Sunday, January 26, 2014

Taking the Semester Off

I'm getting to the time where everyone is asking me why I am not back at school. It's not winter break any longer, although it certainly is winter here. And I'm getting asked questions that I usually have no idea how to answer. Things like, "Are you going to school somewhere else?" or "What are you going to do now that you're home?" or "Why aren't you at school?" And I usually respond with the generic, I'm just taking the semester off to figure out some life stuff and I'm going back to school in the fall. It's a perfectly reasonable explanation, I think, especially after the advice that one of my professors gave me: 

"It is difficult to answer people's questions. They never mean any harm by them, yet its very awkward when you don't want to talk about it. You'll have to come up with a short, very generic answer. It is important to remember that people take time off from college for a variety of reasons... A semester off is nothing. I know other students who took off for medical leave, but some just want a break for a while to figure out their path. That is really mature (and wise) to do. So often young adults just jump on the path they think is 'correct' by their parents, friend, or society without looking at all of the options. You get the luxury of looking at your options!"

So I personally think my answer is really good. But then, some people ask me the dreaded question of all questions... 


And it's not that I want to lie to people--I am not a liar (if I was a liar, I would probably still be at school right now)--but I don't exactly know how to read people and judge how they'll react to me telling them the truth. For example, some of the elderly people at church, what would they think? EDs weren't really a thing back then, besides, everyone knows that they all gossip and talk to each other and I don't want anything I say to get misinterpreted and rumors to be spread and whatnot. And a lot of times, people will ask and it won't be an ideal time to share that information because they'll be other people around who I don't want to overhear what I'm saying or there won't be enough time for me to explain the entire situation because you can't just throw it out there that, hey, I've had an eating disorder for almost 7 years and that's why I'm taking time off of school. It doesn't really work like that. 

Also, like my mom told me the other day--it really is none of their business. She was referring to a situation where someone who our family barely knows was asking about why I was taking time off of school. My business is my business and no one else's. 

I do, however, pride myself on being open about my ED because I want to change the conversation we have in society about EDs and the stigma that surrounds them. I am totally okay with speaking freely about my struggles and my illness, but there is a time and a place for it. I know that, and I try to do what I am most comfortable with in the moment. If that means talking about it, then by all means, I will talk about it. But if that means shrugging off the question with a generic answer, then that is exactly what I will do and if people aren't okay with that, well, that's just too freaking bad because it is none of their damn business in the first place. 

I am not selfish for putting my recovery before my education,
my family, my future, and everything else.
Putting everything else on hold to recover is not selfish.
You are not selfish for taking time out to heal.
But there are ways in which I am willing to share what's really going on--through an email, through a text, through a one-on-one conversation where there are no interruptions. Because as easy as it is for me to say I'm taking the semester off, it's a really challenging feat for me, one that I struggle every day to accept, to embrace, and to not judge. 

Most people don't get that I just might not be 100% okay with what I'm doing right now when they ask these questions. And again, they don't mean any harm by them, I'm sure. But every time that I have to look at someone and say that to them, another piece of my heart breaks. 

I sent an email to a high school teacher of mine the other day, sharing a really cool video that I thought she would find useful in her classes. She emailed me back and asked me how school and life were going for me, and I was very open with her about everything. She responded saying: 

"I hope that you can rest in the fact that it is all right to be at home right now.  My youngest also had to take time out from college to get her bearings back, and during that time I know that 'being out' was really hard for her, even though it was the right thing to do.  Life is bigger than our plans, sometimes."

I want people to think a little bit more before they ask questions and pry into people's lives, especially if they do not know them very well. I want them to think about the timing and the location of their questions, especially with something like this. Anyone who knows me well knows that I love school, especially Gettysburg, and that I hate quitting something or not finishing something, so anyone who knows me would know that me being home right now is 1) not a normal behavior for me and 2) not something that I would opt to do on my own free will. I also think people need to be aware of the degree to which it is acceptable to pry into the life of another person in a particular situation. I'm completely okay with telling everyone, in any situation, that I am taking the semester off of school. It's the questions that follow that are not always timed the best, and I'm not always comfortable saying that I don't want to talk about it in that moment. 

And again, I know that people don't mean any harm or hurt to come of their questions, and that usually they are just curious or trying to make conversation, which is fine. I just wish that people would be more careful about when and where they choose to ask things and that they would recognize that this taking a semester off thing isn't as easy as it looks for me, that it pains me to be sitting at home and not in my dorm room or in class and that I'm not just taking a break from school--I'm trying to rewire my brain. And that, my friends, is not easy or simple. 

Saturday, January 25, 2014

Thoughts on Gaining: The Truth about Life after Eating Disorders (Part 1)

A few weeks ago, I finally finished reading Gaining: The Truth about Life after Eating Disorders by Aimee Liu. This is the second recovery book I've read, and coincidentally, the second book by Aimee Liu that I've read. It's taken me a while to get through. 

I first bought Gaining when I was a senior in high school. I thought, A recovery book? Yeah. I'll read it and find out all the ways that I can look like I'm better, look like I'm recovered. I'll read it so I can find all the ways to hide my disorder. Before Aimee Liu, the only ED books I've ever read were memoirs or fiction--essentially instruction manuals for how to become sick, or in my case, sicker. Don't get me wrong--I love ED memoirs. I love that young adult authors are touching on EDs, which leads to conversations and early intervention. I just worry that sometimes they are too real. Too triggering. Too much of a how-to guide.

But Gaining wasn't like that. Gaining was research, put into real people terms, mixed with personal stories (shout out to Dr. Warren, who spoke on both of those sides and whom I've had the pleasure of working with for three years). Throw in Aimee Liu's wisdom looking back on her journey, along with bits and pieces of "You are not alone. There are others out there who feel exactly like you do," and you have a recipe for a very insightful and informative book for sufferers, researchers, loved ones, or the curious. However, this isn't a book review (okay... maybe it kind of is...), so I'm not going to go on and on about the value of Aimee Liu's work.

I am, however, going to go back through the book and highlight some of the important takeaways I got from each chapter--the things I've found helpful in motivating my recovery, the things that have been shocking, the things that have bothered me, the quotes that struck me, the times when she took the words right out of my mouth, all of it. Because I think in doing this, it will help me to figure out a better picture of what my recovery looks like, I think, going forward.

In order to overcome any problem, we must first admit we have that problem. We must face it, examine it honestly, and learn how to manage it. (p. xii)

Introduction--To Gain Is Good. 

To gain is good. We gain confidence as we grow, status and health as we prosper, and--so we hope--wisdom as we age. A gain of intimacy is essential for love, of toughness for survival. By definition, gaining is a source of pleasure and progress. Why, then, do so many women (and, increasingly, men) confound the meaning of this simple, satisfying word with shame and dread? [...] The greatest fear, however, is that gaining will expose some shameful inner truth. It's not about the numbers on the scale. Deep down, we all know that. (p. xiii)

It's true. Gaining is no longer about pleasure or progress, at least when it comes to weight. I remember being 12 and my dad saying something to my aunt about how I almost weighed as much as she did and all I remember is the incredible amount of shame that I felt around gaining. I was at an age where I was supposed to gain! And I was ashamed of it. It goes to show what value we put on numbers and gains in weight in our society. Look at Special K and their slogan, "What will you gain when you lose?" They are associating gaining with loss. What does that even mean?! It's a complete oxymoron. 

And that's not even about the numbers! It's about losing. EDs are not about the numbers. They become about the numbers, but they're not about the numbers. They're about what, exactly? I have yet to figure that out. Everyone is different. But my ED did not start from being about the numbers. I wasn't the least concerned with the numbers. I was concerned with feeling better and being better. 

Yet I now wanted to believe that gaining weight was enough to make me feel normal... What did "normal" even feel like? How did "normal" think? Anorexia had so distorted my perspective that I had no idea. (p. xx)

So let's talk about this one, because it's kind of where I'm at right now. It's not enough to be back in my weight range (which in this moment, I'm not yet in--so close!). Yes, the weight and the medical stability are part of it, but without normalizing food behaviors, without figuring out thoughts and triggers and everything else, relapse is basically inevitable. But what exactly is this "normal" thing? I'm at a place where my normal has, for almost seven years, consisted of being sick, and now, I have to reinvent normal from nothing, at 19. It's something that I'm struggling with as I'm seeking what recovery looks like for me. Which Aimee Liu goes on to talk about: 

Gaining back a full, healthy life in the wake of an eating disorder is largely a process of restoring these three realms of experience [inner self, relationships, experience of culture and society] to their rightful order. The first, most important, and in many cases ongoing challenge is to look beyond the surface of the person in the mirror. As University of New Mexico psychiatrist Joel Yager told me, "Know thyself in a very profound Greek way. What is your biology? What is your calling? How are you built? Study your temperament. Be respectful of it." The second stage involves reexamining and adjusting relationships with families, lovers, and friends. "You're not going to turn yourself into someone you aren't," Yager explained, "and nobody should try to turn you into someone you're not built to be." With enough self-awareness, we can rebuild or form new relationships around trust instead of judgment. Then, aided by this genuine support, we can renegotiate our responses to our culture and society from a position of personal confidence instead of emptiness. When what we do, want, and admire is shaped by a strong sense of self that operates from the inside out, we gain true power over our lives. (p. xxviii-xxix, emphasis mine)

Chapter 1--Connecting the Dots: A Genetic Link

The facts: 
  • More than 2/3 of anorexics and bulimics have a lifelong history of anxiety disorders
  • Typical anorexic qualities--perfectionistic, cautious, highly regimented, disciplined, suffer from self-perceived inadequacy
  • Anorexia nervosa has the strongest correlation to temperament of any psychological illness
  • Bulimia nervosa has a correlation but less so 
  • Even years later, recovered patients will show abnormally high rates of anxiety and obsessive thinking, especially perfectionism

Dear everyone everywhere who ever thought that EDs were choices: they are not, in fact. So let's bust that myth right now. This at least makes me feel a bit better--knowing that this isn't my fault. In another of Aimee Liu's books, she writes that genetics form the gun, and it's true. Research has proved it. 

What completely freaks me out though, is that last point. Recovered patients will show abnormally high rates of anxiety and obsessive thinking, especially perfectionism. WHAT?!

The solution is not to eliminate these traits but to learn to manage them. So in treatment we try to move patients to a new framework, to enable them to accept growth and change. (p. 22)

I think this is what my therapist meant yesterday when she told me that I needed to learn how to be okay with ambiguity--that she really meant that I need to be okay with not knowing, with not being in control, with having my same temperament and not engaging in behaviors to make me feel better when my genetic wiring makes me feel like I need to. This is gonna take some time. 

Chapter 2--Portrait of a Hunger Artist: The Face of Fear

But the turning point, while critical, is not the same as a conclusion. [...] Virtually everyone who recovers from an eating disorder experiences such a moment. It might take a comment, a look, or the scare of a medical prognosis, but suddenly the obsession that just seconds before seemed all-powerful is revealed, like the Wizard of Oz, to be nothing more than the trick of a frightened mind. Once this truth is revealed it becomes safe to say, "I'm sick of this," or simply, "Enough!" (p. 28)

I reached my turning point. About three months ago. Check. However... 

Patterns of eating, thinking, feeling, and behaving that have taken years to develop and that may stem from inborn disposition are not going to reverse in a single afternoon. I know this now from my own experience. I also know it from Caroline Knapp, who at forty-one wrote, "I'm still prone to periods of isolation, still more fearful of the world out there and more averse to pleasure and risk than I'd like to be; I still direct more energy toward controlling and minimizing appetites than toward indulging them; I am one of the least spontaneous people I know." I know it from Marya Hornbacher's observation following her long battle with bulimia: "Always, there is an odd distance between you and the people you love and the people you meet, a barrier, thin as the glass of a mirror." (p. 29) 

Now that's depressing...

People who develop EDs tend to fall into three distinct and mostly lifelong temperamental groups: 

1. Overcontrolled
  • Most restricting anorexics and a minority of bulimics 
  • "Feel like they have nothing inside" 
  • Avoid social contact
  • Tightly control appetites for food and sex
  • Limit pleasures 
  • Withdraw from excitement, sensation, and risk

2. Perfectionistic
  • Most bulimics and a minority of restricting anorexics
  • Tend to be conscientious "good girls"
  • Aim to please, excel, and conform
  • Worry about details 
  • So fearful of mistakes they can't get their work in on time 
  • "Read an arched eyebrow as contempt, a frown as a stiletto through the heart" 
  • Intensely self-critical

3. Undercontrolled 
  • Split about evenly between bulimics and anorexics who binge/purge
  • Emotions are intense
  • Behaviors are impulsive
  • Tend to fly into rages instead of expressing anger passively or turning it inward
  • Desperately seek relationships to soothe themselves

(Crossover exists, particularly between the perfectionistic and undercontrolled groups, particularly during recovery) 

Lifelong?! Ughhh. That makes this SO MUCH harder. But is ultimately, good to know. Because now, instead of fighting my temperament, I can learn how to manage it, to work with it, to direct it in ways that allow it to flourish instead of wither and die. 

The question that must precede any meaningful or lasting change is, Who cares? Who cares whether you live or die, become a janitor or a rocket scientist, wear a size 2--or a size 20? The answer may seem obvious. Given the obsessiveness with which the eating disordered worry about their bodies, they clearly care a great deal. Just consider the language of these disorders. Though filled with self-loathing, anorexics excel at self-discipline and selfless acts of humility and generosity, which they often take to extremes of self-denial and self-punishment. Bulimics tend to be more selfish and self-motivated, but like anorexics, they are acutely self-conscious and riven with self-doubt and self-contempt. Both groups resist self-awareness even as they behave in ways that appear utterly self-involved. Eating disorders are all about the self--a self that somehow claims the center of attention while refusing to claim its own true needs and wants. Recovery begs the larger question: If I'm the one who cares so much, who, then, am I? Until we gain the courage to solve this complex riddle, the figure in the mirror--at any weight--will go right on tormenting us. (p. 39)

Melinda explained to me the other day that this phase of recovery is like me standing on the edge of a cliff and my team telling me to trust them and jump, when all that I can see below me is a giant black hole. Yep. Basically how I feel right there. It's terrifying. 

But I guess it's also exciting. Professor Barlett put it to me this way: 

"It is a time for you to figure out who you are and how that aligns with who you want to be. It's tough. You would think 'who you are' would be innate and we would not have to think about developing it, but that is why so many people just move along in life not questioning anything. It's hard."

At the same time, though, I have this opportunity to figure out who I am. I have the chance to discover my likes and my dislikes, what I'm passionate about and what I couldn't care less about--EVERYTHING. But the sheer open-ended-ness of the possibilities, is, I think, what is so scary. 

Chapter 3--The Laws of Perfection: Obsession and Compulsion

The facts:
  • Most people who have had an ED believe perfection is real and attainable and that it is their duty to reach it
  • Perfection is by definition unattainable, leaving perfectionists perpetually frustrated and disappointed
  • Perfectionism is innate--a function of the temperament one is born with
  • Obsessive-compulsive personality--defined as one who is cautious, rigidly focused, stubborn, perfectionistic, convinced their way is right and everyone else is wrong, terrified of making mistakes
  • Stress heightens perfectionism

“The greatest obstacle to perfection is our own inescapably human fallibility. The more we try to prove our infallibility, the more we are bound to fail.” (p. 47)

“The emotional promise of perfection is security: no one will criticize you, try to change you, or touch you if you have your universe in order. But perfection is impossible, frustration is inevitable and at times unbearable.” (p.53)

Guilty as charged. I am a perfectionist. I feel more secure when everything appears to be "perfect." It's true. I freely admit that. 

People with EDs, especially anorexia, tend to have high serotonin levels all the time, which heighten anxiety and lead to these personality traits--
  • Organized
  • Driven
  • Somewhat compulsive
  • Extremely obedient
  • Overachieving
  • Good at following through
  • Sleep too much
  • Rarely impulsive
  • Rarely domineering
  • Timid
  • Risk-averse
  • Need routine
  • Do worse in novel situations
  • Prone to depression

I mostly fit all of these characteristics. I also know that my serotonin levels are wonky, hence being on SSRIs. But. This is just super interesting to me (it also makes neuro easier because it gives me a real-life application! #psychnerd).

“Character is the real stuff of recovery because it consists of the traits we can change—unlike temperament, which is largely innate and permanent. If one thinks of temperament as the genetic wiring of personality, then character consists of the circuit boards that route, suppress, or maximize the currents flowing through that wiring. The three traits that comprise character—self-directedness, self-transcendence, and cooperativeness—are shaped less by genetics than by experience (how we are raised by our parents, for example, or trained by our culture) and free will (how we choose to interpret and react to experience).” (p. 61-62)

1. Self-directedness
  • Measured by the degree of meaning and purpose we feel in our lives
  • Less to do with what we want and more to do with why we want it
  • Highly self-directed people: realistic about abilities, effective in choices, persistent in problem-solving, hold themselves accountable, take pride in reliability
  • Not the same as self-sufficiency
  • Allows us to work, play, and love others without fearing we’ll lose ourselves while doing it

 2. Cooperativeness
  • Makes us feel part of society
  • Benefits from self-directedness
  • Highly cooperative people: personal passions and talents flourish in groups, high empathy, tolerance, and compassion for others, broad perspective on self

3. Self-transcendence
  • Allows us to feel part of the greater universe
  • Gives us faith
  • Alleviates fear
  • Measure of “the depths of self-aware consciousness, such as awareness of what it means to see the colors of a rainbow or the beauty of a painting….Individuals high in self-transcendence recognize the beauty and meaning of sensory experiences intuitively.” (p. 64)
I guess these are the things that I need to focus on right now--what gives me meaning and purpose, what makes me feel part of society, what allows me to feel part of the greater universe. Those aren't easy things to identify, for anyone, much less someone in recovery. But they are things that I can explore right now, things that I have the time to explore right now, and even though that's terrifying, it's pretty amazing. 

“The struggle between who we are and who we want to be is what motivates most human beings to grow….Unfortunately, what perfectionists strive to prove is impossible. No one is perfect, and everyone has limits. What kills us will not make us stronger or prettier or more lovable. A sense of purpose, connection, and perspective, however, can and will.” (p. 64)

Growth comes from struggling to get from who I am to who I want to be. Struggling. Not moving, not swimming, but struggling. It's not going to be easy. It's going to be difficult. It is a struggle.  And it will not be perfect.

“Error sometimes supplies the surprise that makes life interesting. Sometimes it opens up new opportunities. There’s a good reason why we rarely remember, much less tell stories about, the perfect landings.” (p. 66)

New opportunities. Different opportunities. Terrifying, but opportunities, which will lead to gaining things. 


(Stay tuned for part 2 of my review of Gaining! I don't want to overwhelm anyone--or myself--with an absurdly long blog post.)

Sunday, January 5, 2014

Goal for 2014: Be Me-sponsible

It's a new year. And a lot of resolutions are being passed around with a slogan of "new year, new you." Most of these resolutions have to do with dieting, weight loss, exercising more... You get the picture. I for one am ridiculously sick of hearing and seeing all of those commercials advertising for these products "guaranteed" to change your life or the products that are shaming you for "indulging" over the holidays and convincing you that you need to lose those five pounds that you put on over the past month or so.

I'm over all of it. I didn't stay up until midnight to watch the ball drop because I was in bed by 11. I didn't make any New Year's resolutions because I know that I will not achieve them because honestly, who does? Also, it's not necessarily in my best interests to make resolutions right now. I was reading this blog post the other day about how resolutions can be kind of iffy in the world of ED recovery and that “Resolutions can trigger perfectionistic behaviors and all-or-nothing thinking. Recovery is a reality when we are compassionate with ourselves and focus on the thoughts and behaviors that are in line with what is satisfying for us, deep in our hearts.”

In treatment, I'm beginning to focus more on what I ultimately want out of my life--where I see my ideal self, what makes my life a life worth living. As a group, we're going through life values and setting goals in all aspects of life. And through this process, I have learned that a lot of my goals in the areas that I value can and will only be achieved once I have reached a healthy and recovered place in life. So individually, I've been working on developing this idea of recovery--what it looks like for me, what it means for me, what it is on a very operational level. And I think that article put it well:

Recovery is a reality when we are compassionate with ourselves and focus on the thoughts and behaviors that are in line with what is satisfying for us, deep in our hearts.

At this time of year, everyone around me is making New Year's Resolutions, mostly around eating less and exercising more and losing X pounds, in hopes of making their lives happier or themselves more successful or healthy or thinner or what-have-you. And I'm stuck in this place of trying to figure out what I want my recovery to look like, what I want my life to look like, who I, in a world without an ED, want to be.

Right now, New Year's Resolutions are not even on my radar. Resolutions are so final and not malleable. You set them and that's it--you either achieve success or failure. There is no in between, no middle ground, no grey area.

I've been spending my time making goals for myself--goals that involve having what we refer to in treatment as a "life worth living." Goals that involve going back to Gettysburg in the fall, having healthy and deep relationships, being recovered and healthy and not eating disordered. Goals of pursuing a PhD program in clinical psychology and eventually becoming and ED therapist, researcher, and activist.

It's unrealistic for me to achieve all of these things in the upcoming year, even if I break them down into smaller, more specific goals.

Life doesn't go according to my plans, I've realized. I will set goals and not achieve them. I will make plans and not follow through. I will not live up to my expectations. I will have bad days and lapses and relapses in recovery. I will fail and I will make mistakes. Becoming a better person, developing my character, recovering--all of these things take much longer than year.

And although I have been and will continue to set goals for the upcoming days, weeks, months, and year, I have no expectations of what the year will look like. Will I be back at Gettysburg in the fall? I don't know. Will I be "recovered" by the end of this year? I don't know. Will I know who I am and how I fit into this world? I have no idea. The only thing that I can be certain of is that life is filled with uncertainty. And I can make plans and goals and dreams, but there is only a minute degree to which I can control the environment around me.

What I can control is myself. I can wake up every morning with a fresh start for a new day. I can learn how to be more caring and compassionate to myself. But most importantly, regardless of the situation, I can live each and every day to a degree that satisfies my soul.

"I hope that in this year to come, you make mistakes. 
Because if you are making mistakes, then you are making new things, trying new things, learning, living, pushing yourself, changing yourself, changing your world. You’re doing things you've never done before, and more importantly, you’re doing something.
So that’s my wish for you, and all of us, and my wish for myself. Make new mistakes. Make glorious, amazing mistakes. Make mistakes nobody’s ever made before. Don’t freeze, don’t stop, don’t worry that it isn't good enough, or it isn't perfect, whatever it is: art, or love, or work or family or life.
Whatever it is you’re scared of doing, do it.
Make your mistakes, next year and forever."
-- Neil Gaiman