End of IOP

I write about my personal recovery here and use Velvet Steamroller to write about similar issues in a somewhat more sociological context. But I'll link to myself here: a post about the future of health reporting.

Personal recovery: Tonight was my last night in intensive outpatient treatment at Renfrew. I thought I would be feeling more of a jolt, either a sense of sudden isolation, or freedom, or something. But as my insurance-approved sessions slowly ran out, it sank in more and more that IOP is the beginning of treatment, not treatment in and of itself. I'll still have a nutritionist (monthly) and a therapist (weekly), plus weekly outpatient support group. Those are enormous, but in a way, they're incidental: I will not always have a nutritionist, or a therapist, or a support group. But I will always have my own resources, the tools that I've been given through the more active part of treatment.

I went into treatment not because my symptoms were so out of control (they were bad, but I've had worse and didn't seek treatment then), but because I realized I didn't know what to do to help myself. I thought I knew, but only through proper treatment did I learn that the ways I'd been trying to help myself were actually symptoms of my eating disorder. When I began to realize that, yes, I really had an eating disorder, not a lack of willpower, I looked up treatment plans and tried to do them on my own. I read that ED patients were instructed to eat every four hours, but that didn't work because I didn't know what to eat. I read about intuitive eating, but that didn't work because the barometer of my intuition was calibrated to my eating disorder, not my authentic self. I tried to avoid weight-loss information but instead started looking at the information reallyreallyfast, as though it wouldn't really do any damage that way. In short: I was unequipped to recover on my own. I needed help. And I got it.

I wish I had known earlier that eating disorders were actually treatable. Rather, I wish I'd known earlier that my eating disorder was actually treatable. I thought treatment was something that only really sick people got to have--like, if I'd messed up my heart by purging, or my bones through restricting, then I'd get to have treatment. I didn't know that what I was going through was "enough" to warrant treatment; I thought that, if I needed anything, I just needed some therapy to work on my body image and all would be well. I've read ad nauseam about eating disorders and how complex they are--how they're about control, and family, and expression, and emotion, and anger, and resistance, and, yes, the culture that tells us that our worth is in our shape. But ever since I can remember, my reaction to that has been, For them, sure. But me, I just want to lose a few pounds.

I was wrong.

Bikram Yoga Really, Really Sucks

There are certain things or behaviors that automatically scream DISORDERED EATING to me, even if they're not things that are actual symptoms of an ED. Like, whenever I see a woman buying nonfat Greek yogurt along with Amy's frozen meals, I'm all, I'M ONTO YOU. Now, nonfat Greek yogurt and Amy's frozen meals are healthy and enjoyable, and I don't think that the items themselves encourage disordered eating in the least. But they're the kinds of foods that are constantly endorsed by the dietitians quoted in women's magazines, because they taste like they have more calories than they actually do; plus, they're in single servings, making them appear appropriate for a whole meal, even though they're not. (I used to eat Amy's for every single meal--which I thought was healthy and I now see was anything but. I still eat them, but I have sides with them to get all my exchanges.)

Anyway. One of those things, now that I've done it, is bikram yoga. As in hot yoga. As in yoga at 105 degrees, as in sweating through all of your clothes, as in the instructor was in boxer briefs. I'd heard various things about it--mostly from people who had tried it once, found it to be torturous, and never did it again. I do plain ol' room temperature yoga and find it the perfect combination of soothing and invigorating, and saw no need to turn up the heat. When I've done yoga in warm weather, it felt good but not necessarily better.

But on Saturday, I decided to give it a try. I told myself that it was because a new yoga studio opened in my neighborhood and had a price special. I told myself it was because I wanted to try something new. I told myself that I was just sating my curiosity. But I think that I was really just feeding my ED, trying to keep it alive in little ways--pushing the rules but not breaking them.

Just as with the legions of Greek-yogurt-eaters out there, it's not like I think that everyone who does bikram yoga has an ED. At the same time, unlike Greek yogurt, I do think that the practice inherently encourages a disordered mind-set.

A) It uses artificial means to create a response that's above and beyond what a "normal" response to a healthy situation would be (that is, it uses heat to increase the post-yoga "high").
B) It makes you sweat an enormous amount, leading to a (very) temporary weight loss.
C) Most importantly: All that sweating makes you feel lighter and somehow like you've gotten rid of something. It feels like you are purging. It feels like you are purifying. And that is the whole point of bikram yoga.

"Purity" is one of those words that can mask an ED, because it seems virtuous and healthy--few people would ever comment on the amount of food I was eating when I was restricting, but I would frequently be praised for my food choices. "Eating clean," "being pure"--I hear these just as much from my fellow patients as I do eating less, and those thoughts, when vocalized, are much less likely to garner concern/frustration/disdain than visibly restricting portions across the board.

I love yoga, and its benefits have been widely documented--including its benefits for eating disorder patients. But yoga-as-practice differs from yoga-as-lifestyle, and, as in anything that is embraced as a lifestyle for its, well, style instead of for its intrinsic qualities, it becomes something that can be ranked. Yoga class trumps yoga DVD; yoga studio trumps gym-class yoga; bikram yoga trumps hatha yoga. So suddenly, simply practicing yoga isn't enough. It has to be pushed to another extreme. And that extreme, in order to have any meaning, has to be a symbol of greater health, greater purity, greater cleansing--forgetting, of course, that yoga is about balance, loss of ego, breath, and unity of the mind, body, and spirit. It becomes a competition instead of a cooperation. In becoming a lifestyle, it loses its essence and retains only ever-increasing hallmarks--more sweat, more discipline. Which is pretty much what one end of my eating disorder was all about: Instead of focusing on actual health, I focused on what signaled "health" to my ED.

So hot yoga is bad for me because I'm recovering from an eating disorder, but so are lots of things that might be perfectly healthy for others (tracking calories, taking body measurements). But I also think it's bad for the body. Not only was I extraordinarily sore the next day, but two days later I got a painful charley horse in my right thigh. I know the difference between normal postworkout soreness, or even the kind of soreness that comes after trying something new, and this kind of soreness. This was beyond what it should be--this was harmful.

So my legs ache, and only now, on Wednesday, are my shoulders feeling normal again. That's the physical damage. I'm pleased that my mental damage was minimal--in fact, if anything it may have made me more aware of the ways in which I try to trick myself, how I try to "get away" with things. Again: If I am going to recover fully, I need to not trick myself. It's easy enough to recognize my ED when it's telling me to binge or restrict; it's harder to identify it when it's leading me to hot yoga or crazy 1970s books on macrobiotics. But I recognized this as a trick, which is a start. A couple of months ago, I wouldn't have.

Grocery Shopping, Levity, Recovery

I've always liked grocery shopping. I like going at off-hours--the piped-in music that's carefully calibrated to create a sense of well-being does exactly that to me, and when the store isn't heavily populated I can dance my way through the aisles. And I do: I shuffle off to Buffalo in frozen foods, I heel-toe my way through whole grains, I shake it in condiments. For all my food hang-ups, shopping for groceries has always brought me a sense of joy. (I once went on a date where the guy suggested we go grocery shopping together, and I was in heaven. But he smelled weird, so.)

So on my first official grocery trip of recovery, I was none too pleased to find myself panicked. The rules had changed. My assumptions about what I "could" and "couldn't" eat were in flux, so what had been a pleasant, simple routine was literally making me dizzy. What cheese should I get if it's not for a party, just for me? I "can" drink juice now--what kinds do I like? My god, the cereal aisle! I stood in front of the nuts section for a solid four minutes trying to decide if I could let go of the raw-foods dictate that only raw almonds were acceptable.

I knew that my reaction was understandable, but it was also disappointing: Was this paralysis what the future held for me? What new rules would I come up with for myself? The whole point of recovery is to make my life fuller, and because of the rules I'd come up with for myself in my normal grocery shopping, it was something I could relax into. I liked reading the backs of packages, I liked the constant back-and-forth of putting things back. It was a direct channel to expel my food anxieties; it contained them in a public manner--I'm not at home bingeing, there's nothing to be ashamed of--so it felt safe. I could relate to the world and food in a controlled environment without having to make the choice of what I was actually eating in any given moment. That's where the fear came in; that's when it wasn't enjoyable. Grocery shopping may be panic-filled for other ED sufferers; for me it was a joy.

Today was another grocery shopping expedition, the second one I've done with my newly developed list of staples.* I came to the yogurt aisle. Last week, I picked yogurt just on what sounded good, and found a new brand that had passionfruit and mango, two of my favorite fruits. I bought it without looking at the nutritional information, and only upon eating it and finding myself saying THIS IS SO GOOD out loud, alone, in my apartment, did I look--it was full-fat yogurt. I don't think I've ever had full-fat yogurt before, except as a part of a dessert (the one place I've never skimped--full-fat, real-sugar everything--which is probably why that, and nothing else, is what I would binge on). So today, I picked up that flavor again, and three other flavors of the same brand, all full-fat. And as I put them in my basket, I got this feeling in my solar plexus--light but full, a sort of content elation. It wasn't giddiness, exactly--it felt too deep to be that. It felt like a release.

The last time I felt something similar was the weekend after I broke up with an ex-boyfriend three years ago. It was a troubled relationship with a troubled person, and I'd been steeling myself for the unimaginable waves of pain that would hit once I left him. They never came. Instead: I woke up on Saturday morning at 8 a.m. without an alarm, jumped out of bed, and without putting too much though into it, started doing things that I had put off for years. I dyed my duvet cover. I scrubbed my cabinets. I took a dance class. I cooked myself a good meal. It was April, the time when New York begins to percolate with a certain kind of vibration, and for the first time in the six years since I'd been with him, I was a part of that energy. I walked through the city fully alive, fully awake. I remember it now in candy colors: the pink of spring coats in Soho, the green of the first batch of spring produce at the farmer's market. And, as in this weekend, it wasn't giddiness: It was seeing the world in the way that I'd be able to from that point on.

That feeling wore off, of course. And when it did, I was confused: Breaking up with him was the hardest thing I'd ever done in my life, and I'd thought that the floaty feeling would be my reward--it was supposed to stick, to make sure I knew every day that I was finally happy, dammit.

I'm better prepared this time around. Happiness wasn't my reward for leaving my ex; leaving him was reward enough. I still had all the troubles I'd had, including the ones that led me to get into such a crappy relationship in the first place, but I didn't have to deal with him anymore. And it's the same with the levity I had in the grocery store today. I'm glad I had it--I'm thankful for all the bursts of revelation, all the jumbled emotions I've had since beginning recovery. But that is now what I'm doing it for. I am in recovery not to have the feeling of breaking free, but to be free. I don't think I'll ever take recovery for granted, but I see that the goal is to take the actual liberation for granted.

So: I'm going to enjoy those moments. I'm going to eat the full-fat yogurt and be thankful. I'm going to waltz through the grocery store when it's called for, but I will not cling to that as proof of my recovery. Recovery will come when I have the yogurt just because it tastes good, not because of what it signifies. It hurts to type that, because food has been a signifier for my whole life, and it's hard to give that up. But what I get in exchange is worth more.



*I sat down and made a list of foods I wanted to make sure I always had around so that I'd always be able to make an appropriate meal or have a good snack without having to go to the grocery store at the last minute. I look at it on Sunday, see what I do and don't have, and then go shopping. This is probably what most people in the entire world do, but I've never managed to do it until now.

"Now It's All Ruined": Perfectionism

Art therapy has been a mild letdown until today. I have artistic impulses but little artistic skill, so I was looking forward to having a roomful of chalks and pieces of felt and watercolors and told to "run with it," with little import placed upon the final product. But more often than not, I'm left feeling confused by what I've created, or I intellectualize it.

But today, I was in a sort of haze all day--which, before I started treatment, was my default state. But in the past month, I've only rarely felt foggy or out-of-it; part of that is eating correctly, part is awareness, part is unmasked anxiety vigorously surfacing through the shroud of depression. So when we were told to create the "here and now," I wanted something muted, foggy, hazy--gray felt and olive mesh over periwinkle paper, with strips of black funneling through.

When I was explaining my piece, I used those words: muted, foggy, hazy. But the therapist noticed that letters were peeking out underneath pasted-on bits of felt, and asked me to share the words if I felt comfortable. I did: "Don't Pass Me By" (the Beatles song came to mind); "There's Luck Around Every Corner" (a tune that only came to me in-session--I'm not normally a songwriter, so it's Words and Lyrics By ED-NOS, I suppose); "just say it." I'm not sure what that means--but the obscured phrase that made my face go hot was: "Now it's all ruined."

I was referring to the piece of white paper that was covering the words. I'd intended to lightly chalk it with yellow and wound up getting it dirty--ruining it. But my reaction made me see that I meant more: the days I felt were ruined by bingeing, the "diets" I felt were ruined by me sating my hunger; the afternoons with my father that would be ruined by him exploding. One of the most hurtful things anybody has ever said to me was that I ruined his birthday. (He was a jerk and said it to be hurtful, which it was.) I am petrified of things being ruined. It's why I'm so eager to sweep personal tensions under the rug--tension might ruin the day. It's why I quit my first job and why I never gave editing a bigger chance. It's why I don't wear my prettiest dresses. It's why I follow my meal plan practically to the letter and yet still play games with myself about what I can "get away" with while doing so.

It's why I restrict or binge, and find it so difficult to do neither. A day is good or a day is ruined. I haven't considered myself a perfectionist since dropping AP history in high school--perfectionists, after all, are perfect, and I wasn't. But my non-perfect academic record and long (long!) bouts of slackerdom don't mean that I don't have perfectionistic tendencies. If anything, the slackerdom indicates the opposite: I don't want to write unless what I'm writing is good. Which makes me never want to write. This blog is freeing for that reason--I'm structuring my thoughts here, yes, but I'm not trying to let loose perfect pearls of recovery wisdom that will make the reader weep with perfectly worded recognition. I'm just sharing. It's good for me.

Hyperawareness

My stated recovery goal is to eliminate my disordered eating behaviors and develop better coping mechanisms for anxiety and depression. My ultimate recovery goal, however, goes farther and will take longer: to turn off my mental treadmill of disordered thoughts and poor body image.*

Since starting recovery, I've found that I'm hyperaware of my eating.
(Obviously, hyperawareness of my food intake is nothing new to me. And this is a far cry from the disordered hyperawareness I've engaged in before...mostly.) Even when I'm not resisting impulses to restrict my intake, everything I eat takes on a new level of meaning. I'm having a salad for lunch, so I don't have to find an extra vegetable at dinner; I had a glass of juice midday, does that count as another fruit serving or just as a snack? There's no such thing as grazing from the potato chips bowl or having a bonbon anymore. I give myself those things as allotted exchanges or scheduled snacks, so it's not like I'm falling into good-food-bad-food thinking--but neither am I eating normally.

The whole idea of going on the meal plan was to regulate my eating behavior, which is working. But the thing is, as much as I restricted before in order to compensate for my bingeing, 70% of the time I wouldn't have been in a space where I wouldn't let myself graze from the potato chips bowl. That 70% of the time, I'd munch from the bowl at parties; would have a beer; might have an afternoon cookie. That 70% of the time, I'd at least appear normal to an observer, regardless of what I was doing for meals or at night. But now--now that I'm in treatment and feel as though everything that goes into my mouth means something, whether it means that I'm getting my protein exchanges or having carbohydrates where they still feel odd or am having one of my thrice-weekly desserts--now that observer would see me refrain in most instances. Now I don't appear normal.

I'm nervous about treating my meal plan as a diet--as another plan for me to get freaky about. My body will respond much better to a wholesome meal plan than it would to, say, my raw-foods phase (I felt great while doing raw foods, but "great" in that "I'm restricting every day and feeling TOTALLY AWESOME because of it" ersatz narcotic way, not in a truly healthful way). So at least my body is taken care of, but what about my mind?

So here comes my refrain: It took me 25 years to get to recovery; recovery will not be complete in my six weeks at Renfrew, or six weeks beyond that, or six weeks beyond that. I am hoping it won't take a lifetime--I'm hoping that I will get to a point where I'm able to eat intuitively and stop the whirring of mental calculations. But it will take time. I know that my body feels miles better, and my mind scads sharper, now that I'm nourishing myself properly. That is a victory. I think that the meal plan will eventually settle in and my vigilance will wane, if I pay as much attention to the rest of recovery as I have the meal plan. I'm ready for my thoughts to go elsewhere.

*Here's another place where finding "normal" feels impossible. It's hard to find the mythical "normal" eater, but doubly so to find an American woman with a wholly intact body image. I don't want to set a goal for myself that's unachievable; is it possible for anyone to feel only thanks for her body, no forgiveness, exceptions, or qualifiers needed?

Why Kate Moss Doesn't Matter

One of the most remarkable surprises I've had in recovery is how little I'm thinking about my shape or weight.* My body size has preoccupied me for even longer than my eating disorder; I remember being eight years old and trying to decide between letting my stomach go au naturel (pooched out but with a slight indent at the waistline) and sucking in my stomach (flatter stomach but with no waistline). There have been periods of my life where I have thought about my body fat every single waking minute of the day.

Logically, I'm not surprised. I know that eating disorders are about control, not about losing weight or even about food. So in recovery, my thoughts are certainly food-oriented--but instead of thinking about food I want to eat and will deny myself, or about food I'm going to binge on, I'm thinking about food combinations, satiety, getting my proper exchanges. I still daydream about food, but overall it's been non-disordered.

More important, though, when it is disordered I'm able to look at it and examine it. Sometimes I merely tell myself to stop; more often, though, I ask myself, Why this? Why now? Why is that image popping up now; why are those words affecting me now? In short, I'm finally able to look at the cause, not the symptom.

And that's what I like about Laura Collins's take on the Kate Moss "nothing tastes as good as skinny feels" bit. A month ago, prior to entering treatment, I would have pshawed the thought that the skinny-model phenomenon wasn't a primary cause of eating disorders. But--hello!--I have an eating disorder: I have a myopic focus on the body. Whatever anger I managed to take outward instead of inward, I targeted toward what I perceived as the problem: I wasn't skinny enough, and the reason I thought I wasn't skinny enough was because of the images I was absorbing. That anger, plus the righteous anger that comes with awareness of the double standard surrounding women's appearance, creates a laserlike focus on those images.

But those images weren't the problem, or at least weren't the locus of the problem. My desire to be thin was a symptom of my eating disorder, and my focus on those images a secondary symptom of that desire. If my true problem were merely a sheer desire to look like a model, I'd be abusing my face and hair the same way I have my body--plastic surgery, expensive hair treatments. But while I've certainly looked in the mirror and wished my teeth were more even, my pores less visible, my hair more naturally picture-perfect, it pretty much stops there. A bit of makeup, a deep conditioning, and I'm through. I treat my face much the way I imagine a non-disordered woman treats her body--wishing it were more to her liking and taking certain means to ensure that it's closer to her desires, and then directing her energies elsewhere.

This isn't to say that we shouldn't continue to object to the iron maiden of beauty presented to us. What woman in the western world hasn't looked at a cover-girl model and felt inadequate? What woman hasn't cursed her body for being too fleshy, or too flat-chested, or too short, or too wide-hipped--the standard being the image of a model who is paid to look the way she does, and that image manipulated to inhuman proportions? Every day, women feel robbed of our own brand of beauty because of these images, and I'd love to see our culture's definition of beauty expand thousandfold. As a feminist--as a woman--I'll continue to seek out those images, applaud outlets that dare to use a wider definition of beauty, do my best to avoid those who take the narrow path.

This also isn't to say that those images don't play any role in eating disorders. Besides being fantastic fodder for using symptoms, they normalize body dissatisfaction and "fat talk," making it easier for those with EDs to engage in disordered behavior without others noticing. And, of course, the desire to be model-skinny has kick-started many a diet, which creates hungry people, which leads to disordered eating, if not eating disorders. But I'm happily signing on to Ms. Collins's rant nonetheless. The woman and feminist in me cares. The eating disorder patient in me doesn't.

*This may seem contradictory to last week's Rice Meltdown, which was, on its surface, provoked by appearing to have gained weight. But given that at its core I've always been more preoccupied by calories and food than by my body weight, and that an inconsistent up-down of less than two pounds has never bothered me because I know full well that it likely has nothing to do with my actual body fat, I can now see that it was about trust, not weight. Again: Weight was a symptom, not the root problem.

Sitting With It

We have weekly weigh-ins at Renfrew. I'm guessing that the idea is that the staff can monitor by our weight whether we've been following the meal plan. Some women are weighed blind; I'm not one of them. Today I wish I were.

I have followed the meal plan very closely. I'm not always 100% perfect with it--but my slip-ups have been negligible. (I didn't eat enough for lunch on Saturday to pre-compensate for a big meal that night, which turned out to be not that big; I went over on exchanges a couple of times, but in the course of a normal meal, not bingeing--two starches over because I had two slices of pizza to get enough protein exchanges, for example.) And I have accepted on blind faith that my nutritionist is right: I will not gain weight with this plan, and in fact will probably lose some weight.

But this week I was up 1.5 pounds from last week. Now, I know full well that that means exactly nothing. Nothing! The clothes I was wearing, my water retention--1.5 pounds is utterly meaningless. But it still sunk me: I had been doing everything right, and I felt like my body was repaying me in fat.

I think I acted out at dinner as a result--I was supposed to eat a cup of rice and it felt like punishment. Punishment for having been fat in the first place, even though I'm not overweight by BMI standards. Punishment for every minute slip-up I've had; punishment for years of fucked-up eating that may have damaged my metabolism. Punishment for wanting to eat, punishment for being soothed by foot; punishment for having gotten to this place, even though "this place" is far, far away from where some of my fellow patients are. (I'm certainly on the healthier end of the spectrum there.) I didn't finish my meal, and the more the therapist intervened, the more upset I became. She gave me a supplement--which I think a part of me wanted (I wanted to get it, not to drink it), as a weird sort of badge of defiance. I think there was a part of me that was curious to know what would happen if I wasn't the model patient for once; if I said "fuck this" and didn't eat what I was supposed to. And doing so at Renfrew was a safe place to do that. There was support around me afterward; there was a therapist reminding me via the supplement that, yes, I really do need a cup of grains; nobody was going to either boot me out or treat me somehow "special" because I didn't eat my meal.

We talk a lot about "sitting with" a feeling. As in: You're anxious; can you just sit with that? "Sitting with" a feeling is a positive coping mechanism in and of itself, up there with reaching out for support, or going for a walk, or distracting yourself with a movie. It's not something I'm very good at. But the only way to get better at sitting with a feeling is to just do it.

So: I feel fat. Part of that is literal; I run my hands over my stomach, feel my flesh, feel my roundness, am upset. But "fat" is not a feeling--so what exactly is it I'm supposed to sit with? I feel disappointed in myself for not having exercised enough. I feel ashamed at having acted out at dinner; I feel sad and weak that a number on a scale can mean so much to me. I feel sad that I will never be as thin as I once was; I feel sad about no longer leading the life that symbolized (I was confused, but I was also having a lot of fun--everything felt new to me). I feel angry that I care about my weight; I feel angry that I'll never look a way I'll never look. I feel angry that I feel angry. I feel sad that I feel sad.