Anyway, I can sum up the chapter in one line:

Women who struggle with disordered eating more often than not have an overly dominant inner masculine aspect that continually attempts to control the inner feminine.

Basically, Anita explains how everyone has a masculine and feminine side and that it’s important to achieve a balance between the two.  Problems arise when either side is more dominant than the other.

If we develop our feminine side and not our masculine side we may find ourselves caught up in relationships where we focus on taking care of others without setting limits and find that we lose our sense of self.  If we develop only the masculine, we find ourselves caught up in competitive power struggles and feel a pervasive sense of alienation that comes from not connecting with others in a heartfelt way.

Given her theory (that women with EDs have overly masculine thinking), I was surprised to read this description.

feminine = care-taking of others (but not self, codependent relationships, and a decreased sense of self
masculine = competitive, power-struggles, alienation

Now, which sounds like more of the “eating disorder personality” (were such a thing to actually exist)?  My experience has been that most people with EDs are care-takers.  Group therapy is filled with individuals concerned about everyone else (and not themselves).  Everyone is eager to take care of everyone else.  Lots of women are also in codependent relationships, although I’m not sure if that’s related to the eating disorder or to other issues.  It seems that ED individuals embody the characteristics of the feminine side, and avoid those of the masculine — competition, power struggles, etc.  I will be the first to admit that I’m very conflict-avoidant!

Anita makes another point that really stuck with me:

An individual who is able to perceive the bigger picture and be receptive to his or her inner guidance but cannot take action can experience as many difficulties as someone who is all action and impulse with no inner sense of direction or meaning in her life.

Hmmm… sounds kind of like my ”being aware of your crap and actually overcoming your crap are two very different things” mantra, doesn’t it?  I think this is a huge roadblock for many people in recovery — having a lot of insight and knowing what they need to do, but not being able to do it and make changes (or not really wanting to).  This poses a couple of really interesting questions:

1. is psychoanalytical insight necessary for changing behaviors / recovering?
2. if you never make change, is there value in analyzing everything?

It’s something to think about.

Sidenote: ELM = Eating in the Light of the Moon.

We’re starting with Eating in the Light of the Moon, by Anita Johnson. It’s a good choice, as Anita has a unique approach and insight into eating disorders. I’ve actually read it before, so maybe that will give my posts a little bit of an edge (oh wait, this isn’t competitive blogging…). Anyway, expect to see a post about each chapter every week. The chapters are short, sweet, and to the point… whereas my blog posts are not, so it’s my personal goal to make sure my posts aren’t longer than the reading.

This week: Chapter 1, Woman Spirit. The Root of the Hunger.
Honestly, this chapter is just an introduction and I don’t have anything particularly meaningful to say about it. Anita sets the tone and hints at the themes she’ll discuss later in the book (feminity, nature, intuition, patriarchial society, etc.). So, in liu of my rambling, I’m giving you a copy of my sketchnotes (be excited!).

(click on the image for the full-size)

Mission “write a short post” — accomplished.

1. I don’t want to — My persoal favorite.  My therapist usually refuse it with something equally as thoughtful, like “yeah, no kidding.”
2. I’m not sick enough -- Everyone (yes, everyone) has used this excuse at some point.  Other variations include:
   • I’m not thin enough / my weight is okay
   • My labs are okay
   • I don’t have serious health consequences
   • If it were really a problem, my spouse / doctor / friends / parents would have said something
3. I can’t take the time off from work – This one isn’t unreasonable… except for that whole part about having a life-threatening disorder.  You kinda need to be around (and relatively health) to do your job… don’t you think?
4. It’s too expensive -- Isn’t that the truth!  However, there are ways around this.  Lots of professionals / treatment centers can work with you on a sliding scale or scholarship.  There are free, research-run programs in some areas.  Still, lots of people DO (unfortuantely) run into the financial barrier.
5. I did treatment before, and it didn’t work – Third time’s the charm… or fifth, or tenth.  Lots of treatments (for mental or physical illness) don’t work the first time.  Personally, it took my having several negative experiences to figure out what is helpful for me.  I could think of lots of cliche’s to address this one: “If at first you don’t succeed, try, try again.”  Or, “Fall down seven times, get up eight.”  You get the point…
6. I can do this on my own — This is another one that everyone has used.  If that were true, you would have done it by now.
7. I’m not ready to recover and am waiting until I am 100% motivated – it seems that rarely motivation is not proportiona to sickness.  If you keep waiting… and waiting… not only are you going to be miserable during that period, but you’re continually putting your health in danger.  Sometimes it takes starting treatment to make you want to get better.
8. There’s no treatment near me — You’ll have to be creative.  Maybe you’ll have to drive, or go residential somewhere far away, or try online therapy…
9. I’m too old – Despite the stereotype, eating disorders are not liited to adolesent females.  In fact, something like 30% of the Renfrew Center’s patients are over 30.
10. Shame — So many people with eating disorders feel a lot of shame… along with many other internal demotivatos, like fear of disappointment, judgment, and rejection.  If you can just get over that initial fear for enough time to seek help, it’s something therapy can help you work on.

There are lots of reasons to NOT seek treatment, and many of them are valid.  However, reasonable or not, they are still excuses and they help keep you sick.

Note: While there is REAL research on barriers to treatment, this post only contains my opinion.  Maybe I’ll blog about the factual stuff later…

I’ve often thought about what my therapist would say were I to tell her about my blog. I bet she’d be thinking something like the following (note: I am NOT the artist that Therapy Tales is!):

Yeah, I don’t think we’ll be having this conversation any time soon…

Tracking food:
I still track food exchanges (well, sometimes), and originally I could only find one app that was appropriate for this in the app store: EatRight.  After that I discovered Foobi, and most recently have converted to FoodTrackerPro.  Note: none of these apps use calories — just servings/exchanges — and I’ve been pretty pleased with all of them, but FoodTrackerPro is definitely the coolest.  PLUS, it works on the iPad, so bonus points for that.  You can customize your meal plan and make charts and set goals and all of that… but it also has a great food servings cheat-sheet — for all those times that you’re trying to remember how much hummus equals a protein exchange (for example).  iPhone/iPad, $1.99.

Tracking mood:
I started doing this on paper awhile ago and found that it was actually a good exercise for me (not only to see the patterns in mood but also just to check in with myself).  I’ve seen several apps for this, but currently my favorite is MyMoodTracker (same company as FoodTrackerPro, actually).  It’s only for iPhone (no iPad yet, bummer), but it tracks mood using a 1-10 scale and little emoticons.  You can track sleep on here, too, and see how that influences mood.  iPhone, $1.99.

Meds:
You know those times when you’re at the drug store trying to purchase something to help with your nasty cold, and you can’t remember if it’s okay to take Sudafed with the Wellbutrin you’re on?  That’s when you need Epocrates.  Or… when you have a headache and have already taken Tylenol twice and are not sure if it’s okay to take another dose yet?  Okay, maybe it’s just me, but I run into situations like this all the time and would be lost without this app! Plus, when you’re on more than one med at a time (which is pretty common these days), things get complicated (drug interactions, dosing, side effects, etc), and it’s just good to have it for reference.  iPhone, free.

Countdown:
By now you’re probably thinking, “okay, you track way too many things”–and it’s probably true.  BUT, do you know what’s even better than personally tracking something?  An app that does it for you!  That’s Countdown.  I have countdowns for everything — how long I’ve been married, how long it’s been since I last acted on symptoms, how many days until my next therapy appointment, how long until my birthday (hey, why not….), etc.  Random countdowns aside, there’s something really motivating for me about knowing that I haven’t skipped a meal in three months, or drank coffee since…. err, yesterday (okay, really bad example), or that I have therapy in 1 hour, 42 minutes and 18 seconds (and really need to do my therapy homework).  I just love seeing that.

Coping Skills:
Remember my series on coping skills?   Well, for each of those items, there is of course an app for that:

1. card stores – it’s not a card store, but someecards can entertain me for an embarrassingly long period of time (both the app and the website).
2. bulletin boards – Corkulous would probably by my favorite app-equivalent of a regular cork bulletin board.  However, the real purpose of bulletin boards for me are to serve as reminders, so that the “out of sight, out of mind” thing doesn’t kick in.  For that, I’d probably actually use a todo app or custom background/wallpaper (not going to link these because there are a million and I don’t have a favorite!)
3. kudos chart – again, this is something you could probably find in a todo app, but if you’re looking for something a little more…. sticker-chartish… try GoalTracker (ipad).
4. crafting — there are a million apps for: coloring, collaging, drawing, photo-editing… really, a million. You might start looking in Apps for Kids.
5. dvds — you can download just about anything from tv/dvd onto your iPhone/iPad from the app store.  Additionally, ABC has an awesome media player that lets you stream shows for free.

Okay, that’s the end of my list for today.  If anyone has any other app suggestions, I would love to hear them!

While I’m not in a position where I have to calculate hours spent on a task, I was thinking about how the eating disorder would affect my focus factor.  It’s kind of scary (and pathetic) when you really think about how much of your time the eating disorder can consume.  Obsessing about your weight, what you’re going to eat, what you already ate (etc) is really distracting.

I tried to break down the components of my focus factor, and came up with the following pie chart:

Eating disorder-wise, this isn’t really current for me.  I’d say the numbers are accurate for when I’m struggling moderately — not at my best or my worst.  When you add it all up, I’m really only focused on work for 1/3rd of the time I should be working (this isn’t including the rest of the non-work day).

One time when I was struggling, I cut back my work hours to do day treatment.  I fussed about what a disaster it was going to be to not be getting work done.  I was afraid I’d be letting my coworkers done and hurting the overall quality of my team’s work.  As it turned out though, by getting more treatment I drastically reduced the amount of time I spent on all those ED thoughts and ended up being MORE productive.  Go figure.

My therapist still loves to bring it up, in some kind of “remember how you are actually more productive and successful when you make treatment a priority?” comment.  While it’s definitely true, I knew I shouldn’t have admitted it…

Note (05/02/2010): I’ve updated the mind-map to a) remove the typo and b) make it bigger for printing purposes.  Click on the image to load the larger diagram.

It has occurred to me lately how often I say “I don’t know” in my appointments (possibly even more often than I say “I know” !).  My therapist has come to totally disregard the phrase, which for me, has become very versatile:

Type 1: the how-did-you-feel-in-that-situation “I don’t know”
Usually used when discussing some childhood event that I kind of remember.  I could probably figure out how I felt about it, if I spent some time thinking about it, but I really don’t want to… so off the top of my head I don’t know.

Type 2: the I-do-know-but-I-don’t-want-to-tell-you “I don’t know”
There are lots of reasons why I might know and not want to say anything….

1. I don’t want to analyze it, and I know that my therapist is going to
2. I’m embarrassed
3. I don’t have the energy to get into it at that moment
4. I just don’t feel like telling her

Type 3: the can-this-conversation-end-already “I don’t know”
This “I don’t know” is often accompanied with a lot of “uh huh”s, “yeah”s, and “mmhmm”s.  Saying anything besides “I don’t know” is going to continue the conversation, which I definitely do NOT want to encourage.

Type 4: the I-don’t-believe-you “I don’t know”
Usually a response to a statement rather than a question… when I’m being told that taking care of myself is important and it’s okay to ask for help and I’m not too needy, and all of those other things I have a hard time believing.

Type 5: the I-want-you-to-tell-me “I don’t know”
Okay, sometimes I test my therapist, and sometimes I just want to be told things.  I know what I think, I’m bored with my answer, and I want a professional’s perspective.

…you know, the more I think about this, the more types I can come up with.  Maybe I should just make a mind-map:

I could not, would not, on a boat.
I will not, will not, with a goat.
I will not eat them in the rain.
I will not eat them on a train.
Not in the dark! Not in a tree!
Not in a car! You let me be!
I do not like them in a box.
I do not like them with a fox.
I will not eat them in a house.
I do not like them with a mouse.
I do not like them here or there.
I do not like them ANYWHERE!

I do not like green eggs
and ham!
I do not like them,
Sam-I-am.

–Dr. Seuss

There are more than a dozen interpretations of “Green Eggs and Ham” out there (just google it, you’ll see), but I’m pretty sure that mine isn’t one of them. When I hear the rhyme, I think of all the rules that individuals with EDs have surrounding food. Sometimes we’ll get a new patient who is not going to eat the meal if any of the following are true:

• One food is touching another food.
• Something requires a spoon.
• The food can’t be picked apart or cut into tiny pieces.
• There are caloric drinks (milk, juice, etc).
• Something is “not warm enough.”
• A piece of fruit has a spot on it (even a microscopic spot).
• The food can’t be eaten in a particular order.
• The room is too hot or cold.
• She’s sitting at the end of the table.

…and I could go on. I will definitely confess to doing some of these things. I hate juice and/or milk. My point is, though, that said new patient is against eating the food here, there, or anywhere. She’s wrapped up in the eating disorder and not even considering any of the above.

While I totally sympathize, part of me can’t help thinking “Well…. actually, you will eat your green eggs and ham – and you’ll (learn to) like it.” That’s kind of how treatment is. You come in screaming, “No no no! I will not I will not I will not! Not in a box or a house or even in the dark!” And you learn (or slowly realize) that not only are you going to eat them in the dark, but with a goat in a tree while it rains as well.

On the 12th day of Christmas,
my therapist gave to me…

12 new feeling words
11 prying questions
10 goals for eating
9 self-affirmations
8 ways to be mindful
7 coping skills
6 restructured thoughts
5 empathetic statements
4 problem solutions
3 anti-depressants
2 more diagnoses, and
a reminder she won’t be here next week

There are lots of situations where I’m tempted to say “use your words!” (don’t worry, I usually resist the urge).  Often this is with the ED, becuase often people use their eating disorders to communicate.  I’m a huge offender.

For me, restricting could mean…

• I’m not okay
• I need more help
• I am overwhelmed and can’t handle life
• I need a reason to be cared about
• I feel undeserving
• I want someone to think I matter
• I’m having a bad day
• I’m anxious
• I’m depressed
• I’m lonely
• I’m frustrated
• I’m hurt

There are so many things that I won’t say (and things that I won’t even let myself THINK).  Somehow, though, saying them through the eating disorder makes them valid.  Maybe it’s because there is physical proof that something is not right.  Regardless of how I feel (because really, who cares about feelings?), I’m hurting myself and that you can’t ignore.  That matters.

The problem is, this is a really ineffective means of communication!  Restricting could mean a hundred things.  Throw bingeing, purging, SI, exercise, laxatives, etc. into the mix and you have enough symptoms to illustrate your whole emotional vocabulary.

However, it might as well be your own secret language, because no one else really knows what you are trying to communicate.  You’d probably be better off investing in some flares and arranging them to say “HELP” in your backyard.  Or learning morse code.  Or writing down “I’m not okay” and sending it to someone that you care via carrier pidgeon.  Why?  Because you could be overwhelmed and acting on symptoms at every available opportunity to deal with the stress.  Eventually something will happen – someone will notice, you’ll end up in the ER, you won’t be able to take it and will quit, etc.  Something WILL happen.  However, it’s likely not a happy ending.  Do you know how much more effective it is to just SAY something?  Say “I’m feeling overwhelmed.”  If it’s at your job, then you can figure something out to make your work load more manageable.  If it’s with life in general, you can figure out how to get more support, prioritize things, delegate more, weed out less important responsibilities, etc.  You just need to SAY something.

Granted, it’s really hard to do this (for myself as well).  I think some of the reluctance to talk is related to fear – fear of others knowing you’re not okay, fear of ruining relationships, fear of asking for too much, fear or others caring… lots of fears.