A dishonest vegetarian

I had a dietitian call me this once… and I’m sure she didn’t create the label just for me. By “dishonest” she meant that I wasn’t a vegetarian for moral reasons, but for ED reasons.

If you’ve ever been residential, you know that there is a much higher incidence of vegetarianism in eating disorder patients than in the general population (similar to how there are so many more runners (even marathoners!) with EDs… but I’ll save that thought for another day). Coincidence? Probably not.

Converting to vegetarianism is often an early sign of eating issues… it is, for one, a type of restricting. Not only are you just not eating meat… but it’s a “great” excuse for avoiding all kinds of things. No pizza if there’s pepperoni on it. No chicken noodle soup. No sandwiches (most of the time). You can’t go to the company BBQ, unless they happen to have tofu wings or something. It’s an excuse for avoiding high calorie foods, for eating anything at all (since sometimes everything has some kind of meat in it), and for avoiding social eating altogether. All of this sounds pretty obviously eating disordered.

Now, I will argue that I never liked meat — as a kid I would eat all the other non-meat stuff at dinner. I never touched pepperoni pizza — eww, pepperoni. I am sure I have never in my entire life ordered a steak (but then again, how many 10-year olds order steak?). I think that high school was the first time that I realized I COULD be a vegetarian. Granted, this did coincide with the worsening of my eating disorder….

I will also argue that since becoming a vegetarian (and having been one for many years), eating meat seems increasingly disturbing to me. Turkey lunch meat could be okay… but ham? Or a chicken breast? I don’t want to eat something that has the name of a body part in it. Granted, I DO eat fish… and this is mainly because my life would be really difficult if I didn’t (at least I can order seafood at a restaurant and get some kind of decent protein). Fish bother me sometimes…. because they look like fish. I don’t want to remember that my food was swimming.

So, how much of my vegetarianism is eating disordered? I’d probably say 50%.

But… so what? Maybe vegetarianism is healthier than eating meat. There are plenty of studies out there that link meat eating with heart disease, cancer, and strokes (for additional examples, see GoVeg.com). What if vegetarianism is the picture of health? It’s becoming an increasingly popular idea. In this case… I’m just trying to be healthy. Granted I need to eat ENOUGH of everything, but the vegetarianism should be fine… right?

I had a therapist tell me that I could be a vegetarian AFTER recovering from anorexia. After challenging all my food fears and incorporating meat back into my diet, THEN I could re-evaluate and decide to be a vegetarian for purely moral beliefs. This brings up a familiar sticking point for me (which I have written about before — see my Dr. Drew should treat EDs post): “This may be normal but I can’t engage in it because I have an eating disorder” (like with skipping meals when you are sick and don’t feel well or training for a marathon). Anyone else can be a vegetarian for any reason that they want… I, on the other hand, can’t because of my ED history. It’s healthy for them… but not for me?

I understand my therapist’s point — if the vegetarianism is a part of the eating disorder, then it needs to be addresses and overcome. If it’s a truly moral thing, I can go back to it after getting over my fear of eating meat. But at the same time, if I’m eating enough and doing well in my recovery, who cares if I choose not to eat meat? My great-grandmother had Alzheimer’s, and the consumption of meat has been strongly linked to Alzheimer’s. I don’t want Alzheimer’s — in fact, I want to do everything I can to prevent it. Shouldn’t that be enough of a reason to not eat meat?

It might be a touchy subject, but what do you think? Is vegetarianism not-okay if you have (or have a history of) an eating disorder?

Things I would hate about CBT-E

Well, I am officially the last one to jump on the “New Psychotherapy Has Potential to Treat Majority Of Cases Of Eating Disorders” article. I’ll admit, this journalist did a great job with his headline — not only did I read the article, but I went on to read up on CBT-E.

To quickly define CBT, Cognitive Behavior Therapy and Eating Disorders explains:

The strategy underpinning CBT-E is to construct a ‘formulation’ (or set of hypotheses) of the processes that are maintaining the patient’s psychopathology and use it to identify the features that need to be targeted in treatment. Thus, a personalized formulation is constructed at the very onset, although this is revised as treatment proceeds.

That didn’t really mean much to me, but I skimmed through the book and quickly decided that CBT-E was not for me.

Things I would hate about CBT-E:

1. It’s time-limited to 20 sessions. This just makes me mad from the start. I want to think that if I’m still having a hard time in 20 sessions from now, that I would still be able to get help. That ED treatment isn’t like antibiotics — you take a course of them and you’re cured.
2. It’s not meant for anorexia. Which means…. it wouldn’t help me?
3. It doesn’t help with depression. In fact, Major Depressive Disorder is a contraindication.
4. There’s no “treatment team” — only one therapist can be treating you. While I understand there can be communication issues once more than one professional is involved, I’ve always found it helpful to have a separate psychiatrist, nutritionist, etc. I don’t really want to talk to my therapist about food exchanges or prozac.
5. Significant others are hardly involved. (And family is not involved at ALL, but I’m not really complaining about this in my case). But really, shouldn’t you involve your loved ones so that they can better help you? And isn’t it possible that there are things going on in your surrounding relationships that could be affecting you and your eating? According to Cognitive Behavior Therapy and Eating Disorders, “topics outside the eating disorder are not usually addressed.”

The Rule of Thirds

Around one third of patients [with anorexia] recovery fully; another third improve significantly and the last third do not recover.

—Eating Disorders Factfile

I had a therapist explain this statistic to me once…

Group 1: Full recovery – The individual either recovers on her own or with treatment. The duration of the illness doesn’t really matter… what’s important is that the she goes on to live a relatively symptom-free life.

Group 2: Significant improvement – This could mean two things: Either the individual improves to a point where she can have a life with manageable symptoms or she “rides the ED roller-coaster,” so-to-say, with up and down periods of recovery and relapse. While the eating disorder still may affect her life, she’s a functional, productive member of society.

Group 3: Chronic illness — The individual is severely ill for most of her life (since diagnosis). Periods of recovery are brief (if existent at all) and all of her time is spent either consumed by the eating disorder or in treatment for it.

So, given these definitions, I decided that I was probably in group 2 (okay, go ahead and tell me that that’s the wrong mindset and that I could be in group 1 if I wanted to, etc. I am being realistic here). Kind of kiddingly I asked, “So, if you’re not in group 1, are you in therapy for life?” And her response: “Maybe–sometimes.”

WHAT! I only asked this question because I thought it was a pretty absurd question. She went on to explain that for the 2/3rds that don’t recovery completely, the goal is minimizing symptoms. Maybe you can go 6 months without treatment… and then after a year of going back to therapy and getting back on track, you can make it a full year without needing to see someone. The goal is always to get better… but if that means intermittent–or even consistent–treatment throughout your life, then that’s okay.

… thoughts?

“All we’ve done is make a girl cry”

From an Episode of House, MD: Episode 3-12, One Day, One Room

In case you haven’t seen it, a girl has been raped and refuses to talk about the trauma. These are the last lines of the episode.

CUDDY: She’s gonna be okay.
HOUSE: Yeah, it’s that simple.
CUDDY: She’s talking about what happened. That’s huge. You did good.
HOUSE: Everyone will tell you… that that’s what we gotta make her do. We have to help her, right? Except we can’t. We drag out her story. Tell each other that it’ll help her heal. Feel real good about ourselves. But all we’ve done is make a girl cry.
WILSON: Then why did you…?
HOUSE: Because I don’t know.

Doesn’t this sound like the promise of therapy? That if you show up and talk about stuff that sucks, you’ll be okay? That’s at least the initial illusion that I had (similar to my inpatient treatment illusion — that you go away for a couple of months and come back okay).

So I went and I talked and I cried and I did not leave feeling okay. In fact I left feeling worse than before, and it took months (maybe years) to get back to my beginning neutral (apathetic) state. And I’ll admit that I had more insight than I began with, but if anything that just made some things in life harder for me (i.e.: particular relationships).

And then, after grieving my loss of hope that I would someday get over this, I moved onto accepting that “I just can’t be helped” (is that progress? probably not). It wasn’t really a “this is hopeless, there is not point in trying for the rest of my life,” defeat-like acceptance, though… but more of a “I am never going to work through this so I need to do my best to just ignore it” acceptance.

And that worked okay, because I finished school and formed meaningful relationships and functioned as a self-sufficient adult. But… then I went back and found a therapist. Why?

Well…. I don’t know. Because things weren’t quite right and I didn’t have any better ideas.

"All we've done is make a girl cry"

From an Episode of House, MD: Episode 3-12, One Day, One Room

In case you haven’t seen it, a girl has been raped and refuses to talk about the trauma. These are the last lines of the episode.

CUDDY: She’s gonna be okay.
HOUSE: Yeah, it’s that simple.
CUDDY: She’s talking about what happened. That’s huge. You did good.
HOUSE: Everyone will tell you… that that’s what we gotta make her do. We have to help her, right? Except we can’t. We drag out her story. Tell each other that it’ll help her heal. Feel real good about ourselves. But all we’ve done is make a girl cry.
WILSON: Then why did you…?
HOUSE: Because I don’t know.

Doesn’t this sound like the promise of therapy? That if you show up and talk about stuff that sucks, you’ll be okay? That’s at least the initial illusion that I had (similar to my inpatient treatment illusion — that you go away for a couple of months and come back okay).

So I went and I talked and I cried and I did not leave feeling okay. In fact I left feeling worse than before, and it took months (maybe years) to get back to my beginning neutral (apathetic) state. And I’ll admit that I had more insight than I began with, but if anything that just made some things in life harder for me (i.e.: particular relationships).

And then, after grieving my loss of hope that I would someday get over this, I moved onto accepting that “I just can’t be helped” (is that progress? probably not). It wasn’t really a “this is hopeless, there is not point in trying for the rest of my life,” defeat-like acceptance, though… but more of a “I am never going to work through this so I need to do my best to just ignore it” acceptance.

And that worked okay, because I finished school and formed meaningful relationships and functioned as a self-sufficient adult. But… then I went back and found a therapist. Why?

Well…. I don’t know. Because things weren’t quite right and I didn’t have any better ideas.

I am a beautiful person

This is not going to be an insightful or even remotely academically-based post — nope, just something that’s on my mind today: Positive Self Talk (PST).  I have to know… does this actually help anyone?  If you are having a lousy body image day and stand in the mirror and tell yourself that you are a beautiful person… do you feel better?  Because on these days when I am truly depressed over weight or self-image or the like, there is NO self-love coming out of my mouth.  These are days where I avoid the mirror and scale at all costs and wear clothing that I know will absolutely fit… and when I try my hardest to distract myself with work and friends and my dog and to not wallow in my bad body image-inspired depression.

Now, there are some “better” days where maybe my jeans are tight and I’ll make excuses for myself… I ate 300% of my DV of sodium yesterday or I just pulled them out of the wash or something… but still, I am never in the mood to plant myself in front of the mirror with a list of affirmations.

I only bring this up because a certain body image therapist highly recommends that I practice some PST… and I have to know if others get something out of this.  I’m really not writing this post out of ignorance but out of frustration.  Please–change my mind about it.

Some treatment could sink the Titanic

“I’m not going to rearrange the furniture on the deck of the Titanic.” — Rogers Morton

I think that during recovery, a lot of people get stuck rearranging deck chairs. While you’re spending all this time working on some trivial issue, your overall recovery progress is stagnant (at best).

Examples from my own history:
* Dozens of Dermatologist appointments during the height of my eating disorder (I’m sure my acne was caused mostly by nutrition issues). When asking my Dermatologist about the depression side-effect of Accutane (since I was already on antidepressants), she replied “oh no, it will actually help grey’s depression! she’ll have clearer skin so she’ll have higher self-esteem and therefore be less depressed.” … Really? And who cares about acne when my EKG is off?

* Spending months talking about how I was controlling food because my parents were too controlling of me. (not only do I think this is complete BS, but really… what were we waiting for? My accepting this as true and therefore then being able to move on and give myself permission to eat?

* Three months fighting with my nutritionist about eating a sandwich. She felt the sandwich was very symbolic of my motivation to recovery…. I felt (and still feel) like it was just a sandwich. I wasn’t eating more than 1000 calories at the time (obviously not a stellar recovery period)… who cares about the sandwich?

* Art therapy. Okay, lots of people participate in meaningful art therapy… but really, I was happy to just draw pictures and make stuff up about their significance. “My mother and I are wearing the same color because we compete with each other.” “My flower has no roots because I don’t feel like I know myself.”

My point: Great Feng Shui won’t keep your boat from sinking.