Happy almost 1-yr anniversary to this blog

Today is the start of yet another National Eating Disorders Awareness Week. Last year, I hesitantly posted this story and shortly after that, I started this blog. I had what I thought was a great topic to post about this year, but after thinking about it I started having doubts that it would be well received. Yikes; such an anxiety-provoking awareness week!

In the past, most of my qualms with this week have centered on misconceptions that I think those “on the outside” sometimes unintentionally spread in the name of awareness. For example, often I felt that certain factors were overemphasized and others not at all mentioned when talking about what “causes” eating disorders. I hated the thought of people being fed an over-simplified idea of what all eating disorders were or were not, when I knew just how diverse and complicated they were.

This year, however, I realize that many of my reservations are now related to misconceptions that I think are perpetuated by some of my fellow sufferers. I know I have to be careful when talking about this, because the last thing I want to do is invalidate anyone’s personal struggle.

As I’m sure some of you have noticed, these days NEDA week is often “celebrated” by a current or former sufferer posting a dramatic “before and after” collage on instagram (or Facebook, or Tumblr, or whatever their platform of choice is). These collages often feature photos from their very bone-jutting sickest next to pictures of their smiling twinkle-eyed face today. When I see these posts, I’ll admit, I kind of want to scream. A post like that tells me absolutely nothing. All it tells me is that you used to be really skinny and (apparently) quite sad, and now you’re healthy (maybe) and (apparently) quite happy. Yay! Good for you, really. However, I’d much rather see a candid non-photoshopped picture of you doing something you love, or read about all the things you can do now in recovery that you couldn’t do in your eating disorder. That would be way more interesting and inspiring to me, but of course it’s the dramatic before/after collages that get all the “likes” and re-blogs.

One more word about the pictures, and then I’ll move on. It’s perfectly fine and even admirable to be so proud of how far you’ve come. And while weight is not a factor in every eating disorder, it is in many, and I realize firsthand what a big accomplishment it is to finally begin to accept yourself at a more normal weight. I have my own pictures, and I sometimes look back on them to reflect how far I’ve come. Please, however, think before plastering these kinds of pictures all over social media. This is a very competitive illness, and people can be negatively affected by such things at all stages of illness and recovery. If you feel the need to hold onto all of your sick pictures, fine. Keep them in a box and pull them out whenever you need a reminder of how far you’ve come. If you feel the need to share them, share them with close friends or family members who you know won’t be triggered, or with your therapist or your cat. Don’t post them on your public instagram tagged #soinspirational. I can almost guarantee you, you are not inspiring people in the way you hope.

Another troubling mindset that I notice is rampant in the eating disorder community is that idea that “more treatment is always better.” Whenever anyone currently struggling with an eating disorder even hints that they’ve recently been struggling more than before, the first thing their so-called supportive friends (all of whom also have eating disorders) often say to them is, “Go back to treatment!” Surely, $1,000+/day residential treatment is the answer to everything, right? Because a good couple months of equine therapy and challenge snacks is all anyone needs to break a lifetime habit of self-destructive behavior! That must be why anyone who goes to those places never needs to go back, because the treatment is just that awesome. Oh wait… that pretty much never happens. 😦 What does happen (more often than not) is that person gets sucked into the toxic treatment center vortex. They do well in treatment because everything is neatly packaged and decided for them, and all the triggers of everyday life are removed. When they’re finally forced to leave (often due to insurance “kicking them out”), everyone seems surprised that they can’t keep up what they were able to keep up in the treatment center bubble. As soon as they struggle, they’re sent right back to treatment to repeat the whole cycle all over again. To many of us on the outside looking in (many of whom have been caught in our own treatment center vortex at some point), it seems so obvious. “Treatment” isn’t working. You’re never going to learn how to live a healthy life by being trapped in a completely unrealistic bubble for months at a time. I’m glad that I finally realized this myself, before I wasted even more time in the treatment center vortex.

Before I go any further, I should clarify something– I am not saying that all treatment is toxic or unhelpful. I am certainly grateful for much of the treatment I was fortunate enough to receive over the years. In many cases, it kept me alive and/or helped me get to a place where I was able to make more rational and life-focused decisions for myself. I am not against treatment when it is truly needed from a physical or psychological standpoint.

After all these years though, I do think I can honestly say that I am almost always against long-term inpatient or residential treatment when similar treatment can be provided in a less-restrictive environment. I’ve just seen too many people I know and care about become overly reliant and harmed (yes, harmed) by this kind of treatment. It is not healthy to keep a person in residential treatment for years at a time, or to lead that person to believe they are utterly helpless without that kind of 24/7 support. (Click here to read more about my thoughts on residential eating disorder treatment).

For many years as an adolescent and young adult, I was blessed to have really amazing insurance. This meant I was “lucky enough” to have several long-term treatment stays completely covered by insurance. If ever I was set up to make a perfect recovery, it was then. But what actually happened? I left each treatment center more hopeless and frustrated at my inability to get better. Any progress I seemed to make while in treatment was completely erased once I got home. When I lost this amazing insurance back in 2008 (this is back when they cut you off from your parents at age 24, not 26), I thought I was doomed. And yeah, the first few years really sucked, but I eventually learned to be more resourceful and I think it was during that time that I finally started to think differently about myself and what I was capable of. When I truly needed it, I was forced to spend time in a few very unpleasant state hospitals, and the only actual “treatment” I could access involved me agreeing to be a guinea pig for a bunch of eating disorder studies being conducted at the time. What I realized though, is that however much I thought that treatment “sucked,” it wasn’t really any worse than the treatment I received at the expensive residential centers. It was just different. At the end of the day, it didn’t really matter where the treatment was or what exactly it consisted of, what mattered was what I decided to do once that treatment was over.

I know several people who I’d say are quite seriously “addicted” to treatment. They don’t know how to live without that continuous 24/7 support. These are adults who have not been able to experience anything remotely “real” in years because they’ve been kept in this overly protective bubble. Sometimes I don’t even know who I’m angry at for this or if it’s even anger at all. Half the time I don’t think these people even realize why it’s so bad for them. I didn’t really know this myself, until I got out. Do I get mad at the people who are telling them to stay there, when they should know better, after all these years of seeing the cycle repeat itself? I don’t know.

Of course “getting out” of the vortex is only the very first step. It’s not like I just stopped going off to treatment and suddenly figured out how to handle my illness on my own. Not at all. For many years I was kind of just “white knuckling” it, as they say. I knew I couldn’t do it completely on my own but I also wasn’t about to throw all my progress away and get sucked back into the treatment vortex. I started trying out support groups and therapists. I encountered a lot of really unhelpful therapists (some downright harmful), and groups that sent me into high anxiety and panic. For a while it seemed like I really was completely on my own.

Eventually though, I stumbled upon a system of support that works for me. I am now lucky enough to have amazing insurance again, although this time I’m not using it to run off to treatment whenever things get hard. I’m using it to get valuable outpatient therapy to work on the things I never had time to work on before, when I was too busy dealing with the latest crisis of the hour and planning my next treatment stay.

Everyone’s journey is different, and I try to respect that. I just really doubt that a glitterized before/after collage is ever going to be the key to anyone’s recovery, nor is that 17th stay at that famous center in Denver.

 

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“I wouldn’t want you to throw this all away.” Don’t worry, I won’t.

 

I feel like the tone of this blog has been shifting towards more personal posts lately which has been unintentional but perhaps meant to be? A couple weeks ago I was really concerned with “what to do” about this blog once I become a legit therapist who sees clients as if that were scheduled to happen like, tomorrow. I’ve since calmed down a little and realized I still have time to figure all that out.

As scared as I often am of being so open here, I hope I’m at least doing my part to “shatter the stigma”– the stigma of being a person still struggling with mental illness while out living life in this big scary world.

Yesterday I spent Christmas with my family and it was pretty wonderful. My little sister and her fiance are in town from the east coast and it was great being able to see them along with the rest of my immediate family. We did our yearly tradition of eating dinner at this restaurant on the beach near where my parents live.

During dinner the topic of me applying to “get my second master’s” came up and my dad expressed doubt that this was the best idea. “You’re doing so well where you are now, I’d hate for you to give that up.” This wasn’t the first time I’ve heard this concern; hell, I’ve had this very concern myself. Outwardly, I am doing pretty well right now. I have a stable job at a great company and most days I even enjoy what I’m doing. Why would I want to give that all up to take a risk at something that has no guarantees at providing me that same stability? Well, for one, I don’t plan on “giving this all up.” My plan is to stay at my current job for as long as I can while in school, even if that means dropping down to part-time eventually. I don’t plan on leaving the world of research entirely, I just hope to supplement it with something I’ve always dreamed of doing but haven’t been in a place to pursue until now. I know to the casual observer though, this sounds suspect.

The truth is, the past several weeks have not been easy. I’ve been wrestling with this decision and trying to convince myself it will all be worth it in the end. I’ll admit though that I keep coming up against imagined road blocks, many related to my ability to do what I really want to do given my own demons. When I first had this idea, I was so excited that I got this burst of motivation to make a lot of serious changes in my life. For example, I increased my calories quite a bit and told myself I was going to finally let myself get to a healthier weight and stay there because that’s part of what I thought being a successful eating disorder therapist required. I was almost surprised at how “easy” it was at first. My body image concerns became mostly background noise and I was able to ignore them and remain focused on my new life’s ambition, for the first time ever. It was pretty amazing but seemed almost too good to be true.

Sure enough, a few months into this new way of life things started to get a whole lot harder. I’ve become really uncomfortable with my bigger body and I’ve started to question why it’s even necessary. Even if I do plan on working with eating disorders, it will still be quite a while before I’ll be doing that in any direct capacity. What’s the hurry? I might as well take advantage of this time and you know– “get all the eating disorder out of my system”– have one final hurrah. This is the same thing I used to think every time anyone mentioned a higher level of treatment. “Ok, I’ll go into treatment, but not before I lose as much weight as possible and have as much ‘fun’ with behaviors as possible because once I’m in treatment, that will all be taken away from me, and once I’m out, I’ll be in recovery and none of that will be acceptable anymore.” Of course, given my history of many failed treatments, this method was never that effective. Every single time, my “one final hurrah” just sent me into a deeper state of despair and made it that much harder to succeed in treatment.

What’s scary is, I can totally see myself going in for my “one final hurrah” now and never coming out. I’ve seen firsthand from friends who have been fighting this as long as I have, that things really start to shift  around this age. Not only is the body increasingly less resilient to the abuse, but the level of hopelessness that accompanies the deeper stages of this disorder becomes even more ingrained and hard to overcome.

I’m actually glad my dad made that comment at dinner last night, because it caused me to really reconsider the idea of the “one final hurrah.” Whether he meant it or not, I took his comment to mean that he doubted I could succeed at something other than what I’m currently doing. He’s seen how long it’s taken me to get to where I am today, how much I’ve had to struggle and fight. I’m sure it would be very hard for him to see me “throw that all away.”

Well, I don’t plan on throwing it all away, and over these past 24 hours I’ve regained some of my steam. My dad hasn’t (to my knowledge) been reading this blog, nor have we really discussed my reasoning for choosing to go down this new path. Perhaps if he knew these things, he’d feel differently, although in the end it shouldn’t really matter what he thinks. For Christmas I asked for a bunch of therapy-related books, some of the “must reads” for every new therapist. I’m already well into the first book and it’s become even clearer to me that this is what I want to be doing. Has it all become “easy” again, like those first couple months? No, not at all, but I have a renewed sense of hope that somehow, I can and will succeed at this.

 

How to appreciate the mental aspects of yoga: take two!

I’ve had a pretty complicated relationship with yoga from the start. See this blog for details.

For the past several months I had been toying with the idea of doing Yoga Teacher Training in the spring. I know- what? Haven’t I made enough life-changing decisions recently? Well, I really wanted to deepen my yoga practice and I had always heard that going through teacher training was a great way to do that. It’s “expensive,” but comparatively a drop in the bucket when you consider how much I’ll be shelling out to go back to school.

I took a one month break from yoga back in August in an effort to explore some of my ~feelings~ around it and I came back in September with a renewed love for the activity. I thought all my complicated “yoga issues” were behind me, but I guess that wasn’t exactly true. I keep coming back to my idea that I have to be doing a certain type of yoga every day in order for it to “count.” If the class is only an hour long, it doesn’t count. If the yoga doesn’t make me sweat, it doesn’t count. If I’m doing yoga in my apartment and get sidetracked by my cats for a minute , then that doesn’t count as yoga either.

My studio that I have a membership to doesn’t offer hot yoga, but I kept hearing that hot yoga was the real “legit” yoga so I started paying separately to attend hot yoga classes at a nearby studio that I didn’t even like. It didn’t take me long to figure out that if I’m honest with myself, I really dislike hot yoga. Warm yoga, sure, but 98-100 degree yoga? No thanks. I was eventually able to convince myself how stupid it was to be wasting money on something I wasn’t even enjoying all in the name of becoming more of a “real” yogi.

What kind of yoga do I like? I like the variety of (non-hot!) yoga offered at my original treasured studio– sometimes that means a vigorous vinyasa flow and other times it means a slower more strength-focused hatha class. This is the studio I originally fell in love with and the one I keep coming back to after all my little breaks to find (get over?) myself.

The #yogaeverydamnday movement is strong, and I’ll admit I got sucked into it, thinking I needed to be doing X hours of real “legit” yoga every day in order to consider myself someone who was serious about yoga. Who’s to judge that anyway? Is someone who religiously does 2 hours of hot power yoga a day more serious than someone who does one hour of non-hot yoga most days? What if the person spending less time on the mat is the one who actually succeeds at bringing the principles of yoga into her/his life?

I’m so grateful for my amazing friend Emily for helping me realize that I don’t need to spend thousand of dollars on a teacher training to be able to appreciate the benefits of yoga in my life. I realized my fixation on becoming a “serious yogi” was actually fueling my eating disorder, and there’s no need or room for that right now. My Christmas yoga wish would be to figure out how to simplify the existence of yoga in my life, because I’m pretty sure yoga was never meant to be this complicated.

(This is my spiritually-minded cat Wendy practicing yoga. For the record, she’s not a fan of hot yoga either…)

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Living authentically feels so good

I’ll officially be submitting my applications to the four MFT programs I’m applying to within the coming weeks. Aside from the one program that does rolling admissions, I likely won’t hear anything until late January/early February. I’m hoping to get interviews at each school so I can carefully assess which program would be the best fit for me. Overall the process has been so much more pleasant and less terrifying than applying to PhD programs back in 2013. This is something I truly want to be doing and I feel none of the same pressure and dread I felt back then. Don’t get me wrong– I still feel pressure (from myself) and anxiety, but it’s a completely different and better kind.

I’ll admit I’ve found it slightly harder to concentrate on my current life since making this decision, but only because I’m so excited–for once– for my future. Not all that long ago I still dreaded and feared my future, if I could imagine it at all. Lack of focus was always a byproduct of depression or eating disorder, never excitement— what even is that?

I’m trying harder than ever to live authentically and not worry about what people may think of my choices, changes in my behavior or appearance, or anything else. I’m currently at the highest weight I’ve been at since leaving treatment in 2012. I’m letting myself eat more freely in social situations and not beating myself up (as much) for eating a more normal amount of calories each day. My body image is pretty shitty but dare I say not quite as bad as I imagined it would be at this point? I sometimes can even recognize that I’m still thin. I did yoga in front of a mirror for the first time ever over the weekend (my home studio doesn’t have mirrors, which I like). I was completely surprised that I wasn’t doubling over in disgust at how gross and fat my body looked. It actually looked way more acceptable than I imagined it would look at this weight. Were those trick mirrors? “Skinny mirrors?” Perhaps, especially considering I was doubling over in disgust just hours later when in front of my mirror at home. However, just that fact that I was able to see myself– even for just 75 minutes– a little closer to how others see me was pretty significant.

I had a good talk with someone the other day about how it’s not necessary to completely LOVE your body in recovery, or even as a recovered therapist. You merely have to accept it and be willing to let it take up less mental space in your life. Maintaining an unrealistic weight of under XX lbs used to be at the top of my priority list. My self-worth was determined almost entirely by how far below that weight I could be, because I thought it actually meant something. In reality, it meant very little. I never made a positive impact on the world or even just one person because of how thin I could be. Do I like my body now? Hell no, but I’m slowly becoming more okay with just accepting it as a very insignificant part of who I am.

 

Therapists’ self-disclosure of recovery status (not into coming up with a creative title tonight, haha)

I recently read this article about the pros and cons of therapists’ self-disclosure of their own eating disorder history. I’m not going to say a lot about this now because it’s something that I’m sure will come up more and more the further along I get in this journey, and I expect my opinion to shift some, but I wanted to at least mention it.

I’ve decided that I really do want to work with eating disorders one day– maybe not right away when I start seeing clients, but eventually when I’m ready. Do I disclose that I’ve recovered from my own eating disorder? Do I not mention it but be honest about it if asked? What about this blog? Should I stop writing in it once I’m a practicing therapist? Do I just make sure it stays completely anonymous (which it pretty much is except for the pic in the “About this Blog” section and my gravatar thing)? I know how people love to google their therapists… what if they found this? Would that be absolutely disastrous? Am I getting way ahead of myself in worrying about this so early in my journey? I haven’t even gotten accepted into a program yet, haha… but I like to be prepared. 😉

I’d love to hear your opinions– from the therapist side, the client side, or the average Joe side.

When the most exciting part of your day is planning that perfect binge

I’ve been sitting on this blog for several weeks, but I decided to finally post it. My instinct is not to talk about bingeing (b/ping in general, but particularly the bingeing aspect), because to me it’s the most shameful part of my eating disorder. I know I’m not alone in this though, and I hope that the more I address it the less ashamed people will feel about confronting this behavior.

The article “Investigating the Reinforcing Value of Binge Anticipation” talks about binge eating in terms of alleviating negative emotions. A person apparently binge eats in the context of these emotions and through negative reinforcement the binge eating behavior alleviates this negative affect. When I first read this, I kind of disagreed. In the worst of my eating disorder, I binged/purged in the context of any emotion. I sought to numb myself completely but I was also physically starving, so I relied on the constant b/ping behavior to distract from the never-ending hunger. I was either severely restricting or bingeing on large quantities of food and then purging until completely empty (or well, as empty as was possible for me). That was in the worst of my disorder though. When I’m not as physically starving, I do notice the urge to binge is related more to negative emotions and anxiety.

I also noticed right away that the article focused no attention on the role of purging, which makes me wonder if their generalizations apply more to individuals who binge eat without purging, rather than those with bulimia or anorexia- b/p type. For me (and I’m sure others), bingeing is always paired with purging, and purging almost always follows true binges, not regular eating. This is why I usually refer to the entire behavior as “binge/purging” or “b/ping,” because those two behaviors are always linked for me.

That said, the article then goes on to talk about the unique role of binge anticipation, which is rarely, if ever, discussed in the literature. Ah, binge planning… so many memories of scrambling to write down all the foods I was craving in the moment and hoping they’d be the same foods I craved hours later when I actually got the chance to binge. Clearly for most people, bingeing directly following negative emotions is not always possible. You may be at school, at work, or simply unable to obtain the food necessary for the binge until a later time. This is where binge anticipation comes into play. Researchers hypothesized that often this binge anticipation phase may serve the same purpose as the binge itself, in terms of alleviating negative affect. This may explain why so often I’d be in heaven while planning my perfect binge only to be sadly disappointed when the actual binge failed to live up to expectation (or when the streneous purging part ruined it all).

The article talks about a recent pilot study that examined the brain activation of women with bulimia using an MRI scanner. The experimenters used a mood induction technique to place the subjects in a negative mood. They then measured the subjects’ brain activity when they were asked to plan a binge versus when they were asked to pick out furniture for a fictional apartment. They found a large drop in amygdala activation when the women were planning a binge, but almost no change in amygdala activation when picking out furniture. The pattern of amygdala-related change observed when the subjects were planning a binge has been associated with a decrease in negative affect. They also noticed an increase in activation of the caudate, which may indicate positive reinforcement and “appetitive reward.” In other words, this data suggests that the decrease in negative emotion that has been long associated with bingeing happens (also? instead?) during the binge planning stage. Another study they mention involving the anticipation and actual consumption of a milkshake suggest that this reduction in negative affect is solely associated with the planning, and not the eating itself. However, I think there are too many variables not accounted for to make this conclusion, including the role of purging and level of physical hunger before the binge.

The authors go on to suggest more mood induction, ecological momentary assessment (i.e., rating moods in the moment using some kind of mobile device), and longitudinal brain imaging studies of binge anticipation. I would add that studies should be done with a variety of diagnoses that involve bingeing (binge-eating disorder, bulimia, and anorexia- b/p type).

So the answer is simple then? Just do all the fun planning and skip out on the actual binge (and purge). Negative emotions sill reduced! Problem solved! Haha, right. Up next, how to actually apply these brainy findings to real life…

No easy answer: Anorexia and the right to die

A few people have asked about my opinion of this case in New Jersey where a judge ruled that a 29 year-old woman cannot be force-fed against her wishes; instead she will receive palliative care. Honestly, I have no simple opinion on this matter. It’s way too murky for me to say one way or another whether or not this is the best choice. I would love to be the optimist who says, “Anyone is capable of recovery, this woman included,” but do I really believe that? I’ll admit my overall opinion of recovery has shifted over the past several months. I used to think that everyone had a kind of a pre-destined “recovery potential” that dictated the maximum level of recovery they could ever achieve given the best case scenario. I now see things a little less black-and-white. I used to think this was about as good as it would ever get for me, and now I think differently. I believe I’m capable of more, and I hope to get there one day.

Some of my closest friends have severe eating disorders and I can’t imagine myself ever giving the “okay” for them to give in and settle for palliative care at such a young age. Part of this has to do with knowing the profound effect that malnutrition has on the brain. It’s pretty much impossible not to be intensely depressed when you’re starving. However, I’ve watched people I love make dramatic transformations through re-feeding– not just physical transformations but mental and cognitive transformations as well. I’ve also experienced this myself. When you’re drastically underweight and malnourished, simple food will have a much bigger impact on your mood and thinking than any antidepressant will (and actually, most antidepressants probably won’t work at all when your body is that compromised).

On the flip side, anorexia is an illness not unlike many physical diseases that, when determined to be terminal, have led to approved physician-assisted suicide. Have I ever felt defeated enough by my illness to wish death upon myself? Absolutely, more times than I can count throughout the course of  my eating disorder. However, I honestly don’t think any judge would have granted me permission to die (or to give up on treatment) had I asked for it at the time. As sick as I was at times, I had never done such irreversible damage to my body that it would have seemed warranted. Obviously I don’t know the details of this woman’s case, but I’m guessing her body has deteriorated to a degree that they believe she has little chance of ever making a full physical recovery. Re-feeding can be extremely dangerous when a person has gotten to such a grave physical state, so much that many hospitals won’t admit patients who are below a certain BMI. The places that can treat patients with single-digit BMIs or serious medical complications is very limited. For all I know, this woman may have exhausted all her options and is now just looking for any kind of relief– relief that only palliative care may be able to give her (I also can’t help but note that the article states she suffers from binge/purge type anorexia, which, at least in my experience, is like double the horror).

It’s depressing for me to even be writing about this. I’ve watched more than a few people die from this illness. Some of those people had clear wishes to die and others died very unexpectedly. I worry about my current friends and acquaintances with eating disorders every single day. I hate that this illness takes so many lives, whatever the circumstance, and I wish everyone could be as lucky as I’ve been to experience such a life-changing shift in perspective on the prospects of recovery.