Today, we’re joined by Dr. Margo Maine, where we discuss how eating disorders effect people of all ages, and specifically talk about eating disorders at midlife and beyond.
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Full transcription –
Kathy: Hello and welcome to ED Matters. This is Kathy Cortes your host and today it is my pleasure to introduce you and welcome Margo Maine. A founder and adviser of the National Eating Disorder Association and founding fellow of The Academy for Eating Disorders. Dr. Maine is the author of Pursuing Perfection: Eating Disorders, Body Myths and Women at Midlife and Beyond, Treatment of Eating Disorders: Bridging the Research- Practice Gap, Effective Clinical Practice in the Treatment of Eating Disorders, The Body Myth, Father Hunger and Body Wars and Senior Editor of Eating Disorders the Journal of Treatment and Prevention. Dr. Maine is the 2007 recipient of the Lori Irving Award for Excellence in Eating Disorders Awareness and Prevention and the 2015 recipient of the NEDA Lifetime Achievement Award. Dr. Maine is a member of the Renfrew Foundation Conference Committee and their Clinical Advisory Board and the Walden Clinical Advisory Board. Dr. Maine is a 2016 honoree of the Connecticut Women’s Hall of Fame. She lectures nationally and internationally on eating disorders and maintains a private practice Maine & Weinstein Specialty Group in West Hartford, Connecticut. Welcome Dr. Maine.
Dr. Maine: Thanks. It’s wonderful to be here.
Kathy: It’s such a pleasure for us and for those of you who are familiar with Dr. Maine, you know that she has a tremendous amount of knowledge and she’s also remarkable when it comes to her writing skills. So although we’re going to focus on her most recent book, Pursuing Perfection: Eating Disorders, Body Myths and Women at Midlife and Beyond which she wrote with her colleague Joe Kelly, we’re also probably going to branch out into other things but we will see how this develops. So here’s how we’re going to start. We’re going to start with something that you mentioned very early in Pursuing Perfection. You make the comment, the answer to major life questions may be elusive but a woman can judge her “performance” as a woman today by measuring pounds, calories, hours of exercise and clothing size. Such a sad reflection. Can you speak to this?
Dr. Maine: It sure is sad and it’s devastating for women. Women or grown up with so many pressure on them from the time they’re very little, by the time they get to be an adult, they have had decades of speaking the language of fat translating any negative feelings into bad feelings about their body, feeling fat and not really being able to accept themselves for all their wonderful qualities and to see body image as just part of them. In our culture, women are objectified constantly and that is only intensifying. It’s not getting better with the advent of the social media, we are constantly surrounded by messages. You may be thinking you’re going to go on Facebook and have a nice conversation with a friend or text or e-mail a friend but the pop ups are all negative messages about women and their bodies. So we can’t get away from it and as a result women grow up really disconnected from their bodies and as they think about being a success in this world and being a woman that other people admire, they don’t feel good about their body so that’s the thing they work on, that’s the thing they think they can get control of and it is a very, very sad statement about our culture and it isn’t something that goes away at 18 or 20. When you graduate from college you don’t have this all worked out and I think our field has been short sited in terms of the emphasis it has put on younger people but women continue to have the struggle throughout the decades, through midlife and beyond even into the geriatric period.
Kathy: Which, you know, I think we all need to pause and recognize that it is something that’s spans the life cycle. You chose the title Pursuing Perfection: Eating Disorders, Body Myths and Women at Midlife and Beyond, I’d love for you to talk about that pursuit of perfection and how it does impact women.
Dr. Maine: Yeah. We decided to emphasize perfection and how it dominates women today and again, as I said a few minutes ago, girls learn from the time they’re very, very young that they have to please people through their bodies and they have to be perfect and that message continues for women and women today are expected to achieve and be active in so many dimensions that 50 years ago were not part of their lives. We have to be athletic, we have to be academic, we have to be very active in our communities, we have to be wonderful lives, mothers, sisters, daughters, caregivers and there isn’t much left for the self. The pressure on women to do all of these things and to do them perfectly is enormous. So, you know, many of my adult patients if they have friends over for a dinner party they can’t just have a nice dinner. They have to make the placemats and sew the napkins and I think the Martha Stewart influence and then the expense of that kind of thing through Instagram and other social media has made it just about impossible for women to ever be satisfied with anything that they do. We’re always able to do more and to be more perfect and we always have that standard in front of us. So we really are aware of how women are constantly pressured to be perfect in all dimensions and the body is the way it often plays out because that’s the one thing that we can supposedly control. We might not be able to be sure we’re going to accomplish what we want in our careers or get that book published or whatever, but we know that we can exercise more and we can eat less and maybe we can lose that five pounds.
Kathy: So can you take us there into that aspect of control of the body and perhaps that myth and how it relates to the stressors in a woman at midlife?
Dr. Maine: Well, midlife is full of new developmental challenges and transitions. We know that eating disorders are likely to start during developmental transitions. We know that the ages of 13 to 15 and 17 to 19 are peak times for an eating disorder to develop because there’s so many new things happening in that young woman’s life. Her body changing, going into puberty at the same time there’s a lot of social expectations that are changing and 17 to 19 getting ready to leave the family and really having to incorporate a more mature sexuality and relationship to her body and have all of her life decisions kind of settled where she’s going to go school and what career she’s going to have. So we know that those two peak times are full of developmental issues making women at risk but we’ve kind of neglected adult development when we’ve looked at eating disorders and as I have worked with women, it’s clear to me that adult development is full of new transitions, new challenges and I certainly was not prepared for being an adult woman. I think we all sort of grow up thinking, well, you get to be about 25 or so and your life is kind of settled and you just keep going on. But really, women are always facing new things when you decide to develop more permanent relationship on marriage or partnership of some sort. When you decide to have children, if you have fertility issues or anything like that, if you have other health issues that come up, if you have problems in your relationship then you go through a separation or a divorce, if your parents start to get – well, your parents do start to get older, it’s not if, they do, so you start to lose people who are important to you. You might even lose friends. So adult life is just full of these transitions and full of decisions that women have to make. If a woman does decide to have children, can she balance that with a career? Does she give up her career? Does she go back? Does she go into a different field so that it might be easier to balance the work and the family? There’s all those decisions that women are constantly making, putting tremendous pressure on them, and what we do in our culture is we just keep on layering on those pressure for women. One on top of another and we never have like a graduation party. Like you got through that, you got through 8th grade and you had a graduation party. Well, you got through that decision about whether you’re going back to work or not and now it’s time to celebrate. We don’t have those. There’s no ritual. It’s just continued pressure, continued new things. And at the same time that they’re going through this women’s bodies are changing. Women’s bodies go through so much in each menstrual cycle and if women do have fertility issues or have pregnancies, all of the revolution in their body and often never feeling their body is theirs quite the same again. Then there’s menopause, the big one. And I think for women all of those rhythms in their body can be quite disruptive when you also have the other psychosocial rhythms disruptive. So tune into that body and trying to calm that down and control that gives a woman a false sense that those other things are going to be okay, that I’ll be able to manage life if my body is under greater control and we’re constantly new ways to control our bodies, you know. Twenty or 30 years ago the women who got cosmetic plastic surgery tended to be older women who have a lot of money. Now, people start getting plastic surgery at very, very young ages and some of them don’t have much money. The Plastic Surgery Association has loan programs for women so you find some women who don’t have much money who are getting cosmetic plastic surgery, paying out of pocket, paying loans for forever just the way we have to pay our college loans and there’s nothing in our culture that tells a women to accept her body as is. There’s only more and more messages that we need to control our bodies. So I think the juxtaposition of all the developmental stressors and new issue that a woman experiences and the changes in her body and then the constant message that you can control that body. You might not be able to control those things but you can control that body. It’s like a perfect storm.
Kathy: Even though your tone of voice suggests how serious those complex issues of growing up are and I actually would want everyone to just pause and take in how serious those are. Please don’t minimize the next divorce or the problem with the relationship or the kid having trouble in school or, you know, how are we going to make that more mortgage payment. Can you just tell us more about that element and how people may be don’t get, don’t get the support they need around how serious those concerns actually are on every level, functional, emotional, etc.
Dr. Maine: Well, I think it ties back in to the theme of the pressure to be perfect. That women are really given the message that they have to do this life to the max and never complain and just be happy. That women are not allowed to be unhappy or to say that there’s anything wrong. You know, many of my younger patients who are going through pregnancies, they have a lot of concerns about the pregnancy. They may have wanted the pregnancy but they worry about it. They worry about the health of the baby. They worry about whether they’re going to be able to handle this next stage in their lives but they are able to say that as soon as a woman is pregnant she’s supposed to be this Madonna who is totally happy and a woman with young children is supposed to be totally happy all the time. Well, life isn’t really like that. Life is full of anxiety and self-doubt and we need to give women more opportunity to say those things. When we don’t, we encourage them to translate everything back into that language of fat. Anything that you feel bad about is just that I’m fat. It’s just that my body is out of control.
Kathy: Something they can point to.
Dr. Maine: Right.
Kathy: It’s this, it’s that. You see this.
Dr. Maine: Yeah.
Kathy: And then in terms of some, we’ll just call it social relationships, there’s unfortunately a fair amount of support for do I look good this way? Should I buy this? What do you think about that? Oh so and so did get lipo.
Dr. Maine: Yes.
Kathy: So okay, so we have this individual and she is practicing an eating disorder and now how does she take that deep breath to realize there is help for her?
Dr. Maine: Well, I think what you just said is so important that there is so much support for the behavior of an eating disorder. There’s so much support for body image distortion and believing that if you control your body your life is going to be good. There isn’t much support for saying I need help and many of the adult women that I’ve worked with are women who are quite accomplished. They’re successful, they look to other people as if they have their whole lives together and inside they know they don’t and they are so fearful of saying that out loud. Somehow we have to – if a woman does come to us we have to breakthrough that deep shame she has about needing help. Many of the women I see they’ve never needed anything from anybody. They’ve been, you know, girls who just kind of sailed through grammar school, high school, college, etc. going forward in life and inside they were not sailing but to the outside it looked like they were sailing. They were able to really do what they needed to do to be seen as a success by other people and to be the support of other people in their lives. So the idea that they are going to say there’s something wrong is pretty major. I strongly believe the medical profession needs to be more tuned into eating disorders and not just anorexia and bulimia but the whole gamut. Adult women with eating disorders are more likely to have the mixture of anorexia and bulimia.
Kathy: Vary of symptoms.
Dr. Maine: What you call NOS or OSFED or subclinical eating disorders and they can be just as disruptive in a person’s life. So one of the most important things as clinicians that we have to do if someone gets in our door is we have to help them to break through the shame they have about feeling that they should be all better because this is a teenager’s problem, that they don’t deserve our time because they should know better. They should have this under control and start really talking about things that they’ve never talked about and it’s a wonderful process and most women will get better but it’s a really hard process to enter the door of therapy and she needs a lot of support along the way. You know, one of the things we’ve talked several times during this about women going through pregnancies in that time in their lives, if OB-GYNs and primary care docs were more willing to talk about weight issues and body image issues during those times when they have a lot of contact with a woman like during the pregnancy and after pregnancy, that would open the door to knowing that it’s okay to talk about this and maybe get a resource. So I think there’s many ways in which we can support adult women more that we need to work on.
Kathy: So in a way, we were actually talking a bit about the stigma, not only of eating disorders but of feeling shame because you need help.
Dr. Maine: Yes. Yes. If you’re perfect you don’t need help and most women have been raised their whole lives to feel the goal is to be perfect and to be perfect is to need no one. And, you know, you mentioned before the relationships with other women, women can be the most wonderful resource for each other but they also can be a source of pain and constant competition and I often ask my patients to really look at who they spend time with because if you are only going to a gym or running with other women who are always trying to lose weight and talk about their bodies in a negative way, that is not going to help you in any way, whether you have an eating disorder or not. That’s not going to help you because it’s not going to be a very full relationship. It’s going to keep you focused on one dimension of yourself.
Kathy: As a clinician, one of the things I know is, valuable and eating disorder recovery, is what I call the process of acceptance and I think you are talking about that so could you speak more directly to what are some of the things we want, you know, the women at midlife to be able to accept about themselves with grace, with kindness and eventually with love?
Dr. Maine: Yeah. Well, one of the things I want them to accept which comes as a foreign language to them initially is to accept their body’s wisdom. When you go through menopause, for example, and your metabolism slows down and you add some weight and that weight is right around your middle which is a place women don’t want their weight, not that they want it anywhere. That your body is actually expanding the fat cells around your middle so that it will produce more estrogen as your ovary shut down and that’s going to help you to have less symptoms of menopause, less hot flushes, less vaginal drying, lots of other things related to menopause. So the body has innate knowledge, it’s doing the right thing for us. Women need more fat on their bodies to be healthy. Women in a famine only 10% will die. In a famine, 50% of men will die. Women need fat on their bodies to survive. So just talking about the innate wisdom our bodies have and beginning to appreciate that and to try to accept our bodies as they are. I also work a lot with women to understand the impact of the media on them. Again, that’s not just something that affects girls. It affects women their whole lives. They need to have more of a perspective on how they develop this self-image and this body image and learn that it is an artificial construct instead of what their body really is and then work on acceptance that way and I think another area that they have to work on accepting is that we can’t control our lives completely.
Kathy: As I laugh…
Dr. Maine: Yes, right, right. And we are at our best when we are experiencing life as it happens and we have values and desires and goals but we are not trying to control and micromanage every minute of our lives.
Kathy: I can’t thank you enough. I do hope that as we close this is one of a number of future podcast we will have with you. My guest today has been Margo Maine and thank you so much for joining us and your wisdom.
Dr. Maine: Thank you. I loved it.