Wednesday, November 25, 2009

29 Ideas of Thanks

Particularly in the world of young people who struggle with eating disorders (but not excluding old people, or those who don't have eating disorders!), there is a great distaste for Thanksgiving. "I don't like the food" "Why do I need turkey to show that I'm thankful for my family?" "I don't even know if I'm thankful for my family!"

I don't like turkey, and I'm not sure how I feel about my family. But here are 29 ideas of what you and I might be thankful for this year, Thanksgiving 2009.

29. I am thankful that I am not in the hospital (or residential treatment center, or other form of intensive treatment). You can even play this up by adding, BECAUSE I DO NOT NEED TO BE THERE! But only if that's really truly true.

28. I am thankful that there is wine at Thanksgiving Dinner...and also thankful that I am not dependent on it.

27. I am thankful that this holiday happens only once a year... but I am still thankful that it does happen every year.

26. I am thankful to have a family who I do not need to spend time with every waking moment of every day.

25. I am thankful for technology, and the instant access to support that it brings me.

24. I am thankful for my friends. (the good ones, anyway)

23. I am thankful for my therapist. (I was thankful for her last year too)

22. I am thankful of my pet(s). I don't know where I'd be without my cat, Paws, except that I would have a few less scars on me...

21. I am thankful that we have vegetables at Thanksgiving dinner.

20. I am thankful that my extended family is just about as uncool as I am.

19. I am thankful for Scrubs, The Golden Girls, Sabrina the Teenage Witch, and Law & Order: SVU.

18. I am thankful that I am in school, and not on a leave of absence.

17. I am thankful that I am healthy enough to practice yoga.

16. I am thankful that I can read, and even more thankful that I have the time to do so.

15. I am thankful that I'm a good "stalker" and can find out basically anything I need to know (even though it would be much easier if I had a Blackberry!).

14. I am thankful that I am not in middle school anymore. (Or high school, for that matter. Or college...)

13. I am thankful that I have been learning to take care of myself.

12. I am thankful that I am not allergic to cats.

11. I am thankful that I live in New York.

10. I am thankful that I have a license and a car.

09. I am thankful that I know how to spell, and know how to write well (even if I don't use proper grammar 100% of the time. At least I KNOW it).

08. I am thankful for my psychiatrist and my nutritionist.

07. I am thankful for the ability to find the best in even the worst situations.

06. I am thankful that I have a personality and a sense of humor.

05. I am thankful that I am really good at texting while driving (although I really need to stop. It is really dangerous. I am also thankful that I haven't hurt myself or anyone else while doing this. And thankful that I have been able to cut it way way down).

04. I am thankful that I am not addicted to caffeine anymore (or anything else, for that matter!)

03. I am thankful for Ugg boots because I don't know what I'd wear from September to May without them.

02. I am thankful for the ability to use language, art, and yoga to express myself instead of the maladaptive ways that I used to use.

01. I am thankful to know that I'm not alone in this life.

Saturday, November 21, 2009

The WORST of both worlds: The Mental Healthcare System

Okay, so it's approximately 1am on a lovely November Sunday morning. I just arrived home from babysitting. Sleeping would be great right about now. However, I am about to devote the next I-don't-know-how-long to a ramble about the mental healthcare system, and how really, there is not much right about it.

I'll start off by saying that we've hit this spot where we've started seeing people as individuals. FABULOUS! But, now that we are seeing each person as an individual, we are recognizing that we may not be able to give them the proper care. HOWEVER, that's not stopping us (now...the use of "us" and "them" are going to be switched off interchangeably throughout this blog and that's just the nature of it being all about the best of both worlds...or the worst) from referring them elsewhere or denying services. When questioned about WHY we're serving the individual in a particular manner, though, we'll just say that it's all we can do because they don't really fit the mold of people whom we serve, so we're giving them the most individualized approach that we can.

I don't even know where to start. Okay. Let's start in the emergency room of a medical hospital with no psychiatric unit. A patient comes in, looking to be medically cleared to be sent to a psychiatric hospital with no medical unit, after an overdose. The hospital does not actively work with psychiatric patients and there is no psychiatrist on staff, however they cannot turn this patient away, as she needs immediate medical care. The team comes up with a protocol. Lock up all her things. Take off her pants. Berate her for crying. Don't answer any questions because she's crazy. Treat her differently from every other patient ever seen in the ER. Treat her differently than she has been treated every time she has been in the ER medically. Don't allow her to use the bathroom. Don't allow her to read a book. She brought her baby blanket because she knew it would comfort her but she's not allowed to touch anything that isn't provided to her by the hospital. Call her psychiatrist at 3am, and then hand her the phone, confusing both the psychiatrist and the patient. Threaten to restrain her when she tries to get out of bed to use the bathroom. Don't remove the IV from her hand, threaten to restrain her if she tries to pull it out, even though there is nothing dripping through the IV, and when there was, it was only an anti-nausea medication.

Let's take a look at Door #2, the hospital which, after hearing about this incident, the patient above swore that she would never go to. A patient is transported by the police, due to suicidal ideation, to the psychiatric unit of a local hospital. She is not allowed to pack anything to bring with her. "We don't know what you might bring." She invites the officers to stay in the room with her while she packs clean underwear and a pair of pajamas. The officers refuse, and bring her out to the car. Upon entry to the hospital, she is told that she must be strip searched, however, there are no female staff on duty at this time. This particular patient has a trauma history, but a patient without a trauma history would probably be disturbed by this as well, and rightfully so. The patient is told that she will be given a 1:1 if she will not agree to a strip search. "This means that a man will be watching you go to the bathroom, etc." The next morning, she is told that if she does not comply to the strip search, it will be forced upon her.

Taking a step away from horrible experiences at psychiatric hospitals, just for a few minutes, let's take a look at a young woman with various learning and psychiatric disabilities, who attends a special school. She attends the school due to trouble learning and managing her social anxiety and impulses at a public school. Like every student in the school, she has an individualized education plan, and a special calming plan that she brought with her from her last hospitalization. However, the staff at the school find it to be too much trouble to deal with her calming plan, because it involves taking 30 seconds out of their day to grant her the permission to leave the classroom, or it "burdens" the crisis staff if they need to talk to the student, although it appears to this outside observer that they are just doing their job. The student's needs were consistently unmet, and one day the difficulties in school led her to a suicide attempt. When hospitalized after that suicide attempt, the student explained to her social worker, "It's a school for kids like me. But they don't know what to do with me. I came in showing them how to work with me, and it's like they don't get it." The majority of the students at the school have behavioral problems, and start fights, or have developmental disabilities that prevent them from being able to succeed academically in a mainstream classroom.

Or take a look inside a community mental health agency. In the day program, most of the clients struggle with psychotic disorders. Although many of the clients are in fair remission, they do often exhibit symptoms of psychosis. This is tolerated pretty well. However, when clients show symptoms of anxiety and depression, it is looked at as the client's irreverence. One gentleman gets very anxious during his groups and tends to speak out, asking whatever random question comes to his mind. He is often very harshly redirected, which tends to hurt his feelings. Another woman struggles with severe anxiety and depression, with no history of psychosis whatsoever. She is brushed off to the side when she's just coasting by, but as soon as she starts to struggle, she explains that staff accuse her of being lazy or stubborn. This continues digging a deeper hole of low-self esteem than she already started with. Her depression and anxiety show little improvement, and while she may not be responding well to medications, this observer tends to believe that her environmental situation may be perpetuating the anxious and depressive symptoms.

Back to the psychiatric unit. Most patients who are admitted to the female psychiatric unit of a particular prestigious hospital struggle with mood disorders - either bipolar disorder or depression. Some also have psychotic symptoms, but few struggle with mostly anxiety. At one recent time, two patients on the unit were treated for anxiety disorders. When either patient cried - as a healthy way of expressing discomfort, instead of keeping it inside and allowing it to mull, like many anxious patients do - it was ignored, dismissed as manipulative, or seen as a symptom of mood dysregulation. When both patients spoke with intake staff about the unit, staff informed them that anxiety disorders are very well-served on the unit. However, the milieu staff did not help to redirect the patients. All they were looking to do was make sure that no individuals hurt themselves or anyone else. Both patients did report leaving the hospital in somewhat of a better situation than they entered - mostly because neither wanted to ever have to be in the situation where they would have to go back there again. Those death-like anxieties were nothing in comparison to the threat of another hospitalization.

And this doesn't even touch on the insurance aspect of mental healthcare. This only covers people who are currently being treated, whether against their will or voluntarily. It demonstrates that hospitals and agencies have a mold that they are set to serve, and while they will happily accept people outside of their mold (if only for financial reasons), they will not modify any of their protocol to better serve those patients.

That's not to say that some agencies, hospitals, and professionals do not genuinely care. However, my psychiatrist said it best when she said that most healthcare follows an impersonal insurance-based model, and even when insurance isn't being considered an issue, the fact is that the model of treatment has been based around it, that it's just a best-fit model. There are people out there, like my psychiatrist and my therapist, who do not work their treatments around this best-fit insurance model. All I can say is, thank God.

This was written over the course of about half an hour, way past my bedtime, so I apologize if it's poorly written or repetitive. I'm not really even writing it to inform anyone else. That will be done at a time of day when I am far more coherent. This was more for my own benefit, of getting my own experiences and the experiences of those who mean a lot to me, out there, out of my head and onto the internet.

Because sometimes broadcasting my thoughts allows me to feel temporarily free from them.

I'm not an overachiever. I'm not good enough at it.

Never, ever in my life have I considered myself an overachiever.
Have I been called one before? Certainly.
But I'm not quick enough, not efficient enough, not perfect enough to hold onto that title.
Even in the fullest of my times, when I was working full time, attending graduate school in the evening, interning part-time, embarking on my yoga teacher certification, recovering from an eating disorder and dealing with debilitating anxiety (which included not only eating and medication management, but it got to the point of daily therapy appointments, weekly doctor's appointments, bi-weekly nutrition and psychiatry addition to the emotional drain, and commuting time), and attempting to maintain some semblance of an appropriate 23-year-old social life (oh yeah, and showering, sleeping, and breathing, too), I did not consider myself an overachiever.
Why not?
Well, I was working 30 hours a week. I had co-workers who were working 40 hours a week and put in even more time than that. I had co-workers who were also in school full time. I had classmates who worked 60 hours a week, and girls I interned with who kept their full work hours and did all of their internship hours on the weekends. There were people in the teacher training program who were able to attend class every Wednesday and attend the monthly Sunday workshop whereas I've only been able to attend one class so far. There are people with far more rigorous treatment schedules than I have. There are even people who have a much more complex "getting ready" routine every morning, involving more makeup, better outfits, and more complicated hairstyles than my own.
Can I honestly say, though, that I have ever encountered a person who was doing all of this at once?
I was hardly even managing to do so.
I managed to pretend that I was fine for quite a while.
But eventually that fell through.
So I couldn't achieve this thing that might have been considered an overachievement.
I couldn't even get help until I was sure I was sick enough.

So now, I haven't done much with my time for the past few weeks.
Does that make me an underachiever?
An overachiever?

I don't know where I lie.
I also don't know where I got the idea that I have to figure out what everyone else is doing, and do the same or better in order to be good enough.

I'll never consider myself an overachiever, because there will, inevitably, always be someone doing more and somehow managing.

And I refuse to put myself in that place again.

Wednesday, November 18, 2009


Recently, I've identified a pattern in my life (and began to realize that I'm not the only one who deals with this).

Often, I find myself in the same uncomfortable situation again and again.

I'll go out with the same friend week after week, and come home feeling worse every time.
I'll go to the doctor and come home feeling horrible about myself because of something she said, something that wasn't meant to be offensive, but that I interpret in such a way, every time.
As a child, I'd try on shoes and clothes that were too small, hoping that they would fit, and being upset that they didn't, every time, and shopping became terrible.
Or I'd forget my homework or my flute or a textbook or a paper that needed to be signed, so I'd start dreading school in case I'd forget something.

So, I became comfortable living with the constant feeling of dread. Even though I knew there were ways to make things better, they seemed so big, so scary, so terrible that just sitting with the constant dread was the better way for me to go.

The first time I realized that I needed to break out of the comfort zone in order to actually hit a more comfortable place was in recovery from my eating disorder. The first couple of times I was in treatment, I wasn't ready to do anything uncomfortable. I was hoping to change my attitudes and once my attitudes were there, I'd change my behavior. Well, there's something chemical about eating disorder behaviors that influences the attitudes. I don't know whether or not it's been scientifically defined yet, but I know it's been observed, and I know it's true of myself. I know the whole "starvation syndrome" where malnutrition = more thoughts of food, and a less positive mood. Anyway, I'm not sure exactly WHY this hit me, but in my most recent (almost two years ago now) residential treatment, I realized that staying where I was comfortable, would not get me to where I wanted to be. I would most likely die in my comfort zone. And dying, really, didn't seem all that comfortable.

I likened my change of heart, change of attitude, and change of direction to standing on a cliff above a lake and jumping in backwards. Not knowing what's below me, how far it is, if I'll live or if I'll die. Now, I'd never advocate doing that IN REALITY. But metaphorically, it served me. I mean, I suppose we could just call it standing on top of the high dive and closing the eyes and jumping in backwards. But fear-wise, it definitely felt like jumping off the cliff. I began to embrace the mantra, feel the fear and do it anyway. I realized that the fear would never go away, not at this rate, and I would just need to do what I needed to do.

I could apply this to my eating disorder, and could give advice to others to do the same. It was the only thing that got me through the rut. Why, then, did it take nearly two years for me to realize that this circle I went through with the eating disorder that needed to be broken, really needed to be generalized to the rest of my life!? Good question. A lot of times, eating disorders are just a way of expressing the problems of the rest of our lives. When the eating disorders are gone, the problems are still there. Thank god for therapy.

Yeah, therapy. So I didn't realize this whole thing myself. My therapist brought up the fact that I needed to do something about my work situation, and that yes, it would be uncomfortable at first, to tell my supervisors that I would be leaving and so forth, but that I would need to leave my comfort zone (of just getting by at work and being 99% burnt out) in order to be more comfortable.

Then today, I went to the doctor. She said some things to me that made me "feel fat," and that I had predicted would happen. I had asked my nutritionist to talk to her and she agreed to, but she constantly reiterates that I need to talk to her. As do my friends who know her, and those who don't know her. I need to speak up for myself and deal with the discomfort of doing so, in order to be more comfortable with my doctor.

I can't go back in time and start writing things down so as to never forget to bring something to school, but I can stop the dread by starting now.
I can't go back in time and stop trying on clothes and shoes from departments that were too small for me to stop the negativity that comes from shopping, but I can accept my size now (I'm 23 and there is no need to try to shop in the kids department...all right, except for certain occasions it's okay to see what's there since it's cheaper. But only certain stores).

But I can speak to my doctor next week about the way I feel when we talk.
I can resign from my job. I can say goodbye to toxic friends.

And I can't expect things to go beautifully every time.
In fact, I have said goodbye to toxic friends, and they became very bitter and the drama dragged on for too long. I have also resigned from a job or two and felt disrespected and unwanted by my supervisors after doing so.
But these are not pieces of evidence why I shouldn't go out of my comfort zone. It's why I should try again and again to build more evidence as to why I should and why it's all right.

Too often, our comfort zones mean that we're settling. Sometimes, they're not even all that comfortable at all. Just a shelter. I told a friend today, hiding in your eating disorder (or whatever other comfort zone) is like hiding in a trench or a little dugout shelter in an active war zone. You have the option of getting to safety, getting to real comfort, real LIFE, but you'll have to pack up your things, book a flight, and leave everything behind. Luckily, I'd say about 99% of the time, at least in my life, it's not nearly as scary as that.

But we still need to leave that comfort zone sometimes in order to become more comfortable in our lives.

I have a lot of comfort-zone-leaving to do in the next few months.

Tuesday, November 17, 2009

Trying this AGAIN.

This time, I'm going to try to write in here more regularly. I was so active on LiveJournal, years ago. It was a great release for me. I'm trying to find a great release again. Here's today's reflection.

Pretty much anyone who knows me, knows that I have an incredible relationship with my therapist. Sure, some people have been weirded out by the fact that I text her (although we are working on decreasing that, because I was using it as a coping skill). Others might find it creepy that I have googled her randomly, although I'm never looking for any new information, just proof that she exists outside of our sessions (and, in true therapist fashion, I get minimal results...unlike when you google me and get the Myspace pages of a few pre-teens from Ireland). And still others might wonder why I have such a great therapist who is not a specialist in eating disorders (well, I think it might be for that very reason. because she specializes in working with PEOPLE, not disorders!), or that I could afford a NICE apartment if I didn't go to see her for therapy and saw someone on my insurance instead.

I had a long "weekend" of Thursday through today of thinking and reflecting, and had many many pages of journals, so last night I texted my therapist asking if we could have a session-and-a-half or a double. We started off planning on a 75 minute session but ended up with a 100-minute session. It was the best 100 minutes I could have asked for.

Why? Well, I mean, I did work out some important things, got a lot off my chest, and learned her daughter's name by a total accident! But that's not what was so inspiring.

My therapist has disclosed to me before that she's been in therapy. She implied that she may have been in the first few months that we worked together. Then once we were talking about terrible therapists, and she told me that she once saw a therapist who constantly fell asleep in the middle of their sessions. Every once in a while, she reminds me that going through "shit" and going to therapy is as "normal" as normal can be.

It's just so empowering, to have a therapist, who appears PERFECT (although she reassures me constantly that she is not, that she is human), to be showing no shame about being in therapy. It's the attitude I LONG to be able to show at work (I would get in trouble for disclosing it at my current job, which is understandable since I work with a different set of clients), and to be comfortable with saying it out loud in the world.

Her honesty makes me feel sane. Makes me feel capable. Makes me feel like I can do what I want to do, and if something's going to get in my way, it's not going to be my past.

Self-disclosure is a very controversial thing in therapy. Honestly, I don't wanna hear about her marital problems (although in my head, she does not have any) or if eating Coldstone makes her feel fat (I do believe that she has told me that it does not, that she finds it purely delicious. I LOVE her food attitudes. Better than a nutritionist, because her stuff is based on human nature, not scientific nutritional knowledge!) or that she has a pounding headache (I'm sure she has had one at some point while working with me, it would have been nearly impossible not to!). And she doesn't disclose those inappropriate things.

But what she shares, is so powerful. Empowering.

When I say I want to be like her, I don't just mean in the "I want to be a thin blonde with a great, husband, a sweet daughter, and a baby boy on the way" but that I want to connect with my clients the way she can connect with me, to have the dedication, understanding, and empathy that she is able to share with me. To have that with just one client, even, would be enough.

My therapist is incredible.
The therapeutic relationship we have built is so strong, the strongest, stablest, healthiest relationship of any kind that I have ever had. (at least, in my opinion...and it's helping me to form MORE stable, healthy relationships)
And I'm realizing that sometimes in order to follow my dreams, I need to do less, not more.
I am not the same as everybody else.
Or anybody else.