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Letter to the Editor: Worried About How You Look?

in Letter to the Editor/Open Letter/Opinions by

I wish that my son could tell his own story, but he can’t, so I will try for him, perhaps to give courage to others who are in the grip of the illness that cut his life short at the age of 24.

“It’s odd,” I mentioned to my then-18-year-old’s therapist. “Nathaniel shaves with the lights out in the bathroom and the door propped open to let in a little light from the hallway.” The therapist’s eyes widened with sudden understanding and alarm.

“It’s BDD — Body Dysmorphic Disorder,” she blurted out.

The moment plays in slow motion in my head, locked in my memory. BDD? Never heard of it. I had no idea what she was talking about, but it did not sound good.

As soon as we got home, I ordered Katharine Phillips’ seminal book about BDD, “The Broken Mirror,” and read it in one sitting. When I finished, I knew this was the disorder Nathaniel had been suffering from since age 11 when he first became anxious, and that we were in for a rough ride. It had already been hard, and it got harder — much harder.

Our six-foot four, handsome, intelligent, and incredibly funny son was wrestling with an inner demon that I could not fathom and could hardly bear living with. If it was torture for us, his family, it was unmitigated hell for him. He hated his appearance and was convinced that his skin was defective — “hideous, disgusting” were the words he used. Yet he had a beautiful complexion, and by anyone’s standard, he was handsome. A shaving nick or a minor blemish would keep him indoors for days, or he would cover them up with tiny pieces of bandage so that he could bear to go out. The focus was mostly his skin, but when he was younger, the worries had shifted: he thought the roll of flesh on his tummy was too pronounced (“But you are a growing boy!” I would say), the shadows under his eyes were too dark (“But everyone has them!”), his hair had to be just so (“Do you need all that gel?”). He compared himself with his younger sister, wanted to be her weight and keep up with her level of activity to satisfy an inner command. He was victimized by narratives in his head that dictated he cover up blemishes, exercise compulsively, or compete with his beloved sister. There is no logic to BDD, so no logical argument or reassurance helped.

Nathaniel was the kind of kid growing up that other kids wanted to hang out with. Inventive, smart, full of ideas for games and imaginary play. He never lacked friends. His teachers loved him because he did his school work to perfection and participated fully in class. A natural athlete, he was an avid soccer player and later cross country runner. And sense of humor? He could mimic anyone and would leave us in stitches. Once he invented an on-the-spot musical that he sang on a family car trip to our endless amusement. He could even turn criticism into comedy. While out driving once, he said calmly, “Mom, it’s a source of great comfort to me to know that if you ever have an accident and lose an arm, you won’t have to change your driving habits.” I burst out laughing, but the message got through; I have been driving with two hands on the wheel ever since.

When he first became ill in fifth grade, it was as if a bomb had dropped from the sky and blown our delightful son into an alternate reality. He ran one, two, then three times a day, virtually stopped eating, and lost so much weight that he had to be hospitalized. SSRI medication helped, and from then on, he began seeing therapists regularly. The diagnoses ranged from anorexia to OCD to school anxiety to social anxiety to generalized anxiety disorder, but he didn’t get the correct BDD diagnosis until seven years later.

BDD, an OCD spectrum disorder, is more prevalent than many realize.  Two to four percent of the population suffer from it, with the highest proportion among college age students, yet many mental health providers do not know of the disorder or how to treat it. Convinced that they are ugly, sufferers often get stuck in the mirror or avoid mirrors completely, compare themselves to others, skip social situations due to concerns about how they look, and spend hours trying to “fix” or cover up flaws that others see as insignificant or non-existent. The focus is most often the face (nose, skin, hair), but sufferers can be paralyzed with concern about any part of the body. Not remotely like vanity, this crushing preoccupation with appearance can disrupt schooling, make employment difficult, and strain relationships. The suicide rate is the highest of any brain disorder — higher than for those with severe depression or schizophrenia.

Having a name for a brain disorder, sadly, doesn’t disarm the demon any more than knowing that you have diabetes improves your insulin levels. But it did lead us to skilled practitioners. Drs. Katharine Phillips, Michael Jenike, Tamar Chansky ’84, and Marty Franklin all had their times with Nathaniel, trying to help his mind find the space and energy to combat BDD’s onslaught. He tried various SSRI medications and many combinations of medications, which sometimes provided relief. Cognitive Behavior Therapy and Exposure and Response Prevention strategies — the gold standard of treatment — were only slightly helpful.

As he grew older and his symptoms intensified, he had to leave high school and earn his diploma from home. Some days he couldn’t leave the house, although he managed to work part time and found joy in coaching middle school cross country and teaching in an after-school program. By his mid-twenties, he was still living at home and could see no promise in his future. He watched his sister and friends go off to college, find partners, launch their careers. “BDD is my only companion,” he told me once. “It dictates my entire day, from the second I get up, until I go to sleep — the only time I get any relief. I would not wish this on my worst enemy.” He ended his life in 2011.

Very few people understand brain disorders, and even some people who knew Nathaniel didn’t fully grasp that his condition was not caused by faulty reasoning or an inability to face life’s challenges. Because BDD is under-recognized and under-diagnosed, my family and I have devoted much of our time to raise awareness and funds for research. Recent fMRI studies at UCLA have discovered that the brains of those with BDD process facial images on the left side of the visual cortex instead of the right, like the rest of the population. The brains of those with anorexia show the same anomaly, suggesting that sufferers focus on tiny details of appearance and not the whole picture. More research will determine if this finding is causal or correlative, but it points to anatomical factors involved in BDD and suggests that visual re-training in treatment might help. Genetics and social/environmental triggers also play a role, but the pathway of the disorder is not yet fully understood.

Brain-circuit-based therapies such as Transcranial Magnetic Stimulation, currently in wide use for depression, and Deep Brain Stimulation using implanted electrodes to stimulate areas of the brain — similar to the treatment used for Parkinson’s disease — may hold promise for those with severe BDD, but more research is needed.

If you think you may have BDD, or know someone who might be struggling with appearance concerns that interfere with daily functioning, don’t hesitate to reach out to a therapist at the college health center. The International OCD Foundation website has a large section devoted to BDD where you can learn more about the disorder. If you want to read more about Nathaniel, the website Walkingwithnathaniel.org details our family’s journey more fully.

Nathaniel knew that after he died, we would wonder what we could have done differently. “Please don’t,” he wrote in the letter he left us. “We were all doing the best we could and there is no regret in that.” No regret, but no silence, and no stigma either. Please spread the word about BDD, and get help for yourself or others who might need it. No one should have to struggle with this devastating illness alone. I know that is what Nathaniel would say.

Judy Nicholson Asselin ’75

Womyn problems and womyn powers

in Campus Journal/Columns/People Watching at Swat by

 

“Defining myself”

 

It is very easy to locate Lila Weitzner ’19 in the bustling crowd of Sharples at 6:30 p.m.. Her splendid head wrap, colorful crop tops, high rise leggings, and heels separate her from most of her fellow Swatties. People have described Weitzner’s style as “grandma prostitute chic”. A lot of clothes she wears are like dance clothes — items that show the shape of her body. She also loves bold colors and embellishments like embroidery or beads. When asked about how she developed her style, Weitzner said that it largely came from her need to define herself before people defined her. Weitzner lost her hair and one eyebrow in 3rd grade because of an autoimmune disorder called alopecia. Her hair came back a little bit during 6th grade and has been “on-and-off” since then.

 

“I felt like I was floating for most of the time. There’s no partially bald girl in the media, and barely any in the real world. I had nothing to hold on to to tell me what I should look like. There’s no beauty standard I can aspire to. So the burden is completely on me—I need to rely on myself to figure out what it means for me to be beautiful”, Weitzner said.

 

Growing up in Washington D.C., Weitzner spent a lot of time taking public transportation and being watched by strangers.

 

“I’m always perceived by the world. People make decisions about me”, Weitzner said. She can’t remember how many times people assumed that she had cancer or she was a member of a punk rock band who wanted to look different for the sake of looking different. “But first of all, I’m perfectly healthy. Second of all, I’m more ‘normal’ than people think — I do hate the system we live in and all the oppression, but I’m not necessarily anti-establishment,” said Weitzner with a little chagrin. The reactions she received from people were not always negative. Instead, Weitzner said walking around partially bald made her “the subject of so much kindness.” She remembers that people always came to her and praised her for her braveness because they mistakenly assumed that she had cancer. However, Weitzner said such kind gestures somehow placed her in a tricky position.

 

“If I just simply accept their kindness, I’m being dishonest. But if I correct them and tell them the truth, they might think that I feel very insecure for not having hair, and then they feel bad for calling attention to it, even though I recognize the good intention behind their actions,” she explained.

Colorful head wraps and clothing allow Weitzner to present herself the best way she can. She loves the fact that people see courage and triumph in her, but she doesn’t want people to make incorrect assumptions. Instead of being “hardcore” or someone’s “inspiration,” she wants her outfit to be able to brighten someone’s day. To Weitzner, her distinctive style is a way to celebrate her body, one that might not be conventionally beautiful and thus may not be celebrated. She feels good about her body, and she wants people to know it.

“It’s totally okay if some women don’t celebrate themselves this way. But I see a lot of women trying to do that but lacking the audacity to actually dress to be proud of their bodies! I really want to help them! They might just need to fold their shirt in a little bit or wear a belt!” Weitzner’s pitch got higher as she got excited when talking about offering fashion advice.

 

“Am I feminine enough?”

 

Like most of us, Weitzner has not always been satisfied with her body. She has mixed feelings towards many aspects of her body: when she first hit puberty, she found it difficult to find bottoms that could fit both her hips and her waist. While her wide hips gave her a classically-feminine figure,  Weitzner was frustrated by the fact that she didn’t have large boobs or long hair, two other elements closely associated with femininity. In middle school, she was confused by the unsolicited attention from men complimenting her on her body. Unaware of any standards of femininity that lay outside of the mainstream, Weitzner said she couldn’t tell if it was sarcasm.

 

Weitzner said she only learned to fall in love with her own body around 9th grade. She went to Duke Ellington School of the Arts, a school with a majority Black student body. Weitzner said this was the first time that her body type, and more specifically her curves, had been close to the beauty standard. Around the same time, White American culture started adapting and appropriating the predominantly Black beauty standard valuing female bodies with big butts and hips.

 

“Girls switched from asking ‘Does my butt look fat in this?’ to “Does my butt look fat enough in this?’”, Weitzner joked.

 

Weitzner said this was when she realized that there was no single beauty standard. Different body types are celebrated more or less in particular times and places, but the reality is that there are limitless ways to be beautiful.

 

As Weitzner started college at Swarthmore, she sometimes felt disconnected from her body. Weitzner said her busy schedule makes it impossible for her to dance in her room in front of the mirror or put on body lotion after she showers.

 

“My body has been changing so much all the time. That’s why I really want to feel my present body. Appreciating my skin and knowing someone else will also appreciate it makes me so satisfied. When choosing my outfit, I feel more expressive and more beautiful if I have a little part of my stomach or back exposed. It’s not even about look. I just want to touch my skin and have more control over my body. I want to see my food baby after a big meal,” Weitzner explained.

 

At the same time that Weitzner has been on a journey to happiness with her body, she has gotten older and been exposed to more catcalling based on her appearance. Weitzner says she finds some irony in the fact that her body, which she used to worry about not being feminine enough, is consistently considered by strangers to be attractive. But the incidents of catcalling themselves, Weitzner finds problematic.

 

“Am I feminist enough?”

 

Yes, we all hate the over-sexualization of the female body. Yes, we hate catcalling as it reinforces the notion of male entitlement to female bodies, and the oppressive rape culture that this supports. But if a woman feels good when someone tells her she looks hot, is she somehow not feminist enough? Is sexism already deeply coded in the way we think? Are we being “vain” and trying to please men when we dress up? And, most importantly, how do we navigate ourselves through all these moments of self-questioning?

 

When I raised these questions to Lila, she sighed and paused for a few seconds.

 

“So many forms of oppression have been telling me that I shouldn’t feel good about myself. I don’t identify with the kind of feminism that makes me turn my back on things that make me happy. Dressing up and being pretty is my way of celebrating myself. Who created the idea that valuing my appearance means I want to please men? I want to have control over how people perceive me. Knowing that the way I look has impact on people is empowering.

 

“There’s an idea that caring so much about my appearance means I’m not confident enough of my natural beauty, and that always makes me feel not sure about wearing makeup. But the fact is that the shame around makeup is just the world trying to make me feel less powerful.

“How are you going to tell women that if they care about how they look, they are not ready for serious business, but at the same time pour all the bullshit on women about the right body type? Are we just going to accept that we’re not beautiful and we can’t redefine beauty? Discovering my natural beauty doesn’t mean not putting any effort in it. ‘Natural’ is to listen to myself and to be authentic to myself. Celebrating myself is celebrating so many versions of me. Fashion is what allows me to do so.”

 

Weitzner expressed similar thoughts on the topic of women’s bodies. Weitzner believes that with the cultural fascination with the idea of a “strong woman” comes a push for women to have more muscular bodies. She finds this a little bit unsettling.

 

“My body is very flexible. Recently, a doctor told me that hyper-flexibility will give me limitless athletic ability once I get stronger. No one had ever told me this before! People don’t tell me that I’m strong and athletic just because I’m curvy and I don’t run very fast.” To Weitzner, it doesn’t make much sense that women are told to get stronger by acquiring stereotypically masculine qualities instead of being told to recognize the qualities they already have as strengths.

 

Weitzner suggested that we think about these topics a lot so with the ultimate goal of thinking about them less. She hopes that in the future, when she chooses to wear something pretty and ‘revealing’, she won’t have to go through the process of thinking, as she says,  “People are going to yell, but do I care?” She wishes she could simply look good and feel good without shame.

Asian woman overcomes obesity, loses 94 pounds in seven months

in Op-Eds/Opinions by

Nineteen year old Rikta Bhumi may look like the typical Bollywood dancer; with her petite frame and long dark hair, few would believe her physical transformation from flab to fab happened in just the last year. But just over seven months ago Rikta had a Body Mass Index of 34.4 and was considered obese! What was her trick? The Yoga Diet.

“I had my annual physical last year, and my doctor told me I needed to lose weight. I didn’t know how—I had always struggled with it—so I asked him for suggestions and he told me about Yoga,” said Bhumi, demonstrating a perfect One Fingered Two-Branch Tree pose.

Bhumi’s primary care physician, Dr. Dan Des Lionnes, explained his use of Yoga to the Phoenix, claiming “I’ve been in medicine for over 45 years, and every year they come up with something new. I had heard about this Yoga thing, I knew the Patels or whomever brought it over from their country, and Rikter [sic] looked like a nice girl who could benefit from learning the ways of her people. It seems she’s lost all of that baby fat anyway, those Asians have different metabolisms and they just have to learn how to tap into them.”

Rikta got her hands on a book by Swami Abhedananda called How to Be a Yogi, a sacred and exotic text published in 1902 about the science of Yoga. She “ignored all the boring introductory parts about spirituality” and focused on the sections pertaining to weight loss; Rikta then began attending hot Yoga sessions and following the strict diet outlined by the book.

“I feel like an archaeologist! I discovered ancient practices for weight loss and made them relevant to my modern life. The book said some yogis don’t eat for several weeks at a time, and when they do they follow a vegetarian diet. And I guess there was some stuff in there about spiritual hunger versus physical hunger, but I honestly just skimmed it. I had all of the info I needed, and it worked!” said Rikta. The Springfield native has already lost 94 pounds on the Yoga Diet, and she’s just getting started.

Rikta’s Yoga instructor, Paul, mastered the secrets of Bikram Yoga and the Ayurvedic lifestyle in his travels to India and Nepal. “I stayed at an ashram for six months, where I learnt the secrets to that really Asian type of skinniness, you know? My guru told me all about ghee and turmeric and all that good stuff, so I taught Rikta everything I knew. She makes sure to eat whole chili peppers, and drink hot water with ghee every morning. It really purifies the system and staves off those hunger cravings,” said the 33-year old Berkeley native, “oh, and I taught her about incense too, so that should help with her chakras. Namaste.”

Rikta, a sophomore at University of Illinois, is studying psychology in hopes of becoming a doctor. “When I first started losing so much weight with the Yoga Diet, I thought maybe something was wrong. I went to the school counselor and she said that Indian women don’t really get eating disorders, that it was probably genetic and that I was good to go. She encouraged my Yoga practice and said it was just what I needed,” said Rikta clenching her teeth in a grimace she swears is a smile. Although Rikta isn’t a Bollywood dancer, she has promised her Instagram followers that she will pose with her very own bindi after she loses the next ten pounds.

“I was really concerned when I saw how much weight Rikta was losing. She didn’t really go to meals and stuff, and kept doing Yoga even when she was really tired,” said her roommate, Sophie Cromwell, a gymnast and debate team captain from New Jersey. “But everyone kept telling me that it was just part of her religion. They showed me pictures of those really skinny girls in India and tried to convince me that it was just the way Indians were. I wasn’t so sure, there’s a lot of Indian people in my hometown and their bodies vary as much as white people’s. But I check in with her a lot and she always says she’s doing fine. Should we really be celebrating her extreme weight loss with a news interview, though?”

The Yoga Diet may just be the next sensation to sweep the nation: Rikta already has 200,000 Instagram followers tracking her success, and lots of copycats. Could this ancient Ayurvedic treatment from the land of spices be the secret to weight loss success? Only time will tell.

Outrage after Bryn Mawr invites students on high BMI list to take weight loss class

in Around Higher Education/News by

Last Friday, several Bryn Mawr students received a personally addressed email from the Bryn Mawr health center. Bearing the subject line “Give a HOOT,” the email invited students to sign up for a weight loss program that was eligible for P.E. credit and run by athletic facilities, the health center and dining staff. The email described the program as a “fitness program for students with elevated BMIs.” The body mass index is a measure of body fat according to height and weight. Since the program is focused on students who have so-called “elevated BMIs,” it appears that students who received the email were chosen based — at least in part — on their records at Bryn Mawr’s health center.

The email sparked a range of reactions from the Bryn Mawr community. One junior, Rudrani Sarma, posted about the email in a Facebook status that garnered dozens of comments, most of which supported or identified with Sarma’s reaction. “Dear Bryn Mawr College,” read the status, “Sending your students a message ‘inviting’ them to take a weight loss class because they’re on a ‘list of students with elevated BMI’s’ is not ethical. It’s problematic, it’s hurtful, and it’s just plain stupid.”

“My first reaction to this was obviously horror. I felt awful to be targeted like that,” said Sarma. “I felt like it was an incredibly impersonal email and just incredibly unethical to receive something like this. I just thought of all of the other students that might have a problem with weight who received this email and how horrible they must feel.”

After posting her status, Sarma received many responses from other Bryn Mawr students, some of whom had also received the email.

“A lot of people responded with anger to the message itself,” said Sarma. “Health is so personal, and having this sent out was, for a lot of people, shocking … they felt violated.”

Heidi Gay, a Bryn Mawr senior who also received the email, thought that the College approached the issue in a counterproductive way.

“It’s not a terrible idea of a program, but they’re not doing themselves any favors by using languages that stigmatizes people who would even want to do it,” she wrote in an email.

In Gay’s eyes, Bryn Mawr has a responsibility to deal with health in a better way.

“The Health Center needs to understand that many, if not most of us, have received negative body image feedback at some point in our lives before Bryn Mawr, and probably will after Bryn Mawr,” she said. “Because we are a women’s college, it’s especially important that we start thinking about these issues — obesity, eating disorders, etc. without stigmatizing anyone … We need to prepare students to be confident in their bodies, no matter what, and to able to talk about these issues without feeling ashamed.”

Ava Hawkinson, also a junior, did not receive one of the emails, but engaged in the online conversations that followed. Hawkinson believes that the emails put forth an incomplete notion of health.

“It’s more concerned about weight than it is about actual health,” she said. “It is body policing, it’s size discrimination, it’s fat shaming, and I think all of those things are pretty terrible.” Hawkinson expressed doubt that Bryn Mawr can play a truly helpful role in promoting student health.

Noemí Fernandez, Swarthmore’s new wellness coordinator, shares Hawkinson’s belief in maintaining a broad definition of health, but thinks that colleges and college communities can play an active role in grappling with the breadth of what “health” is.

Swarthmore’s wellness program stands on five “pillars,” as Fernandez calls them, of health and wellness: intellectual, mental, physical, spiritual and sexual. Fernandez uses, and has written on her chalkboard, the World Health Organization’s definition of health, which reads: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

For Fernandez, physical health is important, but is also highly tied to other forms of health.

“Physical health in particular is really the most obvious but sometimes the one that has the most myths revolved around it,” she said. “We experience physical health both as a result of lack of nutrition for ourselves, but also as a manifestation of unhealthy mental, intellectual, spiritual health too.”

Fernandez believes that colleges can actively promote this definition of health.

“My approach is really about education,” she said. “[It’s] about educating individuals and promoting programs and workshops that provide life skills, and then using those skills and workshops to build on bigger conversations about how the community portrays and works around issues of health … [and] promoting a culture of health that we both support and model as individuals, and as departments and as an institutions.”

With regards to BMI, Fernandez believes that it is useful, but only in limited ways.

“BMI is not necessarily the most accurate and best way of assessing someone’s healthy weight, for multiple reasons,” she said. “It is useful in the sense that you can use it to assess around where you are, but it is not the end-all be-all of what a healthy weight is.”

In a 2009 report titled “Body Mass Index: Considerations for Practitioners”, the Centers for Disease Control delineated several limitations of the BMI. Factors such as weight, distribution, ethnicity and age may distort the meaning of BMI in relation to actual relative body fat and health. Especially notable in the case of Bryn Mawr, the report also noted that women tend to have lower body fat relative to BMI than men. BMI is used over more precise or specialized measures of weight and health because it is cheap, efficient and can track the movements of populations over time.

The report states that “BMI is a reasonable indicator of body fat for both adults and children. Because BMI does not measure body fat directly, it should not be used as a diagnostic tool. Instead, BMI should be used as a measure to track weight status in populations and as a screening tool to identify potential weight problems in individuals.”

In light of these various concerns, Sarma and Gay both responded to the email and communicated with health center staff. The health center staff apologized to Sarma, informing her that her height had been incorrectly registered and had therefore mistakenly included her in the “list of students who would qualify for the program.” In issuing this apology, the health center confirmed for Sarma that there was indeed a “list” of students chosen for OWLS that was created using the medical data of those students. The response concluded by expressing an interest in further discussion between the Health Center and Sarma.

“I’m glad that they admitted that their mistake wasn’t an excuse … but at the same time, it was just a personal email to me, and it wasn’t apologizing to the community,” said Sarma. “I think that more apology is definitely necessary, both to individuals who received this email and have ‘elevated BMIs’ and to the general community for bringing this up in such a cold manner as well.”

In terms of wider changes, the response Sarma received pledged to improve the “screening processes” that resulted in the height mistake and to remove the first line of the email in the future. The first line reads “We want YOU to be in the Fitness OWLS (Onward to Weight Loss Success) Program.” The response stated that “while [the first line] personalizes the message for some, it could be disturbing for some of the people who may even be appropriate for the class.”

Gay was less impressed with the response she received.

“The response … quite frankly disgusts me even more and angers me for [the] unwillingness to take responsibility for the Health Center’s idiotic actions.”

The response to Gay focused on clearing up what the Health Center sees as “misconceptions” about the OWLS programs.

“Because we have limited resources, we are currently limiting enrollment to students who are most likely to get the most health benefit from the program, but it would be appropriate for anyone,” it read.

This explanation claims innocence on the part of the Health Center. According to the response, the emails were simply sent to provide their recipients with easier access to the OWLS program, and that any negativity coded in the email was inadvertent.  The response went on to say that “there is no pressure for anyone to participate.” The email concluded by asking for “constructive feedback,” writing that “getting accurate information out to people when you can’t talk to everyone one-on-one can be quite challenging.”

Fernandez expressed sympathy for the Bryn Mawr health center regarding the difficulties they face in engaging with the student body.

“It’s sort of a chicken and egg problem. If you have a population of students that aren’t engaging in these conversations and you’re trying to reach them, how do you reach them without targeting them specifically,” she said. “It’s a difficult balance and we learn from mistakes. They tried this and they received a response and now as an institution you can use that and learn to go forward.”

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