A Treatment Refresher

While I do have several new posts on the way, I want to highlight a couple of older Grey Thinking posts (some are several years old!  I bet you were not reading GT two years ago) that talk specifically about treatment, your attitude toward treatment, recovery expectations, etc.  While there are a couple of people that I have in mind when it comes to the subject of these posts, I think that everyone can use the refresher.

You as your own case manager
Originally Posted: 01/01/2009

I wish that all these guys were going to stay clean, I really do. I’ve just seen it so many times that I can tell when someone’s really willing to do whatever it takes and when someone’s willing to do what they think it should take. And it’s just not going to work like that, unfortunately.

–Shelly, Celebrity Rehab with Dr. Drew 2

Wanting to want to recover
Originally Posted: 06/12/2008

Motivation to change implies an intention–weak or strong–to change one’s behavior. However, AN patients may at the same time both wish to recover and be highly resistant to change their behavior. Therefore, we suggest that assessment of motivation in these patients should include not only their motivation to change, but also their different wishes to recover which do not necessarily imply a behavioral intention.

Dr. Drew should treat eating disorders
Originally Posted: 07/01/2008

There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

1. Recovery is a lifelong, daily process
2. Denial, and not necessarily that you have a problem, but that you need help
3. The importance of personal accountability
4. There’s no magic cure
5. The disorder should be taken as seriously as any potential fatal disease

Do not pass Go, Do not collect $200
Originally Posted: 12/09/2008

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

That's not actually a deep question

“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

1. What does it mean to feel?
2. How did it feel to be in that space?
3. How does it feel to be in this space now?
4. What does it mean for you to not be in that space anymore?
5. How do you experience that process?
6. What would it mean for there to be grey in your world?
7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

1. It means that I have feelings
2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

That’s not actually a deep question

“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

1. What does it mean to feel?
2. How did it feel to be in that space?
3. How does it feel to be in this space now?
4. What does it mean for you to not be in that space anymore?
5. How do you experience that process?
6. What would it mean for there to be grey in your world?
7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

1. It means that I have feelings
2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

I'm going to need that in writing.

I am not  an auditory learner.  At all.  I’m definitely a visual learner — in college I took copious notes, but didn’t really grasp the class material until later going over and reading those notes.  There’s just something about reading/writing that I need to get it.

Unfortunately, this doesn’t serve me too well in therapy.  I can have a great session and later that night not even remember half of what we talked about.  And on the same level, when I’m in session I don’t remember half of what I planned to say.

In an effort to make my time in therapy more useful, I’ve started to write things down.  Not quite journal, but write when I’m upset or just a couple of points I want to make sure that I let my therapist know.  If I’m afraid that I won’t bring up the issue in therapy, sometimes I’ll email them to her before my appointment.

That’s just one way that writing things down helps me in treatment.  Another is with my meal plan.  I know my meal plan backwards and forwards at this point, but one day I decided to pin it to pin it to my bulletin board above my desk.  This probably sounds silly, but it has made such a difference.  I am reminded all day that my meal plan and recovery are important.  When I’m in the middle of work I think “oh, I’ll eat that later” or “I am too busy right now,” but just having it written out and sitting in front of me helps me remember that treatment is important even when I’m not in my therapist’s office.

A third way is with affirmations.  Well, affirmations may not be the word that I’m looking for… but clips of little things that mean something to me.  For instance, also on my bulletin board is a fortune from a fortune cookie that says “Remember there are people who care deeply about you.”  I also have this paper on which my therapist wrote, “You can let go of your ED and still be validated” and “Never forget, but forgive and make yourself a better person.”  And then, sometimes I’ll print out pieces of funny or significant emails (from anyone in my life) and pin those up.  Yes, I have a very large bulletin board!

I need a written reminder for several reasons:

1. I’m a visual person
2. I twist things and second-guess myself and think “she didn’t mean it that way” or “I am reading into that too much.”
3. Being continually reminded helps me convince myself that it is true

Different types of therapy are helpful for different people, and I think that there is some trial-and-error involved in figuring out what works for you.  Personally, I highly recommend investing in a bulletin board.

I’m going to need that in writing.

I am not  an auditory learner.  At all.  I’m definitely a visual learner — in college I took copious notes, but didn’t really grasp the class material until later going over and reading those notes.  There’s just something about reading/writing that I need to get it.

Unfortunately, this doesn’t serve me too well in therapy.  I can have a great session and later that night not even remember half of what we talked about.  And on the same level, when I’m in session I don’t remember half of what I planned to say.

In an effort to make my time in therapy more useful, I’ve started to write things down.  Not quite journal, but write when I’m upset or just a couple of points I want to make sure that I let my therapist know.  If I’m afraid that I won’t bring up the issue in therapy, sometimes I’ll email them to her before my appointment.

That’s just one way that writing things down helps me in treatment.  Another is with my meal plan.  I know my meal plan backwards and forwards at this point, but one day I decided to pin it to pin it to my bulletin board above my desk.  This probably sounds silly, but it has made such a difference.  I am reminded all day that my meal plan and recovery are important.  When I’m in the middle of work I think “oh, I’ll eat that later” or “I am too busy right now,” but just having it written out and sitting in front of me helps me remember that treatment is important even when I’m not in my therapist’s office.

A third way is with affirmations.  Well, affirmations may not be the word that I’m looking for… but clips of little things that mean something to me.  For instance, also on my bulletin board is a fortune from a fortune cookie that says “Remember there are people who care deeply about you.”  I also have this paper on which my therapist wrote, “You can let go of your ED and still be validated” and “Never forget, but forgive and make yourself a better person.”  And then, sometimes I’ll print out pieces of funny or significant emails (from anyone in my life) and pin those up.  Yes, I have a very large bulletin board!

I need a written reminder for several reasons:

1. I’m a visual person
2. I twist things and second-guess myself and think “she didn’t mean it that way” or “I am reading into that too much.”
3. Being continually reminded helps me convince myself that it is true

Different types of therapy are helpful for different people, and I think that there is some trial-and-error involved in figuring out what works for you.  Personally, I highly recommend investing in a bulletin board.

Adults & Adolescents – In Treatment Together

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:

1. Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
2. 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.
3. Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.

Cons:

1. 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.
2. 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.
3. 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).
4. 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.
5. Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
6. 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.

More than stigmatization

There is definitely a stigma surrounding mental illness.  It doesn’t receive the same kind of acceptance as physical illness.  I’m not really going to get into stigmatization and society and whatnot, but I just want to make it clear that I believe that physical illness is much more understood than mental illness.

That said, I am a little disappointed to read this article on relationships and mental health:

A partner is four times more likely to leave you because of a mental health condition like depression than because of a physical disability.

The survey, which asked people about issues that would make them break off a romantic relationship found that 20 per cent of British women wouldn’t stay with someone if they were diagnosed with schizophrenia, yet only a few of them would break up with someone who became disabled and needed to use a wheelchair.

The article chalks up the entire discrepancy to stigmatization.  Naturally, I think that there are other elements contributing to this problem:

1. Personality changes – I think the biggest issue is that mental illness has a larger impact on your personality, mood, and temperament.  It’s not easy to be around someone who is really depressed.  You want to connect with your partner, spend time with them, and in general just be happy to be around them.  Most mental illnesses cause people to push others away, be irritable, isolate, etc.  These qualities are not very conducive to relationships.  In high school, my eating disorder definitely affected my relationships.  I didn’t want to go out to eat.  I didn’t want to see a late-night movie because I was too tired.  I took everything personally and was really depressed.  I was much more interested in the disorder than in my relationships.  I was not a fun date (to say the least).
2. Expectations of recovery – I think that it’s frustrating to be with someone who you feel should be getting better, but isn’t.  If you are in a wheelchair (to continue with the article’s example), you might never be expected to walk again.  However, if you have an eating disorder, you are expected to get over it.  It’s tiring to spend years and years worrying about someone who is continually in and out of treatment, rarely making significant gains in their recovery.  Your expectations are different.  Realistic or not, it can be exhausting to watch someone chronically struggle and feel like they don’t necessarily even want to get better.
3. You don’t know what you’re getting into. When you start dating a guy in a wheelchair, you know he’s in a wheelchair.  You very well may not know that your date is bipolar, though.  Again, it’s an expectations thing.
4. Baggage. As non-PC as this is, it’s true — mental illness carries a lot more emotional baggage than physical illness.  Someone with a mental illness is more likely to have a familial history of mental illness, childhood abuse, an alcoholic parent, or some other kind of trauma.  Eating disorders don’t develop in a vacuum, right?

Naturally, I wouldn’t discourage anyone from dating someone with a mental illness.  Actually, I don’t even like the “mental illness” label.  If we’re all on a mental health / mental illness continuum, then where do you draw the line, anyway?  (this is a discussion for another time!)  I just think that there’s a lot more at play than just stigmatization.

The bio-psycho-social-economical model

Headline: Bad Economy Spurs Eating Disorders

According to Twin Cities, the patient load at Park Nicollet’s Melrose Institute/St. Louis has increased by 36 percent from one year ago, while the patient load at The Emily Program/St. Paul has increased by 20 percent for the same time period.

For instance, he says, people who suffer from an obsession with their weight, but who exercise to control weight gain rather than starve themselves, may no longer be able to afford their gym memberships. In that case, Jahraus says, they may decide to limit their food intakes, which can lead to eating disorders.

Oh, this article could have been so interesting! It was an interesting thought. The part about not being able to afford your gym membership and therefore developing an eating disorder killed the article (for me), though. Oh well…

Still, I wouldn’t jump to the conclusion that a bad economy spurs eating disorders… but rather that a bad economy motivates more people to get help for their eating disorders. Why is this?

Well, I think that there are several reasons….

1. A big barrier to treatment is work. You have responsibilities… you can’t just disappear for a month or two to go into treatment all day. If you are laid off, though, suddenly you are available in the middle of the day. You don’t have another commitment. You have time to get the treatment that maybe you’ve needed for a couple of years but never felt you had time to get.
2. Feelings of disappointment, shame, and embarrassment. These are tough feelings for anyone, but are especially tough feelings for someone with an eating disorder. It’s not unlikely for someone with an ED to take being laid off personally… as if they somehow failed. They might think it is a reflection of themselves — they’re not good enough. What are they going to tell friends and family? Others will be so disappointed. When you’re feeling this depressed and hopeless, you’re more motivated to go and get help — you don’t want to feel like this.
3. Lack of structure. Many people with eating disorders struggle with endless periods of free time. Work provides a daily structure that’s helpful. When you are missing that, sometimes things fall apart. Maybe getting intense treatment will help you with that transition… to either help you figure out how to cope with the free time or to tide you over until you get a new job.
4. Friends and family have time to notice your issues. If you’re at work all day, your friends and family might not realize how little you’re eating or how much you’re exercising. When you’re suddenly at home all the time, they have a much clearer picture of what your eating/exercising habits are like during the day… and they might be concerned and encourage you to get treatment.

I’m so okay that I’m boring

Chase: You don’t let other people’s problems affect you. You don’t let your own problems affect you, and it’s the screw-ups that make us interesting. You’re never out of control, which is good… and boring. Never losing control means you’re never putting yourself out there, never pushing your limits.

— House MD, Lucky Thirteen

The problem with perfection (ha, that’s ironic): it’s boring. There’s nothing “special” about seeming perfect. And yet, I still strive for it. I want for everything to be “correct.”

I want to….

• always get good grades
• never appear to have any problems
• not struggle with anything
• never screw up
• never need help
• handle everything with grace, unflinchingly
• be completely independent
• never seem disappointed or hurt or angry
• always be positive
• seem to get along with everyone
• have only good relationships

etc, etc, etc. I don’t ever want anyone to think that something is wrong. I don’t want to seem vulnerable or not-okay. I just want everything to always seem okay (well, and to be okay, but I’ll settle for “seem”).

And this makes me boring. Chase hits the nail on the head with why: “Never losing control means you’re never putting yourself out there.” Relationships require for you to put yourself out there–to be vulnerable and relatable and imperfect. The friends that I am closest to are those who have seen me NOT okay. They know that I have issues with eating and depression… they know I don’t agree with my fiance 100% of the time… they know that things are weird between me and my parents. They know that I get overwhelmed with work and that there are coworkers who really get to me. They know there are a lot of things that I really suck at (like trying to learn a foreign language, most team sports, and cooking).

When I think about it, I am essentially putting so much time and energy into being boring. And maybe I could justify boring as feeling better (being in control, not being as affected by things, minimizing negative interactions and consequences), I think it just feels safer–not better. Because when you never let your guard down, you never let people in. If you never admit that you’re not okay, how can anyone ever help you feel better?

I'm so okay that I'm boring

Chase: You don’t let other people’s problems affect you. You don’t let your own problems affect you, and it’s the screw-ups that make us interesting. You’re never out of control, which is good… and boring. Never losing control means you’re never putting yourself out there, never pushing your limits.

— House MD, Lucky Thirteen

The problem with perfection (ha, that’s ironic): it’s boring. There’s nothing “special” about seeming perfect. And yet, I still strive for it. I want for everything to be “correct.”

I want to….

• always get good grades
• never appear to have any problems
• not struggle with anything
• never screw up
• never need help
• handle everything with grace, unflinchingly
• be completely independent
• never seem disappointed or hurt or angry
• always be positive
• seem to get along with everyone
• have only good relationships

etc, etc, etc. I don’t ever want anyone to think that something is wrong. I don’t want to seem vulnerable or not-okay. I just want everything to always seem okay (well, and to be okay, but I’ll settle for “seem”).

And this makes me boring. Chase hits the nail on the head with why: “Never losing control means you’re never putting yourself out there.” Relationships require for you to put yourself out there–to be vulnerable and relatable and imperfect. The friends that I am closest to are those who have seen me NOT okay. They know that I have issues with eating and depression… they know I don’t agree with my fiance 100% of the time… they know that things are weird between me and my parents. They know that I get overwhelmed with work and that there are coworkers who really get to me. They know there are a lot of things that I really suck at (like trying to learn a foreign language, most team sports, and cooking).

When I think about it, I am essentially putting so much time and energy into being boring. And maybe I could justify boring as feeling better (being in control, not being as affected by things, minimizing negative interactions and consequences), I think it just feels safer–not better. Because when you never let your guard down, you never let people in. If you never admit that you’re not okay, how can anyone ever help you feel better?