Brain Over Binge Page 8

  I'd attended a few OA meetings and read some of the OA literature. But OA hadn't felt right to me, mainly because the group advocated a very strict diet that excluded all white flour and sugar. I knew that restricting food groups, like fats and sweets, had helped develop my problem in the first place, so more restriction wasn't the answer for me. Certainly, I wanted to stop bingeing on sugar, white flour, and many other things, but I didn't want to stop eating them altogether.

  OA, as I understood it, asserted that eliminating those food groups was necessary because overeating was a disease that caused one to lose control when eating white flour and sugar. OA's position seemed to be that the disease could never be fully cured, only managed by eliminating the problem foods. I already disliked being on a meal plan—which I thought was necessary for my recovery—and I especially didn't like the idea of a meal plan that excluded foods I really liked. I found the OA members to be very nice, but the meetings were discouraging to me. No one in the group, except the moderator, seemed to have had much success with remaining abstinent from problem foods or giving up overeating.

  OA was also unappealing to me because of what I thought was a religious overtone. OA does not claim to be religious, but I interpreted the "Higher Power" to mean God—the Judeo-Christian God that I learned about as a child. I had turned to God for help with my bulimia in my freshman year of college, but it didn't help. I had naively expected God to take away my desire to binge, but eventually, I came to believe that God does not do favors; and although people can derive strength from spirituality and prayer, we ultimately have to help ourselves. By the time college ended, I struggled to have any belief at all and saw religion as primarily an academic pursuit. OA, then, seemed like the wrong fit for me.

  Because of my lack of interest in OA, I was very interested when I found Rational Recovery (RR). Since the book claimed to be an alternative to AA, maybe it could be an alternative to OA as well, I thought. One sentence on the back cover caught my attention. It explained that RR disagreed with the idea of alcoholism as a disease and could give hope to those whom traditional treatment fails. This simple synopsis was enough to make me want to buy the book. Even if it turned out to be useless, at least it would distract me during the many hours on the treadmill, stair climber, and stationary bike. I purchased the book and drove to the gym.

  RR did much more than distract me from my workout. In fact, it did more to help me than anything else I'd tried before over the years. RR finally made me take full responsibility for my binge eating, then taught me how to do something about it—something specific and targeted to my real problem. I didn't know it at the time, but the ideas in that book would lead me to complete recovery from bulimia.

  10: My Two Brains

  Within five minutes of starting my workout, Rational Recovery in hand, I learned the book's central tenet: anyone can recover from alcoholism or another addiction whenever they want, without treatment. The author, clinical social worker Jack Trimpey, believes that AA does a disservice to alcoholics by promoting the disease concept: the idea that drinking is not under an alcoholic's control, but a chronic disease. The author points out that society at large also embraces this disease concept of addiction, which only encourages and excuses addiction by failing to foster individual responsibility.

  Trimpey explains how he once shared AA's and society's view of alcoholism and how this only served to help him avoid responsibility for stopping his destructive behavior:

  I believed that my desire to drink was irresistible, and that my own moment-by-moment drinking behavior was a symptom of something unknown and beyond my control. I sincerely believed it would take something besides my own critical judgment and self-control to take care of the problem. ... I surrendered to a highly gratifying belief that I drank for hidden causes and would need outside help of some kind to stop.21

  When I read this, I immediately recognized that Trimpey's former beliefs about his alcoholism were quite similar to my beliefs about my bulimia. Like him, I believed that my binge eating had hidden causes and was a symptom of deeper problems. I decided to read Trimpey's words again using a technique I'd learned from my brief experience in OA. I replaced the word drink in the text with the word eat. OA members perform this word substitution when they read material originally meant for alcoholics, like the 12 steps and the Big Book.

  Read that way, it was as if the passage came straight from my own experience in therapy. An eating disorder is different from an alcohol or drug addiction, but the similarities are plentiful. Whether someone is addicted to binge eating, drugs, alcohol, or any other vice, that person wants to quit but continues to drink/use/binge despite efforts to stop. Furthermore, the act of binge eating, the feeling of pleasure, the relief from desire, and the numbing effect of large amounts of sugar and fat can certainly be as reinforcing as the effects of alcohol.

  I decided to read the rest of the book using the word substitution; however, I decided that for me, it was more useful to substitute the words binge eat for drink and bulimic for alcoholic (OA members traditionally replace alcoholic with compulsive overeater). I will use this word substitution throughout this chapter and any other time I refer to RR, even though I realize that substituting binge eating/bulimic for drinking/alcoholic does not create a perfect analogy.

  As I read further, I began to think about my own treatment and how I'd come to believe that I was flawed, defective, and not in control of my own binge eating. I thought about how I believed I ate because of my depression, anxiety, and low self-esteem. I thought back to my first experience in therapy when I was 16, when I'd first encountered the disease concept of an eating disorder. I remembered the therapist telling me that my dieting and eating behaviors were merely symptoms of more difficult problems and part of an illness called anorexia. I'd been so put off by this concept of my eating disorder that I made a vow never to go back to therapy. Yet, when I'd returned to therapy in college, I'd come to accept the idea that I had some sort of illness and ate to cope with more difficult life issues. Even though my experience on Topamax had made me rethink what I learned in therapy, I still clung to the disease concept in many ways.

  Not only does the disease concept foster addiction, says Trimpey, but the treatments that stem from the disease concept are not effective. This is because treatment for [bulimics] assumes [binge eating] is the result of hidden causes; therefore, therapy attempts to treat those causes instead of the [bulimia] itself and does not offer a direct way to stop [binge eating]. The treatments assume if you correct the hidden cause, the [bulimic] behaviors will unexplainably disappear. This was, in fact, what I had been trying to do in therapy for many years, without good results.

  Trimpey says that therapists convince [bulimics] that [binge eating] is a symptom of another problem. Therapists say that you cannot be free of [bulimia] until you reach other important goals, so instead of working directly on your addiction, you work on reaching other goals in hopes that your [binge eating] will go away. But the [binge eating] does not go away, Trimpey says. Even if you solve such problems as "self-worth, self-awareness, relationships, and childhood conflicts, deprivations, and traumas, you are still left with your original desire to [binge eat]."22

  THERAPY'S IDEAS MAY HAVE BEEN HARMFUL

  I was overwhelmed by what I was finding in RR, because this was the first time I'd read something that contradicted what I'd learned in my own treatment. For so many years, I searched for a hidden cause of my binge eating and tried to solve every problem I could think of; yet all my self-improvement work had done little to reduce my desire to binge eat. This was the first time I'd read something that suggested I could stop my destructive behavior without therapy or a long journey of self-discovery. It was the first time I'd read something that said recovery was not a difficult and life-consuming process. In fact, Trimpey says that trying to solve personal problems before recovery only wastes time and resources.

  Part of me agreed with every word I was reading, because it explained why
therapy had not worked for me. But another part of me resisted the information in RR. Maybe alcoholics could just quit, I thought, but eating disorders were more complicated. Wasn't it nearly impossible to self-recover from them?

  That warm spring day at the gym, I realized that the answers weren't clear and had never truly been clear. I had sensed something was wrong with eating disorder treatment when I was 16; even after I'd accepted the idea that binge eating was a coping mechanism that fulfilled inner emotional needs, a small part of me had remained unsure. The doubtful part of me didn't know how to express the problem I sensed in therapy through the years; but RR finally made me understand why therapy had not been effective for me. Therapy was not solving the real problem.

  If it hadn't been for my experience on Topamax in the summer and fall of 2003, I probably would not have been as open to the ideas in RR as I was. I probably would have resisted the concept that I could stop binge eating without solving my personal problems and without therapy. However, when Topamax was working, it temporarily corrected something in my brain that was generating my urges to binge, even as my other problems remained. Although the medication's effects weren't lasting, the experience had caused me to leave therapy, even though I still held to many of therapy's ideas.

  Reading RR made me wonder if those ideas were actually hampering my recovery instead of helping it along. I began to wonder why therapy had led me around the problem instead of targeting it directly. Maybe I could get better, I thought, only if I stopped believing that I needed to travel a long journey of self-improvement in order to stop binge eating. Maybe I could get better only if I stopped trying to cure myself in a roundabout way. Maybe I could get better only if I stopped believing that I was using food to deal with unsettling emotions. Maybe I could get better only if I stopped believing that I had an illness and that I needed to become whole or become happy before I could give up my bulimia. I realized that solving my other problems might take a lifetime, but I needed to solve my real problem quickly.

  ADDICTION IN LIGHT OF THE BRAIN

  RR suggested that this could be done by first understanding my own brain. Trimpey says that addictive behavior is understandable when viewed in light of this remarkable organ. He explains that addiction comes from a part of the brain that is older in terms of evolutionary history. This area, which Trimpey calls the "animal brain" or "beast brain," is responsible for maintaining our basic biological functions and ensuring our survival. The animal brain/beast brain is the primitive brain region that generates our survival drives for food, water, sex, oxygen, and other things that it senses are necessary for survival. The animal brain is automatic, unthinking, and irrational. It is buried in the central region of the brain and surrounded by the wrinkled outer layer—the cerebral cortex.23 The animal brain is often referred to as the subcortex because it lies below the cortex; but I will continue to call it the "animal brain" and, later, the "lower brain." The animal brains of humans are nearly identical to the brains of animals, as well as to much older species.

  The animal brain's function in humans is indeed fundamental to our survival as individuals and as a species; but when it comes to addiction, the animal brain works against us. When someone is addicted, the animal brain falsely believes that the addictive substance is necessary for survival and therefore drives the addicted person to the substance, as though it is just as vital as water or oxygen.24 In my case, my animal brain believed that binge eating was a necessity, so that an appetite for binge eating got mixed in with all of my other valid survival appetites.

  The animal brain expresses itself through what Trimpey has termed the Addictive Voice (AV). The AV is "any idea, feeling, or behavior that supports [binge eating]."25 He says that a [bulimic] must be able to recognize her AV and separate herself from it, because the Addictive Voice is not really her voice. It is merely the voice of the animal brain. My animal brain was in control, directing my life as if large amounts of food were oxygen; I blindly followed the messages urging me to binge eat, unaware of their origin.

  Trimpey encourages [bulimics] to observe their own thoughts and feelings using a thinking skill he calls AVRT® (Addictive Voice Recognition Technique). The thoughts and feelings that encourage [binge eating] are the AV, and those that support quitting are the true self. When a [bulimic] recognizes and understands her AV, then completely separates herself from it, recovery becomes effortless. She must get apart from it, Trimpey says, realizing that "it" is merely an appetite that originates in the "biological, animal side of human nature."26 "It" is not really you.

  "It" is housed in the animal brain, but the real you is located in a different part of the brain. The real you, or the true self, resides in the newer and more sophisticated part of the brain—the human brain, which is the part of the brain that developed most recently in evolutionary history. The human brain makes you yourself because it gives rise to your consciousness, self-awareness, identity, reason, memory, and intelligence. The human brain also controls your voluntary behavior because it houses the voluntary motor center, which controls any body part you can move voluntarily, including arms, legs, hands, mouth, and swallowing muscles.27

  To stop [binge eating], Trimpey says, you must know that your animal brain cannot make you do anything, because it doesn't have control over your voluntary muscles. Because the human brain houses your true self and your voluntary muscle movements, you—your true self—have ultimate control. In the case of bulimia, "it" cannot control whether or not the bulimic will open the refrigerator or drive to the nearest fast-food restaurant to binge. The only thing the animal brain can do on its own is send messages urging the bulimic to binge eat, but ultimately, the true self—residing in the human brain—is in control of what that person does upon hearing the call of the animal brain. Trimpey says that given the right information, the human brain is "able to suppress any appetite, able to defeat any addiction, any time you choose."28

  Trimpey says that once you decide to quit and fully commit to stopping your [binge eating], all you have to do is recognize the AV, realize that is not really "you" but instead "it"—the voice of the animal brain—and simply stop listening to it and letting it direct your actions. Even though you can hear and feel the AV urging you to [binge], you know the animal brain cannot act on its own, so you know you can always choose whether or not to binge.

  Attempting to argue or reason with the AV is futile, he writes, because the animal brain is not rational and doesn't listen to reason. You only need to recognize it, ignore it, and it will soon fall silent. Trimpey says that once you learn to separate yourself from the animal brain and realize you are in control, your urges to [binge] begin to taper off, and stopping your addiction for good becomes easy.

  11: I Had Control All Along

  This theory of two brains—the human brain and the animal brain—that Trimpey presented seemed reasonable to me. It seemed to explain why I sensed my urges to binge were not really me, but instead an imposter taking control of my mind and body until I gave in and binged. It seemed to explain why part of me wanted to binge more than anything and part of me truly wanted to quit. There were two brains in conflict within me.

  The most important thing I learned while reading RR at the gym that day was that I had ultimate control over my actions. My human brain—the seat of my intelligence, reason, language, and voluntary movement—was the only part of me capable of the voluntary act of binge eating. This new and rather simple information gave me a feeling of power. It gave me new hope that I could overcome my urges to binge eat. It gave me reason to believe I had a choice when the urges arose.

  In a sense, the information in RR was something I already knew but hadn't been able to express. I'd already known that I didn't have to act on my urges to binge even before reading the book; but until that point, I'd felt powerless against them. In therapy, I learned that I needed to develop alternative coping skills or fulfill my emotional needs in other, noneating ways. Yet when the urge to binge arose, it always seemed tha
t nothing else but food would do.

  MY URGES WEREN'T REALLY ME

  RR seemed to explain why my urges were so irresistible. Maybe it was because I thought those urges signaled a real need, whether that need was physical, emotional, or even illness-based. Maybe I believed the thoughts and followed the feelings that were urging me to binge because I thought they were my thoughts and my feelings. It only made sense that I believed this, because the urges certainly seemed to be coming from me.

  When I had the urge to binge, I heard enticing thoughts, in my own voice, saying things like, It won't hurt to binge just one more time. ... You can work out tomorrow and then start over. ... You've had a hard day and need to relax. ... You've done so well for the past three days, so you deserve it. I heard myself giving all the reasons that it would be OK to binge just one more time, and sometimes they seemed like very logical reasons. As the urge grew stronger, my feelings of anxiety and craving mounted and I felt I truly needed to binge in order to feel normal again. My feelings felt like my own as well, and like my thoughts, they expressed what I sensed to be a true need.

  RR made me realize that perhaps the thoughts and feelings that encouraged binge eating didn't correspond to any of my needs—real or symbolic—and that maybe those thoughts and feelings didn't even come from me at all. Maybe they were an automatic and unthinking voice coming from the more animalistic part of my brain and didn't have any power over me or my actions. Maybe all I needed to do was separate my true self from that lower part of my brain for the urges to go away on their own.

  As I continued exercising and reading RR, I came to a significant realization. All through the years of therapy, I had been trying to make my urges go away or prevent them from ever arising. But what if that was the wrong approach? What if I didn't need to make them go away, but just needed to change how I reacted to them? What if I could separate myself from my urges and choose not to follow them anymore? Perhaps, I thought, in spite of even the most powerful urge, I could choose not to open the refrigerator, not to drive to the convenience store; and maybe if I did that over and over, the urges would simply go away on their own.