Anyway, while discussing Bob Forest, we decided that we wouldn’t want to have to hunt patients down when they left treatment AMA.  Do addiction counselors really do that?  It’s TV-rehab, so I’m guessing probably not, but I have no experience in this domain so I don’t really know.  I can’t say I’ve ever seen a psych professional ever go searching for a patient, though.  In fact, I’m pretty sure it would be viewed as inappropriate.  I’m trying really hard to envision the ED-version of Bob’s driving into the dessert to get Heidi back into treatment… but I’m having a hard time imagining my dietitian (or therapist, or anyone else) driving to my house (or local laundromat?) to make sure I didn’t skip lunch.  It would never (even in a million years) happen.

There are lots of things that professionals do in Celebrity Rehab which I’ve never heard of before:

1. Actually going out and finding patients that leave treatment AMA.
2. Having patients stay at your house for a night if they leave sober living.
3. Have your house re-decorated while you’re in treatment.
4. Going to the veterinarian with you if you have to put your dog down.
5. House calls (or hotel, in Seth’s case) to visit former patients and convince them to come back to treatment.
6. Setting up random activities to help patients find themselves (ballet lessons for Mary, a benefit concert with School of Rock for Mike)

Just to name a few.  Again, I know it’s VH1 and not exactly “real life,” but wow — where can I find a treatment center that will redecorate my house while I’m gone?

“Addiction is the only disease that you have to convince people that they have.”

I highly disagree with this statement, and think that denial is a large part of many mental illnesses… and even some physical illnesses. Just to name a few:

• eating disorders
• personality disorders
• depression
• ptsd
• dementia

Sometimes people just don’t want to admit that they’re struggling with a mental illness (maybe they think it means they’re a weak or defective person). Sometimes people feel their issues aren’t severe enough to warrant a diagnosis. “I’m not depressed — I’m just in a negative funk.” Some of this probably has to do with the stigma and stereotypes of people with these diagnoses. You always think of the most severe cases. With anorexia, you think of an adolescent girl who’s emaciated and never eats, ever. With depression, you think people who never leave their house and cry all the time or are suicidal. With PTSD, you think rape or child abuse or something horrific. You end up comparing your symptoms with those on the far end of the disordered spectrum… and then of course you feel like you’re okay! There’s also the misperception that you can’t be sick and be functional in life. You can be both awesome at your job and still very disordered.

Denial and minimization are hallmarks of eating disorders. There are probably a thousand different reasons why, but to name a few:

• not feeling “sick enough”
• still functioning in everyday life — maybe you’re even very successful in other aspects of life
• weight is not extremely low (maybe it’s even normal or above)
• still eating (or keeping food down) sometimes
• you have previously been much sicker & are comparing current symptoms to those during the height of your disorder
• “everyone has somewhat disordered eating”
• “I am healthy enough”
• all-or-nothing thinking — you have one or two good days and feel that you are therefore fine
• fear of having to change

One difference between addiction and eating disorders, is that you are forever a recovering addict (at least that’s the most popular ideology). You can be sober for 40 years, and you’re still a recovering alcoholic. With eating disorders, you can jump all over the diagnostic landscape. There’s switching between disorders, periods of recovery, relapse, and maybe full & sustained recovery. Because of this, you may have to be convinced a dozen times in your life that you have an ED. And, with the line between normal and disordered eating being so fuzzy (diet food… disordered or not?), it can be hard to tell whether or not you have an issue.

Convincing someone that they have an eating disorder can be a long, frustrating, and repetitive process. I’m very biased, but I’d even venture to say that EDs take more convincing than addictions.

“Currently, we are concerned about young people using the Internet, eating too much, spending irresponsibly, and being promiscuous, and these worries are being expressed in the language of addiction. The medical terminology helps us to believe we’re avoiding moralization or blame, and popular science has given us a sound bite of pseudo-neurology to support our prejudices. For these problems, addiction is little more than a fig leaf for a realistic understanding that would address why people return to unhelpful ways of coping with isolation, stress, and depression. Instead, we prefer to rely on a trite and unhelpful catch-all label that prevents people from getting appropriate help for their difficulties. We need to break the addiction habit, before it breaks us.”

–Slate, The Addiction Habit

My first thought when reading this article was “ouch.” I’m not an addict, but still, that’s a pretty strong statement. Addiction as a fig leaf. Hmm…

I’ve written a post on this before (A diagnosis for everyone), which would largely agree with the author of the mentioned quote. I do think that the addition label is used too literally.

However… after having watched Sex Rehab, I have a slightly different view on the subject. In terms of true addiction, I’ve always really only considered drugs and alcohol as qualifiers. I wouldn’t even say an eating disorder is an addiction (although many would argue with me), just because there isn’t one identifiable thing that you are addicted to. There are a lot of similarities between the two, though. Anyway, that’s a debate for another day.

Regardless of whether sex addiction is a “real” addiction, these people came and got help. There was much more that they needed to deal with than just the sex – most of them had either some kind of abuse history, unresolved issues that were affecting their daily lives, or an underlying drug/alcohol issue. Whether or not sex addiction “counts,” these people were really struggling with a lot of stuff in life. They definitely left in a better place than they started, and I’m sure that the ongoing treatment can help them be healthier, happier people with satisfying relationships (hopefully).

They wouldn’t have made these changes unless they were removed from their everyday lives. They needed a rehab. They wouldn’t have gone to rehab unless they had a real problem, though. If sex addiction didn’t “count” as real, who knows if they would have ever gotten help.

So I guess my point is… yeah, the word addiction is definition used too liberally. Internet addiciton and sex addiction are most likely in a different category from substance addiction. However, I disagree with this part of the quote:

“…we prefer to rely on a trite and unhelpful catch-all label that prevents people from getting appropriate help for their difficulties.”

I think that MORE people get help when their struggles are verified as real problems. If you spent your entire adult life playing online role-playing games, to the detriment of your career and relationships, then yeah, I’d say that’s a problem? An addiction? ehhh… I don’t know. But if labeling it as such would give someone the permission to get help for something they can’t get over on their own (isn’t that largely what it comes down to? getting help for a problem that you can’t handle by yourself? that’s hurting you, your loved ones, and your life?”), then sure, call it that.

Maybe we shouldn’t call these behavioral obsessions “addictions” – but we should come up for something that validates them. The article makes a relevant point:

“Recent work by psychologist Meredith Young and colleagues at McMaster University in Canada has shown that if we replace a common name for an illness with a medical term—pharyngitis for sore throat, e.g.—people tend to perceive the illness as being more serious.”

Okay, so come up with some scientificish name! Someone must know what “behavioral obsession” is in Latin. Just give it a real name so people can recognize it as a real problem.

For some reason I feel like I should include this… Disclaimer: This whole post is based purely on observation and not remotely rooted in any kind of research. It is not really reflect my views on trauma, treatment for trauma/abuse, or the significance of abuse.

Tonight I stumbled upon a forum thread discussing Sex Rehab with Dr. Drew. I don’t know how I have missed it all of this time! Anyway, there are a lot of great things being said in the 30-page thread, but a couple of things caught my eye.

The first was this comment:

This is a danger in all group therapy of being the “best worst”. If you can’t be the best, best you can always be the “best worst”.

And then, this comment:

“If you need to see me in my addiction practice, there’s almost a 100% guarantee you suffered childhood neglect, physical abuse, or sexual trauma. It’s always there. Always.”

The second remark wasn’t really in response to the first, but I definitely think there is a connection between being the “best worst” and trauma. I don’t mean that people with a trauma history want to be the sickest patient, but instead the opposite – people who want to be the sickest also want to have the worst trauma.

I realize that this is a gross generalization, but it’s something that I always noticed in treatment. When I was inpatient, there were special groups for people with a trauma history. They were definitely necessary and no one WANTED to go to those groups, but for whatever reason having that trauma label made those patients’ struggles seem more valid. You could pull the trauma wild card when things started getting competitive.

Anyone who has been inpatient knows what I’m talking about. There are some patients that want to make sure you know that their eating disorder is the worst. With anorexia, it’s about who developed their eating disorder at the earliest age, ate the fewest calories, got to the lowest weight, or had the most hospitalization. With bulimia, I remember comparisons over who ate the most while bingeing, purged most frequently, spent the most money on a binge, had the most irregular labs (potassium in particular), and have purged in the weirdest places. I think the same thing happens with trauma. When the girl sitting next to you has some horrific childhood trauma (for instance… she grew up in a nudist cult where her mother divorced and one week later remarried a high school boy 5 years your junior, or something crazy like that), you can’t help but sit there and think “Wow, she REALLY had it bad. She has way more to deal with than me.”

There was actually a third comment that I liked:

Just because a patient admits to trauma does not mean that

1. its true
2. said trauma is the cause of adulthood problems
3. the solution lies in dwelling over the past.

All three of these notions are commonly assumed.

I’m not sure where I stand on the issue of trauma treatment, so I’m not going to dive into that, but I just want to point out that not everyone with an eating disorder (or an addiction) has a history of abuse. Individuals can develop an eating disorder regardless of how great or awful their childhood was.  Abuse/neglect is horrible and unfortunately many with eating disorders have this history.  However… I wish trauma didn’t get tied up in the whole “best worst” competition.

Lately, I’ve been reading Dr. Drew’s latest book, “The Mirror Effect.” It addresses celebrity narcissism and the extreme behavior that goes along with it. Dr. Drew does a great job at highlighting what has become typical tabloid material – multiple stints in rehab, sex tapes, drug use, eating disorders, etc. – and explaining the self-destructive pathology behind it.

Dr. Drew references troubling celebrity behavior over and over throughout the book. As I read, I found that most responses to this self-destructiveness fit in one of three categories (depending on one’s own background):

3 responses to troubling celebrity behavior:

1. Dr. Drew (empathetic / sympathetic)
2. “Regular” society (intrigued)
3. Relaters (Individuals with their own psychopathology)

The Dr. Drew Response

“As a group, however, [celebrities] often behaved in ways that unnerved and puzzled me.”

“…their behavior makes my heart ache for them.”

I’m coining this the Dr. Drew Response since I can’t think of any other word to better describes the reaction. His heart aches! He sees someone being self-destructive and he cares and feels their pain. It’s sympathy + knowledge + understanding + insight.

“Regular” society

“…this kind of behavior is portrayed as tragically glamorous, dramatically alluring, and, most alarmingly, normal and expected.”

A lot of people are interested in the self-destructive behavior of celebrities. It is a little bit of an obsession: Is Nicole Richie losing weight? Is Lindsay using? Is Amy Winehouse still alive? People want to know. The troubling behavior is intriguing and the press does a great job at, in essence, kicking celebrities when they’re down.

Relaters

“Witnessing such behavior also tends to provoke our own narcissistic impulses, causing us to feel envy, and tempting us to act like the celebrities we admire.”

“But for anyone who has experienced childhood trauma – the fundamental source of pathological narcissism – surrendering to such impulses can lead even mildly narcissistic people to spiral out of control with devastating results.”

Individuals with their own psychopathology or traumatic histories can be tempted (or even feel envious) by the self-destructive behavior of celebrities. There’s something triggering about it that makes these people want to engage in the same self-destructive behavior.

So there we go: In this world we have Dr. Drews, Regulars, and Relaters. I think that your response can change depending on the situation, and that it applies to anyone struggling – not just celebrities.

For example, I think about this girl who went to my college and was very obviously struggling with an eating disorder. “Regular” people would gossip about how sick she was. You’d hear the “I see her at the gym every single morning” and “I heard she eats a plate of broccoli for dinner” comments. Yes, it’s wrong and mean, but unfortunately that’s reality (at least on college campuses). Now, I was a Relater (struggling with an ED myself), so this girl kind of triggered me. I didn’t want to be that sick, but seeing her around campus would almost encourage my eating disorder; tempt me to cut corners, lose just 5 lb., eat a plate of broccoli for dinner, etc. That drove me CRAZY. I didn’t want to be a Relater – I wanted to be a Dr. Drew. I wanted to just empathize with her, wish she would get help, recognize how miserable she probably felt, and know how tough things were for her right now.

This is still a goal of mine: That Dr. Drew Response.

You as your own case manager
Originally Posted: 01/01/2009

I wish that all these guys were going to stay clean, I really do. I’ve just seen it so many times that I can tell when someone’s really willing to do whatever it takes and when someone’s willing to do what they think it should take. And it’s just not going to work like that, unfortunately.

–Shelly, Celebrity Rehab with Dr. Drew 2

Wanting to want to recover
Originally Posted: 06/12/2008

Motivation to change implies an intention–weak or strong–to change one’s behavior. However, AN patients may at the same time both wish to recover and be highly resistant to change their behavior. Therefore, we suggest that assessment of motivation in these patients should include not only their motivation to change, but also their different wishes to recover which do not necessarily imply a behavioral intention.

Dr. Drew should treat eating disorders
Originally Posted: 07/01/2008

There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

1. Recovery is a lifelong, daily process
2. Denial, and not necessarily that you have a problem, but that you need help
3. The importance of personal accountability
4. There’s no magic cure
5. The disorder should be taken as seriously as any potential fatal disease

Do not pass Go, Do not collect $200
Originally Posted: 12/09/2008

“I don’t want to play the rehab game anymore”

– Jeff Conaway, Celebrity Rehab 2

I think that recovery can feel like a game at first because it is so different from the rest of your life. It’s nice to have others care about your wellbeing and there’s something about treatment that gives you permission to take care of yourself. Plus, there is so much positive reinforcement (gold star for following your meal plan over the weekend!). All of this doesn’t sound so bad… and I do believe you can make progress — even with this mindset.

When does the game end? Personally, I think this is when the disorder starts to feel threatened. There is something scary about recovering, and suddenly it doesn’t sound like a great idea anymore.

1. It’s called Loveline
2. Half of it is sex talk
3. I have to pay $5 a month for it!

Still… It’s Dr. Drew, so I have to do it.  There are calls about addictions and psychological issues, and listening to his responses to those questions is worth my $5.

Dr. Drew had a particularly great quote today:

“It’s not what you’re doing, it’s what you’re missing – and you deserve better.”

The quote was not in relation to alcoholism or eating disorders, but it really hit home with me.  Yes, you need to get better because it’s important to take care of yourself, people care about you, you should care about you, you want to be healthy, it’s pathological, etc.  But also, when you are wrapped up in the ED you are missing life.  Maybe that’s semi-intentional; maybe you’re avoiding life.  You might think you’re just coping with life in an unhealthy manner, but you really are missing it.

You’re missing:

1. Close relationships with friends
2. Many normal social situations (getting pizza, going out for lunch, meeting for a drink, getting ice cream for no reason)
3. Good experiences (as well as bad experiences) that shape you as a person

I can think of a lot of things that I “missed”

1. Close relationships with HS friends
2. Trying anything new (for most of my life)
3. Getting ice cream with friends
4. A lot of summer cookouts
5. Trips I wouldn’t go on because there would be too much food or b/c I was depressed & wanted to stay home
   (okay, this is a depressing list so I’m going to stop here)

I think that eating disorders are as much about avoiding life as they are hurting yourself.  First there is all the time that you spend wrapped up in the disorder.  You’re isolating, avoiding events with food, and spending 90% of your day thinking about food and weight.  You have no idea what is going on around you.  And then there’s treatment, which takes up even MORE time… because along with the continuing disordered behavior (it’s not going to go away overnight), you now also have a dietitian, a therapist, a doctor, a psychiatrist (and this is assuming that you don’t really put your life on pause to go to a residential or partial hospitalization program).  You are spending your free time in treatment.  And I don’t know about you, but when I’m working on tough stuff in therapy, I have a harder time dealing with the rest of life.  When I’m upset about whatever my therapist said two hours ago, the last thing I want to deal with is a presentation that’s due tomorrow.  So yes, even in recovery, you are avoiding / escaping / missing (whatever you want to call it) your life.

It’s kind of ironic when you think about it.  You spend so much time in therapy trying to change behaviors, discussing why you are coping with life via your ED, identifying unhealthy aspects of your career and relationships, etc.  However… how much time do you spend talking about what you’re missing?

And for awhile, this is the point.  Maybe something in your life is not okay.  Maybe there is too much on your plate, maybe you are in a bad relationship, maybe you do need to change your job, maybe you are killing yourself trying to please everyone else in your life–whatever.  One of the best things about residential (I think) is that you don’t have to deal with the real world while you’re in treatment.  I can just focus on myself and what I need to be doing without the constant stress and anxiety of bills, relationships, responsibilities, work, money, and the list goes on.

However, I am not new to treatment, and neither are several of my friends.  And while I do worry about their health and their symptoms, what really makes me sad is what the ED takes away from them.  For one friend, it takes away time and energy that she would rather be spending with her children.  For another, it limits her career because work has to be planned around the ED and ED treatment.  Another friend has to put relationships, summer plans, and a lot of the life that she has created in the past year on the side right now to get more intense help.

All of these friends are making the right choices to work on the eating disorder and to get the help that they need!  Absolutely.  Friend #1 can’t take care of her family if she isn’t taking care of herself, Friend #2 won’t be able to put the energy and concentration into the job that career that she really wants until she is healthier, and Friend #3 won’t be able to maintain that life if she doesn’t do intensive treatment.  My point is, though, that what saddens me the most about these friends is not their concerning ED symptoms, but all the things that they are missing out on in their lives.  They’re such wonderful people and are meant to do so much more in the world than they can with this eating disorder.  They deserve so much more out of life than this eating disorder, and that’s why I hope they can get better.

“Most believe [addicts] connect around a common experience of pain and powerlessness without the fear of exploitation. Their pain is so raw and tender that getting them to start the process requires them to be convinced that their pain will be understood. They’re all people with extreme trust issues, and the only people they’ve ever trusted are other addicts. They understand each other. (Interestingly, doctors have discovered that survivors of torture have similar reactions to treatment. They don’t open up unless they’re around others who’ve been through similar horrors, as though the pain of being misunderstood would be too great of a risk.)”

If you’ve ever been in ED treatment (or addiction / trauma treatment, I assume), you know that there’s something very different about the relationships that you form with other ED patients. You know all about their relationship issues and what they are / aren’t eating — but don’t know their last name. They might be thirty years older (or younger) than yourself or living a totally different lifestyle. Maybe they are completely opposite of the type of people that you usually hang out with, and if you met them in any other context you probably wouldn’t hit if off. But… despite all these differences, just their having an eating disorder makes it easier to talk with them than non-ED friends that you’ve had for years.

I have good friends, but the closest friends that I have are all people that I met in treatment. I just can’t open-up to other people in the same way that I can with them. Some of it is their ability to understand me — that definitely is a large part. My non-ED friends cannot relate to my frustration over food rituals. But I think it’s more than just their ability to empathize. Because they have an eating disorder (and were in treatment), it means they are the kind of person who you CAN talk to about this stuff. They have issues, too. I don’t know how some of my “regular” friends will respond to the stuff that I tell them… however, I do know that these ED friends are not going to invalidate my struggles. They aren’t going to think that I am ridiculous, and I don’t have to feel so ashamed. Dr. Drew explains it so well — “the pain of being misunderstood would be too great a risk.”

Upon thinking about it a little more, though, I wasn’t sure what this Anti-ED Coach would protect me from. Would he make sure no one served me diet coke? Or that we only went to public places with healthy-weight people? Or would he stand outside the bathroom (any bathroom) and make me count? Okay, so maybe the idea was silly.

However, then I went and Googled “Sober Coach,” and found a website that explains what a sober coach does. Wow, they do a lot… they really seem like “life coaches” to me. If I had to adapt the list from this website for eating disorders, it would look something like this:

1. 24 Hour Crisis Support
   1. Phone support available 24 hours a day, 5 days a week.
   2. Education on how to ask for help.
2. Daily, Weekly, & Weekend Planning
   1. Creating an hour by hour schedule when necessary.
   2. Learning to deal with free time and/or unstructured time.
   3. Establishing weekly goals.
3. Physical Well-Being
   1. Nutritional consulting.
   2. Support with eating disorder issues.
   3. Support for anxiety and depression.
   4. Creating a personalized self-care plan (acupuncture, yoga, body coach, personal trainers, etc.)
4. Career / Academic Guidance
   1. Finding a job / volunteer work / internship.
   2. Support with changing careers.
5. Fun / Passion / Purpose
   1. Learning how to have fun & explore different hobbies.
   2. How to build fun into weekly schedule.
   3. Finding one’s own aspirations and dreams.
6. Recovery Support
   1. Help in finding appropriate treatment.
   2. Daily relapse prevention plan.
   3. Support in establishing healthy friendships and relationships.
7. Team Approach
   1. Works with psychiatrists, therapists, dietitians, and outpatient programs to provide a team approach.
   2. Referrals to various professionals as needed.

If you look at the original website, you’ll see that I didn’t have to add much. If Sober Coaches really do all of the above, that’s pretty amazing. I need someone to educate me on “how to ask for help” and “how to deal with free time and/or unstructured time” ! I also like the idea of someone coordinating things with a treatment team. I think that often professionals don’t work well as a team or they don’t necessarily consider the input of the patient (when appropriate). It’s a nice thought to think you could have someone advocating on your behalf in those meetings…

I realize that this is probably realistic, but it’s an interesting thought. An Anti-ED Coach could play a role that I don’t think really exists right now in treatment. Many of these responsibilities don’t fall under the job description of your doctor, therapist, or dietitian. It’s tricky relying on your spouse / family members to serve all of these functions, too, because they all don’t necessarily mess with the nature of the relationship. For instance, if I’m having a bad night and freaking out about something food-related, I don’t really want to make my fiance listen to my possibly irrational rant about calories. At the same time, though, it wouldn’t be appropriate for me to call or email my dietitian about this, either.

I am fortunate enough to have ED friends in recovery who can support me and give me advice during tough times, but that’s still a different relationship that with a Sober or Anti-ED Coach. You always have to consider if you are hurting or triggering the friend with your ED thoughts and behaviors.

I’m sure you’ve heard these before… like FINE – Frustrated, Insecure, Neurotic and Emotional.  Now, look at a few of Gary’s…

Doubt - Debating On Understanding Bewildering Thoughts
Romance – Relying On Magnificent And Necessary Compatible Energy
Fear – False Evidence Appearing Real
Fun - Finally Understanding Nothing
Sober – Son Of a Bitch! Everything’s Real
Fraud – Finding Relevant Answers Under Deception
Faith – Fantastic Adventures In Trusting Him

So, I thought that I would create some of my own, relating to eating disorder treatment.  Personally I don’t think they’re useful — I just think that they are amusing.  However, since it took me 2+ hours to come up with these couple of Greyisms, I think that they are a little less fun.  Anyway, here’s what I’ve come up with:

• Cope – Changing Overwhelmingly Problematic Experiences
• Shame – Sense of Hurt And Malicious Embarrassment
• Fear – Flee Emotions Around Reality
• Want – Wish About Needing Things
• Denial – Dismiss Every Notion Implying Anything Less
• Therapy – Telling Her Everything Rough About Previous Years
• Support – Someone Understanding Pretty Painful and Overwhelmingly Rejecting Thoughts
• Know – Kinda Not an Original Word

So there you go — those are my best Greyisms.  If you come up with better ones (which you will surely do), definitely post them!