Gaining: Book Review
The author of Gaining, Aimee Liu, wrote a memoir about 30 years ago called Solitaire. At the time, Liu thought she was recovered, that she had left the depths of her disorder behind and knew her identity. Now, Liu revisits what she thought recovery was, talks to women of all ages about their experiences with ED (recovered or not), and deciphers what it truly means to gain.
gain vi. 1. to make progress, improve or advance, as in health or career 2. to acquire wealth or profit 3. to increase in weight, gravity, or substance 4. to increase in speed 5. to win competitive advantage 6. to move forward in time 7. to mature or age
The book begins addressing one of the most discussed issues in the field of EDs: the media and culture. The UCLA director of their ED Program states, “There’s minimal cultural influence in anorexia nervosa, it’s not causal. It only contributes if the inherent risk is there” (p. 20). This correlates with what I have gathered from my class lectures, and Liu continues to explore this conundrum throughout the rest of the book. She encounters the genetic background that can play a role in developing an eating disorder, effectively multiplying the risk, especially if a close family member has struggled with an eating disorder. Moreover, Liu investigates an issue I’ve always been curious about – when we talk about eating disorders, does it make them more likely? She doesn’t quite find the answer, but she discusses one case where a girl named Jessica read a book called The Best Little Girl in the World and instead of finding it helpful (the original intention of the book), she imitated the self-destructive rituals. Her mother eventually got the book banned, but not before numerous girls had read it and begun copying the practices. I thought this was important to consider when designing education materials, creating group dialogues, and one-on-one counseling with individuals suffering from eating disorders.
Beyond genetics, Liu explores the prominent personality type that could be a significant characteristic of those with eating disorders. Highlighted is the Obsessive-Compulsive Personality or OCP, described as someone who is cautious, rigidly focused, stubborn, perfectionistic, and tend to be quite certain that their way of acting is right, terrified of making a mistake (p. 45). These are important temperaments for me to be aware of as I prepare to enter my first rotation (ED counseling) in May.
Liu then talks to a woman who describes sensation as the opposite of the numbness and denial often sought after in ED. She says to experience sensation means making contact, allowing closeness, and letting go of inhibition—all feelings that go against the instinct of someone with AN. Bulimia Nervosa, on the other hand, is explained as an individual with a strong sense of her true nature, but feels she must hide the most intense aspects of herself because they will be judged or shunned by others. Dialectal Behavioral Therapy attempts to break through these sensation barriers encouraging mindfulness, making conscious contact with things around the client, and training patients to trace the chain of events that link with their behavior (such as a binge or purge). Overall, each patient with each disorder will be different and suffering for different reasons, but understanding the general characteristics that are associated with various eating disorders can better prepare me to enter the counseling atmosphere. These characteristics often appeared very young for these women -- some have recognized them in their own children. Modeling is one of the most powerful behaviors to influence children, so one mother emphasized how much she shows love for her body in front of her daughter ("isn't mommy's belly soft? it's a great pillow!").
A common trend in eating disorders is to describe the ED as something apart from oneself—that the ED feels differently than the client does. On p. 112, Liu quotes Marya Hornbacher: “It’s hard to describe how these two things can take place in the same mind, the arrogant self-absorbed pride in yourself for your incredible feat, and the belief that you are so evil as to deserve starvation and any other form of self-mutilation. They coexist because you’ve split yourself in two.” While it will be important for me to challenge the patient with their contradictory statements or thought patterns, I must also understand their confusion with their sense of self. They might retaliate when their ingrained patterns are questioned, and deny actions or speech that seem to oppose those patterns. Reiterating this point, Sheila Reindl, clinical psychologist and counselor at Harvard, writes in Sensing the Self, “To fully recover from an eating disorder, a woman has to lose her conception of who she thought she was or thought she should be… She has to relinquish her effort to craft a constructed self and instead must let herself be who she is” (p. 125). As a counselor, I am able to help them navigate their eating disorder and slowly tease out speech from their ED in contrast with their own thoughts and beliefs. Consequently, I need to be patient, and understand that a client’s beliefs about food do not change quickly even if they’ve gained weight.
I found this book to be an important read because my first dietetic rotation will be at an outpatient eating disorder clinic. As complex illnesses, eating disorders are still not well understood and need more effective treatment and prevention options. In order to contribute, I have to get to know my clients and validate their experience as their truth. Through the lens of people who have recovered, and those that say they are recovered but don’t seem to be, I gain a better sense of who I might encounter sitting across from me in the counseling chair. Liu also discusses the important influence of family, and, as research shows, family based therapy can actually be very effective for some patients. There are a variety of different motives people have for recovery – family support, faith in God or higher power, self-motivation, or perhaps something else. Acknowledging that patients cannot blame themselves entirely, neither can family, can be an important step to recognizing that this multifaceted disorder must also be treated as such. There isn’t a ‘cure’ for eating disorders, and it was powerful to hear stories about women relapsing in their 30s, 40s, and beyond. As a counselor, my patients need to know they aren’t alone in this struggle. I think the primary message from Gaining is that it means different things to different people, and that while there is a strong emphasis on gaining weight in order to remain medically stable, there is so much more to gain from recovery.