Surfacing After Silence

Life. After.

Depression and Eating Disorders and Spirituality Mosh Pit

Delicate_Things by *aspi at DeviantArt

I want to address something that certain commenters have deemed appropriate to challenge me on, not necessarily here, but through not-so-anonymous questions of formspring.

One question resulting from my last post: “Recovered and working the twelve steps?  I’m confused.”  I have two answers to this.  The first is that my post explicitly stated I wasn’t using the Twelve Steps in a traditional manner to stop an addiction such as an eating disorder.  I am using them to take a deep spiritual inventory.  And, personally, people who have never had a mental illness or addiction could use the Twelve Steps for that purpose.  And I may use them again for that purpose twenty years from now because my faith is ever growing and changing because I am ever changing and growing.  The second answer to that:  I write as someone recovered from an eating disorder.  That does not mean that I have nothing else to work on.  That does not mean that the depression will go away. (more on that later) And a lot of people who recover from alcoholism using the twelve steps then go on to apply the twelve steps to another addiction–because it is extremely difficult to tackle everything all at once.  Not saying I’m an alcoholic and will now need the Twelve Steps for that.  I’m saying it’s not unusual to go through the steps more than once–while in a state of recovery from something else.  I learned that from the mental health techs at Rader, many of whom are in recovery themselves. (the Rader patients stay on the same unit as the chemical dependency patients.)

I’ve also been challenged that recovery from an eating disorder would mean no body image problems and no depression and anxiety problems.  I would agree that the depression and anxiety resulting from the eating disorder goes away.  I do think that for those of us who have had an eating disorder for most of our lives and it was tied up with performance or appearance through certain sports, body image issues take longer to resolve.  I will admit that I still have distortions, but they’re in my head and don’t result in me acting on symptoms.  They’re now “just” cognitive distortions that I need to work on by countering them with reality checks and logical thinking.  They aren’t tied up in my identity anymore.

And yes, I am struggling through one bitching hell of a depression right now.  It is as bad as the depression I had in 97-98-ish.  Here’s the thing:  I am also Bipolar Type I.  According to NIMH, Type I “is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.”  I usually tend toward depressive swings, but I experience full blown mania as well, excluding me from the Type 2 category.

There is no cure for Bipolar Disorder, just like there is no cure for epilepsy.  They manage the symptoms as best as they can.  I mention epilepsy because Bipolar Disorder and epilepsy originate from the same part in the brain, which is why all anti-seizure medications are also mood stabilizers.  There was no medication used for Bipolar Disorder until they discovered Lithium, an anti-seizure medication, controlled mood swings as well.

What does this mean for me?  It means that this depression is independent of my recovery from an eating disorder.  They don’t even have a correlation, let alone a dependence.  Right now, I’m being treated for Bipolar Disorder and see my regular doctor for routine labwork and weight checks, which will happen for years because I’m not naive and fully realize that there are medical consequences to the years I had an eating disorder and my medical doctor is an important part of my team.

People sometimes think that recovering from an eating disorder means happiness and joy and life will be awesome from now on.  And recovering from the eating disorder has allowed me to experience happiness and joy and awesomeness, but life is still life.  Shitty things are going to happen and there will be resulting difficult times when it’s the hardest thing in your day to smile for the cashier at the checkout line.  And there are still other illnesses that cause other psychiatric symptoms that don’t disappear when the eating disorder vanishes.

My bipolar disorder is the smile of the cheshire cat that still hangs there in mid-air after the body of the cat (the eating disorder) has vanished.  Except in this analogy, the smile will always be hanging in the air, an interrupted slice of the sky.

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April 14, 2010 Posted by | Eating Disorders, faith, recovery | , , , , , , , , , , , , , , | 2 Comments

reconsidering being a stepper

Some of you may remember my post: Twelve Steps? What? Me? No Way. I talk about being somewhat (completely) resistant to the Twelve Step idea at Rader for the first few days I was there, until I got bored from the snow storm and decided to answer the questions in the workbook to pass the time.  Since then, I discovered In The Rooms, a fabulous site for addiction recovery with all different Fellowships, including one for Overeaters Anonymous and Eating Disorders Anonymous.  You can be in any stage in recovery to be part of this community, but it is definitely a pro-recovery site.  And I decided to visit.  And then join.  And participate.

My previous post mentioned how helpless I feel right now.  The depression is the worst it’s been since 97, and bad things happened back in 97.  I saw my interim psychiatrist, who is a resident, who told me that there is nothing that can be done with my meds, which I don’t believe for a second.  Her only suggestions were, “Call the outpatient clinic to do ECT and please call someone if you feel like you are going to hurt yourself.”  I did make the call to speak with the doctor I worked with during ECT this past winter.  And I am reconsidering it.  But to be honest, I don’t really know what to do.  I wandered around Barnes and Noble for 1 1/2 hours the other night and couldn’t decide on a book or magazine and walked out empty handed.  If I can’t make a decision about a book, given that I am passionate (usually) about reading, how am I supposed to make this decision?  My therapist is not against med changes or ECT, but he doesn’t want me putting all of my faith into either for a cure.  Which I’m not.  A cure I know is out of the picture, but relief is not.

One of the things I’ve returned to recently (a month or so) is an intensive daily Bible study, using the lectio divina style (yes, I did just post a link to wikipedia.  But it’s a fairly general description that serves my purpose).  And since I did learn a significant amount about myself and my spirituality by doing the workbook exercises at Rader, I think I’m going to continue with that work.  I know the Twelve Steps are not going to take away my depression, but I do have a workbook (Overeaters Anonymous) that is similar to what we used at Rader and it has questions for me to journal on and I think I will continue to learn about how I tick.  And maybe I’ll find some answers to help me through this time.  I’m certainly willing to follow some guided prompts if it will help me get through this time.

So maybe I’ll turn into a “stepper” after all.

April 11, 2010 Posted by | coping, Eating Disorders, faith | , , , , , , , , , , | 3 Comments

Making me work again

Depression_by_nicoleatheart (deviantart.com)

So I’ve struggled with how to approach this post.  I’ve been mulling it over for the past couple days.  It all started with a couple of questions in my daily devotional that basically had to do with what parts of your life aren’t exactly where they should be.  When I read thought about that, I basically when “GARGH” and rested my head on the back of my sofa and stared up at the ceiling.

This depression has gotten to a point where it is controlling me and I am not controlling it.  By “controlling it” I mean that I was still able to function with a degree of ease that is not there right now.  Currently, making myself get out of bed everyday seems like an insurmountable task.  And then I have to convince myself to do something.  Anything.  But “anything” always takes such a great amount of effort and I spend hours debating whether or not I should attempt it.  It’s amazing how long I can stare at one spot on the wall.

This has affected my eating.  And here is where I struggle with how to define it.  One of the characteristics of depression is lack of appetite for some or excessive appetite for some.  And for me it’s lack of appetite.  And there’s the energy it takes to go to the fridge, open up the door, and decide which frozen dinner I want to stick in the microwave, well, that’s a lot of energy to expend.  And it requires that I get off the couch or bed.  But then there’s also the part of me that wants so badly not to feel anymore, because feeling this day after day is wearing me out.  And not eating is one way to not feel.  And depression increases all the negative body image thoughts–depression increases all negative thoughts–and I feel that incentive to “fix it” the old way.

I don’t know what to call what this is.  I’m certainly doing better than before I went to Rader, if you don’t count the depression and the desire to remain a lump nested within my comforter all day.  There’s part of me that wants to whine that this would not be happening if I had my normal treatment team.  Right now I cannot see two out of three of them because I’m on medical leave for a semester, and they are part of student health, so I have has substitutes since January and will until August.  And, like a lot of substitute teachers filling in for a day, they just don’t get it.  But then I question if it’s not my fault?  If I couldn’t be doing more to make myself better.  Except I just can’t figure out what that “more” is.  And thinking about doing more makes me tired.

I shouldn’t worry about what whatever this stage of my life is called.  And maybe it doesn’t matter what is causing it.  They’re just labels.  I need to find a way to make me work again.

April 8, 2010 Posted by | Eating Disorders, feelings | , , , , , , , | 3 Comments

How to . . .

This is a question that many, if not all, parents and spouses and loved ones ask if they have someone struggling with an eating disorder.  My family therapist at Sheppard Pratt recommended Surviving an Eating Disorder: Strategies for Family and Friends and my parents actually read it and found it helpful.

But I think there needs to be a “How To” for those of us who have an eating disorder.  How to tell someone we have an eating disorder.  How to say we need help or more help.  Explaining what an eating disorder is.  Here’s the conversation I had with my mother (years before the above book was recommended to my parents) before I was admitted to the hospital for the eating disorder the first time.  This is after several hospitalizations for self harm and depression, including a three month IP-followed by a three month PHP program for self-harm.

ME: My therapist said if I don’t show up at the hospital tomorrow they will 2PC me (mandatory commitment.)

MOM:  For what?

ME: For anorexia.

MOM: But why do you have to go to the hospital?

ME: For anorexia.

Mom: Oh.

There has to have been a better way to have that conversation with my parents.  I know there was a better way to explain why I didn’t want to eat to them than how I attempted to.  How do you tell someone you don’t want to eat, even though you really do know you need to eat to live, and that it’s not about how you look?  And how do you explain that when you look in the mirror you see something vastly different than what they see?

While I was at American University, working on my Master’s, I was also going through the last and most dramatic relapse I had gone through.  I really, honestly, thought I was hiding it.  But it turns out that my two literature professors had noticed me “literally fading away” (in one of their words) during the semester and had talked about it together and had consulted a mutual friend who had experience with eating disorders.  So when I went to them with the stuttering, “Um, I, sort of, well, have this problem, and I think, well, I may be going to the hospital  . . . ” talk, they were already in the problem solving mode of “how can we help you get better?” and “how can we help you finish this semester?” (Notice the priority of those two questions.)

Right now, I will talk about my experiences with the eating disorder openly.  I’ve written my memoir and am finishing up the last chapter and revisions and am getting ready to send it out.  I welcome questions from friends or professors who don’t understand eating disorders.  I’d rather people ask than go about assuming what may be erroneous information.  But I do remember the period of “I can’t tell anyone” and then the period of “I want to tell someone but how?”  Usually my “telling” was solved by me being in the hospital and word getting out.

There’s so much shame and embarrassment and guilt tied up with having any mental illness, but I think there is more when it comes to an eating disorder because eating disorders are so misunderstood.  How much is caused by a brain disorder and how much is a choice?  And do people just want to be thin?  And Why can’t you just eat, for Christ’s sake??? (That’s been thrown at me in the past.  Many times.)

I do know I chose whom I told very carefully at first.  I chose my closest, most supportive and understanding friends.  If they could stand by me through the self-harm treatment, I figured they could handle hearing I had anorexia.  Then I gradually expanded the people who knew.

Suggestions?  Do people have success stories?  Do people know of a good book for those struggling?  Anything else to add?

April 3, 2010 Posted by | Communication, Eating Disorders | , , , , , , , , , , , , | 7 Comments

“older” women in treatment

Old Soul form Devianart.com

Someone brought up the subject of “older” women in treatment.  But really, it’s about being plain old adult women in treatment.  By “adult women” I mean late-twenties and thirties.  When I think “older women” I think retirement age and older.  (And I do think that topic needs to be addressed, too.)

My first time in treatment for the eating disorder I was one of the oldest at age 22.  The vast majority of the population were in high school.  The same thing was true the next couple of times.  I had a couple of people around my age.  And then there was the hospitalization where I was the only one not in high school or in the first two years of college.  One day at dinner, a patient looked at me and said, “I’m 14.  You’re 28.  That’s, like, twice my age.”  My reply: That is twice your age.  While I was in treatment at Sheppard Pratt, most people were high school or college aged, with a few of us “oldies” making up the rest.  Yup.  I was nearing 30 and was considered old.

It’s awkward being this age and needing treatment for an eating disorder.  I don’t have any ill will toward any of the younger people I have met in treatment or whom I talk with online.  That’s not what this is about.  Obviously, we all need/ed help and life throws groups of people together like that.  But there are some unique challenges that adult women in treatment centers face.

A) Hopefully, at some point, generally after college, you start dealing with a very different set of day-to-day concerns and issues that may or may not affect your eating disorder but are definitely affected by your eating disorder.  Talking to your boss about needing time off is different than talking to a college professor.  Insurance is a whole different ball game.  Money is a whole different ball game.

B) Family.  Family dynamics hopefully change as you get older as well.  For some, this means adults learning how to talk to their parents as adults and not children.  For some, this now involves spouses and children.  For some, this may mean including friends in family therapy rather than family members, as I chose to do at one hospital.

C) Interests, hobbies, topics of conversation.  There’s nothing wrong with teenagers talking in their lingo and listening to the popular music of the time, but sometimes the noise and adolescent drama can grate on adults’ nerves.  And I am fully aware that adults have been part of said drama.  So maybe drama isn’t the right word.  But the adolescent energy.  As a thirty year old, it was somewhat tiring to be around–physically tiring, I mean.

D) One of the difficult things for all ages on an eating disorder unit is body image and comparison to other patients.  “How thin am I compared to her?” (“Who is sicker?”)  What makes this especially difficult for adult women is that we’re comparing ourselves to people who haven’t finished puberty, or, in some cases, haven’t really started puberty yet (Sheppard Pratt does admit pre-pubescent ages).  Logically we may know that our hips have widened to give birth and no amount of starvation can change that, and our breasts have developed and our weight distribution has changed–but emotionally it’s hard to accept these things, especially when you’re already emotionally vulnerable and when you’re surrounded by it constantly.

These are just a few issues.  I know the first time I was at Sheppard Pratt, they had groups for people over 24.  And I loved those groups, because it was a chance to talk about all of the above things.  The second time I was there, they did away with that, and a lot of the groups veered toward parental relationships, especially parental control, and rules and living at home and living in the dorms and I noticed a lot of the adults kept silent.

I’m not saying that treatment wasn’t beneficial overall.  I am saying there were challenges my age group faced that were not addressed and generally do tend to get overlooked.

Most media focuses on eating disorders among high schoolers and college students.  Which sort of makes those of us over thirty think, “gee.  I’m too old to be dealing with this.  What’s wrong with me?”  And it also prevents a great deal of women from seeking treatment: the embarrassment of having a “teenager’s illness.”  There are treatment centers who won’t take women over a certain age–usually in the mid-twenties.  I remember when I finally made THE decision to do whatever it took to get better, I really wanted to go to Mercy Ministries and I was told I was too old.  I was 27.  One of the things I appreciated about being at Radar was that they didn’t take anyone below 18.  We got to talk about “adult stuff” all we wanted.

I’m not advocating having separate treatment centers for each age group, because where do you draw specific lines?, but also because there are a lot of issues that overlap age groups.  I just think that there should be groups for the different age groups so that age appropriate discussions can take place.

April 2, 2010 Posted by | Eating Disorders, therapy | , , , , , , , , , , | 14 Comments