Category Archives: Uncategorized

October 2016

The 15-minute walk to work is daunting. She has a fast and mechanical step, always on the same sidewalk of the same street, instinctively making sure her feet don’t stay on the ground too long. Paranoid, she hides beneath an oversized black nylon winter jacket zipped up to her nose, and a dollar store beanie from which blond streaks of messed up, scarecrow-like hair come out.

The shrill of her 8 a.m. alarm is startling. The ring that’s been making her anxious lately doesn’t usually manage to wake her in time for work, but for the past few weeks, She hasn’t been sleeping at all. She goes to bed at around 1 a.m., and lays there, restless, oppressed by pervasive thoughts, until she hears the dreadful hail of the clock blaring through the room. She makes her way to the bathroom through the scattered boxes and bags left to unpack from her move five months ago, prompted by a poor relationship with her landlord. Anytime she has a major transition that involves change, her OCD comes on full force, and now is a horrible time of anxiety for her. She barely eats, lost a solid ten pounds, cut herself off from friends, and only leaves her apartment to go to work.

She starts her morning ritual: pet the cat, jump in the shower, wash twice in scorching water and scrub until skin is left chapped and sore, apply eczema cream vigorously, remove clean clothes from the dryer, put on several layers of clothes and carefully pack away remaining garments in double-layered plastic bags, start a third rinse cycle of clothes in the washer, and repeatedly check stove, fridge, kitchen and bathroom faucets, light switches, and backdoor lock.

The 15-minute walk to work is daunting. She has a fast and mechanical step, always on the same side of the sidewalk on the same street, instinctively making sure her feet don’t stay on the ground too long. Paranoid, she hides beneath an oversized black nylon winter jacket zipped up to her nose, and a dollar store beanie from which blond streaks of messed up, scarecrow-like hair come out. Her hands are buried deep down her pockets, fists clenched to avoid contact with germs; she never looks up, her gaze hooked to her calcium-covered boots. Any bystander would notice she has some sort of social phobia.

At 9:42 a.m., Liz walks into work, her mascara dripping from the cold. She looks troubled, exhausted. Her deep and sunken eyes and eczema-reddened face unable to conceal the heavy burden of acute anxiety she’s been bearing. “Sorry I’m late, I had door problems this morning,” she says. An excuse often heard.

Obsessive-compulsive disorder is a common, chronic anxiety condition with a waxing and waning course, marked by urges that interrupt everyday thinking, and repetitive behaviours aimed at easing the anxiety and distress the invasive thoughts cause. Dr. Alain Lévesque believes there are over 750 K registered OCD cases in Canada. Well in his fifties, the grey-haired child psychiatrist from Rivière-des-Prairies Hospital says OCD can occur at any time of life, and can develop from the interaction of several biological, environmental and social agents.

OCD is often treated with sertraline, an antidepressant that affects serotonin levels in the brain that may become unbalanced and cause the disorder, but Liz hasn’t renewed her Zoloft prescription since her health insurance card expired two months ago. Since being off her meds, she’s had a sense something terrible will occur if she doesn’t perform her rituals, leading to a constant feeling of uneasiness. She also put an end to her Skype therapy sessions because her therapist, an OCD specialist, made her feel “uncomfortable.” The past two months have been excruciating.

Dr. Lévesque who has never treated Liz but has seen many similar cases, says control is a debilitating defence mechanism of people with OCD. “In order to alienate anxiety, they try controlling all elements of their environment by performing repetitive actions.” Liz falls into two OCD areas: checking and contamination. Her obsessive fear of danger causes her to examine things compulsively, while her obsessive fear of death by means of contagion triggers the need to clean and wash, over and over again.

Four years ago, 28 year-old Liz flew to Montreal in search of better work opportunities, leaving her native Bordeaux behind. She grew up on a vineyard in a quiet area in Southwestern France, where morning fog would give way to burning midday hues, and she and her parents drank the wine they crafted along some sautéed foie gras on the ceramic terrace overlooking the vineyard. Second child of a family of three, Liz says she was like any other happy teenage girl, until mild obsessive thoughts she kept to herself appeared when she was 14. “I would constantly check my watch and flicker light switches, but the anxiety remained low.” Dr. Lévesque has seen many OCDs develop among teenagers and young adults, possibly because of the many changes the adolescent brain goes through. But for Liz, it’s her “journey to Canada that caused the OCD to skyrocket.”

Upon arrival, she quickly got an account coordinator position at a wine-importing company in the heart of the lively Mile End area, where I also worked. The second she walked in on her first day, I knew she was tormented.

At 9:50 a.m., another ritual begins before she settles down. She locks herself up in the office bathroom, washes her hands several times, brutally rubbing up to her elbows, tap stream fully on, spraying walls, floor and counter with hot water and soap as she does so. She’ll sometimes leave a clod of brown paper in the toilet or on the floor, for fear it might contaminate her. She squirts on some hand sanitizer just in case she missed a spot and then, she’s finally ready to get to work.

For four years, I have experienced Liz’s OCD firsthand: her rituals, her ups and downs, and even the onset of new phobias and ensuing compulsions, trying each time to understand what went on in her head. She opened up to me a few times here and there, but never let me in completely, always avoiding the extent to which the disorder affected her everyday life.

A few weeks ago, I tried interviewing her for what I originally intended to be a profile story. Although she had given me her consent prior to our conversation, she would not open up; I believe this was due to her need to control the situation. She was OCDing. When she uses rituals as a strategy to control the obsessions, she is in fact producing the opposite effect, thinking about the obsessions even more. Being subjected to this constant need for control motivated me to focus on my personal observations and experience of Liz’s overpowering need to always be in the driver’s seat.

Another reason why she shared so little information about her condition is because “people with OCD are terrified of other people’s judgment,” according to Dr. Lévesque. But as she refused to answer when asked how she perceived herself, I realized that not only was she afraid of other people’s judgment; she was especially terrified of her own. Her incapability of letting me in “did not reflect a lack of will, but rather a great fear of losing control over the situation, as well as a fear of looking deep within herself,” thinks Dr. Lévesque.

At 7:15 p.m., Liz’s the only one left at work. She starts drafting emails, typing with what’s likely a false assurance, tidies up her desk a little, stretching the last few moments before heading back home, where her demons await, behind a front door she will unlock and lock again several times. The walk back home is even more daunting, her fast and mechanical step on the same sidewalk of the same street even more noticeable. She stops by the same convenience store every night to buy a 25-pack of Benson & Hedges Silver she will smoke entirely. She will skip dinner, just like she will skip breakfast in the morning, the fear of food poisoning outweighing her need to eat. She will call off her plans for the weekend, pretending she’s busy when in fact she’s just smoking cigarettes, doing laundry and checking things, over and over again.

October 2016

She would only munch on carrots and celery sticks, and sometimes, when the ballet class had been too intense, she would allow herself a puffed rice cake with a side of guilt.

16 year-old Leah had become well acquainted to the conniving, destructive disorder. Activating her gag reflex had become easy. She would tilt her head up, put her index finger down her throat, and bend over to let her mom’s spice-rub T-bone steak out. The shower was always running so that her mom and sister wouldn’t hear the wet vomiting sounds. She would pour herself a glass of water, chug it, and start over, and over, until she was sure she had purged every last piece of dinner.

She had become used to the bitter, persistent taste of bile. Sometimes she even craved it. Leah stared at her reflection in the fogged mirror — sunken cheeks, dark circles under her eyes, her face swollen from bulimia. Despite the reflection of her frail frame, “fat and disgusting” was what the voices of her mind repeatedly told her. A statuesque 5 ft.10 Leah had plummeted to just 93 pounds, the lowest she had ever weighed. In fact, she had a BMI of 13, when her normal BMI should have been somewhere between 17 and 25. It wasn’t her first episode, only this time she had hit rock bottom. Before bed, she spent hours browsing the Internet for “thinspiration”, weight loss tricks on superskinnyme.com, skinny girl products, and photos of Victoria’s Secret angels. A year earlier, Leah had been diagnosed with anorexia nervosa with intermittent bulimic episodes.

Leah is part of a troubling generation of pro-ana (pro-anorexia) and pro-mia (pro-bulimia) blogs, “how-to” sites, and social network influencers that glorify ultra thin people, promote false or unreachable ideals of beauty and have turned eating disorders into a “lifestyle.” There is ongoing debate as to whether or not these sites have the potential to cause the eating disorder, but healthcare professionals all agree they certainly are a catalyst.

In Leah’s case, this type of damaging media has considerably reinforced her condition, spiralling her further into the disorder by encouraging dangerous restricting behaviours camouflaged as “thinspiration”, and healthy dieting. “Awesome tips to lose belly fat fast,” and “How to be skinny and look great” are examples of the countless stories in which dangerous dieting methods are feigned as desirable behaviours. “These sites are a double-edged sword,” explains Dr. Alain Lévesque. On one hand, they are helpful in reducing isolation by creating a community of anorexics, but on the other they foster denial and don’t support recovery.” “Just as we all tend to seek advice from who will tell us what we want to hear,” he says, “pro-ana and pro-mia sites create false groups of belonging that stigmatize a false debate, and value poor judgement.” Girls like Leah go to these sites and think, “well maybe we’re right about being 90 pounds.” Dr. Lévesque says that what is most concerning about pro-ana sites “is they bolster the notion of control, inherent to the eating disorder,” by providing girls with even more tools to compulsively restrict their calorie intake and control every single aspect of their diet. An eating disorder is a power trip in a sense.

Years of dancing and circus arts are part of the reason behind Leah’s skinny figure and accordingly, her obsession with weight. She was admitted to the most prestigious ballet school in the province, and even though the earliest warning signs of anorexia had appeared when she was still a child, the unspoken competiveness and constant pressure at the academy had triggered a relapse. “I was always looking at other girls in their tights and leotards,” she says, and it would only reinforce the pressure I felt to lose weight.” Her professor Mr. Olivier would often correct her posture by firmly pressing on her stomach to lower her pelvis. “I don’t want pregnant women in my dance class,” he once told her, referring to Leah as one of the larger girls of the class. This had prompted the bulimia episode and drastic weight loss. She might not have been performing as well because of it, but it had gotten her plenty of compliments from other dancers who started envying her concave stomach, and had gotten her to sign a modeling contract. She could barely manage to get through the day and was so weak she would often pass out. By practicing restrictive eating behaviours, her brain had tricked her into believing she could only eat if she had the possibility to throw up afterwards. She would only munch on carrots and celery sticks, and sometimes, when the class had been too intense, would allow herself a puffed rice cake, with a side of guilt. She had become an expert at professing self-control, thanks to the fasting tricks she had sought online, but it only fuelled her binge eating fire at night.
Leah’s relatives called her out on her weight loss, but she refused to admit she had an eating disorder. Even though the artistic director of the ballet academy suggested she seek treatment, it is only once she started suffering from serious hair, muscle and bone density loss, absence of period, mood swings, dehydration, and was unable to focus that she agreed to finally seek the help she needed, after two years of extreme yo-yo dieting.

“Recovering from an eating disorder literally means reprogramming your brain,” says Dr. Lévesque. Over time, anorexics learn to “only think in terms of calories, numbers, and math, according to an extreme dichotomy of foods, and all of a sudden, boom! They’re told they need to start making choices based on new factors, or they will die,” he says. What makes the transition difficult is that programming is usually done in the tender years; at the same time self-image starts developing, the first symptoms usually appear. The basis of any eating disorder is in fact an identity disorder, so someone who’s been afflicted by an eating disorder for a long time essentially has to create an entirely new sense of self; the disorder has become part of who they are. Dr. Lévesque says the danger with pro-ana and pro-mia websites is that “they make the reprogramming process even harder, and prevent the rebuilding of a new identity that is not solely based on the anorexic or bulimic lifestyle.” Consequently, eating disorders are not a technological problem, but rather a societal one. Technology only exposes and advertises the condition.
Society today is obsessed with food. Whether considered a vital need or simple leisure, food has acquired a mythical aspect. There is a growing social concern about food that translates into a myriad of new restaurants, specialized groceries, cooking shows, cookbooks, new dieting trends, and tons of articles, all of which form our cultural mosaic. Food has become the determining factor by which we identify to a subgroup. “Those are the vegetarians, those are the vegans, those are the anorexics, those are the obese, and so on,” says Dr. Lévesque, and “this creates rivalry.” So it all comes down to which group will be the healthiest, skinniest, and thus the happiest. Dr. Lévesque believes our society’s obsession with food is much more likely to cause a rise in the number of eating disorders than pro-ana and pro-mia sites, and “that is why treating an eating disorder is also about learning how to eat within our social context, again.”

At 18, Leah quit ballet, modelling, and her job, and embarked on the 16-weeklong treatment at the Douglas Mental Health University Institute. The focus of the treatment was precisely to reinstate social eating habits, and defuse the detrimental relationship she had with food, which in turn would allow her to reprogram her brain, and develop a new sense of identity independent of any subgroup. She ate three meals a day with fellow patients, with whom she shared discussions in an attempt to learn re-socialization. “I’ve never worked so hard on myself,” she says, with a half-sorrowful half-happy look in her eyes. “Restriction habits don’t stop overnight, but I’m slowly beginning to figure out who I am, deep down, and its great to know there’s something beyond the bulimia.”
16 weeks have passed and Leah knows she’s in for a hell of a ride. “I’m still adjusting to everything, but I’m learning to cherish my body, even though it’s so easy to fall back into the restriction scheme again.” For Leah, as for many girls in her position, learning to reprogram her brain will be the struggle of a lifetime, especially in today’s social context. Anorexia and Bulimia have become a culture in which technology is used as a vehicle for promoting and enhancing a sense of identity, whether good or bad. While she sometimes still feels a little afflicted by restriction thoughts, Leah doesn’t see herself as fat and disgusting anymore. Rather, she tries to harbour the idea that her body is a work of art that carries a beautiful soul.