July 3, 2008

Joy’s Letter

Introduction:
What follows is a letter written by Joy (not her real name), three years after treatment. Eating disorders at times present with a number of associated symptoms. A nine year follow-up of this case will be published in an upcoming guide for families and sufferers.

I had been given many diagnoses and opinions from many well-meaning specialists in the mental health field. They included manic-depressive with rapid mood swings, severe anxiety disorder, borderline personality disorder, depression, bulimia, and anorexia. I was on seven different medications; all prescribed in an effort to enable someone as sick as me to live a somewhat normal life. I was very dependent on my medicine. I would not consider missing a timed dosage of any one of them for fear that I (or one of my many disorders) would break through.

On a particularly frustrating day I would use my diagnosis as a consolation: “It’s O.K.,” I’d say, “I’m too sick to expect much of myself anyway.” I was hospitalised a number of times and spent a year in a day-program that was designed to help ‘mentally ill’ people cope with their daily lives and learn to become independent. It was a wonderful program that included things like goal setting, time management, support groups, and daily meetings with professionals in the mental health field. All I had to do to receive the maximum benefit from this program was to accept that I had a mental illness, that I would always have a mental illness, and that I would need to be on medication for the rest of my life.

Daily, I would tell doctors in one way or another that I was not willing to accept that as fact, and that I was interested in getting well and moving on with my life. Daily, they would tell me that I not only needed to accept my ‘mental illness’ status, but that they could not help me until I did.

Eventually, I stopped talking with them about it, but secretly hope I could prove them wrong someday… It became a private vendetta, one which I eventually found difficult to maintain. Well-meaning people would tell me or insinuate that this sort of denial thinking was, in fact, part of the ‘illness’ itself. I did eventually graduate from this program, considered ‘stable’ on my seven different medications (I was, however, still bulimic, had frequent anxiety attacks, and resorted to self-destructive behaviours when things got too stressful.)

My release was conditional; I needed to find a psychiatrist who would monitor my medication. I met with this doctor once a month and he refilled my prescriptions. We spoke very little. I needed more. I wanted to work on my life, my relationships, figure out why I was so angry all the time. I had one or two sessions with 5 different doctors, all of which I walked out of very disappointed and/or angry. I didn’t know what I was looking for but I did know that none of these were it.

Dr Fishman – a different approach

My sixth try led me to Dr Fishman’s program in New Jersey. I was still terrified of my medication lapsing, so our first interaction was on the phone; me pleading with him to refill my many prescriptions. I made an appointment for a few days later.

The minute I met him, I knew something was very different. He didn’t want to hear long stories of my mental health history. As a matter of fact, he didn’t want to talk about my past very much at all, except to find out briefly what brought me here. He basically wanted to know how I was doing right now. Where did I want to go, and what were my plans for getting there?

A part of me reacted violently to this ‘taking responsibility for my life’ approach. “How dare he!” I thought. “Doesn’t he know I’m ‘sick,’ way too sick to be expected to participate in this line of reasoning?” I was very angry. I almost left, but I didn’t. You see, there was another (very medicated) part of me that was yearning for this sort of recognition, this kind of opportunity, this chance to use my own inner strength to make something of my life. Here was someone who believed in me, who validated my strengths.

My therapy became about what I could do well, and looking for ways to do more of it. No longer was I focused on the limitations of my ‘illness’. As a matter of fact, it seemed to be a sort of unspoken rule in this place to leave ‘limitations’ and ‘illness’ outside the door before you came it. In this process, I came to believe in myself again and I began to flourish.

Soon I was able to stop my medications, one by one. I was required to bring the people I was in close relationships with into my sessions, one at a time. This was a very important part of my treatment. We didn’t talk ‘about’ my life, we worked within it.

One of the things I discovered is that I tend to isolate myself, especially when things get tough. We had worked on this in my previous day program a bit, but we called for support only within our groups in the program. Dr Fishman essentially was asking me not only to do this in my daily life, but to bring my friends and family right into his office, so I could get my support network set up right here and now.

There were times when this was the last thing in the world I wanted to do. (I would have much preferred to talk about how hard it was.) But as difficult as it was, I felt like ‘I’ was really doing my life; I was at the helm. I discovered in this process why I was so angry all the time. I felt alone (I isolated myself), I felt powerless (I hung around with amateur ‘shrinks’ and let them define me). ‘I’ was disappearing.

In our sessions, I let people in my life know, one by one, that I wanted their support in where ‘I’ was going. I established that I was strong and capable and that I could be even more so with their support. I learned to ask for this support in effective ways.

I would say that the most impactful insight for me has been the realization that I am, in fact, not ‘mentally ill’, I am very, very sensitive. I’ve had difficulty setting boundaries, and I tend to take on too much, which I try to do alone. Once we broke it down into these basic components, it was much more manageable. I’ve been able to make powerful changes. I actually keep a note which I read when things get hard and I need to remember. It begins with: “I am not mentally ill – I am a very sensitive person”.

I look to see what I need to do to take better care of myself. Mostly it begins with calling a friend; telling the truth about something uncomfortable, or telling someone how much they mean to me. Above all it means remembering that I am a super-woman to do what I do in my life, and that I need to let up on myself.

Bulimia disappears!

Another incredible outcome: my bulimia began to disappear. I felt like I just didn’t have a craving to overeat anymore. We never worked directly on my eating disorder; as a matter of fact, we rarely mentioned it. Instead we worked on making effective changes in how I do my life.

I began to see that my eating was directly related to who is in charge of my life. If I let others tell me how it is, if I can’t tell someone the truth when I need to, or if I’m withholding love in any way; it directly affects my eating. The more I worked on these areas, the more my eating became normal. My bulimia is basically not ‘my’ bulimia anymore. I’ve learned to see my now very occasional bouts wit it as a signal – a signal that something is out and that it’s time to take a look at what I can do to take care of myself better.

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Book: Enduring Changes in Eating Disorders

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