as fully capable of standing apart from and resisting any urge. If I saw my highest human brain as being on the same playing field as my lower brain, there is no way I could have separated myself from my urges to binge. But viewing my urges as neurological junk, and my highest human brain as the powerful seat of my true self, allowed me to put brain over binge.
With this mindful separation and distance in place between my highest human brain and my urges, I was able to stop paying attention to them. Attention, as it turns out, is vital to neuroplasticity.
181
When we focus attention on a particular task, or on an aspect of the external environment, or on an internal state or sensation, the brain activity physiologically dedicated to whatever we focus on is amplified.
182
So it was that when I paid attention to my urges to binge, the neural firing that produced them increased; and when I stopped paying attention to them, the neural firing decreased.
Since neuroplasticity depends on the repeated firing of neurons, paying attention actually strengthened the neural connections and made the habit stronger; and not paying attention weakened the neural connections that comprised my binge-created brain-wiring problem. Indeed, "attention exerts real, physical effects on the dynamics of the brain"
183
and can direct neuroplasticity.
184
My attention, unlike my automatic urges to binge arising in my lower brain, was something I could control. Brain scans have shown that people can "willfully change the amount and quality of attention that they focus," and this, in turn, changes the brain.
185
I could willfully direct attention away from the urges—and onto anything, or on nothing at all—and this acted back on my brain to gradually erase my habit. This doesn't mean I was always able to completely shut the urges out of my awareness, but awareness is different than attention. For example, I am
aware
of lots of things going on around me right now as I type—music on the baby monitor, the humming of my refrigerator, an occasional drip from my leaky kitchen faucet—and I can be
aware
of random thoughts popping into my head about things I need to do; but I am not putting conscious effort into thinking about those things, I am not paying
attention
to those distractions. It was the same with my urges to binge. They were certainly in my awareness when I first quit, but I did not turn my mind toward them; and this is what I mean when I say I "stopped paying attention" to my urges.
SEPARATION TECHNIQUES ARE NOT NEW
Employing separation techniques in the treatment of eating disorders is not unique to this book. The idea of separating the true self from the eating disorder is rather common in the eating disorder community today and is used in some traditional therapies. Women with eating disorders often give their disorders names and personas of their own. Anorexics sometimes call their problem "Ana," bulimics call their disorder "Mia," and women with all types of eating disorders call their problem "Ed"—a play on the abbreviation for eating disorder (ED).
"Ed" has become more popular since the 2004 publication of
Life Without Ed,
by recovered anorexic and bulimic Jenni Schaefer. In the book, Schaefer describes how she pictured her eating disorder as an abusive husband named Ed living in her own head, whom she had to divorce in order to recover.
186
Others have called their bulimia "the Monster," picturing it as an evil brute living inside them.
Whether she calls it Ed, Ana, Mia, or the Monster, the woman envisions the creature/persona as separate from her true self. The creature/persona has a personality of its own. It has thoughts, feelings, and desires that are not normal or healthy and that supposedly cause the woman to perform eating disordered behaviors. In order to recover, the woman must defeat the creature/persona.
Although separation from the disordered thoughts and feelings of bulimia or BED is indeed desirable, there are five main problems with the way separation techniques are used today.
1. Current Separation Techniques Are Unrealistic