Saturday, March 17, 2012

So My Therapist Says, Vol 2

So my therapist says that I care a lot about what others think about me.

Well, actually she asked, "Do you think you care a lot about what others think about you?" in that leading way that therapists do.

Well, shit, of course I do! Who doesn't? Don't you? I don't see you coming to sessions in your sweatpants or pajama bottoms.

Look, no matter how much I try to do things just for me, just do thinks I like, just "be me," it's my opinion that it's often difficult to draw the line between what I do because I like it and what i do because it gets me the desired results, whatever they may be.

My primary example in this is how one dresses and behaves in work and social settings. When I have a job, I try to obey the dress code. I don't usually wear any piercings, other than earrings, to job interviews and, unless the boss says otherwise, I don't wear them on the job. "Work me" is completely fine not being "all me" while at work. I try to dress according to the social situation and have the proper manners. I might not really want to put on some slacks to go to a cabaret show at a fancy (to me) bar. I might really want to stay in my pajama pants, but I don't. Now I might not get kicked out of a place for wearing them but I'd feel even more awkward than I already do in my skin, so I try to dress accordingly.

At the time, we were talking about how I had acted, as well as how I said I had not wanted to act at a get-together for to remember my uncle's passing, on the one year anniversary of it. Everyone else was acting happy, trying to enjoy the company of other people that they had only known because of my uncle. We told funny stories about him, but no one was crying. I find it very hard not to cry when I talk about him, even just when I think about him. I think my therapist was trying to get across to me, or remind me, that crying is a valid response to thinking and talking about a dead loved one and I shouldn't have felt prohibited from doing that. But I just didn't want to be that person. However valid an emotion might be, even however justified an emotion or the reaction to that emotion might be from a psychotherapy point of view, even from my point of view, it isn't necessarily seen that way culturally and I get tired of being seen as the crazy or overly-emotional or overly-sensitive one that everyone has to walk on eggshells around. I might know that experiencing that emotion that I'm feeling isn't the end of the world, that justifiably being angry or sad and reacting to it isn't going to make me hurt myself, but others don't. Or it just makes them feel uncomfortable in a way that can't be resolved then and I get tired of being the one that does that.

And I do care a lot about what the people I care about think of me and, unless I think it's just way out of bounds or outside my character, I do things that will please them. Take dating and romantic relationships. First date, I dress sexy in my opinion and place/activity appropriate. When I first start dating someone, I try to lay my cards out fairly quickly, so we can part if we aren't suited to one another. If someone doesn't want to be in a relationship with someone who's living with a mental illness, I get that and I'd rather tell hir now and have hir say that, than months in when I have an attachment to them. (Only one example of many.) But, after I'm with someone, especially on the things I could go either way about, I'm happy to oblige. I try to be GGG (good, giving, and game, from Dan Savage) not only in the bedroom, but everywhere in our relationship, within reason. I had one someone who, as the country song says, likes his women just a little on the trashy side, when they were their clothes too tight and their hair is dyed, with too much lipstick and too much rouge. When we went out together, like 'date night' out, I wore tight slacks, very low-cut tops, and full make-up. Now, another someone I was with for awhile, has completely different ideas of what makes a woman look sexy. When we went out on dates, I wore (almost) no makeup, and clothing that left something to the imagination. Now both of these men had seen me in the morning as well as sick as a dog. Ultimately, they'd go out with me no matter how I looked, within reason. They never asked me to look a certain way, but I didn't really care either way so I did what had the best results, which was looking in a way that they found sexy. But they also do things that they know I'll like. Neither took me to a football game, because I don't like football. Both try to pick out movies that I won't think are completely stupid when we go to movies. When I've asked them to wear certain things, they have. We both care about what the other thinks of us, which isn't always a bad thing.

I am also very aware that I do things specifically to get negative reactions from people. When I was younger, I used to think that I did these things just because I liked them. Now, I do like them, or at least most of them, but I know I'll get specific kinds of not-positive reactions and I'm either ok with that, or, usually, trying for that reaction. As I've said before, I share many things that others might save for a later date, or for never, specifically so people can decide to leave if that doesn't suit them. I really like weird shoes. When I was a freshman in high school and I felt invisible, I wore the weirdest, funkiest, chunkiest shoes I could find. I might not have had any romantic admirers, but I was no longer invisible in those black lace-up shoes with the two inch platform and the five inch heel. I still have, and wear, the black and white wingtip Doc Martin's I got my junior year. I just bought a pair of purple and lime tennis shoes. I have piercings and tattoos, which I flaunt proudly (as long as I'm not in a work environment.) If a person is on the more conservative side of public presentation, it might come off as mean or scary. Though this means less in some circles than in others, I still feel like it makes me seem tough. I still feel like I've earned my stripes, in a way. Moneypenny has suggested, in as nice a way as he could find, that it also makes me less approachable, which I'm ok with. I'm overweight and I don't really feel like I want to be what is considered a normal weight for me. When I was eighteen and still pretty close to that normal weight, I was robbed in my home. I've been overpowered and sexually assaulted. I have hopes that the piercings and tattoos which make me seem unapproachable and my weight itself make me a less desirable target all around. Last but not least, I have my hair cut short, not quirky manic pixie dreamgirl short, but short short. Though I'll date anyone on the gender spectrum, I hope that it is a bit of a dogwhistle to other queer women (hey, you can hit on me.) Also, until I really want to grow it out or I fall for someone who wants me to grow it out or Moneypenny finally gets me that neck tattoo, I'm going to wear it short because my ex-husband said he'd never fuck me again if I cut it short and I never want to fall back into that situation.

So, yeah, I care about what other people think. I think about, wonder about, what other people think. Maybe I do it too much. But, until the reality is such that not caring, or not caring as much, about what other people think is a problem, I don't see a need to make it a problem.

So My Therapist Says, Vol 1

The first in a series of posts where I try to sort out my own feelings on things my therapist has put forth...

So my therapist says,

Disordered Eating is Self-Harm

and my mind does it's best Keanu Reeves' impersonation, "Whoa...."

I've been having lots of different eating issues lately and it seems like every time I accept the current problem, it changes to a new problem. But the things that never seems to permanently leave me are that I overeat and that I eat more food out than is healthy or currently affordable.

It was about a month ago that I realized how out of control the problem was, as it was something that I was lying about, sneaking around with, and overall making myself sick with. So I brought it to my therapist, said that I wanted to work on figuring out why. I wasn't, and maybe still am not, ready to change it. I just wanted to figure out why. She suggested I start using a modified diary card (another DBT thing, used to track your emotions and harming habits over the week) to track my emotions and when I binged. (Man, writing that word suddenly makes this feel way more personal. But what's the point in shame if it's not public, right?) The first week that I used the modified diary card, I thought it might help for me to write down what I had eaten. For me, it helped me get a better idea of exactly what I was eating, instead of forgetting the things I had mindlessly eaten. My therapist suggested that I continue with this as long as it wasn't triggering, which I can see how it could be, is for some people, but that isn't an issue I currently have.

After several weeks, sorta out of the blue, the big reason I was doing this hit me, the one I'd been missing. I'm educated about anorexia and bulimia, have watched the Intervention episode on them, with the best of them. In theory, I know that, at the core, they all seem to be about control, exerting control over your life in an area you have control over, your eating. Also, in theory, I know all about emotional eating, about eating habits we learn from our families growing up, all of that. But it's another thing to a) say "yeah, that's me" and b) figure out what it is you are trying to get control over. Because it is about control, at the heart of it. But I don't feel it as control. What I feel is that I don't want to feel poor. Saying it outloud, writing it here, makes it seem silly, but that's what it is. Personally, I don't have any money. In the last several months, I've gotten and quit two jobs. I'm lucky enough that my folks are both still able to work and both still have jobs and I'm living off of them. There are lots of reasons for this situation, some from my mistakes, some not. Even if I got the best paying job I could probably get right now, I would have just enough money to continue my therapy, pay my bills, and start paying back my student loans, and that's it. I would not have enough to move out. For awhile, I wouldn't even have enough to help out financially around my current household. My financial situation seems out of my control. But there's this weird culturally-trained voice in my head that asserts that poor people can't eat out at restaurants or fast food joints, can't even buy sorta lavish stuff like Ben & Jerry's ice cream, so if I do that, I must not be poor. Hey, I never said that it was good logic, but there is a logic there and I can't change the pattern until I know what starts it.

Warning: Kinda gross, sharing even more than I've already shared ahead

In all honesty, looking at it now, this has probably been going on longer than I previously admitted to myself. I had finally gotten to a place where I was moderating my eating, when my uncle and my grandfather became ill and I said "fuck it, I'm going to eat whatever fast food I want." Which I could, because I'd often vomit after any fast food meal, caused by the gallstones I didn't know I had at the time. I wasn't purposely purging, but one followed the other, so I can't exactly say I wasn't aware of the outcome. Within a couple of months, my gallbladder was removed at which point the after meal outcome switched ends. My primary care physician at the time suggested I just eat better and lose weight and that would stop, though she gave me a prescription for a powder to use when eating well was unavoidable, like Thanksgiving dinner. I never found any way of eating that allowed me to avoid the problem. Finally, after several very embarrassing accidents, I started using that powder everyday and the issue quit. I also started blowing up like a decomposing whale on the beach, baking in the sun. For awhile, especially while I was grieving heavily, my weight was the last of my problems and I didn't care. Last fall, all of that fast food and overeating started to aggravate what I'm assuming are stones that have developed in my bile ducts. After a few weeks of pain, I finally accepted the situation and changed my diet. After the two weeks in which I was very cranky, it seemed to all be under control. Except that it made my lithium levels go crazy which lead to the hospitalization. The stones must have gotten dislodged in all the mayhem, because I could eat however I wanted to, pain-free, when I got out. And I did, with a vengeance. After the hospitalization, I felt horrible, guilty and ashamed about what I'd done, and worried all the time about how much it was going to cost. Hell, you could go back further if you wanted, to my big after-mono weight loss, largely caused by not wanting to eat during the mono, then going to a therapist a few months after who told me that my real problem was chronic fatigue caused by Epstein-Barr and that I needed to cut all processed flour out of my diet, which meant just about everything I liked to eat.

When I brought my big reason to my therapist and she said, "You know, disordered eating is a form of self-harm," I had to pick my jaw up off the floor. Fuck. I had no rebuttal, didn't even think she was wrong, but I had just never thought about it like that. And FUCK. I thought I'd stopped the self-harm. I'd been suicide-thought free for months, hadn't cut or anything in even longer, didn't misuse my medication, rarely drank alcohol, and had even stopped drinking Coke after dinner. I thought I was doing so fucking good with not harming myself. Being told that this issue I had just started dealing with, this thing I wasn't even saying I was going to stop doing yet, was more self-harm was like having my balloon popped. A very necessary and true balloon pop, don't get me wrong, but...fuck.

Now I said in the last post that all that DBT shit would be coming into play and here's where it does. To change this, I feel like I have to not only accept the situation itself, but to figure out and accept where the line gets drawn, what I believe is healthy and what I believe is unhealthy, what is the right way to handle this particular disordered eating and what isn't, what a good and achievable goal looks like at this moment.

Because I have this thing with "diets" and "dieting." First of all, my personal (familial) experience, as well as scientific research, has shown that "diets" are unsustainable and, the majority of the time, result in the dieter gaining back all the weight ze'd lost and then gaining some more on top of it. Scientific research shows that this yo-yo-ing is very unhealthy for the body, probably even more unhealthy than staying the original, overweight weight. "But all it takes is determination, willpower, stick-to-it-iveness, counting calories, keeping smaller portions, pre-making all your meals, working out to offset any desserts and you'll be able to lose that weight and keep it off," you say. And that all might be true and I might just take you up on that offer someday. I know one of the precepts of Buddhism is not harming any living things and, when I was first getting into that, I knew that someday I might feel so hardcore about Buddhism that I stopped eating meat. But I also knew that, at that moment, it was not something I was willing or able to do and it wouldn't stick. My willingness can only go so far at this point. Also, if I spend every waking moment fighting my mind and my body over what I'm going to eat or not going to eat, I'm not going to have any time, energy, or mind-space to think about anything else. Maybe, someday, I'll be that minority of people who lose weight and keep it off, but there is nothing pointing me to that being the reality now.

So where does that leave me? I guess the answer is that I'm still looking for an answer. Not necessarily from you, gentle readers, but within myself. As someone who has never been convinced that we aren't in the Matrix, that we aren't brains in a vat, reality has never been very clear or fixed for me and I'm still trying to figure out what the reality in this situation is that I need to radically accept, so that I can work for change. And I'm not sure if that's a for of willingness, that I'm looking at all, or willfulness, because I'm not doing anything yet.

Friday, March 16, 2012

Radical Acceptance, Willingness vs. Willfullness

Hello, Gentle Readers. As some of you may know, I'm currently participating in DBT therapy, both group and individual. Unless you are in DBT or close to someone who is, you probably have no idea what that is. Here's a sorta dry but accurate description of what DBT therapy is:

Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality (BPD). It is not unusual for individuals diagnosed with BPD to also struggle with other problems -- depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems. DBT is a modification of cognitive behavioral therapy (CBT). In developing DBT, Marsha Linehan, Ph.D.(1993a) first tried applying standard CBT to people who engaged in self-injury, made suicide attempts, and struggled with out-of-control emotions. When CBT did not work as well as she thought it would, Dr. Linehan and her research team added other types of techniques until they developed a treatment that worked better. We’ll go into more detail about these techniques below, but it’s important to note that DBT is an “empirically-supported treatment.” That means it has been researched in clinical trials, just as new medications should be researched to determine whether or not they work better than a placebo (sugar pill). While the research on DBT was conducted initially with women who were diagnosed with BPD, DBT is now being used for women who binge-eat, teenagers who are depressed and suicidal, and older clients who become depressed again and again.

While one of my group members likes to describe it as its own little cult, to me, this great combination of psychotherapy and Buddhism, which provides and reinforces coping skills for living with the mental illness issues that I am dealing with. Oh, and despite what it seems like at the end of the previous paragraph, it is not just helpful for women, teenagers, and old people. I honestly think that many of the life skills can be helpful for anyone and my particular group has (has had) quite a few men who have found DBT helpful for them.

When I started the therapy, honestly, I just wanted to be able to make it through the day, or even just an hour, without crying. It was several months after my uncle's death. Everyone else seemed to be moving on. Mom and I had done a grieving support group. But I was still crying all the time, as well as backsliding into other behaviors which I knew were just negative coping skills. But I didn't know what else to do. It lead me to this.

But now I'm past 'just getting by,' past just wanting to make it through a day without crying, past wanting to JUST not hurt myself. I want to move forward with my life. I want to flourish. I want to deal with my problems (so I can get all new ones.) I want to turn mistakes into opportunities, instead of making them crisis. And, in DBT, the skill for making that transition, the basic skill for accepting reality, since you can't change something you don't acknowledge, is...drum roll please... RADICAL ACCEPTANCE. But what does that mean?, you might ask. Well, let's start off with the bullet point description in my book (capitalizations are the book's):

  • Freedom from suffering requires ACCEPTANCE from deep within of what is. Let yourself go completely with what is. Let go of fighting reality.
  • ACCEPTANCE is the only way out of hell.
  • Pain creates suffering only when you refuse to ACCEPT the pain.
  • Deciding to tolerate the moment is ACCEPTANCE.
  • ACCEPTANCE is acknowledging what is.
  • To ACCEPT something is not the same as judging it good.

All of this reminds me a great deal of Oprah's views on forgiveness. Forgiving is something a person does for themselves, not the person ze feels has wronged them. It is done to stop fighting that something has happened, to stop wishing that it was different, but to acknowledge the truth of the situation as it is and move forward from there. It does not say that something is good, alright, ethical, or legal. But the concept of radical acceptance moves beyond just things that others have done to you to encompass something one can do in all situations.

It also revolves around this very Buddhist distinction between pain and suffering. Pain is not only unavoidable, but it is helpful and necessary. Pain tells you when to stop. Pain draws your attention to damage and hurt. But pain is not suffering. We suffer because we refuse to accept the painful reality we are faced with. But the greater the pain, the more difficult it is to accept, because we don't want it to be the reality, so we fight it, deny it, wish for it to change, which is where the suffering comes in.

It isn't easy though. For bigger, more difficult situations, a person usually has to keep radically accepting again and again, which DBT calls TURNING THE MIND. (It has it's own bullet points but I think it's fairly self-explanatory.) Just like in Buddhism, meditation in DBT works, in part, as an exercise in radical acceptance. You just let everything be what it is. In a video we watched a few weeks ago, the creator of DBT, Marsha Linehan, suggests that you start trying to radically accept little things before you try to tackle big things. For example, radically accept that, though you don't like it and it may make you late, traffic on the highway will go at it's own pace. Maybe, if you are travelling at the same time of day again, now accepting the traffic for what it is, you'll leave earlier or bring a better cd to listen to in the car. But don't learn the idea of radical acceptance and make the first thing you try to radically accept be that you've been very damaged because your biological father has abandoned you. It's a good one to work on, but, if that's the first and only one you have in your mind, it'll be much harder to do without the other experience and you have much more on the line if you feel like you have failed.

Radically accepting things also requires WILLINGNESS, not WILLFULNESS. This sometimes gets me into trouble, as I'll talk about in a later post really soon. It's about having the right attitude, not being stubborn or obstinate, blah, blah, blah. They each have their own bullet points so I'll let those help me:

Cultivate a WILLING response to each situation.
  • Willingness is DOING JUST WHAT IS NEEDED in each situation, in an unpretentious way. It is focusing on effectiveness.
  • Willingness is listening very carefully to your WISE MIND, acting from your inner self.
  • Willingness is ALLOWING into awareness your connection to the universe- to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to.

  • Willfulness is SITTING ON YOUR HANDS when action is needed, refusing to make changes that are needed.
  • Willfulness is GIVING UP.
  • Willfulness is the OPPOSITE OF "DOING WHAT WORKS," being effective.
  • Willfulness is trying to FIX every situation.
  • Willfulness is REFUSING TO TOLERATE the moment.

So, if you weren't already, I bet you're asking yourself just why the hell I'm telling you all this. I am not trying to bring you into the cult. But all this knowledge will come in handy in the next couple of posts. See, all of these ideas are well and good, but, like Buddhism has always done for me, putting them into use means asking myself what the reality is that I need to accept, what it is that I need to be willing to do to accept that and then to change it if needed. That judgment has to come from inside me or it won't really be very effective, but sometimes there are complicated situations with no simple answers. (In fact, DBT works to steer us away from black & white thinking, challenges us to realize that there are many times when seemingly opposing things can be true at the same time and that is fine.) My next post will look at this dilemma in terms of food, eating, and weight issues, but there are many big situations in my life where, though I want to do what it takes to move forward or make things better, I'm not always sure what those things are, what things I might be not accepting right now which are blocking my ability to find the answers to. So just take the ideas for what you will, but they are meant as groundwork for the next couple of posts.