Rules

Every time I talk about treatment, I mention some of the crazy rules or nuances of treatment. These normally get me a "wtf face". I decided I will compose a list of the craziness of treatment. :)

This is a work in progress, much similar to my recovery :)


1. You cannot break your cookie. You must take the entire cookie, raise it to your mouth, and bite into it. It does not matter if the cookie is stale and is too hard for you to bite. The only exception to this rule is if you are at Panera.

2. When you have cereal, you must make sure that all the flakes of cereal and all the almond slices are cleaned from your bowl. You cannot have any food particles remaining in your bowl. If you leave almond slices or cereal flakes in your bowl, you will be redirected to take your spoon and get all the remaining pieces before leaving the table. This sometimes will result in you having to spend about five minutes working on getting tiny slivers of food from your bowl, but that is not what is important. What is important is that you are not acting on your eating disorder.

3. If you are having cereal, you can have Raisin Bran and yogurt. You can have Cherrios and yogurt. If they are out of Cherrios, you can have Frosted Flakes with yogurt. If it is any other cereal, or if you do not mix your yogurt into your cereal creating some weird somewhat gelatinous substance then you must put milk in your cereal. This rule gets very complicated, so I will subdivide.
a) You cannot have yogurt with cereal unless you mix the cereal with the yogurt.
b) If you don't have yogurt, you must have milk. If you have milk, you must put it in your cereal. You cannot have dry cereal and drink milk.
c) Frosted Flakes cannot be mixed with your yogurt if Cherrios are available.
d) You can put extra raisins into your Raisin Bran as your fruit component.
e) You cannot put raisins in other cereals if it "doesn't make sense" to the dietitian. This subdivision of a rule is up to the interpretation of dietitians and online staff.
f) Having dry cereal is "eating disordered".

4. You cannot put your Mini Wheats or Frosted Mini Wheats in the microwave even though the commercials and the box tell you to do so for a "warm cereal during winter months".

5. You cannot put salt in your oatmeal, including non-flavored, original oatmeal, even though it says on the instructions to add salt.

6. You can put fruits in your yogurt if they are fresh and cut up or if they are dried and bite size. Prunes (even if cut up) cannot go into your yogurt. Dried apricots, though much larger than bite size, can go into your yogurt. Apples, bananas, strawberries, plums, etc. all can go into your yogurt and can be cut into insanely small pieces to fit into your yogurt container. Preparation of the fruit + yogurt combo can take up to fifteen minutes. I've seen this happen.

7. You cannot put apples and peanut butter on your bagel, but you can put bananas and peanut butter. Duh, that's so less eating disordered...

8. You cannot make your bagel into a peanut butter and jelly sandwich by having peanut butter and getting jelly.

Proposals

Before my nineteenth birthday, I had been proposed to three times: once by my high school sweetheart and abusive boyfriend when I was eighteen, once by a street vendor in Monaco when I was sixteen, and by Ed when I was four. I refused to recognize almost all of these as proposals until I was in my twenties, particularly Ed’s proposal. Some things are just better left forgotten, or so I believed. While all of these proposals were insanely strange, I suppose I shall start with what I still consider to be the strangest of all.

I was eighteen, a college drop out, and in a relationship with Daniel. Daniel did not have a job, and he had been homeless for the majority of our relationship. As you can imagine, his proposal was not very elaborate. It was what I refer to as the “Hey, I’m going into the military, and there’s a possibility you might be pregnant, so let’s do this thing” type of proposal that was all too common around my hometown. As we stood in my parents kitchen, Daniel threw his class ring at me, still engraved with the initials of his ex-girlfriend, and he said, “So… Yeah… You know… What do you say?” I said no, and we broke up a few weeks later.

My proposal in Monaco was not really a proposal, but I group it in here with the others because it is the happiest of the three. I had just fed a crepe to a seagull, and I was meandering the alleyways of Monaco with some close friends. The menagerie of Lamborghinis and other expensive cars caught our attention until a young man and his father in a street side shop called out for us in French. I, speaking only Latin, could only pick up a few words. Beautiful. Ladies. Something about a boy or his son? I turned to my friend travelling with me, who translated for me. “Beautiful ladies! American women! My son! You marry? You marry?” Next thing I knew, the kid was on one knee. I ran away giggling with my friends as any scared American would.

 Finally, the proposal I remember least vividly. It was the summer I turned four. I was at my maternal grandmother’s house. Somewhere along her hallway lined with mirrors, which I often compare to the Hall of Mirrors at Versailles, Ed proposed to me. I accepted without hesitation. Who’s Ed you ask? Ed is my eating disorder. Ed is the man who saved my life and nearly killed me a few times along the way. Ed and I are currently in the process of filing paperwork to finalize our divorce.

Christina Syndrome

A few years ago, my best friend started having adverse reactions to certain foods or after eating. She would have extreme stomach pain, cramping, and a ton of GI problems that no one ever resolved. We just called it "Christina Syndrome".

When I was refeeding, it would take me hours to finish 50% of a meal. My stomach could not digest properly. Digestion was a foreign thing to my body. I had deprived my body for so long of nutrients, that taking in those nutrients became extremely painful. I'm sure Ed was in there too, and that it wasn't entirely my body reacting to food.

While I don't consider myself "in recovery", I am no longer refeeding. I'm not at my goal weight (whatever that is). I have not gained enough weight to be considered an "appropriate" range. My metabolism is out of whack, and Katherine has put me on a really intense meal plan so that I don't lose any more weight than I already have coming out of treatment. Ed doesn't like this idea. Regardless of the weight I have gained and the progress I have made, eating has not become easier either mentally or physically. Here's the process...

I eat, therefore, I feel sick.
I eat, therefore, my stomach screams in pain.
I eat, therefore, I can feel my body attempting to digest food.
I eat beyond fullness cues so that I meet my meal plan, therefore, I send my body into immense pain, giving me high restriction and purging urges.
I eat, and immediately I have stomach pain.
Nothing is regulated.

I'm already horrible at assessing pain levels, but now I have to do it after everything I eat. Blood draws, GI appointments, dietitian appointments... I'm going through all of these hoops in some attempt to figure out why eating is so difficult. I know that there is a mental component to this, but there is also a physical one. I shouldn't feel like I'm in that scene from Alien when the alien comes out of the stomach every time I eat. It even happens when I eat "safe" foods. Have I really screwed up my body so much that now I have created an intolerance to certain foods because I deprived my body of them for so long?

Ya know... people say "It's not about the food." But dammit... I need to eat. I know I do. Some Part of me wants to eat! But why can't I eat, digest, and have a nice, normal cycle like that!?!? Why can't it just be food? Why can't I just eat it, and not be in pain?!




P.S. I'm really tired of Web MD-ing my symptoms... Suggestions? Get on x, y, and z medications. I'm on ALL OF THOSE. THEY DON'T HELP. SCREW YOU.


=/

Blame and Responsibility

As I thumb through the Rolodex that is my history, certain things stand clear. Memories I wish I had never experienced and days that happened in the early 90s and in my teens that are as vivid today as they were back then.

Recently, my grandfather passed away. Since then, we have been sorting old pictures that we found in his house, pictures of my childhood that hide this dysfunction and show the mask. Was I really wearing the mask at the age of 7? I can't help but think to myself, "How the hell did it get this way?" When did everything change? How did it change? How did I go from...

To the chronically ill person I am today? Who do you blame for that? How did that little girl grow up to have hundreds of papers and documents in hospital basements, psychiatrist offices, and therapists' offices? Who fucked her up? Was it you or was it me?

When I was fourteen, I started going to my pediatrician for pain. This wasn't the beginning of everything, but it was the beginning as I knew it at the time. You're growing. It's just growing pains. Yeah, right. I hadn't grown in two years, so that was ruled out. A few months later, I saw the same pediatrician. Tendonitis. Your tendons are just sore; take Tylenol. Okay. No luck. Again and again and again until that doctor got the idea that I should probably see someone more specialized. So then came the orthopedic appointments. Jumper's Knee. Right, because I jump all the time... Wrong. Tendonitis. Still not that... Arthritis. I'm fourteen! Juvenile Rheumatoid Arthritis. Wrong again. Torn meniscus. Nope. Broken patella. Nope. Synovitis? Well sorta. But your medication didn't help. X-rays, nuclear medicine tests, MRIs, you name it. I was given some test for it. This lasted until I was about seventeen. Eventually with the orthopedic it got to three phases of not knowing what was wrong. Phase 1: Cortisone shots! That made things worse. Phase 2: Let's just open your knee up and look at this! Phase 3: Call you a hypochondriac. So then came the new doctor, a sports medicine doctor. Mind you, I sucked at sports. My sports career had ended when everyone else became the same height as me. He said I had arthritis, and I was put on an Asprin regimen. He then referred me to a fellow at Vanderbilt who specialized in rheumatology. I swear, she and her supervisor were bound and determined to diagnose me is PsA. They failed. June 1st 2009, I was diagnosed with Fibromyalgia. 

And that was it. Life = altered. Welcome to the world of being "chronic", the world of pain medications, and the world of being an invisible sufferer (though I was already used to that). I did my research. I saw some clips from doctors. I heard some podcasts. Something about all of my research stuck out. The most common thought surrounding the onset of Fibromyalgia is severe emotional or physical trauma. Let's see, I was 14 when I started complaining of pain... and I was 14 when fit hit the shan with my grandmother... Hm. Common denominator, anyone? And with that, the blame began.

Along with being diagnosed with Fibromyalgia, in one singular doctor's appointment I was also diagnosed with Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Chronic Fatigue Syndrome, and Attention Deficit Disorder. So, I'd like to say a big ole thanks to whoever gave me all that crap.

As I grew older, so did my list of medications. Exactly two years after being diagnosed with Fibromyalgia, I was diagnosed with Anorexia Nervosa. It was one of those times where I kept saying, "But this is how I've been my entire life!" A few days after being told I needed inpatient treatment, I weighed myself after a heavy restriction period followed by binge drinking. I was a little under 70% of my suggested body weight, and I was 9 lbs away from my goal weight. I think it was at that moment, knees shaking, on the scale that I realized I had been this way my entire life...

Good food. Bad food. Eat this. Not that. You have to fit into size 0 jeans. You can't even try on those jeans. Buy everything in an extra small. Breakfast is unnecessary. You're not hungry. You're just a picky eater. On and on and on and on and on. Whoever says "I wonder where Ann got that from?" obviously doesn't know me or my story very well. 

I was anorexic at the age of four, actively restricting by five, eating normally but purging by thirteen, back to restriction throughout high school and college, and once I started working it was a new beast of restriction, bingeing, and purging. 

Who does that to themselves? See that girl up there? I did that to her. 

When I went into treatment, there was a list of words and acronyms underneath MEDICAL/PSYCHOLOGICAL that made me realized how I was nothing more than a few really shitty diagnoses. ED: NOS, GAD, CFS, OCD, Depressive Disorder, Fibromyalgia, Potential for electrolyte imbalance, Hematemesis, Hypokalemia, Osteopenia, Chronic Vitamin D Deficiency, and that one I didn't expect PTSD. What?!?! You mean, that thing that all those soldiers at Ft. Campbell have when they come home from Iraq? No. Not me. What?!? Post-Traumatic Stress Disorder?! These words and acronyms brought something new to my life I had never truly understood. I narrowed it down to one of three options...

1. I fucked myself up hardcore.

2. Someone else fucked me up hardcore.

3. God made me this way.

-------

This was originally going to be a blog post about some anger I have towards people and some shame I have towards myself. How did I get to where I am now? Is it my fault or is it yours? I think I stayed from the path somewhere in there, and I ask your forgiveness for that. All I know is that right now I have no idea on how to express the shame and responsibility I feel for taking that little girl and causing her muscles to atrophy, starving her, forcing her to expel nutrients from her body. I cut her. I bruised her. I deprived her. I gave her scars. I gave her the bones of a woman 50 years her elder. I put her into chronic pain. I am the reason why she has to take a handful of pills in the morning to function, some throughout the day so she doesn't fall over from intestinal pain, and a handful at night so she can sleep and the noises of her perpetrators (those people I let get to her) will quiet down just for a little while. 

The Last Two Months

A little over two months ago, I had one of the most horrific experiences of my life. Crumpled on a bathroom floor in my work clothes, I held back every emotion possible as my shaky hands pressed against the porcelain seat of a toilet to push my body to a standing position. I wiped off the remnants of whatever semblance of a breakfast I had earlier in the day from my lips and replaced it with the mask. The mask is what I wear. She is who I am not. She is who I wish I could be. She was the woman my students saw. She wasn't always there, but she was there a lot. She covered up the tears and the shame and the guilt and the shaking in my legs after days of restriction. She made me look put together.

Only God knows how I got through two classes after that... It was after this girls' bathroom experience that I had a meeting with my dietitian. Somewhere in the mix of all of this, she and I decided that I needed residential treatment for my eating disorder. I went for seven and a half weeks until I was kicked out for reasons that I find completely illogical. Regardless, while I was there, I did learn a lot about my eating disorder. I learned a lot about myself. Communication became better with me and my family. That's the Reader's Digest version. In truth, I don't think I could ever explain what happened between October 10th and December 1st in any blog or in words at all. It was a convoluted mess of writing agendas on how I "need to be sick" and what my eating disorder was trying to say to everyone around me. I wrote a history of my life as I saw it through my rose colored glasses. I uncovered memories I had suppressed from the age of four, some when I was thirteen and the most grotesque from when I was eighteen. I had therapy, endless hours of therapy. I made relapse prevention plans. I battled insurance companies. I ate three meals a day, three snacks a day, one cup of chocolate soy milk with dinner, and tried going without acting on behaviors.

While in treatment, I did listen to Ed. He was pretty sneaky. I did what he wanted, and I still do to this day. That's a scary statement to write. He won't let me wear jeans; so I haven't worn jeans in six weeks. He won't let me wear form fitting shirts; so I haven't worn a form fitting shirt in weeks. No butter. No cream sauces. No fried anything. No ice cream. The last time I ate ice cream (save one time at Castlewood), I binged. I didn't know I binged until recently. I told you Ed was sneaky.

More recently, things have been.... different? I suppose that's a fitting word. I'm seeing Thom. Ed hates him. I love him, and that's the way it should be. I'm seeing Katherine again. Ed still hates her. I still love her. As Thom says, we need to be pissing that son of a bitch off. Who knows if I'm pissing him off now or not... Sometimes his voice sounds a lot like my own. It's pretty hard to discern. I have no idea if my forced restriction upon myself is Ed. I know... I know... Forced restriction, Ann? That sounds like Ed. But seriously, I am in pain if I eat to my meal plan. That's not right, is it? Maybe this is all rationalization. I don't know. I feel like I don't know much of anything these days.

Dialogue with My Eating Disorder

Dear Ann,

What do you gain from me? I’ve only been behind every accomplishment and good thing that has ever come out from your life. Do you think you would have excelled in academics without me? Without me, you would not have even stayed in Latin. I kept you there, because it was so safe for us. I made Latin and myself your primary focus, which brought you great success in various competitions. You know I was the reason you did so well in college. Do you think that you could have graduated summa cum laude in five semesters without me? Absolutely not! You would have fallen on your fucking face. You know I was there at your job interview. Don’t lie to yourself. You know Dr. Ash hired you partly because of your achievements (which all can be chalked up to me) and partly because of how skinny you are (obviously you have me to thank for that). Your students think you’re cool and funny, because you care so much about them. I give you the ability to put them as your #2 priority behind me. If you were eating breakfast, then you would be late to work and not completely ready for the lesson plans for the day. If you were eating lunch, then you wouldn’t get things graded as quickly as you do. If you were eating dinner, then you wouldn’t have the time to make up the amazing activities for your students. Let’s face it, the only reason you’re good at what you do is because of me.

Think about your family. How dysfunctional are they? Your mother is an alcoholic. Your father is an enabler. Amy has an eating disorder. Nanny is an absolute nutcase. Do you honestly think that without me that you could have some handle on all that shit? There is no escaping your family, except through me. I have helped you escape their pain and abuse for years. Lord, imagine your life without me. It’s not as if you could handle the shit storm they constantly put you through without me? Plus, and let’s just be honest about this, Nanny has already threatened to disown you. If you get rid of me, then that could be a definite possibility. I know some other parts will disagree here, but I really am just trying to protect you from that abandonment. If you get rid of me, then you will probably be exiled from your family.

If you give me up, there will be consequences. Big consequences! You cannot do your job without me, at least not successfully. You will be spending all your time eating and making lunch and making snacks and preparing dinner. You’re going to be wasting a shit ton of time that you could be devoting to your students. Your family loves you now! Look at all the attention I have gotten you and your younger parts. I am helping all parts here. If you give me up, you will have no way of dealing with the pain and the hurt that you and your other parts will experience. Your family will not pay any attention to you. Amy or Jocelyn or Blair or someone else will get all the attention, and no one wants that. I know this sounds really arrogant and attention-seeking, but you will just be forgotten and ultimately abandoned if you don’t listen to me.

I hope you know what you’re getting into. I don’t trust you at all for being here. You better listen to me or you will face some serious hell. You don’t know a world without me. Don’t start to look for that world now. It’s too late.

Sincerely,

Your Eating Disorder

Dear Eating Disorder,

I understand your desires to protect me. I know that you have served certain functions in my life, and for that I am thankful. You have gotten me through emotionally taxing times. You were part of the reason I excelled so much in school and in Latin. It’s too much, however. I need you to back off. I know you think you’re doing everything in the best interest of me, but you’re not. I am going to have to take some risks. I need you to step back and maybe take on another position or roll. Please. What we are doing now isn’t healthy.

You have to trust me that these risks will pay off in the long run. If you step back, then I will be able to be a better teacher. I need to get healthy so I can teach. Remember when I was in the hospital because of you? If we keep that up, then God knows I won’t be the teacher I need to be. I know I am going to be putting myself out there emotionally as well, but I am trusting that the treatment team knows best. I think it’s scary for both of us to see how much I am eating and how I am not purging or exercising. I am nervous about this too. But please, trust me in what I am doing and in what Jane and Alyssa are saying. I know deep down that I will always be loved by my parents and by my friends. Mom and Pop wouldn’t isolate me because of Nanny. I know that a Part of me thinks that they did before and they will again, but they won’t. They are much more supportive now. They understand both of us better.

I am going to have to take the emotional risks by stepping out without you and your destructive ways. It will be mentally, physically, and emotionally taxing. But remember, all of this is going to help heal some of my Parts and make me more efficient at doing everything you helped me do before.

My life is going to be different without you. We need to learn new jobs for you that don’t hurt me as much. The people here are trying to help with that. My life needs to change. I am going to have to start a bunch of things over from scratch because there is too much history between us there. I know you don’t like me thinking about quitting my job, but that might have to happen. I know you don’t like me thinking about moving back in with Mom and Pop, but that might have to happen. I am going to be taking some steps towards living a life with better coping mechanisms. With that life, I will be able to succeed more just like you taught me to but without the isolation, physical destruction, social repercussions, and emotional detachment that came along with what you did.

I hope you know that I understand your fears, and that I often fear the same things as well. Sometimes you’re so loud that I don’t know whether you are talking or I am. I just need you to step off for a bit. Please. This will be the best choice for all my Parts, including you.

Thank you for what you did help me with, but I won’t be forgetting the pain that you also put me through. We can’t go through that again. Just trust me.

Sincerely,

Ann

What I Gained

On the day I decided to enter recovery, when I was still in denial about my problem, an eating disorder specialist who was pushing me towards residential asked me something I will never forget...

What do you think you will gain in recovery?

 

My answer, at that time, was simple. Weight.

As I traversed my way through EDA meetings online and met new friends, I soon learned the new things I'd gain in recovery.

• knowledge about how many calories you can lose via various ways of purging
• opinions on the most effective forms of purging
• new tricks on how to hide food, make it look like I ate more, etc.
• new ways to lie

Then, as my life continued spiraling out of control, and as my weight continued to dwindle, I started gaining new things without intending on doing so...

• perspective - a voice truly my own, not Ed's
• friends, friends who wanted to help me and were not there to give me tricks and tips, but to cry with me when I relapsed, rejoice with me when I ate, and encourage me when I had urges to falter
• my health, after a trip to the ER and a few bags of potassium and magnesium

And if you're wondering, yes. I have gained weight. Am I okay with that? I'll answer that later. But what I can tell you is that about a month ago in an EDA meeting I began to cry. I cried my eyes out. I couldn't stop. I just kept crying. People kept asking if I was okay, and a friend kept her arm hugged around me. It was in that moment that I was making a decision. This decision had been denied validity by Ed for 17 years. It was in recovery that my true self started to fight Ed on this issue. It was in that EDA meeting that I fought with Ed, not listening to a single story or confession or "Hi, my name is ____. I have an eating disorder." For 23 minutes, nearly half the session, I tuned out. I felt like I had two brains, two living beings inside of me, two people trying to control one body. Finally, Healthy Ann won.


It was that day that I decided I would rather be fat and alive than skinny and in a coffin.

I have tried to live with that core belief for a while now, and while it may not always appear that I am believing that with every fiber of my being, it is the sole thing apart from my family, my friends, and my students that is keeping me in recovery.

What did I gain from recovery? I gained a second chance at life.