“…individuals with low self-esteem actually felt worse about themselves after repeating positive self-statements.”
“…paradoxically, low self-esteem participants’ moods fared better when they were allowed to have negative thoughts than when they were asked to focus exclusively on affirmative thoughts.”
Now, I don’t think I’ve ever claimed positive self-talk caused anyone to feel worse… but personally, I’ve never found it helpful as a coping mechanism. The results of the study do make some sense to me, though. Saying completely untrue statements like “I accept myself completely” make me feel further from that as a goal. I start to think, “Will I ever really accept myself completely? What’s wrong with me that I can’t right now? Does it matter if I do? Will I really feel better if I do?”
Also, the article makes a good point with being “allowed to have negative thoughts.” I think that often only positive affirmations are used in treatment in recovery. Things like “Everyone can get better,” “I know that you will beat this, you are such a strong person,” “You have too much potential to struggle with this forever,” “You’re making amazing progress,” etc. are all meant as motivational compliments. Maybe for some people they are… but again, I am backwards and actually feel a little invalidated when I hear how awesome I am doing in recovery. I don’t mind my therapist telling me I’ve made a lot of progress, but I do mind being told that I am doing great when I am feeling crappy. Additionally, sometimes I do worry that I will never get over this or that I will be considered “recovered” once I am 100% ideal body weight, regardless of whether or not I feel mentally/emotionally okay. I’d rather be told that she (therapist) knows that I am struggling and that she is there to support me, and that those fears are understandable becuase people do die from this illness or suffer from it their entire lives, but that I’m in treatment and working for something better than that.
I would love to see if there is a difference between others giving you affirmations vs. you creating them yourselves. I have a letter from an old therapist that says “you are more than enough” as well as a card from a different professional that says, “there are people who care deeply about you.” Both of these are comments that I could tell myself (I am lovable, my family and friends love me, etc.) but they are only significant because I care about and really look up to the people who gave them to me. I guess that’s what makes it so different from positive SELF-talk.
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:
because it is biological
because there isn’t one thing
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.
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.
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.
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.
I know a lot of patients (and professionals) who refer to their eating disorder as “Ed” (E.D.). I’ve always been a little wary of this… it feels weird to name a disorder that I’m struggling with. It makes me feel like I have schizophrenia or DID or something. However, in some ways it helps to thing of the eating disorder as a separate voice. It helps me to separate what I want from what the eating disorder wants.
My dietitian once told me “don’t bring Ed to dinner – leave him at home.” I have this vision of my sitting at a restaurant, with Ed at the end of the table with just a glass of water. Very silly, I know… but for some reason that helps me. Maybe it’s because I am separating the eating disorder from myself.
People with eating disorders are competitive — that’s (one) reason why you have to be careful who you put in groups together. I have some friends who I really like, but feel competitive with or triggered by. It’s easier for me to think of our two Ed’s fighting. We brought them along with us and now they are arguing.
Okay, now it sounds like I have an invisible friend… and usually I don’t think of the eating disorder as “Ed” — but there are certain situations where it’s helpful for me. But, my question is — what does your Ed look like? Do you have a mental image of it? I’m curious to hear how others envision it. I’ll draw mine and post it in the next entry…
I have been extra tired lately. VERY extra-tired. I go through spells of this and am always fairly convinced that there’s something wrong with me. It’s not normal for someone to get eight hours of sleep and need one – two naps during the day. I end up having conversations with my fiance like this:
grey: I think that I’m anemic. fiance: oh? grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps… fiance: Funny, those sound like the same symptoms of anorexia.
Then, the next month…
grey: I think I have hypothyroidism. fiance: You don’t say. grey: No, really — I have all the symptoms. fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles…. fiance: Kinda like anorexia.
And again….
grey: I think I have mono. fiance: Let me guess — lack of energy, loss of appetite and chills. grey: Exactly! fiance: You don’t have mono, you have anorexia. grey: I could have anorexia AND mono. fiance: Do you have a severe sore throat? grey: Well…. not YET….
Humph. He is right — these could all be consequences of the eating disorder. For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else. My eating isn’t particularly worse that day — why should I feel worse?
I think that I forget that how I treat (or mistreat) my body compounds over time. If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay. And, even on a larger scale, I think that years of disorderedness has taken a toll on my body. My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years. Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc. I can’t get away with the things that I used to be able to. Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono). But… maybe all the years of the eating disorder has taken a toll on my body. Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.
However… I am still going to have labs done at some point to rule everything out. You know, just in case…. (and in secret hopes of proving my fiance wrong!)
I have been extra tired lately. VERY extra-tired. I go through spells of this and am always fairly convinced that there’s something wrong with me. It’s not normal for someone to get eight hours of sleep and need one – two naps during the day. I end up having conversations with my fiance like this:
grey: I think that I’m anemic. fiance: oh? grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps… fiance: Funny, those sound like the same symptoms of anorexia.
Then, the next month…
grey: I think I have hypothyroidism. fiance: You don’t say. grey: No, really — I have all the symptoms. fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles…. fiance: Kinda like anorexia.
And again….
grey: I think I have mono. fiance: Let me guess — lack of energy, loss of appetite and chills. grey: Exactly! fiance: You don’t have mono, you have anorexia. grey: I could have anorexia AND mono. fiance: Do you have a severe sore throat? grey: Well…. not YET….
Humph. He is right — these could all be consequences of the eating disorder. For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else. My eating isn’t particularly worse that day — why should I feel worse?
I think that I forget that how I treat (or mistreat) my body compounds over time. If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay. And, even on a larger scale, I think that years of disorderedness has taken a toll on my body. My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years. Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc. I can’t get away with the things that I used to be able to. Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono). But… maybe all the years of the eating disorder has taken a toll on my body. Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.
However… I am still going to have labs done at some point to rule everything out. You know, just in case…. (and in secret hopes of proving my fiance wrong!)
I have mixed feelings about putting adolescents and adults together in treatment. I have been on both sides of the equation (treatment as an adolescent and treatment as an adult), and definitely have a stronger opinion about it now that I’m older.
Pros:
Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
Adults are (hopefully) more mature and less competitive. Eating disorders in general are competitive… and I’ve just found that when you have a large group of ED high school females in a room, who are not necessarily in the best place, you could be in for a disaster. Sometimes just having a couple of older people in the room is enough to keep everyone from competing as much.
Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.
Cons:
Being an adolescent and seeing adults in the group can cause some hopelessness that you’re never going to get better. It can give you the sense that people never really do get better and that you’re going to struggle with this the rest of your life.
As an adult, I often feel like a bad role model — especially if I’m having a hard time and an adolescent is doing well. I feel like as the older, “more mature” one, I should be responsible for setting the example.
Adolescents still live with their parents and (hopefully) their families are very involved in their treatment. I’m always a little jealous since my parents were pretty anti-treatment and didn’t (and still don’t) think that eating disorders are really problems. Sometimes interacting with others’ parents brings up stuff that you haven’t thought about recently (maybe that’s good, but it feels bad).
Adults and adolescents have different bodies, ideal weights, nutritional needs, etc. I know adults who have a really hard time being on the same meal plan as a 15-year old, with all the info they’ve heard about slowing metabolisms, muscle loss with age, etc.
Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
Adolescents and adults are (obviously) at different stages in life. Sometimes it’s hard to relate to one another and certain sessions may not seem helpful for one group or the other.
This is just the start of a list — I’m sure there are 100 reasons. Personally, as an adolescent, I was really happy to be in treatment with older women. I really looked up to them and thought that they were so wise — they knew so much and had so much insight. There were a couple of people who I wanted to be like. There were also people who I did not want to be like, and it was motivating to me. I definitely told myself that I would NOT be one of those adults with an eating disorder. It wasn’t until I WAS an adult that I started feeling guilty about still struggling and/or being a bad example.
If you haven’t noticed, I’ve added a poll to Grey Thinking’s sidebar (on the front page of the blog). I’ve thought about doing polls before, and while this one is not particularly creative, it is something that I’ve been wondering — how did you find out about GT?
I promise that future polls will be more interesting….
If you haven’t noticed, I’ve added a poll to Grey Thinking’s sidebar (on the front page of the blog). I’ve thought about doing polls before, and while this one is not particularly creative, it is something that I’ve been wondering — how did you find out about GT?
I promise that future polls will be more interesting….
‘But I ask myself if an eating disorder unit is the best place for an impressionable young girl to be,’ says Deanne Jade. ‘As any inpatient will tell you, a specialist unit is the best place to learn how to be really, really good at anorexia.’ They also breed their own subculture.
Oh, what a statement! This article is a couple of years old, but I still think it’s bold to suggest that the “highest level of care” for eating disorders actually makes people sicker. Everyone’s inpatient experience is different… but there is a lot of truth to this statement.
What about inpatient stays can make people sicker?
Exposure to the sickest of the sick. You know who these people are… the frequent flyers who have the most severe symptoms and often are the most manipulative and/or resistant to change.
Picking up other ED symptoms that you didn’t originally have. It’s not unheard of for a restricting anorexic to pick up purging after treatment.
Competition among eating disorders. This ranges from being the thinnest, eating the least, and having the most inpatient stays to comparing “worst BP episode” and visits to the ER.
Unhealthy modeling. Everyone around you is doing a great job of modeling ED-behaviors.. but other than the staff, there’s not a lot of “healthy eating” modeling going on.
Negative attitude toward treatment. If you weren’t originally treatment-resistant, there’s nothing like being surrounded by a group of girls who don’t want to be there to kill your motivation.
No life outside of the eating disorder. This is such a catch 22 of ED treatment… by making your recovery first and putting everything else on hold, your whole day revolves around the ED–which is kinda want the eating disorder wants. There’s no stress of school or work because all you’re doing is eating and sitting in eating disorder therapy.
As as for “breed[ing] their own subculture”… well, I’ve always said that there is an eating disorder world. You make friends in treatment. After discharge, you keep up and talk about how everyone is doing… is so-and-so back in treatment? I heard so-and-so is doing really poorly. Because you’ve given up school or work to go into treatment, the most interesting things going on in your life are your therapy and nutrition appointments. Everyone talks to each other about their appointments. You send each other cards. You continue doing the same arts and crafts that you were doing inpatient. Everyone’s lives are still consumed by the eating disorder so no one is doing great. It’s all very dysfunctional.
This is not true to everyone’s experience (not even necessarily to mine) and often residential treatment is the level of care that someone needs to get better and make progress in his/her recovery. My own inpatient stays were KEY to my recovery. However, negative stuff does go around in treatment. It’s kind of the dark side of inpatient treatment that people don’t talk about very often.
Grey Thinking 