Recovery Matters by Leslie E Murray

"One size" fits none

2011-12-18T21:39:20-08:00

As a young girl, I was fascinated by the concept of "one size fits all." The idea of the same shirt being able to fit me and my father was amazing. It also made shopping easier. Looking at old pictures, I realize now that the "one size" shirt didn't fit me well (went to my knees) and was still loose and hung below my father's waist. While the shirt did address the need to cover the torso, the fit was poor. The best fitting garments that I've ever had were tailored to my body. I never questioned why these garments worked so well for me, because it was evident. Someone was taking time to measure me and make certain that I received a product that fit my needs. So when I think of they way we often want treatment and recovery paths to proceed, it makes little sense. Comparing ourselves to others is a no win proposition.

Amazingly, it took class action lawsuits to slow the use of the term "one size fits all." Now it is more common to see garments labelled "one size fits most," or simply "one size." Hopefully, the idea of "one size" will fade. When we look for providers, we want those that tailor the treatment to our needs and address our specific concerns; we don't say "give me the standard round of care."

So why does it become difficult when your recovery doesn't keep "pace" or mirror the recovery of another? In this journey, I've met people who recovered after 6 months of treatment and those that recovered when in their late 50s. Recovery is never too soon or too late. While we know some factors that are predictive of recovery, we can still never predict with certainty. The literature may hold evidenced based treatments, but even this has to be tooled to suit the individual.

I write to hopefully encourage patience with the process. We must enjoy the journey and learn from our mistakes. Find the tools that you need to make your recovery a success. Resist the temptation that jealousy and envy often pose. Instead, learn to celebrate your own uniqueness. Find providers that understand your challenges and work actively with you to make these strengths. Lastly, believe in the power of your ability to change.

Peace be with you.

Speak your truth

2011-10-20T20:34:39-07:00

At the past Lobby Day sponsored by the Eating Disorders Coalition, we were encouraged on multiple occasions to "speak our truth." I found this phrase endearing. As people who may not have naturally honed the skills needed to be assertive, encouraging the telling of our stories is simply an empowering process. In speaking our truth, you tell things the way that you feel them, uncensored.

"Voices not bodies," is a refrain that has been propagated through eating disorder recovery circles. The ability to use one's voice is in fact very powerful and reaffirming to a budding self esteem. Dis-ease can be thought of as externalizing (acting out) or internalizing (acting on self). While neither is healthy, when we internalize (anxiety, depression, substance abuse, eating disorders) feelings are expressed through self blame, doubt and destruction of the body. Using our voice allows us to channel emotion in more positive directions.

Surprisingly, in many facets of life I find myself not as assertive as one would expect. A natural evader of conflict, I would prefer to keep the peace. I often joke that I was taught to be a physician, but I had to learn the rest of life on my own. I'm still learning to seek out my own opinion first when making life decisions. This is true for so many of us. We all have spirits that must be cultivated and nurtured.

Lobby Day was a great exercise in speaking my truth and telling my story of being a provider trying to practice medicine in a managed care environment. It was my opportunity to tell not only my own story, but the story of my patients who have struggled. I spoke without fear of retribution or scorn. I would love to say that this type of supportive environment exists in all parts of life, but it doesn't. My thoughts are now that it can.

I am responsible for my environment. I am responsible for the way I allow others to treat me. I feel a responsibility to educate the schools and help those who have not yet found their voice. I have a responsibility to be my authentic self and to ignore the comments of those who don't agree. I also have a responsibility to treat others with kindness and to not make assumptions about their life paths.

In speaking my truth, I continue to break down the barrier of shame and regret. Recovery is about the ever evolving ability to live in truth. I recently heard in a talk that our defense mechanisms include denial and avoidance because they can be soothing in the moment. They may soothe, but they do not solve our problems.

I invite you all to become problem solvers. I invite you to speak what is true. Tell your story. Realize your worth. Your words and voices will inspire others and most importantly, inspire yourself.

Peace be with you.

Finding health through self love and acceptance

2011-08-27T19:41:34-07:00

I was taken aback after reading Jessica Weiner's recent article in Glamour magazine. Soon after, I learned of a book targeted for 6-12 year olds about a overweight girl who diets and subsequently (magically?) becomes a popular soccer player. Both were the source of much debate and discussion. Many questions recurred about the premise of the "Health at Every Size" (HAES) movement and when (and if) weight loss should be a goal. Throughout it all, one overriding theme became more apparent to me: Loving yourself means taking care of yourself.

Regardless of where we lie on the weight spectrum, our goal is health. The definition of health is ideally all encompassing and will incorporate the spiritual, mental, emotion and physical. True health cannot exist and thrive in the presence of body hate and eating disordered behavior. While health can occur outside of the prescribed "ideal" body weight and often begins with body acceptance, it doesn't end there. Lastly, true health comes from positive cognitions about ourselves, not from shame or negativity.

HAES encourages health by following the path of self love and acceptance. When we care about something (or someone), we take care of it. If weight loss must be undertaken due to medical reasons, the approach should not be through a path of fear and guilt, rather through a desire better care for the body.

Love yourself and show your body love by giving it nourishment, cleansing the mind of negativity and by engaging in movement.

Peace be with you.

Weight stigma at the physician's office

2011-07-26T20:05:22-07:00

The day I learned of the blog carnival hosted by Voice in Recovery and sponsored by the Binge Eating Disorder Association, I found myself in an unique position. I learned I was being given the opportunity to design my new office. The first blog topic? Weight stigma.

I had wondered how many times I'd walked into a physician's office and seen chairs, medical equipment, gowns, and restrooms that didn't accommodate a variety of sizes. Too many. I'd also heard painful stories about lectures about weight when a person presented to the physician for a non-weight related complaint. A physician lecture (on weight) often occurs after patients have sat in an uncomfortable waiting room chair; had their blood pressure taken on the forearm due to lack of proper fitting cuffs whilst sitting in a gown 2 sizes too small. These are the people who visit the physician. Others choose to forego health examinations due to the indignities suffered. I have difficulty seeing this scenario as empowering and inspiring healthy choices, yet it happens.

All of this is part of weight stigma. It also includes the assumption that thinner automatically equates a healthier disease free state.

It will be my pleasure to provide a comfortable area for people. People see their physicians to share maladies and problems. Ideally, the visit shouldn't create problems due to logistics. An important part of addressing weight stigma involves empowering people to ask for their needs to be met. Stigma is also only powerful as long as people let it continue to exist. Let's watch our words and take care of each other.

Peace be with you.

Dr. Nancy Snyderman gets it wrong on eating disorders

2011-07-19T22:57:58-07:00

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While I commend The Today Show for covering eating disorders in women over 30, covering the topic is just not enough. I was beyond dismayed when I saw the embedded segment. Dr. Nancy Snyderman, an otolaryngologist serves as the chief medical editor for NBC News and sits in for the interview.

Admittedly, in a five minute interview a full lecture can't be given on eating disorders, but I expected more. Here's what we don't hear from Dr. Synderman: 1.) Eating disorders are thought to have both genetic and environmental triggers (multifactorial in etiology). 2.) Full recovery is possible. 3.) Treatment consists of team based approached usually combining medical, nutritional, psychological and psychiatric components.

Here's what we did hear: 1.) We loathe our bodies. 2.) {It is understandable} that beautiful blond suburban women have to hold themselves to a higher beauty standard. 3.) Eating disorders are dangerous illnesses that kill. 4.) Eating disorders are about control. 5.) Television personalities, including physicians, try to project an image that they "believe" society wants, not who they actually are. Where is the choice in this matter?

With the exception of #3, I have great difficulty agreeing with Dr. Synderman. It isn't natural to loathe your body. "Beauty standards" are relative and a creation of society. They also vary from population to population. Eating disorders are NOT always about control.

The good news: There are great treatment centers addressing this problem, like Renfrew. You are not alone. Please seek help today.

Peace be with you.

A piece of my mind: "Manorexia"

2011-07-18T15:39:18-07:00

The Journal of the American Medical Association often features essays by physicians titled "A Piece of My Mind." Often refreshing, and often anonymous, this offers physicians an opportunity to be what they have little opportunity to...be human and express emotion.

Today, I decided to offer my edition. While news was being made that the prevalence of eating disorders is increasing in males, I kept seeing the word "manorexia." I personally found it demeaning. (Suppose this is similar to a man saying he is a feminist?) I won't pretend that I don't understand the shorthand and why the word was created, but it is crude. Should we then create a word for males who are diagnosed with bulimia or binge eating disorder? Probably not, because it isn't as sensational.

Similar words are drunkorexia and diabulimia. Orthorexia is also a newer term, but more research will be required to determine if this is a separate disease entity.

None of these words are in the DSM-IV and doesn't appear that they will be in the DSM-V. I ask, why are they used? Does this term help men feel that they are suffering from a man's illness?

The "illnesses" would be treated according to their symptoms. Do we, unlike the French automatically accept words that people insist on putting into our lexicon; or do we decide how we are labelled?

In truth, the symptoms and drive behind eating disorders are different in men. Clinicians know that. Perhaps we need more education to help the media know that too. Continued word creation won't help education efforts.

Peace be with you.

meeting marya: letting go of eating disorder paraphernalia

2011-07-09T19:19:47-07:00

This blog is inspired in part by the following at Between Living and Existing.

A couple years ago, I met Marya Hornbacher when she spoke at a NAMI function in my town. Upon hearing that she was coming, admittedly curiosity got the best of me. MAR-YA, after all, had written a book that I read, carried around, dog eared, and knew all too intimately. Her book has been banned in schools and much work had been done to undo its damage. Was I angry? Yes. At whom, I wasn't quite sure. I'd come to wonder why such books were even published.

So why did I go?

I hoped her message would be of recovery and hope. She presented her new book and disclosed her bipolar diagnosis. Her struggle was poignant and I felt my anger toward her dissipate. While the eating disorder was no longer her main struggle, she spoke of the difficulties of depression. I couldn't be indifferent or heartless when it came to her struggle.

During the book signing, I saw a tired appearing, petite woman with a smart haircut and tattoos covering scars on her arms. I saw someone, in my opinion, who looked like she needed a hug.

I don't know where the signed books are anymore. I don't care. I let go, I had won my battle. I wish her peace.

We choose which things we hang on to in life. Let go of the things that weigh you down. Don't put people on pedestals, it leaves them no where to go but down. Don't read things that make you feel bad about yourself or fuel your eating disorder. Don't look at images and compare yourself to others.

While I don't want to make recovery seem easy, you don't have to make it harder on yourself. Loose yourself from the ties that bind.

Peace be with you.

Reviewing the literature: Why a Health At Every Size (HAES) approach may be for you

2011-06-27T21:10:05-07:00

Everyday society reminds us that obesity and overweight are not desired conditions. Between the commercials to join diet clubs, buy diet products, and news stories about children now afraid of becoming overweight, the message is undeniable.

There are multiple diet and even surgical approaches for obesity which can be associated with significant morbidity and mortality including the risk of regaining weight. Dieting can also be associated with weight cycling, poor self esteem, risk of eating disorders and poor body image. So why do people do it, and why do clinicians continue to recommend it?

I first learned of the Health at Every Size (HAES) approach in 2007 at the Academy for Eating Disorders conference. While I didn't learn of Intuitive Eating until later, I've become more convinced of its utility and have added it to my "therapeutic toolbox." HAES is a "non-diet" approach to overweight. While difficult for some clinicians fathom recommending, it just makes sense.

As the article below states, "HAES shifts the focus from weight management to health promotion. The primary intent of HAES is to support improved health behaviors for people of all sizes without using weight as a mediator; weight loss may or may not be a side effect."

1. HAES asks for acceptance of your body. We naturally take care of the things that we love.

2. HAES asks for rejection of the diet mentality and adoption Intuitive Eating. This is a wonderful way of eating pioneered by Evelyn Tribole, MS, RD and Elyse Resch, MS, RD, FADA. It stresses listening to your hunger and fullness cues and learning to enjoy, yes enjoy food.

3. HAES asks for physical activity and movement that is enjoyable, not for exercise.

hope is a good thing

2011-06-20T18:15:30-07:00

As a clinician, I try to take every opportunity possible to instill hope in my patients. So much in life is based on hope, dreams and believing in one's ability to effect change.

Eating disorders is a young field and the definition of recovery is not yet firmed. Medicine tends to operate on a disease model, not a wellness model. Perhaps rightly so, more effort is spent helping people out of illness, than studying what keeps people well. But what is well? What is recovered? If recovery happens how concerned must someone be about relapse? Is there full recovery?

We must keep our humanity in our interactions. To the patient with an eating disorder who feels trapped, hope is in fact a good thing. Hope plus action (nourishment, therapy, medical monitoring) is a fabulous thing. Hope also requires telling the hard truth sometimes. Hope can build alliances and allow family and partners to participate in care. Hope doesn't mean sitting back and "magically" thinking will someone eat or that their weight worries will dissipate. There are boundaries and limitations. Hope must be realistic; it doesn't cure cancer.

So why do I ask about hope? Because I have no guarantees. However, I am aware that people face a world that is difficult and don't need someone to clip their wings. I am also aware of the potential healing opportunity in the doctor-patient interaction.

Find clinicians that are supportive of your recovery goal. Recognize that recovery requires hard work. Relapse is a real phenomenon, but it doesn't mean that full recovery cannot happen. Create your own recovery.

Peace be with you.

Faking It

2011-06-09T22:38:12-07:00

I've almost completed Aimee Liu's new book Restoring Our Bodies, Reclaiming Our Lives. It is a beautifully interwoven combination of letters from sufferers and commentary from prominent clinicians. While reading, I came upon a story that stressed the need for recovery on all levels; behavioral, nutritional, psychological, and social.

While some may say you should "fake it until we make it," replicating actions to learn "normal" behavior will not automatically guarantee a recovery. There is still the need to learn how to handle the everyday stresses of life. Relapse prevention and coping skills are taught to provide a method to handle triggers to disordered eating.

While emulating "normal" behaviors in early treatment can be encouraged as part of the learning process, the ultimate goal is to become more connected with your own body's hunger and fullness cues. As you progress, your challenges will include learning to modulate your emotions without the use of your eating disorder. Psychotherapy and talking with others about handling challenging situations may prove beneficial. The goal is to develop self confidence and the belief that you are able to manage your problems on your own. There won't be any faking to it.

Peace be with you.