Saturday, March 17, 2012

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.


anna said...

It doesn't seem silly at all. The hardest part about emotions, and understanding one's self, is the unintuitive way these things are connected. Habits and actions become so disassociated from their sources, to the point that nothing of the original root cause can be found, nothing relates back, so the connection isn't at all apparent. To be able to find your way back to such a thing, and have the gut instinct reaction that, yes, this is that thing, can be huge.

Marcy said...

The same thing happened to me with my therapist. She told me that eating disorders are a form of self-harm and it was a real wake-up call. I hate it when she's right all the time. Be wrong, just once...

AvaAlso said...

I don't think my therapist is right all the time. Well, wait, let me say it this way: I don't think that what she suggests for me is always something I want to do or can do at this point. I only have so much energy, so much ability to really process what I'm going through or what I'm doing. BUT I think that she understands that and doesn't expect perfection from me.

I also think that eating is REALLY complicated. Even for someone who has a more healthy relationship with food, it's difficult to know and stick with what's the most healthy at the right times. And even those people who aren't living with a mental illness or self-harming issues do things that aren't healthy, whether it's driving too fast or being out in the sun (sunscreen can help protect against skin cancer but many have hormones that do crazy things, including cause cancer) or not getting the right amount of sleep. Maybe it's the people that i hang with, but I don't know anyone who does everything right all the time.

I recently got a high cholesterol reading. As with the disordered (over) eating, I'm trying to fix it in moderation, in smaller steps, which my therapist seems to be in agreement with. For me, especially without being in some kind of strict (inpatient) environment that doesn't have temptations, I couldn't make drastic changes. Even then, I'm not sure I could keep them up. My cutting behavior didn't end in a day and neither will my eating issues.

So your therapist is right, but that isn't the full story and Rome wasn't built in a day. Good luck.