Eating Disorders: A Secret In The Legal Profession

I remember the day in April 2007 I finally confided to my psychiatrist that I was struggling with drugs and alcohol. I did not mention at that time that I had also struggled with both exercise and traditional bulimia for over two decades

I felt completely stigmatized and alone in my eating disorder and did not feel that anyone, including him could understand or help. Adding to the stigma was my profession. Not only was I a male with an eating disorder, I was a male lawyer with an eating disorder. How stigmatizing was that? I have spoken openly about my eating disorder recovery for years and to this day, I am unaware of any other male in the legal profession who has publicly professed to dealing with an eating disorder. The hard statistics of how many males are afflicted with eating disorders tell us that they are of course out there.  Along those same lines, I have received numerous emails from females in the legal profession who are struggling or are in recovery from both anorexia and bulimia.

Why do males struggling with eating disorders in in the legal profession seem to be so few and far between?  We can look to a recent study of mental health issues in law school published by the Journal of Legal Education, which found 27% of law students (18% of male respondents and 34% of female respondents) screened positive for eating disorders.  Yet only 3% of respondents had actually been diagnosed.  While I do not have the breakdown, I suspect that the majority of that three percent diagnosed is female.

I believe one reason for this reluctance to seek treatment compounded on top of the strong societal stigma is the culture of the legal profession. The fear of showing weakness and vulnerability.  The fear of showing “weakness” is so ingrained into our thought process as lawyers and even starting as law students that as a profession, we are often unable to distinguish between how feelings need to be channeled to do our best to excel in the profession versus what we need to do to help ourselves when we are struggling with mental health issues. We have difficulty stepping back and embracing the vulnerability of telling people when we are struggling as being a virtue.

Here is the catch. This type of vulnerability is something that is absolutely necessary in mental health recovery. Particularly eating disorder recovery.  It may involve opening up the well of emotions that may date back over a lifetime that are holding you back from getting better. Not a pleasant thought, is it? Very counter-intuitive to the projection of knowledge, competency, and strength in the profession

I can tell you that while I struggled with my eating disorder, and then moved into recovery, that recovery did not begin in earnest until I allowed myself to be vulnerable in a setting that I felt safe to do so. And it took time to feel safe. I finally got honest with my psychiatrist and those close to me. I then began to move forward in a positive way. I had been lying by omission for years, simply getting my anti-depressant meds and not opening up about all the unresolved pain, layer upon layer going back to childhood. The mentally abusive relationship with my mother. The severe bullying as a teenager. (I do not blame either as causes of my eating disorder. As we know, there is a difference between cause and correlation.) The feelings of inadequacy and lack of self-worth also played a role. While there is no other history of eating disorders in my family, the role of genetics cannot be dismissed as well.

I see this issue regularly when I speak to lawyers and law students who are struggling. People who would rather pull their toenails out with their teeth than talk about such things. Talk about the pain of a little boy or girl, failed relationships, trouble at home. Possible environmental triggers that have been long buried in the subconscious.

It’s easier to simply say, “I’m over that,” and move on. To emotionally isolate from the world. To compartmentalize the pain. But they often have not moved on and those feelings are always just under the surface, waiting to trigger destructive behaviors or playing a role in not dealing with the ones already present. The stress of billing. Stress of trial. Stress of grades. Problems at home. Childhood trauma. The list of possible triggers is endless.  I totally get that. Binging and purging was a huge stress release for me during both law school and as practicing lawyer. The same was true of my obsessive-compulsive exercise. Probably my biggest trigger issue present day.

I am here to tell you that allowing myself to be vulnerable and let those feelings out was a key in my long-term eating disorder recovery which now stands at just over ten years.  Those feelings that dated back to childhood no longer control me.  I even write letters to my teenage self.  I talk to my “inner child.” Doesn’t sound very “manly” or “lawyer-like,” does it?  It does not mean telling everyone your childhood secrets. It means realizing that being vulnerable and facing such feelings is both beneficial and necessary in moving forward in recovery. Find a safe setting. Give it a try.

 

 


The Bulimic Lawyer(And Law Student)


Gender Bias As A Barrier To Evidenced Based Eating Disorder Treatment(An Open Letter)

Last week saw some conflict in the realm of eating disorder advocacy around the role of feminism in eating disorders treatment and recovery. It began with some “live tweets” from the Keynote Address at the 15th Renfrew Center Annual Gala. Renfrew is an eating disorders treatment center (that according to their website, treats only women). Feminist Gloria Steinem delivered the speech.

Eating disorder awareness advocate Brian Cuban and I took note of the tweets. We were concerned about the evidence-based foundation for endorsing an outdated feminist understanding of eating disorder treatment and recovery with the choice of speaker. We were also concerned with a treatment center promoting gender bias in an arena where males are still struggling with high levels of stigma resulting in an exponentially more difficult time than females getting diagnosed and treated for eating disorders.

In truth, all-female eating disorder treatment centers should be a thing of the past if current research informs treatment.

“We are in a gender prison. And gender prisons cause eating disorders” @GloriaSteinem#renfrewconf2015

Brian struggled with bulimia for over two decades and December 1, 2015 will mark four years since my youngest daughter started a “healthy eating makeover” and quickly and dangerously spiraled down the eating disorder (ED) rabbit hole. Because she fit the stereotype of an anorexic (affluent, white, female, teen), she was diagnosed quickly. Because we live in San Diego and have excellent insurance, she got immediate, state-of-the-art treatment at University of California San Diego (UCSD), an academic center that bases their treatment on the latest research findings in the field.

UCSD’s approach is “agnostic” as to the cause of a person’s eating disorder and focuses on treating the ED rather than conducting archeology to determine a cause. Importantly, they do not believe an eating disorder has an “underlying cause,” but rather that it is a biological, brain-based disorder related to a period of a negative energy balance in a genetically vulnerable person. This is not to say there are not those with other issues that will need to be dealt with during the recovery process, but that is very different than those issues being seen as the cause of an eating disorder. It’s an approach that works to save both lives and years to decades of suffering on the part of both patients and families.

For Brian and I both, as relative newcomers to the eating disorder advocacy movement, our biggest shock and disappointment has been with the many clinicians, treatment centers, and even advocates clinging to yesterday’s understanding of eating disorders. When we saw tweets coming out of the 2015 Renfrew Center Foundation we were confused, angry and sad.

Confused: Why would a leading treatment center give a keynote platform to a speaker with a particular, feminist viewpoint of eating disorders rooted in 1985 and which hasn’t evolved to keep pace with 21st century research findings? Why would anyone (Steinem or Renfrew) want to add to the societal “knowing” of eating disorders that reinforces the public to think they are about choice and vanity? Why—and this is a HUGE one—is it okay to espouse an understanding of EDs that makes it sound like eating disorders don’t impact males?

We are wondering how Renfrew and Steinem would explain the eating disorder of my friend’s son—a mere child, growing up running free in nature on beautiful acreage in New Zealand and with no knowledge of gender prisons and no need to rebel against an unjust world?

Angry: Eating disorders have the highest mortality rate of any mental illness and they come with a host of medical complications that can happen quickly and last for a lifetime. “Treatment as usual” (the eating disorder must MEAN something so let’s figure that out first) has an abysmal track record with 2/3 of those affected having a moderate lifelong struggle with a relapse/recovery cycle or a severe struggle ending in premature death (statistics according to the Eating Disorders Coalition). Why continue to base treatment and advocacy on an outdated understanding that is dismissive and cruel to males impacted by EDs?

Sad: Eating disorders affect all genders, occur in all cultures and have been present throughout history; yet the public dialogue, encouraged and promoted by people and entities like Steinem and Renfrew, continues to center around white females. Society funds Alzheimer’s at the rate of about $100/sufferer because we know it can happen in all families and to our own loved ones. Society funds EDs at a rate of about $1/sufferer because they “know” they only happen to affluent white teen girls with controlling parents.

We are sad that for our friends with sons, Rogers Memorial has the only residential facility for men and boys in the United States(they also treat females) as NPR detailed in a piece titled, “For Boys With Eating Disorders, Finding Treatment Can Be Hard.”

If Renfrew wants to make women and feminism a cornerstone of a future conference, we have some Keynote speaker suggestions: Dr. Cynthia Bulik, who is conducting amazing research at UNC with the Anorexia Nervosa Genetics Initiative; Dr. Laura Hill whose research and interpretation of the latest findings have helped countless families and individuals understand why it is such a struggle for someone affected with an eating disorder to just eat; Dr. Roxanne Rockwell, who has helped build, from the ground up, an evidence-based treatment program that produces results for male and female patients alike, or perhaps Laura Collins, an advocate who has worked tirelessly to promote increased access to evidence-based treatment models based on current research.

Eating disorders are not female-only problems and it is long past time for both Gloria Steinem and Renfrew to embrace that understanding and evolve to become part of the treatment solution rather than part of the access-to-diagnosis-and-treatment problem that is, in a very real way, hurting and even killing our fathers, brothers, sons and partners.

JD Ouellette and Brian Cuban

Advocates For Evidence-Based Treatment Availability For All Who Need It.

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Anorexic man photo available from Shutterstock


When Should Advice Columnists Just Shut Up?

In order to prevent giving out medical advice which is off the mark or potentially damaging to the point of terminal, standard practice for any advice columnist should be to consult an expert and disclose who they contacted. If no expert is available, they should just shut up.

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What Is Body Dysmorphic Disorder?


Brian Cuban is a an author whose best-selling book “Shattered Image: My Triumph Over Body Dysmorphic Disorder” chronicles his first-hand experiences living with, and recovering from childhood bullying, eating disorders and Body Dysmorphia Disorder (BDD) and drug addiction. Brian speaks regularly to about his recovery and breaking the male eating disorder stigma. You can purchase Shattered Image here If you would like Brian to speak to your university, group or organization please email alana@arlangroup.com
For interview requests please contact MWilson@rubensteinpr.com



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