Your new year’s resolution: STFU about your weight and dieting

A friend who is in early stages of recovery from an eating disorder just posted a request on FB that others who made 2017 resolutions involving weight/food not talk about them around her.  My first thought was, it is cool that she’s asking this; there have been so many times in my life when I could have used a sign around my neck that said this, or little cards saying this to hand out to people. But then I thought, no. This message needs to go further than to just her current friends, and it shouldn’t be the responsibility of people like her who are currently suffering from eating disorders to tell the rest of us to be considerate and STFU.

In case you don’t already know how bad all the weight/food talk is, let me tell you in no uncertain terms, it is really bad. In the dining hall at college, lunch breaks at my jobs, eating meals with relatives, I’m constantly being forced to hear people talk about whether or not they have been ‘good’ (in terms of dieting/exercise). Would you try to tempt a person to drink while they were trying to stay sober, and make them feel ashamed for not drinking? If not, consider that your self-serving calorie talk does exactly the same thing to the people who have no choice but to listen to you, especially the people who are struggling with eating disorder symptoms that you may or may not be aware of.

Just to illustrate how bad this phenomenon is, one of the hardest things I had to do as a therapist-in-training was to spend my days with other therapists who considered themselves qualified to treat people with eating disorders. Someone would bring in a cake to celebrate a birthday, and the first piece would just get repeatedly passed around the table as if it were something dangerous or disgusting —  with one comment after another from my co-workers about their weight, dieting, and exercise.  This bothered me so much that I started always taking the first piece of cake, regardless of whether I wanted it, but I still felt upset that so-called “healthy” people could be so oblivious about the effect of their outrageous behavior on everyone else in the room.

Overcoming an eating disorder takes working like hell and I have worked like hell. My first 5 years of recovery were the hardest, but the next 10 years involved a lot of struggles and even now the problem flares up now and then.  I realized early on that having to listen to other people’s shit could undo my progress, and that it was up to me not to let that happen.  But I also didn’t want to be that person, the one who constantly lectures others on how obnoxious their behavior is to people dealing with eating disorders. Especially when I was in recovery, and others wouldn’t necessarily know from my appearance that eating disorders were a serious issue for me, I really didn’t want to have to bring it up.  So I chose the only responsible decision I could think of, which was to isolate myself, and to particularly avoid spending time with other women. Though I had close female friends in high school (before my eating disorder), I haven’t spent time in groups of women or become close to many of the women I’ve met in more than 30 years, and I’ve missed out on getting to know great women as a consequence.  This makes me sorry, and it makes me angry that anyone else should have to do what I’ve done.

Wherever you are in dealing with your food/body issues, ask yourself why you find it necessary to inflict them on the people around you, and do whatever it takes to stop. If you want to talk about these issues in private with someone you are close to, check how they feel about it before you proceed. And if you’re someone who CAN’T stop talking about your weight/food shit in public, even though this is likely to be causing other people harm, then I hope you’ll get help — whether for your own eating disorder or for your lack of compassion.

Thank you.

The punishing truth about campus mental health policies

Recently I have seen several articles critical of Northern Michigan University, where last year students received emails warning them that talking about their struggles with mental illness could result in removal from the college  (see link below). I’ve been following this story with quite a bit of interest, because as a college student I was profoundly affected by campus mental health policies, and as a faculty member I’ve served on the committee charged with creating such policies.

What I think is missing from discussion of this news story is recognition that students who want to stay in school while suffering from mental illness are ostensibly punished for suicidal ideation, nonsuicidal self-injury, and other aspects of their disorders (such as eating disorder symptoms) in colleges everywhere. In fact, the only thing really striking about the NMU case is that the school’s punitive policies had been expressed to the students directly, transparently, and in writing, rather than in the usual stealth ways.

At the college where I work, for example, students aren’t explicitly prohibited from expressing self-destructive feelings, but there is a policy that justifies a mandated (involuntary) leave of absence for students with mental illness if they 1) place their own health and safety at risk, or 2) cause others ‘substantial distress’ above a ‘normal, everyday’ level, or 3) are returning from a psychiatric hospitalization. While #1 is well-intended, it isn’t objectively defined, and students find it unfair that some forms of self-destructive behavior (such as nonsuicidal self-injury or eating disorder) result in much more harsh consequences than forms of self-destructive behavior with less mental illness stigma (such as consuming dangerous amounts of alcohol). What #2 means to a student with mental illness is that if your roommate worries enough about you, you might have to leave school, whether or not you want to. And #3 means that if you seek help at an emergency room or elsewhere in order to get through a tough time, you might not be welcome back on campus when you feel the danger has passed.

The language of our policy really troubles me (and I’m sorry that my need for anonymity makes me unable to directly quote it for you). For example, I wonder whose standards get to determine what constitutes a ‘normal, everyday’ level of distress, since it certainly isn’t going to be the level of distress that students suffering from mental illness live with every day. Is the college really requiring students who are disadvantaged by extraordinarily difficult lives to put on a pretty face about it for the sake of their luckier peers?

But perhaps what is most disturbing is how easily a school that considers itself modern and inclusive can get away with legitimatizing bias against people with mental illness. At this college, students with mental illness who have violated no conduct codes nor fallen out of good academic standing can nevertheless be banished from the college just because others find their presence upsetting. The campus community would strongly object to a policy like this if it were directed against students on the basis of their gender, sexual orientation, race, ethnicity, physical disability, etc. It would even oppose applying this policy to students who persistently cause others significant distress by expressing abhorrent ideas. By adopting this policy specifically for students with mental illness, the college is telling these students that they cannot count on same basic rights as anyone else. And though the broader community doesn’t seem to care or notice, the targeted students really do take this message to heart.

I struggled with mental illness for my entire time in college. And one tearful night mid-semester in my third year, when my residence hall leader asked if I had any suicidal thoughts, I answered honestly. As a result I was faced with eviction, which unsurprisingly did wonders for my mental state, and I “voluntarily” withdrew from school because I had few other options. I still have a lot of questions about what happened back then. Did my undergraduate institution genuinely act in the interest of its students when it required me to decide between denying my suicidal thoughts or being forced to leave? When I admitted feeling suicidal that night, was I asking to be removed from college and placed in the mental health system for my own good? Or did I just make a stupid mistake that dramatically changed years of my life in a largely unwelcome way? Decades later I’m still not sure.

There are sometimes very good reasons to require students to take a leave, to protect those who aren’t able to freely choose protection. Indeed, my own sad story might have been even worse if I hadn’t been forced to withdraw when I did (we will never really know). Regardless of the intent of mandated mental health leave policies, though, the students faced with them quite reasonably feel disenfranchised; and the fact that these students realistically fear being punished if the college knew the extent of their suffering prevents them from getting help. I don’t know what the answer to this problem is, but the problem is far more complicated and widespread than either the administrators or the students closest to these policies are going to be willing to admit.

Reference: http://nymag.com/scienceofus/2016/09/a-school-is-threatening-to-punish-its-suicidal-students.html?

The truce between me and my body

I hate my body, but over time we’ve learned to coexist without undermining one another. Our truce is built around trying to maintain stability — which is ultimately good for my body and good for me.

In college and for several years afterwards, hating my body more or less took over my life. Often my intestines stopped working, all kinds of disgusting situations prevented me from leaving my room, and I had a tendency to pass out here and there, but that wasn’t even the worst of it. I frequently came to that standstill where I’m doing nothing but count the hours, thinking if time is passing and I’m not eating I’m making some kind of progress. There was no moment unaffected by starvation, temptation, shame about over-indulgences big and small, determination to do better, and every possible form of physical and psychological exhaustion.

Getting over an eating disorder is typically a long process that involves lapses and relapses and so on. It isn’t something you can just quit, and since you have to eat to survive there is no “abstinence” option, you can’t avoid the triggers. Like many people, I gained weight when forced to, but even after my weight was high enough that I was no longer being monitored for danger, the larger problem persisted. Hating my body — and thinking I MUST do more to change it – was always at the forefront of my mind.

The way I took my life back was essentially by accepting defeat. At my lowest weight I hated my body and felt I really needed to lose bulk around the middle. Ten, twenty, thirty, forty pounds heavier I felt the same way. But here’s the thing: my body hatred isn’t actually any worse now at a “normal range” weight than it was at a dangerously low one. I’ve just learned from experience that I’m never going to have a body I’d be happy with and that trying will only get me a body that stops working. Determined to at least have a minimally functional body, I went many years avoiding scales, full-length mirrors, and looking down in the shower. I’ve also avoided having to spend time with people who talk about weight/food in ways that would upset me and potentially disrupt my life — even though this meant eating alone a lot and having almost no female friends. I had things to do and needed the eating-disordered tyrant inside to be quiet.

More recently I’ve been trying to make room for workouts in my life, and the struggle is how to pursue being healthier without re-awakening that force that would want me to commit to losing bulk around the middle, etc. I’m not about to pick any fights with my body, since I’m not going to win them, and the two of us are stuck with one another for the long haul.

Shit clueless parents say to their children with mental illness, part 1

In college I had finally started to get help for my mental illness — because I no longer needed my parents’ permission to do so – but still being in close contact with my parents, I faced a lot of opposition to my efforts (e.g., my father said that I was being selfish and lazy by paying a professional to talk to me rather than change myself into someone worthy of real friends). Now, my father has said a lot of shit to me over the years, but I’m thinking that some of what he said to me during this time was truly exceptional.

These might be my father’s top three:

  1. “You are NOT taking a semester off from college. You want to work minimum wage? I’m not going to let you ruin your life like that”.

I was going to an ivy-league school and very academically motivated, but during my first year in college I was so severely depressed that I was not appreciating any of it, and often couldn’t even make it to class. I had told my parents that rather than wasting money and credits on courses that I was getting so little out of, I might be better off taking a leave of absence for a semester to work and get my health together. Looking back it is obvious that taking a semester or more off would have been the right thing for me to do, but my father had some image of the ‘perfect college experience’ that meant four consecutive wonderful years and he was unwilling to let go of that dream. And despite having a Ph.D., he was unable to grasp the basic distinction between leaving college for a semester and dropping out forever. Of course, I got my leave of absence two years later, when my mental health problems had become a crisis and I had to withdraw mid-semester for two months of hospitalization. But too bad that it ever had to come to that.

  1. “You should exercise a lot while gaining weight, so it becomes muscle and you won’t get fat”.

By the end of my second year of college, the administration had taken notice of my worsening eating disorder and decided that I would only be allowed to return to classes in the fall if I had gained enough weight to no longer be an imminent health risk. So I spent the summer (at home) seeing therapists and nutritionists with the explicit goal of gaining weight. Somehow my father missed the message that I needed more body fat to stay alive, and that the possibility that I’d get fat should have been the least of his concerns.

  1. “You want to kill yourself? Why don’t you just do it already!”.

A month after I returned to college for my third year everything went from awful to worse. Though I really didn’t want to live, I had promised myself not to take my own life and often struggled to resist that urge. My father later explained that he only said what he did to “snap me out of it” (whatever that means). I don’t think I even need to explain how fucked up this is. But a meme I saw recently is applicable here: ‘The worst thing you can do to a person with an invisible illness is make them feel like they need to prove how sick they are.’

Here is where you can read part 2 of “Shit clueless parents say”: https://sayingwhatgoesunsaid.com/2015/08/10/shit-parents-clueless-parents-say-to-their-children-with-mental-illness-part-2/

Are we getting something out of this all-encompassing trip?

I am in my late 40’s with a Ph.D. in clinical psychology, working as a relatively new college professor. Most people in my position are nearly 20 years younger than me, but that’s because along the way I lost a lot of time.

I first remember long periods of inconsolable despair at age 4.  I was prescribed antidepressants at age 8 — and this was in the 1970s, when the available antidepressants were more dangerous and it wasn’t common for people to take them, let alone talk about them. My parents threw the prescription away and also refused to let me go for counseling. I kept getting good grades, so my parents probably figured my problems must not be too serious. My father said it was just that I acted too weird, and he thought he could cure me of that with enough criticism and frequent fits of rage.

Leaving my high school friends for college was very hard. I started going to the college counseling center, and they recommended therapy several days each week. (My father said I was being selfish, wasting money paying someone to talk to me because I couldn’t make real friends.) After a period of starving myself and experimenting with faster ways of ending my life, I decided it was time to try medication, but it didn’t help me as much as I needed it to. Late at night I would sometimes try to study in public areas, because I was afraid that back in my room alone I would be unable to fight the urge to hurt myself. My college eventually decided that it didn’t want responsibility for me, and I was no longer allowed to live in the dormitories. With nowhere else safe to go, I admitted myself to the hospital. It was clear that moving back home would not be good for me, but I was not ready to live completely independently. So I was eventually discharged from the hospital to a residential program for adults with severe and persistent mental illness. From there, I resumed college classes and applied to graduate school.

Over the next 25 years I tried just about every medication and psychotherapy available. I was never really free of depression, social anxiety, OCD, and nightmares — but usually managed to get by. MAOIs and IPT both helped me through some very rough times. Then a few years ago I was offered my dream job — a tenure-track faculty position in an excellent department — and I decided to take it. My symptoms got so much worse, and I was hospitalized. Though ECT caused memory problems it did help for a while. But after that I was back to hating myself and unable to get out of bed, even while taking a ton of medication.

Ketamine treatment

Since the spring of 2015 I’ve been regularly receiving ketamine infusions (in addition to some other medications, therapy, nutritional supplements, and exercise). Within days after my first infusion it was as if a light had been switched on somewhere inside that had been always dark before. Suddenly I was able to feel at peace with myself, and do things, without paralyzing self-doubt. Ketamine treatment isn’t covered by insurance, and the effects of each infusion only last a few weeks, but since this actually works I plan to stick with it until I have other options. To stop hating myself after 40 years is not only really expensive, but priceless.

I live quite far from the nearest ketamine clinic so about once each month I travel all day to get hooked up to an IV bag, and let the medication drip into my hand while spacing out and listening to “Present tense” on repeat through headphones. The infusions are typically very peaceful and pleasant. Sometimes I feel my fingertips against the chair arm and can get fascinated by that. Or stare at my hands. Often I find that something will make me laugh, just because it is a little strange. Like when I see the leaves on the tree outside blowing, and for a split second they look like they are waving at me or waving along with the music, though I still know that they really aren’t. After an hour it feels like I’m waking up, feeling progressively more alert and less dream-like. And an hour after that I feel enough like my usual self to leave and get on a crowded train.

At my treatment session last week my doctor and I decided to try increasing the ketamine dose to see if maybe this might help the benefits last longer. This was the first time that I’ve felt more than mild psychedelic effects and it was so similar to movies about psychedelic trips that it was almost like a cliché. I thought I could see myself as a tiny dot among millions of moving and flickering dots. I could see the dots interacting with each other, and I also saw some of them disappear. I was certain that this image represented life, and that the only significance of each individual dot was what it meant to the others around it. But soon after seeing what I thought was the meaning of life, I saw my own dot disappear. I sat there stunned, believing that my little story was suddenly over.

I realize that what I experienced under the influence of ketamine last week was kind of like a dream, and no more important than a dream, but it felt so much more real and has lingered in my thoughts. All week I have found myself anxious about my mortality (which is highly unusual for me), and also grieving for the years I lost.

I wish I could tell my younger self to hold on and believe that a life worth living is possible. Not that living with my illness is easy — even now that I’ve finally found a treatment that really helps, maintaining my mental health takes a lot of work. But the difference is that now my life actually matters to me. I want to stay and make my time here count.

References:

About ketamine treatment for depression:

About IPT: https://en.wikipedia.org/wiki/Interpersonal_psychotherapy

Present tense (Pearl Jam, 1996) : https://www.youtube.com/watch?v=Tlx3GPsRD9M

Present tense (Lyrics)

Do you see the way that tree bends?
Does it inspire?
Leaning out to catch the sun’s rays
A lesson to be applied
Are you getting something out of this all-encompassing trip?

You can spend your time alone, re-digesting past regrets, oh
Or you can come to terms and realize
You’re the only one who can’t forgive yourself, oh
Makes much more sense, to live in the present tense

Have you ideas on how this life ends?
Checked your hands and studied the lines
Have you the belief that the road ahead, ascends off into the light?
Seems that needlessly it’s getting harder
To find an approach and a way to live
Are we getting something out of this all-encompassing trip?

You can spend your time alone re-digesting past regrets, oh
Or you can come to terms and realize
You’re the only one who cannot forgive yourself, oh
Makes much more sense, to live in the present tense

Let’s see tomorrow*

*There is indecipherable chanting at the end of the song, and “let’s see tomorrow” is just how I hear it.