It’s An Illness

“There’s something about addiction. When it’s about the people we care about we call it an illness. When it’s about someone we don’t know, we just look at them like criminals. I’m supposed to know it’s always the former. WE have a disease. But, it’s a disease we can treat. That’s my 5 year NA chip. I’m more proud of that than my MD. I want you to have it.” ~ Dr. Savetti, Code Black – The Same as Air

This heartfelt line by Dr. Savetti comes after, earlier in the episode, he chastised a patient who came in seeking narcotics. Prior to this line, he had not revealed that he also struggled with addiction. He has a really good point that we often think of mental illness/substance abuse differently when it is someone we love versus someone we don’t know. Furthermore, as he says, doctors are supposed to remember that mental illness and drug addiction and illnesses. This is definitely not always the case. I have had several doctors tell me that I should “know better” when it comes to the eating disorder, as if it was a simple choice just to eat or not.

I can also relate to what he says about his NA chip. Recovery has proven to me to be far more difficult than medical or graduate school. I have heard others in recovery also say it’s the hardest thing they have ever done.

Uncertainty

From Grey’s Anatomy Season 14, Episode 22 – Fight for Your Mind:

Meredith: Fixing your mental health isn’t like surgery. You can’t just run the bloodwork and check the vitals. With mental health, progress is way harder to measure, and if something is wrong, we have to take action. There is a lot of uncertainty, there’s a lot of fear, and what might be easy for one person, for someone else might take inner strength you can’t even imagine. But we have to try. We have to stand up to our demons. We have to face reality whenever possible and ask for help when we can.

There have been a couple of times that I have blogged using Grey’s Anatomy quotes that discuss how recovery is a long process, and that recovery from mental illness is usually not as cut and dry as physical illness. Even the diagnosis of mental illness isn’t usually as cut and dry. Most of the time diagnosis is based on a cluster of observable symptoms and/or thoughts; there aren’t really clinical tests like labs and vitals. This is something that I struggle with a lot when it comes to my own mental health issues. Especially with the eating disorder, I feel like there has to be some proof in the sense of my weight being low or my vitals being off to warrant treatment.

Moving on from diagnosis, as Meredith says, fixing your mental health is a long, uncertain process. Often there are some evidenced-based treatments, but for most people I know, treatment and medication is often the process of trial and error. Everyone’s struggle also looks different. I struggle with some things that friends I have met in treatment do not struggle with (even though we technically have the same diagnoses) and vice versa.

I like also how Meredith puts in the part about asking for help when you can. It’s often really hard to ask for help for a problem that others cannot see. But, a good support system is a key factor for many people (including myself) when it comes to recovery.

Priorities

From Mom, Season 5, Episode 15 – Esto Loco and a Little Klingon:

Christy: I know this has not been the ideal weekend, but helping people stay sober is what helps me stay sober, so it has to come first.

Patrick: I guess then I’ll always be second

Christy: I’m crazy about you, but if I don’t stay sober, there is no second.

In the above quote, Christy is explaining to her boyfriend why her AA responsibilities have to come first. I could really relate to this. First, I do agree that helping others with their recovery helps me. If I know a friend of mine is struggling, I’ll go out of my way to eat with them, which ultimately helps me too. However, unfortunately I am still at the point where I often put my recovery second to the relationships in my life. This is something I am trying to work on because as Christy says, if you don’t put recovery first, nothing can come second.

Later on in the episode, Christy and Jill, her sponsee that keeps relapsing, are at a meeting. Jill is hesitant to take another newcomer chip, her fourth in as many days:

Jill: I’m not taking another [newcomer chip], it’s too embarrassing 

Christy: You have nothing to be embarrassed about

Jill: What if I take another newcomer chip at every meeting for the rest of my life?

Christy: Then I’ll be right here with you

To all of my friends out there struggling, know that if relapses happen, but you are willing to keep fighting, I will be there.

No Reason

From Chicago Med Season 1, Episode 12:

Dr. Charles: You’re one hell of a performer. I mean, a real trouper. Keeping it up for so long, selling this idea you think who you need to be all the time, carrying around the weight of that performance…isn’t it tiring? Aren’t you exhausted?

The patient: I have absolutely no excuse to be sad.

Dr. Charles: You don’t need a excuse, man. You’re a human being.

This quote really resonated with me. I have been pretty depressed lately, but keep beating myself up for feeling that way. I keep saying to my therapist that I don’t understand why I am so sad. Objectively everything in my life is going well – I am in graduate school, I have a job, I have a boyfriend, I have great friends, a great family etc. I look around and see people that are less fortunate than me, and feel guilty that I am still sad and hopeless despite everything that I have. Logically I know that when you have depression you don’t need a reason to be depressed, but I still often feel bad about my mood being so low. So, it was nice to hear the line about not needing an excuse to be sad.

In addition, I could really relate to the first part of the quote. I am exhausted all of the time, and find being around people particularly draining. I think it is because when I am around people I put on this act that everything is ok. I act happy and energetic, and then come home and collapse. Dr. Charles is right that putting on that performance is exhausting.

Every Day

From Mom Season 3, Episode 18 “Beast Mode and Old People Kissing”:

Adam: Where you going?

Bonnie: We’ve got a meeting.

Adam: You just had a meeting last night.

Bonnie: I know, but then I woke up today and I was still an alcoholic. 

I recently started watching Mom on CBS, and I love it. Of course I love Allison Janney in anything, but I especially like the way the show deals with addiction and recovery. It shows that recovery is hard work, but possible with support. It also shows that relapses can happen, but also that it is possible to get back on track.

Bonnie (the Mom, who is in recovery) has the above exchange with her new boyfriend. He doesn’t understand why she goes to meetings so frequently until she shows him a tape of her drunk and out of control at a wedding.

Just that one line “I know, but then I woke up today and I was still an alcoholic” says so much. I know that for me it is easy to forget that I still have to be diligent about recovery and following a meal plan. I will have a few good days, and then think “see, I’m fine, I don’t need this.” This happened recently when I went on vacation – I was so focused on having a good time on vacation that I put having fun first and following the meal plan second. My therapist said that is like an alcoholic thinking “I can just have a few drinks, I’m on vacation.”

While I know that my therapist is right, it wasn’t until I watched this episode and heard this quote that it really struck me. Every day that I wake up, I am still a person that has an eating disorder. I may be in recovery, but I still need to be diligent about recovery every day. This quote is also a good reminder that while in recovery it is ok, and in fact a good thing, to continue to ask for help, whether that be going to meetings, going to therapy, etc.

Be Patient

House Season 6, Episode 3 – Epic Fail:

House: My leg’s killing me. Cooking helped for a while. I guess I got bored. My leg started hurting again, then I got worried, and that made the pain worse.

Dr. Nolan: What are you worried about?

House: That nothing’s gonna help. That I end up in the very dark place. I’m fine… Just not happy.

Dr. Nolan: I didn’t let you out because you were happy. I let you out, because I believe you had the skills to cope with that. You tried one thing. It didn’t work. So move on. Write. Play chess.

House: What if nothing works? What if nothing gives me more than a few days before my brain starts looking for the next fix, before my leg feels like someone’s shoving nails into it? What do I do then?

Dr. Nolan: If nothing in the world can hold your interest, uh, we’ll deal with that when we get to it. But you have to trust me, and you have to be patient.

I can relate a lot to how House feels here. Although the last several weeks I have been quite depressed, for most of this year I have been “fine…just not happy.” In fact, I have been pretty miserable. On the surface though, things are fine – I’m maintaining my weight, going to class, going to work etc. I have great friends and a family. But I’m not happy because my brain simply will not shut up.

Like House, I worry that nothing is going to work. In his case he is looking for a distraction from the pain in his leg, in my case I am looking for relief from the eating disorder, depression, and anxiety. I have a new treatment plan that seems to be working well, but it is very slow going and, well, I am not a patient person. Everyone keeps telling me that it is going to take time. After all, I have had an eating disorder for 18 years – it isn’t going to go away with a few months of recovery. I am trying to hang on and trust everyone, but it is definitely quite hard some days.

Giving

“The joy supposedly is in the giving, so when the joy is gone, when the giving starts to feel more like a burden, that’s when you stop. But if you’re like most people I know, you give till it hurts, and then you give some more.” ~ Meredith, Grey’s Anatomy Season 6 Episode 10: Holidaze

I know that personally, I love to give things to friends, to coworker, and to my family. I like to feel that I am being helpful. As Meredith says, you get joy out of giving. It makes me happy to think of a friend reading a card I sent, or seeing them open a present I gave them. Even just giving my time makes me happy – I wouldn’t hang out with my friends if it didn’t give me joy too!

But everyone has their limits, and I personally am very bad at saying “no”. I am definitely getting better, but I still have a ways to go. I was always the first to volunteer to provide extra time on a project, or go to dinner with a friend if they were having a bad day, or feel like it was my job to make everyone happy. If someone did something nice to me, I felt obligated to buy them a gift to show my appreciation, or spend extra time trying to show them how grateful I was. Rather then putting myself first, I put making others happy first. As a result, sometimes I would feel overwhelmed.

I am trying to be better about setting limits, but am still really struggling with feeling like I am not giving enough. I think I am particularly struggling because all of my friends have been giving ME so much as I try to recover. Many people regularly ask me how I am doing, and offer to help if they can. And what do I do? What have I been giving? Nothing. The meds I am on make me sleep like 10 hours a day, and I am generally tired during the day. I try to do as much as possible with work, but I always feel like I am falling short. I am lazy so I rarely call people. I have been trying to work with my therapist on lowering my expectations for myself and allowing myself to say no, but it is slow going.

Rationalizing

ER Season 14 Episode 5: Under the Influence

Janet: You drank? When? Last night. You want to get to a meeting?

Abby: I don’t have time to go to a meeting. I don’t need to go to a meeting. I just I had a bad day, a very bad day, and it was just one time. I’m not going to start drinking again.

Janet: Really? Are you an alcoholic?

Abby: Yes, but..

Janet: Yes, but? All those years that you were sitting in meetings, were you an alcoholic then? Yes or no? OK, keep drinking. Do the research, see what happens.

Abby: I can handle this.

Janet: Just let me know how it works out for you. OK, I’ve got a clinic full of patients.

Abby: Janet, Janet, you’re my sponsor.

Janet: I was your sponsor, but now it’s very simple. If you’ve decided you’re not an alcoholic, I can’t help you. If you are, I’ll be your sponsor again and I’ll support you in recovery. Let me know what you decide.

This conversation between Abby and Janet reminded me of an internal dialogue I have with myself a lot – debating whether or not I really have an eating disorder, and thus whether or not I really need to follow my meal plan. My therapist often likens restricting a few exchanges to an alcoholic having one drink. Much in the same way that Janet responds to Abby, if I restrict a little she tells me that I need to get back on track ASAP, that it is a slippery slope. Too often though, I rationalize, just like Abby is doing here. I say that it’s not a big deal, that it could be worse, and that I’ll get back on track tomorrow. Kind of like Abby, I say “yes, but…”. There is always a “but.”

Sometimes though, the rationalizing goes even further. I’ll convince myself that I don’t really have an eating disorder – I’m not underweight, I’m eating enough, I’m not overexercising or purging etc. Then, the logic goes, if I don’t have an eating disorder, why do I need to follow this meal plan? Why do I have to keep eating even when I’m full, or make sure to be diligent about meals/snacks? Normal people don’t eat the same amount every day, so why do I have to follow this meal plan?

The problem is, as Janet points out, this doesn’t end well. As she says, “do the research, see what happens.” Just like an alcoholic eventually starts drinking more than one drink, I start restricting more than one exchange. One exchange becomes two, two becomes three, and then those three never come back. I think Janet’s point to Abby is that she has to recognize that she has a problem and that she has to take certain steps (perhaps going to a meeting), to overcome it. In the same way, I need to stop rationalizing and accept that I need to follow my meal plan in order to achieve recovery.

To the Bone

I watched the new Netflix movie To the Bone, which is about a young women with anorexia. Contrary to what some people said about it, I don’t think it glamorizes eating disorders. I think they made her struggle look painful – they show her compulsively doing situps, running up and down the stairs despite being out of breath, and passing out in a train station. I do take issue with the fact that the lead actress, who has a history of anorexia herself, lost weight for the role, as it feeds into the stereotype that everyone with an eating disorder is underweight. However, when she goes to treatment, there are people there with a variety of body sizes, which hopefully helps to combat the idea that one needs to be severely underweight to seek out residential/inpatient treatment.

What I take issue with is the portrayal of the treatment process. I get that the place where is goes for treatment, a residential place run by a psychiatrist played by Keanu Reeves, is supposed to be “nontraditional.” However, I really doubt that any treatment place would employ some of the methods used by this place. For one, meals are completely unsupervised. The patients just sit at the table with a bunch of food, and are allowed to eat as much or as a little as they want. One patient almost exclusively eats peanut butter from a jar too. Although I know that some treatment places ultimately have patients practice intuitive eating or get to a point where they prepare their own food, most places have patients start out with supervised meals and meal plans. They basically make it look like treatment is living in a nice house, going on some field trips, and engaging in a group or two. I worry people who watch the movie will have an unrealistic view of just how hard residential/inpatient treatment is.

Furthermore, towards the end of the movie the main character has a revelation/near death experience, and then is shown going back to the treatment center, more willing than before. It is implied that now she will be compliant and get better. Although I have never had a near death experience, I know many people that have and continue to struggle. It’s not that simple. It is a daily, sometimes hourly, sometimes minute by minute, difficult decision to continue on the path to recovery. I wish they would make a second movie that documents her struggles now that she is going to be cooperative in treatment – because that’s when shit gets hard.

Although I did not personally find it triggering, that doesn’t mean that it is okay for anyone with an eating disorder to watch this movie. I know that others have found it triggering. If you are considering watching it, talk to your therapist or another professional first to make sure it is in your best interest.

My Brain Works Differently

I’m an alcoholic. I don’t have one drink. I don’t understand people who have one drink. I don’t understand people who leave half a glass of wine on the table. I don’t understand people who say they’ve had enough. How can you have enough of feeling like this? How can you not want to feel like this longer? My brain works differently. ~ Leo, The West Wing, Season 3 Episode 10 – Bartlet for America

I was watching this episode yesterday in anticipation of The West Wing Weekly podcast about it, and this quote really stuck out to me. Leo is talking about his experience as an alcoholic, but I can relate this very much to the eating disorder.

For most people, restricting their food intake is an adverse experience. They don’t have a chance to eat lunch or a snack one day, and they feel like crap and think “I am definitely going to make sure I have that tomorrow.” However, for me the opposite happens. I get this sort of high, and think “I want this feeling to continue.” I want to keep feeling that hunger, that emptiness. As Leo says, my brain works differently.

This is also why restricting is such a slippery slope for someone with anorexia. Just like Leo cannot have one drink, I cannot have one missed meal or snack. It just leads to more restricting. There are many days were I want to miss a little, and think it’s not that big of a deal. But if history is any indication, pretty soon that one exchange or one meal becomes two or three, and it just keeps on going. Why? Because as Leo says “My brain works differently.”