“If you tell the truth, you don’t need to remember anything.”

– Mark Twain

“I don’t ask why patients lie, I just assume they all do.”
“It’s a basic truth of the human condition that everybody lies. The only variable is about what.”
“I’ve found that when you want to know the truth about someone that someone is probably the last person you should ask.”

– Gregory House

So, while everyone lies sometimes, people struggling with an eating disorder (or addiction, or probably other mental disorders) lie more. It’s the nature of the disorder — you lie to others and you lie to yourself.

Mark Twain’s quote made me think about my own truth, though. Sometimes I think that I lie to myself so much, that I don’t even remember whether or not it’s the truth. Or maybe it’s that I can’t identify what is or isn’t true? And, as odd as that sounds, I think that’s kind of the goal of avoidance — isn’t it? To pretend and ignore things that you don’t want in your reality. You convince yourself that you don’t care, that it didn’t matter, and that it didn’t really happen.

In therapy, you run into that lying combination (to yourself and to others). It’s confusing enough when you’re just lying to yourself… but when you’re really into your disorder and your lying to professionals, to, it just gets MESSY. For the sake of this post (because I am sure I can think of more), let’s say there are four types of lying:

Lying to yourself:

1. Rationalizing with myself to the point where I’ve convinced myself it’s not actually true.
2. Not being able to gauge or recognize whether or not something is significant.

Lying to others:

1. Omitting information
2. “Real lying” (as I like to call it).

Lying to myself:
By the time I get to my therapy session, I really do feel “fine.” Maybe I had the worst weekend ever, but come Tuesday I’m thinking “oh, it was okay, and that was so two days ago.” Sometimes I don’t even remember significant events until my therapist brings them up. I can say (and pretty much believe) that eating went pretty well, until she asks something specific… like “how about that dinner you were really nervous about on Friday?” Oh, yeah……. THAT dinner…. forgot about that one.

Lying to others:
While lying to yourself creates plenty of chaos around determining what’s actually true, lying to others makes it 100 times more complicated. You can probably sense my personal definition of “lying” just by my distinction between “omitting information” and “real lying.” So, let’s say in that same therapy session, I failed to mention that I kind of quit taking my medication (and by “kind of,” I mean I did). It didn’t come up in the conversation, and she’s not my psychiatrist, so….. It’s easy to rationalize. And, as for “real lying” — well, I probably don’t even have to come up with an example of that one.

You can see how managing this information becomes increasingly difficult with each session. You’re struggling to determine if you really did have a bad day last week and to remember if you admitted to acting on symptoms in your previous session. It just doesn’t work well.

Personally, it’s much harder for me to stop lying to myself than it is to be truthful with others (and that’s including all the “positive” reasons that I do lie to them — wanting to protect them, not wanting to be a burden, decreasing worry, etc). With myself, determining the “truth” is this multi-step process. I have to determine whether or not I’m upset… then identify what is upsetting me and whether or not I do actually care about it. From there, I have to decide whether or not I’m going to acknowledge (let alone ADMIT to my therapist) that whatever event didn’t feel or go okay. It’s such a… process.

Summary:
If I had planned a takeaway message from this post, it would be this:

Now that I have her for a group again, I’m realizing that I definitely act differently with her as a facilitator — as opposed to the other group therapists.  It actually makes me nervous.  I can think of a few reasons for this:

1. She knows me well and calls my bluff.
2. Sometimes group topics are very similar to what we talk about in individual.  Maybe it’s just a coincidence, but I don’t know…
3. I don’t want to disappoint her and say something stupid.
4. I worry that her seeing me in a different environment will somehow lead her to change her opinion of me (and not for the better).

You would think that her presence would make me more comfortable (since we have a good relationship and I trust her), but that’s not the case at all.  I feel the need to perform — say something insightful, be a good group member, talk the right amount (not too much or too little), etc.  On some level I know that she’s not there to judge my group member-savviness, but I still feel this (internal) pressure to step it up a notch for her.  Make her proud?  I’m not sure.

Probably even more interesting is that I have similar feelings when the scenario is reversed.  On occasion, I’ve met with one of the group therapists on an individual basis (usually when my therapist is out of town).  I feel that same pressure to be a good patient.  However, whereas in the first situation I’m more worried about disappointing my therapist or leading her to think less of me, in this case I’m concerned about being worth the other therapist’s time.  I’m not her patient and she doesn’t have to see me, so she’s really doing me a favor.  I don’t want her to regret agreeing to see me in my regular therapist’s absence.

Now that I’ve written it out, this all probably stems back to my fear of disappointing people.  It’s also probably backwards that I’m so preoccupied with how the therapist is perceiving the time spent with me, instead of my using that time together to process stuff.

It’s just a matter of time until I test this theory… and not because I really want to, but because it’s inevitable that sooner or later I’ll say something really stupid in group (as if I haven’t already!).  Maybe it takes that experience of screwing up and not hurting the relationship to feel less fearful.  Or, maybe working with her in a group setting just takes some getting used to.

I think that a lot of the same principles that Mark Goulston points out can apply to mental illness in general. A few of them really stood out to me:

Failure to develop new and healthy relationships
I see this two ways:

• Old relationships – maintaining unhealthy relationships (people who drag you down in any way, bad influences, people who don’t respect your boundaries, triggering people, etc) is just going to keep you sick. Good things just aren’t going to come from perpetuating bad relationships.
• New relationships – In treatment, I think you have to be careful about the friends that you choose. With eating disorders, people are competitive and hanging out with others can be triggering. With that said, it’s also really validating to find individuals who can really relate and understand what you’re going through. So… just be careful that your new friends are good influences.

Trading addictions
I see this all the time! Changing from bulimia to anorexia is not recovery! And how many people pick up smoking while trying to kick another addiction? Tobacco companies should stop marketing to teens and target the addiction crowd (really, it’s that prevalent).

Self-deception
I think this is even a bigger problem in EDs than in substance addictions. There is no abstinence from food, so it’s easy to think you are “healthy enough.” It’s a really foggy, zig-zag line between disordered and healthy. Skipping one meal is not the end of the world… nor is over-eating on occasion. It’s easy to tell yourself that, too.

Failure to develop meaningful life goals
This is not exclusive to addictions, eating disorders, or other mental illness. I think that feeling like your life has a purpose is key to living a satisfying life. Personally, not feeling like I am doing anything significant or fulfilling is a significant part of what keeps me stuck in my ED.

Anyway, I highly recommend that you read the original article with all 10 “cracks” in the recovery process.. Dr. Goulston does a great job of highlighting the red flags.

A lot of Meredith’s monologes hit home with me, but she said something the other day about surgery and recovery that really hit me:

“The goal of any surgery is total recovery – to come out better than you were before. Some patients heal quickly and feel immediate relief. For others the healing happens gradually, and it’s not until months or even years later that you realize you don’t hurt anymore. So the challenge after any surgery is to be patient. But if you can make it through the first weeks and months, if you believe that healing is possible, then you can get your life back. But that’s a big if.”

Maybe the ultimate goal of treatment (for eating disorders, addictions, depression, anything really) is total recovery… but I think most people would tell you that intense treatment doesn’t immediately fix things. You don’t go to intense treatment and come back cured — it’s not that black and white. However, what I think people don’t realize is that treatment and recovery doesn’t even feel good a lot of the time. It can be miserable. Maybe there is some immediate relief at the beginning of treatment… usually because you’re pretty miserable in your disorder/addiction and knowing there’s help and a light at the end of the tunnel is some much needed hope. I knew a girl (in treatment for anorexia) who said the first month of intense treatment was easy, just because she was so hungry and tired of restricting. I can understand that.

My experience has been that much of treatment is uncomfortable. You’re pushed past what you’re okay doing and your negative coping skill of choice is taken away. Doing better can feel so much worse. How much does that suck?

I think Meredith is right on when she says “if you can make it through the first weeks and months, if you believe that healing is possible, then you can get your life back.” You might feel miserable during treatment. You might feel even worse immediately after intense treatment, when you’ve dropped levels of care and are dealing with the real world without your eating disorder / addiction. After a few months go by, though, it doesn’t feel so awful. That hurt and misery fades.

In the moment, the uncomfortableness feels so permanent. Unbearable, maybe. But, I think if you can keep plugging away… being patient with yourself, giving yourself some grace, and really just giving recovery a chance… it will get better. Maybe the word “healing” sounds so soothing and therapeutic… but like with surgery, that post-op period just isn’t fun. However, it’s also not permanent.

Sometimes I think that blankets should be banned in group therapy.  I understand that:

1. group rooms can be cold
2. body image is tough and it’s easier to hide behind a blanket
3. blankets are comfy
4. therapy can suck

… but really, how much are you getting out of group if your head is under the blanket?

I’ve been in an outpatient eating disorders group for awhile now.  There’s nothing special about it — it’s just a weekly / bi-weekly group at a treatment center, with women of all ages and ED diagnoses Everyone either has to be in outpatient therapy at the center or have done some kind of intense treatment there.   The latter is definitely the norm — most patients have stepped done from day treatment or IOP.

What’s weird right now is the make-up of the group: 5 restricting-anorexics and 2 binge eaters.  I don’t know where all the patients in between these two groups are.  I guess most of the women struggling with AN-R technically fall into the EDNOS-AN-R category, but you know what I mean.  There are no bulimics, and way more restricting anorexics than there should be–statistically.

There are three issues that I have with this:

1. There are too many anorexics in one room.
2. Since there really isn’t any middle-ground, the group feels very divided by diagnosis.
3. One of the girls is really really really underweight.  Really.

Issue #1: betta fish
I think that anorexics are like betta fish — you’re not supposed to put several of them in the same bowl.  I could expand this to all individuals with eating disorders, but I think that there is something especially competitive about anorexia.  Even when they are doing well in their recovery, putting too many of them in a group is just not a good idea.

Issue #2: no grey
I definitely believe that eating disorders are on a continuum and that we all have similar struggles despite the different diagnoses.  However… we seem to be missing all the people in the middle of that continuum.  It sucks to have BED and be in a group with all anorexics.  Heck, I think it’s triggering for anyone to be in that group (see issue #1).  With such a polarity, it feels a little them vs. us.

Issue #3: too sick
I don’t care how great you’re doing mentally — if you’re that underweight, you shouldn’t be in outpatient group.  You could be drinking boost like it’s water, and I still wouldn’t be okay with it.  It’s just too triggering.  I think it’s an especially bad combination in the current group, because the majority of girls have gone through refeeding in the last year and are struggling with body image now that they are at healthy weights.  Plus, personally, my whole “I don’t need to be here because I’m not that sick” complex starts creeping up on me.

Issues #2 and #3 are definitely elephants in the room.  Everyone feels weird about the divide and triggered by said sick patient.  No one will say anything (myself included).

I think you have to be so careful when putting together outpatient eating disorder groups… and I think that a certain level of physical health is necessary — even if someone is 100% gung-ho, yay-recovery-is-awesome.

This time, I’ve been watching the series as intended — week by week, with all 5 patients in a row. It’s interesting how much the viewing order has changed my perception of the show. Originally, I saw things more from the patient’s point of view, rather than Paul’s (the therapist). I had no idea what was really going in in Paul’s life (especially since I didn’t watch the one patient, Alex, at all).

Now that I’ve been watching straight through the week, I see things more from Paul’s perspective. He has a life and various patients — all kids of things happen during the week. His real life affects his mood/actions in therapy (though he’s pretty good at separating the two).

It’s interesting to experience therapy from that perspective, since I’m always the patient. I know that my therapist has other patients – not to mention a life outside of the treatment center – but I’m not really thinking about that during our sessions. I’m only there one day a week, so I guess I expect things to be kind of where we left them the previous week. Granted, things happen in my life between sessions, but therapy stands still. Meanwhile, life at the treatment center moves on.

Another good example of this I’d with email. If I email my dietitian and she doesn’t reply, I get kind of frustrated. Sometimes I’m annoyed, but often I’m thinking “I shouldn’t have emailed her, it was a stupid question, she’s too busy” etc. I forget that it’s a one-to-many relationship. She’s my one dietitian, but I am one of her many patients. For all I know, she could get 100 emails a day. My one email is far more significant to me than it is to her.

Interestingly, this treatment point-of-view changes with level of care. When I was in a 5-day program, there was no time lapse between therapy. We were on the same page. I was THERE for all the other stuff. I was still just one patient, but was in a sense creating a lower patient-to-professional relationship (by occupying a greater percentage of time).

Anyway, the moral of the story is: watch “In Treatment” in order!

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!

Your problem is you’re… too busy holding onto your unworthiness. – Ram Dass

As someone who’s struggled with an eating disorder for longer than I would like to admit, I’ve definitely had periods of falling into the “I suck at recovery” trap.  It connects directly to the “I am wasting everyone’s time and don’t deserve help” trap as well as the “I’m actually fine and asking for too much because I’m attention-seeking like that” trap.  And let’s not forget the “It’s not fair that my family / friends / husband / dog have to deal with my having an eating disorder” trap.  I have a complex and well-developed network of traps, apparently.  Kind of like dig dug.

What happens is that I get SO CONCERNED that I’m asking for too much help or am burdening everyone so much that I don’t actually make any progress in treatment.  Because, what if I’m crying wolf and don’t actually have an eating disorder?  Then making progress in therapy is irrelevant because it’s not like there’s anything to treat in the first place.

My problem during these periods is exactly as the quote describes:  my preoccupation with my unworthiness for help keeps me stuck.  I need to stop obsessing over whether or not I’m too needy and just get it through my head that I still need therapy.  THEN we can actually do something therapeutic.  Nothing productive comes from holding on that “I don’t deserve help” idea.  Doing worse or not telling my therapist anything for fear of “burdening her” probably just causes more frustration for everyone.

I know I’m not the only one who struggles with this, because I see it all the time with friends.  I’m sure it’s something worth exploring in therapy — why do you feel unworthy?  However, I also think it’s the result of a lot of arbitrary expectations and “shoulds” — that there’s a maximum length of time you should be in treatment, or fixed amount of help that you should need.  Using that logic, when you exceed those two years of therapy (I’m completely making that number up), it means you’ve worn out your welcome in the treatment world.

The other idea that I get from this quote is the security of holding onto the “I’m not good enough” idea.  My therapist would tell me that I hold onto the unworthiness thing because it’s easier to make myself the “bad” one than to admit that people around me couldn’t/didn’t meet my needs… and maybe that by continuing to hold onto the idea, I’m protecting myself from being let-down again.  I don’t know about all of that, but I do know that being in the “I not worthy / deserving / needing of” trap does definitely keep you stuck.

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: