“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:

In case you missed it (like I did), the new season of Celebrity Rehab began a couple of weeks ago. I’m just now catching up, and in the process of trying to watch everything on VH1.com, ran across a blog post about Drew Pinsky and his interview in GQ magazine.

When Vargas-Cooper asks Pinsky if putting troubled, narcissistic people in front of a camera as they endure the recovery process, he justifies that, saying “Here’s the thing: These are unmotivated people who want to be on TV and make money. That’s why they’re there. And in spite of that, they end up getting treatment, feeling good about it, being transformed by it.”

First of all, this is a great response for my husband’s and my “Is Celebrity Rehab helpful or hurtful? Is Dr. Drew just exploiting celebrities for the entertainment factor?” debate. Of course, being the Dr. Drew fan that I am, I believe 100% that he has good intentions, but my husband is a little harder to convince. Anyway, I think it’s a great point about treatment motivation — that you don’t have to be 100% “I want to get better, I want to recover, I know I have a problem, yay health” to actually get help. Same goes for eating disorders, of course.

So, maybe if treatment centers were more attractive for different reasons, we would have ulterior motives to go… and once we were there and engaged in the process would realize that we did need to be there and it was important, etc. etc. I have a few ideas on how they could do this:

1. Pay us to go (not the other way around)
2. Make treatment centers more like resorts (hmm… maybe this is why so many are in California / Florida?)
3. Hire staff as cool as Dr. Drew and Shelley

Then, next, I was thinking about something I heard a therapist say once, about staying in treatment being a way that people can escape life (you know, that idea that has us so fearful of being “too reliant” on treatment?). If you applied Dr. Drew’s philosophy to this, though, couldn’t you argue that maybe you are avoiding some of the responsibilities of life, but you’re getting help and getting better…. and eventually you’ll want to go back to life? That even if your motivation to be in treatment isn’t to get better (but to avoid something else), you’ll make progress in recovery and be better able to handle life with your ED / depression / anxiety / PTSD / whatever under control?

I’m not sure I actually believe this, but it’s something to think about. Also, unfortunately at least in the US, the treatment system doesn’t really allow for extensive ambivalence toward treatment — or for you to stay in treatment for as long as it takes for you to decide you to feel 100% ready to move on.

This afternoon, my husband and I went and saw the movie “Everything Must Go.”  In general, I’m not much of a movie watcher.  It’s funny how I can watch a House marathon all day, but run out of patience about 2/3rds of the way through a film.  Anyway, when I heard the movie had Will Ferrell and was about alcoholism, I obviously had to go.

First, as a kind of sidenote, I don’t think I’ve ever seen a serious Will Ferrell movie.  I didn’t really even know it was possible, actually, and was definitely not anticipating it.  So, be warned: it’s not funny (or silly).  At all.

I think that the movie provides a very sobering (no pun intended) picture of what addiction / alcoholism takes from your life.  It ruins relationships, careers, health, and lives.  I don’t think this is a surprise to most people, but the film portrays it in a very relatable circumstance.  Nick (Will Ferrell) seems like an average guy — he has a good career in sales, lives in suburbia, is married, middle-age, etc.  Boring, in a way.  He’s clearly struggled with alcoholism for a long time (they point out at least two stints in rehab), but is what you’d probably consider a functional alcoholic.

You see these glipses of who he was and who he could be.  He reconnects with a girl from high school, who tells a story about how he took care of her at a party.  He befriends a young boy and takes on this father-like figure (for 5 days).  He gives a (possibly) homeless guy his leather recliner (which was was sleeping on at the time).  There are all these little things that lead you to believe that he is a good guy and make you want to root for him to pull through.

Walking into the theater today, I was feeling pretty crappy.  I was anxious about eating today, worried about some big decisions that I have to make, and crawling out of my skin from horrible body image.  All I was focusing on was eating disorder stuff.  I was probably driving my husband crazy from fidgeting so much.  Anyway, it was a good message for me today: eating disorders (like addictions) wreck lives.  Probably not in an acute manner, but slowly, over time, they eat away at those same things — relationships, careers, health, etc.  And it’s sad, because most of the people I know with EDs are wonderful people.  They’re caring, intelligent, talented, supportive, driven… and you just want the best for them.

In the movie, Nick is definitely at a low point in life — but who knows how many other lows he’s had before.  It’s clearly not the first one, and who knows if it’ll be the last.  You see the same thing with eating disorders (different lows, but lows nonetheless).

It’s easy to see the destruction that addiction / mental illness causes when you’re on the outside.  It’s also easier to recognize when the person you’re observing is at a low point.  In most cases, I think it takes a long time to reach a point where you’ve lost your job, all your belongings are on the front yard, and your wife wants a divorce… but the movie definitely does a good job at emphasizing the toll that it takes on your life.

If nothing else, “Everything Must Go” was a good reminder to me that the ED is not going to take me where I want to go in life.  It doesn’t affect just me, and the consequences of maintaining it suck and are very real.

Carrie beat me to posting about this Grey’s Anatomy quote:

After a trauma, your body is at its most vulnerable. Response time is critical. So you’re suddenly surrounded by people—doctors, nurses, specialists, technicians—surgery is a team sport. Everyone pushing for the finish line. Putting you back together again. But surgery is a trauma in and of itself, and once it’s over, the real healing begins. It’s called recovery. Recovery is not a team sport. It’s a solitary distance run. It’s long. It’s exhausting. And it’s lonely as hell.

The length of your recovery is determined by the extent of your injuries. And it’s not always successful. No matter how hard we work at it. Some wounds might never fully heal. You might have to adjust to a whole new way of living. Things may have changed too radically to ever go back to what they were. You might not even recognize yourself. It’s like you haven’t recovered anything at all. You’re a whole new person with a whole new life.

– Meredith Grey, Grey’s Anatomy

The timing of this quote could not have been more appropriate for me — I had just gotten out of the hospital from having major surgery and was still kind of in shock about the whole thing.  Of course, I think this quote extends far beyond recovery from major surgery. While relating it to my own trauma issues is difficult, it is very relevant to my eating disorder.

As I see it, there are three phases/periods of “trauma recovery” that the quote mentions:

1. the critical period immediately after the trauma when you are most vulnerable
2. early recovery
3. the rest of life

Critical period:
I associate more intense treatment with “critical periods” in my eating disorder. In residential or day treatment, you’re pretty much surrounded by professionals. The rest of your life (school, work, other obligations, etc) is on hold, because your health takes priority. Doctors, therapists, and dietitians are “putting you back together again.” I don’t mean to discredit the hard work that it takes to be in intense treatment, but in many ways your biggest contribution is just showing up and being compliant. Someone else is managing everything else: your meals, your weight, your medication, your schedule. There is literally an entire team taking care of you.

Early recovery:
While the critical period is part of early recovery, I’m going to make a distinction and in this case define that time as the period immediately after intense treatment. You re-join the real world and have that “oh crap, I have to do most of this on my own” moment. Even with supportive family, friends, and professionals, at the end of the day it’s still YOU making the choice to get better. And, as happy as you are to not be in therapy all day, it kind of sucks. Like Meredith says, “It’s long, and it’s exhausting, and it’s lonely as hell.”

The rest of life:
As time goes on, you get over / adjust to / accept the shock of early recovery and realize that healing takes a long time. Personally, I usually feel lost. You spend so much time in the throes of the eating disorder, and then immersed in treatment, that when you’re done with it all there’s this big void. Previously you were constantly preoccupied with ED stuff — either engaging in behaviors or working through them in therapy — and now you’re doing what exactly? Everything has changed: your body, your schedule, your eating, your relationships, your coping skills. While logically I know that I’m doing better, I don’t feel “over” the eating disorder, which makes it all the more frustrating.

With that said, I don’t think of “trauma recovery” as a linear process. Each relapse (or even slip) in the eating disorder can lead to another critical period. Hopefully you get to a point where you stay in “the rest of life” even through ups and downs. Don’t get me wrong, there are great things about recovery. I think that many people (without eating disorders) don’t realize how trying and lonely the process can be, though.

I think I’m going to have to break my thoughts up into several posts, so let’s start with Emma and her OCD. Will’s attempt to help Emma with her OCD is not too far from experiences I’ve had with friends trying to help me with my eating disorder (both good and bad):

1. Expressing care and concern – important. Just ignoring her issue (like the rest of the faculty) doesn’t help her, and kind of gives her the impression that her OCD is okay and maybe even normal.
2. Helping Emma clean her fruit - just enabling the disorder. It reminds me of when I first started treatment — my mother took me to the grocery store so that I could buy safe food. You know, sugar-free jelly, pickles, light yogurt, etc. Sure, it eased my anxiety around food, but it also just helped perpetuate the eating disordered behavior.
3. Bringing Emma unwashed fruit — frustrating. In my experience, while my mom realized was filling the house with fat free foods, my boyfriend at the time was headed the complete opposite direction with trying to force me to eat a lot of dessert. This, along with all the “just eat” comments, was also not helpful.

I’m personally glad that they are at least seriously addressing Emma’s OCD, because up until now (with a few exceptions), I feel like they (Will and the other faculty) have largely ignored it and maybe even mislead her to believe it’s not really a problem. Sure, Will makes a comment every once in awhile about how he thinks she’s doing better/worse, but for the most part he just eats with her and lets her clean her fruit like it’s a normal thing to do. It’s become Emma’s identity and a large basis of her character: she’s OCD; it’s just the way she is. As a result, I wasn’t surprised when she made this comment tonight:

“I’m not sure I want to lay on a couch and tell some stranger all of my secrets and I don’t want to start popping pills just so I can turn into someone that other people want me to be. This is how I am, this is who I’m supposed to be.”

I think this does bring up a really good point though, and something that I know I struggle with when it comes to mental illness: How much of my issues (anorexia, depression, anxiety, etc) is mental illness, and how much of it is me?

I’m pretty sure that I’m a perfectionist by nature and that I’ve always had obsessive compulsive tendencies. These are definitely pieces of my personality and they definitely contribute to my eating and anxiety issues. However, I am very certain that I’m not “supposed” to be anorexic or depressed. Even the genetic predisposition and biological contribution to mental illness doesn’t make these struggles my identity. They’re just that — struggles. Something that I have to deal with and work to manage or overcome.

When I was younger and first starting treatment, I worried that something would happen in therapy that would change me when I didn’t want to change. Somehow my psychologist would change my thoughts and I would be a different person. Ha, if only! I’m sure a lot of therapists out there would love for it to work that way. The reality though, is that you are the one doing all the work in treatment. Maybe you can be forced to gain weight or to take care of yourself while in intensive treatment, but it’s your personal responsibility to maintain that change.

From the article:

• The more frequently people watched non-fiction crime documentaries like “The First 48,” the more fearful they were of becoming a crime victim. They also were less supportive of and less confident in the criminal justice system and said they believed the national crime rate was climbing.
• Frequent viewers of fictional crime dramas were not affected by the programming to believe they would become crime victims, and their support of and confidence in the criminal justice system also was unaffected by their viewing habits. Interestingly, though, the more frequently they watched crime dramas, the more certain they were in their support of the death penalty.
• The more often people watched crime coverage on the local news, the more they believed that the local crime rate was increasing.

While reading the article, I was thinking “hmm… what if they applied this to medical television?”  Maybe researchers at the University of Nebraska-Lincoln will look into that next?  In the meantime, I have a few hypotheses about the medical TV viewers (and the conclusions that they make):

People who watch medical dramas…

• Think zebras, not horses (I mean… doesn’t everyone get amyloidosis?)
• Are disappointed when their real-life neurosurgeons don’t look like Patrick Dempsey.
• Think that all nurses, doctors,surgeons,  residents, medical students, veterinarians (etc) are in dysfunctional relationships.
• Have occasional “I need a Dr. House” moment whenever they have some mystery symptom that their doctor can’t explain.
• Don’t relate portrayed patient outcomes with their own health (personally, I’ve never worried about dying from the hiccups).

People who watch non-fiction medical series…

• Think zebras, not horses (okay, so no amyloidosis, but you don’t see too many patients with strep throat or the flu on TV, do you?)
• Are bigger hypochondriacs.
• Have a sick fascination with blood / trauma.
• Should look into a career in the medical field (maybe a paramedic?)

not that any of these things would apply to ME…. of course not…

Since I’m taking this quote so out of context, I feel like I should provide some background.  From the episode recap on tv.com:

House notices Jeff (the patient) and is intrigued by the fact that Jeff is unceasingly nice. He calls in the team to diagnose Jeff, but they’re skeptical that anything is wrong, and suspect House is just trying to prove someone can’t possibly be so happy.

House immediately dismisses the arguments about how maybe Jeff is just that happy and perfect, and responds:

House: You’re either perfect or you’re sick. In my experience, “sick” is much more common.

I thought this comment was really interesting, given all the perfectionistic people that I’ve been in treatment with (myself included).  I’d be lying if I said I wan’t extremely concerned with appearing “put together” — aka: not having any issues.  There’s definitely a higher-incidence of perfectionism among individuals with eating disorders, but had never thought about it the other way — that people who appear “perfect” are more likely to have mental illness.  Okay, so this is not research and not exactly what House is implying, but think about it:

• the most mentally-healthy people that I know are not perfect.  I don’t know if they even want to be.
• probably a third of the people that I’ve been in treatment with are extremely perfectionistic.

It’s ironic that society dictates such a goal of perfectionism — perfect family, perfect career, perfect house, perfect weight, etc — while actually being “perfect” could definitely be a sign of being sick.  It’s human-nature to fail, disappoint, have issues, have flaws, and make mistakes.  Fighting human-nature can’t be healthy.

This kind of came up in one of my therapy sessions not too long ago.  We were talking about recovery and how you can never tell who is and isn’t going to get better (in the near future).  Some of the sickest girls (physically, mentally, and emotionally) that I knew in treatment are doing awesome now.  However, the friends who seemed so functional and fine are still in and out of treatment.  Maybe these scenarios are the exception to the rule, but you really just can’t tell.

My therapist’s response was really interesting — she said that being put-together is a bad prognostic factor in treatment, because it means that you’re not being open / honest and engaging in the process.  I had never thought of it that way, and her theory really ties together perfectionism and illness.  I can’t say that I fully believed her at the time… but that was before HOUSE said it.  If House says it, it must be true (kidding).

I’m not saying I’m going to pick out my top 5 most-perfectionistic and non-eating disordered friends and start worry about their wellbeing, but it’s definitely something to think about.

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!

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.