cave inimicum: boundaries in recovery

Hypothetical scenario: you are female and a male acquaintance says, without you asking for their opinion at all, "I think, by the looks of it, you might be wearing an underwire bra at the moment. And I really think you need to know that underwire bras cause cancer and I mean I wouldn't want you to get cancer. Yeah, so I read it on a website run by a really smart guy who knows his stuff that it's about how the breasts get all squished and that's unhealthy for breast tissue..."

Would you:

  1. Be worried that underwire bras cause cancer.
  2. Be worried that this acquaintance is an idiot.
  3. Be creeped out that this acquaintance noticed the shape of your breasts and figured you were wearing an underwire bra.
  4. Feel all of the above in quick succession and then decide that the acquaintance needs to be told that your undergarments are not up for discussion.

The point of this exercise— and no, underwire bras and bras in general are not correlated with breast cancer risk i, for those who might be stuck on item (1)— is to frame the issue of boundaries in our lives. As we are somewhat desensitized to the inappropriateness of discussing others’ food choices, body shapes and weight, bras seemed a better way to highlight the problem.

If anyone has to tell someone else that the food they are eating is "harmful" then it's all about the speaker and not the listener.

Here is a great rule to try to apply in all our lives (hard to live by but certainly one to always strive for): if someone hasn't asked for your input or opinion, then don't provide it at all.

And the corollary rule is: if someone offers you an unasked for opinion, then you need to have built, refined, upgraded and walked the perimeter of your own boundaries enough that you feel comfortable distinguishing between when an unasked for opinion is an invasion of those boundaries, and when it is merely an irritant. 

With practice, you will get to a point where you'll be able to identify that someone who is all up in your face about your food choices "for your own good" is really dealing with serious orthorexia in their own lives. Knowing that will help you to diffuse the relevance of their message such that you will only feel empathy for the intensity of the fears that they face.

Trigger Warning

Last year the use of the term “trigger warning” blew up in mainstream discussions and the media. Many college administrations, prodded by requests from student organizations, were asking their instructors to flag with a trigger warning any and all assignments containing material that might cause emotional distress for students.

In the days coming up to the first week in February assigned to eating disorder awareness, many national associations provided media guidelines for responsibly reporting on eating disorders. That meant, among other things, no listing of low weights and no detailed description of restrictive behaviors.

And of course we use the “TW” tag all over the forums on Your Eatopia, including a forum dedicated to trigger warning material.

The origin of the term was actually “trauma trigger” associated with flashbacks of trauma incidents that could be triggered for those with post-traumatic stress disorder. It was adopted several years ago within the online community environments as a way to give other readers a heads up that the following material might be problematic if the reader was in an emotionally vulnerable space.

I face considerable ambivalence on this topic.

Dr. Metin Başoğlu, when quoted in a Telegraph article ii on the topic of trigger warning use becoming rampant, suggested that avoidance of triggers is not optimal and that exposure helps. I would agree with this statement but within the context of formal treatment to alleviate anxiety. Using guided exposure is a clinically confirmed way to address numerous anxiety disorders, but flooding in the absence of trained psychotherapeutic guidance can simply exacerbate the intensity of anxiety and worsen the condition overall.

If you pour hot McDonald’s coffee on yourself, should the absence of a clear warning that the coffee is hot render McDonald’s culpable for your burns? Many of you are likely familiar with that case, but you may not know the details. Sadly none of us knows the final outcome as it was settled out of court in the end, but the details are fascinating and can be found here: Electric Law File.

Likely most of you view this case as an example of the extreme litigiousness found in the United States. But in fact, the coffee was served scalding to the point where it was assured of causing full-thickness burns; it was served to those commuting with full knowledge that it would be consumed en route; and, importantly, numerous burn cases had already occurred prior to the case in question.

In other words, McDonald’s had every opportunity to address the risks of its coffee burning people driving to work long before the corporation refused to pay for the skin grafts for 79 year old Stella Liebeck (the woman in the case referenced above and who was also not the driver but the passenger).

There is personal, corporate and societal responsibility, and the delineation of where one ends and the other begins is utterly amorphous and shifting all the time.

The nature of nonsuicidal self-injury videos on YouTube may foster normalization of nonsuicidal self-injury and may reinforce the behavior through regular viewing of nonsuicidal self-injury–themed videos. Graphic videos showing nonsuicidal self-injury are frequently accessed and received positively by viewers.” iii

The researchers quoted above found that close to 40% of these videos had no warning, despite graphic content, and 80% were accessible to the general public. Prevalence of non-suicidal self-injury for youth and young adults ranges from 14% to 24%.

Many of you may not be aware that the media almost never reports on suicides from jumping off of bridges yet it happens constantly. Why don’t they report on these suicides? The Werther Effect (copycat suicides). There is enough research data to confirm that publicizing suicides generates a rash of copycat suicides in its wake. iv To protect vulnerable individuals within our society the media self-censors, at least when it comes to suicide by jumping off of bridges. As such, is it an impingement of freedom of speech and information to further self-censor stories on restrictive eating behaviors or non-suicidal self-injury? Is YouTube a media outlet and as such does it have an obligation to protect vulnerable viewers from content that will elicit copycat behaviors?

And does this mean that my relaying of non-suicidal self-injury material present on YouTube fails to abide by responsible authorship rules given that my readership is predominantly faced with some level of emotional vulnerability?

I recently received the following criticism via e-mail:

I am still upset that you chose to cite a paper…and that you kept the reference in even when I protested… What really bugs me about all this is that if you took most references [on topics mentioned*] out of your blog posts…it would not take anything away from the blog posts. And it would not alienate or trigger readers.”

*I have removed the details in question as leaving them in would likely identify the sender in the absence of their authorization to do so.

Here is an extract of my response:

I am more than willing to reassess my work and greatly appreciate anyone who is going to take the time to contact me directly and let me know that my understanding of a particular topic has gaps or mistakes. However, in many instances, it will come down to how each individual chooses to interpret the material. Ultimately, the blog posts are my opinion.

If my opinion is offensive to others, then they simply do not visit the site or engage with anything to do with my work.” 

In the end, I believe it is most realistic if you do not expect to wholly abdicate your personal responsibility to a point where you can depend entirely upon other individuals, corporations or society as a whole to protect you from your own vulnerabilities.

Avoidance, Precautions and Flexible Walls

In our modern social-media infested world, we face a gratuitous level of disturbing, triggering and victimizing material. Avoidance is a viable and necessary tool in the toolkit for addressing exposure to distressing content. The way to distinguish between resilient and brittle levels of avoidance is to identify whether the avoidance has to be maintained at a level that impinges on your quality of life. If fear is the driving force for applying avoidant behaviors, then a brittle emotional state is at work.

Developing boundaries is a bit like the fairytale of the three little pigs and the wolf. The first pig builds his house of straw and the wolf huffs and puffs and blows the house down. The second pig builds his house of sticks and the wolf blows that one down. The third pig builds his house of brick and the wolf cannot blow that one down.  In each case, the first and second pigs avoid being eaten by the wolf by scuttling along to the more secure home (first sticks, then bricks).

In the fairytale, the wolf eventually decides to attack by coming down the chimney and he lands in a pot of boiling water placed there by the pigs.

If your boundaries represent the house of straw right now, then you cannot allow for someone to huff and puff about their fears of harmful foods all over you, not to mention any invasive observations about your underwear either! The sooner you shut them down, the more likely your boundaries will remain intact. Learning how to do so without disowning your own responsibility for your emotional brittleness is something best navigated with the help of a good therapist.

It’s one thing if the wolf comes to your door; but if you go looking to set up your straw hut camp in the middle of wolf territory, then you cannot really expect the wolves to warn you ahead of breathing heavily all over your hut. First and foremost, you are the one tasked with protecting yourself and your emotional wellbeing.

Eventually, you will graduate from straw to sticks and then bricks. But unlike the fairytale, you are not quite done when it comes to real-world boundaries.

Had the pigs built a fourth house providing protection from the wolf but also allowing the good things easy access within their walls, then they could have defended against more than just one lone wolf. They would have happily resided there receiving everything they needed for a fulfilling life while maintaining their safety from any future predators as well. With an impenetrable wall you become a city under siege and that’s always a time-limited survival endeavor.

The most advanced boundary is more akin to a cell membrane— it will only let in what is allowed through the barrier.

Within the world of biology, the cell membrane is festooned with specialized, targeted receptors that identify and neutralize all manner of predators and call in reinforcements from the rest of the living ecosystem when needed, all while seamlessly identifying beneficial elements that slide through the wall utterly unimpeded.

Or, if you would like a poetic framing for how a cell membrane works, maybe think of it as something more like the series of magical spells used by Hermione Granger in the Harry Potter book series to protect the space where they were camping: Cave inimicum (strengthening an enclosure from enemies).

Casting spells for flexible boundaries takes practice and a good teacher, or teachers.

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i Chen, Lu, Kathleen E. Malone, and Christopher I. Li. "Bra Wearing Not Associated with Breast Cancer Risk: A Population-Based Case–Control Study." Cancer Epidemiology Biomarkers & Prevention (2014).

ii http://www.telegraph.co.uk/culture/books/11106670/Trigger-warnings-more-harm-than-good.html accessed February 16, 2015.

iii Lewis, Stephen P., Nancy L. Heath, Jill M. St Denis, and Rick Noble. "The scope of nonsuicidal self-injury on YouTube." Pediatrics 127, no. 3 (2011): e552-e557.

iv Stack, Steven. "Media coverage as a risk factor in suicide." Journal of epidemiology and community health 57, no. 4 (2003): 238-240.