Last fall, HBO aired a documentary that had good intentions and a terrible outcome.
Thin was created by filmmaker Lauren Greenfield, whose goal was to show the devastation of eating disorders and the price its sufferers pay in health, well-being and overall quality of life. She succeeded. And that’s the problem.Princess Diana was a woman who struggled with bulimia for many years, but may not have found lasting recovery from this tough addiction during her life.
Viewers of this highly-touted documentary, which was reviewed in every possible media outlet, watched four women — who were closely tracked by the cameras during their stay at the Renfrew Center and afterwards — run through tens of thousands of dollars, their insurance coverage, and their families’ emotional resources, only to wind up in worse shape in the months after they were released.
This is not unusual in the world of eating disorder treatment, unfortunately, but it’s also not the entire story, and both the filmmaker and HBO missed a golden opportunity to assist millions of struggling people with eating disorders and infuse them with some of the seminal theories of Positive Psychology.
If even one bulimic had been featured who had gone home after an inpatient stay (and the Renfrew Center does have stories like that) to create different eating habits, new sets of behaviors and friends, and establish a foundation for ongoing recovery, some hope might have been sparked with the documentary, and thousands of people might be tasting the happiness of recovery today.
However, every single person I have spoken with who either watched Thin or works in the eating disorder community, said that the message that was universally received from the documentary was one of hopelessness, i.e. “No one gets better, or certainly not for long.”
Nothing could be further from the truth. I am one of those long-term recovery stories, and I even wrote the first book by a survivor of bulimia, called “My Name is Caroline” (Doubleday 1988). My recovery was sparked one night at a self-help group for recovering compulsive eaters when a woman — who looked a lot like me — spoke honestly and forthrightly about her long battle with bulimia, and said that she was now in recovery. That moment changed my life. For the first time in many years, I felt hopeful. And that hope is the reason why I was able to persevere through the difficult and long process of recovery.
Paula Abdul has been in and out of treatment for her bulimia on several occasions. This disorder is very common among public personalities.
In the MAPP program at Penn, we studied “hope theory,” which was devised by C.R. Snyder, and it elegantly explains why hope is so essential to well-being, and now I understand why it was also the linchpin of my recovery. When people are hopeful, they have goal-oriented, pathways thinking that allows them to persist longer as they work at achieving their goals. Hope also allows people to believe in themselves, and to think more creatively about how to get around obstacles, stay focused, and make better choices when self-regulation is low. “Thin” wiped hope off the map in one short hour by managing to only highlight failure.
Albert Bandura’s self-efficacy theory is also critical in understanding the development of self-esteem and positive emotions, which contribute to recovery. People with self-efficacy believe they can accomplish the goals they set for themselves, and one of the most important ways this “self-efficacy muscle” can be built is through proximal role models. The woman who spoke at the meeting I attended in early 1984 not only sparked hope in me, she also served as a proximal role model who helped to guide me in my early months of getting through the days without throwing up and resorting to laxative abuse. Bandura posits that self-efficacy is bolstered through “verbal persuasion from a significant other,” and I received this from my new role model, as well.
As a result of the Thin documentary, I have decided to go public again with details of my life in a new autobiography that will be published in June 2008 by Gurze Books, which specializes in eating disorder work. Because I work full-time and very happily as a performance coach, teacher and speaker in the fields of Positive Psychology, this was not an easy decision, because it opens me up to a new and different kind of scrutiny than I’ve experienced in my current profession.
But I feel strongly that the story must be told — in this case, for the first time in publishing history — of how someone put together more than two decades of recovery from bulimia, without switching to another addiction or living a white-knuckle life of waiting for the “Food Sword of Damocles” to slice off your head.
By doing this, I am hoping to provide some role-modeling for the millions of women (and some men) who don’t know anyone who has more than a few months or years of recovery, and who may have seen “Thin” and concluded that long-term recovery is a myth. My book might even give readers hope that will inspire goal-focused and pathways thinking that could change their lives for the better, contribute to their self-efficacy, and put them solidly on the road to being happier, healthier and more empowered.
Positive Psychology has much to add to the field of eating disorder recovery because so many of the things I did instinctively to save my own life are now studied and well-validated as positive interventions that can contribute to happiness. None of these topics existed or were discussed in the early 1980s when I set out to create recovery for myself, so I felt very alone. Now that I have over twenty years of recovery, and I’ve been fortunate enough to learn from the best of the best in the Penn Masters in Applied Positive Psychology Program, I would like to point out where Positive Psychology tools can create meaningful and lasting change for someone who is strugging with an eating disorder. As they say, “You can’t keep what you don’t give away.”
In addition to finding positive role models who contributed to my self-efficacy, the following tools and new behaviors are a few that allowed me to string together days, then months, then years, then decades, of recovery:
- Daily journaling helped me to unravel the many threads of my eating disorder and depression, and to have a safe place to express my feelings — and even to list my food. Laura King and James Pennebaker have done outstanding research on how journaling enhances well-being, creates meaning out of chaos, helps with goal prioritization, and even supports antibody production.
- Socializing with others who were striving towards similar goals gave me access to lots of role models, it forced me to be more extraverted when I didn’t want to be, and it prevented me from ruminating and being alone. The power of others is so well-documented and staggering that I don’t feel compelled to cite studies, but it is important to note that bulimics are often isolated in their disease, and encouraging them to learn about the power of “faking” extraversion can be very helpful.
- I completely eliminated downward social comparisons by removing the scale from my life. I haven’t weighed myself in twenty-plus years (and am not told my weight at doctor’s visits for these reasons), because I had absorbed too many negative messages about the weight I “should” be in order for the number to be helpful at my height of 5’10”. Those daily negative comparisons cast such a pall on my life that I shudder to think of what might happen if I ever chose to weigh myself again and pay attention to the numbers.
- Instead of striving for extrinsic goals around being admired for how I looked (thin), I changed my goals to reflect more intrinsic properties of being energetic, healthy, honest and kind. Research shows that striving for “look at me” goals is correlated with depression, and many eating disorders are born from this value.
- I began to volunteer within the support group so that I felt more connected to others. Self-determination theory states that when we move towards behaviors that create competence and belonging, we experience greater well-being. This certainly was the case with me, and I also found that the well-researched effect of giving my time to others had a profound impact on my happiness.
- Instead of giving into every whim to eat whenever I wanted, I developed greater self-regulation by setting small, achievable goals that gave me mastery experiences (again, a component of developing self-efficacy). Roy Baumeister of Florida State University told me that if you cannot develop self-regulation, you cannot achieve a goal. So creating an action plan of what I’d eat every day, and then following through, was part of this multi-step process that resulted in lasting success (to hear Roy Baumeister’s fascinating interview with me about self-regulation, visit my podcasting page).
- I eliminated negative, gossipy people from my life. There is great research about how easy it is to “catch” others’ moods, so I deliberately created a new set of friends who had goal-oriented positive outlooks that rubbed off on me.
- I developed a sense of spirituality and began a several-decade quest for more knowledge in this area that included investigating different forms of worship, getting myself baptized in my thirties, and joining a Bible study group in my forties.
- I made amends to people I had harmed, and discovered the power of forgiving myself and others. Because I couldn’t change the past, my focus was on asking for and receiving forgiveness and living in daytight compartments where I just strove to be the best I could be.
- I exercised in healthy, new ways that didn’t mirror the compulsive exercising of my youth. I got a black belt at the age of 40, took up scuba diving, became an avid rollerblader, experimented with yoga and Pilates, and even returned to competitive swimming in my forties after a 25-year layoff. The smell of chlorine had once cued me to think bulimic thoughts, and to overcome that connection, I joined a Masters team that emphasized fun and fitness, not being first.
- I took up new hobbies that created feelings of “flow” and connection with others. Bulimics understand “junk flow” well, because a binge/purge session is often a several-hour fog of buying food, eating it, and then eliminating it somehow. I often lost track of time and my life when this happened, but it wasn’t good flow. My new hobbies that induce “flow” are knitting, scrapbooking, reconnecting with my childhood love of playing the piano, and reading books.
I am very grateful that I am someone who was able to experience seven years of a self-destructive illness, and then rise above it through sheer determination, hard work and the support of some key people. What I did wasn’t magic, but it also wasn’t easy.
Now that I have a solid education in Positive Psychology, I see how this knowledge can dramatically help those who suffer in the ways I once did. If every eating disorder specialist understood the power of journaling, role modeling, self-efficacy, emotional contagion theory, flow, hope theory, and even goal-setting theory, I believe that documentaries like “Thin” wouldn’t be made at all, or would at least be salted with some hope.
Until then, I will offer my story up with the sincere wish that it might create some joy for someone else, and thus “add to the tonnage of happiness in the world,” as Marty Seligman has said. I can think of no better legacy to leave behind.
Caroline Miller has published two books about her own experiences overcoming bulimia:
Miller, C. A. (1991). My Name Is Caroline. Gurze Books.
Miller, C. A. (2013). Positively Caroline: How I beat bulimia for good… and found real happiness. Cogent Publishing.