Authors: Kathryn Hansen
28
Brain over Binge, Step 5:
Get Excited
S
tep 5 was a bonus. It was a natural result of resisting my urges to binge; but little did I know, it actually served to speed along my brain changes. Praise, from others or from within, and enthusiasm for learning something new cement that learning on a physical level in the brain.
197
This is why we all naturally praise babies and children for their small feats. It not only makes them feel good, but it has a physical effect on their brains, making those accomplishments easier for the child to repeat in the future. It is the same with adults. In short, "Celebrating a new discovery increases the likelihood that it will be remembered."
198
I got excited every time I had thoughts and feelings encouraging me to binge and didn't act on them; every time I felt a craving without letting it lead me to the refrigerator; every time I had powerful urges to binge but remained detached and unaffected by them. I was
really
excited. My urges had consumed me for years, and all of a sudden, I had power over them. It felt as though I had been granted a brand-new life, even though nothing changed except my binge eating.
What I didn't know was that every time I got excited, I was focusing positive attention on my highest human brain's accomplishment. Since brain functions that are given attention and significance strengthen, and brain functions that are not given attention and significance weaken, it only makes sense that this would have sped along my brain changes. Focusing on the power of my highest human brain and congratulating myself for it served to strengthen new connections in the prefrontal parts of my brain and weaken the old ones in the automatic, lower parts of my brain.
No, I do not have scientific proof of my brain changes, as Schwartz had with his OCD patients. I do not have a PET scan of my brain before and after my recovery to illustrate exactly where and how these physical changes occurred. What I do have as evidence is my experience: I no longer have urges to binge. Thoughts, feelings, and urges don't arise out of nothing. Every moment of our experience is the result of neural activity,
199
and unless electrical signals from neurons fire across synapses, we don't experience sensations.
200
Since all sensations encouraging me to binge—all the thoughts, feelings, and urges—disappeared completely, I can only conclude it's because the neurons that once fired their electrical signals to produce those thoughts, feelings, and urges are no longer firing.
My "self-directed neuroplasticity, " as Schwartz labeled it in his OCD patients, was a real biological cure for my bulimia. My eating disorder is no longer wired into my brain. This doesn't mean I will never have an urge to binge in the future, because, as I'll discuss in the next chapter, it is possible for neurons to remember old patterns of activity. However, if my lower brain sends out an urge in the future, I will know exactly what to do: I will listen to it with detachment, and I won't react emotionally to it or act on it. Then, my habit can never develop again.
29
: Is Relapse a Possibility?
M
y urges to binge were the one and only cause of my binge eating, and my urges to binge are gone; therefore, I won't binge again. Due to my brain changes, it's doubtful that I'll ever feel an urge to binge again; however, it is certainly possible. I'm sure my lower brain remembers my past at some level and remains capable of producing urges; but that doesn't mean I'm at risk for relapse.
In order to relapse, I would have to not only experience an urge to binge, but choose to act on it. The cause of a relapse is the same as the cause of any binge eating episode: an urge to binge. Now that I know that my urges are the real problem, and now that I know how to deal with those urges, I have foolproof protection against relapse. To prevent relapse, all I have to do is never act on an urge to binge, ever.
Granted, if I did act on urges to binge one day, I could probably redevelop the habit of bulimia rather quickly. Just as an out-of-practice musician can begin to play much more easily than someone who has never played, I could probably reestablish my binge-created brain-wiring problem easier than someone who has never had bulimia. But to develop my habit again, I would have to choose to. My brain cannot reestablish old patterns of neural activity unless I willingly take action.
But why would I do that? Now that I have tasted freedom from my urges and compulsions, there is simply no chance that I would ever binge again. Now that I know my binge eating was never a way of coping with life, I will never let difficult life events turn into excuses for binge eating. Now that I know binge eating wasn't a symbolic way of fulfilling emotional needs, I will not delude myself into thinking I could find comfort in binge eating.
RELAPSE IN TRADITIONAL THERAPY
"Relapse after treatment is relatively common. "
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One study found a 35 percent relapse rate for bulimia.
202
In traditional therapy, relapse is often blamed on the failure of the patient to "recognize and confront any underlying issue."
203
The supposed reason for relapse often depends on which type of therapy is being used. For example, in psychodynamic therapy, relapse could potentially happen if the patient does not fully deal with shame from prior sexual abuse, and she binges to stuff down those shameful feelings that she can't deal with. From the perspective of cognitive behavioral therapy, relapse could happen if the patient's self-esteem is still shaky. If she fails in some way, such as getting fired from a job or stood up on a date, she could feel terrible about herself and binge to escape feelings of worthlessness. In addiction treatment, relapse could happen if the patient eats one of the foods she is supposedly powerless against, such as a piece of cake or something else containing white sugar.
In all of these examples, relapse supposedly happens because of an outside event or an inner conflict. Relapse is something that happens
to
you in traditional therapy, not something you bring upon yourself, not something you choose. This type of thinking only promotes relapse. The truth is, relapse doesn't happen because of inner emotional turmoil, stressful life events, or eating a piece of cake. Relapse is a choice.
I've been through plenty of hard times since I recovered, and not once did I consider binge eating. I've also been through plenty of happy times since then, and not once did I consider binge eating. Because I separated my bulimia from my other problems and all life events, nothing causes me to contemplate binge eating. My eating disorder will not spring up again, catching me off guard, throwing me into the abyss of uncontrollable bingeing and purging.
If one day I happen to hear an old thought or feel an old feeling encouraging me to binge eat, I can say,
No thanks, brain, I don't binge anymore,
and go about my day. It won't matter when the urge occurs, it won't matter what I'm feeling at the time, and it won't matter what problems I may be dealing with—I simply won't act on it.
Another insurance I have against relapse is that the factors that originally caused my urges to binge when I was a teenager—dieting, strong survival instincts, and incomplete development of my prefrontal cortex—no longer exist. I don't diet anymore, and even if I did, my survival instincts would not be as strong as they were when I was younger. Furthermore, if I did choose to diet, my prefrontal cortex would be better able to override those survival instincts, because it is now fully developed. At nearly 30 years of age, dieting simply wouldn't cause the same biological havoc in me that it did when I was 16. I will talk much more about dieting and eating normally in Chapters 31 and 32. The bottom line is: nothing can make me relapse besides free choice—not survival instincts, not neurological remnants of my old habit, not life stress, not character flaws, not emotional issues.
Now that I know what my bulimia was all about and how I was able to recover, I am free to move on with my life, knowing that I will never again become bulimic.
30
: Where I Am Today
I
n therapy, I often feared recovery because I worried about what was to come after my bulimia ended. I thought I had to be something great after recovery—fulfilled, confident, successful, spiritual, and capable of dealing with anything life threw my way. My lower brain often used this idea to create excuses to binge. On days when I didn't binge yet still had a bad day for reasons wholly unrelated to eating, I heard thoughts like these:
I didn't binge, and my day wasn't any better than if I had, so what's the point of quitting? ... I'll never amount to anything, so I might as well keep binge eating.... Life is too hard anyway, so there isn't any reason to recover.
Looking back over my old journals, I see multiple lists of "Reasons to Recover" containing lofty ambitions like, "I can fully give myself to someone else (be in love)," "I can find a fulfilling career," "I can live peacefully in the moment," "I can be confident and fully accept myself and my body." However, no amount of envisioning my transformation could convince my lower brain that recovery was better than binge eating. Eventually, I had to accept that I needed to recover, whether or not I'd be better off afterward. I had to do as
Rational Recovery
suggested and "simply quit [my] addiction, now and for good, and let the chips fall where they may."
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Turns out, my life
is
much better after recovery, but not because I'm always happy or fulfilled, and not because I've accomplished spectacular things. My life is better simply because I stopped a shameful, time-consuming, expensive, health-sabotaging, and life-draining habit. I haven't binged in over five years, and my life is not perfect by far—it certainly isn't like the recovery I envisioned in my journals. I can't tell you I am emotionally and spiritually fulfilled or completely happy in every aspect of my life. I can't tell you I eat a perfectly healthy and balanced diet, keep a consistent exercise routine, and love my body, because that would be pure exaggeration.
My recovery was not the butterfly tale I talked about at the start of this book. But I can say that stopping my bulimia has brought me a long way toward becoming the person I want to be. Stopping my habit has given me more confidence, more strength, and most importantly, more control over my life than I ever could have imagined just a handful of years ago. I am thankful every day that I no longer binge and no longer have to spend my days at the gym. I am also thankful that I don't have to work on my recovery one day at a time. My recovery is over, and there is nothing I have to do to maintain it—no meal plans, no support groups, no counseling to cope with life to prevent me from returning to binge eating.
Stopping my habit has given me the chance to have a real life. I have a wonderful husband and my three beautiful and loving children— Maximilian Thomas, Amelia Eden, and my new baby girl who I have yet to meet—who keep me laughing, very busy, and often very tired. The possibility of becoming a mother seemed unfeasible during the years I was bulimic, because I was so caught up in my own problems that I couldn't give much to anyone else. Now, although I struggle with the everyday stress of being a parent, I am able to care for my family without my disorder draining my energy, my time, and my spirit. I am able to pursue goals, nurture relationships, and simply perform my daily activities as a stay-at-home mom without constantly having to worry about whether or not I will binge.
Life isn't easy, and if I still believed I binged to cope, I could find lots of excuses in my life. I feel quite alone raising our children much of the time, as my family and Greg's family live far away and Greg's work takes up a great deal of his time. I miss my parents, my sister—who I've become very close to again as we've entered motherhood—and her three children, but right now living near them is not possible. I feel a great deal of anxiety in my home because we live in a high-crime area, and I don't have many friends where we live. Granted, these are rather ordinary problems, but I'm sure if I were still bulimic, my lower brain could find lots of "poor me" stories to tempt me to binge.
One of the more difficult things that happened to me came only a few months after I stopped binge eating. My childhood home, which my parents still lived in at the time, was destroyed by Hurricane Katrina. Of course, the most important thing was that my parents were all right, because ultimately, material things can be replaced. Still, it was a difficult time for us and many of my family members and friends who lived in the New Orleans area and lost so much. However, it was very different to experience a major life event without it having any implications on bulimia. There was nothing special I had to do to cope with the crisis to prevent binge eating, because my binge eating was over.
I simply coped the best way I knew how. A week after the storm, Greg and I requested leave from work, loaded up our car with supplies, and drove 1,500 miles across the country to help my parents. In my bulimic days, this would have been a very "dangerous" situation in that, when we were in Louisiana, we didn't know where our next meal would come from and we didn't have much control over what we ate. A local charity organization provided food for our community, and there was no choice in what was served and when it was served. Prior to quitting, this would have caused me a lot of stress; but after recovery, I was able to accept whatever food was given with nothing but gratitude.
My parents had about six feet of water in their one-story house, so we had to throw out just about everything. It was a surreal feeling to see all the things I'd grown up with in a huge, wet, dirty pile in our front yard. I saw the pain on my parents' faces as we worked, knowing how much effort and love they had put into that house over the years. I didn't quite know what to say, so I quietly carried load after load of moldy drywall out of the house in a wheelbarrow and dumped it on the pile.
At one point, my dad and Greg had to cut a hole in a kitchen wall to remove the refrigerator—one I had binged from countless times. As they lowered it into the garage, it began to leak, and there is nothing I could say that would accurately describe the horrible odor that came from it. They quickly put it down, and we all ran as far away from the house as possible to escape the smell. As I looked at the refrigerator in the garage, I thought about how I once thought the food in it was laden with symbolic meaning in my life. I once believed it held my emotions, my pain, my inadequacies, our family conflicts; and now all its contents were spilling out on the ground in a putrid mess. I could finally see food for what it was: just food—nothing more, nothing less.
I might have had an urge to binge while I was helping with cleanup efforts in Louisiana, but honestly, I don't really remember because other memories of that time are much more prominent. If I did experience any remnants of my binge-created brain-wiring problem, I was able to ignore them and perform the work at hand. As Greg and I drove back to Phoenix, we traveled the same route that my dad and I had taken when I first moved there a year and a half prior. I remembered, while on that drive with my dad, I had been anxious about binge eating and wondering how I would ever recover.
Now I was traveling the same road and fully recovered, even if the urges to binge hadn't fully tapered off yet. The drive this time was much more like when I drove to meet Greg while I was on Topamax, in that I may have had other problems and life may have been difficult, but I was suddenly free to other possibilities. This time, my freedom was all of my own making. I didn't know the full extent of it at the time, but by taking control and changing my behavior, I was physically changing my brain—erasing the very neural pathways that had kept me trapped for so long. I was becoming normal again—flaws and all.
In the next section, I'll explain a little more about what my life is like today as I address topics often discussed in traditional therapy, like self-esteem, poor body image, coping with problems, and triggers. By talking about these topics and things like purging, medication, and prevention, I hope to present a new view of these issues that is more conducive to recovery.