This article was originally published on Medium.

The other night I had the gift of listening to a friend perform a Schubert piano sonata to an audience of rapt listeners. For a moment, when the music quieted to a haunting adagio refrain, something about the beauty of the piece made me want to cry. I reflexively wanted to hit “replay”. Damn our on- demand culture. The expectation of being able to get what I wanted — now — momentarily roadblocked me from hearing the next part of the sonata.

But what was the beauty I wanted to return to? I’m in an arena where I’m engaged in discussions about beauty all day long. Mostly I hear “I’m too fat” which, in our culture, definitely means not beautiful.

Even my model thin (yes, stunningly beautiful) 24 year old patients feel fat. Several wonder why men don’t approach them when they dare to enter a bar. Why, they ask me, do they get lost in a crowd? Do they look fat? Are they really not that beautiful? (I can assure you, they are).

I’m an eating disorder specialist but i’m hardly the only one thinking about what beauty means. What made Schubert’s sonata beautiful? Art and music scholars question beauty endlessly. A group of researchers from McGill University discovered that music produces pleasure through enhanced emotional responses and the release of dopamine in the mesolimbic reward system. ( The emotions induced by music are evoked, among other things, by temporal phenomena, such as expectations, delay, tension, resolution, prediction, surprise and anticipation. In other words, we can’t always get what we want — now — and that, actually, can be associated with beauty.

So what about model skinny twenty year olds who walk into a club and feel fat? What actually does “feeling fat” really mean and how can they feel beautiful?

Beauty has to do with emotions. If you are focusing on your thighs or stomach, likely you’re not feeling anything at all — and neither will anyone else who is looking at you.

What are your eyes saying? Your smile? the tilt of your head?

Victor Hugo put it well when he said “Music expresses that which cannot be put into words and cannot remain silent.” Can your stomach do that? Your “fat” arms? Do flat stomachs and skinny thighs evoke emotions?

Think about it.

I’d say no.

So the next time you walk into a bar or a club, play with beauty. If you were music, what would you sound like? Slow the pace, play with the tension, talk feelings with your eyes when you are speaking to someone. Find one thing about yourself that you think is beautiful — your hands, your walk, the glimmer in your eye. Let that lead you into the room. Play your inner sonata gently, quietly or with gusto.

If your eyes are talking, if there is music nuanced in your look, someone is bound to feel something. Maybe then those around you will hear beauty. Maybe then they too will want to hit “replay”.

This article was originally published on Medium.

Healthy might be worse than you think

When I go to work, I get to talk to people all day about food — No TV food channels for me. I’m tuned in from the moment I get to my office.

These last weeks have been interesting. Girl scout cookies have arrived. Do you know how many women told me they ate (guiltily) a sleeve of cookies? (maybe men galloped through those cookies too but for now I’m talking about women — women who hate their bodies and who hate that they ate those cookies).

“This isn’t normal, right?” one patient demanded. She had been eating healthfully for weeks on end — but then, the damn cookies- the whole box in fact. “When will I be able to eat like a regular person? What’s wrong with me? Normal people don’t eat like that.”

Or do they?

The question of what is normal abounds. Almost all discussion about binge eating has to do with what isn’t normal. In recent years, the DSMV added Binge Eating Disorder to its roster of disorders. It is defined by eating a large amount of food in a short amount of time, feeling badly about the eating, feeling out of control. By definition “a large amount” means “larger than what most people would eat in a similar period of time under similar circumstances”. The question obviously is what do most people eat?

But maybe the most important diagnostic cue is not what is eaten, but how often. If you binge once a week or more for 3 months or so, you’re likely in trouble. But it’s the repetition, not the binge, that defines trouble.That’s interesting, no? Because it implies that maybe we all binge from time to time- and who doesn’t feel badly about themselves when they eat like that? It always implies a lack of control, uneasy feelings.

There is no question that everyone eats from time to time to quell emotions, to sooth one’s self, or just to blow out of the controlling demands of work, home or relationships. People get drunk (18.3 percent of us report binge drinking-Institute for Health Metrics and Evaluation ), have affairs (that’s around 60%! Buss and Shackelford), lose their anger (12% of us have very serious anger problems, British Association Anger Management) or throw teddy bears at their kids (self report from many of my friends and patients!) yes, it’s quite amazing what people can do when they are frustrated, angry, despairing.

So in the scheme of things, can a sleeve of Girl Scout Cookies (followed by a pint of ice cream…or more) be normal?

maybe so.

Unhealthy is when food is turned to as a main way of coping with feelings or anxiety, when your life revolves around what you are going to eat or when one day of eating defines what is eaten the next day — again and again.

But perhaps the most defining criteria for unhealthy eating is what one thinks. My patients are tormented by the ongoing, relentless drone of noise about food in their heads. This is a very different experience than that of someone who binges, feels badly, but then gets reinvolved in life so that food plays a very peripheral backdrop role the very next day.

I’m concerned that being healthy in our culture has morphed into being perfect. And perfection morphs into robotic. Soon enough AI creatures will be ruling the world. I want to make sure that we all continue to take a stance about being human. Perfection is not the goal of being human.

As Alexander Pope wrote “To err is human”. How about in order to stay human, we have to “err”?

I’m all for days off, broken rules, and moments of impulse and sway. The critical part is that one moment doesn’t define the next (i.e., “blowing it” doesn’t mean it’s time to give up and keep eating- or to starve) and that one moment of bingeing doesn’t interrupt life (a Sunday night binge doesn’t mean work is skipped the next morning). If a binge is just one kaleidoscopic note is an every varied array of ways of being and feeling — then I’m all for the moments of disarray.

Eat, drink and be merry. And don’t let a book tell you how to do it. We’re still just learning what it means to be normal.

Thirty-three years ago, I sat with a psychologist friend, Ellen, at the edge of the water in the Hamptons and said, “I feel fat”.

We were in our twenties and this was (as it still is) the language of girls. We had just eaten a big lunch and were there in our bathing suits deciding whether we dared to go into the water.

“I used to throw up when I felt fat,” Ellen told me (Ellen in later years would be “out” about having been bulimic, so no secrets divulged here). I was stunned. Slowly over the afternoon, Ellen told me what it was like to binge and vomit. She told me that she had been to a therapist at Cornell University, Dr. Marlene Boskind-White, who had discovered that other girls were throwing up too. Ellen had found a way to deal with her eating and thought we should open a center to treat girls in Manhattan who were bingeing and vomiting. I was working at St. Vincents at the time as the head of the Group Therapy Program in the Alcoholism Outpatient Division. We decided that with Ellen’s understanding of this new disorder and my expertise in addictions, we could carry the work that Dr. Boskind-White was doing in Ithaca (with her permission) back to New York City.

My friends thought we were crazy. Surely there weren’t enough girls doing this to run a business. “Everyone sits by the side of the ocean and fantasizes about opening a business,” a friend told me, “but doing it is another thing”. Ellen and I decided to do “another thing”.

By word of mouth (Ellen was in EST at the time and this was a venue where word traveled fast), we were able to find 5 women who were tormented by the way they were eating. We started a group and then sent out a press release (remember, no internet in those days) letting the media know that two NYC psychologists were starting a treatment program for girls who binged and threw up.

We were picked up by a cable TV show in Long Island, aired—and then our visibility exploded. The media loved it—pretty girls who were vomiting. It was a sad statement of the publicity world. The media wanted to know if we could teach people how to throw up in order to lose weight. That clearly wasn’t the point. But the extraordinary exposure in the media (the Today show, 20/20, innumerable national media clips and news articles for years on end) broke the deadened denial of a disorder that was already becoming an underground epidemic. We got thousands of letters from people (many with recognizable names), and, rapid fire, Ellen and I put together the first center ever for the treatment of bulimia, the Bulimia Treatment Associates.

At that time in New York City, Dr. Bill Davis was running the Center for the Treatment of Anorexia. I met with Bill, picked his brain, and Ellen and I ran by the seat of our pants to set up an effective program to treat bulimia. We developed three-day weekend groups (we had a half year waiting list for participation in these Bulimia Workshops) and Ellen and I hired a group of therapists to jump in and learn from our patients what we could do to help.

The time was exciting, inspiring and incredibly frenetic. After about a year, Ellen and I decided to split our partnership. I moved on to work with a good friend and new partner, Dr. Michele Siegel. We relocated from 9th Street to University Place in Manhattan and the Eating Disorder Resource Center was born.

Over the next several years, Michele and I put a center in place that housed 6 offices; we worked with approximately 20 therapists. The field was flying. Centers were opening up throughout the country, the severe extent of eating disorders was revealed. EDRC rapidly grew in size, opening its doors not only to patients suffering from bulimia but to those challenged by anorexia and binge eating disorder as well. During this time, we spoke to so many families that we decided to write down what we were telling family and friends, and Surviving an Eating Disorder: Strategies for Family and Friends was first published. Michele and I wrote, trained and gave talks internationally. These were thrilling times.

Then in 1992, tragedy struck. Michele, mother of four year old Jesse, and pregnant with her second son, developed breast cancer. Months after Michele gave birth to Josh, she, my business partner and incredibly close friend, died. Everything stopped.

That next year, I condensed EDRC, narrowed the scope of what we were doing and stopped to catch my breath and mourn the loss of Michele. Later that year, I also met the man who would become the father of my children and within two years, I would be the mother of twin girls.

Life somehow carried on. But at that time, I redirected my focus, extended my private practice, took care of my children and kept EDRC as a quiet sidebar in my professional life. Thanks to the help of many extraordinary therapists who kept the center vibrant along the way (thanks most recently to Dede Kammerling, Jay Pott and Debra Farbman), for over twenty years EDRC stayed as an anchor in the city for the treatment of eating disorders. Through those years, we kept a steady but low profile as my mainstay attention remained focused on my daughters and my patients.

Recently however, much has changed. Eating disorders have become interwoven into our culture and the field in general has expanded exponentially. EDRC needs to attend to the fact that our patients, the community and families need more. Perhaps as important, I find that my daughters, now full into their teenage years, are as grateful for the time I spend at work as they are for the time I spend at home! For the first time in years, I am able to invest time and energy back into the Center. EDRC is ready to grow again and all of us at EDRC are excited for the expansion of a center that has quietly taken root over the years.

What’s Happening Now…

And so in that spirit, I write to tell you about EDRC. We are growing in size, in program development, and in capacity to handle the ever-expanding needs of the patients and families challenged by an eating disorder in the tri–state area.

Looking back, oddly the moment the center was born was the kind of moment we hope for all our patients. My saying “I feel fat” allowed for a swirl of inspiration that changed my life.

Our mission and goal at EDRC is to turn challenge and struggle, the “I feel fat” moments, into inspiration and opportunity. We thank those of you who have supported EDRC with these goals for the many years along the way. We look forward to continuing the growth of our patients, EDRC and our relationships with you in the years to come.

Three years ago, my father passed away. When he was dying, I held tightly the ever fleeting images of him through words. Weeks prior to his death, I wrote the blog below for Gurze Press and the Huffington Post. This was written as a New Year’s Resolution—but I think it is apt for any time of the year—particularly now when we are about to lurch into the rush of the oncoming holidays.

I repost it now as a reminder to myself—and hopefully to you. In the next fast paced weeks of shopping, rushing, partying—and yes, eating—for a moment, STOP.

Crisis as Opportunity: My New Year’s Resolution

December 2011

On May 20 of this year, my father, out of the blue, was diagnosed with a severely aggressive leukemia and was given two to six weeks to live. A quick run to Google (because that’s what we do these days when we’re scared) confirmed that the doctors weren’t being alarmists and that we really had to start saying goodbye now.

In a matter of weeks, life turned on its head. We sold and cleared out the family house, gave away the family dog, spent endless hours, days, weeks at Sloane Kettering and planned a funeral. My father even wrote his own obituary. (My father’s bucket list included anything that could make life easier for my mother—and my mother was not exactly up for planning my father’s death). My father grew weaker, more and more sickly, lost his sense of humor and the twinkle in his eyes. Finally, we all gave in and my father was moved to a residential hospice facility. He only had a week or two left at the most, and we wanted him to be comfortable. We watched him go from a robust 160 lbs down to 150, 140, 130… and finally to 109 lbs. Visiting him felt eerily like I was still at work.

My father said goodbye to everyone, wrote letters and had touching moments of connection with us all. We were grateful that he wasn’t in pain and relieved that he might just slip away gently.

Except it didn’t happen that way.

Right now, my father is on a flight to Florida with my mother, strong enough to plan a trip to their winter retreat. Removed from all medications once he was in hospice, closely monitored by extraordinary nurses and surrounded by the love of his family, my father tentatively has come to life once more.

Two days ago my father left the small room at the hospice facility within which he surely was going to die. It was one of the most extraordinary days of his life, he tells us. He talked about the disbelief, reentering a world he had said goodbye to. He couldn’t believe he was seeing trees again, people, traffic, the stoplight he passed every day of his life.

The stoplight??

I know the stoplight my father is talking about. It’s oddly interwoven into my life as well. But grateful for the stoplight? Pay attention. My father is more alert than the best of us.

These last days, I’ve noticed that I too have a myriad of stoplights in my life. I now am stopped short frequently, finding myself staring at what was, only last week, the background of my life—the lamp on my office table, the tiny oil painting over my desk, the dappled light as it glints through my window in the afternoon. Background has become foreground and I am endlessly moved at the experience of wondering how the details make me who I am. I think of Helen Keller, objects suddenly cascading into her otherwise pitch black night, life found anew. Water.

Of course, I’m ever filled with joy and gratitude for the people I love and for the large, daily events that make up the tapestry of my life. But it is rare that I look so caringly at the details, the Seurat-like blinks that color in the picture at every turn. It is rare that I stop to look at all.

In truth, I don’t know how much longer my father has. I don’t even know if he will make it through the flight to Florida. But as a result of the crisis of his pending death, my father has given me a gift that surpasses any of the holiday presents I’ve received in years’ past. He has reminded me to see.

With every crisis comes the flicker of opportunity. My new year’s resolution is that each time I stop at life’s metaphoric stoplights, instead of impatiently pumping the brake, I’m going to catch my breath, settle in and take a look around. I only hope that, no matter what happens, as crisis evolves into the hushed chaos of quotidian life, that when I see the next stoplight, I actually won’t drive on through.

I (someone who has been known to race through yellow-turning-red lights) hope this resolution lasts longer than any I’ve made before.

Happy new year. jb

(my father died one week after this entry was written)

We hope the summer was long enough for everyone to have had some quiet soulful moments, some wonderful adventures and enough of a lull to be ready to jump back in to a more normal rhythm of work and school.

Over this last month, I’ve had the opportunity to listen to Adam Johnson’s The Orphan Master’s Son, the capacious, stunning Pulitzer Prize winning novel ostensibly about a North Korean spy, but also about identity, love, intimacy and the vacuous space between our two nations’ cultures. I was dragging my iPod and computer from car to apartment, room to room, so compelling (and beware, gritty) was the story.

Throughout the book, the author talks about the pain training that the young spy, Jun Do, has had to learn and endure. When you feel pain in one part of your body, Jun Do is taught, travel to another untortured part of your body. Focus on how that part of you feels, get lost in thoughts or memories that are evoked by the the parts of you that are not broken or in torturous pain. Jun Do wears the scars on his arm from the lit candle held to his skin during the arduous preparation for his life as a spy and kidnapper.

This is a book you live not read. And so throughout the multitude of thoughts it engendered, I found myself wondering if what we do at EDRC each day is “pain training”? Life is tough. Lit candles are held to our skin in endless ways. How do we hold on, be brave and remember that when the pain occurs in one place, there are safe havens to retreat to– other than food, starvation — or yes, even the intense focus of burning or cutting itself. I wondered what place in my body i could go to during “pain training”?

Years ago, when one of my daughters parted from me for her first foray into pre-school, she ran back to me and wordlessly grabbed my leg, right above my knee– and wouldn’t let go. Yes, we slowly pried her hands free; yes, i sat with her until she was quietly engaged in drawing; and yes, i was able to soon leave with the gift of a proudly drawn picture, a warm teacher and a quick-shot view of my daughter smiling, holding the hand of another child as she took her first steps into the world and I was guided out the door.

Maybe for me “pain training” would take me to my leg– a place initially associated with pain but soon lodged with images of connection, relief and love. Maybe if i were a spy in pain training, i would think of that part of my leg, right above the knee, where my daughter’s hands took hold.

What would “pain training” mean to you?

So much for sun and beach and travel and the time to wander while being read to for 20 hours.

Guess it’s time to get back to work…

The new psychiatric diagnostic manual, the DSM-5, is about to be released this month. Many of the new diagnostic categories are being questioned. One of particular interest is that of Binge Eating Disorder. Bingeing, or eating a large quantity of food in a shorter period of time than is typical, is a disordered behavior according to theDSM-5. An individual who has eaten excessively at least 12 times in a period of three months meets criteria for Binge Eating Disorder. That means if you “blow out” once a week, you have an eating disorder. Really??

For many, this may be true, but I’m really curious these days about how women (i’m starting there, at the risk of momentarily losing my male audience) REALLY eat.

I know the usually prescribed base for people struggling to maintain healthy eating is three meals a day, two snacks. But once people slide into the reality of everyday life, is that how we really eat? When I give talks to teens, they tell me they frequently skip breakfast, eat “junk” through the day, “pig out” after school if they have raced through the day without eating much. Are they eating disordered? Harried moms pick at their kids meals before they go out and then worry that they “overdid it” when they finally sat down to dinner, relaxed, eating until they are more than full. Is that a binge? (They will assuredly tell me it was a vast amount of food in a short amount of time—and afterwards they have their laments). Colleagues tell me that when a paper is due, they sit down, make a mess of their notes, their thoughts and their eating as they get their thoughts on paper. Later, they clean up their words, their thoughts, their eating. Is that disordered?

In this culture where most everything is now diagnosed and pathologized, I am wondering what “normal” eating really is. A study of 2000 British women revealed that participants confess to eating two snacks a day—but usually when no one is watching because they are embarrassed about eating the snacks. If women can’t even eat a snack in public, what else are they doing that they are embarrassed about or can’t even report in an anonymous study? My guess is it’s much more than two snacks a day.

Remember how sexuality was spoken about a few decades ago? (Well, maybe you don’t remember—but this is how it was)—Pre-60’s, women all knew what they were supposed to do in bed (missionary position) and no one talked about anything more. Everyone likely assumed there was more to the picture… but no one really knew what people did behind closed doors. This of course all changed with research and literature (think The Joy of Sex). With open discussion about what men and women REALLY did, knowledge, shame and a sense of choice about sexual possibilities radically changed.

In the arena of food, however, we are back where we were in the arena of sex generations ago. We are still in the dark ages, with mystery surrounding what women really eat and shame coloring our ability to even talk about it.

We all know that disordered eating has to do with one’s world being out of balance—food and weight are used to cope with feelings, to withdraw, to protect one’s self. We all have moments of that—sometimes even once a week—Does that mean we are all eating disordered?

A patient of mine once asked me if women REALLY do eat candy if they are not bingeing. Yes, i answered—all the time. But that question prompted my wondering how we can better know what women really do—and what is healthy—and what is not. The new DSM-5 presents many answers. But how can we use the new manual to allow for new questions as well. What do women REALLY eat? When is eating healthy? When is it not?

As fellow EDRC psychologist Lauren Waine notes:

“The cost of not knowing how women really eat may be the continued marginalization of people with normal human behavior, with the net effect being a veil of shame, self-reproach, and the felt need for secrecy and hiding among all people”

I couldn’t say it better.

The sun is beginning to emerge, the weather has warmed (a bit) and we are finally allowed the wisp of hope for spring and summer. Yes, bathing suit weather may actually soon be upon us.

This means that millions of women (and men too, despite my gender tilted language) are going to slough off winter layers, stand in front of the mirror—and be horrified. The airbrushed and photo-shopped bodies they’ve seen in magazines all winter will look nothing like their own. Panic will ensue and for many, the promise of summer will mean extreme dieting, fasting, cleansing and vomiting.

And many will ask “What’s so bad about that?
It’s temporary, the weight will come off. It’s just a phase. ”

Except for many, it won’t be.

“Just” a week of dieting, fasting and purging is always the way a severe eating disorder starts. There is never a guarantee regarding who will be okay and who won’t. It’s just too easy to do. Didn’t every two-pack-a-day smoker start with just one cigarette?

Every culture has its toxin. There’s cocaine in South America (piles of it as appetizers, I remember. I really saw that). There’s plenty of marijuana in Mexico, alcohol abuse in Indian tribal communities, cigarettes in France, food in America. It’s hard to be a human being.  We crave time out.

So is bulimia the new cigarette smoking? And if so, how do we remind our teens and our patients, that vomiting not that cool, just as dangerous (maybe more) and won’t even achieve the effects that someone wants (most people suffering from bulimia are of normal weight or above. Check the charts. Unfortunately no one wants to be of normal weight anymore. That is surely not an incentive to binge and throw up).

We like to turn to substances and the outside world to fix our weight, to fix our feelings and to fix our soul. The problem is that these solutions always work—for a minute. Then feelings, hungers, eating and distress inevitably come back. And the need to start eating, purging and dieting starts all over again. Talk to anyone caught in this battle—it’s torture.

So when the warm weather sends you into a swirl of body-obsessed panic, catch your breath. Dare to take a walk to the river and when the body torture thoughts come up, go inside, just for one moment. The sun, the warmth, the promise of spring holds the hope of good times and bared bodies. But what will you look like inside of yourself? What will give your life meaning this summer? What will your soul look like? If the sun and warmth can get you outside so that you have a moment to reflect and go inside, it will be one moment more that your body, the culture and the need to be skinny and cool are not the only things that matter. Take ten minutes away from the mirror. Take a walk outside. And take a big, long breath. Summer is about to begin.

Is there any holiday filled with more “forced-march” trepidation than Valentine’s Day? I’ve had my share of fun Valentine’s Days—but I’ve also had horrified moments of expectations not met. And i’ve certainly had “successful” Valentine’s Days that unfortunately meant sitting in a restaurant in a line of 10 couples, table to table, guys on one side, girls on the other, all playing out the protocol of what romance should look like. It all felt pretty silly and almost embarrassing at the time.So yes, there is the forced march into intimacy –but also, what about all those chocolates? if you don’t get them, that’s supposed to be a sad statement in our culture (really? maybe just bad timing. If Valentine’s Day were a month away, it could be a different story). And what if you do get those chocolates? Now what? How many do you have to eat to prove you’ve celebrated successfully?

This Valentine’s Day, how about celebrating in a new way? Can you have one moment of connection with someone you love? and as far as i’m concerned, that doesn’t have to be a cupid-arrowed partner. What about your kids? a friend? What (horror on Valentine’s Day) about yourself?

This is a holiday about connection and intimacy that has gone awry. It’s a holiday too that often has people focusing on what they DON’T have—not what they do.

So why not use this day to have one intimate connected moment with anyone, including yourself. Focus for that moment on what you DO have, not what you don’t. And in terms of those chocolates—if you are going to have them, stay present, mindful—Don’t have one unless you are ready to taste what you are eating and actually enjoy it.

This doesn’t have to be a holiday where you are robotically ushered into a pro-forma set up in a restaurant, a holiday where you are pressured to be and act close. It doesn’t have to be a wild run of a day with chocolate wrappers strewn throughout. Make it a true holiday—a day to pay attention to who is important to you, yourself included. Otherwise, you too will run the risk of being a Hallmark card run amok.

Celebrate—in a fashion that feels true to yourself and your hungers for closeness, self acceptance—and even for those chocolates.

(And, as our support group leader Jamie notes—It’s nice to give and receive love on any given day. So perhaps if we practice celebrating love (for ourselves, our family, our friends) on a more regular basis, this day might hold less of a punctuated, personal meaning? Thanks Jamie—I couldn’t agree more!)