abstinence


Around Christmas of last year I stopped listening to podcasts. That was a big change. Prior to Christmas, I listened to podcasts during all of my breaks, walks, exercise, chores, errands, and commutes. Whenever I wasn’t interacting with someone or studying for my marriage and family therapy licensure exam, I was listening to podcasts.

I love listening to podcasts. I heard someone say that this is the second great age of radio, and I agree. I wasn’t there for the first, so I don’t get a vote, but I suspect that this one is better. Listening to podcasts, my days were full of super high quality radio shows: stories, lectures, news, analysis, entertaining, educational, emotionally moving, on demand, whenever, wherever. It was wonderful.

Once I set the date for taking my LMFT exam, though, I also started thinking about starting my private practice. Despite a private therapy practice being my fond desire for over a decade, despite having worked hard all that time to prepare for this moment, I started to feel anxious. That anxious feeling helped me realize that I needed to ditch the podcasts and focus on my own thoughts and plans. I’ve studied for exams my whole life, and I can do it with podcasts in my life. Starting a business is new and a big deal for me. I needed to hear everything my brain had to say on the topic, wrap my head around all the options, give myself mental space for it. Podcasts were taking up almost all of that space. A lot of mental problem solving does happen behind the scenes, so to speak, in parts of our brains that do not report directly to our conscious awareness, so a lot of problems are best solved by concentrating hard for a while and then completely taking your mind off of them for a while, maybe by listening to a podcast. The set of problems I’ve been working on are not like that. They require no burst of inspiration, just continued concentration. For example, what should my informed consent form have in it? I need to read and understand the relevant laws and ethical codes, read through my notes, look at the various examples I’ve collected and are available online, and write one. My task is thoroughly and effectively integrating and using existing information, not solving or creating new problems or solutions.

I started listening to podcasts in 2006. I had a broken heart and needed help derailing some persistent, not-useful thoughts. It worked wonderfully. My mind could trace the grooves of great thinkers and storytellers instead of loop unhappy thoughts. The only side effect was learning a ton. I listened to easily thousands of hours since then. My Planet Money listening alone totaled more than 150 hours of learning about economics. By the time I quit, I was listening to almost every episode of over 20 podcasts. (See the full list below.) Podcasts on so many different topics made for lots of great cross-referencing of information in my mind and generated lots of good questions. Quite a bit of what I’ve written about in this blog started off with my attempts to bring two or three podcast narratives to terms with each other.

Quitting means learning less overall, but more deeply in one area: casting a learning net that goes deep but much less broad. I’ve been reading business articles, buying malpractice insurance, looking into potential office spaces, figuring out insurance panels, working on a marketing plan, making a budget, learning about bookkeeping and taxes, and on and on. When I take my now silent walks or drives I can watch my thoughts working through these topics and take note of any new clarity, priority, or question. The only problem is that it’s boring. With podcasts I was almost never bored. Without them, it’s very common. I’ve experienced way more boredom in the last few months than in all of my last ten years combined.

My first whiff of this change came while listening to Joshua Waitzkin on the Tim Ferriss podcast. Waitzkin is a former world champion in both chess and tai chi push hands, and a compelling speaker. At one point he says, “I like to cultivate moments of silence in my life,” and I had to stop the tape. I thought, “That sounds wonderful! That sounds useful! That sounds like something I’d like to do. But I never do that.” More recently I read Cal Newport’s Deep Work (thanks to Blake Boles), in which he sings the praises of boredom. He says that resisting distraction, remaining bored, is like calisthenics for the mental muscle you use to do the difficult, focused, high value work that he calls “deep work.”

I’m sold, at least for now. I’m cultivating plenty of moments of silence and I’m doing a fair amount of deep work and benefiting from it enormously. It’s great to feel and be productive. But I can feel the tension. Integrating what I catch in my broad net is a big part of who I am and what I have to offer my clients and community. My choice is clear when it’s between listening to podcasts or launching my private practice effectively and efficiently. But once it’s up and running (and paying the bills) I’ll be listening again, though I hope with a better sense of when I’ll benefit by turning them off to take a silent walk around the block.

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Complete list of podcasts as of 12/25/2016:

99% Invisible – Great stories about how human design effects our lives and culture. Interesting but also often inspiring or moving.

Bulletproof Radio – Dave Asprey interviews interesting people about biohacking. He does a fair amount of self-promotion, but his guests tend to be good and he presents some really interesting ideas. I was listening to about half of his episodes. If you want to check one out, go through his archives and choose a topic you’re interested in.

The Daily Evolver – I really miss this one. Jeff Salzman analyzes current events from the perspective of Ken Wilber’s integral metatheory. It’s often political, and he’s a rare optimistic voice on the progressive side. My favorite episodes, though, are when he interviews Keith Witt, an integral psychotherapist. Check out whatever he’s posted most recently with Witt. Those episodes are called “The Shrink & The Pundit.”

The Ezra Klein Show – A wonderfully nerdy political show with great interviews that go deep. 

Fareed Zakaria GPS – Intelligent current events analysis each week, from a world-centric perspective. I miss this one too. 

FiveThirtyEight Politics – Nate Silver and his team bring much needed data and data analysis to current events and news. 

Freakonomics Radio – Relentlessly counterintuitive findings from economics. 

Hidden Brain – A good psychology podcast from NPR.

Imaginary Worlds – Eric Molinsky talks about sci-fi and fantasy world building in popular culture. If you’re a fan, check out his series on Star Wars.

Invisibilia – Another psychology podcast, very engaging.

Judge John Hodgman – My comic relief podcast. John Hodgman hears and rules with wisdom and hilarity on real disputes.

Left, Right & Center – Weekly political analysis from a liberal, conservative, and centrist. This show taught me that political analysis is all about outcome-irrelevant learning.

Longform – Good interviews with authors about writing. 

The Memory Palace – Fantastic, very short, poetic, moving episodes about historical events, usually on a personal scale. So good.

More Perfect – Fascinating stories about US Supreme Court decisions.

The New Yorker Radio Hour – This started off as interviews with New Yorker writers about current articles, and has morphed into more of an art/culture/politics variety show. I preferred the former version, but it’s still really good, as one would expect from The New Yorker.

The New Yorker: Poetry – Short episodes in which Paul Muldoon hosts a poet who reads two poems from The New Yorker, one of their own and one by another poet.

Off-Trail Learning – My friend Blake Boles interviews alternative-education thinkers and doers, often focused on unschooling. Check out his interviews with Dev Carey and Liam Nilsen. (He also interviewed me recently, if you are particularly interested in me.)

Planet Money – Short stories about and explorations of economics and the economy. You learn and are entertained. Check out “The No-Brainer Economic Platform,” about the six things that all economists agree on, and “The One-Page Plan to Fix Global Warming.”

Revisionist History – Malcolm Gladwell tells stories in that fascinating way he does, only on a podcast. Check out his episode on the song “Hallelujah.”

Seminars About Long-Term Thinking – The Long Now Foundation presents authors and thinkers talking about their ideas from the perspective that “now” is a long time—the last 10,000 years and the next 10,000 years. It’s fantastic—one of my favorites.

Sound Opinions – Pop/rock record reviews and conversation.

TED Radio Hour – Interviews with TED speakers on a theme.

This American Life – The prototypical podcast. Great stories.

This Week in Microbiology – Three microbiologists discuss recent microbiology research. It’s super nerdy and good. I loved keeping up with developments in this exploding field.

The Tim Ferriss Show – Author Tim Ferriss interviews very interesting people. Tim’s access is astounding and his knowledge base is wide enough that he can have interesting conversations with anyone. The theme is deconstructing top-level performance, but topics are all over the place. Chances are he’s interviewed someone you’re interested in, so look in his archives and start there.

Vox’s The Weeds – Very nerdy and very good political analysis. These folks are actually reading the original documents—laws, reports, policy papers, etc—and it shows. Outcome-relevant learning in political analysis.

Waking Up with Sam Harris – Some of the most interesting and inspiring conversations about science, philosophy, and spirituality that I’ve come across. Unfortunately, he also puts up a lot of episodes about Islamic terrorism, which are boring and quite skippable once you understand his perspective on the topic. His non-terrorism political rants tend to be quite interesting and often surprising, and it’s just lovely to hear him tear into Trump. I’d advise starting with an interview with one of his scientist or philanthropist guests, though, maybe “The Light of the Mind,” about consciousness with David Chalmers.

You Are Not So Smart – Each episode is about some facet of faulty thinking, why we fall for it and how to fight it. Clever and fun.

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I just went to my first Alcoholics Anonymous meeting. It was the closest one I could find using a Google search–a few blocks from my house, maybe a four minute ride, in a house that I’ve passed hundreds of times. I didn’t expect that. I probably would have guessed that there were something like five or ten AA meetings in all of Eugene and Springfield, but when I searched “Eugene 12-step meetings” I immediately had a list of one hundred and seventy-eight meetings within 15 miles of my zip code. One hundred and thirty-four of those were AA, most of the rest were Narcotics Anonymous, and some were Gamblers (4) and Overeaters (10) Anonymous. They happen every day of the week, from early in the morning until late at night. This movement is huge. No one knows exactly how big because there is no registry, no dues, and the meetings are self-organized, but there were 10 people at my meeting, and this was Halloween night. If 10 is average, that’s something like 1,800 attendees per week, though there is certainly lots of overlap–people attending multiple meetings. Still, that’s a lot of people sitting in a lot of meetings, and that’s in an area with a population of about 200,000.

It was interesting to be so outside of my normal social bubble. I was nervous to go, and nervous when I got there, but everyone was super nice. There were 6 boomers, 2 X-ers (including me), and 2 millenials. I guessed a few were middle class and the rest working class. I’ve been working class my whole life, but these days my social circle is mostly upper-middle, with thin skin and clean hands. My eyes were drawn to the “mechanic hands,” with grease practically tattooed into the grooves of the fingers, and the rough, thick faces of hard lives. We sat in a circle, introduced ourselves, and started reading from Alcoholics Anonymous, the Bible of AA. We each read a paragraph and then passed to the next person. About half of us had what sounded like a grade-school reading level, another reminder of the thin slice of society I live in, so highly educated.

The story was about a rich alcoholic, who failed to get sober in the US and went to Carl Jung in Europe, who also failed to cure him. Apparently, after some effort, Jung told him something like “I have never had any success helping your type of drunk. Sometimes a spontaneous spiritual epiphany can do the trick, and I have been trying to produce that in you, but have failed. You are a hopeless case.”

The format was that anytime anyone felt moved to speak, they would pipe up: “I’m so-and-so, and I’m an alcoholic” and then tell their story or make their comment on the reading. I found it moving to hear their stories and even just to cop to being alcoholics. There was clearly power behind that ability to admit powerlessness. One woman shared about how her life before sobriety was “insanity,” not only in that she was constantly miserable to the point that she felt like her life was “hell,” but in that “What I thought or what I decided about drinking had no impact on whether I drank that day.”

A lot of the readings for my Modern Issues in Addiction class are critiques of the 12-step model, the “disease model,” of addiction. The in-vogue model in post-modern circles like my Couples and Family Therapy program is the “harm-reduction model,” which is secular, so it requires no spiritual epiphany to reorganize the addict’s behavior, and is not aiming at abstinence, but at reducing the damage done by the addiction. One reason harm-reduction is appealing is that you are allowed to count positive outcomes that fall short of abstinence; isn’t it a victory if someone who used to get drunk every night now gets drunk just 3 nights a week? Yes, I think so. Another reason harm-reduction is appealing is that God, even as vaguely defined as it is, is such a dicey topic, hard to manualize for therapy, hard to justify getting behind for us multiculturalists, not wanting to offend the atheists or the theists who have another word for God. The AA God has a male pronoun, for God’s sake. So unhip. It’s hard for us to get behind a program that is not for everyone.

The critiques of the 12-step model have all been theoretical critiques of theory–a form which is quickly becoming my least favorite form of writing. If you have a theory you want to critique, please use data to do so. Please build your counter-theory on data. That would be lovely. The trouble is, the data does not contradict the 12-step model. The summaries of evidence I’ve read (which were written by the critique-ers) basically say that 12-step programs work at least as well as harm-reduction programs, however you measure outcomes, and they work significantly better for addicts who are religious.

The God part of the program was clearly a key part for the folks in my meeting. Two men told harrowing stories about their pre-sobriety days that focused on their denial of their problem. They would go to meetings but they didn’t really “get it” and things got worse and worse. Both described turning-point moments that turned on a prayer. One night, one said in anguish simply, “God, help!” The other said, “Oh, God, I will do anything.” And suddenly they knew that they had a real problem, and that they were personally powerless against it.

I have a difficult time relating to the concept of a second-person God–it’s hard for me to believe anything I can’t directly experience–but I think there is something real and useful going on here. It reminds me of what it’s like to sit in Vipassana meditation. I sit and systematically observe the sensations in my body. It seems as if I have some control over what part of my body I’m focusing on, but I don’t seem to have any control over what sensations I experience in that part of my body. I look and feel what is there, and what is there is given. I am learning to relinquish control over the things that I cannot control. I am practicing not reacting against what is given. And really, how I react is also mostly not in my control, also part of what is given, so I sit with the intention of allowing reality to happen and watch. Suffering is part of the reaction. If I have pain in my body and I react against it, that is suffering. If I have pain and I don’t react against it, that is just pain, which is radically different. And the difference between reacting and not reacting, I think, is grace. It’s my willingness to sit and pay attention, and grace. This is not so different from an alcoholic turning their life over to God. It’s like the serenity prayer, which we said:

God, grant me the serenity
To accept the things I cannot change;
Courage to change the things I can;
And wisdom to know the difference.

When we went around the circle introducing ourselves, each person (just like in the movies) said their first name and that they were an alcoholic. When it came to me I said “Hi, I’m Nathen, and I’m new here.” I was a little nervous about it, but they seemed to like that fine and said “Hi, Nathen!” with just as much enthusiasm as they did for the others.

I’m not an alcoholic. I don’t like alcohol. The first swallow can be pretty interesting, especially if it’s expensive stuff, but after that it starts tasting like something you would scrub your sink out with. I think I inherited that from my mom’s side of the family. That’s how you can tell the Pikes from the in-laws at a family reunion: The in-laws are drinking, the Pikes are not.

I can relate to compulsive behavior, though, mostly around food. And when I say food, I mostly mean sugar. (I seriously considered going to an Overeaters Anonymous meeting for this project instead of AA. I think that I didn’t because I (unfairly, I’m sure) imagined the real food addicts staring at me, maybe hating me in my effortlessly thin body.) At times, I can relate to the woman who said it didn’t matter what she thought or decided about drinking. I can make what feels like a very serious decision not to eat any more cookies today, for example, and then find myself rationalizing my way back to the package. Or ice cream, chocolate, pretty much anything sweet. I can remember sitting, my stomach already feeling kind of bad, looking at a half-eaten bag of chocolate chips, and realizing that I was going to finish those chips. It didn’t matter that I would feel terrible. It didn’t matter that I would have trouble getting to sleep. They weren’t even tasting that good anymore. But I was going to eat them all. I find that disturbing. I think of myself as the kind of person who can and does make decisions and follow through, all the way. That is the kind of behavior psychologists call “ego-dystonic,” or counter to the conception of the self.

So I had my moment of feeling like I was in the right place. It was Halloween night, and they had a big container of candy on a table in the middle of the circle and said, “Help yourself!” It was all crap, in the sense of my intention for this year, “Do not eat crap.” I saw that immediately. I was not hungry, but I wanted some candy. I thought, “I should probably eat a piece or two of that candy to take part in the culture of this group.” I took and ate two Reese’s Peanut Butter Cups–probably my favorite of the crap-class candy–during the meeting. I’m certain no one would have noticed if I hadn’t. My rationalization was just my rationalization. I felt a little guilty for breaking my intention and I noticed my attention going back to the candy throughout the meeting. It was easy not to eat any more, but that may have been because there were no more Reese’s Peanut Butter Cups visible. I would have had to dig noisily through the container while others were reading or sharing.

But while I did have that experience, I don’t mean to make light of the experience of the people at that meeting, or of actual food addicts. I am not a food addict. I have some usually-mild compulsive behavior around food, but not to the point that I’ve ever done anyone wrong or maintained an unhealthy lifestyle. These folks were dealing with something on a whole other level of suffering and trouble. And they seemed to be doing admirably. One man described how when he started craving alcohol, he knew it was time to “reach out”–go to more meetings, call for support, be with good people. As with the others’ sharing, I was moved by his sincerity, conviction, and wisdom.

After an hour of talking, we stood, held hands, and closed with the Lord’s Prayer. I did not expect to be moved by it, but their delivery of the about temptation and evil had such feeling and meaning after hearing their stories:

Our Father who art in heaven,
hallowed be thy name.
Thy kingdom come.
Thy will be done
on earth as it is in heaven.
Give us this day our daily bread,
and forgive us our trespasses,
as we forgive those who trespass against us,
and lead us not into temptation,
but deliver us from evil.
For thine is the kingdom,
the power and the glory,
for ever and ever.
Amen.

A month ago I participated in an event called Earth Hour, where I used no electricity between the hours of 8 and 9 at night. It took some doing to get everything off–there are so many little lights on my gadgets that let me know they are powered down! Then I remembered that this is only one kind of “phantom load,” or energy use by appliances that are supposed to be off. I unplugged my refrigerator, thinking that even though I had turned down its thermostat all the way, there may be part of the thermostat using electricity by monitoring the temperature in there. Then I decided to just shut off the breaker that supplies my part of the house.  In doing so accidentally shut down power to the rest of the house for a minute–sorry Katie!–but at least I could be pretty sure I wasn’t using any electricity.

I spent most of the hour, then, just enjoying the silence and dark. I realized that these various glows and hums that I live with are anxiety-inducing. I love silence. I really dislike that my refrigerator makes noise, whenever I notice it. I want cold food, but why am I also paying to move the air like that, producing annoying sound waves? It’s inefficient and irritating. I don’t always notice, thank goodness, but sitting there in the silence, I believed that part of me is aware of all of that stuff all the time, and it drains me.

I also liked how I was not subject to be contacted and that I had made a clear, conscious decision not to contact anyone. It reminded me of a lecturer I saw several years ago who preferred the term “tethered” to “connected.” Don’t get me wrong, and don’t stop calling me! I love talking to my friends and family. It’s just that the possibility of constant connection creates a conflict between my desire for connection and my need for time just being in my body, slow, internally focused. And there are always people who it’s been too long since we’ve caught up, and the emails keep pouring in…

My means of production were mostly off the table, too. No computer, so no Word, WordPress, Excel, or Protools. No electric or electronic musical instruments. I played a some acoustic guitar and sang a little, but mostly I just rested, calm.

Then I decided to take a walk, maybe see if there were any signs of others taking part in Earth Hour. This is Eugene, after all. I was disappointed. Outside it was brightly lit up, just like it always is, and it pissed me off. It wasn’t that my neighbors all had their lights (and TVs and everything else) on. They probably didn’t know and/or didn’t care about Earth Hour and maybe even energy issues in general. I can understand that. I’ve been there. The thing that got to me was that the whole town of Eugene is brightly lit. For example, there is a huge parking lot just north of my house and even though it is not used at night, every square inch of it is brightly lit up, all night. Who benefits from this and how? It’s an empty parking lot. It’s not just a waste of energy, it’s an eyesore. Who decides about lighting up this parking lot? Do they think I want it lit up–that they are doing me a favor, spending all that money? I’d rather it was dark.

And it’s not just the ground. At least with that parking lot there is a chance that someone might want to get across it, climb the fence, and stumble on an unseen pebble or something if it was dark. But because of the level of illumination and probably the design of the lights, the whole sky is lit up, too. The light of Eugene illuminates the underside of the clouds over Eugene. Who benefits from that?

I do not. It’s ugly and I hate it. I would rather have darkness at night. If there are no clouds, I’d like to be able to see the stars. Why should we waste energy obscuring our view of the stars? It makes me miss the desert, where it is dark at night, where the stars are bright, where people use their cars’ headlights to see where they are driving, and flashlights to see where they are walking, if they need to, if there is no moon out.

Even in the desert there is an occasional street light, which has always baffled me. If we can get along just fine in the hundreds of miles of dirt roads in Joshua Tree, why did it seem like we needed that one streetlight on Hacienda Road and Willow Lane? As far as I’m concerned, all it does is waste energy and hurt my eyes at night. Many times over the last 25 years I’ve fantasized about shooting it out. And then there are the people who insist on lighting up their yards as bright as day. I suppose it makes them feel as if they are safer. My dad says, “City people… always afraid the Indians are going to sneak up on them.” I want those folks to believe they are safe, but I want them to do it without shining a light onto my property.

My parents forwarded me an email from a family friend, Lauren (musician and poet), who is going off email for six months. She’s concerned about distraction (including in her email the quote “It’s commonly believed and understood that it takes about 4 minutes to recover from any interruption. If the computer dings at you and you look 30 times, that’s 120 minutes of recovery time. That’s the crisis.” —Marsha Egan, Author of Inbox Detox), concern over what seems like addictive behavior, valuing face-to-face or at least voice-to-voice communication, and this article about a study which found that emailing reduced productivity more than pot.

She had a series of questions about it email and her project, which I answered. By email. I think she’s starting on April 14, but if she’s already started,she can read my answers in six months.

1.     How many times a day do you check your email?
I don’t know. It varies between one and many–20?–depending on the style of my day. There have been days that I don’t check–camping, procrastinating. If I need to concentrate, I do not check email or even keep a browser open until I’m done.
 
2.     How many times a day do you send or receive a text?
Zero. I sent one text in my life, just to try it out, and I strongly encourage my friends not to text me. It doesn’t appeal to me. I’m also vaguely offended by the use of “text” as a verb.
 
3.     Have you ever had a miscommunication via email or text?
Yep, at least a few. It took a while to realize that the pragmatic (i.e. non-verbal) context of communication really does not come across in email.
 
4.     Do you feel anxious over the thought of not having email for
six months? Do you feel anything negative at all? Happy? Just tell me
how you think you would feel.
Hmm. It would be tough. First of all, I’m in grad school and email is how all of my profs and peers communicate important info. We often get our reading over email, and turn in our papers, too. Second, I’m in a long distance relationship, and email is helpful in keeping a sense of connection. We depend mostly on Skype, which is allowed in your plan, but I wouldn’t want to give up email before Reanna and I are living in the same house. Plus, she emails me mp3s of her reading articles I’ve been assigned, so I can “read” while cleaning my kitchen. Plus, she edits my writing over email. Third, I’m so busy that losing the super quick, no-strings-attached communication ability would mean isolating myself even more from my geographically dispersed family and community. Last, as I understand it you are going off of Facebook, blogging, texting, messaging, and chatting as well as email. That all sounds fine except for blogging. I’m pretty attached to my blog. It’s my most consistent form of creative expression these days.
 
On the other hand, I feel relieved and relaxed when the power goes out, and a big part of that is losing the computer. I went to a lecture years ago by a woman whose name I can’t remember who said “You’re not ‘connected,’ you’re ‘tethered.’ She recommended taking vacations from the leash–phone included. That appeals to me. When I climbed Mt. Whitney, ten years ago, two behaviors really confused me, seeming to miss the point: At the summit, a few people lit up a cigarette and many people immediately called home. It seemed like in sharing their moment they were also missing it. At least they weren’t texting, I guess.
 
 5.     Do you think there is anything important to be learned/gained
by not having email for six months?
Yes.
 
6.     Do you use email more for work related messages or for
family/friend correspondence?
Mostly school. Family and friends second. Work a distant third.
 
7.     How do you feel about me not emailing you for 6 months?
Well, we haven’t communicated in years, so I don’t feel much about it. If we were close I might have feelings.
 
8.     Are you sitting with a Bluetooth in your ear, reading and
sending a text with one hand, eating soup with the other, glancing
frequently at your To Do list, all on your twenty minute lunch break?
Don’t feel bad. While writing this letter I checked my email 3 times,
ate handfuls of dry Panda Puff cereal, and listened to my sweetheart
talk about his online class.
No, actually, I’m sitting at my first shift on the University of Oregon Crisis Line, waiting for someone with a crisis to call me. I do have my cell phone with me (and will almost certainly use it at least once), I am (obviously) using email, and have a to-do list that you wouldn’t believe, but I doubt that I’ll check my email more than three times today. Mostly I’ll be reading about counseling gifted children, assessing families, and conducting group therapy.
 

There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

Diagnostic criteria for 307.1 Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

I wrote this essay for myself, two years ago, a spin-off of and companion piece to my paper on why people become vegetarian. It was the culmination of a lot of thinking and reading and trying different ways of eating. I like it but you may not, especially if you are on an abstinence diet right now. That may be because you are, like many vegetarians I’ve met, not like me: not driven to take things all the way, not terribly annoyed by things that don’t quite add up. Bless you. I might look down on you a little for what seems like lack of intellectual rigor, but mostly I’m envious of your relaxed way of being in the world. It sounds nice. I don’t recommend that you read this. Read something fun instead. On the other hand, you may be like me, an agnostic who found religion in a diet, ready to get uptight when someone tells me I might not actually be saved. I don’t recommend you read this, either, unless some part of you is dissatisfied with your religion and you are ready for some discomfort. For everyone else, or if you plan to read on anyway, or if you are a stickler for references, I recommend you also read “Vegetarianism and Reason” for context—personal, historical, demographic—and a good bibliography.

When I was in college in the San Francisco Bay area in my twenties, a close friend asked me how she could lose weight. Maybe it was because I was, as I always have been, such a slender person. At the time I thought it was because I’d read more about nutrition and diets than most people. My advice was, “Stop eating meat and dairy products.” I said that with confidence both that she could do it and that it would resolve any problems with she had with her body. I’d been vegan for a year or two and vegetarian for several years before that, was in great health, and never had the slightest problem maintaining those diets. My housemate, who’d overheard the conversation, was incredulous: “Why didn’t you suggest something that normal people are capable of, like cutting back on snacking?” That kind of advice had not occurred to me. I knew the answer and gave it to her. These days I’m much more circumspect. I know a lot more about nutrition and diets now than I did then, but am a lot less confident about that knowledge.

Abstinence diets and arguments

An abstinence diet is a way of eating that is defined by what you don’t eat. There are many varieties of this way of eating, but the arguments for engaging in them fall into two basic categories: ethical or ‘spiritual’ arguments, and health or ‘science’ arguments. Most Americans who stop eating meat, for example, do so because they believe they will be healthier, while most vegans do not consume or use animal products on ethical grounds. My own path was the opposite, but I followed the same two lines of thought: I became vegetarian on ethical grounds and vegan (and for several weeks ate only raw food) for health reasons. These two basic tracks led me, perhaps a little too neatly, to what I’ve come to see as my five rabbit holes—thought processes and behaviors that cannot be followed all the way.

The ethical track

While the health/‘science’ track has its own rabbit holes, genuine health-based arguments do not lead to vegetarianism or veganism. I do believe that a vegetarian or vegan diet with plenty of variety is miles better than the standard American donut-coffee-burger-fries-Coke diet, but read any of the thoughtful writers on the subject—Robbins, for example, in Diet for a New America—and you will see that the health-based arguments are really advocating a plant-based diet, not abstinence from meat. Ethical arguments, on the other hand, do lead, seamless and compelling, to vegetarianism and veganism. (Check out Fox’s Deep Vegetarianism, for a great example.) The problem is you cannot follow them all the way.

Rabbit hole #1: Non-violence

On the ethical track, you base your diet on the principle of non-violence. When you become an ethical vegetarian, it is because you have realized that animals are not all that different from humans, and decided that their suffering is important. In a way, you have been able to identify with and have compassion for all animals, instead of just humans. The next step is to see that any product that comes from an animal requires that animal to be coerced and caged. It no longer has freedom. When you come to identify with animals enough to condemn their slavery as well as their slaughter, you become an ethical vegan.

Not many people stay vegan for long. It’s hard to do, for many reasons. To do so requires a hard core dedication to a nonviolent lifestyle. By this point, your ethical thinking has gone beyond animals. You are concerned about the life of the planet, for example: You probably wash out and reuse plastic bags (if you use them at all), you bike when other people would drive, you start hopping freights for longer trips, or guilt trip yourself if you don’t. You probably get interested in libertarian philosophies like anarchism and compassion-based philosophies like Buddhism. This is no longer just a way of eating.

If you are one of these serious ethical vegans, you start to hear about the next step, fruitarianism. Chances are, you are not a serious ethical vegan, so this may seem like a huge, untenable leap. It is a leap that vegans usually do not make, either, for reasons I’ll get to in a minute, but it is something they will consider.

Most of us have inherited the “knowledge” that plants and animals exist on separate ethical continua. It’s easy and intuitive to think that way, but it turns out to be surprisingly difficult to argue: Plants behave radically different than we do. They move extremely slowly. They don’t seem to have emotions and they don’t even seem to feel sensations like we do. True, but animals also behave differently than we do, so this is a matter of degree. Does something being different from you mean you can kill it? If you are really serious about compassion, use this argument with great caution. It has been used to justify such evils as genocide, racism, sexism, and meat-eating. But we grow them. They exist in their current form because of us. Pretty weak. The same can be said of cows and slaves.

And so on.

We are probably right to think that the plants in our garden do not suffer the way animals suffer, but that does not mean that the death and mutilation of the plants that provide us with root, leaf, stem and flower foods are not a form of violence. The ethics of eating seeds is dubious, too, from that standpoint. We grind or chew them up and they are no longer able to serve their purpose of propagation. The only parts of plants that have been designed for eating are fruits. They are often brightly colored to attract our attention. They are often sweet. They are nutritious. This is all supposedly so that animals will eat the fruit and inadvertently spread the seeds. A true fruitarian eats only fruit that has fallen off of its parent plant. (I do not know if they also try to poop in useful places. They really should.) There are people who eat a fruitarian diet, too, though their numbers are so small (and presumably the time spent on the diet is so short) that the evidence for its efficacy is sparse and anecdotal. So, unless you try and love the fruitarian diet, your easy, morally convicted choices have been taken from you and you are left with a continuum of diet choices to make based on your level of comfort with violence to various creatures.

Rabbit hole #2: Transcendence

This is the “spiritual” or “ascetic” rabbit hole. I believe that many eating disorder based abstinence diets fall into this category, but look up orthorexia if you are interested in that. I’m more familiar with the diets based on the ascending spiritual tradition—most likely a misunderstanding of that tradition.

The basic idea is that human beings are perhaps part animal, but divine, immortal, non-material beings at our core, and that our job is twofold: Use meditation practices to strengthen our spiritual self, increasing our awareness and compassion until they extend to the entire universe, and at the same time, subdue our animal nature using such disciplines as celibacy and fasting.  Abstinence diets from vegetarianism all the way through to fruitarianism are quite appealing from this standpoint. They seem like permanent fasts, but come along with the promise of great health. The problem is, until you die, there is always somewhere purer to go, and fruitarianism is not the end of the line. There is also breatharianism, where you live on air and sunshine alone. I have never met a breatharian, but I’ve read about and heard of a few, including one in Paramahansa Yogananda’s Autobiography of a Yogi. If you are on this track, consider that the Buddha went before you and then decided on the Middle Way. Be kind to your body and skip the asceticism!

The health track—Rabbit hole #3: Information overload

There are two major health and science related rabbit holes. The first has to do with information. There is so much ‘information’ out there about diet and human digestion! Most of it is pure metaphysics–assertions of Truth with only passionate belief to back it up. And metaphysics aside, without the blinkers of ethics it is very, very difficult to find an uncontested assertion about what foods are best to eat. If you dive in deep, the density and spin are quickly overwhelming. And that’s just at the macro-level, talking about stuff like apples and pooping. Human health also happens at the level of the quadrillions of chemical reactions that happen in your body every second, the way those reactions act as nodes in networks, and the networks of networks that emerge in the process. Vast amounts have been written in scholarly journals about it and we are still so far from figuring it all out. Furthermore, the folks at university labs studying intracellular protein transport and stuff like that are far removed from the questions you and I have about diet. They probably eat at McDonalds on their lunch break and don’t think twice about it.

Then there’s the question of human biochemical individuality. Are there foods that are good for me but bad for you? Probably, but this makes finding the ideal diet for you even more difficult and makes it less likely that a simple abstinence diet like veganism will be the answer.

Rabbit hole #4: The Fall

The second health and ‘science’ (read ‘metaphysics’) related rabbit hole is based on theories of human evolution. Veganism seems to be the jumping off spot for a huge number of diets. If you are vegan and still frustrated by ill health or low energy, what do you do? You will come across a diet whose argument is basically the myth of the Fall: “We were doing great until….” Raw foodism, which tends to mean “raw veganism,” is the most popular of these, maybe because it throws veganism a bone: You’ve got it all right except that you are destroying the nutrients in your food by heating it up! And, according to the format, all of humanity was doing great until we started using fire. Then, if the now raw vegan still feels bad, they may continue looking and come across the information that there is no evidence of any indigenous people who didn’t consume animal protein. It makes sense, now, that if you were an early human and came across a bird’s nest or frog or whatever, you would take advantage of that concentrated source of protein! This brings us to the multitude of what to the uninitiated seem like crazy diets, including Paleolithic (wild, raw plants and animals), Anopsology (anything raw except dairy + other rules), Essene (raw dairy and plants), Primal (raw meat, dairy and plants) and Traditional (only unprocessed foods, mostly raw, with raw meat and lots of raw dairy). Some of these diets include eating animal feces, too—raw, of course—and intentionally rotting the (raw) meat before eating it. This all makes perfect sense from the right jumping off spot! I’ve been there. I still have some interest in trying the Essene diet and I’m fascinated with some aspects of Anopsology, but I have yet to try them. They are so elaborate that it’s hard to imagine having, simultaneously, the money and the social support required to maintain them.

So, where does this leave us?—Rabbit hole #5: Epistemology

What can you really know about the food we eat and its effect on our body? We know what we have read about it. We know what has been said to us. Those paths lead us to the other rabbit holes. We also know, though, what foods we have actually eaten, what they looked, smelled and tasted like, and how we felt before and after eating them. Shouldn’t that, over the years, add up to a lot of perfectly legitimate and applicable information? Can’t you observe yourself like a science experiment?

Unfortunately, there are a couple of problems with that. First, there is no control group. In order to know the actual effects of the experiment, you need to be able to see what you would have felt like had you not eaten that slice of cheese or whatever. The subtleties of human sensation render our “experiments” dubious at best. You may find that every time you eat that slice of cheese you throw up. That’s pretty clear; you should probably stop eating that cheese. Unless, of course, you ate the cheese with other foods and you can’t really be sure it was the cheese and not the pickle, or maybe the combination of the cheese and the pickle, or maybe you just were trying to eat too early in the morning or late at night, or maybe it was because it was the cheese you always ate with your ex-girlfriend…. That gets to the second problem with our experiment, and probably the most important. How can you separate your physiological responses to foods from your psychological responses? They have the same feedback mechanisms: sensation. Do you feel good because the ice cream reminds you of nursing as an infant or because that ice cream is benefiting your body? Or because you are a sugar addict, getting your fix? Or is it because humans evolved a craving for sweetness and fat to survive in a calorie-scarce environment?

I’m sorry to say that you can’t know. You really can’t.

I’m assuming that if you’ve read this far, you are involved enough in this debate that is obvious to you that eating from your local food coop is better for you than from McDonalds, that turnips are better for you than twinkies, that eating a variety of foods is better for you than just a few, and that eating in ways that make you remarkably fat or thin are probably not good ideas. This is for you. This is the only advice I can give that I am completely confident of concerning diet: You can’t know what the best way for you to eat is. You have to guess. But when you guess and while you are guessing, you can also feel happy, comfortable, excited and flexible about your guesses and the fact that you are guessing. And, more important, enjoy your food! Savor how it looks and smells and tastes and feels in your mouth and stomach. Love your food and love your body every moment that they are interacting.

Thanks to my editors, Ce Rosenow, Grace Llewellyn, Joseph Kwiatkowski, and Reanna Alder.

I just posted a research paper I wrote a couple years ago about vegetarianism, its history, philosophy, and demographics. It’s pretty good. If you’re interested in vegetarianism, abstinance diets, or just food, check it out by clicking here. It’s called “Vegetarianism and Reason: A Personal Evolution.” The title is the worst part, I think.