Brain Over Binge

by Kathryn Hansen

  From the first time I had an urge to binge and didn't act on it, I began teaching my brain that my habit was no longer necessary. In turn, my brain began to correct my binge-created brain-wiring problem by weakening the neural connections and pathways that supported it, wherever the exact location of those pathways may have been. As I experienced more and more urges that did not lead to binge eating, my brain learned that I no longer needed the habit. The faulty neural pathways that once led me to the refrigerator weakened with lack of use "until they [were] able to carry signals no better than a frayed string between two tin cans in the old game of telephone."157

  I couldn't teach my brain this lesson by arguing or trying to rationalize with it. I could teach my brain this only through my own repeated actions. In other words, I couldn't talk my brain out of my habit, I had to act it out. By not acting on my urges, I physically corrected my brain-wiring problem. I had to make those willful behavioral changes; then my brain fell in line and turned off my urges to binge. Once I decided I wanted to take a different path than the one my brain had carved out for me, I, my true self, had to go down that different behavioral path before my brain. Then my brain followed, not the other way around.

  Rational Recovery gave me a simple thinking skill that turned out to have incredible power—the power to rewire my brain, completely erasing my bulimia. I didn't realize it at the time, but I was actually utilizing the plasticity of my brain to end my habit. The same property of the brain—neuroplasticity—that created my habit completely erased it. This was possible only because of the capabilities of a specific region of my brain, the prefrontal cortex.

  THE KEY TO RECOVERY: MY PREFRONTAL CORTEX

  Whether my binge eating habit was a habit of excess, a habit of pleasure, or a habit of impulsivity—or, as I believe, probably a combination of the three—part of me still remained apart from it at some level; otherwise, I would not have been able to put an end to the habit. The part of me that remained unaffected and directed my recovery was my prefrontal cortex—a brain region I talked about briefly when discussing the teen brain in Chapter 17.

  The prefrontal cortex—the most evolutionary-advanced part of the brain that gives us our sense of identity and capacity for voluntary action—makes up the largest part of the frontal lobe (see Figure 3).158 Compared to our animal ancestors, we have a very large frontal lobe, which occupies much more of our total brain than for any other creature.159 The frontal lobe has connections to other parts of the brain and can inhibit those parts, giving humans the ability to stop and think and divert primitive responses.160 Humans don't have to follow every impulse from their brains, and the prefrontal cortex is vitally important in this ability. The prefrontal cortex has the greatest role in inhibiting behavior and withholding automatic responses.161

  The prefrontal cortex is the seat of the will—of freely preformed volitional activities. 162 In order to binge, I had to use willful voluntary muscle movements (acquiring food, putting it in my mouth, chewing and swallowing it), all of which my prefrontal cortex had complete power to stop me from doing. No matter what thoughts, feelings, or cravings my animal brain generated automatically, I could choose my actions because of my prefrontal cortex. I could stop myself from performing "inappropriate motor actions."163

  My prefrontal cortex had this power because of its role as the brain's command post, chief executive, or "conductor of the orchestra."164 The prefrontal cortex is the best-connected part of the brain, meaning that it communicates directly with all functioning parts of the brain, including the animal brain.165 Since it is the agent of control within the brain and central nervous system,166 its job is "coordinating and constraining" those neural structures.167

  It was the prefrontal cortex that gave me the ability to say no to—or use veto power over—my urges to binge. Veto power is a type of willpower that psychologist Richard Gregory first called "free won't."168 Without getting into a philosophical discussion of free will that is beyond the scope of this book, I'll say that free will does not necessarily work by initiating voluntary actions, but instead, it works by allowing or suppressing those voluntary actions.169 In other words, we may not have the capacity to choose what actions the brain automatically prompts us to perform; but because of our prefrontal cortex, we can choose which of those automatic promptings to follow and which ones to disregard.

  When I stopped acting on my urges, I was using veto power. Without being able to describe the process at the time, I had in fact discovered the ability of my own prefrontal cortex to disregard my lower brain's automatic signals. I realized that, despite my intrusive thoughts, powerful feelings, and strong urges, my prefrontal cortex could indeed suppress inappropriate actions. I discovered "free won't"—the ability not to act—and by not acting over and over, I corrected my binge-created brain-wiring problem.

  I believe the prefrontal cortex is the specific region of what Rational Recovery calls the "human brain" or the "I" that gave me the ability to recover. It certainly wasn't necessary for me to know the technical details of my brain anatomy to recover; but now that I do know more, I can better explain how I was able to say no to each and every urge to binge. As I do so, I hope it will help others discover the power of the prefrontal cortex as well.

  FIVE STEPS I USED TO STOP BINGE EATING

  The next five chapters describe my recovery, step by step. When I stopped binge eating, I was not consciously thinking that I was following a set of steps, but shortly afterward, I could look back and see exactly what I did that enabled me to use my prefrontal cortex to quit—some of it derived from the advice I read in RR and some from my own insights.

  Here are the steps that corrected my binge-created brain-wiring problem and brought my bulimia to an abrupt end:

  Step 1: I viewed my urges to binge as neurological junk from my lower brain.

  Step 2: I separated my highest human brain from my urges.

  Step 3: I stopped reacting to my urges.

  Step 4: I stopped acting on my urges.

  Step 5: I got excited.

  The first three steps made the fourth step possible; and once I practiced the fourth step for long enough, my urges to binge disappeared. The fifth step was a natural result of my success in resisting urges, but I believe it turned out to be very important to speed up and cement the brain changes that erased my habit.

  BRAIN OVER BINGE

  Together, the five steps I used comprise what I mean by "brain over binge"—thus the title of this book. This concept is definitely an offshoot of "mind over matter" because it was my mind—my true self, my prefrontal cortex, my highest human brain—that had the capacity to override the harmful matter, my urges to binge, coming from my animal brain. The prefrontal cortex lies structurally above and forward of (over) the animal brain; therefore, my recovery was not only mind over matter, it was—quite literally—brain over binge.

  In the chapters that follow, I'll often refer to the five steps of my recovery as simply "brain over binge." To illustrate this and draw the distinction between lower and higher brain functions, I will also begin referring to the animal brain as simply the "lower brain" and the prefrontal cortex or the true self as the "highest human brain." This takes the two brain functions at work in bulimia down to their most basic forms. When I use the term lower brain throughout the remainder of this book, I am referring to the parts of the brain and nervous system that automatically produce urges to binge, regardless of specific location.

  Like I have previously said, the brain and nervous system are not understood well enough yet to be able to pinpoint the specific regions and peripheral functions that create the urges, so even saying "animal brain" has been somewhat of a stretch. However, I can say with confidence that the urges arise automatically in regions of the brain and nervous system inferior to the prefrontal cortex—that is, in lower brain centers. I can also say with confidence that the prefrontal cortex—the most sophisticated and highest (in ability and mostly in anatomy) part of the human brain—gives
us the capacity to override the automatic impulses from the lower brain. This is why I will keep things simple, talking about just the lower brain versus the highest human brain.

  24: Brain over Binge, Step 1: View Urges to Binge as Neurological Junk

  In order to stop acting on my urges to binge, I had to see them as essentially meaningless. I could not hold on to the idea that I somehow needed to binge for this or that reason, or that my urges signaled an emotional need. I had to view the urges as junk and only junk, emanating from the depths of my brain and not worth any further consideration whatsoever.

  As I've said, therapy concepts and secondary benefits were some of the reasons I followed my urges, and this step involved completely letting them go. If I would have held to the belief that I binged to cope with life or some underlying emotional problem, I probably wouldn't have been able to stop so abruptly. If I had remained under the false impression that I needed to binge for some mysterious psychological reason, then I would have taken that as an excuse to continue my behavior indefinitely.

  I was fortunate to have the experience with the medication Topamax that temporarily alleviated my urges to binge. Nearly two years prior to my recovery, Topamax taught me that the problem wasn't my life or my inability to cope with it. It also taught me that, without urges to binge, I didn't need the secondary benefits of binge eating—nor did I want them. When my urges to binge temporarily subsided while on the drug, I didn't feel a need to be sugar-drunk; I didn't feel a need to be temporarily numb to my problems; I didn't feel a need for the pleasure that binge eating brought me.

  This information was invaluable to me when I finally recovered. Since I knew my urges to binge weren't symbolic indicators of what I truly wanted or needed—physically or emotionally—and since I knew I could easily do without the secondary benefits of binge eating, it was relatively easy to start viewing the urges as neurological junk from my lower brain. I could clearly see that the urges were merely products of my "binge-created brain-wiring problem," completely apart from my higher self, which brings me to the second step in my recovery.

  25: Brain over Binge, Step 2: Separate the Highest Human Brain from Urges to Binge

  My urges to binge weren't truly mine—I was not my habit. I wanted a better life than stuffing large amounts of food in my mouth and then desperately purging to undo the damage. I had goals for myself that I knew were inconsistent with my eating disorder. I knew I wanted a real life, but my habit kept me trapped in destructive patterns of behavior.

  Part of me—the seat of my consciousness and identity—knew binge eating was wrong, and that part of me regretted each and every binge. That part of me was my highest human brain, my prefrontal cortex, my true self.

  EGO-DYSTONIC URGES

  Rational Recovery introduced me to the idea that there are two separate brain functions at work in addictions. In the case of my bulimia, there was my lower brain, which involuntarily generated my urges to binge (first due to survival instincts, then due to habit), and my highest human brain. My urges to binge were ego-dystonic, meaning that they seemed "apart from, and at odds with, [my] intrinsic sense of self."170 My true self's desire was to be healthy, but my urges to binge interfered.

  I first learned the term ego-dystonic about a year after my recovery, while reading about a study of patients with obsessive-compulsive disorder (OCD) directed by neuropsychiatrist Jeffrey Schwartz. This study shows remarkable similarities to how I stopped my bulimia, and it explained to me how my recovery was possible and why it was permanent. Like bulimia, OCD is ego-dystonic in that sufferers have intrusive urges that they feel driven to follow. They have recurring obsessive thoughts and feelings urging them to repeat the same compulsive behaviors (e.g., hand washing), which are akin to the intrusive, recurring thoughts and feelings that drive a bulimic to binge.

  Like bulimics, those with OCD feel that the urges are apart from their true selves, and they know rationally that they shouldn't follow those urges—but they can't seem to resist. For example, an OCD patient who has urges to repeatedly wash his hands knows quite clearly, in a part of his mind, that his hands are not really dirty. This is because in OCD, the faulty brain connections that give rise to the obsessions and compulsions spare some of the patient's brain. The spared brain regions are the most sophisticated and evolutionarily recent parts of the brain, located in the prefrontal cortex.171 In other words, the highest human brain is spared in OCD, just as I believe it is spared in the habit of bulimia.

  My urges to binge were not a function of my highest human brain, regardless of exactly where and how the urges arose in my lower brain. It didn't matter what neural pathways drove my habit, my habit remained separate from my highest human brain, and my highest human brain remained capable of resisting the urges. Even if a habit of impulsivity (see Chapter 20) was the primary mechanism—meaning some circuits in my prefrontal cortex indeed weakened through lack of use in resisting the urges to binge—my prefrontal cortex was still distinct from the source of the urges, and it still remained capable of learning to say no and therefore strengthening.

  In Schwartz's OCD patients, and in my case as a bulimic, the "core reasoning power and sense of identity remain[ed] largely intact."172 There were "two competing systems of brain circuitry": one system generated the faulty brain messages of OCD (or, in my case, the intrusive urges to binge); and the other was the patient's mind—the prefrontal cortex— which remained capable of overcoming the faulty brain messages.173 Put another way, the lower brain and the highest human brain competed in my bulimia. When I didn't know this competition was due to two separate brain mechanisms, it was nearly impossible to resist my urges.

  EXPERIENCING URGES IN A NEW WAY

  It wasn't until I separated the most sophisticated and most uniquely human part of my brain from my urges, and really felt that separation, that I felt capable of saying no. Separating my urges to binge from my highest human brain was so important because it allowed me to experience those urges in a completely different way. It allowed me to see that they were just automatic functions of my binge-created brain-wiring problem. I learned to recognize any thought or feeling that encouraged me to binge as something completely apart from my true self, as merely a product of the habit. This immediately made my urges to binge less threatening and gave me the sense that I was above them.

  I was able to look at my lower brain from a distance, so to speak. Each time I experienced an urge to binge, I was able to monitor what was going on in my brain and observe what I was thinking and feeling. I felt I could float above my lower brain and look down on all the thoughts and feelings encouraging me to binge, all the while viewing those thoughts and feelings as neurological junk. I was able to see clearly that my urges to binge were not an indication of any real needs, but merely an indication that my brain was on autopilot, trying to maintain my habit. I was able to disconnect from those thoughts and feelings and not get so wrapped up in them.

  A SIDE NOTE ABOUT ANOREXIA

  The ability to separate oneself from urges is not as easy when it comes to anorexia, which is why I believe that it can be more difficult to treat. In anorexia, resistance to eating is not ego-dystonic, but ego-syntonic,174 meaning it is usually what the anorexic's true self wants to do. Anorexics, at least in the early stages of the disorder, rarely lose their appetite; rather, they willfully refuse food175 and feel successful, powerful doing so. Indeed, when I was caught up in restrictive dieting, it was hard for me to see that what I was doing was wrong. I wanted to lose weight and that's what I was doing, so I didn't see why it was a problem. My extreme appetite, on the other hand—I could definitely see why that was a big problem, because it was so out of line with what I set out to do: lose weight.

  I think this is why anorexics are usually not as motivated to overcome their problem as binge eaters, because that would certainly involve gaining weight, and often a significant amount of weight. This resistance to weight gain and lack of motivation to change makes anorexia more dange
rous and deadly than bulimia. Furthermore, if the willed starvation continues long enough, anorexics eventually do lose their appetites.176 A starvation habit (which could be called a "starvation-created brain-wiring problem") sets in, so that eating normal or even small amounts of food feels downright wrong. Anorexics can then follow their starvation habit right to hospitals and, sadly, even to the grave. Indeed, anorexia has the highest mortality rate of any psychiatric disorder.177 Despite health consequences, the anorexic's ego-syntonic drive to be thin makes them feel they doing the right thing; whereas, in the case of a binge eater, it is easier for her to see what she is doing as abnormal and thus separate herself from it.

  MINDFULNESS AND THE POWER OF ATTENTION

  I found remarkable similarities between the way I separated myself from urges to binge and the process Schwartz used in his study. Specifically, Schwartz taught his OCD patients a skill called "mindfulness," which is essentially "the practice of observing one's inner experiences in a way that is fully aware but nonjudgmental. You stand outside your own mind, observing the spontaneous thoughts and feelings that the brain throws up, observing all this as if it were happening to someone else."178 Schwartz thought that experiencing brain-generated OCD urges with mindfulness—the calm clarity of an external witness—could strengthen his patients' ability to resist them. Without knowing the name of that thinking skill, I was using mindfulness to experience my urges to binge with detachment.

  Schwartz believed mindfulness could help his patients because they could use the healthy part of their brain, their prefrontal cortex, to observe their own symptoms, which would give them "an impartial, detached perspective on [their] own thoughts."179 He hypothesized that mindfulness, which " puts mental space between [the] will and the unwanted urges that would otherwise overpower the will,"180 could empower the prefrontal cortex to resist the urges.