The Dr. Drew Response

Lately, I’ve been reading Dr. Drew’s latest book, “The Mirror Effect.”   It addresses celebrity narcissism and the extreme behavior that goes along with it. Dr. Drew does a great job at highlighting what has become typical tabloid material – multiple stints in rehab, sex tapes, drug use, eating disorders, etc. – and explaining the self-destructive pathology behind it.

Dr. Drew references troubling celebrity behavior over and over throughout the book. As I read, I found that most responses to this self-destructiveness fit in one of three categories (depending on one’s own background):

3 responses to troubling celebrity behavior:

1. Dr. Drew (empathetic / sympathetic)
2. “Regular” society (intrigued)
3. Relaters (Individuals with their own psychopathology)

The Dr. Drew Response

“As a group, however, [celebrities] often behaved in ways that unnerved and puzzled me.”

“…their behavior makes my heart ache for them.”

I’m coining this the Dr. Drew Response since I can’t think of any other word to better describes the reaction. His heart aches! He sees someone being self-destructive and he cares and feels their pain. It’s sympathy + knowledge + understanding + insight.

“Regular” society

“…this kind of behavior is portrayed as tragically glamorous, dramatically alluring, and, most alarmingly, normal and expected.”

A lot of people are interested in the self-destructive behavior of celebrities. It is a little bit of an obsession: Is Nicole Richie losing weight? Is Lindsay using? Is Amy Winehouse still alive? People want to know. The troubling behavior is intriguing and the press does a great job at, in essence, kicking celebrities when they’re down.

Relaters

“Witnessing such behavior also tends to provoke our own narcissistic impulses, causing us to feel envy, and tempting us to act like the celebrities we admire.”

“But for anyone who has experienced childhood trauma – the fundamental source of pathological narcissism – surrendering to such impulses can lead even mildly narcissistic people to spiral out of control with devastating results.”

Individuals with their own psychopathology or traumatic histories can be tempted (or even feel envious) by the self-destructive behavior of celebrities. There’s something triggering about it that makes these people want to engage in the same self-destructive behavior.

So there we go: In this world we have Dr. Drews, Regulars, and Relaters. I think that your response can change depending on the situation, and that it applies to anyone struggling – not just celebrities.

For example, I think about this girl who went to my college and was very obviously struggling with an eating disorder. “Regular” people would gossip about how sick she was. You’d hear the “I see her at the gym every single morning” and “I heard she eats a plate of broccoli for dinner” comments. Yes, it’s wrong and mean, but unfortunately that’s reality (at least on college campuses). Now, I was a Relater (struggling with an ED myself), so this girl kind of triggered me. I didn’t want to be that sick, but seeing her around campus would almost encourage my eating disorder; tempt me to cut corners, lose just 5 lb., eat a plate of broccoli for dinner, etc. That drove me CRAZY. I didn’t want to be a Relater – I wanted to be a Dr. Drew. I wanted to just empathize with her, wish she would get help, recognize how miserable she probably felt, and know how tough things were for her right now.

This is still a goal of mine: That Dr. Drew Response.

Alternative coping – a tough sell

I thought that these quotes would be especially appropriate after my series on coping skills.

Dr. Meredith Grey: In the hospital, we see addiction every day. It’s shocking, how many kinds of addiction exist. It would be too easy if it was just drugs and booze and cigarettes. I think the hardest part of kicking a habit is wanting to kick it. I mean, we get addicted for a reason, right? Often, too often, things that start out as just a normal part of your life at some point cross the line to obsessive, compulsive, out of control. It’s the high we’re chasing, the high that makes everything else fade away.

Dr. Meredith Grey: The thing about addiction is, it never ends well. Because eventually, whatever it is that was getting us high, stops feeling good, and starts to hurt. Still, they say you don’t kick the habit until you hit rock bottom. But how do you know when you are there? Because no matter how badly a thing is hurting us, sometimes, letting it go hurts even worse.

I’ve talked about this before, but I think that wanting to want to recover is a big roadblock in eating disorder treatment. Meredith explains it very well — we get addicted for a reason. The ED plays a role in our lives. You don’t go seeking an eating disorder… but for whatever reason (I’m sure largely biological), coping via food / exercise works for you. Restricting did give me some kind of a high, but more importantly it did make “everything else fade away.” Of course it didn’t SOLVE any issues… but it did somehow mask them and make them less important to me.

The eating disorder doesn’t “work” for me like it used to. It doesn’t give me that relief that I’m looking for. It doesn’t make stressors go away. 10 years ago, I felt some kind of sick accomplishment from restricting. Like somehow not eating made everything better. These days, maybe it deadens things a little bit, but largely it throws off my blood sugar and makes me feel like crap.

I’ll admit that for whatever reason, in many situations it’s still my first instinct to use the ED to cope. All the coping mechanisms I mentioned are attempts to replace the disorderedness with something healthier. But really, it takes three “healthy” coping mechanisms to offset one unhealthy one. The kudos chart is an everyday thing and a bad day might require coloring AND card shops.

I think a lot of people struggle with feeling like they still need their ED. Even if it is kinda ruining their lives and not working like it did in the past, they still feel like they won’t be able to deal without it. If you’re trying to replace that disorderedness with bubble baths and crafts — well, that’s a tough sell.

I’m not saying it’s not worth it or that EDs are just unhealthy coping skills… I’m just saying that recovery takes a lot of coping skills.  You burn some of them out (for instance, reading does not help me like it used to) and have to be creative and come up with new ones.  And sometimes they feel ridiculous.  Heck, I’m in my mid-20s and googling “print complicated coloring pages.”  My kudos chart is remarkably similar to the sticker chore chart that I had when I was seven.  I’m not sure any of this is “normal,” but hey, it helps.  Ridiculous or not — just go with it.

Economists and bulimia

I can’t remember the last time I saw “economist” and “bulimia” in the same headline — I usually don’t put the two together.  However, this article (Eating-Disorders Experts Challenge Economists’ Conclusions About Bulimia) made some pretty interesting statements:

1. Bulimia Nervosa (BN) is an addiction rather than an eating disorder
2. Black females are 50% more likely to be bulimic than white females
3. “Bulimic behavior” is less likely among wealthier, better-educated families.

You should definitely read the article, but I have a couple of things to add to these points:

1. BN is an addiction
I always compare eating disorders and addictions — but I still wouldn’t put BN and alcoholism in the same category.  There are several key differences:

1. Lack of an addictive substance: Addictions require you to be, well, addicted to something — alcohol, opiates, cocaine, etc.  With bulimia, there’s no addictive substance.  I don’t think you can even argue “food” as the addictive substance.
2. No healthy use for symptoms: Occasional purging is not okay or normal.  I’d argue that anyone who purges has an eating disorder (at least on some level).  However, there are appropriate uses for alcohol, opiates, and even cocaine.
3. Goals of treatment: With addictions, the goal is to abstain from the addictive substance.  However, you can’t abstain from food (maybe from purging, but again, that’s only half of it).
4. Psychopathology: “Addict thinking” is not really the same as “eating disorder thinking.”  Similar — but not the same.

2. BN more common in black females
I don’t have much to say about this one, except that I’m skeptical.  I don’t think EDs are limited to certain races, but I think that if you looked at the cultural make-up of treatment centers, you’d find this claim to be false.  Yes, this is measuring those in treatment vs. BN prevalence — and there is likely a difference — but not a 30%+ difference!

3. Bulimia less common in upper-class families
Similarly, I don’t think that BN has socioeconomic limitations…

If for no other reason, the article at least challenges the many ED stereotypes.  It’s curious to me that a) there is no reference to males with eating disorders and b) the study is unique to bulimia.  I’d be interested to see if authors found similar results with anorexia.

In tune with each other

I’ve been reading Dr. Drew’s book, “Cracked: Life on the Edge in a Rehab Clinic.” There are a million things that I could talk about concerning this book, so don’t be surprised if it’s referenced several times in future posts. Tonight, the following quote really caught my attention:

“Most believe [addicts] connect around a common experience of pain and powerlessness without the fear of exploitation. Their pain is so raw and tender that getting them to start the process requires them to be convinced that their pain will be understood. They’re all people with extreme trust issues, and the only people they’ve ever trusted are other addicts. They understand each other. (Interestingly, doctors have discovered that survivors of torture have similar reactions to treatment. They don’t open up unless they’re around others who’ve been through similar horrors, as though the pain of being misunderstood would be too great of a risk.)”

If you’ve ever been in ED treatment (or addiction / trauma treatment, I assume), you know that there’s something very different about the relationships that you form with other ED patients. You know all about their relationship issues and what they are / aren’t eating — but don’t know their last name. They might be thirty years older (or younger) than yourself or living a totally different lifestyle. Maybe they are completely opposite of the type of people that you usually hang out with, and if you met them in any other context you probably wouldn’t hit if off. But… despite all these differences, just their having an eating disorder makes it easier to talk with them than non-ED friends that you’ve had for years.

I have good friends, but the closest friends that I have are all people that I met in treatment. I just can’t open-up to other people in the same way that I can with them. Some of it is their ability to understand me — that definitely is a large part. My non-ED friends cannot relate to my frustration over food rituals. But I think it’s more than just their ability to empathize. Because they have an eating disorder (and were in treatment), it means they are the kind of person who you CAN talk to about this stuff. They have issues, too. I don’t know how some of my “regular” friends will respond to the stuff that I tell them… however, I do know that these ED friends are not going to invalidate my struggles. They aren’t going to think that I am ridiculous, and I don’t have to feel so ashamed. Dr. Drew explains it so well — “the pain of being misunderstood would be too great a risk.”