As I read this, I couldn't make up my mind whether the sheltering was a good thing or not. I guess as an adult you would want to decide what you can and cannot handle, but I imagine the docs at the facility had a hard choice and may have erred on the side of caution. Psychiatric medicine is still such an inexact science in so many ways. For all they knew, that trauma could have pushed one of you over the edge. This is a most unique 9/11 experience, and very well told.

This was an important recollection to share. Thanks for doing it. R

"What I do know is that when it comes to 9/11 I will always feel a step behind because I was absent from the first month of full disclosure; the events, the newscasts, the horrible images, the commentaries."
excuse me-- you wish you had felt the full impact of the horror and media madness? its all in how you look at it, isnt it? maybe the shielding was a blessing that the rest of the world could have benefitted from. on that day, it would seem, everything outside of your psych ward was crazier than what was inside of it.

the head psychiatrist told you the salient details, and I commend him for his choice & difficult judgement call of truth and brevity at the same time.

" And I was angry that we were being treated like children, protected, and shielded from the world. "
uh huh. maybe someday when you're fully sane, you'll understand how fundamental that is. the psych ward is designed to be exactly like that even *without* the events of 911. and you got there on your own free will/volition, didnt you? so you are exactly like the child that complains that the consequences of its own actions are unpalatable.

Gerri, I rated this yesterday but wanted to think about it before commenting. I think that healing would have been incredibly difficult with this on the television 24/7 as it was in most of our homes and places of work. I am hesitant when I express how this day affected me especially since I did not lose a loved one. Almost as if I feel, "what gives me the right?" But I know that even those who did not directly lose someone that day lost parts of themselves that were hard to recover. And the sadness we felt for those who did... I know that I was a mess. And I was in my own home. So perhaps, the less information you received for that time was a good thing. Thank you for writing this.~r

It is clear from a couple of comments posted here how far we still have to go when it comes to understanding and having compassion for mental illness.

Thank you Joan for your understanding and your empathy.

I'm pretty acerbic myself, but Tom is downright rude. Compulsions come from a very deep part of the brain, way below the level of conscious thought, so the idea that anorexia is a conscious decision, as if anyone would choose that behavior voluntarily, seems ridiculous to me. Even if it were true, it's simply impolite to tell a sufferer that she's the cause of her own dis-ease. For sure, some anorexics are anorexic because they are concerned about body image, but that's before the body becomes hooked on the behavior, after which purging becomes a matter of necessity rather than choice.

Tom - these are for you. I feel nothing but disgust at your obvious ignorance. I hope you take the time to educate yourself.

Reprinted from several different articles on www.healthyplace.com
(eating disorder section)

Examination on the impact of the environment on the activation of personality traits displayed in humans, while offering the views of Walter Kaye and Wade Berrettini, who are conducting studies on genes that predispose some persons to anorexia and bulimia. Occurrence of anorexiabulimia during the 17th, 16th and 19th centuries; Role of deoxyribonucleic acid (DNA) in detecting the cause of eating disorders in individuals. and

On any list of the dark side of modern culture, anorexia and bulimia would rank high. But a radical view holds that while binging, purging, and starving behaviors may be new, the groundwork for them is as old as mankind itself.

Current environmental triggers have activated hard-wired personality traits, contend Waiter Kaye, M.D., and Wade Berrettini, M.D., Ph.D., who are leading a search for the genes that predispose some people to anorexia and bulimia.

Accounts from the 17th, 18th, and 19th centuries show that anorexia is not just a modern disease, says Berrettini, professor of psychiatry at the University of Pennsylvania. Still, the risk of eating disorders has doubled in American women born after 1960. Since genes don't evolve that quickly, social factors must weigh in.

Indeed, Kaye and Berrettini believe that cultural messages about weight interact with inherited characteristics to produce anorexia or bulimia. "Sufferers tend to have certain vulnerabilities," says Kaye, professor of psychiatry at the University of Pittsburgh. "They are obsessed with perfection."
Once, this predisposition may have remained dormant. "There may be times in history where people had genes for these traits and didn't develop a disorder, due to a low-stress environment," says Kaye.

These genes might also have been expressed in other ritualistic behaviors. But our culture's emphasis on thinness has given women an all too ideal outlet for perfectionist drives.

Kaye and Berrettini are collecting the DNA of women whose families have two or more relatives with eating disorders. Berrettini expects to identify at least one of the genes by the year's end. Their research may allow them to pinpoint those at risk and may lead to better treatments.



How Personalities, Genetic and Environmental Factors and Biochemistry Combine to Cause Eating Disorders

Written by Lee Hoffman

Dec 25, 2008


In trying to understand the causes of eating disorders, scientists have studied the personalities, genetics, environments, and biochemistry of people with these illnesses. As is often the case, the more that is learned, the more complex the roots of eating disorders appear.

Personalities
Most people with eating disorders share certain personality traits: low self-esteem, feelings of helplessness, and a fear of becoming fat. In anorexia, bulimia, and binge eating disorder, eating behaviors seem to develop as a way of handling stress and anxieties.
People with anorexia tend to be "too good to be true." They rarely disobey, keep their feelings to themselves, and tend to be perfectionists, good students, and excellent athletes.

Some researchers believe that people with anorexia restrict food -- particularly carbohydrates -- to gain a sense of control in some area of their lives. Having followed the wishes of others for the most part, they have not learned how to cope with the problems typical of adolescence, growing up, and becoming independent.


Controlling their weight appears to offer two advantages, at least initially: they can take control of their bodies and gain approval from others. However, it eventually becomes clear to other that they are out-of-control and dangerously thin.


People who develop bulimia and binge eating disorder typically consume huge amounts of food -- often junk food -- to reduce stress and relieve anxiety. With binge eating, however, comes guilt and depression. Purging can bring relief, but it is only temporary. Individuals with bulimia are also impulsive and more likely to engage in risky behavior such as abuse of alcohol and drugs.


Genetic and environmental factors
Eating disorders appear to run in families -- with female relatives most often affected. This finding suggests that genetic factors may predispose some people to eating disorders; however, other influences -- both behavioral and environmental -- may also play a role. One recent study found that mothers who are overly concerned about their daughters' weight and physical attractiveness may put the girls at increased risk of developing an eating disorder. In addition, girls with eating disorders often have father and brothers who are overly critical of their weight.
Although most victims of anorexia and bulimia are adolescent and young adult women, these illnesses can also strike men and older women. Anorexia and bulimia are found most often in Caucasians, but these illnesses also affect African Americans and other racial ethnic groups. People pursuing professions or activities that emphasize thinness -- like modeling, dancing, gymnastics, wrestling, and long-distance running -- are more susceptible to the problem. In contrast to other eating disorders, one-third to one-fourth of all patients with binge eating disorder are men.
Preliminary studies also show that the condition occurs equally among African Americans and Caucasians.



Biochemistry
In an attempt to understand eating disorders, scientists have studied the biochemical on the neuroendocrine system -- a combination of the central nervous and hormonal systems. Through complex but carefully balanced feedback mechanisms, the neuroendocrine system regulates sexual function, physical growth and development, appetite and digestion, sleep, heart and kidney function, emotions, thinking, and memory--in other words, multiple functions of the mind and body. Many of these regulatory mechanisms are seriously disturbed in people with eating disorders.
In the central nervous system -- particularly the brain -- key chemical messengers known as neurotransmitters control hormone production. Scientists have found that the neurotransmitters serotonin and norepinephrine function abnormally in people affected by depression. Recently, researchers funded by NIMH have learned that these neurotransmitters are also decreased in acutely ill anorexia and bulimia patients and long-term recovered anorexia patients. Because many people with eating disorders also appear to suffer from depression, some scientists believe that there may be a link between these two disorders. In fact, new research has suggested that some patients with anorexia may respond well to the antidepressant medication fluoxetine which affects serotonin function in the body.

People with either anorexia or certain forms of depression also tend to have higher than normal levels of cortisol, a brain hormone released in response to stress. Scientists have been able to show that the excess levels of cortisol in both anorexia and depression are caused by a problem that occurs in or near a region of the brain called the hypothalamus.

In addition to connections between depression and eating disorders, scientists have found biochemical similarities between people with eating disorders and obsessive-compulsive disorder (OCD). Just as serotonin levels are known to be abnormal in people with depression and eating disorders, they are also abnormal in patients with OCD.
Recently, NIMH researchers have found that many patients with bulimia have obsessive-compulsive behavior as severe as that seen in patients actually diagnosed with OCD. Conversely, patients with OCD frequently have abnormal eating behaviors.

The hormone vasopressin is another brain chemical found to be abnormal in people with eating disorders and OCD. NIMH researchers have shown that levels of this hormone are elevated in patients with OCD, anorexia, and bulimia. Normally released in response to physical and possibly emotional stress, vasopressin may contribute to the obsessive behavior seen in some patients with eating disorders.

NIMH-supported investigators are also exploring the role of other brain chemicals in eating behavior. Many are conducting studies in animals to shed some light on human disorders. For example, scientists have found that levels of neuropeptide Y and peptide YY, recently shown to be elevated in patients with anorexia and bulimia, stimulate eating behavior in laboratory animals. Other investigators have found that cholecystokinin (CCK), a hormone known to be low in some women with bulimia, causes laboratory animals to feel full and stop eating. This finding may possibly explain why women with bulimia do not feel satisfied after eating and continue to binge.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH).



Eating Disorder Behaviors Are Adaptive Functions

Written by Carolyn Costin


Dec 01, 2008 A + A - RESET


Page 1 of 3


The Obsession: Reflections on the Tyranny of Slenderness

A struggling will, an insecure feeling, and despair may manifest themselves in problems with the care and feeding of the body but are fundamentally a problem with the care and feeding of the soul. In her aptly titled book The Obsession: Reflections on the Tyranny of Slenderness , Kim Chernin has written, "The body holds meaning . . . when we probe beneath the surface of our obsession with weight, we will find that a woman obsessed with her body is also obsessed with the limitations of her emotional life. Through her concern with her body she is expressing a serious concern about the state of her soul."
What are the emotional limitations commonly seen in individuals with eating disorders? What is the state of their souls?

COMMON STATES OF BEING FOR THE EATING DISORDERED INDIVIDUAL
• Low self-esteem No Iframes
• Diminished self-worth
• Belief in the thinness myth
• Need for distraction
• Dichotomous (black or white) thinking
• Feelings of emptiness
• Quest for perfection
• Desire to be special/unique
• Need to be in control
• Need for power
• Desire for respect and admiration
• Difficulty expressing feelings
• Need for escape or a safe place to go
• Lack of coping skills
• Lack of trust in self and others
• Terrified of not measuring up

The scope of this book does not allow a detailed analysis of every possible reason or theory that could explain the development of an eating disorder. What the reader will find is this author's overview explanation, which involves the discussion of common underlying issues observed in patients. Additional information on the development and treatment of eating disorders from varying theoretical viewpoints can be found in chapter 9 on treatment philosophies.

Eating disorder symptoms serve some kind of purpose that goes beyond weight loss, food as comfort, or an addiction, and beyond a need to be special or in control. Eating disorder symptoms can be seen as behavioral manifestations of a disordered self, and through understanding and working with this disordered self the purpose or meaning of the behavioral symptoms can be discovered.
In trying to understand the meaning of someone's behavior, it is helpful to think of the behavior as serving a function or "doing a job." Once the function is discovered, it becomes easier to understand why it is so difficult to give it up and, furthermore, how to replace it. When exploring deep within the psyche of eating disordered individuals, one can find explanations for a whole series of adaptive functions serving as substitutes for the missing functions that should have been, but weren't, supplied in childhood.
Paradoxically, then, an eating disorder, for all of the problems it creates, is an effort to cope, communicate, defend against, and even solve other problems. For some, starving may be in part an attempt to establish a sense of power, worth, strength and containment, and specialness because of inadequate mirroring responses, such as praise, from caregivers.

Bingeing may be used to express comfort or to numb pain, due to a developmental deficit in the ability to self-soothe. Purging may serve as an acceptable physiological and psychological release of anger or anxiety if the expression of one's feelings in childhood was ignored or led to ridicule or abuse. Eating disorder symptoms are paradoxical, in that they can be used as an expression of and defense against feelings and needs. The symptoms of eating disorders can be seen as a repression or punishment of the self, or as a way of asserting the self, which has found no other way out.
Here are some examples of how these behaviors fill emotional needs:
• An expression of and defense against early childhood needs and feelings. It's too scary to need anything, I try not to even need food.
• Self-destructive and self-affirming attitudes. I will be the thinnest girl at my school, even if it kills me.
• An assertion of self and a punishment of self. I insist on eating whatever and whenever I want, even though being fat is making me miserable . . . I deserve it.
• Used as cohesive functions, psychologically holding the person together. If I don't purge I'm anxious and distracted. After I purge I can calm down and get things done.
The development of an eating disorder can begin early in life when childhood needs and mental states are not properly responded to by caregivers and thus get disowned, repressed, and shunted off into a separate part of a person's psyche. The child develops deficits in his or her capacities for self-cohesion and self-esteem regulation. At some point in time, the individual learns to create a system whereby disordered eating patterns, rather than people, are used to meet needs because previous attempts with caregivers have brought about disappointment, frustration, or even abuse.

Page 2 of 3

For example, caregivers who do not properly comfort and soothe their babies, allowing them to eventually learn how to comfort themselves, create lacks in their children's ability to self-soothe. These children grow up needing to seek abnormal amounts of external comfort or relief. Caregivers who do not accurately listen, acknowledge, validate, and respond make it difficult for a child to learn how to validate himself. Both of these examples could result in:
• a distorted self-image (I am selfish, bad, stupid)
• no self-image (I don't deserve to be heard or seen, I don't exist)
Disruptions or deficits in self-image and self-development make it increasingly difficult for people to function as they grow older. Adaptive measures are developed, the purpose of which is to make the individual feel whole, safe, and secure. With certain individuals, food, weight loss, and eating rituals are substituted for responsiveness from caregivers. Perhaps in other eras different means were sought as substitutes, but today turning to food or dieting for validation and acknowledgment is understandable in the context of the sociocultural factors described in the previous chapter.

Personality development is disrupted in persons with eating disorders, as eating rituals are substituted for responsiveness and the usual developmental process is arrested. The early needs remain sequestered and cannot be integrated into the adult personality, thus remaining unavailable to awareness and operating on an unconscious level.

Some theorists, including this author, view this process as if, to a greater or lesser degree in each individual, a separate adaptive self is developed. The adaptive self operates from these old sequestered feelings and needs. The eating disorder symptoms are the behavioral component of this separate, split-off self, or what I have come to call the "eating disorder self." This split-off, eating disorder self has a special set of needs, behaviors, feelings, and perceptions all dissociated from the individual's total self-experience. The eating disorder self functions to express, mitigate, or in some way meet underlying unmet needs and make up for the developmental deficits.

The problem is that the eating disorder behaviors are only a temporary Band-Aid and the person needs to keep going back for more; that is, she needs to continue the behaviors to meet the need. Dependency on these "external agents" is developed to fill the unmet needs; thus, an addictive cycle is set up, not an addiction to food but an addiction to whatever function the eating disorder behavior is serving. There is no self-growth, and the underlying deficit in the self remains. To get beyond this, the adaptive function of an individual's eating and weight-related behaviors must be discovered and replaced with healthier alternatives. The following is a list of adaptive functions that eating disorder behaviors commonly serve.


ADAPTIVE FUNCTIONS OF EATING DISORDERS
• Comfort, soothing, nurturance
• Numbing, sedation, distraction
• Attention, cry for help
• Discharge tension, anger, rebellion
• Predictability, structure, identity
• Self-punishment or punishment of "the body"
• Cleanse or purify self
• Create small or large body for protection/safety
• Avoidance of intimacy
• Symptoms prove "I am bad" instead of blaming others (example, abusers)

Treatment involves helping individuals get in touch with their unconscious, unresolved needs and providing or helping to provide in the present what the individual was missing in the past. One cannot do this without dealing directly with the eating disorder behaviors themselves, as they are the manifestation of and the windows into the unconscious unmet needs. For example, when a bulimic patient reveals that she binged and purged after a visit with her mother, it would be a mistake for the therapist, in discussing this incident, to focus solely on the relationship between mother and daughter.


The therapist needs to explore the meaning of the bingeing and purging. How did the patient feel before the binge? How did she feel before the purge? How did she feel during and after each? When did she know she was going to binge? When did she know she was going to purge? What might have happened if she didn't binge? What might have happened if she didn't purge? Probing these feelings will provide rich information concerning the function the behaviors served.


When working with an anorexic who has been sexually abused, the therapist should explore in detail the food-restricting behaviors to uncover what the rejection of food means to the patient or what the acceptance of food would mean. How much is too much food? When does a food become fattening? How does it feel when you take food into your body? How does it feel to reject it? What would happen if you were forced to eat? Is there a part of you that would like to be able to eat and another part that won't allow it? What do they say to each other?


Exploring how acceptance or rejection of food may be symbolic of controlling what goes in and out of the body is an important component of doing the necessary therapeutic work. Since sexual abuse is frequently encountered when dealing with eating disordered individuals, the whole area of sexual abuse and eating disorders warrants further discussion.

Page 3 of 3

SEXUAL ABUSE
A controversy has long been brewing about the relationship between sexual abuse and eating disorders. Various researchers have presented evidence supporting or refuting the idea that sexual abuse is prevalent in those with eating disorders and can be considered a causal factor. Looking at the current information, one wonders if early male researchers overlooked, misinterpreted, or downplayed the figures.

In David Garner and Paul Garfinkel's major work on treating eating disorders published in 1985, there were no references to abuse of any nature. H. G. Pope, Jr. and J. I. Hudson (1992) concluded that evidence did not support the hypothesis that childhood sexual abuse is a risk factor for bulimia nervosa. However, on close examination, Susan Wooley (1994) called their data into question, referring to as highly selective. The problem with Pope and Hudson, and many others who early on refuted the relationship between sexual abuse and eating disorders, is that their conclusions were based on a cause-and-effect link. No Iframes
Looking only for a simple cause-and-effect relationship is like searching with blinders on. Many factors and variables interacting with one another play a role. For an individual who was sexually abused as a child, the nature and severity of the abuse, the functioning of the child prior to the abuse, and how the abuse was responded to will all factor in as to whether this individual will develop an eating disorder or other means of coping. Although other influences need to be present, it is absurd to say that just because the sexual abuse is not the only factor, it is not a factor at all.

As female clinicians and researchers increased on the scene, serious questions began to be raised regarding the gender-related nature of eating disorders and what possible relationship this might have abuse and violence against women in general. As the studies increased in number and the investigators were increasingly female, the evidence grew to support the association between eating problems and early sexual trauma or abuse.

As reported in the book Sexual Abuse and Eating Disorders, edited by Mark Schwartz and Lee Cohen (1996), systematic inquiry into the occurrence of sexual trauma in eating disorder patients has resulted in alarming prevalence figures:
Oppenheimer et al. (1985) reported sexual abuse during childhood and/or adolescence in 70 percent of 78 eating disorder patients. Kearney-Cooke (1988) found 58 percent a history of sexual trauma of 75 bulimic patients. Root and Fallon (1988) reported that in a group of 172 eating disorder patients, 65 percent had been physically abused, 23 percent raped, 28 percent sexually abused in childhood, and 23 percent maltreated in actual relationships. Hall et al. (1989) found 40 percent sexually abused women in a group of 158 eating disorder patients.
Wonderlich, Brewerton, and their colleagues (1997) did a comprehensive study (referred to in chapter 1) that showed childhood sexual abuse was a risk factor for bulimia nervosa. I encourage interested readers to look up this study for details.
Although researchers have used varying definitions of sexual abuse and methodologies in their studies, the above figures show that sexual trauma or abuse in childhood is a risk factor for developing eating disorders. Furthermore, clinicians across the country have experienced countless women who describe and interpret their eating disorder as connected to early sexual abuse.

Anorexics have described starving and weight loss as a way of trying to avoid sexuality and thus evade or escape sexual drive or feelings or potential perpetrators. Bulimics have described their symptoms as a way of purging the perpetrator, raging at the violator or oneself, and getting rid of the filth or dirtiness inside of them. Binge eaters have suggested that overeating numbs their feelings, distracts them from other bodily sensations, and results in weight gain that "armors" them and keeps them unattractive to potential sexual partners or perpetrators.

It is not important to know the exact prevalence of sexual trauma or abuse in the eating disorder population. When working with an eating disordered individual, it is important to inquire about and explore any abuse history and to discover its meaning and significance along with other factors contributing to the development of disordered eating or exercise behaviors.
With more women in the field of eating disorder research and treatment, the understanding of the origins of eating disorders is shifting. A feminist perspective considers sexual abuse and trauma of women as a social rather than an individual factor that is responsible for our current epidemic of disordered eating of all kinds. The subject calls for continued inquiry and closer scrutiny.
Considering the cultural and psychological contributions to the development of an eating disorder, one question remains: Why don't all people from the same cultural environment, with similar backgrounds, psychological problems, and even abuse histories develop eating disorders? One further answer lies in genetic or biochemical individuality.

By Carolyn Costin, MA, M.Ed., MFCC WebMD Medical Reference from "The Eating Disorders Sourcebook"



Tom - now what do you think?

I do sympathisize with your situation but nevertheless the level of narcissism in this post is almost beyond the pale. VZN has some good points

Gerri:

I always enjoy your storytelling and that you are so willing to share very personal experiences. I feel like I'm included in a very personal dialog and I like that.

That said, I find it hard to stay in a room where so much combat happens. You seem to attract roaming attack dogs with a vengeance. That's no big deal because it’s their issues and problems but the ensuing word duels detract from the immersion in and enjoyment of your work, The side show makes so much noise that it drown out the music in the main tent.

You shouldn't change anything about which you write. It's always fascinating and delightfully intimate but the heckling and the heckling of the heckling is intolerable. It spoils the reading. The response to the more critical and inflammatory comments by you (and others hunkering for a fight) is too distracting.

Please consider turning off your comments and let your work play as a solo act without a lot of resulting chaff billowing out the bottom.

Chronic complainers won’t usually comment if they can’t be read. Let whatever combat happens, take place in private mail.

Then I can go back and reread this post without the WWII soundtrack.

---Gary

Thank you for your piece and the highly personal reflection, Gerri. Judgement via faceless commentary apparently comes so easily for those who know little. Shake it all off, my dear. Personally, I think you should feel very free to manage your comments and delete those by folks so obviously consumed with hostility and so eager to waste their time fighting with people whose journeys they cannot begin to understand. Thank you for your writing. Love to you, my dear.

This is one of the most interesting of the 9/11 stories I've read, and it was such an all-encompassing event that I still find it hard to picture being sheltered from it. It reminded me of one of the more bizarre 9/11 stories: The reality-TV show "Big Brother" was filming then and they isolate their "contestants" from the real world. On 9/11, the producers debated whether to reveal the facts to the players, and decided that, since at least one of them had family in New York, to give them a limited revelation, as the hospital staff did to you. In the show's case, it sounded pompous and self-important; the hospital staff may have had more justification.