Managing The Basics

Can’t I just stay in bed all day? I mean, who would really miss me?

Valium and bed — here I come.

This is my last weekend before I see Dr. S. I’ve been emailing with A a lot recently and we’ve been encouraging each other and comparing notes about what works for us in terms of making healthy choices. (In my case, not much is working at this point, but A hasn’t given up on me yet. Thank you, dear friend.)

She called me to account yesterday. She identified what I’m doing with my behaviors: I’m letting it all go and giving in to all my urges because I know that come Monday everything is going to have to change. Right now binging and purging is the only way I have to cope, but that is going to have to stop on Monday. Dr. S will either refuse to see me or insist that I go back to the hospital if I keep doing what I’m doing.

The theory is I’m binging and purging with increased frequency because come Monday I know I have to stop. Isn’t that the most unhealthy thing you have ever heard? But I think A is right. She said that she has done the same thing, too: when it looks like a hospitalization is unavoidable, her behaviors increase in intensity/frequency in anticipation of NOT being able to engage while in treatment.

Well, I guess I can take comfort in knowing that I am not alone in this phenomena

It wouldn’t surprise me if someone much smarter than I has conducted research into this behavior: increased symptomology prior to anticipated increase in treatment intensity. If they haven’t someone should. Or maybe I should, and get paid for it – I could be a researcher anda research subject. If they couldn’t pay me, they could at least give me health insurance, right? (If I can’t laugh about my situation I’d spend all day crying. It’s ok, you can laugh with me.)

I’d feel like a fraud if I typed, “my goal this weekend is to not binge/purge.” I KNOW that is a goal I cannot obtain. E says that when I say that, in essence I am PLANNING on engaging in my eating disorder. That maybe true. If it is I hate to admit it. I mean, who wants to say, “Yeah, this weekend I’m going to clean house, go to the drive-in, and then binge and purge?” As my nephew would say, “That is bisgusting!” But ultimately, it’s the truth: that is what I’m going to do.

And then I’ll see Dr. S on Monday and he’ll give me an ultimatum: stop, or ELSE. And for awhile things will get better. I’ll recommit to recovery. He’ll play around with my meds. I’ll go for days, maybe even a week or so, without binging and purging.

And then I’ll relapse.

The cycle starts all over again: intense therapy, quasi-recovery, relapse….. repeat, repeat, repeat. Even as a kid I got sick on merry-go-rounds. And that is what my life has become, one never ending ride on a merry-go-round from hell.

I don’t know how to get off, or how to make it stop.

What does recovery look like? What is recovery?

I’m sure for some people, recovery is “normalcy.” They eat when they’re hungry, stop when they’re full, they don’t count calories obsessively, and it is second nature for them to listen to and obey their hunger and fullness cues appropriately. They think about the eating disorder they once had as a distant memory, the way you might remember your sixth birthday party: a fleeting event in life that really does not effect who you are today.

I doubt that is what “recovery” will look like for me. The statistics are stacked against me to begin with: I was older (24 years) at the onset of my symptoms, and I have mixed symptomology (anorexic and bulimic behaviors). Both of these factors are associated with lower rates of “recovery” (in this case “recovery” meaning no longer having an eating disorder as classified by the DSM, NOT necessarily the cessation of all patterns of disordered eating).

What really scared me now, however, is the fact that I have been CBT-ed to death, and I’m still sick. I learned more “coping skills” at ABBHH and Remuda than you can shake a stick at. I can name and recognize every cognitive distortion there is. I know the physiological damage and physical danger that I am inflicting on myself each time I engage.

And yet I am no better than I was when I was diagnosed.

From all my hospitalizations at ABBHH and Remuda, I have learned the skill set that is supposed to enable me to use my voice instead of my body to communicate my needs and struggles. And I actually use them: I draw mandala’s until my colored pencils are nubs; I listen to calming music; I take warm baths; I read entertaining books; I journal here on my blog and in my private journal; I take my medications as prescribed; I get adequate sleep; I do my CBT worksheets every day; I work with my treatment team and the members of my treatment team work with each other on my behalf; I’m involved in the community as a Venture Scout troop leader and member of the rescue squad.

I had none of these skills when I was first diagnosed.

I have these skills now, but I am still sick.

That makes me feel like I am “unfixable.” I don’t think there is anything left for me to learn. At least when I was first diagnosed and heavily engaging in behaviors I had the excuse that I hadn’t had the treatment/therapy to learn to manage my thoughts and feelings. I don’t have that excuse anymore, and yet I still can’t manage myself.

G, (and others) at ABBHH are fond of saying that recovery comes with “consistency over time.” (I’ve always found that to be redundant, but who am I to question G? ) Well how fucking consistent do I have to be for how long?!

That is why I do not think that “recovery to normalcy” is possible for me. Hopefully, if I’m lucky, I’ll get to a point in life where I can maintain a healthy weight without binging and purging. But I think that the obsessive thoughts about food, weight, and appearance will always be there in the forefront of my mind. It’s a sad thought, but my goals need to be realistic, and the longer my illness persists, even as I use the skill set I’ve been taught as an in-patient and out-patient, the more I believe that a “complete” recovery is out of reach for me.

I have dental insurance effective July 1. I haven’t had dental insurance in five years, so I haven’t been having regular six month check ups. I think the last time I saw Dr. D was four years ago for an acute visit (I cut my gum pretty badly on a popcorn kernel and thought I might need stitches.)

I have an appointment with her scheduled for July 14. I’m worried about a lot of things. Obviously my teeth aren’t going to be in great shape since I haven’t really seen the dentist in years and I drink a pot of coffee a day. So I’m thinking I may have a bunch of cavities and gingivitis.

But I’m also worried about the enamel of my teeth. Purging is really rough on the enamel on your teeth, and I’m afraid to find out to what extent I have caused irreversible damage. I thought about just not telling her about my bulimia, and playing dumb when she said something about it, like “I have no idea why my enamel would be so thin or eroded! I’m shocked!”

As tempting as that option is, I don’t think it would work. First of all, she isn’t dumb. She’s great at what she does (I’ve never been to a dentist that i actually look forward to seeing — but she is so kind, gentle, nonjudgmental, personable, and talented at her work that I’m  glad to have an appointment with her). Second of all, it is pretty obvious that something is up. I weight considerably more now than I did at the height (nadir?) of my anorexia, but I also weight considerably less than the last time I saw Dr. D. So I don’t think hiding my bulimia from her is realistic.

I hate having a disease that is hard to hide. People with heart disease or diabetes or prostate cancer don’t have bodies that are walking bill boards of their disease. Generally, you cannot tell by looking at someone if they have high blood pressure or high blood glucose levels. People with eating disorders often do not have the same anonymity, our bodies give us away. That makes it hard for me to think that I’m not being judged by people before the get to know the real me.

There is a contradiction here, though. Part of the reason I do not want to stop my eating disorder behaviors and I want to weight 100 pounds is because I want people to notice my suffering. I don’t know any other way to convey the fact that I hurt so much and I feel so helpless and hopeless. I’m afraid if I quit restricting and quit binging and purging than everyone will think I’m “cured.” That I will have no way of communicating my pain. People will think that because my behaviors have stopped nothing is wrong anymore.

I’ve written about this before: something must be wrong. The infuriating thing is that I don’t know what it is. I’m fighting and invisible enemy. Maybe it’s biochemical. Maybe it’s environmental. Maybe it’s family of origin issues. Whatever it is, I cannot identify it. It’s like trying to answer a question when you don’t know what the question is. Impossible.

When I started this blog, I made the disclaimer that I wasn’t going to edit what I wrote for the sake of anyone’s feelings. I explained how I meant to use the blog as basically an adjunct to therapy: a safe place to write what I think and feel and how I experience the world through and with my mental illness.

But I didn’t expect that anyone would actually read what I wrote. I didn’t think anyone would care enough to read about my ups and my downs. But, for whatever reason, people are reading what I’ve written.

One on hand I’m honored that people are interested enough in me and my life to listen to what I have to say. On the other hand, I’m worried that people will define me by what they read here on this blog.

As my Facebook profile says, “I am more than my disease.” The last thing in the world I want is for people to think of me as “the depressed girl” or “the girl with the eating disorder.” But I can see how you could get that impression from what I write here.

Please understand that the point of this blog is for me to process my thoughts and feelings as they pertain to me depression and eating disorder. The point of this blog is not, and never was meant to be, a summary of my entire life experience.

I am more than my disease. However, this blog is about my disease, so that is what I write about. My life is more than depression and anorexia/bulimia, but this blog is where I feel free enough and safe enough to describe my journey.

I’m also worried about my ABBHH and Remuda friends. I know that some of you read this blog. By no means am I going to tell you not to read it, but I do request that you really take the time to consider whether reading about my struggles is a healthy choice for you to make. I don’t want anyone to justify her eating disorder behaviors by saying, “oh, what I’m doing is ok — I know what Anna’s doing and she’s a lot sicker than me, so my behaviors are ok.” I also don’t want to cause anyone to become depressed or to trigger anyone to engage in patterns of disordered eating.

While I’m really touched that you chose to take time out of your day to read what I write, please keep in mind that I am more than my disease, and my struggles are just that — my own. Please do not take them upon yourself.

I finally got out of bed at 6:25 this morning. My motivation is so low right now that getting out of bed before the last possible minute just seems impossible. If I could I would stay in bed all day. I did have time to take a shower, but I did not really take care of myself. I did not condition my hair, shave my legs, do my worksheets, or eat a healthy breakfast. I just don’t have the time to do those things when I leave for work at 6:45 and don’t get out of bed until 6:25.

I’m going to try something different today: I’m going to take a shower (and condition my hair/shave my legs) tonight, before I go to bed. I’m also going to do tomorrow’s worksheets this evening. I’m going to stop by the grocery store on the way home so that I at least have healthy, easy to grab food in the house.

This may mean that I get nothing else accomplished tonight. I’ll get to Franklin around 6:30pm; I’ll get home from the grocery store around 7pm; by the time I eat dinner it will be 7:30pm, and it will most likely take me from 7:30pm until 8:30pm to shower and do my worksheets. That gives me a half hour until 9pm, which is when I want to be in bed. (My meds make me groggy – the more sleep I get the better I can function at work.)

So what is the point of all this rambling? The point is that being sick is a huge waste of time. My CBT worksheets take time, my meds make me need more sleep, I don’t function as efficiently when I’m depressed, and it takes time and effort to binge/purge in private.

I would be able to get so much more accomplished in a 24 hour period if I was in recovery and my depression was under control. I’d have more energy and wouldn’t feel as paralyzed by exhaustion. My ability to cope would be increased and it wouldn’t take so much effort to make the littlest decision.

When my depression and eating disorder are managed I am a more effective person.

That in itself should be motivation for recovery. But I am so depleted and deflated that I cannot muster the energy needed to break the self destructive cycle I am in. I can, and do, recognize it, but I cannot break it.

Maybe I can find a way to get my hands on some Adderall. (Just kidding. Really. I do not need to find another addictive behavior to add to my repertoire.)

It is 9pm here in West Virginia. I am going to go to bed now. Getting eight hours of sleep would put me waking up at 5am.

So I am going to set my alarm for 5am. And when it goes off I am going to get up. I am not going to keep hitting the snooze button until 6:30am.

I am going to get up and take a shower. I will wash and  condition my hair. I will shave my legs.

I will eat a healthy breakfast as I work on my daily worksheets (treatment goals, nutrition goals, positive affirmations, grateful list, prayer intentions).

I will pack a healthy lunch to take with me to work, and I will include some healthy snacks as well.

I will remember to take my meds.

If I have any extra time before I leave for work at 6:45 I will write a letter to B apologizing for not being there for her when she needed me.

And sometime tomorrow I will report back here and let you know how well I did at accomplishing these goals. Tomorrow is a new day. I am at least going to plan to start out on the right track.

I do not like the person I am when I’m depressed and engaged in my eating disorder. When I’m depressed, and when I’m in a pattern of binging and purging, I isolate myself from my friends and my support system. I don’t answer the phone when my friends call. I don’t make dates to hang out with people. I stop going to class. I take a lot of valium and try to hide from the world in bed.

Theses actions all hurt me and work together to keep me stuck in the midst of depression and disordered eating. But what I hate the most is that these actions also hurt other people.

Today is a painful day for someone I deeply care about. My friend B lost her best friend a year ago today. I cannot image the pain that she must be feeling today on the anniversary of his passing. The right thing to do is for me to pick up the phone, call her, tell her I love her, and that I’ve been thinking about her all day.

But I just can’t do it.

The idea of interacting with another human being is just too overwhelming for me to even fathom right now. I want to take two valium, crawl into bed, and sleep until….. until I’m “cured.” It takes all my effort to get through a day at work. I simply do not have it in me to be “social.” And honestly, I’m pretty sure that B doesn’t want to be “social” right now either, but I bet she would appreciate a phone call. And I just can’t do it.

So in addition to feeling worthless, depressed, hopeless, helpless, fat, disgusting, and out of control, I also feel like I’m being a shitty friend. I am being a shitty friend. And I really don’t like that about myself.

B, if you are reading this, I hope that some small part of you is able to understand where I’m coming from. You deserve better and more from me. I know this, I just can’t help but feel paralyzed into in-action.

And it’s not just with B. It’s with everyone. I don’t want to talk to anyone right now, mainly because I don’t want to have to come up with an answer to “Anna, how are you doing?” When friends ask me that, no matter how well intentioned they are, all my choices are bad: I can lie, and say that I’m doing really well and my symptoms are under control, or I can tell the truth about how deep I am into my depression and my eating disorder. If I lie, then they think everything is ok and I don’t get the support I need. If I tell the truth, I risk being seen as the “sick” girl who everyone pities. Neither option is too attractive.

So rather than deal with that I use my depression as an excuse to take lots of valium and sleep excessively. I just need to face the fact that doing so doesn’t just hurt me, it has the potential to hurt some of the people I care about the most. I would never hurt them intentionally, but I am hurting them nonetheless. I cannot stand the person my depression has caused me to become.

Had an appointment with E this morning. I hate going to see her when I haven’t been doing well at managing my behaviors. Or, as she so bluntly put it, “Anna, you don’t like to be held accountable.” Yeah. That’s pretty much what it boils down to. Another reason I hate to see her when I’m binging and purging is that she doesn’t even act surprised or disappointed anymore. It’s like she just assumes that I’m going to come in and tell her that I had a bad week, and that that is just the way it is. Like I’m a hopeless case. I’m sure she doesn’t mean it to come across that way, but I can’t help but internalize it as such (mind reading yet again).

I told her about my parent’s gift and how that means I’ll be able to see Dr. S regularly and that we can afford my meds. Then I started listing all the reasons I don’t want to see Dr. S — he is so far away, it takes the whole day, gas is so expensive — and E told me, “none of that mattered when you wanted to get well.” She went on to say that I’ve run out of excuses: we can afford for me to see Dr. S and to get my meds, I don’t work on Monday’s so I have the time to see him, and I have the skills I need to get healthy.

Any excuse I make now is really the equivalent of me saying, “I do not want to recover.”

Hopefully, one we get my meds straightened out, I will become fully devoted to recovery. If we can get this deep depression lifted perhaps I’ll feel like recovery is something that I can do. Right now, with the ways things are, I can’t even imagine being “normal.” Yesterday was so hard that I took THREE valium (for a total of 15 mg) and I still managed to binge and purge once. I guess depending on how you look at it that was an accomplishment of sorts: I wanted to binge and purge three times and only did so once. But I really can’t take credit for it, because it is hard to binge and purge when you are out cold because you have overdosed on valium.

E had me make three goals for this week: no binging and purging, write every day, and email E and T every day with a summary of how I’ve done. I felt like such a phony when I made those goals because I KNOW that I can’t follow through with them. When I told E that she said, “so you are planning on making self destructive choices this week.” Ouch.

Why do I keep going back to E when I know she is going to call me to account? Why have I made an appointment with Dr. S even though it will take all day to get there and back, gas is expensive, and he will challenge my distorted thinking? Why do I keep taking my medications when we could be spending that $700 a month on improving the house? Part of me must want to get well or I wouldn’t do these things, right?

But how can part of me want to get well, and yet I still continue to do unhealthy things? This cognitive dissonance is what makes this disease so hard.

We drove past Fairfax Hospital yesterday and I cried. I cried to because I want to be back in the hospital so badly. I do well when I’m in the hospital. I follow my meal plan, I work the program, I refocus my energy on what is important.

But being in the hospital is not a financial or logistical possibility right now. I have to keep working so I can keep my health insurance that doesn’t cover my mental health needs right now so that if I do have to be hospitalized next year I can be. Until I run out of personal days and sick days and lose my job, and with it my health insurance.

Basically I am working to get a benefit that I need but that I can’t use even once I have it, because using it would most likely mean losing my job and my access to the benefits I was working for.

This is a sad state of affairs. No wonder I’m having a hard time and am having difficulty managing my behaviors. Ultimatly, though, I do know that going to the hospital now is not the solution. I know I do well in the hospital. That is a given. What I need to get practise at is doing well at home, in the real world. I can’t do that locked on 2East.

Don’t get me wrong: it is reassuring to know that the hospital is there. Should I start to feel suicidal again I’ll admit myself voluntarily. For now I will keep plodding along taking it one day, one hour, one minute at a time. That is about all I can handle. Thinking about anything else is just too overwhelming.