Letting Go

The most recent Grey’s Anatomy had a lot of quotes that hit home for me, but there was one in particular that really stood out.  Towards the end, Meredith, via the voiceover, says:

“Letting go is the easy part. It’s the moving on that’s painful…but it’s the only way we grow.”

I am not trying to say that it’s easy to let go of eating disorder behaviors, but in some instances, it can be relatively easy to let go of the behaviors themselves.  Going to an intensive treatment program, whether that be inpatient, residential, or PHP, kind of forces you to give up the behaviors.  If you are compliant, you are pretty much forced to give up most, if not all, of your behaviors.

As Meredith says though, that’s the easy part.  Moving on from the eating disorder, not simply just letting go of the behaviors for the time being, but really committing yourself to recovery, that’s hard.  It’s also emotionally and sometimes physically painful.  But it’s the only way to grow, to evolve, to actually live your life.

Eating Disorder Economics

The other night I had a thought that I was not expecting and it caused me to do some serious thinking. And, in true dork-like fashion, since I am reading a book about the global financial collapse, I came up with what I will call an eating disorder economic theory. Bear with me.

First, the thought I was not expecting. I was talking to a friend who is not doing well ED wise, and I had to cut the conversation short to go eat dinner. When I hung up, I automatically though “it’s not fair that I have to eat and she can get away with not eating.” Now, before everyone jumps all over me, let me say that I am perfectly aware how incredibly disordered this thought is. And honestly, I was quite surprised that it was the first thing to pop into my head. Logically I know that what’s really not fair is that she is struggling and has no support, and if she continues not to eat she will end up inpatient (or worse, dead).

So, if I know where the road of skipping meals leads me and I don’t want to go down that road, why would I be jealous of someone who is headed down that path? Here is where I think the addiction model kind of fits. The idea of skipping a meal, of feeling empty, has the same “in-the-moment/I’m just going to ignore the reality thrill” that I am guessing people who buy lottery tickets (think the recent mega millions mania) experience. When you hear people talk about spending money on these tickets, they describe the thrill and hope that maybe, just maybe, they will strike it rich. In the same way that these people ignore the statistics or think that they will be the lucky one, I somehow always manage to think that somehow this time will be different. That I will get “lucky” and skipping that meal won’t prevent me from accomplishing my educational and life goals.

Making this analogy a little broader, here is where the economic theory comes in.  Basically, the short term positives of the eating disorder are kind of like the housing bubble. They are worth millions at a certain time, but that worth is simply not sustainable, and sure enough, it always ends up busting, and I end up more in debt than where I started. Those positives of the ED are like taking out a subprime mortgage – it is something I can’t afford, but I keep saying “it will be ok” and “I will make it work” until one day I just can’t anymore and I end up defaulting (ie going inpatient). By the same token, the negative consequences, both short and long term, are like more stable investments…in the beginning I feel like I am giving up a lot and not making very much in return, but over time it will pay off.

What my thought the other night showed me is that in the same way that gimicky deals and get-rich-quick schemes are appealing to a lot of people even if they are okay financially, the emptiness feeling is still worth a lot to me despite having a lot of positive things going on in my life (volunteering, taking classes, lots of fun times with friends). But, in the same way that I avoid get quick rich schemes because I know they are scams, the positives of skipping meals are a short term “boom” that eventually will blow up in my face. So rather than end up in a serious recession down the road, I need to invest in the more stable, although less immediately gratifying things.

In order to do that, I need to remind myself of the long term consequences, but I think it will also be helpful to remember that the short term doesn’t feel all that great either. The immediate short term of feeling empty feels great, but it doesn’t feel great to be freezing and nauseated and weak. It doesn’t feel great to miss out on social events because they involve food. I need to remember that I definitely have a selective memory when it comes to the ED. When I’m eating, I remember the “good” feelings of being empty and seeing the scale go down. Likewise when I’m doing really bad behavior wise, I remember the “good” feelings of being more social and not as cold.

I also have to remind myself that it will get better. Just like a good long term investment doesn’t necessarily show it’s worth right away, eating healthy might take awhile to be rewarding. I am at a point right now where I sort of have the worst of both worlds…I am eating so I don’t have that empty feeling or knowledge that the scale will go down, but I am also not feeling 100% physically – I am still nauseated, tired and dizzy a lot of the time. So it is very easy for that voice to creep in and say “well, if you feel all these things whether you eat or not, at least if you don’t eat you will get the satisfaction of feeling empty.” I am doing a good job of ignoring the voice, but it does like to show up a lot! Rather than throwing in the towel whenever it seems like the investment going anywhere, I just have to keep remembering that at some point, it will give me a positive return if I hang on.

Skewed Perspective/Double Standards

On Wednesday was the eating disorders lecture for the medical school that I attend, and even though I will have to sit through it next year, I decided to watch just because I was curious about what the lecturer would say. I remember not liking the way it was presented my first year, but saw that it was a different person this year. The overall lecture still kind of sucked – just like my first year, I think it overemphasized the weight aspect as opposed to the mental aspect.

However, there were two things the professor said when talking about anorexia that show me that I have a seriously skewed perspective when it comes to thinking about my own eating disorder. First, when she said “these patient’s will really, severely restrict their food intake,” I was expecting her to follow that up with something like “some will even go days without eating anything.” But instead, she said “some will only eat 300-500 calories a day.” Honestly, my first thought was “seriously? 300-500 cals/day is what I was eating before going inpatient, and to me that was just ‘a little restricting.’” The second thing she said that caught me off guard was when she was talking about hospitalization. She said “those who are severely underweight, usually less than 80% of ideal body weight, may need to be inpatient in a medical or psychiatric hospital.” I was totally caught off guard again, as I was expecting her to use a percent like 60-65 when talking about “severely underweight.” Most of my inpatient admissions my weight was between 75-80% and I always thought of myself as just a little underweight, not severely.

So, clearly I have a skewed perspective when it comes to severity, and I think that’s because I compare myself to the people who do come into inpatient not having eaten for days and being 60% or lower. I have never thought of my eating disorder as “severe” because of these comparisons. Let me emphasize, however, that when I say “my own” eating disorder, I really do mean just mine. If a friend told me they were restricting down to 500 calories a day (or even 1000), or weighed anything less than normal, or was bping regularly, I would be like “ok, you need more intensive treatment NOW.” I bet if I were to see an empty case file with my symptoms and stuff before inpatient, I would say “that person needs help now.” But for me, I have these weird double standards that lead to me just never thinking I am sick enough.

Trusting Yourself

“‎You can seek the advice of others, surround yourself with trusted advisors. But in the end, the decision is always yours and yours alone. And when it’s time to act and you’re all alone with your back against the wall, the only voice that matters is the one in your head.” ~ Meredith, Grey’s Anatomy

As I have blogged about previously, I have a lot of trouble making decisions.  I am always so worried about making the “right” decision, that I will go around to as many people as possible and ask for their opinion, trying to make sure that everyone agrees with my choice.

But the truth is, inevitably you are going to find some people who agree with you and some who don’t.  On my last inpatient admission, I was trying to make a decision about what to do for aftercare upon discharge, and I kept asking different staff members and patients for their opinion.  Finally, my therapist said “Look, you just have to make a decision, you can keep asking a million different people, and some of them are going to say one thing and some are going to say another, but ultimately you know yourself best, so you just need to trust yourself and not care what others think.”

I have been trying to do that, but as a people pleaser, it sure is hard.

Not About Smarts

A little crossover with my other blog, The West Wing in Real Life…

In the third season episode “Bartlet for America”, Leo, President Bartlet’s Chief of Staff and a recovering alcoholic, is telling his lawyer, Jordan, about a time he took a drink post-rehab. After he tells her about his slip, she says “I don’t understand how you could have a drink. I don’t understand how, after everything you worked for, how on that day of all days you could be so stupid.”

Leo responds with one of my favorite, and most often cited quotes, of all time: “That’s because you think it has something to do with smart and stupid. Do you have any idea how many alcoholics are in Mensa? You think it’s a lack of willpower? That’s like thinking somebody with anorexia nervosa has an overdeveloped sense of vanity.”

There is the obvious eating disorder reference in the last part of the quote, but I actually most often quote the first part when talking about my eating disorder.  As mentioned in a previous post, people often feel the need to ask me how I reconcile my medical knowledge with my eating disorder behaviors.  In response, I pretty much just always say “it’s not about being smart or being stupid.”  Most of the people I have met in treatment are super smart and well aware of how unhealthy eating disorder behaviors are…it’s not like it takes a genius to figure out that making yourself throw up after eating is unnatural.

Furthermore, Leo’s question about willpower is also very applicable to eating disorders.  While in partial a few months ago, I told my therapist that I worry my treatment providers see me as weak or a hypochondriac.  She responded that she actually thinks no one with an eating disorder could ever be thought of as weak because engaging in behaviors requires the ability to tolerate an incredible amount of pain.  In other words, engaging in behaviors requires a tremendous amount of willpower, rather than demonstrating a lack of it.  At the same time, it also requires a tremendous amount of willpower to push through the uncomfortable feelings (physical and mental) associated with recovery.  Either way, willpower is key and it is not about being smart or being stupid.

Starving Secrets

Last night Lifetime aired the first episode of its new show “Starving Secrets with Tracey Gold.” The best way I can describe the show is that it is basically Intervention for eating disorders.

I watched the show, but even before watching it I had a lot of thoughts and feelings about it.    Some of those thoughts my friend Genie summed up nicely, so I hope she doesn’t mind, but you should read those thoughts here. Like she said, a huge aspect of this show that I worry about is the comparison aspect. She mentioned the people on the show comparing themselves to where they were in their disorder when the show was filmed, which is honestly something I had not thought of before.

However, something that I immediately thought of when I first heard about the show is all the people sitting at home watching the show who are in that back and forth of “do I have an eating disorder or do I not.” That is a back and forth that everyone with an eating disorder engages in pretty much everyday in my opinion, and when you show extreme cases on TV, that voice that says “you don’t really have a problem” gets even stronger. I know I was sitting there thinking “That girl on TV – the one who only weighs XX – now she has a problem, but since you never weighed that little you really are not that sick.” That being said, I thought the show did a good job of showing how all-consuming and misery inducing eating disorders can be. There was zero glamorizing and it definitely highlighted how lonely and miserable EDs are.  Furthermore, I think it is quite admirable of Tracey Gold to bring attention to eating disorders and watching the show and pre-show interviews I was struck by how much she genuinely cares about raising awareness and getting people help.

Also, I was happy to see that unlike most other portrayals of eating disorders (::cough:: Dr. Phil ::cough::), only one of the individuals Tracey Gold helped was underweight, which will hopefully help counter the prevailing public view that one only needs intensive treatment if emaciated.  Based on the episode last night and previews for upcoming episodes, I think she is doing a good job of choosing people with a variety of eating disorder symptoms and complications.  I am hopeful that this will educate the public as to how diverse the struggle can be – not everyone with an ED is underweight, or restricts, or purges, or exercises etc.

There were three things in last night’s episode, however, that really bothered me. First, with both individuals they said something along the lines of “this is her 5th or 6th time in treatment, this is her last chance.” Since when did you only get a certain number of chances in treatment? I get that multiple times in intensive treatment can mean that that process might be harder, or the person might have more complications than someone who has not had an eating disorder for that long, but still. It made me feel like I should be saying to myself “well, you tried treatment X number of times, if you relapse that’s it, no more treatment.” I keep telling myself that relapse is not a possibility if I want school to work out, but to me that’s different than the message the show conveyed.

Second, both individuals at the end were basically doing perfect in their recovery. The anorectic woman was a healthy weight and spoke of going out to eat with friends and not obsessing over food. The woman with bulimia was not purging at all and her OCD was under control. While I am happy that both left residential treatment in such a positive place, I think it would have been more realistic to explain that recovery is not always a smooth road and slips are part of the process.

Third, I wish they had showed some more of the treatment process with the woman with anorexia. Now maybe she didn’t want them to show that, and in that case I am glad they respected her opinion. However, cutting from when she entered residential treatment to several months later kind of gave the impression that the struggle is over once one enters residential treatment. They showed her really struggling to follow her treatment team’s recommendations in outpatient, but no struggle in residential. I just feel like that could give the message that a treatment center is sort of this magical place, when in reality most days spent in such settings involve anxiety, tears and frustration. But again, it’s hard to strike a balance between showing the true nature of the process and giving the patient some privacy.

How Depression Feels

Happy  Thanksgiving everyone!!

I have been struggling a lot with low energy recently, which I am attributing to depression.  Well, and also anemia I guess – when I met with my dietitian on Wednesday she said my hemoglobin was “extremely low, like anemia of chronic disease low” so I am trying to accept that maybe this low hemoglobin thing is really not a small thing.

But back to the depression…the frustration thing is that I don’t have anything in particular that I am depressed about, nor any particular reason for being tired (ie lack of sleep), and this lack of concreate identifiers is really frustrating me! A friend sent me a link to the following blog, and it exactly describes how I feel regarding my depression (minus the end when she starts to feel better – unfortunately I haven’t hit that point yet). It also fits well with how I feel regarding my general tiredness.  I pasted the relevant text from the post below, although if you do have time I highly recommend looking at the actual post for the illustrations – they are pretty great. The the link is: http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html.

Anyway, here goes:

“Some people have a legitimate reason to feel depressed, but not me. I just woke up one day feeling sad and helpless for absolutely no reason. It’s disappointing to feel sad for no reason. Sadness can be almost pleasantly indulgent when you have a way to justify it – you can listen to sad music and imagine yourself as the protagonist in a dramatic movie….But my sadness didn’t have a purpose. Listening to sad music and imagining that my life was a movie just made me feel kind of weird because I couldn’t really get behind the idea of a movie where the character is sad for no reason. I tried to force myself to not be sad. But trying to use willpower to overcome the apathetic sort of sadness that accompanies depression is like a person with no arms trying to punch themselves until their hands grow back. A fundamental component of the plan is missing and it isn’t going to work. When I couldn’t will myself to not be sad, I became frustrated and angry. In a final, desperate attempt to regain power over myself, I turned to shame as a sort of motivational tool. But, since I was depressed, this tactic was less inspirational and more just a way to oppress myself with hatred. Which made me more sad. Which then made me more frustrated and abusive….The self-loathing and shame had ceased to be even slightly productive, but it was too late to go back at that point, so I just kept going. I followed myself around like a bully, narrating my thoughts and actions with a constant stream of abuse….Slowly, my feelings started to shrivel up…[and] I couldn’t even muster up the enthusiasm to hate myself anymore.”

She then goes on to her recovery:
“If my life was a movie, the turning point of my depression would have been inspirational and meaningful. It would have involved wisdom-filled epiphanies about discovering my true self and I would conquer my demons and go on to live out the rest of my life in happiness. Instead, my turning point mostly hinged upon the fact that I had rented some movies and then I didn’t return them for too long….And that’s how my depression got so horrible that it actually broke through to the other side and became a sort of fear-proof exoskeleton.”

I guess I am sort of waiting for that last part to happen – I am not expecting a miracle or some “light bulb moment” (although I think my mom is). But I am trying to hold out hope that it will get better. But the longer it goes on, the harder it is to hold out that hope, and recently I have been feeling more and more like it’s never going to happen, which is just feeding into the exhaustion and frustration.