Author’s Note
When I sat down to write The Perfectionist’s Guide to Losing Control, I wrote and I wrote and I couldn’t stop writing.
I knew I was writing outside the scope of one book. I also knew that I didn’t want to invite a conversation about perfectionism without including certain topics.
There was perfectionism and eating disorders, the history of perfectionism in psychological literature, the intersection of socially prescribed perfectionism and white supremacy, the problems plaguing perfectionism research…
I shared my dilemma with my editor, who so brilliantly told me, “If something doesn’t fit in a chapter but you still want it in the book, you can always put it in the author’s note.” I thought, oh, okay.
It felt simple.
It did not turn out to be simple.
My author’s note grew into a book of its own. Just this rambling, wild, rage-filled, hope-filled, research-filled, crowded, endless, sweaty, hungry but not for anything in the pantry, impossible document.
The truth is there’s no way to fit everything in your mind into a book. Like all of us do in one way or another, I tried to wait out the truth. Like all of us learn in one way or another, that doesn’t work.
Maybe, if you’re lucky, you figure out how to put one percent of what you’re trying to say to paper. Then, if you’re stubborn, you publish a long ass author’s note online.
I began my author’s note in my book and kept it at three pages, with a note inviting readers to continue reading it on my website; below is the continuation.
PERFECTIONISM + EATING DISORDERS
Ok. Here we go.
It was the last five minutes of our session. Camilla was excited; she’d just started using a new diet app and had already lost three pounds. While describing the features of the app, Camilla interrupted herself, “Can I just show you?”
“Sure,” I said, and sat down next to her on the couch. I almost never do that, sit down next to clients on the couch; I can count on one hand how many times it’s happened throughout my entire career. In replaying this session over and over in my mind months later, it’s this detail that haunts me the most. I don’t know why.
Camilla was wearing a sundress with blue jays on it. We’d talked about her dress that day; she was proud of herself for wearing it because it showed her knees.
Camilla was self-conscious about her body in general. She saw herself as fat and therefore less-than. She thought her knees especially broadcasted her fatness.
I was recommended to Camilla through her friend Lucy, who was also a client of mine. Three days after that blue jay dress session, Lucy called me to tell me that Camilla had died of a brain aneurysm. It was a beautiful spring afternoon. I was shocked. My first thought was, but this day is too beautiful for tragedy.
Several months after Camilla’s death, I got an email addressed from her. It was early morning, before dawn. As pitch black as New York City gets. Upon seeing her name in my inbox, my stomach dropped through every apartment below mine. I suddenly remembered everything about the way Camilla looked – her eyes, the dimple on her chin, where she parted her hair. The clarity of the memory scared me.
I clicked on Camilla’s full name. The email was from Camilla’s dad. He was closing out her gmail account and had found a string of messages between Camilla and myself about appointment scheduling. Unaware that I’d already been informed, he was writing to notify me that she had died.
The email was short, two or three sentences. He wrote that he didn’t know she was in therapy, then something like, “I understand that you’re not at liberty to discuss the particulars, but could you please tell me if my daughter was happy that last week?”
Reading his question was, for me, an internal collapse. An unknowable amount of time passed. I just sat there at my desk. At some point, I hit ‘reply’ and went about the somber task of responding to this grieving man’s email.
I think it was when I clicked ‘send.’ Or maybe it didn’t fully hit until a few days later? It doesn’t matter when. Something happened after I sent that email. Something deeply uncomfortable. I felt a violence stirring inside of me. An escalating rage which prompted me to put myself in supervision.
Supervision is a type of therapy for therapists which is focused on the dynamics playing out with their clients. I told my supervisor on that first session, “If you tell me I’m forestalling my grief by fixating on anger because my anger is more accessible than my sadness, with respect, I’m going to find another supervisor. This is not that. This is something else.”
My supervisor told me that we don’t get to skip around in therapy. That we needed to “give voice to the rage, and let the rage tell us why it’s here.”
I hated everything she was saying. Her words were all a diminishment; they felt cartoonish, dismissive. I hoped I didn’t sound like her when I spoke to my clients, while also being sure that I must. Therapists can be so aggravating sometimes.
What I uncovered was a righteous rage; it’s still inside of me. I was and am enraged that in the final days of this extraordinary woman’s life, she spent one of her last precious mornings on Earth looking at her body in the mirror that hung on the back of her bedroom door, trying to decide if that pretty blue jay dress she was wearing made her look more or less fat.
I was and am enraged that while riding the 4 train to my office, she used more mental energy wondering how much of her thighs would show as she debated sitting down instead of standing up.
I was and am enraged that in the last time I would see this person alive, she paid me hundreds of dollars to announce to me her conclusion of all this mental energy, which was that her blue jay dress did make her look fat, and she would wear it anyway. She was excited and proud of herself for wearing it anyway. Her smile when she told me – that became the second most replayed detail of that session.
Camilla’s smile was a victorious one – deep down she knew there was no way to win the contest, but she was gleefully distracted with the satisfaction of having won a round.
I think about Camilla more than therapists are supposed to think about their clients. I think about all my clients more than therapists are supposed to think about their clients.
I miss her.
Everyone who knew Camilla will miss her for the rest of their lives. No one who knew Camilla cared about her knees.
On the opening page of this book, I write that the stories within it have been fictionalized beyond recognition, that they’re “amalgamations of amalgamations.” I worry that I haven’t changed enough in this story. I really did work with a woman who had the world at her feet. She was young, ambitious, charismatic, and unaware that she was about to die. Her loved ones really did reach out to me after her death by sending me an email through her gmail account. I really did sit down next to her on the couch that day. She really did smile that victorious smile.
Sadly, maddeningly, what allows me to share this story is the ubiquity of it. “Camilla” could be any one of my clients at certain points in their life. Camilla could be me in my own therapy at certain points in my life. To say that she spoke of her body in therapy is to say that she was a woman; it reveals nothing.
Camilla didn’t have an eating disorder per se, but she maintained an ever-present, silent awareness of whether the type and quantity of food she was eating moved her closer to or farther away from achieving the cultural beauty standard. In other words, Camilla didn’t encounter food without also encountering a framework of consequences.
Consequence wasn’t the exclusive framework within which Camilla’s thoughts about food operated, but the notion of “good food / bad food / good amount / bad amount” endured. Surpassing habituation, by the time Camilla reached womanhood, the deep-seated neurological connection between food and consequence could be considered congenital.
How could you let her talk about her body so much when there were so many other areas of her life that longed for her attention?
That was my reflex reaction when I thought about my last session with Camilla. I felt angry with myself, deeply disappointed in myself.
My conscious response to thinking about my last session with Camilla, however, eclipsed my emotional reactivity: Women have to talk about their bodies, lest they fall into the weeping brook. That’s why I was so full of rage, because I understood the truth.
If you’re a woman and you have a healthy relationship with your body and food, you’ve done a whole hell of a lot of personal work. Years. Decades. Every woman reading this knows exactly what I mean.
I’ve spent so much session time with so many Camillas talking about their bodies. What’s expected of their body. What they think and feel about their body. What their goals are for their body. What their goals are for their relationship with their body. What’s been done to their body by themselves. What’s been done to their body by others. All this mandatory talking about our bodies at the expense of talking about our lives.
Let’s address the cultural beauty standard which the Camilla in all of us is so well-versed.
In a gag gift of a fact, in 2015, American retail giant JCrew began offering clothes in a size triple zero. Not a size zero, which is immediately absurd. Not a size “double zero,” which makes double less sense. But a size “triple zero.” Zero zero zero. This fashion industry practice, known as ‘vanity sizing’ does not occur in men’s fashion.
Men’s clothes are not available in a size zero, double zero, triple zero, quadruple zero, or any version of zero. When men buys pants, the appropriate fit is determined by applying a metric known as “inches” (pronounced: in – chez). Inches are a globally agreed upon standard of measurement which hold a static rate of conversion to metric units.
In addition to living in a world where an international brand that outfits both men and women can casually offer a size triple zero exclusively to women without so much as a raised eyebrow, we also live in a world where women of color are grievously underrepresented across all mainstream media. Eurocentric beauty standards (thin body type, light-skin, small nose, light eyes, and long, straight, soft hair) dominate, particularly across advertising. When Eurocentric beauty standards are abandoned in advertising, it's not a reflection of our emancipation from said beauty standards; it’s a campaign strategy.
As University of Leeds professor of Cultural Geography and author Dr. David Bell states, “It’s important to remember that marketing is not a conspiracy. When advertising works successfully it confirms the stories we already believe.” (16) We live in a racist, misogynistic world. What we believe as a culture is that women and people of color are inferior. We teach this belief through a variety of methods.
The internalization of the cultural beauty standard - its seeping into our psyche, occurs early. As girls learn to walk and talk, they learn what’s considered beautiful and what’s not.
In an effort to raise awareness about unrealistic media images and their negative impact upon young girls, the South Shore Eating Disorders Collaborative (SSEDC) created a fact sheet about Barbie. I don’t need to tell you that Barbie is a doll targeted to young girls because the eponymous brand enjoys a 99% global recognition rate. A hundred Barbie dolls are sold every minute. Barbie consistently ranks as one of the most popular toys. (17)
A few points from the SSEDC’s Barbie fact sheet:
If Barbie were a real woman, she’d have to walk on all fours due to her proportions and she’d fit the weight criteria for Anorexia.
“Slumber Party Barbie” was introduced in 1965 and came with a bathroom scale permanently set at 110 pounds with a book entitled “How to Lose Weight.” The directions inside stated simply, “Don’t Eat.”
The target market for Barbie doll sales is young girls aged 3-12; a girl usually has her first Barbie by age 3. (18)
Do some Barbies feature women of color and diverse body types? Yes, but these representations are always “othered.” For example, in 2016, following plummeting sales, Barbie began to offer a special line of dolls called “Fashionistas,” with different body types, skin color, and hair texture, designed to celebrate diversity. (19) Fashionistas are a separate line.
As a parent I’m in toy stores quite a bit; I have yet to see a Fashionista doll in any of them. But it’s fine, right, because you can buy Fashionistas online. Just like how women’s clothing companies offer size zero in store but rarely keep anything above a size 10 on the rack – that’s fine too, right, because you can just shop online.
As writer Shannon Ashley notes, whenever you buy a Barbie playset, the default doll is white. The pictures in the Barbie dreamhouse and camper are predominantly white. If you walk through the Barbie section of a toy store, you will see the same Eurocentric Barbie almost identical to its 1959 original version. (20) In fact, that’s the current name of the default Barbie’s body type, “original.”
This “original” body type label lies in contrast to existing body type classifications for Barbie in the “alternative” category, such as “curvy.” The “original” body type label also lies in contrast to more accurate label descriptions, such as “thin,” “dangerously thin,” or “FYI this doll fits the weight criteria for Anorexia.”
The message is clear: light skin and thin is the beauty standard, “alternative” options are available somewhere online.
To review, one of the most popular toys in the world is a doll of an adult woman who fits the weight criteria for Anorexia. Size triple zero is neither a typo nor a marketing accident. Whiteness is still the default skin-tone not just across mainstream media, but in every sector, including the toys children play with during the peak of their brain development.
At this point, I’d like to request that we skip the detailed critique of diet-culture itself and just agree that it’s ruinous.
I assume we can agree that conflating body size with health, worth, happiness, and/or using body size as a primary metric of success is – for the sake of argument, let’s call it ‘not good.’
I assume we can also agree that the seventy-one billion dollar diet-industry is chiefly a money printing machine and, considering that ninety-five percent of diets fail, it’s a scam. (21)
Do some diets help a diminutive percentage of people a diminutive percentage of the time? Sure. That’s not a redemption. Let’s continue.
A reflexive association between food and consequence is ever-present in the psyche of American women. That’s not to say the association necessarily dictates choices around food, but it is present. Whether we listen to her or not, there’s a Camila inside each of us.
In addition to the incessant broadcasting of – I don’t know what to call the shit show cacophony that is the beauty standard I just described – women also live with an ever-present awareness that they aren’t safe.
Actively working to avoid being assaulted, raped, and murdered is an everyday, screen-saver consideration for women.
During your morning run. Walking back to your car. On those perfect summer nights when the air smells like falling in love and the breeze makes it cool enough to sleep with the window open – but do you sleep with the window open? Of course you don’t; the reward of the breeze is not worth the risk of rape.
If you assumed you watched too much Law & Order SVU or listened to too many true crime podcasts and that’s why you’re hypervigilant about avoiding assault, rape, and murder – that’s not why.
Women are assaulted, raped, and murdered every day. Women’s bodies are under attack. That’s why.
Research shows that one in four college women will be sexually assaulted by the time they’re seniors.* According to the BBC, solved murder case reports from March 2020 to March 2021 revealed that ninety-two percent of women who were murdered were murdered by men. Ninety percent of rape victims are female (inmate rape comprising much of the remaining percentage for men). (22, 23, 24) *As mentioned in the research section of this author’s note, this research is skewed towards a sample of college students.
As was reported by the New York Times, in recent years, the estimated number of untested rape kits has hovered around four hundred thousand. (25) These grim statistics live alongside the fact that women’s right to decide what happens within their own bodies has been revoked. Abortion is illegal. The point that abortion is not yet illegal everywhere is no consolation.
Now, let’s return to eating disorders.
In a staggering display of gender disparity, the DSM reports that ninety-one percent of those suffering from Anorexia Nervosa are women. The same statistic repeats for those suffering from Bulimia Nervosa; ninety-one percent are women. While we can acknowledge that there are likely issues with boys and men disclosing their eating disorder issues (i.e. boys and men under-reporting eating disorder/body image issues for fear that doing so might seem anti-masculine), the reason for the under-reporting supports this argument in itself.
Despite our knowledge that women’s bodies are under attack in every way – physically, psychologically, legislatively – these social causation factors are given no etiological significance within diagnostic models of eating disorders.
In other words, we’re acting as if the status quo is healthy and women just go skipping along into eating disorders because they don’t feel pretty. We’re acting as if eating disorders befall upon the dysfunctional ones who aren’t able to internalize all the clear messages of love and safety that surround them.
We’re ignoring an obvious connection: the lack of control women have over their bodies in the physical world and the amount of compensatory control they attempt to generate in their psychological world.
We’re placing the locus of dysfunction within the individual woman instead of the collective culture. For example, as per the DSM, treatments for eating disorders are directed at correcting women’s “cognitive distortions,” and helping them lessen their “unnatural” obsession with their body.
This is a big fucking problem.
In clinical speak: we currently frame eating disorders through the lens of individual psychopathology as opposed to cultural psychopathology (or some combination of both individual and cultural psychopathology). When you do that – when you conceptualize any mental illness exclusively through individual psychopathology and tell someone who is not well that they have a disorder – you’re saying that the culture is in order. You’re saying that the culture is healthy, safe, supportive, and functional. You’re saying that the development of, in this instance, eating disorders in women is born from their failure to be healthy in a healthy environment. They’re disordered. They’re sick. They need treatment.
Where’s the accountability for our culture?
Our culture isn’t just unsafe for women, it’s actively predatory; the omission of this critical context in the etiology of eating disorders is negligent, at best.
The reality is that mental illness stems from a constellation of forces, including – and sometimes primarily – dysfunctional and disordered cultures. This is why we need names for cultural disorders - we need language catches - so that we can stop pathologizing (read: blaming) individuals and solve the actual problem.
Examples of language catches include terms like, “sexual harassment” and “date rape.” Until the 1970’s, when we coined those terms and integrated them into the cultural lexicon, it was near impossible for women to understand that when they felt uncomfortable and “off” at work because they were being sexually harassed, for example, their negative internal reactions and subsequent behaviors were not a result of them doing anything wrong. They weren’t being ‘too sensitive,’ or forgetting how to be ‘team players,’ or anything of the sort.
Experiencing a negative reaction to sexual harassment doesn’t mean anything is wrong with you; it’s in fact the opposite.
Sexual harassment is felt by the woman, but it doesn’t come from the woman.
The term “sexual harassment” is an important language catch because it serves to externalize the source of dysfunction so that women don’t internalize the dysfunction themselves (i.e. what’s wrong with me?). In other words, the calls not coming from inside the house. Nothing is wrong with the woman, something’s wrong with the work culture.
So often, the problem is not the person. The problem is that we live in a disordered culture which thrives on systemic oppression and therein needs women (and any oppressed group) to stay sick, silent, and suffering to sustain itself.
Eating disorders are one example of the patterned dysfunction that inevitably arises when people try to acculturate to a culture which is itself sick. I’m not suggesting that eating disorders are healthy by any means, but they are natural reactions. Again, natural does not mean healthy.
Women are constantly told that the way their body looks is their greatest currency in this life. That if they can achieve mastery over their appearance, they’ll be powerful, and that power will protect them from a world they know is predatory.
When women then seek to gain power by doubling down on their appearance and attempting to control the way their bodies appear (which is what culture directs them to do), we treat them like they’re crazy by telling them they have a disorder.
The therapy world has a phrase for this type of dynamic, it’s called “crazy making behavior.”
The question ahead of us is not whether we should change the lens through which we examine eating disorders, but how long will it take for us to see that we need to change the lens. The question ahead of us is also not ‘how do we fix the current diagnostic model;’ it is instead, how do we break it.
Social causation models seek to understand a person’s mental health through the larger social context of that person’s experience; they’re better models for examining the mental health of human beings because, simply put, human beings are social creatures. Our mental health depends on the support, safety, resources, and connections around us.
Mental health does not develop or progress in a vacuum. Mental health is not something that’s inside of you.
Social causation models are frameworks for mental illness that basically say, “Hey, we know you’re suffering but it’s not because anything is wrong with you. The calls not coming from inside the house. The problem isn’t you, it’s the culture you live in. The culture is dysfunctional. The culture is disordered. The distress you’re experiencing is a natural reaction and internalization of the external cultural dysfunction; under similar circumstances, anyone would experience the symptoms you’re experiencing.”
The absence of social causation models in the etiology of mental illnesses is a profound error of the mental health care system. Future generations will be unable to relate to our current myopia. Once corrected, this fundamental error will disrupt the systems that depend on it to survive (misogyny, white supremacy, racism, etc.).
Individual pathology is real and important to understand. What’s also important for us to understand is that cultural pathology is real, too.
The dismissal of primary social causation theories in the genesis of eating disorders is unintelligible. The DSM acknowledges research which confirms that risk factors for developing eating disorders include living in cultures within which thinness is valued. Childhood sexual and physical abuse are also recognized by the DSM as empirically sound risk factors for developing bulimia. Yet, the DSM ultimately concludes that what causes and perpetuates eating disorders remains “insufficiently understood.”
Etiological factors are what cause a disorder. Risk factors are things that increase the chance of developing a disorder. Stating that cultural standards for thinness and violence against women are risk factors for eating disorders but not etiological factors is a cop-out.
Considering primary social causation theories in mental illness diagnoses (as opposed to internalizing the source of dysfunction squarely on the individual) is not unprecedented. For example, PTSD is often contextualized within the experience of being a veteran and having gone to war. PTSD is recognized as a complex reaction to an external stressor: combat.
The pervasive threat and direct experience of harassment, sexual assault, rape, the revocation of fundamental rights, violence, murder – are those not external stressors that might generate reactionary responses, too?
Do you think it’s a coincidence that as a culture, we readily recognize that mental distress in men might not originate in them, and is instead a reaction to an external circumstance beyond their control? (PTSD, while diagnosed for a wide range of causes now, was originally conceptualized as a disorder specifically resulting from men’s experience in war.)
Reverse the gender context and the negligence of dismissing a primary social causation model for eating disorders becomes tiger-in-your-living-room obvious.
I want you to imagine that tomorrow, the cover of every newspaper around the world reads an all-caps headline that takes up the entire top half of the page: MUTANT MEN INVADE EARTH.
I want you to imagine that these mutant men, who are generally larger and physically stronger than “regular men” begin sexually assaulting one out of every four of the “regular men.” Ninety-two percent of the regular men who are murdered are murdered by the mutant men.
Please stop me when you disagree – behavioral, cognitive, emotional, physical, and interpersonal distress would immediately besiege the regular men. In the US, an unprecedented spike in purchase rates of firearms by the regular men would transpire. All hell would break lose. The regular men would go to war.
At least .4% of the regular men (the reported prevalence of women who struggle with Anorexia) would turn their attention to the physicality of their body in the midst of all this traumatic chaos.
As a coping mechanism to the obvious external crisis, some men might attempt to generate a sense of personal agency by controlling the way their bodies looked. At least .4% of the regular men, for example, might go to extremes to change the size of their body; they might start working out excessively or taking steroids, regardless of adverse impacts to their health.
The regular men may also become acutely and chronically aware of the way in which their bodies were interacting with the environments they found themselves in. They may begin to feel self-conscious about running with their shirts off on a jogging trail, for example.
The distress experienced by at least .4% of the regular men would cause significant impairment to their occupational and social functioning. At least .4% of the regular men would do anything they could to their bodies to gain control over the external crisis, even if the control only existed in their minds.
There’s no world in which anyone would dare respond to the regular men’s preoccupation with their physicality by saying, “Gosh, we’re really seeing a spike in perfectionism here. Look at all these men who are trying so hard to be muscular and strong; they don’t realize how handsome they are inside and out. We need to teach them how to love themselves. Maybe we could start with some affirmations in the bathroom mirror?”
Nobody would tell the regular men that their body issues stemmed from poor self-worth. Nobody except the mutant men.
When assessing the mental health of the regular men, ignoring the etiological significance of a phenomenon in which one in four of those men are subjected to sexual assault – the absence of that statistic alone would be an impossibility.
In our mutant men example, social causation models would naturally, logically prevail. Etiological factors would be confidently declared: “Regular men are internalizing distress because of chronic violations to their physical and psychological safety.”
The regular men’s preoccupation with their bodies would not remain “insufficiently understood.”
It's natural and logical to assume social causation models when it comes to cultural phenomenon that adversely impact women, unless you live in a misogynistic culture.
In misogynistic cultures, sexual violence against women is normalized. We’re not taught to view the one in four statistic as a phenomenon. We’re taught to view the one in four statistic as a harsh reality of life, then we’re told not to make ourselves an easy target:
Take your earbuds out when you run or walk in public.
Have so much fun on that first date you’re going on this Saturday! Oh and safety first, be smart - don’t forget to text your friends every ounce of information you have about the person/time/location in case your date is a violent predator. Anyways, let us know how it goes!
Obviously don’t go to a bar and drink your own drink unless you’ve had eyes on that drink every literal second of the night.
Keep your keys grasped between your fingers when you walk to your car to make an attack claw out of your hand.
These Pinterest hacks for not getting raped and murdered are emblematic of the ways in which the onus is placed on victims (women) to avoid risk instead of on perpetrators (men) to stop perpetrating.
In addition to being unspeakably patronizing, these preventative measures are useless. Can you guess where most women are when they’re sexually assaulted? They’re sleeping, or doing some other everyday task, at home. Forty eight percent of women who are sexually assaulted are attacked in their own home. (24)
If the imaginary regular men’s bodies were under attack in the same way that real-life regular women’s bodies are under attack, the regular men would be expected and encouraged to express a righteous rage.
Regular men would feel 100% entitled to protect themselves from the mutant men by any means necessary. Expressions of said protective efforts and attendant rage would be both clinically and legally sanctioned as appropriate.
The regular men would in fact be assessed as pathologically unhealthy if they went about their day pretending as if none of this life-threatening chaos were occurring.
And yet, that’s exactly what we expect women to do.
Women are expected to absorb zero psychological impact while living in this one in four, triple zero, no rights to your own body world. We’re expected to stay healthy and functional under the most unhealthy and dysfunctional conditions.
Tell me again how women experience distorted relationships with their bodies because they have low self-esteem. Tell me again that if it weren’t for perfectionism, if women could just learn to be a little more “body-positive,” everything would be okay. Look me in the eye and tell me that self-love is the solution.
Colossal disconnects with regard to our clinical understanding of eating disorders don’t just present etiologically. A study published through the Harvard T.H. Chan school of public health reported that approximately nine percent of the US population will have an eating disorder in their lifetime. (26) Respectfully, that statistic is out of touch with reality. Disordered eating is rampant amongst women.
Consciously and unconsciously, women maintain awareness over the complex interplay between our bodies, the foods we eat, the way we look, and the dangers that surround us. That awareness can manifest as the desire to be thin.
Being thin is seen as a route to power (albeit a false one). Being thin can also be about the desire to become invisible, to disappear, to be unseen and thereby untouched.
Disordered eating is only about wanting to be thin on a surface level. On a deeper level, disordered eating is about wanting power, sensing that you don’t have power, then trying to substitute power for the next best thing: control.
It’s not that women want to be thin, it’s that women want to have power. That’s why, when women find their power, they let go of the need to be thin. Emphasis on their power. Internal power. Real power. Not power within a patriarchal structure, which is power-over, which is really just control.
As emphasized throughout The Perfectionist’s Guide to Losing Control, power and control are not the same thing.
It’s worth noting that several studies indicate that eating disorders carry a genetic link; that they’re sometimes inherited. One study estimated that genetic factors comprise forty to sixty percent of the vulnerability factor for eating disorders. (27)
While conducting research for this book regarding genetic predispositions to eating disorders, I spoke with Dr. Rabbi Alexander, the Director of Psychiatric Services at the Princeton Center for Eating Disorders. Alexander noted that eating disorders (like Anorexia, for example), can present in much the same way as obsessive-compulsive disorder; instead of a focus on common themes in OCD (cleanliness, contamination, fear of harming someone, etc.) the theme and focus is food. Alexander added that a commonplace opinion in her field is that certain patterns of eating disorder symptomology are better understood as a type of obsessive-compulsive disorder, not as an eating disorder. OCD is known to be due in part to genetic factors.
“Comorbidity” refers to two disorders that show up alongside each other. Anorexia has a notable comorbidity rate with OCD. One study found that thirty-five to forty four percent of those with symptomology for anorexia also expressed symptomology for OCD. (28)
These statics echo the sentiment of many clinicians – that there are certain instances during which the problem should not be identified as Anorexia, it should be identified as OCD with a focus on food.
Another consideration for the genetic predisposition of eating disorders is epigenetic trauma, the empirically validated phenomenon wherein trauma and stress from one generation influences the likelihood of psychological distress presenting in subsequent generations. (29)
From the Greek roots an (without) and orexis (appetite), anorexia is a misnomer to begin with. Anorexia is not about losing your appetite; it’s about suppressing your appetite.
Those who suffer from anorexia do have an appetite – they’re literally starving. They’re starving for food, yes. But they’re also starving for safety. They’re starving for power. They’re starving for acknowledgment that they’re not crazy. They’re starving for connection to the truth.
Anorexia is a profound expression of grief and desperation, laced with pure ‘fuck you’ rage, all turned inward by a person who feels (because they are) deprived of basic personal agency.
To be unequivocally clear, once again, maladaptive perfectionism is a risk factor and maintenance factor for any and every expression of psychological dysfunction. Maladaptive perfectionism cannot exist in a neutral state; it will always be harmful to you.
There’s an overwhelming body of research which highlights the correlation between maladaptive perfectionism and eating disorders. I think of that correlation like this: eating disorders are like forest fires; the potential scale of destruction is disastrous. Maladaptive perfectionism is to an eating disorder what wind is to a forest fire; maladaptive perfectionism exacerbates an already dangerous situation, but it’s not the flames. This is a critical distinction because you don’t prevent forest fires by focusing on ways to make it less windy.
Also, to be clear, the next task at hand does not involve identifying whose fault this all is. It’s not the DSM’s fault for framing disordered eating as an individual disorder, for example. The DSM was never intended to be the exclusive authority and reference point for mental health. Those who contribute to the DSM don’t intend for the DSM to have the final word; it’s designed to offer one perspective – a framework of individual pathology. The field of mental health is using the DSM incorrectly.
This moment is also not about assigning blame to men, to me, to other psychotherapists, to health coaches, to the mental health care system, to diet companies, to Barbie, to JCrew, to yourself, to the generations that came before us (and sure as hell not our mothers). This moment is not about assigning blame to any one person or any one group or any one company or some combination of all the above.
The next task at hand involves acknowledging our collective crisis and responding to that crisis from a conscious, solutions-oriented place. That looks like understanding that the attack on women’s bodies is everybody’s problem; it hurts everyone, and everyone is responsible for contributing to the solution.
Responding to disordered eating from a conscious place also looks like recognizing, with piercing clarity, that to center the locus of dysfunction within the individual when it in fact rests within our dysfunctional culture – that is gaslighting in its finest hour.
Acknowledgment for the ways in which mental illness is exploited to perpetuate oppressive dynamics is not only owed to women, but to all people who are oppressed.
Perfectionism is not the root cause of eating disorders. The degree to which that statement is controversial runs in direct proportion to the degree to which society fails to understand the deep and simple need women righteously possess to feel physically and psychologically safe in their own bodies.
THE ORIGINS OF PERFECTIONISM IN PSYCHOLOGICAL LITERATURE
The first person to introduce the concept of perfectionism into psychological literature was Dr. Alfred Adler. You already know Adler – he’s the person who coined the term, “inferiority complex.”
Adler’s view was this: We’re all perfectionists. We’re all constantly striving, longing, hurting for an ideal; that ideal is perfect community.
Adler viewed neurosis as an absence of connection. The “cure” for what ails us, Adler said, was interdependence; a culture in which every member is both being helped and helping.
Referring to perfectionism as, “the eternal melody we all hear,” Adler framed perfectionism as an innate, natural, and healthy human impulse. (1)
The unshakable desire - the need, to improve upon reality is nestled within each of us for a reason: so that we may direct it toward social cooperation. If every human being was clean, clothed, seen, safe, fed, free, and loved – there would be no perfectionism because the ideal that perfectionism exists to create would already be achieved.
For Adler, measuring a person’s mental health outside the context of their social support system made no sense; he rejected the notion of individual psychopathology. In Adler’s words, “We refuse to recognize and examine an isolated human being.” (1)
Acknowledging that perfection can only be strived for and never attained, Adler called the goal of attaining perfection a “final fiction.” In other words, we understand that there will always be suffering and that we can never fix all the problems, and yet, we feel driven to operate as if we could create a perfect world. (1)
For example, even if we could eradicate 98% of world hunger, we would remain dissatisfied. We’d work as hard to bridge the two percent differential as we worked in the beginning when we had achieved nothing. Until we reach 100% societal perfection, Adler says, “We can never rest satisfied with our achievement. Striving will continue in any case, {because societal perfection is not possible} but with the cooperative individual it will be hopeful and contributory striving, directed towards a real improvement of our common situation.” (1)
Adler’s view of human nature was fundamentally optimistic: We’re all good on the inside; we’re hard-wired to help each other and to connect. Unlike his contemporary, Freud, Adler didn’t believe that the psyche is ruled by two central impulses: sex and aggression.
Adler believed the psyche is ruled by one central impulse – connection. And yes, said Adler, the impulse to connect sometimes includes sexual connection and displays of anger (the need to protect and defend what we’re connected to). Sure it does. Of course it does. But those primal instincts aren’t the whole story.
I think about Adler’s view of human nature in this way: We don’t have to try to take care of each other just like we don’t have to try to laugh if it’s funny. We laugh because laughing is natural, and we take care of each other being taking care of each other is natural.
Importantly, Adler emphasized that while the desire to care for each other is innate, knowing how to put our care into practice requires learning. In Adler’s words, the ability to build healthy relationships is “an innate human ability, which, however, needs to be developed.” I think of this in the same way that the ability to speak and use language is an innate human ability, but it also requires a formal type of learning to blossom into a fully developed skill. (1)
Adler had a name for the natural impulse to operate in the service of others; he called it, “social interest.” The degree to which a person engages in social interest was how Adler differentiated between healthy and unhealthy perfectionists, the latter of which Adler called, neurotics. (1)
In Adler’s words, “The neurotic strives toward personal superiority and, in doing so, expects a contribution from the group in which he lives, while the normal individual strives toward the perfection that benefits all.” (1)
Adler described unhealthy perfectionism as “a feeling of inferiority which demands a compensation.” Just like he believed everyone is a perfectionist, Adler believed everyone carries an inferiority complex. (1)
If a person doesn’t appropriately address their underlying feelings of inferiority (i.e. feeling like they’re not enough), the result, according to Adler, will be an unhealthy attempt for a quick fix:
“Instead of overcoming obstacles he will try to hypnotize himself, or auto-intoxicate himself, into feeling superior. Meanwhile his feelings of inferiority will accumulate, because the situation which produces them remains unaltered. The provocation is still there. Every step he takes will lead him farther into self-deception, and all his problems will press upon him with greater and greater urgency. If we looked at his movements without understanding we should think them aimless. They would not impress us as designed to improve the situation. As soon as we see, however, that he is occupied, like everyone else, in struggling for a feeling of adequacy but has given up hope of altering the objective situation, all his movements begin to fall into coherence.” (1)
Adler also describes how you must understand your self-worth before you can healthfully engage in the drive towards perfection, “Once the great deprivation of the self-esteem has been sufficiently made up, the prepotency of the higher striving is restored.” (1)
Mirroring modern day conceptualizations of maladaptive perfectionism, Adler noted that “neurotics” (maladaptive perfectionists) are oriented towards the completion of a goal at the cost of enjoying the process. “The gaze of the neurotic is directed much further into the future. All present life appears to him only a preparation.” (1)
Additionally, Adler noted that maladaptive perfectionists operate in a state of constant comparison, “It was always preceded by a matching, a comparing of himself with others…with every person whom the patient meets.” The incessant comparisons inevitably amplify feelings of insecurity, isolation, and shame. Subsequently, maladaptive perfectionists feel the need to habitually hide their insecurities from others and numb out the feelings of deep insecurity within themselves:
“So efficiently may an individual train his whole mentality for this task that the entire current of his psychic life flowing ceaselessly from below to above, that is, from the feeling of inferiority to that of superiority, occurs automatically and escapes his own notice.” (1)
In other words, you can spend your whole life reflexively trying to ‘top’ everyone around you without realizing it. What’s more, the goals that you’re pursuing in all your reflexive one-upping may not be goals the true core of you cares about; you’re not passionate about them; they don’t give you energy; pursuing them doesn’t make you feel alive; neither does achieving them.
When you deploy your perfectionism to safeguard you from feeling shame, disappointment, or experiencing failure, that’s also unhealthy. In Adler’s words, perfectionism cannot be, “an infallible means for excluding permanent humiliation from the patient’s experiences.” (1)
Adler described the feeling of dissatisfaction that healthy perfectionists encounter as a “positive pain,” a natural and healthy byproduct of our connection to each other. In adaptive perfectionists, says Adler, the striving towards perfection “remains flexible; and, indeed, the nearer to health and normality an individual is, the more he can find new openings for his strivings when they are blocked in one particular direction. It is only the neurotic who feels, of the concrete expressions of his goals, I must have this or nothing.” (1)
In Adler’s native language, German, there’s a word for being caught up in oneself: ichgebundenheit. Directly translated, ichgebundenheit means ‘self-boundedness.’ Adler saw self-boundedness as a great barrier to mental wellness:
“The self-bound individual always forgets that his self would be safeguarded better and automatically the more he prepares himself for the welfare of mankind, and that in this respect no limits are set for him. The numerous quotations from the Bible are confirmations to be grateful for. They are the deep insight of sublime leaders into the foundations of human welfare…”
For Adler, the great marker of mental wellness was understanding one’s interconnectedness and acting accordingly; being ‘other-bounded.’ (1)
If you don’t understand or simply don’t care that there’s an interconnectedness between all human beings which requires compassionate, actionable attention, then you’re not in a healthy state of mind. Some people possess a highly developed level of social interest; they’re always operating in generous service of the greater good. According to Adler, those are the people with the strongest mental health. (Isn’t it so interesting to see a model of mental health based on collective connection instead of individual psychopathology?)
In case you can’t tell, Adler was a socialist. And yet, Adler named his therapeutic approach “Individual Psychology.” Why would someone so invested in the collective make such a choice?
As former president of the Society of Alderian Psychology Jane Griffith explains, “There remains a holistic character of thought in Adler’s choice of the term Individual Psychology. It’s one word in German, individualpsychologie, meaning indivisible.
To me, being indivisible speaks to one’s inherent wholeness. Human beings – you, me – we’re not broken and in need of fixing. We don’t need correction, we need connection.
In holism (a theory of interconnectedness which Adler was an embryonically early adapter of), wholeness is perfection. Not just in holism, but as we reviewed in chapter two, the etymological origins of the word ‘perfection’ trace back to wholeness.
And this is the crux of what I learned from writing this book. From Adler. From all the research. From all my clients. From all of my own experiences. Perfectionists are seeking wholeness, not flawlessness.
Wholeness is found internally. Once you connect to your wholeness internally, you see perfection all around you, externally; you cannot reverse engineer this experience. You cannot try to make everything around you perfect with the expectation that after doing so, you will feel whole. Trying to achieve flawlessness as a shortcut to feeling whole is an error we all make.
EVOLVING APPROACHES TO ADAPTIVE PERFECTIONISM + LIMITATIONS OF PERFECTIONISM RESEARCH:
There was a moment in time (mostly the 80’s) when the idea that perfectionism could be considered to have any positive qualities - let alone be thought of as a power and a strength – was blasphemous.
The positive psychology movement of the 90’s began to extinguish binary ways of conceptualizing mental health. Positive psychology is the exploration of what makes people thrive. Particularly since the 90’s, our understanding of perfectionism has continued to expand in both width and depth. In addition to the growing acknowledgement that mental health is context-dependent, awareness that mental health operates on a continuum has also increased.
What does any of that mean?
It means that no one really cares anymore about adamantly defending one side or the other of the ‘is perfectionism good or bad’ debate.
Everyone cared for one hot second, then it was over. In the last few years, the most highly regarded perfectionism experts have been encouraging the field to abandon the ‘this is right/no this is right’ academic tug of war in favor of examining perfectionism holistically.
In his 2018 book, The Psychology of Perfectionism, Dr. Joachim Stoeber, for example, noted that he doesn’t like thinking of perfectionism as adaptive or maladaptive, but rather as one concept with abounding dimensions. (2) In a 2020 article that appeared in the Journal of Psychoeducational Assessment, aforementioned perfectionism experts Flett and Hewitt echoed the sentiment, “Rather than focus on the contentious issue of whether perfectionism is adaptive, it is time to pragmatically address why some perfectionists are doing so much better in their lives than are other perfectionists.” (3)
The current, more person-centered approach to perfectionism moves away from antiquated models of distanced pathology in a rush towards empathy. In other words, the question is shifting from “Is perfectionism good or bad?” to “What’s it like to be a perfectionist?” The latter is the more useful question.
Fueling prior controversy on whether perfectionism was adaptive or not were issues surrounding perfectionism research; these issues are worth talking about because they persist today. As researcher Dr. Simon Sherry and his colleagues put it, “Perfectionism is a complex construct variably defined and redefined by researchers. Many perfectionism measures exist, with more continuing to be developed.” (4)
That’s what’s called an understatement.
These varied approaches, particularly the varied definitions of what perfectionism is in the first place, make it impossible to synthesize data in a way that’s useful for everyone. Reviewing perfectionism research goes beyond comparing apples to oranges; it’s comparing apples to paperclips.
Not helping the matter is the fact that most perfectionism research is conducted using quantitative methods. Quantitative methods are the strongly agree/strongly disagree, yes/no, box-checking type of surveying.
An alternative to quantitative research is qualitative research. Qualitative studies include features like open-ended questions and extracting themes from personal stories.
While there’s ambiguity in everything we study (that’s why we study it) perfectionism has proven to embody heterogenous and thus far intangible qualities which the field has struggled for decades to identify. Studying an amorphous construct like perfectionism with a near exclusive emphasis on quantitative research methods does not make sense.
You can’t learn about perfectionism without learning about the perfectionist. One of the best ways to not learn about someone is to ask them a yes or no question. Perhaps the second best way to not learn about someone is to ask them to truncate a context-driven and fluid experience onto a scale of 1-5.
It’s not like researchers don’t know this. Researchers do the best they can against the significant time and financial constraints they’re challenged with. What quantitative methods lack in gradation they make up for with practicality.
Another major issue with perfectionism research is that most of the time, it’s conducted using college undergraduates as participants. Participating in research experiments is often a requirement for most psychology undergrads – a requirement which is emphasized during freshman year and intro-level coursework.
Considering that over 70% of college students enroll as teenagers, let’s revisit common themes explored in perfectionism research: an emphasis on external achievement, parental approval and criticism, rumination over mistakes, and concerns about what others think of you. Elevated levels of the themes of perfectionism research could be considered developmentally appropriate for teenagers and emerging adolescence; this skews the sample. (5, 6)
Furthermore, the overwhelming majority of research data on perfectionism is collected through self-reporting, an approach riddled with disadvantages like bias, exaggeration, and inaccuracy.
Once again, the problem of grafting the psyche of American college students onto the general public is an issue of practicality. Requiring college students to participate in psychological research means you don’t have to pay for research subjects.
In an article highlighting the long-standing issue of skewed research results due to the over-sampling of college students, anthropologist Dr. Joeseph Henrich and his colleagues reveal just how narrow the psychological research database is by pointing out that “a randomly selected American undergraduate is more than 4,000 times more likely to be a research participant than a randomly selected person outside of the West.” (7) Henrich and his colleagues also highlight an analysis of the Journal of Personality and Social Psychology (the leading journal in social psychology) by research scholar Jeffrey Arnett which demonstrated that “67% of the American samples (and 80% of the samples from other countries) were composed solely of undergraduates in psychology courses.” (8)
Because we view mental health through a lens of pathology, it’s also not uncommon to screen for participants who are already experiencing perfectionism on clinically relevant levels (hence “proof” that they’re dealing with perfectionism). What do I mean by ‘clinically relevant’ levels. I mean that the person’s negative symptoms have been shown to disrupt their everyday social, occupational, and/or physical functioning.
Exclusively surveying clinically relevant expressions of perfectionism means there’s a correlation between mental illness and perfectionism out of the gate. If you want to explore maladaptive perfectionism in emerging adolescence amongst participants with an elevated risk for mental illness, this is an appropriate methodology.
Lastly, the emphasis on cross-sectional designs is yet another issue plaguing perfectionism research. Cross-sectional designs collect information at a single point in time; when you do that, you can’t really tell whether the variables you’re studying have a causal effect on one another. (9)
Even if there were a way to conduct research perfectly, of which there is not, the highly individualized nature of perfectionism would still present a challenge in interpreting the results. Research is limited even under the best conditions. As Dr. Karen Horney put it, “Science cannot teach you about your dog, it can only teach you about dogs in general.” (10)
Dissatisfaction with the limitations surrounding perfectionism research is voiced most loudly by researchers themselves. The most notable names in academia repeatedly (I would argue urgently) make calls to the field to engage in wider and deeper explorations of the complex construct we call perfectionism.
Noting that perfectionism seems to operate on a continuum and insisting on qualitative methods to explore themes circling perfectionism in her own research, famed social scientist Dr. Brené Brown has been encouraging more dialogue around perfectionism for the better part of the last two decades. (11) In the same 2020 article highlighted earlier, Flett and Hewitt state, “Clearly, we need more research focused on how situational factors and life contexts magnify the impact of perfectionism.” The pair continued to encourage more qualitative, narrative-based methods, “…We would like to issue a call for research that closely examines the life experiences and narratives of perfectionists so that we can get a much better sense of how they grow, how they work, how they relate to others, and how they age in actual life situations.” (12)
Stoeber’s appeals are just as adamant, “I make a call for more research on perfectionism going beyond self-reports and point to three areas that I believe are ‘under-researched:’ perfectionism at work; ethnic, cultural, and national differences in perfectionism; and perfectionism across the lifespan.” Stoeber also identifies critical issues which obstruct deeper understandings of perfectionism, such as the issue of “assessing perfectionism with measures that do not measure perfectionism.” (13)
It’s difficult if not impossible to convey the level of commitment, focus, and dedication that research requires. There’s a nobility in the quiet, unglamorous, unending work of conducting research; there’s something so pure about it, so earnest – about just wanting to learn more. Of being so curious as to dedicate your entire career to answering a few key questions, sometimes just one question. Of not needing to be right but needing to be informed.
It's maybe the most endearing quality of researchers – they don’t care about being right at all. Researchers are in fact the only group of people I know who light up when they’re wrong.
Researchers do what they do because they care about increasing knowledge. They’re propelled by a desire to explore ideas, discover new connections, test limits, refine language, contribute to public health, and reveal the invisible ink written across the walls of the zeitgeist. Some of my greatest teachers have been researchers; the esteem I hold for them almost intimidated me out of writing this book. Why?
Because the current emphasis on “data-driven” non-fiction books is so intense that it almost feels as if opinions, direct experience, and personal insights are valueless, unwelcomed, preemptively eschewed.
In the non-fiction book world, subtitles are peppered with the words, “The science of:” The science of dating, the science of motivation, the science of habits, the science of awe…
There seems to be an insatiable thirst for any statement considered to be empirically validated, with less emphasis on the measurement tools and methods used to arrive at such validation. As Carl Rogers said in the sixties, “We are ready to believe any finding which can be shown to rest upon the rules of the scientific game, properly played.” (14)
It's an open secret in the field of psychology that “the science of perfectionism” is problematic, at best. This presented a firm dilemma for me. Which studies do I include? On what basis? How much should I qualify what I include? How much should I rely on the research to inform the message? How do I meet the ethical responsibilities and best practices involved in being a licensed professional who is also offering a creative work to the public? At times it felt like the inclusion of any research was a bad idea.
I wrote three versions of Perfectionist’s Guide. One version was research heavy; it included detailed descriptions and qualifiers of each study as best I could explain them. The methods, models, and approaches that were used. Considerations for grafting the findings onto actual people and real-life scenarios. Trends, outcomes, future implications.
Please think of the most boring fucking thing you’ve ever done in your life. Now hold that thought for seven hours. You just read the research heavy version.
I also wrote a memoir-esque version which included no research at all. That book was a hard no. It was just a bunch of analogies. It wasn’t useful in the way I wanted this book to be useful, except that it lead me to the version that’s out in the world now.
The research considerations proved to be unending for me. After much consultation and analysis, I did my best to reconcile them, but they persist. With respect to the specific issue of “the science of perfectionism,” it took me a long time to give myself permission to write this book. I’m not a researcher, after all, I’m a clinician. Ultimately, I arrived at the following conclusion:
Research expertise and clinical expertise are different. Both are valuable. Both are incomplete without the other.
While I’ve worked in a variety of clinical settings, I make no claims that the sample of my clients represents a diverse population, clinically or otherwise. Personality descriptions and reflections in this book are offered as a single point of reference only; I don’t intend for them to be grafted against diagnostic frameworks or molded into a more formal shape – they’re loose and open-ended by design.
When I think about research and theories which contravene my work and my theories, here’s where my thoughts land:
There are a great multitude of therapeutic modalities, frameworks, language choices – so many approaches to healing which seem to be at odds with each other. They’re not. As fellow psychotherapist and absolute hero of a human being, Dr. Carl Rogers once noted about contradictions, “That these two important elements of our experience appear to be in contradiction has perhaps the same significance as the contradiction between the wave theory and the corpuscular theory of light, both of which can be shown to be true, even though incompatible.”
PERFECTIONISM IN PEOPLE OF COLOR AS A RESPONSE TO WHITE SUPREMACY
In the book, I introduced Dr. Paul Hewitt and Dr. Gordon Flett’s concept of Socially Prescribed Perfectionism (SPP), when you perceive others as expecting you to be perfect. The intersection of SPP and marginalized groups begs to be explored.
Repeatedly in my work, I see sociocultural iterations of maladaptive perfectionism - expressions of perfectionism in the individual that don’t reflect individual psychopathology but cultural psychopathology. Sociocultural iterations of perfectionism are reflections of survival efforts in response to systemic trauma.
For example, when I lived in LA, I used to work at a transitional housing center for foster kids who were aging out of the foster care system. “Aging out” refers to what happens when kids who are in foster care or who are “wards of the state” (i.e. in the care of the state because they don’t have a suitable guardian) turn eighteen.
On their eighteenth birthday, foster kids “emancipate” from the foster care system; because they’re no longer seen as children, they’re no longer seen as the system’s responsibility. This means that upon turning eighteen, foster kids are no longer eligible for services they’ve been depending on to survive (for example, food vouchers). Because they’re now adults in the eyes of the judicial system, the foster parents of 18 year old foster kids no longer receive a financial stipend for taking care of them.
The overwhelming majority of foster kids are left to fend for themselves with no housing, no livable wage, no health insurance, no high school diploma, no parents, no family, no vocational skills – no safety net of any kind. Transitional housing centers provide subsidized rent and support services for emancipating foster care youth.
Okay, so now you have context. Onto the story.
So I’m working at the transitional housing center and one day, I had scheduled to drive four of my teenage clients to a job fair. A huge shopping center had opened nearby, and several entry-level positions were available: grocery cashiers, retail clerks, etc. The plan was for everyone to meet in my office, which was on-site, then walk to the car together.
My three white clients showed up in my office seeming, I don’t know, kind of bored – it was early, they were half awake, and they were all wearing t-shirts. My one black client, Damion, entered my office in a burst of distress.
“I can’t find a tie, y’all got a tie?” Damion was wearing a collared shirt two sizes too small for him, buttoned up all the way to the top.
Not realizing the degree or reason Damion was so upset, I said, “It’s alright, you look fine,” then I grabbed the car keys from a little bowl on my desk.
“Okay let’s go guys,” I said. The other three boys toppled themselves into the hallway with the exaggerated style that teenagers so naturally move with. But Damion didn’t leave.
“No.” Damion’s voice slapped the air. “I can’t go like this. You’re not hearing me. I need a tie.”
A two second silence passed as I looked at Damion. I realized that I hadn’t been present until that moment. Damion’s eyes looked like glass; if he were to have blinked, at least five tears would’ve rolled down his cheeks. I told the other boys to go wait by the car and closed my office door.
“Damion, what’s going on?”
Damion wanted me to understand something urgently. That day. That second. With an outstretched arm, he pointed his finger towards my office door, “They wanna be surfer dudes, they wanna be punks, that’s all good. I can’t do that. If I don’t look perfect, the job people won’t even look at me. I need money. I need to work.”
I then understood something Damion shouldn’t have had to explain to me. We stopped by a Ross on the way. I got him a fitted shirt and a tie.
Damion was engaging in perfectionistic behaviors and concerns not because he didn’t understand his self-worth, but because he knew that others didn’t understand his self-worth. He knew that as a young black man, if he didn’t look overtly friendly and preppy as hell, he wouldn’t stand a chance at eye-contact, let alone be hired for an entry-level service job.
Compensatory efforts to prove one’s most basic humanity – forget about worth – through exceptionalism is an everyday experience for millions of people of color. Exceptionalism not just in traditional assessment and achievement contexts, in every context. Walking into a store, driving a car, approaching a doorman building in New York City. The slightest deviation from ‘perfect’ demeanor in these scenarios can rapidly escalate into an immediate safety issue.
We need more language qualifiers which externalize both the perfectionistic pressures and identity struggles which accompany the experience of living under white supremacy when you are not white. Compulsions to live up to impossible standards of perfection so that you may signal your worth to a system that repeatedly denies it does not reflect individual psychopathology but cultural psychopathology.
In the absence of specific language for our cultural illnesses, we can’t quite put our finger on what’s wrong, what’s happening, and what to do about it. Language is powerful; the absence of language is more powerful. If we graft Flett and Hewitt’s concept of SPP onto models of oppression, we get a template to begin the critical task of externalizing the locus of dysfunction (it’s the culture), instead of internalizing cultural dysfunction as a deficit within oneself.
We need to explore the interplay between stereotype threat and perfectionism, deploying perfectionism to mitigate racism, the extraordinary pressure to adhere to traditional standards of success and exceptionalism experienced by first and second-generation Americans.
Acculturation pressure is prismatic and lasts a lifetime. Honor the beliefs and customs of your families culture of origin while also code switching to the beliefs and customs of your present cultural context, while also fostering your own hybrid, cool, autonomous sense of self which somehow exists outside of any one culture, while also cultivating a completely integrated self which is at home in all your cultural contexts at once, while fucking also honoring ancestral sacrifices of the generations that came before you so that you may exist as a representation of your family’s progress.
What?
Who can do that?
And if someone can do that, what is the toll of that supposed accomplishment?
We need to better recognize and dismantle not only overt systems which pressure marginalized groups to overperform to prove their worth, but covert and unintentional ones as well. We need to explore, for example, the intersection of black excellence and perfectionism. Modeling excellence as an inspiring possibility and expecting excellence as a baseline standard are two different things; in what ways does the notion of black excellence inadvertently conflate these aspects of adaptive and maladaptive perfectionism? Expectations of excellence in the black community become toxic when they revoke the permission all human beings need to “just” be ordinary, average, fine, okay, good – to say nothing of revoking further necessary permission to not be okay, to be depressed, anxiety ridden, suicidal, suffering, stalling.
Ditto for models of celebrated perfectionism within the Asian community, SPP as it relates to the attendant pressure involved in the ‘visibility = immediate global representative’ dynamic circling visible figures in the LGBTQIA + space, and more. Varying iterations of socio-cultural based SPP impact all marginalized groups.
Being considered a “high achiever” as a member of a marginalized group spins what emerging scholar Janelle Raymundo refers to as, “A complicated web of both privilege and oppression.” We need to better understand this web, and what’s its like for those of us who feel forced to live inside of it. If we continue to adhere to implicit models of socio-cultural perfectionism without differentiating between their healthy and unhealthy facets, we’re demanding that those living up to the models (any oppressed group) hold a double-edged sword without a handle.
Katherine Morgan Schafler is an NYC-based psychotherapist, author, and speaker. For more of her work: get her book, follow her on Instagram, subscribe to her newsletter, or visit her site.
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