Saying Goodbye to Julie

Goodbyes are really hard for me--always have been. I remember leaving to go home from visiting family and being absolutely miserable because I wasn't going to see them for another few months. Every summer, saying goodbye to my campers and staff was always the hardest part; I missed them almost immediately. And when I graduated high school, I said goodbye to many close friends who I loved dearly and we all went our separate ways. Some of these people I rarely talk to anymore. 

The past few months have been a time of farewells for me. In September, I said goodbye to my PopPop when he lost his battle with cancer. In November, I said goodbye to Gettysburg to come home and get treatment for my eating disorder and depression. In January, I said goodbye to day treatment and IOP as I transitioned to outpatient programing, leaving behind wonderful staff and supportive friends. In February, I officially said goodbye to Katie, the nurse practitioner who had worked with my ED doctor; she was my salvation in high school as I fought against Maudsley therapy and she saved my life in the most literal way. And today, I had to say goodbye to Julie, my dietitian, who is one of the most wonderful women I have ever met. I didn't know she was leaving until today. 

I originally met her in day treatment. She would fill in for Christina on the days Christina wasn't available to check meals. I loved her for how laid back she was about everything. She was really responsive when I told her that standing behind me made me nervous, and when I hadn't seen her in a while, she gave me a hug on a day that I really needed it. When I asked Julie if she would see me for outpatient, she was so excited to work with me, which made all the difference to me. In her nutrition sessions, I learned so much about why dieting is bad, why all foods are good foods, and what normalized eating looks like. 

Working with her in outpatient, I learned so much about how to take care of myself and I was always supported by her in everything. In one of our first couple of sessions, she told me that she thought that my brain had caught up with its health, but that I just hadn't decided to be kind to myself yet. She took the time to explain what that meant--being kind to myself meant being my own friend. How if I was talking to a friend, I would tell her not to use diet pills because they don't work, only give false hope, and are bad for her heart. If I was talking to a friend, I would tell her she needed to eat because food keeps her alive and functioning. And Julie told me that I would tell a friend all of her good qualities and say she was beautiful inside and out and she should accept herself the way she is because she can't change who she is. She can't change the body she was given. And in that conversation, I could tell how much Julie meant all of those things for me and how much she wanted me to believe them. 

"I came to love her the way you love someone who saves you from drowning."

It was always so easy to talk to Julie, even when things were hard. She let me talk about my body image issues, which are really hard for me to even talk about with anyone. And she was really comforting in those moments. She reminded me that I am stuck with the body I have--my shape, my height, my hair color, my skin complexion, etc, and that I might as well accept it and love it because its not going to change. She reminded me that I was more comfortable in my ED body than my weight restored body because I was comparing myself to a 12-year-old's body. She encouraged me to start loving my body now becase it is going to keep changing as I get older. And she was always really honest about her own body image struggles, and Julie always stressed how important self-care is in helping her on those days. 

But there were also times in outpatient when I was really angry with her, like in February when she told me that I basically needed to get my shit together or she was going to not see me until I was more willing. I was so angry with her about that. She told me that she can only do so much for me and at some point, I have to make the choice to listen. Julie also said that she gets offended when she spends time working with clients and they don't listen to what she's saying. I was really upset about this because I felt like she was just giving up on me, even though she told me that she cares about me, worries about me and wanted to keep working with me. She could be really harsh when I needed it to get back on track... Like the week that she threatened to send me back to day treatment for two weeks. 

As harsh as she was when I was struggling (and when I really needed a kick in the butt to get me back on track), Julie was incredibly encouraging and gave lots of praise when I was doing well. It always made me uncomfortable when she told me I was "rocking it" or some other compliment because I never really felt it, but I have no doubt that she believed it with all her heart. Today, after she gave me one last hug, she told me that she had complete faith in my ability to recover and stay healthy. She told me that she believed I could do anything that I put my mind to and that I was going to do great in college. Julie told me that she does not doubt my ability to succeed in anything. 

I don't know how to say goodbye to someone who has challenged me and changed my life forever. I don't know how to express my gratitude for everything that she has done for me or how to tell her how much I'll miss eating snacks with her or looking at pictures of her kids. 

I have no idea how to say goodbye to this woman who has helped to save me from myself.

Goodbyes are hard. I wish this one didn't have to happen, but I know it was inevitable. In a few short months, I'll be saying more goodbyes to people who saved my life and have changed me for good, and I'm not sure how I'll manage it.

How do you say goodbye to someone who you basically owe your life to, knowing that you'll probably never see them again because that's just how these things are? How do you let go? How do you find closure when the relationship ends? And how do you be okay when someone who saved your life is suddenly gone? 

Set Point Theory

Two days ago, I sat in my doctor's office waiting to see her for the first time in a month. I'd had my weight and vitals checked two weeks prior, of course, but never actually got to see my doctor. Finally, I heard the faint knock on the door which signaled her entrance into the exam room and saw her all-too-familiar smile as she opened the door. Before I could forget, I handed her paperwork and asked if she could fill it out so I could return to college in the fall. 

"Sure... As long as you get back into your weight range." 
"I'm not in my range?" 
"Nope. You're out just by a little bit... X pounds."
"Why?" 
"I don't know. You tell me!" 

Inside I was pissed (and I still am)--how the hell am I out of my weight range? I've been following my meal plan for the most part... I don't understand. Followed immediately by the frustrations of doing everything 'right' and how I'm supposed to, yet still being 'wrong.'

Then there was the conversation with my doctor about what my dietitian said last week: 

I don't care what your weight is as long as you are following your meal plan.

My dietitian's rationale was that if I am eating and exercising appropriately, my weight is going to fall where it is supposed to be because there exists a weight my body naturally wants to be. My doctor's reasoning, on the other hand, has to do with my not having been in recovery long enough for my brain to be able to regulate things like my natural weight; she says it can sometimes take over a year for your brain to get back to normal once your body has been restored to an effective weight, which is why it is important to stay in a certain weight range. Going outside of one's range may make one more vulnerable to relapse. For example, when I returned to school this past fall, I was slightly under my weight range and I slipped and then relapsed--HARD. She said she wants me to have a bit of a buffer so if I start to struggle again, I won't fall as hard. 

My doctor and my nutritionist at first glance, appear to have conflicting professional opinions, which is why I did some of my own research when I went home. My research found that both my dietitian and my doctor are speaking to the same concept--this thing called 'set point.' 

Carrie Arnold defines set point weight as "the weight range (usually around 5 to 10 pounds) your body will maintain comfortably without any external input from you--that is, without calorie counting, food restricting, excessive exercise, or purging."

Mirror Mirror, an organization dedicated to educating about eating disorders, has a very good article on set point theory, which you can read in full here. I just want to hit some of what I found relevant--

"Everyone has a set point and just like you have no control over how tall you will be, or what color your eyes and hair will be, you also have no control over what your set point will be. Your body is biologically and genetically determined to weigh within a certain weight range. Set points vary for each individual person. That is why it’s not a good idea to go by the weight charts that you see in medical books or hanging in your doctor’s office."

Read: Weight is biologically and genetically determined; you can't change it. Also, BMI charts are crap.

"When you go below your body’s natural set point, your metabolism will react and start to slow down to try and conserve energy. Your body will start to sense it’s in a state of semi-starvation and will try to use the few calories it receives more effectively. You may start to sleep more, your body temperature will drop, which is why you hear so many anorexics complaining of being so cold, and after too much weight loss many women experience the loss of their menstrual cycle. Basically their reproductive system shuts down because their bodies probably could not handle a pregnancy. Many people that are dieting also experience uncontrollable urges to binge. That is because your body is telling you that it needs more food than you are providing it to function properly.

"Just as your metabolism will slow down when you go under your body’s set point, it will also increase if you go above it. The body will try to fight against the weight gain by increasing the metabolism and raising the body’s temperature to try and burn off the unwanted calories."

Read: Your metabolism will adjust accordingly to keep your body as close to your set point weight as possible. 

"If you have been dieting for years, it can take up to a year of normal eating for your body’s metabolism to function properly and return you to the weight range that is healthy for you."

Read: It takes time for your body to figure out it will be regularly getting appropriate amounts of nutrition, so your metabolism will not start functioning properly as soon as your start eating. It takes time to adjust--sometimes up to a year!

I guess what I took out of all of this is the idea that my body has already genetically and biologically determined what the most effective weight is for me. There is nothing I can do to change my weight. And while what Julie said is true--as long as I am following my meal plan and getting adequate nutrition and exercise, my weight will take care of itself--however, I am in recovery from an eating disorder. In layman's terms, my brain and body are confused and unstable so even missing a single snack or getting in a 20 minute walk can cause my fragile metabolism to shift. Therefore, I need to trust my doctor and stay in my weight range until I am more stable, and then my body will be able to take care of itself. 

(But really, someone remind me of this tomorrow. And today. And every other day. Because although writing about it helps me understand it, the writing doesn't make me believe it any more than I did before.)

-----

To read more about set point theory, check out these articles: 
"Set Point Theory" by the Centre for Clinical Interventions
"A Hunger Artist" by Emily Troscianko, published on Psychology Today
"A Thigh of Relief" by Jenni Schaefer

Reasons to Recover

I haven't written for a while, and frankly, I've just been so completely exhausted at the end of the day to even process what happened and very emotionally disregulated.  Things have changed rapidly for me in the past few days--my insurance company decided that since I have behaviorally stabilized (meaning, since I followed my meal plan for an entire week) and that since I'm mostly medically stable, that I needed to be stepped down to IOP (intensive outpatient), which is essentially the same thing as DTP, except it is only three and a half hours and not six. But initially, I was overcome with a lot of fear and anxiety that this is making me rush treatment, which will just put me back at CCED in another year or so. The other thing that this drop did was to completely invalidate how I felt about recovering from my eating disorder. Insurance companies are really good at doing that. They see a person simply as money, especially when it comes to mental health problems (but seriously, if I had cancer, this would not be how they would be treating me), and don't go by the guidelines for real healing. They just want to have to pay for as little treatment as possible and if the results are just barely in their checklist, then you are magically better and they will not pay for treatment any more.

Luckily for me, instead of dropping me completely, they allowed me to just step down into IOP, but even still, I don't feel okay with it. I feel fake because my actions and medical charts are improving, but my mental state is actually getting worse. Which is normal in eating disorder recovery world. But it makes me feel crazy because to normal people, I am getting better externally while internally I am feeling worse. It's a very frustrating process.


On the bright side, dropping to IOP, it means no more rush hour traffic, no more waking up at 6am, no more driving in the dark. It means no more exposure to one girl's defiance and protest to being in programming and no more exposure to another's hopelessness and desire to be the most pitied girl in the room. So I'm just trying to breathe through it and see how I feel at the end of the week.

One thing that has been the most helpful in getting me to this point where externally things are looking better is to remind myself continually why I am recovering. Why I want to get better. Why I need to get better. And at the beginning, I could not discern any of it for myself. So my favorite professor gave me a little help with why I need to get better, which got me following my meal plan all the time. And now in this time of change when I feel like my illness is being trivialized by my insurance company and I feel invalidated and like I need to get sicker to "prove" that I need the help, reminding myself of my reasons to recover helps me turn my mind from the distorted eating disorder thoughts to wise mind thoughts that allow me to continue following my meal plan. Here are the original 20 reasons to recover that my professor sent to me, which I keep coming back to as my base:

Reasons why you need to get better (which  means following your meal plan): so you can...

1. be HAPPY!

2. live normal again (whatever normal is) =)

3. come back to school and attend awesome classes

4. hang out with your Gettysburg friends

5. chat during my office hours

6. let your body recover

7. finish school and get a great job

8. get that job to help others

9. NOT let the disorder win

10. be that awesome success story that motivates others to get better

11. play with Eric and other little ones (because that is fun)

12. have your own kiddos someday (if that is of interest to you)

13. enjoy meeting up with friends

14. eat out in social situations and actually enjoy delicious food

15. go to church without anxiety

16. truly enjoy family gatherings

17. take back control of your emotional state

18. continue to help all of those friends that need you

19. use all of the potential that is waiting inside of you

20. simply live!

And as treatment has progressed, I've been able to add some more reasons to this list. I need to recover so I can... 

21. enjoy the holidays and not fear or dread them

22. travel and visit new places and far away friends 

23. have an identity outside of my disorder

24. go grocery shopping on my own 

25. fully experience everything around me

26. not have my life ruled by food, calories, and weight

27. stop hurting myself 

28. care for myself in ways that are not self-destructive

29. live freely and be able to have spontaneously with food

30. tell others that recovery from an eating disorder IS possible and actually mean it

Last night, I was asked, "What are the things you DO want? The healthy things? To come back to school, right?" And I responded with, 

"Yes. And to play with kids and smile and laugh and not be self conscious while I'm doing it. I want to be fully alive and able to experience EVERYTHING--to travel. To not be afraid of the unknown. I want to have kids and a rewarding career where I get to help others. I want to love and be loved. I want to live."

Progress.

I Feel Alone.

A few days ago, I watched a video about how even though we are the most connected to others than we have ever been--thanks to social media like Facebook, Twitter, Foursquare, YouTube, Tumblr, Pintrest, etc and things like smartphones and texting that make anyone easily accessible--we are more lonely than we have ever been. I've linked the video here: 

After watching it a third time, it still makes my head spin when I watch it, but it also makes so much sense if you really think about the message it contains. 

Today, I was sitting in church next to my dad and he had his arm around me, like he usually does every Sunday we're in church together.  I was surrounded by a sea of people, most of whom had watched me grow from a first grader into a college sophomore.  I was surrounded, essentially, entirely by my family. 

And I felt completely alone. 

Right before the service began, I had a conversation with a lifelong friend about all that has been happening in my life, if being home was being helpful, how I was feeling, and it ended, like all of these conversations do, with her saying something to the effect of 'Let me know if you ever need anything. I'm here for you, and I love you.' 

So many people have told me that recently. And I very well know that I am not, in fact, alone. I have friends here who have tried to get together with me, but I've just been too tired or just not wanted to be social. I've received letters and care packages from school friends. I've gotten daily texts from some of my closest friends. And on the rare occasions that I have ventured out into the real world, one that is not my house or treatment, I've spent a couple quality hours with people who have been in similar situations. 

But I still feel alone. 

I don't know if I would say that I feel 'lonely,' because I don't think that's what I'm feeling. Lonely to me means missing people you care about, and although I do miss Gettysburg friends and home friends and extended family, that's not what is consuming me. It's the feeling of isolation, of not being understood, of not being fully known or heard, of people just not 'getting' me. The feeling of being alone. 

I know this has to do with my depression and my eating disorder. The two of them are not mutually exclusive from each other--experts still cannot determine a causal relationship between the two things, just that they tend to be highly correlated. But both add to this feeling of alone-ness, or isolation if you will. 

So even in those moments where I am not physically isolating myself, in the moments where I am not letting my social anxiety win, in the moments where I am not actually alone, the feeling of isolation and alone-ness is still there and it feels more present than it does when I am physically alone. 

Maybe this feeling of isolation and alone-ness has to do with my lack of vulnerability in these social situations.  All morning I was answering questions of 'How's school?' 'Are you glad to have had some time off?' 'Are you looking forward to winter break?' as if nothing were wrong. As if, in fact, I was making the five hour trek back to Gettysburg to have one more week of classes, a week of finals, and then over a month off for winter break. Maybe I need to be more vulnerable. 

Or maybe it has to do with the idea that I'm not constantly surrounded by my friends or that I can walk to class and pass four of my closest friends along the way. Maybe it is actual loneliness because some of those who know me best are not present, here, with me. 

Maybe it has to do with my being an introvert and not feeling fulfilled and cared for in large group settings, like church or like family Thanksgiving. But even in the one-on-one contact that I've had with people where I've been vulnerable and open, I have still felt alone. 

But mostly, my feeling alone has to do with the illness. The fact that I suffer from anorexia and depression and anxiety and that person sitting next to me does not. Or that person sitting across the room, although he or she may also suffer from depression, he or she does not also have an eating disorder and anxiety. The fact that I, alone, am being attacked by this specific illness and this specific combination of comorbid conditions makes me feel alone. 

Our culture puts such an emphasis on individuality, and I've been reading about it all semester in social psychology and how different psychological phenomena are experienced differently in collectivist cultures. If I lived in such a culture, would I feel any less alone right now? Probably not. 

Eating disorders are very individualized. Every person who suffers from any type of eating disorder suffers differently. That's why treatment must be individualized to the person in order for it to be effective. My eating disorder is not the same as any of the other people sitting in DTP with me or anyone else who has gone through CCED or suffered with an ED. 

I feel alone because psychologically, I am alone right now. 

This is one of those posts that isn't going to be wrapped up all nice and pretty and topped with a bow. This feeling of alone-ness is not going to go away just by placing myself in a room full of people, or a small group of people that know me well, or even in a room full of people who 'get it.' Because I will still feel alone. No matter how many letters I receive, texts and emails I get, words of encouragement I am told--the feeling of being alone remains.

And in this moment, sitting with this alone-ness and the discomfort it brings is just going to be something that I have to do. 

And maybe, one day, it won't be here anymore. 

An Attitude of Gratitude in the Chaos

I promised myself that I would blog about my first day of day treatment (from here on out, known as DTP).  I promised myself that I would blog about Thanksgiving and how to survive it and have a super compilation of all of the articles I read about how to survive it if you have an eating disorder and how to support a loved one through Thanksgiving. And I did neither of those things. 

My first day of DTP was a whirlwind, from which I went straight into a car for the five hour journey to Michigan, where Thanksgiving happened, then we made the five hour trek back home, and I completed my second day of DTP. So none of the blogging got done because well, DTP is exhausting and I was tired, and I also didn't have the interwebs in the car.  

"By this point, I had long since accepted that I had a problem that could be called anorexia, although I didn't think I was thin enough to 'qualify' for the diagnosis. I was also quite happy to recover from my eating disorder, just as long as I didn't have to eat and gain weight."

--Carrie Arnold, Decoding Anorexia

I started reading Decoding Anorexia by Carrie Arnold last week sometime, and I have still to make it past the introductory chapter because I'm not sure right now is the time for me to read this book.  The quote above has stuck with me ever since I read it the first time because that's exactly where my mind is right now.  I have a foot in both camps--one is in the do-whatever-it-takes-to-recover camp, while the other remains in the I-like-the-idea-but-don't-want-to-eat/not lose-weight camp.

I keep having this discussion with people--from school, from treatment, from my team.  And every single one of them finds it normal that I feel this way and normal that I feel conflicted at this stage.  I mean, I currently have two competing ideologies in my head.  

And I still don't completely understand how sick I am.  I can look at the DSM and see how I fit the diagnosis of anorexia (Criterion B in the DSM: Intense fear of gaining weight. Check.), and I can be told again and again by doctors and therapists and friends and family that I am sick, and I think that I'm just finally becoming on board with that.  I still have my moments though.  

But recovery vs. continuing with my eating disorder?  I don't know.  I can still barely wrap my head around having an ED.  

In DTP, the group leaders have both told me that this is perfectly normal and that acceptance and commitment to recovery will take time for me to develop, but that it will happen and that will be a big part of my recovery.

My doctor today told me that it is going to take time for my mind to get there.  She said that as long as I continue to show up and do the hard work, it will get easier to want to recover.  And she also said that it's completely okay to have one foot in the recovery camp and one foot in the not recovery camp, even if I'm only 51% in the first and 49% in the latter, as long as I'm letting that 51% win.  And sometimes, my balance shifts and it becomes more like 50.00000001% in the recovery camp.

For days I have been feeling like the most insane person on the planet with all of these dissonant thoughts running around in my head.  But today, I feel better because of DTP and because of the supportive staff that work there and I am so thankful for that.

So today, the day after what I'm renaming "Thankfulness Day" because it really is supposed to be about giving thanks, I'm going to turn my mind to the blessings that I have right now, in the chaos, in the uncertainty, in the hard times. And right now, in this moment...

I'm thankful to exist and to be alive;

I'm thankful for warm blankets and naps that bring rest and for knitting, and Criminal Minds to distract after a long few days;

I'm thankful for writing, for blogging, for journaling and for the outlet it gives me right now;

I'm thankful for family and friends who are supportive of my recovery journey;

I'm thankful for a house and loving parents to come home to;

I'm thankful for Gettysburg friends who have been sending love and encouragement, for administrators who have gone above and beyond the call of duty to help me with all the logistics (and to encourage me when I need it), for professors who are becoming more like family away from home and who continue to encourage and support from afar;

I'm thankful for my home community and for older and wiser friends, who I am now becoming close to because of my struggles;

I'm thankful for babies to snuggle and children to watch, for the reminder that life is precious and for the joy their presence brings to me;

I'm thankful for everyone I know who is struggling or has struggled with an ED--for my friends, for those I met and am meeting in treatment, for those I've met by being vulnerable about my own life, for those I've met at school and the NEDA Conference, for those who I blog-creep on--because every single one of these people make me feel less alone and give me a reason to fight my own ED;

I'm thankful for CCED and their staff who are supportive of my recovery and validating of my fears, who understand how overwhelming it is to "just eat" or to "just follow your meal plan," who care about every individual in DTP, who come to work every day with a smile and know exactly what to say to make me laugh, who give me a place of safety where I can be vulnerable and where people just get how I'm feeling;

And I'm thankful for the 50% of me in the recovery camp that gets me to actually go to treatment, because like my therapist continues to tell me, the best thing I am doing for myself right now is simply showing up.

Reality checked

"Do you actually want to recover?"

That's one of the very first questions that my best friend from treatment asked me in our hour and a half conversation Wednesday night when I first began to tell her that I was struggling.  Not what's going on, but "Do you want to recover?"  We talked through a lot on the phone that night.  About what my behaviors have been, what my thoughts are, what my expectations of going home for treatment were.  And she reality checked everything. 

I've been fighting the idea of going home for a few weeks now, mainly because I don't think that things are that bad.  Denial is something that is fairly common among eating disorder patients.  It sounds something like this for me: 

• Everyone diets, so what I'm doing isn't bad. 
• I know what an eating disorder is, and I DO NOT have one. 
• What I’m doing is no big deal. 
• There's nothing wrong with me physically and I'm still very high functioning academically, so obviously, I am not sick. 
• I'm still eating food, so this isn't restricting.
• I'm not thin enough or skinny enough to have an eating disorder.
• I’ll just lose weight until I am X pounds and then I’ll stop.
• I am in complete control, and I could stop if I chose to do so.
• Things aren't as bad as they were in high school, so I'm obviously not relapsing. 

Denial. 

The sicker I became, the more the excuses seemed real and the more my brain believed them.  I went from eating two meals a day to only one to not taking my meds to restricting even more and limiting myself to under X calories a day to throwing up what little I was eating to abusing diet pills to obsessing over weight.  And I still thought that I was fine because I hadn't seen any physical weight loss.  

Then I went home this past weekend and when saying goodbye to a friend's mom who knows about my struggles with ED and depression, she said that I needed to "Stop losing weight."  
"What?"  
"You've lost a lot of weight since I saw you last in September." 

Even in that moment, it was hard to believe her.  The next day, I got dressed for church in an outfit that I had worn less than a month ago.  I couldn't keep my pants up and my shirt was so baggy... ugh.  Unfortunately, I didn't bring a nice belt home because I didn't think that I would need one, since these pants fit a month ago, they were still going to fit.  

Luckily for me, my brother had left a nice belt at home. And at first, I completely freaked out when I realized that was going to be my only option.  My brother has always been skinnier than me.  Always.  So there was absolutely no way that his belt was going to fit me... even at the very last notch.  But I put it on because I was running late for church and had no other options.  I held my breath while I put it on his belt... It didn't just barely fit.  It fit like any of my belts do.  

Had I really lost that much weight? No.  I couldn't have.  I don't see it, so obviously it can't be true.  This belt is probably just too big for Jacob, which is why he left it at home instead of taking it with him.  

But it still bothered me.  The whole weekend bothered me--exchanges with my parents, with my friend's mom, with how my clothes fit on Sunday, with my brother's belt.  And when I got back to school on Sunday night, I checked my weight, hoping to ease the dissonance in my mind.  

Numbers don't lie.  They showed that I was X pounds under my "ideal weight range," according to my growth curve (my treatment team at home doesn't use BMI to determine ideal weight ranges because of reasons stated here). 

I started to think that maybe I had a problem.  Maybe I needed to go home and get help... but it wasn't that bad yet.  I was still in control.

Monday night I was attempting to study for an exam and had a major depressive episode.  And Tuesday I ended up talking to Dean Cole and we decided that maybe it would be best for me to go home and get some help.  I called my team on Wednesday, trying to reach Katie, mainly, because I like her best (yes, I have favorites...) but was unsuccessful.  Then Annie called me.  I was scared, and I wanted to talk with her, wanted her to make me feel better and tell me that I was right and didn't need any more help and definitely didn't need to go home.  

She called me out on all of my bullshit.  She told me that I was sick, that I needed help, that I was sicker than I was able to understand.  She told me that my idea of going home for a few days or a week was just complete bullshit--I wasn't going to recover that way.  Maybe I would be able to keep things in check for another month or so, but I was just going to relapse again and again until I spent serious time working towards recovery.  

I gave her every excuse to not work toward recovery, and each time she told me, 'Yeah, I totally get that, but here's why you're wrong...'  I talked to her about school and how I was scared that I wouldn't be able to return next semester if I went home for serious treatment.  Her response was that was good, that I'm not going to recover in college--no one can. That I should take the year off and reach full recovery... Something that terrifies me very, very much.  We talked about maybe going to rehab (different from inpatient), so that I could work intensively on my recovery and not have the added stress of being at home.  (Not to mention that it may increase the likelihood of me being able to return to Gettysburg in the Spring).

She reminded me that I am very much diluting the quality of my life and that since she has recovered, she's been able to enjoy things like pizza multiple times a week and ice cream and all the foods that I am terrified to eat right now.  And now that she's comfortable with her body, she can do all sorts of things she never would have before.  She also reminded me that I am killing myself.  

I hung up the phone with her feeling like someone had just punched me in the face.  But also convinced that whether I recover or not is completely up to me and that I need to put the effort in and work my ass off in treatment so I can get better and get back to my life.