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Pursuing Perfection Interview

Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond – Interview

Margo Maine, PhD, FAED, CEDS, one of the author’s of Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond joined us to discuss her book. What follows are our questions in italics, and Dr. Maine’s thoughtful responses.Margo M by David Hall 2012-11-10 21.32

Very early in your book, Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond, you quote Caroline Knapp from her book, Appetites:  Why Women Want, with “(A) woman’s individual preoccupation with weight often serves as a mask for other, more intricate sources of discomfort, the state of one’s waistline being easier to contemplate than the state of one’s soul.” What are some of the reasons that obscure this dynamic?

Contemporary women live in a culture that demands so much of them and yet dismisses their worth at the same time. With globalization, our fast moving consumer culture has created unprecedented opportunities and unprecedented stress for women.

Women have so much today – growing economic strength, political influence, educational and career opportunities. Yet according to a Gallup – Well-Being Index, women aged 45 to 64 have the lowest well-being and highest stress of any age group or gender in the US. There is something wrong with this picture!

Women are now taught that they can do or be “anything”- but somehow that has been translated into needing to be and do “everything.”

We are “dancing as fast as we can,” but the cultural pressures to be perfect–including a flawless, slim body—are relentless. Our consumer culture always has a diet or exercise program to sell us, a pill to increase our metabolism or dehydrate us, cosmetics or clothing to create an image, spanx to make us look leaner.

We may be unsure we can succeed in other areas, but we are taught that our bodies are malleable and that we should always be “working” on them.

It’s easier to find a new exercise program or a new diet than it is to answer the questions we have about how to manage the tensions between our careers and our families, how we will achieve gender equity when it comes to pay and to power, and whether we are truly happy and fulfilled, or just following the cultural script for contemporary women.

We all have to decide what mark we want to leave behind on the world. Do we want to be remembered as “a good dieter,” or as “a great friend?” Do we want our epitaph to be “she slimmed down to a size 6,” or “she used her boundless energy to make the world a better place?” Pursuing perfection is an endless and meaningless distraction from the real issues we face today as 21st century women.

How can we as a community more effectively get the truth out about the risks of diets and the diet mentality?

As professionals, we must immerse ourselves in the Health at Every Size paradigm. We need to be able to articulate the science behind HAES – and there’s plenty of it (See Body Respect– Bacon & Aphramor, 2014). We need to educate ourselves, our patients, our communities, our peers, and especially medical professionals who are always being confronted with “the war on obesity.” We must raise the public and professional consciousness about weightism and all the myths linking weight and health. That is the only way we can gain any ground against the pervasive spread of eating disorders. If you care about preventing eating disorders and helping those who have suffered, or are suffering, you have to add being a HAES advocate to your job description. We need to make our culture a safer place for all body types and weights so the cult of thinness will itself begin to shrink.

Do you have some suggestions on how women can pause and appreciate the complexities that are active in their lives today?

That’s the million $ question, isn’t it? We keep women so busy as they navigate multiple roles in their families, careers, and communities. Most women I know don’t stop moving and don’t have much time to reflect. Living in a fast moving consumer culture like ours keeps us from asking the questions we need to about whether we are really achieving what we want. Is having the perfect clothes, or body, or appearance, more important than feeling connected to our core values and to the people in our lives?

One thing I often ask my adult patients to do is to take a few minutes at the end of the day to write down the things they did that day – and then to note which things they enjoyed or felt good about. Often there are few that really felt satisfying – quite a lesson there.

We have to create time to reflect and we have to cultivate relationships that are safe enough to discuss these feelings. Today, many women are in constant competition with other women, so they don’t have a safe place to be their true selves.

It is time to get off the treadmill, and start having honest conversations about our lives. Many of my adult patients are only talking to me about their emotions, their self -doubts and insecurities, their eating and body image issues, and the many deep questions they have about the direction of their lives. In other words, they have only one or two hours of honest conversation per week. That’s not enough. No one else knows how they are struggling and how empty they feel inside.

Women have to stop competing with each other and start sharing at a deeper and more real level. That is the only kind of energy and connection that can compete with the power of an eating disorder.

You include a list of “Mom’s Hand-Me Downs.” This list mentions

  • complain about the changes in her weight or appearance as she aged
  • label food good or bad
  • express remorse or guilt after eating

What are some of the reactions women have when they recognize they’ve integrated these beliefs?

Most are really surprised – if not shocked – that they are duplicating their family’s patterns in their adult lives. It opens their eyes for the first time to the ongoing impact of their family’s messages on them. I point out that they had the double whammy of living in a culture that imposed impossible demands on them regarding appearance, weight, and shape, but that they also heard these messages at home.

Instead of home being a safe place, many of my adult patients were constantly pressured and never allowed to feel good about themselves “as is.” The silver lining is that, for those who are mothers, they see the importance of their recovery for their children. This motivates them like little else can.

So many women enter eating disorder treatment because they have children who are now getting to the age when their body image and eating problems started. Eager to not let these problems affect the next generation, they will work very hard to address their own issues and monitor and modify the messages their behavior around food, body image, and self -care are creating for their children.

Eating disorders don’t have to be the family hand-me-down. Women feel very empowered when they see how they can change the legacy in their families and overcome the past.

In your chapter entitled, “The Shape of Recovery,” you comment, “Recovery requires finding new and nurturing ways to express and accept the richly imperfect self:  the good, the bad and the ugly.” Can you please share more about the exquisite acceptance involved in the “richly imperfect self”?

Life is best lived when we accept ourselves as we are, with all our flaws, imperfections, and warts. Perfection is an illusion that can never be realized but can create a standard of comparison that feeds constant self-doubt, shame, and insecurity – the perfect breeding ground for eating disorders.

Women spend too much time worrying about creating the perfect image, having the perfect body, home, and life. Only when we let go of the pursuit of perfection, do we truly experience life and have the potential to contribute meaningfully to our world. Letting go of perfectionism, allows us to grab onto meaning and purpose – that’s when we can make a difference in this world. That’s what life is all about.

When we take the time to reflect, most of us recognize that the people we love and admire the most aren’t necessarily perfect- but they are necessarily real. They are genuine, honest human beings who give of themselves and live intentional, compassionate, meaningful lives. I ask women to think about the people they really respect and love. What makes these people so special? It’s not usually what they look like. It is what they give to others and how they live their lives.

Rosa Parks is a hero to me- she wasn’t trying to be perfect, but she was being painfully honest about the impact of segregation on her and other black Americans. Tired and angry about racism, she decided to sit down on that city bus in Montgomery, AL, in 1955, and she helped to launch a new era in the efforts for civil rights.

Our world is a different place because of Rosa Parks. Sitting down can be a powerful act. Maybe we all need to do just that – sit down and think a bit more about what is right and wrong in our world. That will get us out of our bodies and into our values, beliefs, and spiritual needs.

It takes time and effort and guts to give up perfectionism as that is what we have been taught and that’s the kool-aid we have been drinking. Be gutsy. Be a rebel. Decide to love yourself “as is.” You’ll have more fun and the people around you will as well.

Can you please explain the cognitive distortion of “selective attention”?

Selective attention happens when we only pay attention to things that support our world view or our view of ourselves. We disregard anything that challenges these thoughts or beliefs. Those with eating disorders and body image issues will ignore or even dispute anything that contradicts their beliefs about the importance of appearance and weight, the value of thinness, or the risks of weighing more. They might be drawn to orthorexia (rigid, overly “correct” eating) or diets that exclude food groups or that suggest that some foods are inherently and always bad for us.

Selective attention also filters out any positive input – such as compliments and praise for things other than appearance, weight, dieting, and related eating disorder values. It allows the eating disorder to blossom and take hold.

Selective attention is a powerful cognitive distortion, as it will not consider any other information or opinion. With no countervailing input, nothing challenges the eating disorder or body image distortion.

A technique called cognitive restructuring can break through selective attention and other cognitive distortions. Cognitive Behavioral Therapy (CBT) is generally included in treatment programs and most eating disorder clinicians are schooled in this approach and blend it into therapy and counseling sessions as needed. The chapter Thinking and Coping in New Ways describes how to use cognitive restructuring to challenge typical eating disorder thoughts. With practice, we can change our thoughts and that makes changing behavior much more likely.

Please tell us about the value of flexibility in eating disorders recovery.

Eating disorders are often a means of controlling life when it feels like it is spinning out of control. That is why they frequently appear or intensify during periods of transition – like moving into or out of adolescence or during midlife passages that we discuss in our book, Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond.

During these transitions or other traumatic times, life feels uncertain, so controlling our bodies becomes an attractive coping mechanism. I often compare the experience of an eating disorder to grabbing onto a life preserver when you are in turbulent waters and fear drowning. Hanging on tight makes sense if you think you are going to drown, but you can’t survive for long that way. You have to begin to let go, deal with the troubling feelings and self-doubt that you are experiencing, and learn to swim in turbulent waters, so you no longer need that life preserver.

Recovery is about letting go of the old behaviors, thoughts, and even relationships that reinforce the perfectionism and negative self -image underneath the eating disorder. Eating disorders are full of familiar rules and compulsions falsely promising safety. It is frightening to begin to break some of those rules and take life more as it comes instead of controlling every bite and every step, but living in the moment has so many rewards.

Sometimes I ask patients to try breaking the rules and being more flexible for an hour or two at a time – just to taste it. They don’t have to sign up to give up all their eating disorder rules for the rest of their lives. Usually, slow changes are easier to absorb and get used to. I always say: “Slow and steady wins the race.”

Decide to cultivate what Buddhists call “the beginner’s mind,” allowing life to happen in the moment rather than trying to predict (perfectly) every permutation of the unknowable future. Practice being less of an expert and more of a participant in your life. This requires relinquishing the pursuit of perfection, an important ingredient in recovery that brings so many other rewards.

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About the author:

A Founder and Adviser of the National Eating Disorders Association and Founding Fellow of the Academy for Eating Disorders, Dr. Maine is 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, 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, CT.


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