205 Days

205 days ago, at the crack of dawn, I left dh and ds for what I thought was going to be 6 weeks of treatment for atypical anorexia. 205 days later, I am being discharged from the program, a healthier, happier and completely changed person. Although difficult in many ways, this extended treatment was the best thing that I could have ever done for myself. I want to thank all my supporters, near and far for helping me on my journey. I also want to thank my therapists, dietitians and other staff at Hilltop for their expert care and guidance that has helped give my my life back. Today will be a day of mixed emotions as I leave the program that saved my life and also look forward to flying home tomorrow to start a new chapter of my life.

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Moving to IOP

It’s like every time I get on board with blogging…I get interrupted in the flow.  But as of this week, I think I can be much more consistent with my blogging because I am going to have more free time.

Tomorrow, I start my first day of the intensive outpatient program (IOP).  IOP is significantly less demanding in terms of program time.  Instead of being in programming for 10-12 hours a day 7 days a week (although the past few weeks I have been having weekends off so was only there 5 days/week) I will be in programming 4ish hours a day 5 days a week. The meal system changes too.  At PHP, as you go through the levels, you become more responsible for your meals.  At IOP, you are responsible for all of your meals and only have one supervised meal a day.  And that meal is something you bring in yourself.

So, I am going to have more free time, more meal responsibility and less programming. This part of the program is going to be the most challenging and the most work out of all the levels I have been in so far.  I am a little scared.

Of course, the change of programming means a change of treatment team (again!).  I am truly fortunate, in that my psychiatric NP from home is picking me up for psych stuff while I am in IOP.  Since I adore and trust her, I really couldn’t be happier about it.  However, I will have a new therapist and dietician.  I have met them both and I really like the therapist and Kyla highly recommends her.  I actually ran into Meg a few days ago and she also thinks the new therapist will be a good fit. <phew> The new dietician though….I have met her and….Let’s just say, I am highly skeptical.  And I am really frustrated because I felt like she was questioning my integrity and also wanting to over-support me.

My PHP dietician at Hilltop has been very hands-off with me for the past couple of weeks.  I got thrown into my first solo-weekend day with no support from my dietician, but I made do.  After that, I expressed concerns about portioning and food-anxiety, etc. and my dietician kept telling me that I was doing fine and that it wasn’t a problem.  She didn’t review a menu with me, didn’t ask me what I was eating…She just reassured me that I knew what I was doing and to keep doing it. Okay…So, I did.  Honestly, she was totally missing me on my need for support, but I muddled through, kept asking for support and not getting it and then just saying, “Fuck it” and doing it on my own.

Now the new dietician wants me to track every meal and send her daily “Honesty Logs.” This is when I got mad.  First of all, I have never had to do an Honesty Log.  Those logs are reserved for people who lie, deceive, and try to cut corners without telling their team.  I am totally insulted that I have been asked to do Honesty Logs.  I have a lot of integrity and am always honest with my team.  I don’t lie or try to deceive my team.

And….If I was given so much autonomy by PHP dietician, who repeatedly assured me that I know what I am doing and was totally hands-off with my independent meals and meal planning, then why do I have to be micro-managed now?  Argh!  I am so annoyed.  The new dietician tried to explain it was to better use our appointment time so that we weren’t talking about food and what I had and how it went, but so we could do more important stuff.  ?????  Hello???  Does this make any sense?  I am in ED treatment.  Talking about food and how meal planning and eating is going seems kind of important to me.

Sooo….I am skeptical.  Of course, the most annoying thing is that I was pissed at our transition meeting and she knew it.  I told her that I would consider whether or not I would do “Honesty Logs” and if I decided I would, then we would not be calling them “Honesty” logs.  I am not sure she knew what to make of that.   Ummm…and I don’t know exactly how I did at making a good first impression.  😦

Oh…and one last thing about IOP.  It is in an ugly place.  I mean that literally.  Both the residential program and PHP program have been tucked in woods, peaceful, serene….Deliciously soothing to mind and body.

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IOP? It’s in a totally more urban area and it overlooks a parking lot, McDonald’s, Krispy Creme and gas station.  And the view just past all that is the highway.

I don’t like change.

 

 

 

Panic and Hope

And then sometimes, the panic about food just hits me.  Like, it is a visceral response where I feel the breath sucked out of me and my anxiety rockets through the roof and I feel almost woozy and as if I am imploding.  The panic is because I have been eating food.  I used to panic like this really frequently about food.  Now, it is less frequent, but it will just hit me randomly and I feel like, “What am I doing?!  I have been eating food! I have to make this food go away.  I have to do something…I can’t eat like this anymore.”  Of course, “eating like this” means following  a normal meal plan.  But to me, it seems like an excessive amount of food and the repercussions of eating so much food for so long….Well, I just about can’t take it.  And so the panic hits me…And the room whirls around me and I need to catch my breath and collect myself and talk myself down from the fear.

It’s moments like this when I know I have an eating disorder.  Not that spending almost 4 months in eating disorder treatment doesn’t remind me of that every day..

Now, instead of escalating the panic, I can talk myself down from it.  I don’t have to engage in behaviors to make it better, and lately, more days than not, I feel like I have actually made a ton of progress.  Progress does not mean perfection or anything close to it.  But progress means that I am less attached to the eating disorder compulsions.

My dietitian got all excited on Monday because I expressed a slightly tolerant thought about my body.  She pointed out that that tiny bit of tolerance is a huge step forward.  She also said I will sort of bounce back and forth between body hatred and tolerance before I settle in mostly at tolerance (and then do the same thing towards liking and maybe even loving my body.)

I dunno…I think things are changing.  I think I am changing. It is terrifying and exciting.  This treatment experience really has the potential to be life-changing for me, because it is not just the ED being addressed, but the underlying stuff too.

Hold on…You know what I just realized?  I actually feel some hope. Hope! When was the last time I actually felt some hope for my outcome?

Hope? Is it possible?

 

 

Learning About Borderline Personality Disorder

I have known one of my peer-friends here for months now (she came to residential after I did and now we are in PHP together.)  She has borderline personality and since me coming to PHP, she has been obsessed with me, wanting to know every detail about my process here.  Every detail about everything.  I didn’t know that this is a manifestation of Borderline Personality.  That understanding would have helped me.  What ended up happening was that I felt very defensive and intruded upon by what I interpreted as her having sort of a voyeuristic interest in my life.  It was annoying…But, I never spoke to it.  I never let her know that she was violating my boundaries, I just sort of dodged her questions and avoided the issue..  I know, I know…I should have spoken up weeks ago.

So, recently, in one of our groups, she talked a little bit about her habit of obsessing with people, but I wasn’t there for most of that group, so I didn’t really hear what she had to say about it. Then more recently, she spoke about it again and I was there and I had this lightbulb moment.  First of all, she was trying to talk about me, as I am the one she is obsessed with, and I also realized how the behavior is part of her mental illness…which made me feel more compassionate about it.  Not that it’s not intrusive, but now I understand where it is coming from.

I had to leave that group right after she talked about it (about 5 mins early because I had an appointment) and she mis-interpreted it as me walking out on her and promptly burst into tears.  And then some of my peers said that she and I needed to talk. And the direct care person said that I really did have an appointment…that I wasn’t just walking out on her.

The awkward thing for the peer is that everyone knew about her obsession with me…It was pretty obvious.  But she didn’t know that everyone had seen it. Later in the day, we did sit down and talk about boundaries and her BPD and how I had found it intrusive.  And I commented about how people noticed when she and I aren’t getting along (because the intrusiveness has caused minor ruptures in our relationship from time to time.)  We have a pretty strong relationship and I guess it is just clear in the community when we have issues.  I think she was a bit taken aback by the fact that her interest in me was not a secret…But this is a small community of very hypervigilant people, not much goes by unnoticed.

Anyway…I have learned so much in the past week or so about my friend and how her mental illness impacts her and subsequently, the ripple effect that impacts me.  And she and I have actually grown together through it.  I like her a lot and I am glad that I understand her better and I am glad we talked it out.  And like I said before, I have a lot of compassion for and a new understanding of what it means to be Borderline.

Level 3

Level 3

So….Yesterday, I got promoted to Level 3.  This is the highest level at the partial hospitalization program.  I will be responsible for making 7 meals a week and as part of my transition to Level 3, I will be taking off one day a week.  (The day off was a bit of a push from my insurance…but is also good for me to trial a “home” day.) This week I will be taking off Sunday.  I go to UU anyway on Sunday mornings and programming doesn’t start until noon, so it will really only be the afternoon/early evening that will be different.  This seems like a good way to do it on my first day off.

As to the meals…I am very, very nervous about that.  I need to figure out what to have and what I can afford.  I won’t tell you which is more of a priority to me, money or preference.

Having Sunday off will be my first day of no treatment in 104 days.  As of Sunday, I will have been in full day, 7 day-a-week treatment for 104 days.  I think I can use a day off! Actually, I know I can use a day off, I have been ready for one for a while…Just kind of burned out from the whole 12 hours/day 7 days/week thing.

Other than that, it is kind of usual kind of day around here…Someone I like is discharging today.  It is sort of painful, this round after round of people going.  Basically, I am just starting to shut down about it.  I don’t even really cry anymore.  I just have to steel myself to the eventuality that everyone here that I like is going to go.  Or….I am going to go.  Sooner than later, I will be stepping down to IOP (intensive outpatient program).  It could be as soon as next week, but hopefully, it won’t be until a couple of weeks from Monday.  That transition will be hard on multiple counts.  Leaving my friends, leaving my treatment team (I will have a whole new treatment team, with the exception of my anxiety therapist at IOP), leaving Callie, and leaving the familiarity of PHP, where I have been for the past 9 weeks.  But…no need to worry about that now, right?

Callie’s Oops and the Trauma Narrative

Callie’s Oops

Yesterday morning did not go as planned. Callie had a different obligation and did not make it in to Hilltop until after lunch.   My whole plan of reading her my narrative, talking about my fears about presenting it, etc. was totally blown to pieces.  And of course, there was no sitting in on my session with Kyla.  I struggled with this turn of events.  Of course, my core beliefs were triggered, that I am worthless and not important, that I am can’t trust anybody or count on anybody, that’s what I get for being vulnerable and reaching out to someone. And I kind of sorted through the core beliefs and eventually worked my way to my feelings.  I felt hurt that she had another obligation.  I felt disappointed that she wasn’t going to be there.  And I felt scared that my plan of working with her to manage my anxiety didn’t go the way I wanted.

And of course, I didn’t actually talk about any of this during my appointment with Kyla.  Nor did I talk about any of it with Callie.

Ultimately, just before group, I got a very mini-version of what I planned on with Callie and it was helpful.

The Trauma Narrative

So, presenting the trauma narrative was horrific.  I made it through and I did not die of shame, even though I was sure I would.  I did get supportive feedback which reduced my shame and I did leave feeling better than when I went in.

Now, I have a peer who says things she shouldn’t, so she sat with me this morning and listed all the people who had had a difficult time with my narrative (as in were struggling after the session.)  I didn’t really need to hear that.  But…whatever.  This peer actually says lots of things that are upsetting or triggering to me (and it actually takes a lot to trigger me, but she always seems to hit my sensitive spots) and seems to have no awareness.  So, that was kind of hard.

But anyway…the trauma narrative from when I was 4 is done.  I am sure I will get to process it lots more in therapy, but presenting it in the group is done.

And Callie?  Callie was there in the group, and I totally was comforted by her presence. And her being there and having read parts of the narrative right before group (I had her read the parts that would be hardest for me to not skip, so that she could call me out on it if I needed it) really did help me stay accountable.  And I also knew that she had read the parts and not hated me, so hopefully no one else would hate me either.

And this morning, I feel super depressed and sad and raw.  It’s just a typical day at PHP.

 

 

 

Homesick

I woke up this morning to the sound of dog nails on the floor above me…And the muffled sounds of someone preparing for the day.  It sounded familiar and like when dh would wake up in the mornings before me and take the dogs out and start his day making his tea, while I was still cozing in bed.

So, when I was slowly waking up this morning…I thought I was home.

I am not home.  It was not my bed or my house or my dogs or my person getting a start on the day.

The disappointment is palpable.

Vision and Values

I have looked at my list of values again.  I have lot of things!  I guess when I started yesterday, I was trying to narrow it down some by both combining/sub-categorizing some values and just plain trying to weed through them.  I am looking at this list again and feel somewhat overwhelmed.  What I’ve got so far for the big categories are:

  • Authenticity
  • Curiosity
  • Growth
  • Compassion/Fairness/Justice
  • Creativity
  • Loyalty/Security/Stability
  • Autonomy
  • Determination
  • Balance/Peace
  • Family/Friends

I think I want to narrow it down….and I just realized that I want to add Spirituality.  The process of narrowing down doesn’t work too well if I add more!

Okay..

Values

  1. Authenticity –Self-respect, kindness, wisdom, honesty, consistent actions and words, integrity
  2. Curiosity—learning, knowledge, growth
  3. Compassion—loyalty, friends, family
  4. Spirituality – wonder, awareness, one-ness, wholeness
  5. Creativity—beauty, accepting imperfection, process, creating
  6. Autonomy–determination
  7. Balance –centeredness, calmness, security, stability

 

Personal Mission Statement

I will act with integrity from an authentic self, so that I may respectfully, compassionately and justly engage with the people and world around me.   I will maintain a curiosity about both mundane and wondrous things, allowing my inquiries to be opportunities for discovery and growth.  I will live compassionately and approach family, friends and others with the understanding that none of us are meant to be perfect and that judging others is a reflection of my own self-judgment.  I will let my spirit be open to the wonders of the world and have an awareness of the interconnected web of which I am a part.  I will honor my creative energies and allow and accept imperfection in my work as my hands represent what dwells in my heart.  I will live as an autonomous being, depending but not being dependent on others.  I will strive for stability and inner-calm in my life, eliminating the need for extremes, and accepting the gentle place of balance.

Okay…getting closer.  This is still in draft form…But I am honing in on it!

Emotional Development

This morning, instead of having time to blog, I am finishing up two agendas because I might be up on group to read them today.  Here they are:

  1. How Am I Responding To My Feelings The Way They Were Responded To?
  2. What beliefs do I have that prevent my feelings from being expressed?

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1.

I respond to emotions with:

  • Restricting (both emotional expression and food)
  • Historically, emotional eating
  • Invalidating my feelings
  • Distraction
  • Ignoring source of feelings
  • Completely deny having feelings
  • Isolating when I am crying

The main way I re-enact how my feelings were responded to as a child, is by ignoring their existence.  My parents didn’t acknowledge my feelings.  It was like I was in an emotional vacuum.  The times that my mother did respond to my feelings, it was totally mis-attuned and she would tell me that I was either tired or hungry.  And so she would tell me to eat something.

This food-response to feelings certainly was part of what created my emotional eating habits.  If I was upset, then food would make it better.  I was basically trained on that.  Right now, I do not emotionally eat.  Just the same way I emotionally restrict, I also restrict-food.  Only, restricting food is better because not only do I get to shut down emotions, but I get to lose weight too.  It is a win-win situation.

My mother’s response to feelings also served to completely invalidate what I was feeling and never actually look at why I was having intense feelings.  This left me at a loss to manage those feelings on my own.  Eventually, I learned that my feelings are not valid and that it didn’t matter what I felt or how badly I was hurting, feelings were not important.  The source of my pain was inconsequential.  It didn’t matter why I was hurting, it just mattered that my feelings needed to be stopped.

I continue this pattern even now.  I will avoid and distract from feelings and refuse to look at what is causing them.  It just seems easier than dealing with the pain.  And if I don’t want the feelings then why bother to figure out why I am feeling them.  If I am really pushed and really upset, I will regress to, “I don’t have feelings.”  I just shut down completely.  I don’t do it too often anymore, but it is a fall-back response when I am emotionally flooded and/or in too much emotional pain (I mean severe, intense emotional pain.)

I also deal with emotions by withdrawing physically (especially to cry).  When I was young, my parents would lock me in my bedroom when I was having intense emotions.  I used to rage and rage while in my room and then just melt into a crying mess of defeat and worthlessness.  As an adult, I repeat the pattern of the physical isolation when I need to cry.  As a matter of fact, I retreat to my bedroom, close the door and shut down.  As an adult, I don’t rage.  But I certainly crash into feelings of worthlessness, hopelessness.

2.

I also have come to have the belief that my emotions are too much for people, too big for people to deal with.  If my parents weren’t able to support me emotionally and had to lock me in my room when I was emotional, then my emotions were so big that they needed to be contained.  I could barely make sense of what I was feeling and how to manage the feelings (I was only a preschooler and didn’t have good modeling from my parents) so the fact that I had to be shut away when I felt emotions taught me that emotions must be shut away.

When I did approach my parents with intense emotions, my dad was unresponsive.  He was always emotionally unresponsive and unavailable and when he did demonstrate emotions, it was to rage.  He would rage against us kids, he would rage against nothing in particular.  He never would rage at my mother.  With my mother, my father just expressed a cold seething, but with me and my sister it was a terrifying rage and being hit with his belt.

My mother was too self-absorbed to pay attention to my emotions.  Anything else was more important than me and what I was feeling, be it her job, the soap operas she was addicted to or my sister.  If she did notice my feelings she always invalidated and dismissed them.  I never remember her letting me crawl on her lap to cry or to talk about what I was feeling. And if I ever did try to talk to her, there was correction and shaming on her part that was I was feeling wasn’t right.  But really, I was left to my own devices and as a self-sufficient kind of child, there was no real “need” for my parents to be involved in my emotional affairs.

Really, the messages I got were that emotions are bad, especially Sad and Angry.  Emotions would get me punished.  Emotions were too much for anyone, including myself, to handle and that what I was feeling wasn’t really what I was feeling.  As a young child, there was no way to make sense of any of this and thus began the development of some of my core beliefs.

As an adult, I still am emotionally withdrawn.  I feel very vulnerable and expect rejection when I try to share emotions with people, so I don’t.  And if people ask how to support me with my feelings, I often have no idea what to say.  I am afraid to feel sad and I am afraid to feel angry and I am sure if I express those emotions at/with people, it will push them away and I will be all alone again to try to manage what I am feeling with no idea of how to do it.

The Letter (Which is not meant to be sent)

Yesterday was so bad, that I am not sure that talking about it would have a point.  I cried pretty much all day.  I was in so much emotional pain that I could barely tolerate it and I had really high self-harm urges. At this point, I manage those urges much better than I did a few months ago, so I did not self-harm…But that meant I had to feel much more of the pain that I wanted to.  And so I cried.  A lot.

Aside from the hollowness of the depression, I have been dealing with some other stressors in treatment.  One is the recent departure (step-down) of a person I spent a lot of time with.  I was talking about this during my psychiatry appointment yesterday and how I have mixed feelings about this person leaving. And I told him I was confused about it…And he asked me questions about what/who this person reminded me of.  Then he encouraged me to write a letter to her…Not to actually send to her, but to work out my feelings.  I decided this is the perfect place to do it.

Dear Friend,

You and I have spent a lot of time together since you came to the residential program and then when we transitioned to PHP (on the same day).  At first, I wasn’t sure about you, as you have an overwhelming personality that just spills over with your self-loathing and negativity.  And yet, there was something about you that I kind of liked.  Plus, you took it upon yourself to spend time with me.  I know that initially, this was somewhat conditional.  It is because of your size and I have noticed that because I am bigger than our peers, that other bigger people gravitate towards me.  (Yet again, reinforcing that all anyone sees is my size.) And true to this pattern, you tried to engage me in your hatred of your bigger body by making comments to me that you thought I would participate in with my insider’s perspective.  I do enough body shaming of my own…I didn’t need to engage in yours.

But over time, we developed a rapport.  I always felt it to be a bit rocky as sometimes you are very mean.  When you are stressed, you lash out and as someone who was closer to you, I was often the recipient of the lashes.  After such episodes you would apologize, which I appreciated, but felt guarded about because the way you did it always made me feel a little bit dirty, like you were an abuser apologizing to an abusee.

And yet still we maintained a friendship that become a closeness.  People actually identified us as a dyad, knowing that if one of us was around, the other would not be far.  And I do appreciate the time and compassion (because under your vitriol, you do have a lot of compassion) that we shared.

In that respect, I feel really sad that you left.  I feel lost and alone and I have no-one to sit with for breakfast or to vent to or to just hangout with.  There are no more “walks to the car” with you.  I have an empty space in my world.  And it hurts that you are gone, I feel abandoned and left behind.  So many treatment peers have left and I feel the loss over and over again.  It is really wearing me down…So, you leaving too has been hard.  I have experienced the pain of people leaving me my whole life….I have never moved away from my hometown, but over the years, most everyone I care about has moved away.  Your leaving triggered that sadness and emptiness of being left behind.

But I don’t actually want you back here.  I am also completely relieved that you are gone.  Relieved that your negative aura is not spilling all over me and over our peers and over the whole place.  Yes, you have that much negativity and it took a lot of energy to deflect it.  I am glad that I won’t have to hear your bitching and listen to you set yourself up for complete failure in your step-down transition.  I am glad that I won’t be the recipient of your anger and mean-ness.

Did you know that your negativity reminds me of my dad?  I didn’t realize this until talking with Dr. Psychiatrist.  My dad had that same aura of negativity and that same mean-ness and would lash out when he was upset.  I realize writing this, that I think he has the same kind of self-hate you do, only he has deeply internalized it, except for his negativity and outbursts.  He is a hugely large man and you are very large too…so both size-wise and negativity-wise, you both have huge presences.  When I think about it that way, I realize that perhaps you were more toxic in my world than I realized.  You also remind me some of my mom…Not as dramatically as you remind me of my dad, but also bearing some of the negative traits she had.

I suppose, it was no wonder I was drawn to you as  friend, you were the perfect blend of my parent’s dysfunctions and since (according to Hilltop’s treatment philosophy) we tend to re-enact our experiences, you would be the perfect person with which to do so.

Only, you are not my parents and I am not a child.  So, I was able to understand that lots of your issues were things you own, not me.  But still, there was a lot of confusion on my part as I couldn’t quite make sense of our relationship.

Either way, it kind of doesn’t matter now.  Now you are gone and I doubt you will be there when I step-down (as you have basically set yourself up to fail).  And honestly, while I will miss you…I am totally relieved.  You have been a treatment friend, but not a real friend. I don’t plan on keeping in touch with you.  I don’t plan on letting your negativity be part of my life.  And I only feel a little bit guilty about setting this boundary.

I hope that you can heal in the ways you need to.  And I hope you give yourself a chance and don’t sabotage yourself into failure.   And I hope you find the family-of-choice that you need so that you can be loved and supported.

And I hope that you don’t start purging again.

But I also have hope for me.  And you don’t really have a part in holding that hope with me, so I am going to thank you for what time we shared and the friendship we had.  And now, I say good-bye.

–Heidi