I've gotten emails from several people over the last few weeks about finding a therapist, knowing if s/he is for you, and so on. Others have commented on progress (or lack thereof) with their therapist and whether to leave or stay.

One of the arguments in favor of staying--or for what people are looking for in a therapist--is that the person is "nice."

Believe me, I understand this argument. I've been there. I wanted someone nice, someone I could pour my heart out to. I wanted someone to whom I could confess my deepest thoughts and secret desires. I thought this person should be a therapist. In all honesty? I should have just adopted a puppy.

Here's the thing: talking only gets you so far. As someone said at this year's NEDA conference, "Insight doesn't lead to behavior change. Behavior change leads to behavior change." We want to feel loved and accepted and that's not a bad thing. I'm not dissing nice people or feeling heard and validated. But just having someone listen to you isn't going to treat your eating disorder. "Nice" is often code word for "They don't push me into actually making any significant changes."

Being a complete jackass does not make for a good therapist any more than being nice does. I'm not advocating seeing a meanie. I am advocating thinking long and hard about why you are seeing a therapist in the first place. Presumably, you have a problem. If you're reading this blog, chances are that problem involves an eating disorder. So before you go looking for a nice therapist, it might help to think what you want to get out of therapy.

Maybe it's "I want to feel better." Not a bad goal. Now try and think about how, in reality, that might happen. Recovery from an eating disorder usually involves feeling worse before you start feeling better. Feeling better involves doing things like normalizing eating, learning how to socialize and make friends, working on perfectionism. This, not infrequently, sucks. I've had therapists be too nice and not push me to do this because they knew, on some level, how hard it was going to be.

Take my cat. When I first adopted her and she finally stopped hiding under the couch, she liked to jump up on the top of the fridge. Although Her Royal Fuzziness could get up, she didn't quite master getting down. The first few times she got stuck, I hauled out the step stool, climbed up, and rescued her. After a while, however, it got to be really annoying. She kept getting stuck on the damn fridge. Finally, I left her up there for about 10-15 minutes. She was not happy. But I also didn't want her getting stuck up there when I wasn't home, and I also didn't want to be getting her down every day. So I let her stew on the fridge for a bit, tried to drive home the point that, you're welcome to climb on things, but you also have to get yourself down. After her time was up, I got the stool and grabbed her down.

I never had to do it again. I'm not sure whether she stopped going up there or (more likely) she finally figured out how to get herself down. Letting her up there was not a nice thing to do, but it worked.

It's sort of like that with a nice therapist. We tell them about our problems. We talk about how awful the ED is making our lives, is making us feel. And they listen and nod and hand out tissues and seem to get it. Then we leave their offices and go back to the awfulness and nothing changes. It seems to be a good deal because we get to feel like we're "working on recovery" because we dutifully see a therapist for our 50-minute hour, and our therapist gets to be nice and caring and build a relationship with his/her client.

Recovery, though, remains stagnant.

It reminds me of one of the human behavior truisms I've discovered over the years. People don't change when they see the light, they change when they feel the heat. Feeling the heat is uncomfortable. It can seem cruel to insist that a person gain weight when they say that gaining a pound will make them feel suicidal, or that they would rather die than eat that ice cream.

That isn't to say that being an asshole makes you a good therapist, because it's not true. A good therapist listens well, helps you problem solve, is non-judgmental, knows what they are talking about, provides you with an outline of what therapy is going to look like, what the goals are, etc. Nice isn't a bad thing, but it doesn't mean you're a good therapist.

I didn't start getting better until I started seeing a therapist who wouldn't put up with my bullshit. She made it very clear what the ground rules were, and she pushed my forward almost ruthlessly. She did it out of ultimate kindness, but, believe me, she wasn't always nice about it. At the same time, I really respected that. I respected someone who didn't play into the "sick identity" of being anorexic and treat me like I couldn't handle life because I was ill. No, it was "You need to eat, you need to gain weight, and I will help you. You won't like it, you probably won't like me at times, and I'm okay with that."

I had to stop looking for nice therapists and start looking for those who would help get me well. Many of these therapists were nice, but that wasn't how they got me well.

My friend Kathleen MacDonald shared this on Facebook earlier today, and she graciously gave me permission to share it on my blog. I hope you enjoy.


‎"So how did you turn things around?" is one of the most common questions I get about my recovery-process. I wish there was an easy/short answer...but there isn't. (don't worry --this won't be one of my lonnnnnnnnnnnngggggg-winded status to detail the answer) ~ There were several key components to my final recovery process that led to me becoming recovered...here are a few:

a. I got serious about nutrition and I stopped making me the "exception" to needing to eat
b. I got serious about gaining body fat
c. I learned to be comfortable feeling uncomfortable and I didn't fall back into the disease every time my body image felt like hell or my guts distended/I felt pregnant
d. I got serious about the fact that every purge could be my last
e. I got serious about the fact that it wasn't safe to exercise (I ended up taking nearly 2 years off from exercise --which was really hard to do) when I was under-nourished and under-hydrated
f. I realized that I needed to 'over-nourish' my body in an effort to replenish and repair all the damage done (even if my bloodwork was 'normal')
g. I kept Kitty Westin and Ron & Sally Crist George in my heart/prayers ever day 
h. I put God in the center of my recovery-process (along with nutrition)
i. I did not listen to the doctors who told me that I had to give up gluten and dairy b/c I had "intolerances" -- of COURSE I had intolerances to those foods...I had intolerance to most foods b/c my body was so screwed up from all the years of 'dieting'
j. "suicide is not an option" became my mantra -- no matter what, suicide is never the answer
k. I disconnected myself from unhealthy relationships
l. Recovering became my number one focus --above school, fun, relationships, etc... First Job = recovering
m. I dared to dream that RECOVERED existed and I sought after it with all my heart (it exists, trust me!)
n. I put the emotional stuff on hold until my brain was better healed - (and guess what --after my brain was healed and I was thinking clearly for the first time in 16 years, I realized that the emotional stuff that had caused me so much pain and trauma...it wasn't as bad as my ED brain had convinced me...and I was able to heal from it vs. sink into deep despair)
o. I got rid of life-expectations that I had for myself (ie: I must have my Ph.D. by the time I'm 30)...and I just focused on recovering...and I trusted that Ph.D programs would still be available when I was recovered ;-)
p. I stopped trying to help others and I learned to 100% focus on me
q. Gretz, the Super Setter --enough said.
r. I learned to forgive myself
s. I ate thru the pain
t. I stopped purging
u. I stopped believing that I was ugly
v. I stopped believing that my body is less-than-beautiful when I am healthy
w. I stopped thinking that cellulite is ugly
x. I got rid of my scale
y. I healed my body image issues thru nutrition, 'sitting with it', and thru learning to see myself and everyone else thru the eyes of God --which means that I see every single human being as beautiful.
z. I never gave up on the enigmatic power of Hope.

...is a page like this:

Why Schizophrenia Patients Are Difficult to Treat

It explains the issues in a clear, non-blaming, but easy-to-understand format. For many of these (with the potential exception of homelessness as a major issue for many ED patients), replace "schizophrenia" with "eating disorder" and you are probably pretty correct.

Certainly some things I would include:

Chronic ED sufferers often lack social supports that improve the likelihood of recovery.


An ED sufferer often lacks insight into the seriousness of their condition, which makes it difficult to engage in treatment.


EDs can be egosyntonic, which means that the person likes having their disorder. It's hard to work on getting rid of something you like.


Addictions and other co-morbid conditions can complicate ED treatment.


Our culture often praises ED symptoms and normalizes food and weight obsessions.


Insurance and/or national health systems don't provide adequate care.


Now it's your turn: is there anything else that you think makes ED treatment difficult? Share your thoughts in the comments section!

This morning's breakfast was cereal. I like it on several levels--for starters, I like cereal, and I like all of the crazy concoctions I can make in my bowl. Also, it's easy and quick to prepare.

I don't know how many of you are aware of my predilection for yarn, but crochet and reading are my two favorite hobbies. It's where most of my spending money is, well, spent.
I learned how to crochet when I was in treatment from a friend. My aunt had taught me the basics of knitting when I was 13 (I was in choir, and we got "picked" to be chorus members in the school musical production of A Tale of Two Cities. I was a French peasant who walked around knitting...with bright orange acrylic yarn, which I'm sure set the scene nicely), and I made the cliched scarf or four while I was in treatment. But I couldn't really get beyond the basic knit stitch.

Along comes my friend who teaches me to crochet, and it's something I really got the hang of pretty quickly. I didn't really look back after that. I even teach crochet on occasion.

A few of the things I've made recently:

Aria says "This is my blanky..."

In which the cat discovers my yarn stash

Leaf scarf

Crocodile stitch scarf

Chain link placemats

I could wax poetic on what crochet means to me, but I won't. I love the creativity bit, I love being able to transform a ball of yarn into a scarf or cardigan or blanket. I also love how relaxing it is for me. My fingers and hands are kind of hypnotized by the repetitive wrapping of yarn around hook. It's soothing.

On her PsychCentral post about the Zen of Knitting, Sandy Naiman writes:

It focuses me. My mind is often all over the stratosphere. My psychologist wanted me to learn to be more mindful, but I confess, I’m not into examining raisins. However, the gentle rhythm of knitting is perfect for me. The Zen of it works wonders for me.

The yarn tethers my wandering brain to the real world. It brings me back to reality. It slows my pounding heart and the silent whirl of racing thoughts.

It's called kintsugi. The ancient Japanese art form uses gold to join broken pottery, and was thought to have started when a fifteenth century shogun tried to repair a Chinese teapot. Dissatisfied with the less-than-aesthetic repairs he received, the shogun sought out something more visually pleasing. The result was kintsugi.

Photo by Gerda

The irony is obvious: it makes broken pottery (something generally considered uglier than the "original" object, and is certainly much less useful. A broken teapot doesn't really hold tea.) into something more beautiful than the original.

It's a metaphor I like to think appropriate for recovery. Take the photo above. It was a basic white plate before it was broken. Before I got sick, I was like the plate. I looked normal and functional. But the eating disorder, depression, and anxiety...it broke me. Shattered.  It would have been all too easy just to throw everything away, to say that myself and my life had become broken and useless.

Over the past few years, I have picked up the pieces and attempted to put myself back together. At first, I stood back and didn't know whether to keep the final product because it didn't look like the original. It was flawed. I was flawed. As any perfectionist knows, "flawed" just isn't good enough.

But then I heard of the art of kintsugi, and I realized that flawed can be beautiful in its own way. Maybe, even, more beautiful than the original. Of course it doesn't look identical to what it was before it broke, and perhaps that's kind of the point. I am back together, functional again. Not the same as I was previously, but I have survived. I am my own kintsugi.

I turned in my book manuscript draft in mid-February. Then I went on vacation. Last week, I came back and faced down a migraine. The last week has been harder than I thought it would be. My therapist mentioned that this might be the case, especially since I have a history of what I like to call post-adrenaline depression.

I hated final exams at school. I was a stressed-out basketcase. I rarely slept, couldn't eat all that well from anxiety (even before the ED...my love of snacking on pretzels helped stem the weight loss), was usually sick with a cold, and was irritable, moody, and generally not fun to be around. But my need to keep myself together in order to take the exams usually kept things from getting ridiculously out of hand. My myopia saved me, in a sense. After the exams were done, despite being uber-glad that they were over and I could read for fun! and sleep! and drink something that wasn't espresso! I almost always plunged into a depression afterwards. Maybe depression wasn't the right word. It was more like a serious funk--my mood dropped, I was apathetic and unmotivated, and, horror of horrors, bored out of my mind.

The last week has pretty much been a repeat of that. Not quite as serious because bills need to be paid no matter how much I (don't) want to work, and I got a couple of extra projects from one of my freelance places, which also helps. Productivity is my antidote to despair.

Along with this funk came a bit of decline in my eating. It was thrown off first by the end of the book-writing period in which things just got chaotic. Not restrictive per se, but I didn't have the time, energy, and brainpower to take the time I normally would in planning and preparing meals and snacks. I did really well during my vacation, eating responsibly and mostly not too little or too much. Then the migraine hit and I didn't eat nearly what I needed to for that day. I didn't do quite as bad as I initially feared when I tallied everything for the day, but there was a definite drop. The next day, I did eat what I needed but felt terribly guilty. And so the passive restricting began, followed by the active restricting.

It wasn't super severe, especially in comparison with some of the crazy stunts I've pulled in the past. My weight didn't massively go down. Mentally, though, I was having a rough time yesterday. Depressed, cold, apathetic and terrified of everything. Which is kind of what snapped me into action. I texted my therapist and we worked out a safety plan and I'm trying to get back on track. I did a full day of meals today and most of the day yesterday. I was horribly anxious this morning, but I'm pushing through it and it's lifting, mostly.

I have a busy rest of the week planned, which will help, since business helps make the ED stuff more obvious (I don't have the brainspace or time to obsess or engage in behaviors). It also gives me something to think about besides calories and existential anxiety.

So...that's where I am. Regrouping and pressing on.

So I'm trying to finish up my book. The manuscript is due in a little less than a month, and I'm trying to get the last little bits filled in, the references checked, and so on. It's tedious, hard work. I also don't really have much in the way of an advance (basically, the publisher pays the author $X amount in future royalties up front; the first $X of royalties goes to the publisher instead of the author. After that, the royalties goes to the author. It's basically a gamble on the part of the publisher as to how much money they think the book will earn. I'm working with an academic publisher who operates under a royalties only system. No advance, but once the royalties start rolling in, they're all mine.), which means I have to keep up my regular writing stuff, too.

So I devise daily tasks for myself, like finish Chapter 10, email so-and-so, etc. The most common task, however, is "Write XX words." I like numbers. I like tasks that are easily definable and clear-cut. Things like "work on references" are awfully vague, and I never know how much work is required to be able to check that SOB off my list. On the one hand, discrete goals like writing, say, 1500 words are easier to accomplish because they are so concrete.

On the other hand, 1500 words don't always come magically flowing off my fingers. Sometimes I get stuck, sometimes I spend several hours chasing down a single study that I need to make my point (PubMed is a contact sport...really...), sometimes I have other paying writing jobs that act as a giant time suck. My carefully scripted goal of 1500 (or 1000 or 2000 or 500) goes caput.

That happened on Saturday. I did several lengthy interviews during the day, which were all duly checked off. But I still primarily measure my progress in words per day, which was definitely lacking. I really meant to get more done in the evening, but I got in a groove cleaning my place and then some trashy TV came on, which made me keep cleaning so I could justify my occasionally questionable taste in television programs. As it happened, time passed and here I was at bedtime with hardly any progress made on my book.

I was beating myself up in my head for being lazy and not making progress and I was a crap writer so what business did I have trying to finish a book--a book for crap's sake! But then I started thinking. My interviews gave me a LOT of good material, and I can't really write without doing interviews. I got some cleaning out of the way, which was a good thing.

The problem was that my accounting methods weren't actually factoring in the other important work I was doing. It had become just about the numbers, when in fact, the numbers only tell part of the story of book progress.

I suppose this story says a lot about my focus on numbers and on details at the expense of the big picture. No doubt it does. But this focus isn't necessarily written in stone, either. I might gravitate to it rather naturally, but I also need to work on recognizing the problems I encounter when I do this and work on bringing my vision back to be more holistic.

For everyone out there who is struggling and trying to hang on right now, remember this:

I overslept today. My sleep schedule hasn't approached anything that could reasonably called a "schedule" for several weeks (night owl + insomnia = chaos!), so it's probably not all that surprising. The problem was that it was late enough to throw off my food schedule for the day. I'm not on some sort of tight schedule where I need to have breakfast at X o'clock and lunch at Y o'clock, and so on. But I do like to have at least some break between meals so I don't get too full.

So I made up my breakfast at some embarrassingly late hour and then sat down to eat. While I was munching on my peanut butter toast, I started to think: okay, so how am I going to get all my food in today?

I was thinking and making adjustments--I have a crochet group in the afternoon that meets at a coffee shop, so adding a latte would be easy to get in some extra energy without feeling overly full, and then get something to eat along with it. Or I could bring some trail mix. And then add something extra in the evening, and all should be good.

Which is when it hit me: instead of planning how to "get away with" eating less, I was planning how to keep in recovery.

I don't think I've ever done that before. I've gotten past the point where I look for opportunities to restrict, but it's been much harder to *not take them* when they arise. And this was a great excuse. After all, I was sleeping, which isn't really known for its calorie-burning potential. Since I didn't wake up until almost essentially lunchtime (I'm, like, seriously moritified over how late I slept, yo), just crossing breakfast off the list would have been super-duper easy.

Except I didn't. I shifted a few things, and added them in here and there and tried to be flexible. It wasn't always ideal, but I was committed to making it work. And that's a really cool place to be.

It's something I've been noticing lately in my own life: a growing mastery of basic recovery skills. You know, the things other 31-year-olds take for granted, like the regular consumption of breakfast and not exercising myself half to death. In the beginning of recovery, I couldn't do any of these things unless someone was sitting right there and giving me death eyes to make sure I wasn't misbehaving. Preferably with an Ensure for any infractions.

There's nothing to deflate your ego quite like flipping through your friends' wedding and baby pictures on Facebook while realizing that you one even trusts you to, like, you know, eat.

When I first attempted to eat with no real supervision after attempting recovery, it was kind of laughable. I'd start off getting a small, nonfat cappuccino (more air, less milk!) and say I had some massive, calorie-laden drink. Then I'd switch to coffee or tea while simultaneously maintaining I had that beverage. After all, I wanted that drink. I even might have actually intended to order it, on some subconscious level. But faced with the gargantuan menu and the knowledge that there were calorie-free options just waiting for me, I caved to the anxiety. Then, ashamed that I couldn't do something as simple as order a simple snack, especially after promising on my kitty's tail that I would Behave Myself and Actively Choose Recovery, I lied about it.  I justified this by telling myself that I wouldn't cheat again, that next time, I would have the massive calorie-laden drink.

Repeat ad nauseum.

All during this time, I would have sworn up and down that I could easily handle everything on my own. Easily. "I've got this," I said.  After all, I could publish long feature stories in magazines. Surely I could eat adequately.

Except I couldn't. Each time I tried, I would bite off more than I could chew (is that pun intended? I'm not sure...).  Sometimes, I would be forced to be ready because the insurance company said I was ready, dammit. Others, my treatment team thought I was ready.  And still others, I convinced my treatment team I was ready to take on more responsibility for my own recovery. Each time, the result was the same: it was too much, too soon.  The eating disorder triumphed again.

Ultimately, I began to lack confidence that I could ever feed myself properly again. Maybe I was just one of those few who would struggle forever. Maybe I would never get better.

The problem wasn't me or my (seeming) inability to recover. The problem was the complexity of the task and my available skills to master it. It's like asking a five-year-old to do calculus. I'm sure there are a few Einsteins out there who can, but most of us can't. Not that we won't ever be able to do calculus after we learn addition and subtraction and algebra and infinite sums, just that we can't yet do calculus. We don't consider a kindergartner a mathematical failure if they can't figure out a differential equation. Yet I would be discharged from treatment with a sheet of paper containing a list of foods I was supposed to eat and a pat on the back and have no freaking clue where to go from here.

What I really needed was fewer sheets and more time and practice.  I needed to start way more slowly than most people thought. This grated both my ego and my patience (like I said, nothing like a good career to contrast your epic catastrophes around eating).  So I started with tasks I felt confident about, things like putting milk in my coffee (yes, caffeine is a massive theme in my life) or spending short times unsupervised and not exercising. Then I began to build on that. I could figure out an entire snack or spend a whole afternoon by my lonesome and not lace up my gym shoes.

It took years for me to get where I am now, which is that I can eat independently and not overdo the exercise (though the latter is still the largest struggle for me) even if no one is the wiser. I'm not always perfect, but I can be honest about that, too.  I have mastery over basic recovery skills, whether it's feeding myself or calling a support person.  I'm doing calculus.  It took me a little over 11 years to get there from my 2+2s(kindergarten until junior year of high school), but then I ended up a math minor in college. The successes, whether in recovery, math, or even figuring out how to program your DVR, snowball. They build upon themselves. That's what things tend to do, whether successes or failures.

It took me a long, long time to be able to slow down and take recovery one step at a time. To stop feeling that I "should" be able to do something because everyone else could and it sounded easy, ergo, I should be able to do it.  It's still hard for me to admit that I couldn't do these things, and not always for lack of effort. I can't juggle or do those silly Magic Eye things, either, despite a plethora of people who do have those capabilities. I've accepted that, more or less.  It is what it is.

I guess, in the end, recovery is a process. A long, hard, difficult, pain-in-the-ass process. But I tackled it one step at a time, and I did, eventually, get there.

I am once again on the road for my freelance job (meeting to go to this morning- I left my place last night, spent the night in a nice hotel with crap Internet access), which means facing the task of eating on the road. I knew that I would need to eat dinner at about the halfway point of my 4.5 hour drive, seeing as I left at 5pm. I had found a craft store to pick up some yarn at the halfway point (I feel ridiculously oblique writing this, but I'm really paranoid about privacy since I use my real name), seeing as the store by me was all out of the one color that I needed, so I figured I would eat after I got my yarn.

Which I did.

I was going to go to Panera, since it's a pretty "safe" choice AND one where I know I could meet my meal plan requirements without flipping out. But en route from the craft store to Panera, I saw the sign that Moe's Southwestern Grille had recently opened. We have a Moe's by me, and it's a favorite of mine and my parents.

I have my "usual" that I get when I go. It started as a way to use a coupon or some other deal, and I really liked it, so I kept ordering it.  It's pretty much my default when I go. I don't go to Panera that much, so I didn't have a default decision.

The more I thought about it, the more I realized that one of the reasons I really wanted to go to Moe's was because there was a default. I didn't have to decide and calculate calories and things like that. I could just order and pretend I was sort of human instead of agonizing over the menu for half an hour and then spend the next little bit filled with gut-gnawing doubt that I had ordered the "right" thing.

It's hard to explain to someone who doesn't have an eating disorder, exactly how hard restaurants and ordering can be. I don't really have food fears anymore. I'm a little wary at the idea that I don't always know exactly what's in my food, but generally I'm over that. I can deal with it just fine, even if it isn't my favorite idea. For me, the anxiety is over having to decide what to eat from a vast array of options. I find it totally overwhelming.

So that's why I wanted to head to Moe's with my "usual."

Don't get me wrong- I loved my dinner and am glad I ate there over Panera, all other things being equal. But it made my life so much easier to just order without looking at the menu and second-guessing myself. I am that much of a creature of habit. I didn't even think to order anything else. And it was nice to be on my own and eat a complete restaurant meal by myself and not have a total breakdown.

Maybe that's part of the function of "safe foods." It's not just that they're generally lower calorie or whatever, it's also that they help limit our choices when things get overwhelming. Options are a good thing--really, they are--and I'm definitely glad that I've tackled my fear foods. But it also helps for me to have something to order when I can't make up my mind, too. That I can default to XYZ and meet my nutritional needs and also find a pressure release valve for my anxiety.

Does that make any sense? Do any of you do this, too? Please share in the comments, but also try to be mindful not to be too specific about foods and calories lest things get competitive or triggering. I want my blog to be a safe place!

When I was driving home yesterday after one of the most non-ED-related mentally grueling days I've had in a long time, I had to stop for dinner. I was tired. And cranky. And had spent Lord only knows how many hours sitting in traffic the last few days, and I was cruising along well down a major interstate. I was petrified that I was going to hit (yet another) traffic snarl.

Yet the fact remained: it was dinnertime.

So I did something unusual. I pulled over at the next exit to the Chick-fil-A* and went through the drive thru. I realized, as I placed my order, that I was 31 and had just ordered my first drive thru meal. I've ordered beverages at a drive thru plenty of times, but never an actual meal. I've ordered fast food in the actual restaurant as well, also on my own, but again, not the drive thru.

Let me give this a bit of context. Drive thrus were illegal in my hometown because they were deemed a safety issue (eating and driving). They have a point there- I feel horribly guilty for eating and driving yesterday, but it really couldn't be avoided. I really don't like ordering stuff out (it has nothing to do with food and everything to do with my fears of talking to strangers. Apparently, you can be 31, have never eaten from a drive thru and also have an overblown case of stranger danger. Sigh), and since I've been on my own, I've pretty much had an eating disorder. Diet Coke, fine. Actual food, not so much.

But I guess all of that changed yesterday. I got crumbs on my lap and grease on my fingers and I survived. I didn't like it, and I survived. I much prefer eating dinner when I'm not behind the wheel, but I also think the dangers of not eating outweighed the dangers of eating and driving.

So that concludes the tale of Carrie and her First Drive Thru.

Random story postscript: Doing this blog post reminded me of my undergraduate advisor and a story she told me when we were at a conference. She was originally from Taiwan, and when she first moved to the US to start her PhD, her English was pretty limited. She said that for the first week or two she lived in America, she ate dinner at McDonald's every night because you can order by number and she knew she could count to ten. Now, whenever I have to order a menu item by number, I think of her. She was a really neat person.

*As a family, we rarely ate fast food and still really don't. I generally don't like a lot of fast food places, but I do enjoy me some Chick-fil-A. My RD made me to food exposures at all the major fast food chains so I know I can eat there, but still.

I was reading a memoir of chronic loneliness (Lonely by Emily White), and she was discussing  the genetic predisposition to loneliness. She described it as having a backseat driver in your life. Emily was still the driver of her life, but she also had a backseat driver (the predisposition to loneliness) who was shouting out directions.

Of course, you usually don't always know that your backseat driver is an arrogant ass who really doesn't care where you're driving. If you're me, you might be confused about where you're going or how to get there. As much as you might dislike the person giving directions, you're simultaneously grateful to have directions. So you follow along.

Sometimes, the backseat driver gaines in power and influence, and all of a sudden he's sitting in the passenger seat. As Emily said, sometimes the backseat driver even grabs ahold of the wheel from you and is driving the damn car.

The ultimate goal of treatment is to wrest control back from the backseat driver  You might not always be able to toss the SOB out of the car, but you can turn up the radio to drown out his directions. Or you can work to push him back to the backseat, and ultimately to the trunk.

Genetic predispositions work this way. They rarely start out by suddenly grabbing the wheel away from you. Rather, they creep up in importance and influence. We do, ultimately, remain the driver of our lives, but as anyone who has followed GPS directions only to end up at the wrong place knows all too well, bad directions can lead to a very different road traveled.

Our predispositions towards eating disorders or anxiety or bad boyfriends tend to nudge us. They change what environments we're likely to seek out, and our environments can provide new backseat drivers (or new directions for the existing ones). They can be annoying passengers in our lives, but there's also not a lot we can do about them. We're often stuck with them for the ride.

The goal is to diminish their influence. Most backseat drivers I know don't change no matter how many times you tell them to shut their traps. It's much easier to deal with them effectively once you know that they're a) a backseat driver and b) know that their sense of direction really sucks.

Of course, throwing your backseat driver in the trunk can leave you directionless. This makes the asshole in the trunk all the more appealing. It's much more appealing (and less anxiety-provoking) to have someone in control and telling you where to go than for you to be driving the streets of a neighborhood you don't know in the dark. Directions--any directions--seem ridiculously helpful.

Maybe they are, but I have to keep reminding myself that the backseat driver never asked where I wanted to go. He's not interested in that. He just wants to drive. So I can't necessarily get to where I want to go by listening to the jerk.

I also have to remember that the wannabe driver is going to be trying to give directions for a good long time, and that he might figure out how to get out of the trunk and back into the car at some point. I have to be ready for that. I have to get my own directions and be confident in that. I also need a killer playlist for my iPod so I can drown out his racket.

Perhaps I've taken the metaphor farther than it was meant to go. But I think it explains a lot about remission and recovery in EDs. Lock the bastard in the trunk and drive secure. Also be prepared for him to bust out and try to drive your car again. Remember this, however: you are the driver. You get to pick where you want to go. All sorts of things are going to give you a nudge in one way or another. But you're always the driver.

This is actually a post I've been meaning to write for a while: the curious upside to relapse.

Before I go any further, let me say that I don't advocate relapse, I'm not saying you should try to relapse just to "see what it's like" or to stare the demon in the face and see who blinks first.  I'm also not saying relapse is inevitable.

It is, however, exceedingly common.  So common that I don't know anyone who has recovered without at least a minor relapse.

But here's the thing: although a relapse isn't good, it's also not 100% bad, either. Your first task when you find yourself slipping is to pull yourself out of the hole. Then, I've found it helpful to identify triggers and potential turning points where I could have done something differently.  From a number of these dissections, I've learned some things that have ultimately helped my recovery.

1. Relapse can show you where your recovery is weak. For some people, it's PMS. For others, it's work stress. Or kids. Or breakfast. Or whatever. These things can be easy to overlook or shrug off.  But a relapse can give you a chance to address these, head-on.
2. Relapse can force you to re-evaluate your goals. Maybe you love your job but it's stressful as hell, and a relapse is showing you that all that stress isn't healthy. Or that your college major isn't what it's cracked up to be. Relapse can be an opportunity to rethink things with a fresh set of eyes. If high stress and low sleep are demanded by your job or major, it might be time to rethink just how much you want to be on that path.
3. Relapse can remind you just how bad the illness is. We forget, sometimes, just how crappy we feel when entrenched in the eating disorder.  But a period of wellness followed by a return of symptoms helps drive home the difference that recovery can make.
4. Relapse can be humbling. Humbling in a good sense. It's easy to think that we'll be fine, that there won't be any problems, that we don't need extra help. And then comes a little friendly reminder that we do, in fact, need support and lots of it.
5. Relapse can let you refine your treatment. It's easy to coast through and think that everything is fine. And it's hard to see the need for change when things are going well.  Obviously--if things are going well, you don't want to change that. But a relapse can be the extra nudge you need to switch medications or therapists, try a new treatment approach, or otherwise shake things up.

The idea isn't to just let relapse happen. If it does, however, you can use the experience to build up your recovery, rather than using it as an excuse to let everything decay.

What are some of the things you have learned from relapse? Share in the comments!

Some days, I think recovery can go shove it. The process sucks. It's expensive, time-consuming, and it makes me really, really cranky. Like, you know, it's doing right now.

On other days--days when I feel more positive, well-rested, and can take the long view--I can see that recovery, naturally, doesn't totally suck.  Especially on days like today when I'm crotchety and short-tempered, I need to read things like what my friend says about how recovery is a gift:

1. When we stop letting our eating disorders determine our self worth and begin to focus on health, it’s easier to make time for ourselves – no longer over-committing to others or trying to find meaning simply in what we mean to others.
2. Recovery allows us to re-set our priorities. Rather than believing that the only thing that matters is losing x pounds, or running some arbitrary distance, or. . . recovery allows us to see that there are friends who love us, healthy goals to achieve, and life that needs to be lived.
3. Recovery gives us the opportunity to talk out long-buried issues and to grow from our past rather than always living in it.
4. Recovery can teach us life skills. Whether it’s saying no to that one last thing, speaking up when we need support, using yoga/meditation/journaling to gain perspective, or something else altogether, identifying the simple steps needed to get through an anxiety attack, an evening with a large group of people, a moment, an hour, a week, or a year, the process of recovery enables us to draw on a variety of techniques and skills that – sometimes, at least – it seems like others don’t draw on.
5. Recovery allows us the opportunity to construct life on our terms, and to see that there are times when we’re not going to have control – and that those things are okay.
6. Recovery lets us learn more about the parts of ourselves that we’ve buried – and often, while this can be related to pain, it’s the strengths that we’ve given over that we’re able to reclaim.

I don't think my eating disorder is a gift, mind you, but I also think that recovery can force us to reconsider some fundamentals about who we thought we were. I'm still a workaholic and overachiever (I'm writing this after a 12+ hour day, and I'd have kept working except I'm working on that sleep thing), but I'm also much more willing to take a break.  I also have an identity outside of my occupation.  Before the ED struck, all I cared about was schoolwork. I wrecked friendships and had a bloody miserable time in high school and college because of it.

When I had a few minutes in between things at the conference I was at this past weekend, I tried to fit some fun reading in. So I was reading a non-fiction book about cancer (I'm a dork, this is proof) that was really fascinating, and I came across a passage that really struck me.

First, a bit of background.

Cancer drugs typically kill a fixed percentage of cancer cells.  To make the math easier, let's just make it 90%.  If your initial tumor had 1000 cells in it (most tumors are much, much bigger, but again, the math is easier this way), after one chemo treatment, you would be left with 100 cells.  Another round, 10 cells.  Yet another round, 1 cell.  Finally, a fourth round to obliterate that last bit of cancer.  It takes the same amount of drug in each round.

Doctors use hormone markers to monitor treatment progress in some cancers. As the tumor shrinks, so does the amount of hormone in the blood.  Back in the 1960s, scientists worked to reduce those hormone levels, but they never pushed to eliminate them entirely.  Either they didn't think it was possible, or they didn't think it was that important.  When one doctor did continue dosing his patient with toxic drugs to remove all traces of hormone, he was sacked from his job.

This brings me to the passage I want to quote:

But the story had a final plot twist. As Li had predicted, with several additional doses of methotrexate, the hormone level that he had so compulsively trailed did finally vanish to zero. His patients finished their additional cycles of chemotherapy. Then, slowly, a pattern began to emerge. While the patients who had stopped the drug early inevitably relapsed with cancer, the patients treated on Li's protocol remained free of disease--even months after the methotrexate had been stopped.

Li had stumbled on a deep and fundamental principle of onvology: cancer needed to be systematically treated long after every visible sign of it had vanished. The hcg level--the hormone secreted by choriocarcinoma--had turned out to be its real fingerprint, its marker. In the decades that followed, trial after trial would prove this principle. But in 1960, oncology was not yet ready for this proposal. Not until several years later did it strike the board that had fired Li so hastily that the patients he had treated with the prolonged maintenance strategy would never relapse. This strategy--which cost Min Chiu Li his job--resulted in the first chemotherapeutic cure of cancer in adults.

{emphasis mine}

I'm pretty sure most readers wouldn't have been struck by the parallels to eating disorders, but I was.  Most people think that once all visible signs of the eating disorder are resolved (weight is normalized, binge eating and purging have stopped, etc) then you can stop treatment.  The eating disorder is gone, right?  You can't see it any longer.  How can it be there?

But if the thoughts and urges are still there, if the fears and compulsions are still there, then the eating disorder is not gone.  You have to keep chipping away until everything gets down to zero.  That's how you get to full remission--not by stopping at "good enough" and "almost back to normal."  True, it's not possible for all cancers, and it isn't yet possible for all eating disorders, nor can we say for certain that someone with an ED will never relapse, but that's no reason not to try.

One of the things I'm struggling with a bit right now is balancing how far I've come with how far I still need to go.  Thinking about how much more work still needs to be done is rather overwhelming--but that doesn't change the fact that it's ultimately still rather necessary.

I read an interesting blog post on Psychology Today titled How to Become a Great Finisher.

Some interesting bits of the post:

Koo and Fishbach's studies consistently show that when we are pursuing a goal and consider how far we've already come, we feel a premature sense of accomplishment and begin to slack off. For instance, in one study, college students studying for an exam in an important course were significantly more motivated to study after being told that they had 52% of the material left to cover, compared to being told that they had already completed 48%.


When we focus on progress made, we're also more likely to try to achieve a sense of "balance" by making progress on other important goals. This is classic Good Starter behavior - lots of pots on the stove, but nothing is ever ready to eat.


If, instead, we focus on how far we have left to go (to-go thinking), motivation is not only sustained, it's heightened. Fundamentally, this has to do with the way our brains are wired. We are tuned in (below our awareness) to the presence of a discrepancy between where we are now and where we want to be. When your brain detects a discrepancy, it reacts by throwing resources at it: attention, effort, deeper processing of information, and willpower.


In fact, it's the discrepancy that signals that an action is needed - to-date thinking masks that signal. You might feel good about the ground you've covered, but you probably won't cover much more.

I don't think the author is saying that a feeling of accomplishment is bad, but it can be premature. I've met many people who tell me how much more they're eating than before, or how much less they're purging. Which is all well and good (it really is), but when you're still regularly undereating or purging or engaging in any other ED behavior, there's still a massive problem. Yes, you've made progress and give yourself a pat on the back, but (and this is the hard part) don't stop there!

When you're doing something as intense and lengthy and grueling as ED recovery, it's easy to want a break and get complacent.  Taking a little time to breathe and regroup is one thing (my friend Charlotte reminds me, and everyone else, to breathe regularly); but you also can't stop forging ahead. 

A metaphor I love came from the preface to Laura Collins' Eating With Your Anorexic. Psychologist James Lock writes that recovery is like climbing a sand hill: if you stop, or don't get all the way to the top, then you'll slide back down to the bottom.  Although acknowledging how much progress you've made is wonderful, it's also important to consider what's still left to be done.

That's where it gets tricky.  I compare how I'm doing in recovery now to when I was at my sickest, and I just want to say "But look at how much work I've done! Look at how much better I'm doing! Can't I just stop here?"  The problem is that stopping "here" ultimately means a slide backward, and beginning that slog all over again. 

Like so many things in recovery, the answer isn't an either/or question.  It's figuring out to celebrate progress made while balancing that with continuing forward motion.  That being said, I can barely figure out how to walk and chew gum, so we'll see how this multitasking goes...

Pulling myself out of this slip has been exhausting.  It's gotten harder over the past week or two, not because anything has necessarily changed, but because I'm getting burned out.  On the one hand, I can feel the subtle shifts happening; on the other hand, it's just the same old, same old.  It's one thing to push yourself to eat more for a short period because it's time-limited.  Eventually, the hell will be over.

I thought I would pull out of the slip much faster than I did.  Perhaps I misjudged exactly how many difficulties I was having. The other factor is that weight gain is going much more slowly even on more calories.  My life feels like a never ending assembly line of meal-snack-meal-snack-meal-snack.  Seriously?  Shoveling in this much food every day is exhausting.  Like I said, there has been progress, but there haven't been signs that the daily shit-ton of food is going to decrease anytime soon.

I had a bit of a meltdown about it the other day.  I was tired of all of the recovery work, tired of the food, tired of always feeling like the sick person.  I was about ready to throw in the towel.  But my therapist had reminded me of something: last week we had talked (briefly) that if I continued to progress weight- and behavior-wise, then we could talk about reintroducing some mild activity.

Apparently I have progressed, and now I am officially off exercise restrictions.  I get a few short walks during the week at this point.  The idea is to move up slowly so I don't just plunge back in head first and everything goes to pot. 

This event greatly improved my mood, and not primarily from the OMG--I can go back to exercise now! standpoint.  It was also that, for the first time, I could see the light at the end of the tunnel.  I don't know when it will be, but sometime soon I can transition from refeeding mode back to recovery mode.

It's been hard, too, because I generally don't get much feedback on how I'm doing.  I would know if I lost weight, and I don't really like being patted on the back for gaining, either.  It makes me feel horribly guilty.  So it was hard for me to judge exactly where I was along the path, which only added to my frustrations.  I don't want or need to be praised for every bite, but a little feedback would have been helpful.

There's still tons of work to be done, even when this phase is over.  I know that getting back to where I was still doesn't make me where I ultimately need to be in recovery.  For now, though, I'll take what I can get.

After a long, busy, and rather stressful day yesterday, I settled down to (yet another) House rerun.  This episode (Season 7, Episode 12) wasn't necessarily one of my favorites, but as I watched, I realized that it does contain one of my favorite scenes.

The setup (briefly): the patient of the week is a waitress (Nadia) with a perfect memory, and House's team of doctors are trying to figure out if and how this fits in with her other symptoms. They eventually diagnose her with perfect memory as a form of OCD secondary to a genetic condition.  Right after they give her the diagnosis, one of the doctors (Chase) goes in to talk to her.  The following dialogue ensues:

Chase: You said you didn't have a choice to be the way you are. Now you do. [He pulls out a small bottle of SSRIs.] They've been effective in treating OCD.
Nadia: You mean, lose my memory?
Chase: Not entirely; it would just be more like everybody else's.
Nadia: My memory is the only thing that has ever made me special.
Chase: If you want to be special then it means being alone. [He leaves the pills on her tray and walks out.]

It's a feeling I know all too well--realizing that thing you felt made you special was both an illness and wrecking the rest of my life. This realization was rather sobering.

When I'm in the midst of the eating disorder, it's all too easy to forget that starving isn't a sign that I'm really special. It's just a sign that I'm sick.  Only I didn't always understand this. After all, one of the most maddening and frustrating symptoms of anorexia is the fact that when you're in the midst of it, it's even harder to understand that this "specialness" you feel--the only thing you can find to be proud of, the only way you know to make sense of the world--isn't really all that special.  It's the byproduct of a diagnosis.

Having that "one special thing" pulled out from under me shook me to the core.  Then, of course, I told myself that, diagnosis be damned, my ED behaviors made me special.  After all, click on any "health" section and you will be inundated with stories about how to lose weight.  I was good at eating less and exercising more, and the precise reason why didn't matter all that much.

Except that hiding behind a diagnosis is no way to live a life. You'd think it would be a fairly easy, straightforward decision: life without anorexia and a chance at happiness and relationships OR anorexia, loneliness, and death.   But the illusion of specialness is a powerful thing. If I wasn't starving myself, then what? I felt that I would be nothing, a nobody. Even as the disease wrecked everything in my life, I hesitated to make meaningful changes because I feared what would happen to me without the only thing I thought made me special.

I'm still trying to figure that out.