Surfacing After Silence

Life. After.

do we need pictures as proof?

Recently, on social media, there is an article that, while not viral, is rather popular.  It’s a bunch of before and after photos.  The before being when the individual was at his/her sickest with an eating disorder, and the after being when the individual is recovered.  Underneath each pair of photos is a brief paragraph about their recovery.

I have some problems with this article, because while it has been posted by those in recovery or striving for recovery, it has also been posted prominently in the pro-ana and pro-mia sites.  Because the before photos portray extremely thin individuals, and while the article is meant to focus on those individuals’ recoveries, too many individuals are using the before photos as proof that they can indeed lose that much weight and still live.  This is extremely dangerous thinking.  Death does not depend on weight.

One thing the article suggests to an uneducated reader is that an eating disorder is not serious unless you look like one of these before shots.  The article also suggests that these individuals are anorexic or purging-anorexics, giving bulimics and binge eaters false hope that they are out of danger.  But, as I stated in a previous post, I have lost many friends to eating disorders–and most of these friends died at low weights, but not the extremes detailed in the article, and most of them were purging.

This article, by focusing on people at an extremely low weight, tells readers that they don’t have an eating disorder or need help unless they, too, are at that low weight.  In actuality, the earlier you intervene in an eating disorder, the higher the rate of recovery.  Waiting until the end is near is waiting until the crisis is at its strongest and requires much more intervention and support, both on a physical and mental level.

The short little paragraphs stating that the individual is recovered worry me.  The focus is on how sick the individual was, and then he or she had a revelation and decided to get better.  If only it worked like that for the vast majority of those struggling with eating disorders.  My revelation?  It came on Christmas morning, when my brother brought my little toddler nephew to the hospital to see me.  I realized that I did not want my nephew to grow up visiting me in hospitals.  I decided if I could not get better for me, I would get better for him.  And with that decision, I began eating 100% and lost all urges to purge and reclaimed my positive body image as I was gaining weight.  (please note heavy sarcasm)

It didn’t work quite like that.  I was inpatient for another month, and then in their partial hospitalization program for six weeks.  And then I would be hospitalized again a year-and-a-half later.  And then it would be another couple years until I had convinced myself that I would not relapse again, that life was indeed better than an eating disorder.  I remained in therapy and got to discuss all those body image issues I had tried to hide/ignore, I continued working with my family physician to ensure I was, indeed, physically healthy.  Now?  Seven years after that?  Now I can say I am 100% secure in my recovery and am comfortable in my own skin and I know that I will never relapse.

Yes, it is nice to read an article that describes improvement.  We need to hear more of these stories.  But we also need to hear the truth, that recovery is possible and worth it, but it takes a lot of work.  And do we need these before shots to get that message across?  Why not highlight the small steps individuals take in their recovery journey?  When I was sick, people said, “You can choose to get better,” but no one told me how to do that, so I truly did feel that I was up against an impossible task.

And a lot of this occurred for me before the social media frenzy, and before academic research made use of the internet.  I was lucky to meet a professor, one who had lost his daughter to bulimia, who introduced me to someone who had recovered from her eating disorder and was doing advocacy work.  My weight wasn’t that big of a deal to her, but my behaviors were, and how these behaviors were affecting my physical health and creating mental pain were.

Another important issue this article deftly avoids is that eating disorders are mental illnesses.  They don’t just affect your physical body; they are expressions of internal pain and horror that need to be acknowledged and addressed.  I didn’t wake up one day and decide, “Hey, being an anorexic sounds like a great idea!”  But choosing recovery was a phenomenal idea.

Now?  There’s the National Eating Disorder Association and the Eating Disorders Coalition and Families Empowered & Supporting Treatment of Eating Disorders.   These three sites give success stories.  These three sites give details about finding treatment.  These sites give the statistics.  And there are many other recovery-oriented sites that offer support and encouragement.  Grace On The Moon offers forums for discussion and support–that are moderated to ensure they are recovery-focused.

*note:  I did not link to the original article, because even though it has a one-line warning statement, I really do fear that the graphic pictures will be more harmful than helpful.*
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October 10, 2014 Posted by | Uncategorized | , , , , , , , , , , , , , , , , , | 1 Comment

Shame and Guilt

Recently, I’ve had to come to terms and accept certain situations in my life.  Through this process, I have learned a significant amount about my emotions and my reactions to other people and my ability to assert control.

My old therapist will be referred to as MOT (Missouri Therapist) and my current therapist will be referred to as NYT (New York Therapist).  I know, not very original or creative, but they work.

I’ve recently begun working with my NYT–as in, I’ve seen him 4 times.  And he’s stunned me several times.  I want to say, “I trust him,” but I’ve only ever said that about MOT, and it took a couple years to get to that point.  I don’t trust easily.

I want to say upfront that I am not comparing MOT and NYT and naming one as “better” than the other, especially since I’ve seen NYT all of four times.  I worked with MOT for six years, and I made extremely significant and noticeable progress with him.  But, as with all relationships, there were some instances of miscommunication (me getting angry) that were generally worked with openly.  And there were aspects of that type of therapy that, I now realize, may have been why I left certain sessions wondering, “What the hell am I doing wrong?”  So there were emotional highs and emotional lows regarding MOT, but overall I am thankful I worked with him, and I respect his general approach.  And, although I say I may trust this NYT, I am well aware that we’re still in that “getting to know each other” phase and there will be difficult moments ahead for us.

I left a lot of sessions in MO wanting to cry, but I couldn’t really put words to why I wanted to cry other than to say, “I feel like I’m not good enough.”  (Kind of a repeating theme of my life, by the way.)  But I wouldn’t have been able to point to anything specific that resulted in that reaction.

Now I can.  For both MOT and NYT, I have kept/keep Diary Cards.  Each day I rate the strength of different emotions, rate the strength of the urges for different actions, and I circle all the skills I tried on that day.  (In other words, I’m working with DBT therapists.)  So two weeks ago, NYT looked at my diary card and said, “Wow.  You’re using a lot of skills.”  My first reaction was to explain how it might look that way, but in actuality it’s not all that true since I circle all the skills I tried, not all the skills that were effective.  He simply reaffirmed the positive effects of using that many skills.  I felt so . . . proud when I left the office that morning.  Like I had done something right.  While journaling that evening, I remembered the last session I had with MOT before being hospitalized in May.  MOT said, “I’m not sure where to go from here since it seems like you’re not committed to using skills.”  But if you were to compare diary cards from then and now, you’d see the same things circled.  I felt like shit that day, like it was my fault I wasn’t getting better.  Like all I needed to do was use more skills.  I felt guilty for not trying hard enough, even though I had hardly enough energy to get to the kitchen to eat three times a day.

Then at my last session, NYT thanked me for keeping the diary card, since they were so helpful for him.  And I realized that I had never heard those words before, regarding diary cards.  They were a required part of therapy, part of the therapeutic contract we both signed at the beginning of my work with him.  But hearing NYT say, “Thank you” made me feel good about myself, like I was doing something to help.

One of the Action Urges that I rate on a daily basis is the urge to self-harm.  I have now gone eight months with no self-harm.  NYT told me that was a great accomplishment, especially since I didn’t have a therapist for almost four of those months.  I didn’t know how to respond.  MOT never complimented me for remaining free of self-harm for 9 months, since it was an expectation.  Why give praise for something I should already be doing?  Instead, when I did self-injure, the focus was on what I should have done differently to prevent that, and the inevitable question was, “why didn’t you ask for help?”  I am fully aware that my goal is not to self-injure ever again, and that my therapist will push me toward that goal.  But there was no mention of how that was the longest I had ever gone without self-harm.  No “how can we replicate that and make your next clean streak even longer?”

As I said before: maybe there were things the MOT could have done differently, but I am no longer angry for the previous examples, because overall, I made a lot of progress because of my interactions with him.

But NYT has taught me about certain characteristics I have–and that I have the right to meet those emotional needs.

I like to hear that I am doing a good job.  I don’t need ‘fake praise’ for tiny things that don’t require any effort on my part.  But it’s nice to hear “good job” during those times when I am fighting so hard just to keep trying.  That praise gives me reason to keep trying.

I do appreciate a thank you for my actions, even if they are expected.  I am much less likely to feel bitter about my actions if no one notices them or comments on them.

I need praise.  And I say I need rather than I like because I do need it.  We could go back to childhood trauma, teenage angst, college trials, and my ‘failures,’ but let’s just say I am always wondering if I am good enough.  If I am okay.  And it felt so good to hear someone praise me for going 8 months without self-harm.  As if it doesn’t matter if I slip up later, the fact of the matter is I’ve made significant progress right now.

I also learned that these three things I like and need to hear are not a part of everyone’s communication style–especially if I do not let the other person know how his/her words affected me.  Especially if I don’t tell him/her what I would like to hear and how it helps me.  So I am learning to speak up a little more.  I explained a couple of DBT protocol that always leave me feeling bad about myself.  I take on the shame and guilt and hang on to them and obsess over them.  So NYT and I talked about different approaches to handle certain situations.  NYT asked me to let him know if I ever start to feel shame or guilt during our sessions.

Through all of this, I have also learned that I may need to ask my friends and family to say the things that help me the most, since a lot of people don’t know what someone with Bipolar Disorder would like to hear.  Some people may be afraid to say anything at all.  But if I talk to them and say, “sometimes I just need to hear that I’m doing a good job” then they will feel more comfortable saying that.

My right as a client, as a person, is to ask for what I need.  As a friend pointed out–other people may not deliver.  But some people will.  And to all of you who have remained by my side, I thank you with all of my heart.  (And I don’t take ‘heart phrases’ lightly!)

October 5, 2014 Posted by | Uncategorized | , , , , , , , , , , , , , , , , , | 2 Comments