Category Archives: House

equation for truth3

4 ways to lie

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Some interesting thoughts on truth vs. lies from two of my favorite philosophers — Mark Twain and Gregory House.

“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:

house

Either perfect or sick

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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.

You say that like it's a bad thing

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Chase: How would you feel if I interfered in your personal life?
House: I’d hate it. That’s why I cleverly have no personal life.

If you replace “personal life” with “personal issues,” I could have written those lines (although much less eloquently and using three times as many words).  It’s much harder to be hurt when you just don’t have issues–right?

Along the same lines, Chase and House have another conversation later in the show:

Chase: Why does everybody need to know my business?
House: People like talking about people. Makes us feel superior. Makes us feel in control. And sometimes, for some people, knowing some things makes them care.
Chase: I’d tell you my dad left, my mum drank herself to death… you gonna care about me more?
House: Cameron would. Me, I just like knowing stuff. [pause] I know you hate your dad, but I’m gonna tell you something –
Chase: I don’t hate him. I loved him until I figured out it hurts a lot less to just not care. You don’t expect him to turn up to your football match? No disappointments. You don’t expect a call on your birthday, don’t expect to see him for months? No disappointments. You want us to go make up? Sink a few beers together, nice family hug? I’ve given him enough hugs. He’s given me enough disappointments.

If you don’t care — or can dismiss anything unpleasant as being a nonissue — then it’s much harder to be hurt.  Isn’t that convenient?

However, notice that House does not have many friends (…and poor Wilson!).  He’s semi-miserable and no one can ever make him feel better.  Even the drugs aren’t doing it.

Okay, so I’m not House, but I am pretty good at always being okay.  I hate the thought of others suspecting that there’s something wrong.  I told my therapist the other day that it literally HURTS to be not-okay in front of someone else.  It’s hard for me to explain why, but I just hate it.  I would respond just like Chase: “Why does everybody need to know my business?”  My mantra is, “If said person is not really in my everyday life and is not someone that I need to turn to for support, then why do they need to know if I’m struggling?”

“I don’t care” is in a way an ugly way of saying “I’ve reset my expectations.”  Chase’s dad was never going to be reliable.  He wasn’t going to play the father role that Chase needed.  He learned that and adapted.  Personally, I think that’s a relatively healthy response (especially if the alternative is continually being re-upset every time you dad doesn’t show up, for the rest of your life).

I think that it’s important to find support in other places if you can’t get it from your parents.  That said, I also don’t think you can get over the loss of that relationship 100%.  He still wishes that things could be different between them, and he was bothered by his dad’s being there because it is still a sore spot for Chase.  Having a hundred caring friends is still just not the same.  You try and get the support that you need from other people, and that does help.  And you grieve the loss of that relationship, which sucks, but also helps.  But…. still, that longing does not completely disappear (okay, clearly I am talking about myself now and not so much Chase).

My point of all of this (which I am not doing a good job of expressing) is that just not caring does have its advantages.  Life is much simpler when everything is “okay.”  You’re not disappointed if you set the bar low.  However, by lowering your expectations like this, you are also isolating yourself more.  It gets lonely and frustrating when you won’t let others in.  Because I can’t stand the thought of struggling when out with others, I am left to deal with all of the emotions on my own.  By eliminating the possibility of being disappointed, I think that I also eliminate my chances of feeling better.

When I think about all of the people that I care about, the ones closest to me are those who know what’s going on in my life.  We talk about more than just coffee, the weather, our pets, television, work, etc.  It’s that humanness of NOT always being okay that makes us care about one another.  While it is definitely adaptive in some circumstances to re-evaluate what realistic expectations for that relationship are, I personally can’t turn that caring / trusting thing on and off.  Chase did have an honest conversation about the relationship he has with his dad (albeit, the conversation was not his idea and it was with House…), and they clearly left on a better foot than they started on.  I think he feels at least a little bit better.  House, who has “no personal life,” though, likely went home and sat his couch by myself, popping vicodin.   Having no personal life is not that clever.

That's not actually a deep question

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“I’m not deflecting because I’m avoiding something deep. I’m deflecting because I’m avoiding something shallow.” – House, MD

One of my biggest treatment pet peeves is when professionals ask non-deep “deep” questions. For example:

  1. What does it mean to feel?
  2. How did it feel to be in that space?
  3. How does it feel to be in this space now?
  4. What does it mean for you to not be in that space anymore?
  5. How do you experience that process?
  6. What would it mean for there to be grey in your world?
  7. How does it feel to have acknowledged that out loud?

Okay, depending on the situation, some of these questions could potentially be useful. However, I’ve had therapists who use them over and over and over again. “What does it mean to feel?” is probably my least favorite question of all. Maybe it SOUNDS deep and therapeutic, but there are really only two answers to this question:

  1. It means that I have feelings
  2. It means that I am allowed to have emotions and that it’s okay for me to recognize them and not judge them as being either “good” or “bad”but to just accept them as they are… and that emotions may be scary but I can work through them and get support to handle them… and that they are normal and a necessary part of human life and essential to enabling us to connect to other humans and form relationships….

My point is, your answer is either “this is a stupid question” or “I just had this revelation about the significance of feelings and everything else in my life.” And if your answer is the first, then it’s “But what else? What does it really mean?” This is where the House quote comes in. I’m not deflecting the question because I don’t want to address some deep underlying issue, but because it’s really not a deep question! And if you won’t accept “Um, it means that I have feelings” as an answer, then you are going to get whatever fictitious BS I can come up with off the top of my head. Plus, I’ll be frustrated and won’t want to intelligently answer your additional questions.

You can ask me what I’m feeling, what I felt at that time, how I feel about feeling that way, etc…. but I hate when it is reworded to sound like a deep question. “How does it feel to be in this space now?” is just “How do you feel?” with six extraneous words.

Wow, I swear I am not as bitter (or as difficult of a patient) as I sound in this post! I just don’t like shallow questions that are pretending to be deep.

I'm so okay that I'm boring

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Chase: You don’t let other people’s problems affect you. You don’t let your own problems affect you, and it’s the screw-ups that make us interesting. You’re never out of control, which is good… and boring. Never losing control means you’re never putting yourself out there, never pushing your limits.

– House MD, Lucky Thirteen

The problem with perfection (ha, that’s ironic): it’s boring. There’s nothing “special” about seeming perfect. And yet, I still strive for it. I want for everything to be “correct.”

I want to….

  • always get good grades
  • never appear to have any problems
  • not struggle with anything
  • never screw up
  • never need help
  • handle everything with grace, unflinchingly
  • be completely independent
  • never seem disappointed or hurt or angry
  • always be positive
  • seem to get along with everyone
  • have only good relationships

etc, etc, etc. I don’t ever want anyone to think that something is wrong. I don’t want to seem vulnerable or not-okay. I just want everything to always seem okay (well, and to be okay, but I’ll settle for “seem”).

And this makes me boring. Chase hits the nail on the head with why: “Never losing control means you’re never putting yourself out there.” Relationships require for you to put yourself out there–to be vulnerable and relatable and imperfect. The friends that I am closest to are those who have seen me NOT okay. They know that I have issues with eating and depression… they know I don’t agree with my fiance 100% of the time… they know that things are weird between me and my parents. They know that I get overwhelmed with work and that there are coworkers who really get to me. They know there are a lot of things that I really suck at (like trying to learn a foreign language, most team sports, and cooking).

When I think about it, I am essentially putting so much time and energy into being boring. And maybe I could justify boring as feeling better (being in control, not being as affected by things, minimizing negative interactions and consequences), I think it just feels safer–not better. Because when you never let your guard down, you never let people in. If you never admit that you’re not okay, how can anyone ever help you feel better?

house-wilson

House, leashes, and noncompliance.

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Dr. Wilson: House! Why the hell did you let an unstable patient wander the hallways?!
Dr. House: His leash broke.

I’ve always found the transition between “treatment” and the “real world” fascinating. One minute you are a “real adult” — you can drive your car, eat what you want, walk the dog, go to work, go on a vacation, make bad choices, make good choices… but as soon as you walk through those treatment-center doors, all of these adult “privileges” are revoked. Your purse and coat is locked up — you can’t carry your keys, because what if you tried to leave during the day? You ask permission to use the bathroom. Some people have to count while in the bathroom. You can have one packet of salt with your meal. No caffeine. No, you can’t see your weight–stand backwards on the scale.

house-wilsonAnd this isn’t just with residential treatment… but with day treatment or even IOP! Which makes it even more bizarre, because you wake up an adult, spend your day as a five-year old, and go to bed again that night as an adult.

I understand that it has to work this way for a couple of reasons:

  1. There can be kleptomaniac patients.
  2. Maybe someone is sick enough that they would get pissed off during a group and try to run off.
  3. Treatment is about normalizing eating — which means not using 10 packets of salt on your meal.
  4. Having unlocked bathrooms can create unnecessary temptations to purge. You’re there to work through the uncomfortableness of whatever you bring up in therapy and the normalness of the meals… without being able to use symptoms.
  5. It’s easier to do okay when it’s not your choice, because then you don’t feel guilty. You didn’t give yourself permission to eat the meal — you HAD to eat it.
  6. Not stressing over even the little things gives you more room to concentrate on the therapy.

There are already so many regulations in place. You are already being rewarded for eating and for drawing pictures in art therapy and for talking about whatever important issue. Heck, I have gotten praise for sitting still! (“grey, you sat still much longer than usual today — that’s definitely an improvement and I think that you need to learn to celebrate your accomplishments). So, when patients still find some way to evade the rules or act ridiculously helpless it irks me to no end.

I can relate to this House quote and the frustration of being in treatment with impossible patients. I understand having a hard time. You’re not always compliant in treatment because by nature, eating disorders are manipulative. But… the staff already has you on a leash. You don’t have responsibilities and you’re already being monitored. If you’re going to bring an extra set of keys with you to day treatment so that you can escape mid-morning and avoid lunch, the staff isn’t going to chase you. They shouldn’t have to!

Both inside and outside of treatment, you ARE still an adult. You still have some responsibility in cooperating. It’s the treatment center’s job to keep you as safe as possible and to reduce ED triggers and temptations. Therapists and counselors are there to help you in this already rigidly-structured environment — they can’t babysit you.

More House Wisdom

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You think that the only truth that matters is that truth can be measured. Good intentions don’t count. What’s in your heart doesn’t count. Caring doesn’t count.

–Moriarty, House M.D. No Reason

The belief that “things don’t count” has always been a huge obstacle for me in recovery. Maybe originally I used the eating disorder to physically communicate something that I couldn’t verbalize… or maybe it was a manifestation of an unspoken problem that had to surface somehow. Or maybe I just had the biology + trauma = anorexia equation going for me. Whatever the case may be, the eating disorder has now been tied to emotional/mental health.

Eating disorders can be measured. Weight, weight loss, caloric intake, binges/purges, blood pressure, lab values, etc. Losing weight or weighing too little means that you are not okay. Gaining weight means that you are doing better. I could have an awful, depressing weekend… but gain a pound and think “well, obviously I wasn’t really upset, because then I wouldn’t have gained a pound.” That is so eating-disordered, I know, but my point is that eating disorders are measurable — and feelings are not. And while feelings should be more important, it’s hard to give them as much weight when there is physical evidence to the contrary.

The same goes when it comes to giving myself “permission” to take time out or to give myself a break. I have a career, expectations, responsibilities… what’s my excuse for not handling all of that — “I don’t feel okay”? Who cares? Does the world care? No. Because feelings don’t matter. I am physically okay, which means I am mentally okay (see previous paragraph), which means I should be able to handle everything. Everyone else can.

Of course I know that this is disordered thinking, and that sure, feelings do matter… But I can definitely relate to House on this one. The inside stuff doesn’t count because it’s not tangible. But, when you become physically ill… then there’s proof that something is wrong.

house-laurie49

"All we've done is make a girl cry"

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From an Episode of House, MD: Episode 3-12, One Day, One Room


In case you haven’t seen it, a girl has been raped and refuses to talk about the trauma. These are the last lines of the episode.

CUDDY: She’s gonna be okay.
HOUSE: Yeah, it’s that simple.
CUDDY: She’s talking about what happened. That’s huge. You did good.
HOUSE: Everyone will tell you… that that’s what we gotta make her do. We have to help her, right? Except we can’t. We drag out her story. Tell each other that it’ll help her heal. Feel real good about ourselves. But all we’ve done is make a girl cry.
WILSON: Then why did you…?
HOUSE: Because I don’t know.

Doesn’t this sound like the promise of therapy? That if you show up and talk about stuff that sucks, you’ll be okay? That’s at least the initial illusion that I had (similar to my inpatient treatment illusion — that you go away for a couple of months and come back okay).

So I went and I talked and I cried and I did not leave feeling okay. In fact I left feeling worse than before, and it took months (maybe years) to get back to my beginning neutral (apathetic) state. And I’ll admit that I had more insight than I began with, but if anything that just made some things in life harder for me (i.e.: particular relationships).

And then, after grieving my loss of hope that I would someday get over this, I moved onto accepting that “I just can’t be helped” (is that progress? probably not). It wasn’t really a “this is hopeless, there is not point in trying for the rest of my life,” defeat-like acceptance, though… but more of a “I am never going to work through this so I need to do my best to just ignore it” acceptance.

And that worked okay, because I finished school and formed meaningful relationships and functioned as a self-sufficient adult. But… then I went back and found a therapist. Why?

Well…. I don’t know. Because things weren’t quite right and I didn’t have any better ideas.