Alternative coping – a tough sell

I thought that these quotes would be especially appropriate after my series on coping skills.

Dr. Meredith Grey: In the hospital, we see addiction every day. It’s shocking, how many kinds of addiction exist. It would be too easy if it was just drugs and booze and cigarettes. I think the hardest part of kicking a habit is wanting to kick it. I mean, we get addicted for a reason, right? Often, too often, things that start out as just a normal part of your life at some point cross the line to obsessive, compulsive, out of control. It’s the high we’re chasing, the high that makes everything else fade away.

Dr. Meredith Grey: The thing about addiction is, it never ends well. Because eventually, whatever it is that was getting us high, stops feeling good, and starts to hurt. Still, they say you don’t kick the habit until you hit rock bottom. But how do you know when you are there? Because no matter how badly a thing is hurting us, sometimes, letting it go hurts even worse.

I’ve talked about this before, but I think that wanting to want to recover is a big roadblock in eating disorder treatment. Meredith explains it very well — we get addicted for a reason. The ED plays a role in our lives. You don’t go seeking an eating disorder… but for whatever reason (I’m sure largely biological), coping via food / exercise works for you. Restricting did give me some kind of a high, but more importantly it did make “everything else fade away.” Of course it didn’t SOLVE any issues… but it did somehow mask them and make them less important to me.

The eating disorder doesn’t “work” for me like it used to. It doesn’t give me that relief that I’m looking for. It doesn’t make stressors go away. 10 years ago, I felt some kind of sick accomplishment from restricting. Like somehow not eating made everything better. These days, maybe it deadens things a little bit, but largely it throws off my blood sugar and makes me feel like crap.

I’ll admit that for whatever reason, in many situations it’s still my first instinct to use the ED to cope. All the coping mechanisms I mentioned are attempts to replace the disorderedness with something healthier. But really, it takes three “healthy” coping mechanisms to offset one unhealthy one. The kudos chart is an everyday thing and a bad day might require coloring AND card shops.

I think a lot of people struggle with feeling like they still need their ED. Even if it is kinda ruining their lives and not working like it did in the past, they still feel like they won’t be able to deal without it. If you’re trying to replace that disorderedness with bubble baths and crafts — well, that’s a tough sell.

I’m not saying it’s not worth it or that EDs are just unhealthy coping skills… I’m just saying that recovery takes a lot of coping skills.  You burn some of them out (for instance, reading does not help me like it used to) and have to be creative and come up with new ones.  And sometimes they feel ridiculous.  Heck, I’m in my mid-20s and googling “print complicated coloring pages.”  My kudos chart is remarkably similar to the sticker chore chart that I had when I was seven.  I’m not sure any of this is “normal,” but hey, it helps.  Ridiculous or not — just go with it.

Not interested in your perception of “normal.”

This is nothing new, but everyone seems to be on some kind of diet.  Or, if they’re not “dieting,” then they are eating purely organic food, or only raw foods, or cutting out all white flour and sugar.  All of this leads me to ask myself — if this kind of eating is “healthy” or “okay” for the rest of the world, why isn’t it okay for me?

I think that the line between healthy and disordered is so fuzzy (grey territory, I’d say).  Eating organic is healthy.  Raw foods are healthy.  White flour and sugar are not the healthiest ingredients out there.  This is how everyone should be eating… right?  In ED treatment you’re taught that there are no “bad foods” — there’s that “everything in moderation” idea.  And while residential we definitely had cookies, sugar cereal, non-organic fruits and vegetables, non-whole-wheat pasta, etc.

Where’s the line between healthy and too healthy?  And if all these people can be so picky about food… obsessing over healthiness… what’s the big deal about my eating disorder?  If I ordered a salad sans croutons and dressing (which I would never do — I love croutons.), it would be eating disordered.  If my friend did the same, it would be healthy.  Why the double-standard?

My mom cooks primarily out of the Weight Watchers cookbook (note: no one in my family has ever done weight watchers nor has really needed to lose weight), because “it’s healthier.”  My fiance makes mac & cheese without any butter or milk because “it’s healthier.”  Both of these behaviors seem disordered to me (although my fiance does NOT have an ED.  At all.  My mother’s another story).

I spent so much time arguing with myself about this… and ultimately just had to give up and let the whole issue go.  I don’t know where the line is — because actually, the line moves, depending on the person, situation, and a hundred other variables.    And really, healthy/unhealthy labels aside, my vision of recovery includes sugar and white flour.  I’ll admit to owning the Mayo Clinic’s recipe book — but not Weight Watchers.  Even if Weight Watchers isn’t at all disordered and IS the healthier way of doing things — I don’t want it.  I plan on making mac & cheese correctly, eating carbs after 9pm, sometimes having more than one glass of wine, and eating the bread that they serve at restaurants… even if “normal” people without a history of an eating disorder insist it’s unhealthy!

One thing I love about eating disorder treatment is that the recovery ideal seems so livable (albeit slightly unbelievable and unattainable).  No diet food, no skipping meals, no overworking or over-stressing yourself, moderate exercise (aka: not 60+ minutes a day, every day), 8 hours of sleep, lots of support, time to take care of yourself, etc.  Maybe I could technically “recover” and still eat fat-free yogurt, get 5 hours of sleep a night, take on too much responsibility at work and never take a vacation — but do I really want to?  (No).

I don’t want to be so preoccupied with food, exercise, and weight forever.  If that’s the healthy, “normal” thing to do, then I’m aiming for a different normal — Renfrew-normal (or just ED recovery-normal, although that’s slightly more ambiguous).  It sounds like a much more enjoyable existence.

Not interested in your perception of "normal."

This is nothing new, but everyone seems to be on some kind of diet.  Or, if they’re not “dieting,” then they are eating purely organic food, or only raw foods, or cutting out all white flour and sugar.  All of this leads me to ask myself — if this kind of eating is “healthy” or “okay” for the rest of the world, why isn’t it okay for me?

I think that the line between healthy and disordered is so fuzzy (grey territory, I’d say).  Eating organic is healthy.  Raw foods are healthy.  White flour and sugar are not the healthiest ingredients out there.  This is how everyone should be eating… right?  In ED treatment you’re taught that there are no “bad foods” — there’s that “everything in moderation” idea.  And while residential we definitely had cookies, sugar cereal, non-organic fruits and vegetables, non-whole-wheat pasta, etc.

Where’s the line between healthy and too healthy?  And if all these people can be so picky about food… obsessing over healthiness… what’s the big deal about my eating disorder?  If I ordered a salad sans croutons and dressing (which I would never do — I love croutons.), it would be eating disordered.  If my friend did the same, it would be healthy.  Why the double-standard?

My mom cooks primarily out of the Weight Watchers cookbook (note: no one in my family has ever done weight watchers nor has really needed to lose weight), because “it’s healthier.”  My fiance makes mac & cheese without any butter or milk because “it’s healthier.”  Both of these behaviors seem disordered to me (although my fiance does NOT have an ED.  At all.  My mother’s another story).

I spent so much time arguing with myself about this… and ultimately just had to give up and let the whole issue go.  I don’t know where the line is — because actually, the line moves, depending on the person, situation, and a hundred other variables.    And really, healthy/unhealthy labels aside, my vision of recovery includes sugar and white flour.  I’ll admit to owning the Mayo Clinic’s recipe book — but not Weight Watchers.  Even if Weight Watchers isn’t at all disordered and IS the healthier way of doing things — I don’t want it.  I plan on making mac & cheese correctly, eating carbs after 9pm, sometimes having more than one glass of wine, and eating the bread that they serve at restaurants… even if “normal” people without a history of an eating disorder insist it’s unhealthy!

One thing I love about eating disorder treatment is that the recovery ideal seems so livable (albeit slightly unbelievable and unattainable).  No diet food, no skipping meals, no overworking or over-stressing yourself, moderate exercise (aka: not 60+ minutes a day, every day), 8 hours of sleep, lots of support, time to take care of yourself, etc.  Maybe I could technically “recover” and still eat fat-free yogurt, get 5 hours of sleep a night, take on too much responsibility at work and never take a vacation — but do I really want to?  (No).

I don’t want to be so preoccupied with food, exercise, and weight forever.  If that’s the healthy, “normal” thing to do, then I’m aiming for a different normal — Renfrew-normal (or just ED recovery-normal, although that’s slightly more ambiguous).  It sounds like a much more enjoyable existence.

The dark side of inpatient stays

‘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.

— Still at war with our bodies

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?

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.

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?

Sounds like punishment

I ran across this on Junkfood Science this morning. Just what the world needs — another eating plan! This is like weight watchers for kids… eat this many exchanges, write down everything, and go to the groups. It’s not a diet… it’s a “change in lifestyle.”

It’s amazing what you can pass off with the label of “healthy.”

Renfrew’s definition of healthy:

• No food is “good” or “bad.” Everything from pizza to carrots to peanut butter and candy can be part of a healthy menu.
• Eat when you are hungry. Stop when you are full.
• Stay fit by exercising! You can take up a sport or join a class like dance or karate but you don’t have to. Playing with friends can be just as energizing and fun!
• All bodies are different. People of all shapes and sizes can eat well and be healthy.
• Remember that fat does not equal bad and thin does not equal good.

BodyWorks‘ definition of healthy:

• Write things down as soon as possible. Write down everything you eat, even if it’s just one cookie. Be honest. Includes drinks.
• When eating out, the girls are advised to limit fried foods and order the garden salads with low-fat dressings and always pick the low-fat choices.
• Get the smallest serving or sandwich on the menu
• Avoid mayonnaise and use mustard or ketchup because they have less fat
• “try pizza without cheese.”
• Exercise for one hour on most days. “Vigorous active is best for getting and staying fit.” Vigorous was described as so intense you’re “sweating, breathing hard and can’t talk or sing.”

I think that Renfrew’s description is a very “feel good about yourself no matter what” approach and that BodyWorks’ list is probably posted on a pro-eating disorder site somewhere. I can’t help but think that “healthy eating” falls somewhere in the middle.