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.

Underrated coping skill: bulletin boards

This is the third post in the Grey Thinking series, Five of the most underrated coping skills.

Out of sight, out of mind.

This idiom definitely proves true for me.  I get so wrapped up in everything going on in life that I forget about all these health / self-care / positive affirmations / you name it that I’m trying to convince myself of.

I wrote about this in a previous post, I’m going to need that in writing, but it’s definitely worth mentioning again.  I have a bulletin board above my desk with little things on it – quotes, pictures, etc. – that mean something to me.  For example, there’s a fortune cookie fortune that says, “Remember there are people who care deeply about you.”  There’s also a copy of my meal plan and clips from meaningful emails.  Granted… there are also pictures of my dog, a yearly calendar, and sometimes a to-do list… but my point is, I put stuff up there that I need to remember.  And it helps, a lot.

I know that in treatment and recovery, I need to hear the a lot of the same things over and over.  Seeing some of these concepts concretely and being reminded of them regularly has proven to be very helpful.

photo credit: kitchenknife

Underrated coping skill: card stores

This is the second post in the Grey Thinking series, Five of the most underrated coping skills.

I don’t know why more people don’t hang out in card stores.  Just think about it… when you have a friend that’s upset, it’s not uncommon to send them some kind of “cheer up / feel better” card.  So, if you’re upset… doesn’t it just make sense to spend an hour in a card shop and read 100 of those?

I know that there is more to getting cards than the card itself (say… the thought behind it), but funny cards make people feel better.  I scan the aisles at Barnes & Noble nearly weekly for new stickmen cards and can’t help but laugh at Hoops & Yoyo.  Card stores are just a win-win for everyone.

You say that like it’s a bad thing

Chase: How would you feel if I interfered in your personal life?
House: I’d hate it. That’s why I cleverly have no personal life.

If you replace “personal life” with “personal issues,” I could have written those lines (although much less eloquently and using three times as many words).  It’s much harder to be hurt when you just don’t have issues–right?

Along the same lines, Chase and House have another conversation later in the show:

Chase: Why does everybody need to know my business?
House: People like talking about people. Makes us feel superior. Makes us feel in control. And sometimes, for some people, knowing some things makes them care.
Chase: I’d tell you my dad left, my mum drank herself to death… you gonna care about me more?
House: Cameron would. Me, I just like knowing stuff. [pause] I know you hate your dad, but I’m gonna tell you something –
Chase: I don’t hate him. I loved him until I figured out it hurts a lot less to just not care. You don’t expect him to turn up to your football match? No disappointments. You don’t expect a call on your birthday, don’t expect to see him for months? No disappointments. You want us to go make up? Sink a few beers together, nice family hug? I’ve given him enough hugs. He’s given me enough disappointments.

If you don’t care — or can dismiss anything unpleasant as being a nonissue — then it’s much harder to be hurt.  Isn’t that convenient?

However, notice that House does not have many friends (…and poor Wilson!).  He’s semi-miserable and no one can ever make him feel better.  Even the drugs aren’t doing it.

Okay, so I’m not House, but I am pretty good at always being okay.  I hate the thought of others suspecting that there’s something wrong.  I told my therapist the other day that it literally HURTS to be not-okay in front of someone else.  It’s hard for me to explain why, but I just hate it.  I would respond just like Chase: “Why does everybody need to know my business?”  My mantra is, “If said person is not really in my everyday life and is not someone that I need to turn to for support, then why do they need to know if I’m struggling?”

“I don’t care” is in a way an ugly way of saying “I’ve reset my expectations.”  Chase’s dad was never going to be reliable.  He wasn’t going to play the father role that Chase needed.  He learned that and adapted.  Personally, I think that’s a relatively healthy response (especially if the alternative is continually being re-upset every time you dad doesn’t show up, for the rest of your life).

I think that it’s important to find support in other places if you can’t get it from your parents.  That said, I also don’t think you can get over the loss of that relationship 100%.  He still wishes that things could be different between them, and he was bothered by his dad’s being there because it is still a sore spot for Chase.  Having a hundred caring friends is still just not the same.  You try and get the support that you need from other people, and that does help.  And you grieve the loss of that relationship, which sucks, but also helps.  But…. still, that longing does not completely disappear (okay, clearly I am talking about myself now and not so much Chase).

My point of all of this (which I am not doing a good job of expressing) is that just not caring does have its advantages.  Life is much simpler when everything is “okay.”  You’re not disappointed if you set the bar low.  However, by lowering your expectations like this, you are also isolating yourself more.  It gets lonely and frustrating when you won’t let others in.  Because I can’t stand the thought of struggling when out with others, I am left to deal with all of the emotions on my own.  By eliminating the possibility of being disappointed, I think that I also eliminate my chances of feeling better.

When I think about all of the people that I care about, the ones closest to me are those who know what’s going on in my life.  We talk about more than just coffee, the weather, our pets, television, work, etc.  It’s that humanness of NOT always being okay that makes us care about one another.  While it is definitely adaptive in some circumstances to re-evaluate what realistic expectations for that relationship are, I personally can’t turn that caring / trusting thing on and off.  Chase did have an honest conversation about the relationship he has with his dad (albeit, the conversation was not his idea and it was with House…), and they clearly left on a better foot than they started on.  I think he feels at least a little bit better.  House, who has “no personal life,” though, likely went home and sat his couch by myself, popping vicodin.   Having no personal life is not that clever.

You say that like it's a bad thing

Chase: How would you feel if I interfered in your personal life?
House: I’d hate it. That’s why I cleverly have no personal life.

If you replace “personal life” with “personal issues,” I could have written those lines (although much less eloquently and using three times as many words).  It’s much harder to be hurt when you just don’t have issues–right?

Along the same lines, Chase and House have another conversation later in the show:

Chase: Why does everybody need to know my business?
House: People like talking about people. Makes us feel superior. Makes us feel in control. And sometimes, for some people, knowing some things makes them care.
Chase: I’d tell you my dad left, my mum drank herself to death… you gonna care about me more?
House: Cameron would. Me, I just like knowing stuff. [pause] I know you hate your dad, but I’m gonna tell you something –
Chase: I don’t hate him. I loved him until I figured out it hurts a lot less to just not care. You don’t expect him to turn up to your football match? No disappointments. You don’t expect a call on your birthday, don’t expect to see him for months? No disappointments. You want us to go make up? Sink a few beers together, nice family hug? I’ve given him enough hugs. He’s given me enough disappointments.

If you don’t care — or can dismiss anything unpleasant as being a nonissue — then it’s much harder to be hurt.  Isn’t that convenient?

However, notice that House does not have many friends (…and poor Wilson!).  He’s semi-miserable and no one can ever make him feel better.  Even the drugs aren’t doing it.

Okay, so I’m not House, but I am pretty good at always being okay.  I hate the thought of others suspecting that there’s something wrong.  I told my therapist the other day that it literally HURTS to be not-okay in front of someone else.  It’s hard for me to explain why, but I just hate it.  I would respond just like Chase: “Why does everybody need to know my business?”  My mantra is, “If said person is not really in my everyday life and is not someone that I need to turn to for support, then why do they need to know if I’m struggling?”

“I don’t care” is in a way an ugly way of saying “I’ve reset my expectations.”  Chase’s dad was never going to be reliable.  He wasn’t going to play the father role that Chase needed.  He learned that and adapted.  Personally, I think that’s a relatively healthy response (especially if the alternative is continually being re-upset every time you dad doesn’t show up, for the rest of your life).

I think that it’s important to find support in other places if you can’t get it from your parents.  That said, I also don’t think you can get over the loss of that relationship 100%.  He still wishes that things could be different between them, and he was bothered by his dad’s being there because it is still a sore spot for Chase.  Having a hundred caring friends is still just not the same.  You try and get the support that you need from other people, and that does help.  And you grieve the loss of that relationship, which sucks, but also helps.  But…. still, that longing does not completely disappear (okay, clearly I am talking about myself now and not so much Chase).

My point of all of this (which I am not doing a good job of expressing) is that just not caring does have its advantages.  Life is much simpler when everything is “okay.”  You’re not disappointed if you set the bar low.  However, by lowering your expectations like this, you are also isolating yourself more.  It gets lonely and frustrating when you won’t let others in.  Because I can’t stand the thought of struggling when out with others, I am left to deal with all of the emotions on my own.  By eliminating the possibility of being disappointed, I think that I also eliminate my chances of feeling better.

When I think about all of the people that I care about, the ones closest to me are those who know what’s going on in my life.  We talk about more than just coffee, the weather, our pets, television, work, etc.  It’s that humanness of NOT always being okay that makes us care about one another.  While it is definitely adaptive in some circumstances to re-evaluate what realistic expectations for that relationship are, I personally can’t turn that caring / trusting thing on and off.  Chase did have an honest conversation about the relationship he has with his dad (albeit, the conversation was not his idea and it was with House…), and they clearly left on a better foot than they started on.  I think he feels at least a little bit better.  House, who has “no personal life,” though, likely went home and sat his couch by myself, popping vicodin.   Having no personal life is not that clever.

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.

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…

You’ve been in treatment too long if…

(in no particular order)

1. You measure the cost of things in nutrition appointments (ex: That shirt is one nutrition appointment. These shoes are worth two appointments).
2. You start dressing like your professionals (or maybe, they starts dressing like you…)
3. “Treatment” is a recurring event with no end date on your calendar.
4. You’ve never needed to purchase “Eating in the Light of the Moon” because at some point you have been given a photocopy of every chapter.
5. In group, no one sits in your seat, even when you’re not there (because you’ve been sitting there since last year).
6. The group therapist wishes you would just finish treatment already so that she could start recycling therapy topics.
7. You remember when some of the current therapists were interns.
8. You’ve modified the standard food log template to create your own (improved, of course)
9. Your therapist notices when you buy a new outfit (since she’s seen all of your other clothing).
10. When considering changing jobs, the new company’s mental health insurance is a deciding factor.

I am not guilty of all of these…. but more than a few.

You've been in treatment too long if…

(in no particular order)

1. You measure the cost of things in nutrition appointments (ex: That shirt is one nutrition appointment. These shoes are worth two appointments).
2. You start dressing like your professionals (or maybe, they starts dressing like you…)
3. “Treatment” is a recurring event with no end date on your calendar.
4. You’ve never needed to purchase “Eating in the Light of the Moon” because at some point you have been given a photocopy of every chapter.
5. In group, no one sits in your seat, even when you’re not there (because you’ve been sitting there since last year).
6. The group therapist wishes you would just finish treatment already so that she could start recycling therapy topics.
7. You remember when some of the current therapists were interns.
8. You’ve modified the standard food log template to create your own (improved, of course)
9. Your therapist notices when you buy a new outfit (since she’s seen all of your other clothing).
10. When considering changing jobs, the new company’s mental health insurance is a deciding factor.

I am not guilty of all of these…. but more than a few.