Surfacing After Silence

Life. After.

the “dreaded” hospital


"In my place" by lifeinphotos deviantart.com

I dared address that awful word, “healthy”, so now I’m off to address another awful word: hospital.  I’m sure you’re all used to my “I don’t believe in sugar coating things” and “honesty” beliefs, but I am a little nervous about this post.  And at the same time, can’t wait for the private messages of astonishment and judgment.

I recently was discussing the concepts of “sick” and “healthy” and “deserving” with someone, and wrote the following in response (slightly edited for privacy reasons):

And could there be a part of you that feels like a “bad ED person” if you haven’t been IP in three years?  Like, “how the hell can I say I’m sick if I’ve not been in the hospital for so long?”  type of thing?  Is there a part of you that might want to go IP so that people know you are still struggling and need their support and help?   People have posted on my blog about how they don’t want to be a healthy weight because it somehow means they don’t need as much care and support.  I think the same would be true if I put up an entry about going IP.  Sure, we all hated being locked up and having restrictions placed on us, but at the same time, there was at least an outright acknowledgment that we needed help and were in pain.  I know that my last hospitalizations were not about this at all, that I went because I wanted help and was ready to take whatever action necessary to get better, but I do know that I went IP in my early twenties on general psych units for SI when I probably didn’t really “need” to but I sort of “wanted” to.  I hated going.  The locked hallways, the checks, the having my possessions taken from me, etc.  But at the same time it was comforting knowing that someone was taking care of me.  It has taken me a long time to realize that I can have that very same support and care on an outpatient basis, without using any behaviors.  That there are people who see that I am struggling even if there are no behaviors.  And I’ve gotten more help and care and support through using words than I ever did before.

I just admitted some things I’m not all that proud of.  I went IP not with the intention of getting better, but with the knowledge that I would be taken care of while there.  I also now realize, although I didn’t at the time, that going inpatient did signal to my friends and family that things weren’t going well and that I needed their support and care.  I’m not exactly proud of the number of my hospitalizations, and I wonder, now, if all of them were necessary.  But at the same time, I do acknowledge the fact that while I was inpatient, I was safe, protected from myself, if you will.  And that may very well have contributed to the fact that I am still alive and able to write this post.

I have noticed, both now and in the past (there really hasn’t ever been a day when I haven’t seen at least one post or status update about this), updates along the lines of “I wish I were back at X Treatment Facility”–rather than “I wish my insurance would get their act together so I could get treatment.”  There are different implications in each statement.  The latter implies a desire to get better, to do whatever it takes to get there, even if it means going inpatient.  The former may imply those same things, but the idea of missing a treatment center implies a lot more, things that the individual posting the statement may or may not be aware of.  Some of the possible implications: things were easier in treatment, I was supported while in treatment, I had attention while in treatment, people knew something was wrong while I was in treatment, my family actually took things seriously when I was in treatment, my family (or friends) actually acknowledged there was a problem while I was in treatment, I felt safer while in treatment, I felt understood while in treatment.  And there’s probably more that I’m not listing.

Please don’t think I’m judging anyone for any of these things.  I think they are all part and parcel of the eating disorder and recovery process.  There is this weird pull toward inpatient treatment because it does bring with it a certain status in the eating disorder community, and I have noticed that certain treatment facilities have more “weight” than others, that they carry a “you must really have been sick to need that” type of status.  Again, no judgment, but let’s be real and admit that there is a degree of competitiveness among people with eating disorders at the very same time that there is a degree of support and encouragement.  Forum boards are filled with “who has been where?” and “how long were you in for?” posts, as if these things determine how sick an individual is, when the truth of the matter is that it often has more to do with insurance than anything else.

Eating disorders are full of weird dualities.  I want to recovery/I don’t want to be “healthy.”  I want to recover/I don’t want to gain weight.  I hate being in the hospital/I wish I could be at X Treatment Center.  I want to be better/I don’t want to lose the eating disorder patient status.  I want to recover/I still want people to support and care for me and acknowledge my pain.

It’s that last one that really shouldn’t be a duality.  Recovery does not mean an individual is no longer in need of support, care, and encouragement and it certainly doesn’t mean the pain is gone.  Being bipolar, I’ve been in the hospital for severe depressive and manic episodes, and “getting better” (past that particular cycle) meant that I had found the right combo of meds and things were back on track.  Going in the hospital for an eating disorder meant giving up really comforting behaviors, gaining a new body, learning how to get my needs met in a healthy way, forging a new identity, facing all the issues that drove me to an eating disorder in the first place, and then coming out into the “real world” feeling somewhat naked and defenseless.  Sure, I was physically healthy, and at a good weight, and symptom free, but the journey of recovery had really only just begun.  More than while I was inpatient, when I was surrounded by people who “got it” and staff who were there to help me, I needed people’s support and encouragement because now I was expected to do everything I did inpatient on my own while faced with all those triggers that aren’t there while inpatient.

I think this has a great deal to do with why the pull of treatment centers is so great at times.  It is easier while in treatment in a lot of ways.  And people do take you more seriously then.  There is a direct acknowledgment that you are suffering and in pain and need help while you are in treatment.  And there is a general misconception that when you leave treatment, you are “better” and the crisis is over.

The immediate time after a hospitalization is the time most ripe for relapse because of this misconception.  You very well need the same degree of support and encouragement but may not yet have learned how to ask for it with words and not actions.  Showing pain is easier than describing pain and asking for help with words.  Asking for help is often a sign of weakness, or so we like to tell ourselves.

I’ve finally learned how to ask for help.  That I need to ask for help and support before the behaviors start, and not just from people online, but in real life.  There are friends I know I can’t go to for this kind of support; it’s not their fault and they aren’t any less my friends for it.  They are just not prepared to handle the way I may feel or the things I may think.  And I’ve learned which friends can handle what by a process of trial and error.  Which is sort of sucky, but I honestly don’t know any other way to do it.  And it takes a lot of guts to speak up and ask for help.  But I do have to say that once I learned how to ask for help, which at first I often did through writing and handing the writing to my therapist or doctor, once I learned to speak up until I got someone to listen, which admittedly took some time, things became much more rewarding.  Relationships became more real and honest.  Life became more bearable.  And I felt more in control.  And the pull of treatment centers became much weaker.

Let me make certain things clear: If you need more intensive treatment, do whatever you can to make it happen. That is not what this post is about.  I am also not saying it is “wrong” or “bad” to want to be inpatient, for whatever reason.  I honestly feel that is normal, but that it doesn’t get talked about openly.  I am saying that not only can you receive support and encouragement on an outpatient basis, but that you deserve these things.  That just because you are not in need of intensive treatment does not mean you are not in pain, that you are not suffering, and that you are not worthy of care. I am saying that words are your greatest ally, that part of recovery means using your voice to get your needs met.

If anyone told you that recovery wasn’t terrifying as hell, they are wrong.  It may very well be the scariest thing you ever do, the hardest thing you ever accomplish.  But I can also say that it’s the thing I am proudest of.

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July 18, 2010 - Posted by | Communication, Eating Disorders, recovery, therapy | , , , , , , , , , , , , , , , , , , , , ,

21 Comments »

  1. I can totally relate to everything you said and I applaud you for having the courage to say things most people wouldn’t (including myself). I definitely recognize some of the same things in me from past hospitalizations. Thank you so much for posting this, it has really helped me feel not so alone in some of my past thoughts and behaviors.

    Comment by Megan | July 18, 2010 | Reply

  2. you struck a chord with the “forging a new identity” bit.
    one of the reasons i didn’t go ip sooner my last relapse was that i was tired of, as I put it, “starting over.”
    I lost nursing school. I went ip. I lost my second half. I went ip. I met the love of my life. I went back to school. I lost the successful newlywed/housewife identity. I went ip.
    It is sooo hard to rediscover yourself every time you come out. And each time I do it makes me wonder, will i ever find the true me- or just the one that works?
    So now here I am living the dream. I’m studying yoga. My dream career and life love. I am well off and provided for by the love of my life. And I am still struggling. If I did need ip again, would I be willing to risk the chance of having to give either of those up?

    Comment by wednesday v | July 18, 2010 | Reply

    • I guess my question is: If you were to need IP again, why would you have to give up the current dream of studying yoga and having the love of your life? Could you see IP as putting the studying of yoga on hold? And the love of your life hasn’t left you yet, he’s seen you through IP before. So he’ll be there if you need him again. From everything you have written, it seems like this is the truest me you’ve found, and you’ve had moments of loving life and living life. Just because you’re still struggling doesn’t mean those things aren’t the true you. It just means you still have work to do. Remember it’s a process. Yoga is all about being gentle to yourself, remember that. Give yourself time to heal. Give yourself permission to not be perfectly recovered.

      Comment by surfacingaftersilence | July 18, 2010 | Reply

    • I was just thinking of this comment some more. Is there any chance you are equating your identity with what you DO instead of who you ARE? It’s taken me a long time to separate the two. “Grad student” is what I DO; the love of learning, the love of teaching others, the insane love of Latin, the love of reading and the love of writing all comprise who I AM.

      Comment by surfacingaftersilence | July 18, 2010 | Reply

  3. the ?dreaded? hospital…

    I found your entry interesting do I’ve added a Trackback to it on my weblog :)…

    Trackback by Mental Disorders 101 | July 18, 2010 | Reply

  4. ah, yes. i can relate. as usual, you’ve summed it up about as well as it would ever be possible. despite having a couple of years of pretty decent recovery behind me now, i still occasionally find myself missing treatment. i’ve realized that every single time i miss it, it’s because i feel lonely or somehow needing someone to take care of Mommy for a while. not because i miss the eating disorder itself – i’ve also realized just how much i don’t miss feeling like crap all the time – but because i feel like there is something missing….which usually means i need to pay attention to myself. i’m the only one i can count on to give me exactly what i need at any given moment, or at least these days to recognize what that is, even when all i have time to do is acknowledge the need.

    Comment by michelle | July 18, 2010 | Reply

  5. I found this post very hard to read b/c of my own issues of going IP so many times. There were several times I went in b/c I knew if I didn’t I would have died, but I had no intention of actually getting better. I went in to buy myself more time. Looking back, I see this as kind of pathetic. However, it is what it is and I can honestly say those times I went IP, I left knowing more about myself and learning several things that I would later use when I did start to get better.
    Also, from a very early age, I didn’t think I was capale of taking care of myself so I looked to others to take care of me. When I decided I no longer wanted the identity of an anorexic, I did what my OP treatment team told me to do. It was sometimes almost intolerable but I found out I was capable of taking care of myself and dealing with LIFE. The good, the bad and the ugly-I could and can deal with it all. Maybe not always gracefully and it sometimes means asking for help and making my needs/wants heard. I don’t have to do it all by myself. I admit it’s still hard for me to ask for help and I have to check my pride at times. But I have more support now than I ever did when I was sick. Real friends instead of people I used to stay in the ed. Love from others that used to be afraid to love me b/c they were afaid of me dying. My life today is incrediable compared to what it was a few years ago. Not that it’s always easy, or fun, but I wouldn’ trade back for anything.

    Comment by me | July 18, 2010 | Reply

    • “I went in to buy myself more time.” This describes my first three IP stays for the eating disorder to a T. And I’m not proud of it, my reasoning, but we DID buy ourselves more time. We DID get to a point where we were ready to recover. We ARE alive and thriving now. So maybe we shouldn’t be so hard on ourselves for why we went IP. Maybe, just maybe, we should be proud that some little teeny tiny voice was loud enough to say, “Go in and buy yourself time” and that we listened to that voice. Because now we’re here.

      Comment by surfacingaftersilence | July 18, 2010 | Reply

      • You’re right. Going IP for whatever reason got us eventually to a place of health. The end truly justified the means in this situation.
        Good luck tomorrow with your surgery!

        Comment by me | July 19, 2010

  6. Although I spent a lot of months in IOP over several admissions, I never went IP. And as much as I hate to admit it, I feel like I failed at my ED because I didn’t need to go into the hospital. I’d be lying if the threat of IP really scared me – then at least somebody noticed I was struggling. But I’ve learned that it’s much easier to talk about it with my therapist than to keep her guessing how I’m really doing.

    Comment by Jen | July 18, 2010 | Reply

  7. This was a fantastic post- thank you so much! The pull of being taken care of and “achieving” that IP status can be very strong at times. Thanks again for all your insightful posts!

    Comment by Anon | July 19, 2010 | Reply

  8. Thank you for writing this. I’ve long felt the same but not felt able to say it. Afraid I’d be thought of as attention seeking or selfish or fake or flighty or… any number of things. But to be honest? In most of my hospitalizations – particularly as a kid/teen – I looked at being IP as some sort of accomplishment. That competitive drive: that I was the best and the worst. I hated treatment for a lot of reasons, but I also loved it for all the ones you mentioned. And I’ve long felt guilty for that dichotomous relationship going on inside. As I spent more and more time IP and less and less time outside I started to – thankfully – realize that living in hospitals wasn’t part of my life-dreams, that I had gone far enough. I didn’t ever recover, no. I’m still working on it. But when I left my last hospitalization 4 years ago I swore I would never, ever go back. A lot of things changed – about myself, and about how I viewed hospitals. I just… I wanted to thank you for writing openly about this. I might steal your topic and blog on this myself. Mind if I linkback? I’m always told by my therapist that I should challenge things that make me uncomfortable. It is UNCOMFORTABLE to talk about hospitalizations. For all of their implications and also because I understand that desire for that kind of seclusionprotectionunderstandingsafety. Its embarassing, too. Haha. Anyway – great post.

    Comment by Sarah | July 19, 2010 | Reply

    • Sarah–I have no problems with you linking back to this post. Glad that it sparked something to think about/write about!

      Comment by surfacingaftersilence | July 19, 2010 | Reply

  9. Yet again another incredible post Lexi, I am so glad I read it- honestly I have so many thoughts going through my head now- what a tough subject to address and you did it so eloquently and I feel like you really addressed the issues. WOW. Incredible. I don’t know what else to say, if I actually start to write a response I do not think it would ever end……

    Comment by Jessica | July 19, 2010 | Reply

  10. Thank you for these past few posts – as Jessica said, you touched on some really difficult subjects that many people are afraid/ashamed to talk about – and I found that really helpful.

    I am curious about your (and other people’s) opinions as to whether or not the more “cushy” residential programs may be helfup DURING recovery in the program, but make it harder after discharge in terms of missing it more. I haven’t gone to any of those programs, so I can’t make any judgements, only observations. But I have looked at some Remuda and Renfrew groups, for example, on Facebook, that have pictures (yikes – it’s scary they weren’t more strict about that – who knows if people in the background not tagged even wanted to be in the pics) and it looked like people were really enjoying themselves – even smiling and playing around with their NG tubes. Some of the pictures looked like patients were at summer camp.

    Part of my observation may be out of some jealousy, since I never had the opportunity to go to residential programs (I’m not saying all res. prog. are like that) b/c of insurance and not enough money to pay out of pocket. So I had to go to very medical/”hospitally” programs that basically didn’t have therapy, focused just on weight gain and stabilizing vitals. No cute decorated bedrooms, just hospital beds. Or if they were non-medical IP units, they were locked psych. units. While at times I “missed” those units in a way, for many of the same reasons you mentioned above – esp. in terms of safety and “permission” to eat, and being around people who I could relate to, at a time when I felt isolated. But I never missed being there – they weren’t comfortable, nuturing, environments – they were pretty cut and dry and about medical stability.

    So I guess the point of my rambling is that I wonder whether or not people who have gone to the more comfortable residential programs have an even more difficult time in terms of missing the program, as opposed to those who basically went to the prison-like places I did.

    To be clear, I’m not judging those kinds of residential programs, or the people who have gone to them, b/c I have never been there myself. Part of my observations, as I said earlier, may be clouded by some jealousy, and I am just genuinely curious about whether or not things are harder in terms of missing those facilities more.

    Comment by anon | July 21, 2010 | Reply

    • I do think that certain residential programs have more “i miss X Place” posts from people than the more prison-y-hospital places. But I do know some really excential “cushy” residential places that work really hard at stepping their patients down from that cushy inpatient residential to partial to days to IOP and then back home. And that’s the type of program where I’ve seen people succeed the most with. The very gradual step down from a very high level of care to regular outpatient therapy, all with very supportive people along with way. I know I didn’t succeed at the first hospitalizations that jut went from IP to home. I DID succeed at SP because i went from IP to PHP and while in PHP was given days off, increasingly more frequent and they kept me longer because my insurance wouldn’t cover IOP, so I had much more success. i think it would be extremely difficult to go from certain residentials directly to home. Or even their PHP to home, because a lot of the PHP places are still supervised/supportive environments.

      IF ONLY insurance would pay attention to the fact that people have more success with gradual stepdown. They would end up spending a ton less money.

      Comment by surfacingaftersilence | July 22, 2010 | Reply

      • I know exactly what you mean – going straight down from IP to regular outpatient therapy is very overwhelming; it’s essentially going from a protective bubble into the real world without gradually transitioning to more independence, and the triggers that are out there that we were shielded from, for the most part, while inpatient. It would be SO much cheaper for insurance companies b/c more gradual stepdown can decrease the risk of having hospitals that basically have a “revolving door”. This past (and hopefully last) hospitalization of mine had a transition from inpatient to day patient (8 hrs a day, 5 days a week), but the hospital didn’t have enough money to continue their IOP program, which was supposed to be a stepdown from day. I found the jump from 8 hrs a day to regular outpatient to be very difficult, and I know many patients who relapsed. I managed not to relapse b/c I made sure to have a complete treatment team (medical doctor, nutritionist, therapist, psychiatrist) that I saw frequently at first, and my motivation to be able to go to grad school helped. But as I said, even though they did have some sort of stepdown, day patient to outpatient was very difficult for me, and it is such a shame that the hospital doesn’t have the money for it anymore.

        Comment by anon | July 22, 2010

    • This was such an interesting comment, and I appreciated it. It caused me to really think about the things you mentioned. There seems to be so many “pros” to residential, while what you brought up is a legitimate “con”. Because of the “cushiness”, safety, and stability there, it does make the beginning stages of recovery “easier” (in my opinion). You are “nurtured” more than in a hospital, and receiving more individualized attention specific to your needs. This is incredibly helpful.
      However…I never really thought about the downside of this. I went to a more “cushy” treatment facility, and had an extremely positive experience. By the time discharge came, we were all set up with a thorough after-care plan, thankfully. However, there wasn’t a step down program in place or transitional housing. They did offer IOP, which some girls did, but most of us couldn’t afford do do more after having the cost of residential, and a lot of us even lived out of state.
      Going home thankfully went well for me–I had a great support team in place, and going back to school was a great motivation and encouragement for me. But I DID “miss” treatment so intensely for a while, going from around the clock care to eating meals by myself, portioning by myself, being responsible for all of things others had done for me was overwhelming. I’m sorry I’m rambling–that was a long response to your thoughts. I think the residential programs may make the intial recovery process easier. I don’t know if I’d say it makes discharge HARDER, though. Most of the girls I was with created a strong enough foundation in residential (the program I was in was great about not kicking people out, even if insurance raised a commotion, so most were able to stay as long as they needed)to stand on their own two feet upon discharge, which is incredible.

      Comment by Mindy | July 22, 2010 | Reply

      • It sounds like you went to a great program – I’m so glad you had a positive experience, you must have worked really hard in recovery 🙂 I wasn’t referring to all residential programs, but I do get concerned (and also confused), when I wander around facebook seeing pictures of patients while in treatment – sometimes people dedicating a whole album to this. While it does sound helpful to keep in touch with fellow patients who were supportive during treatment, so that they still feel supported after treatment, and can be around people who understand what they are going through, sometimes I wonder if these pictures – esp. the ones where people are “horsing around” can contribute to people clinging to their ED identities. If I remember correctly I think Lexie referred to this in previous entries. Again – I could be wrong – as I’ve said before, I’ve never gone to such programs. And in the end, the most important thing is not the program, but the attitude of the patient. If someone doesn’t want recovery, the fanciest residential places won’t miraculously cure them; and I went to a pretty lousy program 1.5 years ago, but I was really motivated and made the best of it.

        Comment by anon | July 22, 2010

  11. I have to say that I have been both in the hosital based program and residential and YES I do miss the residential program and no I don’t miss the hospital program. Not that I want to go back to the residential program. Because I am begining to live my life outside of tx for the first time ever…however that doesn’t mean I don’t miss the program, it was the first place that I felt anyone truly cared about me, they first place I was able to be myself while descovering exactly who that was with people both clients and staff who got it, who didn’t judge me as I stumbled through it through stepping up and down levels of care. And now that I am on my own basically all I have is my tx team… few friends, no family… so of course why wouldn’t one miss that. And yes I do have pictures of having fun at that place. Its part of my life, my recovery process, part of learning who I am, so of course I would want reminders of that, no I don’t have pictures of the MANY times I came out of a therapy or diatician session or after a group or meal that I was curled up in a ball hysterical. Those pictures are firmly implanted in my brain too as part of my process too because w/o that there is no work done. I guess what I am trying to say is that I doccument my life though pictures and while a lot of the pictures I have posted of what I call the begining of my life were at that res. Tx facility, I have posted just as many since and inbetween. So posting pics of that time of my life is not to idealize it or make it look like “summer camp” its for me and my recovery, reminding myself durring those hard times that recovery/life is a process but it doesn’t have to be all hell. Even at the hardest points in moving forward…. am I making sense?

    Comment by anoninstl | August 29, 2010 | Reply

  12. I have to say that I have been both in the hosital based program and residential and YES I do miss the residential program and no I don’t miss the hospital program. Not that I want to go back to the residential program. Because I am begining to live my life outside of tx for the first time ever…however that doesn’t mean I don’t miss the program, it was the first place that I felt anyone truly cared about me, they first place I was able to be myself while descovering exactly who that was with people both clients and staff who got it, who didn’t judge me as I stumbled through it through stepping up and down levels of care. And now that I am on my own basically all I have is my tx team… few friends, no family… so of course why wouldn’t one miss that. And yes I do have pictures of having fun at that place. Its part of my life, my recovery process, part of learning who I am, so of course I would want reminders of that, no I don’t have pictures of the MANY times I came out of a therapy or diatician session or after a group or meal that I was curled up in a ball hysterical. Those pictures are firmly implanted in my brain too as part of my process too because w/o that there is no work done. I guess what I am trying to say is that I doccument my life though pictures and while a lot of the pictures I have posted of what I call the begining of my life were at that res. Tx facility, I have posted just as many since and inbetween. So posting pics of that time of my life is not to idealize it or make it look like “summer camp” its for me and my recovery, reminding myself durring those hard times that recovery/life is a process but it doesn’t have to be all hell. Even at the hardest points in moving forward…. am I making sense?

    Comment by anoninstl | August 29, 2010 | Reply


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