Why She Feels Fat by Johanna Marie McShane

making choices about where to challenge ourselves

2012-02-10T15:38:26-08:00

When should you push yourself to do something?

Figuring that out is not always clear-cut!

Sometimes it's a good idea to challenge yourself to take on something, while other times it may not be.

Sometimes it's a matter of How much do you want to take on the thing vs How frightened of taking it on are you? And then you've got to think about: How important is it to me to take this on, even if I'm hesitant and frightened?

For example: I think the idea of sky-diving is amazing. I mean, how cool would that be to cascade through the air and then pull out the parachute and drift over the landscape???? However, while the idea of it sounds just breathtaking to me... it also takes my breath away to think about it!!! The idea of cascading through the air, and then being 100% reliant upon a sheath of cloth popping out of a little bag tied to my back sounds...well, count me out. How beautiful the view might be is far outweighed by my abject terror of free-falling (this is why I avoid the Drop Zone and other free-fall rides also- I totally HATE that free-fall feeling! Hate it.)

Now, while some who love sky-diving may say that I'm missing out (and I am in some ways), sky-diving is simply not that important to me. So, skipping it is totally no big deal. In fact, I never think twice about it.

But if it were public speaking that I was terrified of... well, then, I'd be looking for a way to challenge myself and help myself out with that- because speaking in public is something that's WAY important to me.

So, SuperEgg, one of the first things you get to decide is: how important is it to you to go with your daughter to the dentist? If it's not so important, maybe leave it to your husband. If it turns out that at some point it is important to you, you may want to work to challenge yourself to go.

IF you decide to go, I suggest not being black and white about it. It's not ALL or NOTHING (as usual, I'm sure y'all are shocked by this :)

For instance: the first time you go, you and the husband could take two cars. That way you'd have total freedom to leave any time you want/need to. And the first time you go you could plan to go just to the parking lot, or to the waiting room. Maybe the second time you go you'd take one step into the exam room then leave- either to the waiting room, or out to your car, or home (since you could have two cars the second time too.... and the 3rd... and the 14th if you want).

Try to plan this out so it feels stable and predictable. You can also drive by the dentist's office when you guys don't even have an appointment. Heck, you can even trot right in and say hi if you want. Do whatever is helpful to make the process feel step-wise. Challenging is fine; overwhelming yourself isn't helpful.

When we feel like we're in charge of a process we tend to be much less freaked out by it. And because we're less freaked out, we're less anxious- which makes things less scary!

Be patient with the process, SuperEgg. It sounds like the dentist is frightening for you- and you need to respect that and work with it gradually and thoughtfully. Make sure you ask questions, get help, talk as much as you want to about it... all that good stuff.

For sure, though, if you want to take your daughter to the dentist, girl, you will find a way to make that happen. Don't try it alone (in fact, don't try life alone- hey, that's a great Bumper Sticker!). Try it with a pal :) Or with a bunch of pals.

purposes

2012-02-05T20:23:30-08:00

Purpose, or meaning, in life is something people in recovery think about a lot. A lot.

Not at the beginning of treatment, perhaps, when they are deeply in the middle of the eating disorder. When you're deep into the relationship with the disorder you feel confident that you have a purpose- in fact, it wouldn't occur to you, probably, to even question your purpose/s.

After all, if you are following the rules of the ED, the disorder supplies you with meaning and purpose: as long as you follow the guidelines the ED sets out for you, you get to feel "purposeful" and confident, energized, focused, in charge, productive... to name a few "purpose-related" things you could feel.

This is one of the big reasons people do follow those ED-related rules so faithfully- they feel desperate to hold onto the sense of identity, meaning and purpose they believe comes from the ED.

So, then what happens when someone enters treatment, or begins to change the ED on his/her own?

Yeah, well, that sense of purpose begins to change or feels like it's about to disappear. And it can feel like panic sets in. After all, you thought you had everything all figured out. You felt as if you knew what you were doing.

And, even if you honestly wanted to change some things about the ED, it probably didn't occur to you that purpose would be an area that would change along with any other changes you made! When people opt to change their relationship with their ED, they generally think about things like "maybe I'll feel better" or "my doctor says I have to be healthier" or "my parents won't let me go to college unless I'm healthier" or "I'm sick and tired of spending so much time bingeing...."

And, you know what? It's just fine (and maybe even a good thing!) that it doesn't occur to people that other things- like identity and sense of meaning or purpose will be affected when they make changes in the ED. If they were truly aware of that it might seem pretty daunting!

As someone gets a bit stronger in his/her recovery, she begins to come up against things like identity and meaning and desire and opinion....

So, Laura R. consider yourself to be plugging right along with the work or recovery! Here's a saying that I have on a card I found a long time ago: My barn having burned to the ground, I can now see the moon.

I've always thought that was beautiful. And such a reassuring viewpoint on how life can happen. And what perspective to try to keep when life does happen!

When the ED begins to change it can surely feel as if your barn is burning to the ground (it's not really burning to the ground, by the way!). Hard as the changes can be, it's helpful to remind ourselves that we can see the moon- and we can see everything more clearly.

I know you guys know this, but I'll say it anyway: the "purpose" or "meaning" the ED gives you is only an illusion. It can feel incredibly real. I know that. But it's not real. It's an illusion.

So, in order to find true meaning in your life the "barn" must change and you must learn to be able to view the moon.

Developing and discovering meaning and purpose in our lives is not a 5 minute project. It takes time. I'm 47 and I'm still constantly discovering new things that give my life meaning and purpose. So, slow and steady... and experiment lots :)

newfound time on your hands

2012-01-30T21:16:56-08:00

Isn't it amazing how much time something like an eating disorder, or PTSD, or anxiety, or depression... or anything like that, takes up?????

You don't usually realize how much time (and energy) it's sucking up until you begin to get some space from it.

Even though people wish recovery could be quicker, this is one of the reasons it's pretty ok that recovery progresses along gradually- as the amount of time and energy devoted to the symptoms, feelings, thoughts and beliefs related to the illness diminish, you begin to have more time and energy for other things.

This sounds terrific, right? Right. And it is. It's also something that can make people a bit nervous- because it brings up a bunch of questions, such as: what might I like to do? what makes me happy? what's interesting to me? is it ok to pursue what i want? is it ok if I like something?...... know what I mean about these questions? Not always, but often, they can be things people haven't thought of before (I mean, who had time to think about stuff like this before, right? Too many other things to think about while immersed in the illness).

SuperEgg, I bet people can give you lots of ideas of what to do with yourself. And ideas and suggestions are fabulous. At the end of the day, what you fill your time and thoughts with will be as unique as you are. I'm pretty sure not everyone would want to fill their time and thoughts with the exact same things I fill my time and thoughts with! But I'm quite happy with how my time and thoughts are filled, so it's all good.

What you might also ask people about is what was it like for them to begin to have more time, more space, more freedom in their minds and in their lives?. It is such an interesting, exciting, and poignant time in someone's work on his/herself, when she starts encountering this new found space.

Of course, it's also a great time to practice our old favorites: scrupulous honesty and experimentation. So, as you meander around and explore this new space of yours, don't forget to rely on those two staples- they'll serve you well (and help head off annoying things like perfectionism and rigidity...)

For any of you who have experienced this phase of work on yourselves, consider yourself to be congratulated. It's a mark of real evolution and progress when you discover that you're encountering a bit more free time, free space and free-up energy. You get to enjoy it :) And keep it :)

ptsd and other things like it

2012-01-27T00:10:00-08:00

SuperEgg, PTSD, or Post Traumatic Stress Disorder is a set of symptoms that develop in response to overwhelming trauma.

The trauma that precipitates it can be one discrete event or chronic events over time. The event/s can be man-made (ie: war, child abuse) or naturally occurring (tsunami, cyclone, wildfire).

Symptoms that come along with PTSD include: anxiety, dissociation (feeling/s of disconnection from the world and/or from one's self, or a distortion in one's sense of one's self, sense of the world around you, or sense of time), trouble sleeping, flashbacks, hypervigilence (feeling of being on HIGH alert ALL the time- scanning the horizon for sings of danger so you can get yourself prepared), depression, to name a few.

PTSD can be very, very disruptive and debilitating. It can be treated, so even if you do suffer from it, don't despair. Do make sure you work with a clinician/s that is skilled in treating this disorder. Not everyone has the knowledge, training and experience to help people who have experienced trauma (just like not every clinician is a specialist in treating eating disorders or schizophrenia or sleep difficulties).

Although working with PTSD is something I do a lot of, without knowing the specifics of what you are going through I woudln't want to speculate about what you might do to help yourself in specific situations. I can tell you that it is crucial to talk to your therapist about any and all symptoms you are experiencing. And its crucial that you guys come up with strategies for dealing with the anxiety that is a very constant part of this illness.

Sometimes medicine can be really useful- for both the anxiety and for depression. Because resolving PTSD and related things can involve talking about events that are painful and scary, medication can help anxiety from becoming too high and feeling overwhelming in and of itself. Medication is but one option available to you.

BDD, or Body Dysmorphic Disorder is a distortion in someone's perception of (usually) one part of his/her body, or a significant preoccupation and dissatisfaction with a part of one's body. It can go along with an eating disorder, but can also be found by itself in someone who has no signs of an eating disorder.

BDD is not necessarily a co-occurring illness with PTSD- although it certainly can occur along with it, just like an eating disorder can or substance abuse can.

It very well may be that for you the BDD is linked or related to the PTSD. This is something for you to chat with your therapist about. If it is indeed linked, then yes, you would expect it to lessen over time as the PTSD resolves. It may be that you'll need to do some direct work on the BDD, whether or not it's linked with the PTSD, but that's ok. The key to things like an eating disorder, BDD, PTSD and many other things, is to keep plugging away... remember the Dori the Fish song: just keep swimming, just keep swimming, just keep swimming, swimming, swimming... (seriously, that Dori was pretty wise even though she was forgetful!).

One of the things I've found that really, really helps for people who are suffering from PTSD (and research shows this is true also) is for them to get to have their questions about it answered and to have the symptoms explained. I try hard to tell people what to expect, why things happen (like why anxiety might get a bit higher after some week when we've been talking about a particular thing, for instance), and what options there are for helping with symptoms. I do this with eating disorder stuff also- because we know that people feel more in control, safer, and calmer, when they understand things, when they know what to expect, and when they feel there are things they can do to help themselves.

talking about the stuff you need to in treatment

2012-01-26T22:20:11-08:00

Here's LeahV's question, for anyone who didn't get a chance to see it:

"How do you tell your T that you don't think she is pursuing the issues enough. I do a good job about straying away from things that really need attention and like most people with an ED I am great at being misleading when it comes to something that is really bugging me. So I know I have to do my part but I don't think she will pursue the issues if I don't just lay it all out there. Maybe I am expecting too much?"

LeahV, what if you said something to her like this (and this will look pretty familiar to you :)

"Dude, I don't think we are pursuing the issues enough. I do a good job about straying away from things that really need attention and like most people with an ED I am great at being misleading when it comes to something that is really bugging me. I need you to be direct with me about things you think I ought to be working on and to question me about if I'm talking about the things I really need to be talking about in therapy."

If I was working with someone who didn't feel as if we were dealing with the right issues I'd be grateful if they said something like that to me. It's such a bummer to find out that someone isn't talking about the stuff he/she wants and needs to be talking about. And, although I'm pretty good at sniffing out when that is happening, since I can't read minds there are times when I don't catch it (I realize it's totally shocking to think that I'm not perfect... :)

Also, it's not too much at all to ask for you and your therapist to work on the things you really do need to work on. Don't ever sell yourself short by settling for anything less than doing the work you truly want and need to do in treatment.

proceeding after glitches

2012-01-22T16:37:00-08:00

KM, in all relationships, including of course, therapist/client ones, glitches can happen.

Such is life, right? Glitches aren't generally fun (I can't think of a time when I've thought a glitch in a relationship was fun...). And, of course, there are all kinds of glitches, and a range of glitches (everything from small misunderstanding to major fissure in the relationship).

When a glitch occurs in a therapist/client relationship you basically proceed as you would in any other relationship. As you pointed out, KM, the two people talk, and they try to work through what happened.

As in any relationship, this can take some time (depending on what type of glitch it was and how significantly it rocked or damaged the relationship). And, even when working through the glitch is going well, the relationship may need time to recover and repair.

It's not unusual for the connection between people to feel different when a glitch has occured- strained or tense, and one or both people can feel like they are being extra careful or walking on egg shells- at least for awhile. That, in and of itself, is not necessarily an indication of whether the process of working through is on track.

Of course, if, over time, both people don't feel as if repairing is happening, and if both people don't begin to feel comfortable and connected, then it may be that the process of repairing and healing is not going well. This is something to keep assessing, and to continue talking about with your therapist.

The good news about when glitches occur in therapist/client relationships is that therapists are trained to deal with glitches (we spend a ton of time learning how to deal with glitches of all sorts!)- and competent therapists do not shy away from directly working through glitches that come along.

As usual, the best option is to keep assessing the situation/relationship over time, be scrupulously honest with yourself about how you're feeling and doing in the relationship, and try to stay true to what you know and feel.

Although glitches can be hard to deal with, they can sometimes provide great opportunities to deepen and strengthen a relationship. So sometimes a glitch, far from being a catastrophic event, can turn out to be an important and positive juncture.

types of relationships

2012-01-18T14:11:04-08:00

Good question, leanonme... "is there a difference between partnerships and relationships?"

I've never done a scientific study on this, including one on the exact literal meaning of each of those words. But it seems to me that a partnership is a particular kind of relationship. Not all relationships are, or need to be partnerships. (like I said, I haven't done a study and I don't intend for what I say to be the end all be all on this subject... :)

To me, a partnership implies a joint project between people. As Laura said in her comment- in earlier stages of treatment she didn't feel so much of a partnership with a therapist as she'd like to at this point. She's stronger now, more confident of herself and of leading her own life. She wants and needs something different from therapy now. She wants more of a partnership with her therapist.

Another example: If I was going to see my doctor I'd want to feel as though she and I have a partnership. She's for sure the medical expert, and I certainly rely on her knowledge and experience. AND, I'm no dummy. I know myself, I know my body, I know a lot about what's helpful and what's not. I also like to feel in charge of decisions regarding my life. SO, I'd definitely want to be involved in the process of whatever she and I were up to. My doctor and I both have a part to play in this partnership.

I know people, though, who don't want a partnership with their doctors. They want to go and have their doctor tell them exactly what to do and when to do it, and they don't particularly want to know why. It's just a different style. These people still have a relationship with their doctors- but I'm not sure I'd consider it a partnership.

In my way of thinking, partnership implies that joint effort and joint input thing. Joint participation.

No being black and white about this at all: types of relationships that may not be partnerships can be terrific. I'm not bashing any of them at all.

Maybe what's most useful here is to think about, and be aware of, all the different kinds of relationships that are possible. For one thing- so we can marvel at that. For another- so we can keep track of what we're doing in our relationships and keep track of if we're in the types of relationships that work for us.

partnerships

2012-01-16T17:09:41-08:00

I love the idea of partnerships. I'm sure this surprises you guys a whole lot!

Laura, I was happy to see you are conceiving of your therapy with your psychiatrist as a partnership, and that you're excited about the possibilities of this new venture.

Partnerships are so cool. I couldn't even begin to name all the possible kinds of partnerships that exist in the world. Certainly, the partnership between therapist and client is a fabulous one. (and, by the way, most every therapist I've ever met vastly prefers a partnership with a client, as opposed to a "one-way street" or something "non-collaborative"- it's the most fun, the most efficient, and the most effective).

One of the awesome things about a partnership is that everyone involved is valued, and their input counts. This doesn't mean that everyone knows the exact same things, or that they all have exactly the same levels of experience or training, or the exact areas of expertise. It means that everyone gets to participate, everyone gets to be listened to, everyone gets to have a say.

This doesn't mean, of course, that everyone's always thrilled about every single thing! No such luck! It does mean, though, that there's a process to coming to decisions, a process of evaluating, discussing, exploring...

There's sometimes compromises in partnerships. I can tell you that in my practice, if I'm truly engaged in a partnership with someone (which is my preferred way of working, of course), I'm not always 100% thrilled by everything. For instance, sometimes I've thought someone ought to do something, or not do something, and they have made a case for the opposite (or some variation) of what I was proposing.

We talk about it, for sure. And, unless I believe what they're proposing is dangerous, I think that they have a right to try it out. Then, they try it out, and sometimes it works great, sometimes less than great, sometimes way less than great... In a partnership you make a pact to wade through those experiences, learn from them, and add it all to your shared experience/history.

So, Laura, as you embark on this new partnership with your psychiatrist, you get to be proud of yourself for being strong enough to take on a partnership. It takes courage to enter into any kind of partnership. Courage to stand up for what you believe and feel. Courage to be involved more deeply with another person than when there's no partnership involved. Courage to keep practicing all the cool things a partnership allows and encourages us to practice.... Lots of times people shy away from partnerships, because of all those things about courage I just mentioned. That's too bad- since the rewards of being in partnerships are huge.

So, yay for partnerships of all kinds :)

assessing how therapy's going

2012-01-14T20:03:49-08:00

Ann, let me just point out that the fact that you're asking the question about "how do I know if my therapy is going in the right direction?" and "how do I know if the therapist I'm seeing is the right one for me?" shows a lot about how your recovery is going (and the fact that it's going in the right direction)!

It takes courage to ask those kinds of questions. It takes awareness and consciousness to even think of asking those kinds of questions. So, yay for you!

Now, to go on and answer the questions is going to give you some more practice in recovery- so, also, yay. What you're going to do is keep assessing what you want in a therapist and what you want to be getting out of therapy. This is the first "practice" thing.

Especially when you've had some experience in treatment, you have a sense of what's helpful and what's not so helpful. If you've never had any treatment it's harder to know what's out there and what you might benefit from. Having had some previous experience, you can compare different therapists and therapies, and reflect on what you liked.

Since you say that your eating disorder symptoms have really decreased, perhaps you are in the mood to work on other aspects of your life. Perhaps now that you don't need to focus so much on the ED behaviors/symptoms you now want to use therapy to focus on relationships, or career choices, or... or, whatever is important to you right now!!!

As you get clearer (and maybe you already are) about exactly what you want to be working on, then you get to do the next "practice" thing- talking to the therapist about what you want.

Now I know this is going to amaze all of you, but therapists don't always know what someone wants to be working on... I know! Shocking, right?!

I mean, sometimes it's pretty obvious what someone wants to work on, and often times its clear what needs to be worked on first... but when symptoms settle down and someone gets stronger and more sure of him/herself, it's not always super obvious what direction the person wants to go in next. That's not a bad thing at all- it doesn't mean anything's wrong. Often its that the person has gotten so strong and stable that there are now many more options for what to work on in therapy than there were in the past- when the ED symptoms were front and center.

Since we therapists don't always know everything :) we count on people to help us out. After all, therapy is a joint project! So, Ann, go for it. Tell this therapist what you're thinking, tell her how therapy is going, what you'd like it to look like... all that good stuff.

No matter what the therapist says, you'll learn some important stuff. That's the good news. You'll get useful data no matter what.

Best case scenario is the therapist listens to what you're telling her, and you guys work it out so therapy is going in the right direction for you.

Other scenarios may happen, but that's less likely. If, say, the therapist has no idea what you're talking about, or she says it doesn't matter what you want, or she isn't able to understand how you feel you need to work these days in therapy... well, it won't be a fun conversation. And, you'll learn a lot about the therapist, and it will be much clearer to you what you should do next.

it's a good thing :)

2012-01-09T21:33:34-08:00

I think, SuperEgg, based on what you wrote, you understand somewhere inside you that crying is ok.

And you are correct.

Crying is actually a pretty amazing phenomenon. Not only does it clear out our eyes, which is a nice by-product, but it is a very intimate and powerful experience. I'd say it's a particularly human experience, but apparently they've figured out that elephants can cry similar tears as we do also. Who knew?

Sadly, many people don't have decent experiences learning about tears. If we show/teach our children that crying is "weak" or "lame" or "stupid" or "shameful" they will of course have bad feelings about tears, and will try to avoid crying.

Not only is this sad in and of itself, but it leaves the person in a terrible, conflicted position. Clearly we are designed for tears (of many kinds). Tears are natural for us. But what are we supposed to do if we've been taught that tears are bad or an illustration of weakness? We are caught in between what we know is natural and our erroneous (but powerful) belief that tears are bad. It can make someone feel pretty unsettled, if not kind of crazy. It can also produce symptoms like anxiety.

And, also, you know what, SuperEgg, who cares if someone saw you cry? Dude, seriously. I don't know what you've been taught about that, but EVERYONE cries. Everyone. And anyone who says different is (unless they have a medical condition that prevents them from crying) is not telling the truth. I have to say, I can't count the number of times I've cried over 47 years- and many of those times have been in public. It's for sure in the hundreds, if not thousands. So what? Really, it's totally fine. Ok, to prove my point- one of the times I've cried was in the middle of 72nd street in New York City. Talk about public. So there.

Try to not put so much pressure on yourself. And as long as you're busy getting used to the idea of living in your body and being fully alive and human (and from what you write, it sounds as if this agrees with you very much, which is totally awesome!), why not work towards getting used to all the aspects of being human? Crying is simply one of them.