Numbers – a Catch 22

I read this post on Dads and Daughters With Eating Disorders: Eating Disorders – Weights & Scales

To summarize:

Because her health is directly related to her weight.  Measured by scales.
Her recovery is directly related to her weight.  Measured by scales.
Her life is directly related to her weight.  Measured by scales.
Weight matters.
And scales matter because they measure weight.

I posted a comment on this post, which hasn’t been approved yet, but I decided that I wanted to discuss the issue on Grey Thinking anyway.

Yes, weight is inexorably tied to health and to recovery.  Weight restoration is vitally important to recovery.  You can’t be recovered and still be below the healthy weight range.  Professionals need to monitor weight.  Some treatment decisions need to be made based on weight.  In short, I am not at all arguing that weight is unimpotant for recovery.

With all of that said… I find a lot of diagnostic criteria and treatment approaches to be contradicting and frustrating.  In therapy, you’re told that you are not a number.  That you are lovable regardless of what the number on the scale says.  That coping with food / weight is not okay.  That eating should be mindful and emotional eating is unhealthy.  You don’t have to be sick to deserve care.

But think — how is your health measured?

• weight, BMI, % of IBW
• calories, exchanges, % of meal plan completed
• heart rate, blood pressure, potassium, electrolytes
• # of binges / purges, # of laxatives, # of diet pills
• hours exercised

… see my point?  Everything is measured in numbers.

I have an issue with your mental health being measured in numbers.  From this point of view, gaining weight = a good week and losing weight = a bad week.  That has just never been a linear relationship for me.  I have bad weeks and gain weight, and vice versa.  Sometimes I follow my meal plan and lose weight, and other times I restrict and gain weight.  The system reinforces the necessity of communicating through your eating disorder.  If you’re feeling crappy but follow your meal plan, then obviously you weren’t really feeling bad — if you were, you would have restricted.  Plus, when you are at a healthy weight — ta da, end of treatment!  You’re all better!  Even if you feel as crappy as ever, you’re not sick anymore, so…..

Thankfully not all professionals practice this way, but measuring your progress in recovery by numbers is not unusual.  I feel strongly that weight is just a piece of the puzzle… and while weight and eating are core components to eating disorders, by basing treatment on just these factors you are really limiting treatment.  There are people who will stay sick because the system inforces that they need to be to get help.  And that’s unfair…

Testing your therapist

Last night I watched all of the “In Treatment” Sophie episodes.  I am just engrossed in this show.  I feel so connected to the patients and to Paul.  I think that they discuss such intimate details that I feel like I am part of some deep relationship.  I can relate to a lot of what the patients say, so Paul’s responses are meaningful to me.  It’s also funny that I don’t feel comfortable ending therapy at the end of each season.  In episode nine of Sophie I was thinking, “No!  You can’t go!  There are so many things we still need to talk about.  I’m not ready to end therapy!  I’m still processing things.”

Anyway, one of the things that struck me about Sophie were all of times that she tested Paul.  “Testing” is a good word to describe the scenarios.  I probably would have looked at it differently had he not used that word.  But yes, “testing” is perfect.

I was trying to think if I’ve ever tested my treatment professionals.  I’ve definitely never overdosed, threatened to kill myself, or asked my therapist to change my clothing (I felt so awkward even watching that moment)… but the more that I think about it, the more aware I am of how many times I have tested professionals.

For example:
Nutritionist – With my most recent nutritionist, I’ve turned in a couple of really bad days worth of foods logs to see if she would say something (that wasn’t really the reason they were bad, but it’s the reason I turned them in instead of just not writing those days down).  If she didn’t say anything, then it meant that my following my meal plan didn’t matter.  She passed.  Another time when I felt like she was tired of dealing with me, I stopped making appointments.  I figured that when she decided that I needed an appointment, she would say something.  No such luck — failed that test.

Therapist – Sometimes my therapist assigns me homework.  I’ll do it, but don’t bring it up or turn it in during our next session unless she says something.  If she doesn’t, that means she doesn’t remember and it doesn’t really matter.  She usually fails this test.  It’s probably the only test that she fails, though.  For months I didn’t tell her much just because I didn’t trust her… I thought she would think I was ridiculous.  So, piece by piece I’d tell her little bits of information and watch how she responded.  She was concerned and validating and understanding — definitely passed.  Another big issue of mine is calling/emailing/anything outside of a session.  I just feel like it is not her responsibility to deal with me outside of that hour a week.  I am so afraid that I will be too needy or too much and that I will ruin the relationship.  She says that it’s impossible to ruin the relationship, but I don’t know.  Anyway, I called her one day when I was really upset, and she was there for me and she wasn’t at all annoyed that I called.  Pass.

I could go on, but that’s more than enough examples.  While I do like the word “testing,” I think that it has a negative connotation.  I think that to some degree, it’s a part of therapy — learning to trust the professional.  I hate feeling vulnerable and it takes me a long time to open up and trust someone.  I have to feel certain that the person isn’t going to hurt me, though.  It’s like testing the waters.  It’s hard to build trust.  I need to reassure myself somehow that this person is going to care and isn’t going to walk away when I actually need her.

What if your child were ill?

Everyone should go and read the discussion about this post — so many interesting things have been said from people with very different beliefs about the cause and treatment of eating disorders.  One question stood out to me, though:

Who would you go to if your child was ill?

I’m going to change the question a little bit:  What would you do if your child were ill?

I’ve thought about this a lot since “discovering” the Maudsley Method (I had never heard of it until a couple of years ago).  Maudsley contradicts many of the beliefs that I was taught in treatment — it’s not about the food, there are lots of issues to work through, family therapy is necessary, etc.  I’ve been to residential treatment centers a couple of times and seen a dozen (or two) professionals outpatient.  Everyone has a different thought on what “caused” (or contributed) to my eating disorder.  My parents have both been blamed at times (each individually — either my mom OR my dad), sure.  My ex-boyfriend has been blamed.  I’ve been told that I’m just perfectionistic and that I feel out of control in my life.  I don’t even remember half the things that I’ve been told.

Honestly, I think that discussing what “caused” my eating disorder is a waste of time:

1. because it is biological
2. because there isn’t one thing
3. because my childhood was 15 years ago and I am tired of rehashing it

In therapy, I’m dealing with what’s going on now.  Just as an example, I’m afraid of wrecking relationships.  Maybe this is because I didn’t feel like my mother cared, or because I feel unlovable, or because I wrecked a relationship with a guy — I don’t know.  I can’t change any of that and I’m not sure that identifying the source would make a difference.  I can, however, explore how this issue is affecting my life now.  I’m afraid to be open with friends because I don’t want to be a burden and screw things up.  I hate emailing my therapist because I don’t want her to think that I’m needy and unreasonable.  I feel like a lot of my work right now is exposure therapy.  It’s taking that step and emailing my therapist when I’m having a bad night, and then talking about it at our next session and realizing that I didn’t wreck anything.  I’m trying to be more “real” with friends and trusting / hoping / praying that they can be there for me and don’t mind listening.  You get the point.

I know that I seem way off-topic, but I have a purpose for all of this.  When I was an adolescent, I would have probably responded well to the Maudsley Method — especially since I so badly wanted my parents to care and to notice and to tell me that my health was important.  That didn’t happen, but I did get that support and education from residential treatment.  My parents wouldn’t have done family-based treatment if they had known about it.  I don’t really care to elaborate on that, but trust me, they would not have.

If I had a daughter, though, I’d use the Maudsley Method.  Well, if I had a daughter, she would never GET to a point where she needed inpatient treatment because I would have her in therapy so fast.  But yes, I would be the adult and I would tell her that this is important and I would make her sit at the table for two hours or however long until she finished her meal.  Of course I would have her in therapy, too…

Not all families are willing to make the investment that FBT requires.  If you are on this blog and are reading this, then that’s probably not you.  One reason that I think Maudsley is effective is because it addresses so many of the underlying issues and concerns — whether you realize it or not.  You’re telling your child that you love them, that you are the adult, that their health is important, that it’s okay (and necessary) to take time out for themselves, that you support them, that you notice and care, that they matter, etc.  That’s not something that my parents would do, so I got those messages in residential treatment.  It’s not the same, for sure.  I still think that I would have needed years of therapy, just because there is / was a lot of stuff to process.  But yes, I would use FBT with my daughter.  It’s not an option for everyone, but if you are educated and knowledgeable about the illness, then you know how important your role is as a loved one.

Caring makes you vulnerable

If you haven’t seen “In Treatment,” you definitely need to look it up.  It’s on HBO, so I would have never known it existed were it not for a good friend of mine.  Thank goodness she brought it to my attention, because I am so captivated by it.  While it can seem a little slow at times, the dynamics in the relationship between therapist and patient are so interesting.

Anyway, this past week I watched all seven weeks of April’s sessions.  I’m not going to summarize her whole story, but in the last episode she decides to discontinue treatment with Paul (therapist).  She says she can’t continue to see him because he saved her life.

This struck me as a little odd.  I was reading a blog post about it, and the author had a really good point:

“I think this is her way of preserving the feelings and experiences she has had with him, preserving them against the destructive urges she is still experiencing — in leaving school, in believing she cannot have love and a normal life. Leaving now allows her to continue to hold him as her savior…”

Now that makes a lot of sense to me.  She’s been through a lot of pain in her life that makes it hard for her to trust anyone.  She’s always taken are of herself because her parents are preoccupied taking care of her brother.  She probably thinks it’s not okay to have needs or to not be self-sufficient, because she has seen how her brother’s dependency has changed her mother’s life.  She has a pretty tough facade.

I think that on a deeper level, though, she really wishes that someone would really understand her and be able to reach her.  She needs someone to take care of her.  I don’t think that she put off chemo because she really wanted to die, but because she wanted someone else to be the adult and take care of her.

I can relate to that with the eating disorder.  I didn’t want to ask for help — I felt that if I really needed help, that someone would notice that I wasn’t okay and make sure I got help.  i knew that I was hurting my body and didn’t care.  Well, half of me didn’t care and the other half couldn’t understand the severity of the illness.  Never for a second did I think I was going to have a heart attack or end up with osteoporosis or anything.  But, that is like April — she was really sick with cancer and she was still waiting for someone to take care of her.  For someone to tell her that treatment mattered — that SHE mattered and that her health was important.  That she was worth taking care of.

Not only did she not want to have to ask for help, but I think that she felt guilty for needing help.  Not really guilty for having cancer, but that the cancer and her treatment were going to affect other people.  She cared more about not burdening her mother than saving her own life.  Again, I understand that — it’s easier for me to suffer than to hurt someone else.  I hate that my eating disorder affects other people.  I try to minimize the significance of it… not because I’m lying or trying to be manipulative, but because I don’t want to be a burden to my fiance, friends, or family.

I also know the feeling of your therapist being your “savior.” I don’t think I would have ever personally chosen that word, but when someone really does understand and connect to you on that deeper level… when they do just know that you’re okay and take care of you when you don’t ask… that’s valuable!  You have spent forever believing that it would never happen.  And now that there is someone in the world who can connect with you in that way, you’re afraid to lose it.  The thought of being let down by that person is too much to bear.  Or, even worse… what if you drove that person away?  You could ruin the relationship.

I have two theories on why April decided to discontinue treatment with Paul.

1. I think that sometimes when you get what you need, you can move on with your life.  April needed someone to take care of her in that moment and to show her that she mattered.  Paul repeatedly showed concern over her not taking care of herself and eventually even drove her to chemo.  She felt that loved — and that’s what she needed.
2. She wanted to think of Paul as her savior or caregiver, and not just her therapist.  He told her in the previous session that he couldn’t play both roles, and I think that she would rather pretend that he could than continue a relationship where he was just her therapist.  It’s less painful.

I know that I have jumped all around in this post, but basically — I could relate to a lot of the issues that April was dealing with (minus the very real threat of death… and losing my hair).  The therapeutic relationship between her and Paul was familiar to me.  I question her ending treatment with him, however, and am very suspicious that her decision was motivated by the fear of losing someone important.