Congrats and Fuck You, ED

I would just like to say congratulations. Congratulations to my eating disorder. It achieved what it wanted without much hesitation. It ran me right out of virtual IOP treatment back into PHP in person treatment by convincing me to just fall back into its loving arms. I mean it was the hope that I might get to move back to that level of care anyway, right? That was what my team said upon my step down, so might as well use that to it’s advantage and let it run with it’s new freedom without any restraint. I could feel this happening. I let the doubt in my ability to recover that the voices in my sick brain showered over me break down any fighting chance I had to make it work in a lower level of care. But I wasn’t unaware of this. In fact I would say I was hyperaware of this sensation and what it could jeopardize for me if I didn’t either find a way to change my thoughts or get back to a more structured environment to hold me accountable. I asked my new VIOP team immediately if there was a plan to get me back to PHP upon meeting them in my intake sessions. They got in touch with my team from PHP that week and relayed to me a conclusion that said that I was encouraged to “try my best in VIOP and if a step up is needed then that was what would be done”. I was told to try to do what I could with what I had even though I expressed my need for more support. So I waited. I waited for my health to decline for four weeks to provide them with appropriate “grounds” for a request to step up again. They needed it for insurance purposes, so it was not directly the teams fault, but I wish they would have heard my cry in the beginning and taken it seriously. I also came to find out from my PHP team, once I got back a month later in mid-July, that the initial consensus for me to “try my best in VIOP” was apparently a bit misconstrued. My therapist in PHP said that they were told things were going okay on my end by the IOP team and that was why it hadn’t been done more immediately. It wasn’t until I emailed her three weeks into IOP to explain how poorly things were going for me that she had any idea I wasn’t making it work. All this to say, it can be a shit storm trying to get what you need in our world in terms of treatment. I am lucky enough to have insurance coverage at all and access to these things, but it still comes with so much red tape, weight bias, and pushback from profit-seeking companies, though that is a tangent for another day.

A few things are different now that I am back in PHP. Because of the struggles I had with purging becoming an issue again after I started eating more in program and the difficulty that came with trying to get that under wraps with all the other behaviors, there was a "recovery plan" put in place by me and my treatment team during my first week. It doesn't have cold-turkey ultimatums written all over it as other contract-like agreements I have had in the past have been based on. It has seemingly realistic expectations outlined to set explicit goals and also parameters around allowing me to continue care at the PHP level of care, which I have been more than persistent about doing. There is also hope that having this tangible outline of my treatment goals and expectations will help on the insurance side of things, too. Some of these parameters include only supplementing for food I cannot compete in programming one time a day, only engaging in movement related behaviors once a week at most, and, what became, living in the apartments they provide instead of at home. The latter was originally written as having someone drive me to and from treatment, but given the commute from my house and other circumstances with my family, this wasn't really feasible. So at the beginning of my second week back (this past Monday), I moved into the apartments here. Luckily I am able to go home on weekends if I need to or want to for any reason as I am not too far away. I really felt guilty about leaving my family, even if for a matter of weeks. I think that is partially because the emotional distance I have built up between me and my parents that I felt like I could at least make up for some by my physical presence when I was living at home. I also was really sad to not be able to be around my sister. She is leaving for college soon and I just genuinely have been so happy with our relationship and the companionship she gives me that it makes me sad I can't soak up the last few weeks we have before she moves into her dorm. I know it has been a helpful change for me, though. It's easier to try to change my patterns in a new place rather than one I have a rapport of self destruction in. 

Speaking of patterns, I noticed an interesting one when I was doing a mirror exposure with my therapist in our session. When I say "exposure", that means sort of what it implies. Exposing yourself to something uncomfortable in order to build up tolerance for the uncomfortable, and sometimes painful, feelings it brings up. In treatment for ED's, these often come in the form of fear foods, mirrors, certain clothing, shopping, etc. Things that cannot just be avoided in regular life. The thing is, I don't avoid mirrors. I don't start crying when I look at myself while I am brushing my teeth. I know that that is not the only way discomfort surfaces, but when my therapist said she wanted me to do this last week, that is what I explained to her with a dash of sass that has become integral to this particular therapeutic relationship. Of course this didn't stop her from hauling the body length mirror to her office and carrying out the exposure. She grabbed a pen and a notebook and explained to me how it would go. It would be similar to something I had done in groups before at Center for Discovery where we stood in front of a mirror and wrote down only objective, neutral statements about what we saw for intervals of a few minutes at a time. However, this time we were doing it divided among sections of the body and we would first begin with just stating all the thoughts that came into my head, judgements allowed. I would recite them to her as she wrote them down. The top of my head to my shoulders, my shoulders to my hips, and then my hips to my toes each for three minutes. When the timer started I was able to spit out my thoughts and opinions about my body for only around half the time until they came to a stall and silence settled in. I was still having thoughts but they were the same ones over and over. They weren't always in a lingual form either. I would just stare and observe the things my ED fixates on as if to will them to change. When we went back through the sections of the body to perform the objective/neutral exercise, I was able to list of things I saw with less lull. I felt more alive and in myself and it intrigued me afterwards as I recalled the contrast to the seemingly rehearsed utterance of the criticisms I had stated just before. When my ED brain was the one to take over it left me with little less than consciousness and an emptiness that flowed in place of the depth that the words conveyed. 

Then she read them aloud to me. The stream of negative thoughts that I managed to piece together from the fragmented buzz in my head took on a clear and linear progression. She asked how I felt after she finished reading and I was only enticed. I was almost excited at how poetic my pain sounded. It didn't feel like pain at all. There was a since of pleasure and accomplishment that I could have all the thoughts laid out in such an artful manner. I exclaimed that it felt like it should be part of a book and I liked that thought. She pointed to the disconnect that underlies this response. I could see it, too. It felt like the words were empty and I was separate from their meaning even though it was my experience I was describing. The narrative made it feel like I had successfully done my duty of relaying how the world appeared through my eyes and feeling it had no longer become necessary. It was disheartening in a sense: to remember how real-time authentic emotions are so inaccessible to me. The uncomfortable ones, at least. It's frustrating because I feel that it would be easier to heal my wounds if I could feel them. I think it also inhibits my motivation to change because if suppressing negative emotions seems to work so effectively most times without any overflow, little of it seems to disrupt my day to day life that might otherwise motivate me to change. It could be a reason I have turned to other unhelpful outlets to help me feel or express the things that are buried below. Or maybe those self-destructive behaviors are my own form of an outburst of emotion just without...the emotion.

Glo