Dr. Wilson: House! Why the hell did you let an unstable patient wander the hallways?!
Dr. House: His leash broke.
I’ve always found the transition between “treatment” and the “real world” fascinating. One minute you are a “real adult” — you can drive your car, eat what you want, walk the dog, go to work, go on a vacation, make bad choices, make good choices… but as soon as you walk through those treatment-center doors, all of these adult “privileges” are revoked. Your purse and coat is locked up — you can’t carry your keys, because what if you tried to leave during the day? You ask permission to use the bathroom. Some people have to count while in the bathroom. You can have one packet of salt with your meal. No caffeine. No, you can’t see your weight–stand backwards on the scale.
And this isn’t just with residential treatment… but with day treatment or even IOP! Which makes it even more bizarre, because you wake up an adult, spend your day as a five-year old, and go to bed again that night as an adult.
I understand that it has to work this way for a couple of reasons:
- There can be kleptomaniac patients.
- Maybe someone is sick enough that they would get pissed off during a group and try to run off.
- Treatment is about normalizing eating — which means not using 10 packets of salt on your meal.
- Having unlocked bathrooms can create unnecessary temptations to purge. You’re there to work through the uncomfortableness of whatever you bring up in therapy and the normalness of the meals… without being able to use symptoms.
- It’s easier to do okay when it’s not your choice, because then you don’t feel guilty. You didn’t give yourself permission to eat the meal — you HAD to eat it.
- Not stressing over even the little things gives you more room to concentrate on the therapy.
There are already so many regulations in place. You are already being rewarded for eating and for drawing pictures in art therapy and for talking about whatever important issue. Heck, I have gotten praise for sitting still! (“grey, you sat still much longer than usual today — that’s definitely an improvement and I think that you need to learn to celebrate your accomplishments). So, when patients still find some way to evade the rules or act ridiculously helpless it irks me to no end.
I can relate to this House quote and the frustration of being in treatment with impossible patients. I understand having a hard time. You’re not always compliant in treatment because by nature, eating disorders are manipulative. But… the staff already has you on a leash. You don’t have responsibilities and you’re already being monitored. If you’re going to bring an extra set of keys with you to day treatment so that you can escape mid-morning and avoid lunch, the staff isn’t going to chase you. They shouldn’t have to!
Both inside and outside of treatment, you ARE still an adult. You still have some responsibility in cooperating. It’s the treatment center’s job to keep you as safe as possible and to reduce ED triggers and temptations. Therapists and counselors are there to help you in this already rigidly-structured environment — they can’t babysit you.
2 comments
imaginenamaste says:
Jan 24, 2009
I can’t agree more with you on your post.
While being weight backwards is probably one of the most humbling and embarassing things I have ever experienced, I learned that its part of the process. But, I agree with you, I have a really hard time with those in my outpatient groups who just don’t want it. I hurt for them b/c I want to see them want to recover, but at the same time…they annoy me. Why put in the effort if you don’t want it? The therapists aren’t going to be there to hold our hands forever!
morphed says:
Feb 19, 2009
I completely agree with your post. I couldn’t deal with day treatment for the life of me because of the 5yr old to adult, rapid 8 hr growth cycle on a daily basis. Considering this is a disorder that’s marked by an all or nothing approach, day treatment in particular is quite the mirrored response. I too see the logical reasons for the bathrooms or weighing but they’re restrictions that I just can’t swallow (no pun intended) in a program where I go home every evening and mature back to my 20 something year old self. I felt like the restrictions were nearly as intense as those of residential, yet, there was no real reason or value in impressing them upon people since most everyone went home and went pee by themselves, had the option of bingeing/purging/starving and usually did, and got on the scale right before treatment each morning. I could go on for days about day treatment. Interestingly, almost every single person who I know whose gone through any day treatment program (including myself), has been kicked out for non-compliance of some sort.