What does the eating disorder steal from your holidays?

1. Time spent with friends and family
2. Holiday spirit
3. The world outside of treatment
4. Holiday food
5. Almost a whole season of the year that’s different from any other time

I spent this last week dealing with insurance company issues, treatment plans, meal plans, body-checking, self-loathing, lists of coping skills, CBT worksheets, scheduling issues, etc. I fit some Christmas music and shopping in there somewhere… You know, wherever I could fit it in between the eating disorder stuff.

The eating disorder has no season (although I would consider Christmas break and summer vacation to be “treatment season” since it’s a more convenient time to squeeze in some therapy). Maybe you struggle more in the summer because of summer clothing or in the winter because of depression and school stress… But in general, when you’re struggling with an eating disorder, ’tis always the season.

You are always missing out on things when you are consumed with the ED or depression or addiction, or whatever you struggle with… But there is something about the holidays that feels particularly depressing. The whole world (or so it seems) is celebrating and preparing and doing their holiday stuff, and you are in the same place you were last month… And the month before… And the month before that. It’s as if the month if December as no significance.

I kind of want to curse at mall traffic, and wonder why they still even manufacture awful Christmas sweaters, and put up lights on my house. And I’m not saying is isn’t all possible while being in treatment or in the midst of the disorder… I’m just saying that the spirit isn’t there. You’re still living in the ED world. Maybe you’re functioning in the real world, but all the spirit, love, hope, chaos, hurt, and whatever the holidays bring — it’s being stolen from you.

Not to be depressing or anything…. Just a thought

“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:

Something new is happening in eating disorders. The voice of eating disorder patients is less stereotyped, more empowered, and less victimized. Why? I attribute the changes to two separate but interacting elements: the cross-pollination of the Internet, and the shifting narratives of the treatment community.

Before the Internet, our exposure to literature about eating disorders was limited to the few books that happened to be on the bookstore shelves that year and the occasional magazine article. Now we can search for information in a deluge of competing sources and even talk back to them: commenting and quoting and blogging and even interacting with the writers. Treatment providers are also being exposed to and seeking out a new variety of both professional and anecdotal sources.

I think that Laura is on to something here, but I wonder — has the voice of ED patients changed, or is there now a forum (that didn’t previously exist) for more empowered discussion?

When I started GreyThinking, I felt there was a big gap between professionals, patients, research, and personal experiences.  My personal blog had gone from “here’s what’s going on in my life” to “I think the narrow definition of anorexia in the DSM encourages people with EDs to maintain a certain level of sickness.”  Not only did I feel that I had a unique perspective, but I was also frustrated with the lack of commentary surrounding mental illness.  Where were the other research-addicts that wanted to rant about journal articles that were true/untrue to their own experience?

It’s amazing how much has changed in the last few years.  Now I can pose a question on twitter, and have a myriad of people answer me: professionals, sufferers, family members, friends, etc.  As both a blogger and a patient, I think that the interconnection is awesome.

I hadn’t thought too much about the change in treatment landscape for professionals, though (well, minus my own paranoia that my therapist would stumble upon GT…).  I wonder if this interconnectedness helps them understand better or provides them more insight that they can use to treat their own patients.  Personally, the exposure to different blogs and treatment modalities has hugely impacted my perspective of the illness and the usefulness of treatment (if you read back a couple of years ago, you’ll notice that I am MUCH more bitter… although also much funnier, which makes those posts more amusing to read…).

Something I’ve always found to be frustrating with any kind of group treatment, is that the people who are doing really well discharge.  I know, that’s the goal, right?  To get better and not be in treatment?  However, there’s something unfortunate about removing inspiring and motivating people from the group setting.  I think that you need more exposure to people who are doing well and who have insight into the whole struggle.  I’m sure that Laura could speak to that same need for families and other loved ones (connection with those who have been there and made it through).

I’m not sure if the voice of ED patients in general is changing, but I know that there is a lot more access to those who are doing well.

People have this inclination to do more, even if what they do is trivial.

Experiments have shown that the desire for activity is quite strong; people will go to a lot of trouble to maintain their desired level of activity, which can include unhealthy behaviors. Many psychologists have “the idea that people have these highly specific goals,” Albarracin says. “But quite often some significant proportion of our time is engaged in this global level-we want to do something, but what we do ends up not mattering much. You could end up with productive behavior, like work, or impulsive behavior, like drug use.”

The eating disorder takes so much time and mental energy. You’re thinking about your weight, body image, how whatever you’re wearing makes you look fat, what you ate today, what you ate yesterday, what you’re going to eat tomorrow, when you’re going to exercise, how you are going to binge/purge, etc etc etc.

It’s exhausting… but it also keeps you pretty occupied. You feel like you’re doing something, and it even feels productive — like you are changing or working toward some greater goal.

I think there are lots of reasons why I choose to obsess over ED stuff rather than something healthier. It’s easier, more in my control, fixable, and totally conflict avoidant — just to name a few. For that reason, I know that boredom, lots of unstructured free time, and feeling unsatisfied (especially with work, but with anything in life, really… I’m very equal-opportunity when it comes to identifying flaws) are big triggers for me. I want to fill that time or hole with counting calories, obsessing over weight, exercising… you know.

I have a friend who’s therapist told her that she would know French right now if all the space in her brain that she was using for nutrition facts was filled with a foreign language. Sometimes I think about that – who knows what I could have learned or accomplished had I spent those thousands of days doing something a little more significant…

Anyway, NaNoWriMo is an annual event where lots of people commit to writing/blogging a mini-novel in November (50,000 words).  If you write a post every day, it’s not too hard to hit that mark.  The novel can be about anything, and doesn’t have to be structured as a novel at all (read: You don’t have to start at the very beginning with “Once upon a time…”).  You’re just telling a story, one post at a time.

Why bring this up on Grey Thinking?  Well, because I encourage any (or all) of you to participate and write about some of your struggles.  I wrote a post a few years ago on the importance of blogging about mental health, and gave the following reasons as to why I’m such an advocate for it:

1. It can provide a healthy outlet for dealing with feelings surrounding your own struggles with mental illness.
2. It’s comforting to know that “you’re not alone”–there are other people out there struggling with the same things as you. Often another person can articulate something that you’ve been trying to explain/identify/put your finger on for a long time.
3. Community support and wisdom. There is a lot of collective experience within the mental health blogging community.
4. It provides a unique inside look at otherwise poorly understood mental illnesses. How many people really understand how you view/experience the world with a disorder? How does the media affect you? What do you think about current research? What has/hasn’t been helpful for you treatment-wise? There is so much information that only someone who has struggled with mental illness can provide.
5. You can challenge others… challenge them in their recovery, or to look at something from another perspective, or to break through their denial about a problem. Mental health blogs make you think and examine your own reactions.

Participating in NaNoWriMo is a fun way to increase mental health awareness.  Not only that, but it’s a good personal challenge.  Sign-up is free, and the official website has a lot more information on how to start.  If you have any questions about getting started with a blog, I’d be happy to help you.  Just shoot me an email.  Additionally, if you join, let me know via comment or email and I will link to your site from GT.

I’ve been trying to figure out what it is that bothers me about having them there.  I’ve looked up the nutrition facts a hundred times, so it’s not like I’m seeing the calorie count for the first time.  Plus, I still ordered the same thing (hey, I’m a creature of habit).  Still, I didn’t like the calories being there.  I have a couple of theories as to why…

1. Out of sight, out of mind – I know how many calories are in an asiago cheese bagel.  I know how many exchanges it counts for toward my meal plan.  However, I’m not really thinking about it when I order, because I order it all the time.  It’s a “safe” food for me.  The calorie reminder is not helpful — it makes me re-examine my choice.  I stop thinking “I’ve eaten this a dozen times and have been fine, therefore it’s still fine” and start thinking, “hmmm, you know, that is kind of a lot of calories for a bagel.”
2. Comparisons — When you put all the items in a list, I can’t help but compare the calories.  Somehow strawberry cream cheese doesn’t seem like such a good idea when I’m comparing it to the lower-cal plain cream cheese.  I start looking for the “best” choice.  There’s just something about lining them all up that enables me to do that.  It’s harder to choose the strawberry cream cheese when I have the calories of all the different kinds in front of me.
3. Ignorance is bliss — Okay, so I don’t know the calorie content of all the items on Panera’s menu–just the ones that I usually get.  I really had no idea what was in a Sierra Turkey Sandwich (I’m a vegetarian).  Let’s say that pigs flew and that I did order it one day, though.  I’d know that foccacia bread was higher-calorie than whole wheat bread, sure.  However, I wouldn’t know exactly how much of a difference it made.  If I did, there’s no way that I would ever get it.  I understand that this is probably the whole point of the new menus — to make consumers aware of what they’re ordering so that they can make educated decisions about sandwiches.  Well, educated / disordered.
4. Obsessing – I don’t really need any help (or encouragement) obsessing over food, calories, etc.  Seeing the calories while I’m ordering just puts me in the wrong mindset.  I’m thinking about calories instead of exchanges, for one.  And once that’s happened, it’s hard for me to figure out what I want.
5. Calories aren’t the end-all, be-all – It’s actually kind of interesting to me that Panera chose to just display calories.  Granted, that’s probably the most universal measure of food okayness, but these days the diet industry seems to be all about carbs and/or sugar.  So yeah, a blueberry bagel may have fewer calories than the power breakfast sandwich, but it doesn’t have nearly as much protein as fiber.  And sometimes, I actually consider those other factors.

As someone recovering from anorexia, I know I’m in the minority of Panera customers.  I don’t expect them to cater to individuals with eating disorders.  Do I think non-ED people will change their orders based on the new menus?  Probably for some, but I really don’t know.  I’d be curious to see how many people order the Sierra Turkey Foccacia Sandwich now.  Maybe having calories in menus isn’t that different from having nutrition labels on packaged foods.

A patient was saying that she used to have a lot of friends in college, but lost them after graduation.  She hadn’t been able to make new ones because she was weird and no one liked her.  When the therapist challenged that idea, she said that she had a personality disorder — so how could anyone ever get along with her?  There’s something wrong and pathological about her personality.

Only about a hundred things went through my mind when I heard this comment.  There is such gravity to a personality disorder diagnosis… and it’s easy to understand why someone would think this.

There were a couple of things that I felt she was saying:

• having a personality disorder means that she is somehow broken or defective
• having a personality disorder means she can’t have relationships
• the personality disorder is not something that she can overcome.

I’m going to avoid diving into labeling theory… but I think that diagnoses are ultimately meant to guide treatment.  You’re really saying “here are a cluster of common symptoms” so that you can research and treat individuals with those characteristics.  It’s not adequate to just describe someone as being sad, because the other presenting symptoms make a huge difference.  Maybe the individual has major depressive disorder, or maybe they have PTSD.  The approach to treatment is not the same!  Many diagnoses do carry a negative connotation, but I really believe the intention is to help you.  To improve your treatment, to give professionals an idea of where to start and what questions to ask, and as a general warning of other possible common symptoms that may not have been noticed yet.  And while I’d say that most disorders are on a continuum, a guide is needed for drawing some kind of line between healthy/unhealthy.  Maybe it’s a really fuzzy line… maybe the line moves based on the individual… but there has to be some kind of line.  If you can’t draw one, how do you know when you are done with treatment?  How can you gauge if you are where you need to be?

Given that this line is so fuzzy, different professionals may diagnose you differently.  Ideally this shouldn’t happen… but since the DSM-IV is just a guide, it is an issue.  A diagnosis can’t dictate whether or not you can form new relationships.  Not only that… but who said individuals suffering from a PD can’t have meaningful relationships?  It’s not the case at all.  And maybe the label does suggest that there is something wrong with your personality and therefore you’re not compatible with everyone else… but:

1. Everyone has something. You know, baggage.  Negative stuff from previous relationships, insecurities, neuroses, obsessions, issues, addictions — whatever.  Something.
2. The absence of a personality disorder does not make you like-able by default. Anyone can cut off friendships, sabotage relationships, isolate, alienate others (and the list goes on…).  Anyone!

Can you overcome a personality disorder?  Sure.  I think so, but others will disagree with me.  Can you overcome an eating disorder?  How about an addiction?  It’s a tough question to ask.  Maybe someone with schizophrenia has to take meds forever, or maybe someone with anorexia can never go on a serious diet.  It’s a grey area (imagine!).  The statistics may not be in your favor, but because diagnoses are so subjective, it’s hard to accurately research recovery rates.  With eating disorders, there is at least some measurable criteria (weight, binges/purges a week, caloric intake) – but even that isn’t concrete.  Also, eating disorders are based on present symptoms.  If you’ve recovered / been in recovery for several years, maybe your chart say “history of bulimia,” but often not.  There is no “recovering/recovered from bulimia” diagnosis.  However, PD diagnoses do somewhat take your history into account.  Often you can go into a treatment program for anorexia, and come out 8 weeks later without the AN diagnosis (instead it’d be EDNOS).  It doesn’t quite work like that for personality disorders.

Maybe having these caveats mentioned when you’re originally diagnosed would be helpful — I don’t know.  Would they?  Some professionals don’t even tell patients their full diagnoses (Axis II disorders are sometimes left out), but I usually feel that ignorance does NOT equal bliss.  Personality disorders have a bad rep.  With such a loaded diagnosis, maybe it would help to be reminded that diagnoses aren’t designed to label you as broken, defective, or unrepairable.

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